Medicine In Seoul Research Articles

First Author Spotlight.

First Author Spotlight.

A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes.

PurposeThe aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients.MethodsWe reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group.ResultsTwo hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs. ₩3,923,308, P = 0.001).ConclusionThe surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.

Effects of Korean Red Ginseng (Panax ginseng C.A. Meyer) on Menopausal Symptoms in Premenopausal Women After Gynecologic Cancer Surgery: A Double-Blind, Randomized Controlled Trial.

Objectives: Korean red ginseng (KRG) has been widely used as an alternative medicine to relieve menopausal symptoms. However, there is still a lack of clinical studies showing the effects of KRG on menopausal symptoms after gynecologic cancer surgery. Therefore, the authors investigated the effects of KRG on surgical menopause symptoms in premenopausal women with gynecologic cancer. Design: A double-blind, randomized, placebo-controlled clinical trial was conducted. Settings/Location: The study was performed at Severance Hospital at the Yonsei University College of Medicine in Seoul, Korea. Subjects: Fifty-five premenopausal women diagnosed with gynecologic cancer were enrolled in the study. Interventions: Patients were randomly assigned to a KRG (n = 29) or a placebo control group (n = 26). Subjects were administered either KRG (a total of 3 g per day) or placebo supplements for 12 weeks. Outcome measures: Patients' physical measurements (height, weight, and blood pressure) and blood samples (lipid profiles, hormone profiles, biochemical profiles, and neutrophil-to-lymphocyte ratio) at baseline and at 12 weeks were compared. Changes in menopausal symptoms based on the Menopause Rating Scale (MRS) were also compared between these two time points and two groups. Results: After 12 weeks, the MRS score was significantly reduced in each group (p = 0.001 and p = 0.001, respectively), but there were no significant differences between the two groups (p = 0.661). No adverse events were observed in either group. After comparing 11 MRS symptoms between the two groups, the KRG group seemed to be superior to the placebo group on the subscale of sexual complaints (p < 0.05). Conclusions: Through the study, KRG did not show absolute relief of surgical menopause symptoms in premenopausal women after gynecologic cancer surgery. However, the study did demonstrate that KRG may be effective in reducing sexual complaints. Further studies are required to evaluate the long-term effects of KRG in a larger patient population.

Does group cohesion foster self-directed learning for medical students? A longitudinal study

BackgroundThe importance of self-directed learning (SDL) and collaborative learning has been emphasized in medical education. This study examined if there were changes in the pattern of SDL and group cohesion from the time of admission to medical school under the criterion-referenced grading system, increased group activities, and interaction of medical education curriculum. Second, it was examined whether group cohesion influences self-directed learning.MethodsThe participants were 106 medical students (71 males, 35 females) who enrolled in Yonsei University College of Medicine in Seoul, South Korea in March 2014. They were asked to complete a Korean version of the self-directed learning readiness scale (SDLRS) and group cohesion scale (GCS) at the end of each semester for three years. A repeated measures ANOVA and a correlation and regression analysis were conducted.ResultsAll the participants completed the questionnaires. There were differences in the SDLRS scores over the three years. A significant increase was observed one year after admission followed by stable scores until the third year. There was a significant increase in GCS scores as students progressed through medical school years. Positive relationships were found between SDLRS and GCS scores, and the regression model predicted 32% variance.ConclusionsSDLRS and GCS increased as medical school years progressed. In addition, GCS is a significant factor in fostering SDLRS. Medical schools should develop various curriculum activities that enhance group cohesion among medical students, which would in turn promote SDL.

Comparison study for surgical outcomes of right versus left side hemihepatectomy to treat hilar cholangiocellular carcinoma.

