Nationwide survey of internal medicine hospitalists in Korea: motivation and sustainability of a hospitalist career

Background/Aims@#Although a management fee for hospitalist service was established in Korea, the number of hospitalists required for the system to run remains outmatched. @*Methods@#In January 2020 and February 2022, before and after the establishment of the hospitalist fee system respectively, cross-sectional online surveys were conducted among internal medicine board-certified hospitalists. @*Results@#There were 59 and 64 respondents in the 2020 and 2022 surveys, respectively. The percentage of respondents who cited financial benefits as a motive for becoming a hospitalist was higher in the 2022 survey than in the 2020 survey (34.4% vs. 10.2%; p = 0.001). The annual salary of respondents was also higher in the 2022 survey than in the 2020 survey (mean, 182.9 vs. 163.0 million in South Korean Won; p = 0.006). A total of 81.3% of the respondents were willing to continue a hospitalist career in the 2022 survey. In multivariate regression analysis, the possibility of being appointed as a professor was found to be an independent predictive factor of continuing a hospitalist career (odds ratio, 4.00; 95% confidence interval, 1.09–14.75; p = 0.037). @*Conclusions@#Since the establishment of the hospitalist fee system, monetary compensation has improved for hospitalists. The possibility of being appointed as a professor could predict long-term work as hospitalists.

Critical Decision Making at the Point of Care / 대한내과학회지

Optimal decision-making requires an understanding of the principles of evidence-based medicine to judge the quality of the evidence. Numerous pitfalls exist in diagnostic reasoning and decision-making. There are also many considerations with regard to evidence-based prescription. Increasingly, hospitalists have to work in wards organized as Accountable Care Units (ACUs). Practice guidelines and systematic reviews represent the highest quality of evidence available. There is great clinical importance in rapid access to precise answers, especially those based on summary literatures, to various challenging questions. In practice, a culture of education, updates to support hospitalists, and integration of evidence-based medicine into clinical practice, using diverse digital medical resources and cloud storage, are necessary.

Considering Death and Condolences from an Educational Perspective: How to Examine Condolences in Response to Death in Death Education / 의학교육논단

Medical treatments as universal care have been turning into delivering medical technology. Coping with death, which is prevalent in all medical circumstances, without comprehensive understanding results in missing out on significant aspects between life and death. This makes doctors surrender easily to a conventional and binary division of life and death and reduces the chance of including death as a part of the medical realm. Furthermore, in terms of medical education, we need to have the opportunity to consider such subjects that can benefit from special planning and consideration. Through reviewing articles in a variety of disciplines such as medicine, philosophy, psychology, literature, and anthropology, we can better understand death, condolences, and the relevance between them in a contextual way. In order to seek a better approach, this study also aims to survey and review the recent state of death education in diverse fields of medicine in Korea. In conclusion, if it is complicated for us to explain or understand death in general, focusing on condolences as a human response to death could be one meaningful way that deserves contemplation.It is possible to regard condolences as a touchstone and a prerequisite in death education itself.

A Case of Distal Renal Tubular Acidosis and Sjogren's Syndrome in a Patient with Autoimmune Thyroiditis / 대한신장학회지

A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO(3)(-) <3.0 %) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren's syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren's syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren's syndrome in a patient with autoimmune thyroiditis.

Wernicke's Encephalopathy in Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke's encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer. MATERIALS AND METHODS: This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE. RESULTS: A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment. CONCLUSION: It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.

Endoscopic botulinum toxin injection in cricopharyngeal dysphagia / 대한내과학회지

Botulinum toxin has been used to treat various gastrointestinal tract diseases such as achalasia, diabetic gastroparesis, sphincter of oddi dysfunction, and chronic anal fissures. Recently, it has also been used for the treatment of cricopharyngeal muscle dysfunction. Several studies have reported that botulinum toxin injections may be a safe and effective treatment. Previously, cricopharyngeal muscle dysfunction was treated by mechanical balloon dilation or cricopharyngeal myotomy. Here, we report a case of a 57-year-old man who presented with cricopharyngeal dysphagia due to cerebral infarction and who was successfully treated with endoscopic botulinum toxin injection.