PurposeMajor liver resection and radical lymph node dissection has been accepted as a definite treatment of choice for hilar cholangiocarcinoma (HC). However, the perioperative and survival outcomes of right hemihepatectomy (RH) and left hemihepatectomy (LH) still remain controversial. Thus, this study aimed to compare the surgical and oncological outcomes of RH and LH in HC patients.MethodsFrom January 2000 to January 2018, a total of 326 patients underwent surgical resection for HC at Yonsei University College of Medicine in Seoul, Korea. Among the 326 patients, we excluded 130 patients and selected 196 patients, who underwent hemihepatectomy with caudate lobectomy. Among these 196 patients, 114 patients underwent RH, and 82 patients underwent LH. We compared the clinicopathological features as well as the surgical and oncologic outcomes of the RH and LH groups.ResultsThere were no significant differences in disease-free survival (P = 0.473) or overall survival (P = 0.946) in the RH and LH groups. The LH group had fewer complications compared with the RH group, including postoperative ascites (RH: 15 [13.2%] vs. LH: 3 [3.7%], P = 0.023); however, the LH group had more bile leakage complications (RH: 5 [4.4%] vs. LH: 12 [14.6%], P = 0.012). The average time lag from portal vein embolization to operation was 25.80 ± 12.06 days (n = 45). There was no difference in postoperative liver failure (P = 0.402), although there were significantly more frequent ascites after RH (P = 0.023).ConclusionLH might be a good alternative option for the surgical treatment of HC given appropriate tumor location and biliary anatomy indications.

An Effort-Reward Imbalance Model to Study Engagement and Burnout: A Pilot Study

Introduction: Medical students are motivated to engage actively in their studies. Yet at least 50% of medical students suffer from academic burnout. Using a social environmental perspective, this pilot study tested six hypotheses to account for medical student engagement and burnout via an effort-reward imbalance (ERI) model.Methods: This study measured ERI, over-commitment, engagement, burnout, negative affect, demographic variables, and test results during 2017. Seventy-nine medical students at a college of medicine in Seoul, Republic of Korea completed the online questionnaires (response rate: 20.73%). We used hierarchical regression analyses to examine the effects of ERI ratio, over-commitment, and the interaction between ERI ratio and over-commitment on engagement and burnout after adjusting for demographic variables and negative affect.Results: The ERI ratio was negatively related to engagement (p &lt; 0.05), but over-commitment was positively related to engagement (p &lt; 0.05). For burnout, affiliation, age, and negative affect were significant predictors. The ERI ratio was positively associated with burnout (p &lt; 0.05). When we performed regression analyses on three sub-dimensions of engagement and burnout, the factors that affected each sub-dimension were different.Discussion: This pilot study revealed that the ERI ratio in school settings is a common factor for explaining the engagement and burnout of medical students. In addition, over-commitment significantly accounted for engagement, but it did not significantly account for burnout. These results for over-commitment may be explained by the unique characteristics of medical students.

Presidential remarks: WCLC 2017, a successful conference with record-breaking attendance and high scientific quality

Keunchil Park, MD, PhD. Keunchil Park is a professor at the Samsung Medical Center at Sungkyunkwan University School of Medicine in Seoul, South Korea. His research interests include thoracic head and neck oncology, early clinical trials and the development of experimental therapeutics.

Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course

ABSTRACTAs final-year medical and nursing students will soon play key roles in frontline patient care, their preparedness for safe, reliable care provision is of special importance. We assessed patient safety competencies of final-year health profession students, and the effect of a 1-day patient safety education programme on these competencies. A cross-sectional survey was conducted with 233 students in three colleges of medicine, nursing, and traditional medicine in Seoul. A before-and-after study followed to evaluate the effectiveness of the curriculum. Patient safety competency was measured using the Health-Professional Education for Patients Safety Survey (H-PEPSS) and an objective patient safety knowledge test. The mean scores were 3.4 and 1.7 out of 5.0, respectively. The communication domain was rated the highest and the teamwork domain was rated the lowest. H-PEPSS scores significantly differed between the students from three colleges. The 1-day patient safety education curriculum significantly improved H-PEPSS and knowledge test scores. These results indicated that strengthening patient safety competencies, especially teamwork, of students is required in undergraduate healthcare curricula. A 1-day interprofessional patient safety education programme may be a promising strategy. The findings suggest that interprofessional patient safety education needs to be implemented as a core undergraduate course to improve students’ safety competence.

Editorial introductions

Editorial introductions

A Survey of Student Satisfaction with a Portfolio Process and Assessment

The purposes of this study were to identify and analyze students’ attitudes and satisfaction to the portfolio process and assessment for the Introduction to Clinical Medicine course at Ewha Womans University School of Medicine in Seoul, Korea. The subjects consisted of 64 medical school students. Questionnaires consisting of 20 5-point Likert-type items were developed, including three question domains: 1) orientation, 2) portfolios in general, 3) individualized feedback. The mean and median were found and frequency analysis was performed to identify the common characteristics of the participants. A major finding was that 54.7% of the respondents felt that the self-reflection involved in building the portfolio was a valuable learning experience. Plus, the majority of respondents perceived that the individualized feedback had a positive tone and its contents were specific, practical, and constructive. The students perceived that building and writing portfolios heightened their understanding of exit learning outcomes and enhanced their reflective thinking and self-directed learning skills. Meanwhile, some students perceived that there was too much paperwork in the portfolio process and that the process was time consuming. Furthermore, 32.8% of the respondents said that they had difficulty establishing their learning strategies by themselves and self-directing their learning during the portfolio process. In conclusion, it is expected that building a portfolio can help students not only to enhance their ability to accumulate and use their personal learning resources but also to develop the professional qualities required by doctors, such as self-directed learning, self-reflection, lifelong learning, team work, organizational skills, time management and prioritization, and professional thinking and behavior.

Endobronchial Metastases from Extrathoracic Malignancy

PurposeEndobronchial metastasis is defined as documented extrathoracic malignancies metastatic to the endobronchus within a bronchoscopically visible range. Although the clinical and radiologic findings of endobronchial metastasis are similar to primary lung cancer, treatment and prognosis may be different. We hereby investigated the clinical, radiologic and bronchoscopic aspects of endobronchial metastases (EBM) in Korean patients.Materials and MethodsA total of 43 patients with EBM who underwent bronchoscopic biopsies from June 1991 to December 2009 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea, were analyzed retrospectively. We evaluated clinical, radiologic and bronchoscopic characteristics of EBM.ResultsThe patients consisted of 27 males and 16 females and their ages ranged from 18 to 77 years. The common primary cancers related to EBM were rectal (16.3%), colon (11.6%), breast (9.3%) and uterine (9.3%) cancers. The mean interval from diagnosis of primary cancer to EBM was 36 months, and the mean survival duration from diagnosis of EBM was 16.1 months in 33 deceased patients.ConclusionEBM develop in various types of malignancies at various times with unremarkable manifestations. Therefore, physicians should consider the possibility of EBM, especially if a patient has a history of any malignancy, regardless of respiratory symptoms. Respiratory symptoms related with EBM can be treated by various safe procedures.

Major early complications following open, laparoscopic and robotic gastrectomy

Laparoscopic and robotic gastrectomy have been adopted rapidly despite lack of evidence concerning technical safety and controversy regarding additional benefits. This study aimed to compare clinically relevant complications after open, laparoscopic and robotic gastrectomy. This was a retrospective analysis of prospectively collected data on surgical complications in patients undergoing gastrectomy with curative intent for histologically proven adenocarcinoma between 2005 and 2010 at the Department of Surgery, Yonsei University College of Medicine in Seoul, Korea. Complications were categorized into wound infection, bleeding, anastomotic leak, obstruction, fluid collection and other. In a total of 5839 patients (4542 open, 861 laparoscopic and 436 robotic gastrectomies), overall complication, reoperation and mortality rates were 10·5, 1·0 and 0·4 per cent respectively. There were no significant differences between the three groups. Ileus (P = 0·001) and intra-abdominal fluid collections (P = 0·013) were commoner after conventional open surgery. However, tumour stage was higher and more complex resections were performed in the open group. Anastomotic leak, the leading cause of death, occurred more often after a minimally invasive approach (P = 0·017). Laparoscopic and robotic gastrectomy had overall complication and mortality rates similar to those of open surgery, but anastomotic leaks were more common with the minimally invasive techniques.