Correlation between Endoscopic Severity of Gastroesophageal Reflux Disease (GERD) and Indexes of Obesity / 가정의학회지

BACKGROUND: There are many reports that obesity could be associated with gastoesophageal reflux disease (GERD) but the outcomes are controversial and the studies on correlation between endoscopic severity of GERD and obesity are rare. Therefore, we investigated the association between endoscopic severity of GERD and indexes of obesity. METHODS: Among the subjects who visited a health promotion center of a general hospital from January 2007 to March 2008, a total of 527 subjects with typical symptoms of GERD who underwent esophagogastroduodenoscopy and analysis of body composition were enrolled. The endoscopic severity of GERD was classified depending on LA grading classification system. RESULTS: Among 527 subjects, 125 subjects were classified with Non-erosive reflux disease (NERD) while 254, 105, and 43 subjects were classified as LA grade A, B, and C group, respectively. Men and frequent alcohol drinkers (> or = 5 times/week) were likely to be in higher endoscopic severity group (OR, 2.065 and 2.394, respectively; P or = 5 times/week).

A Case of Esophageal Peptic Stricture Concomitant with Vascular Ring in Mid-Esophagus / 대한소화기내시경학회지

Esophageal strictures may result from common conditions such as gastroesophageal reflux disease. Dysphagia is by far the most common presenting complaint in patients with esophageal peptic stricture. Symptomatic peptic strictures are treated by dilatation via ballooning or bougienation. Vascular ring is a term given to a combination of vascular and often ligamentous structures that encircle the trachea and esophagus. Symptomatic vascular ring, also known as dysphagia lusoria, is generally treated by conservative management. However, surgery should be considered when symptoms persist regardless of the treatment. We experienced a case involving a 41-year-old man with dysphagia diagnosed with peptic stricture on upper endoscopy and concomitant vascular ring on chest CT, which proved asymptomatic.

A Case of Malignant Rhabdoid Tumor in the Anterior Mediastinum / 결핵및호흡기질환

Malignant rhabdoid tumors arise primarily from the kidney. Extrarenal malignant rhabdoid tumors are rare, with the liver, central nervous system, and skin reported as the primary sites. Malignant rhabdoid tumors of the mediastinum are extremely rare among extrarenal malignant rhadoid tumors; only 3 cases have been reported to date, all characterized by aggressive clinical behavior. We experienced a 35-year-old woman diagnosed with malignant rhabdoid tumor in the anterior mediastinum with multiple metastases. The tumor was surgically unresectable, and treated with palliative radiation therapy. Three-month after radiation treatment, she died from dissemination of the malignant rabdoid tumor.

A Case of Primary Rectal MALT Lymphoma Presented as Multiple Submucosal Tumors / 대한소화기내시경학회지

MALT (mucosa-associated lymphoid tissue) lymphomas are the most common primary gastrointestinal (GI) lymphomas. MALT lymphomas of the GI tract tend to occur most commonly in the stomach, followed by the small intestine, ileocecal area, colon and the esophagus. However, MALT lymphomas of the large intestine are rare. Previously, a diagnosis was commonly established by the surgical specimens but endoscopic biopsy specimens are currently used to make a diagnosis. A 61-year-old woman was found to have multiple submucosal tumors of the rectum during a screening colonoscopy. The tumors were removed by a polypectomy. The histology revealed the diffuse infiltration of centrocyte-like cells and a lymphoepithelial lesion. Immunohistochemical staining confirmed the diagnosis of a low grade B cell lymphoma of the MALT type. No other site of involvement was identified on the CT of the chest, abdomen and pelvis.

A Clinical Study of the Tibial Condylar Fracture / 대한정형외과학회잡지

The knee joint is one of the major weight bearing joint in the body, and is frequently injured because of its complex motion despite of a simple bony architecture. In the fracture of the tibial condyle the injuries of soft tissues such as ligaments and menisci are frectuently accompanied, and the weight bearing surface is involved. So it often produces a disability of the knee joint. Forty-seven consecutive cases of the tibial condylar fracture treated at the orthopaedic department of the Hallym Medical College from 1982 to 1985 have been analyzed according to its type, radiologic diagnosis, treatment, and end results. The conclusions are; 1. The tomography is important in the decision of the treatment method by the accurate measurement of the extent of depression and displacement. 2. The poor results are usually caused by a severe comminution and some associated injuries such as menisus tear, open wound, and rupture of ligamentum patellae etc. 3. The better results can be obtained with the treatment of early exercise within 6 weeks, of weight bearing between 12-20 weeks, and in surgical cases, within 2 weeks and with a bone graft.