Positioning Patient-Perceived Medical Services to Develop a Marketing Strategy

In today's medical market, marketing philosophy is being rapidly transformed from customer searching to patient satisfaction and service improvement. The principal objective of this study was to contribute to the establishment of a desirable medical marketing strategy, through the factors of customer satisfaction and the positioning of patients' perceptions by marketing institutions. The data were collected from 282 students of the College of Public Health and Medicine in Seoul. The survey tools were developed using the SERVQUAL scale. Analysis in this study involved both statistical and network analysis. The former was used to verify the determinants of service satisfaction as perceived by respondents, via factor analysis and multiple regression analysis. The latter was obtained using a positioning map and 2-mode network analysis with the matrix data converted from raw data. The determining factors for patient satisfaction were identified as facilities, accessibility, process, physicians, and medical staff. The regression equation was significant (R = 0.606), and the most influential variable was the service quality of physicians (β = .569). According to multidimensional scaling, the positioning of medical institutions indicated that patients' perceptions were affected by hospital size and specialization. By recognizing and managing patient satisfaction, medical institutions are able to foster customer loyalty and, in turn, to enhance service quality. It is necessary to develop an adequate marketing mix to provide better medical services and to overcome medical competition among institutions.

The Effectiveness of an Instructor’s Intervention Using Questioning Strategy in Physiology Class

T his study was done to analyze students’ learning and its lasting effect by teaching strategy involving questioning. This study was performed with 68 students who were enrolled in a physiology class of the Yonsei University College of Medicine in Seoul, Korea, in 2003. The students were randomly divided into 2 groups. One group was taught in a way where students asked questions and the instructor answered the questions. For the other group of students, the instructor asked questions, and the students answered the questions. We performed a pre-test before the study begins and post-tests immediately, 3 weeks, and 6 weeks after the study. The results were analyzed by using analysis of covariance and repeated measures analysis of variance. A higher learning effect was observed in a group where questions were asked by students compared with the other group. The post-test results showed no significant difference in the lasting effect of learning according to the teaching strategy. Students’ learning significantly improved when students asked questions and the instructor answered the questions compared with the strategy of the instructor asking questions and students answering to the questions

A Study about Constitutional Disease Syndromes at a Hospital of Oriental Medicine

1. Objective This study aimed to find out the epidemiologic characteristics of constitutional disease syndromes at a hospital of Oriental medicine in Seoul. 2. Methods The medical records of 1354 subjects who have received prescriptions and diagnosis of Sasang constitution from January 2008 to December 2009 at a hospital of Oriental medicine were reviewed. General factors and the frequency of the prescriptions according to Sasang constitution were compared and analyzed. 3. Results 1) Among the 1354 subjects, 562(41.5%) persons were males and 792(58.5%) females. 614(45.3%) persons were Soeumin, 369(27.3%) Soyangin, 364(26.9%) Taeumin, and 7(0.5%) Taeyangin. 2) The frequencies of the prescriptions of 14 constitutional disease syndromes were compared. Taeum Syndrome, Esophagus Cold Syndrome and Yin Deficiency Tidal fever Syndrome show the high frequencies among 14 disease syndromes. Chest Heat Syndrome, Deficiency of Yin and Blood syndrome and Soeum Syndrome show the low frequencies among 14 disease syndromes. Interior disease(63.4%) was higher than exterior disease(36.6%) and mild disease(61.8%) was higher than severe disease(38.2%). 3) Among all constitutional prescriptions, Jowyiseungchung-tang was the most common and next rankings were Gupoong-tang and Dokhwaljihwang-tang in turns. 4. Conclusions From all these considerations, it would seem that Taeum Syndrome in Soeumin, Esophagus Cold Syndrome in Taeumin and Yin Deficiency Tidal fever Syndrome in Soyangin show the high frequencies in a hospital of Oriental medicine in Seoul. Large-scale epidemiologic study in Sasang constitutional medicine may be needed on various ways and places.

A comparison of pure adenocarcinoma and squamous cell carcinoma of the cervix after radical hysterectomy in stage IB–IIA

Objective This study was designed to investigate the survival difference between pure adenocarcinoma (AC) and squamous cell carcinoma (SCC) in early cervical cancer (FIGO stage IB–IIA) after radical hysterectomy with or without adjuvant therapy performed at a single institution. Methods Patients with AC or SCC between November 1994 and September 2007 at the Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Korea were evaluated. Results Among the 775 patients, 636 patients had SCC, and 139 patients had pure AC. In basal characteristics, preoperative FIGO stage, adjuvant therapy after surgery, as well as chemotherapeutic regimens, were not different between the two groups. However, the median age was about 5 years younger in pure AC patients than in SCC patients (44 years vs. 49 years, P = .001). In the comparison of pathological findings after surgery between the two groups, there were no differences between the two groups, except for LVSI status. The recurrence rate was higher in the pure AC group than in the SCC group (SCC; 36/636; 5.7%, AC; 20/139; 14.4%, P = < 0.001, respectively). The pure AC group had a higher recurrence rate in hematogenous/distant areas than the SCC group (SCC: 8/36; 22.2%, AC; 9/20; 45.0%, P = .076, respectively). In multivariable analysis, positive for pelvic LN and the pure AC cell type were independent factors in both DFS and OS. Conclusion We observed that pure AC of the cervix might entail a worse survival outcome than SCC in patients with early cervical cancer (IB–IIA).

Editor’s Choice

Editor’s Choice

Development and validation of a questionnaire to evaluate medical students' evidence-based medicine competencies.

The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. The EBM competency questionnaire was validated.

Preliminary report of Canal Transobturator Tape for Stress Urinary Incontinence in Women Over 65 Years

Purpose: To access the feasibility of Canal transobturator tape (Canal TOT) for stress urinary incontinence (SUI) in women over 65 year old. Materials and Methods: From August 2006 to December 2008, we reviewed the medical records of 261 patients underwent Canal TOT in Division of Urogynecology, Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine in Seoul. This study is a retrospective analysis of the clinical characteristics (age, gravida, parity, body mass index), previous operation history, comorbidity, surgical procedure and operation outcomes. We performed stress test, one hour pad test, urodynamic study, postvoid residual assessment to all patients for diagnosis of SUI. All patients answered self assessment questionnaires (IIQ-7, UDI-6) at 6 months and 12 months after operation. Results: 55 women over 65 years were underwent Canal TOT. Mean follow up was 11±4.5 months. Mean age of patients was 70.2±3.9 years, gravida 5.8±2.3 times, parity 3.9±1.5 times and body mass index (BMI) 25.6±3.1Kg/m. 8 patients had got hysterectomy (14.5%). 16 patients (29%) had sling operation (Canal TOT alone), and 39 patients (71%) had Canal TOT combined with vaginal surgery for pelvic organ prolapse. The cure rate was 96.4% in 6 months follow up. Leakage after operation were reported by 2 patients (3.6%) and 3 patients (5.5%) transiently suffered from postoperative voiding difficulty. Of whom had incontinence complexed with overactive bladder symptoms (frequency, nocturia, and urgency) 12 patients complained of persistent symptoms after Canal TOT (12/33, 36.4%).

Publishing in Physical and Rehabilitation Medicine

This article presents the panel discussion from the "Meet the Editor" symposium held at the 4th World Congress of the International Society of Physical and Rehabilitation Medicine in Seoul in June 2006. It includes contributions by four Editors of international journals in rehabilitation. Some of the topics discussed are of a general nature but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. Topics discussed include the reasons for publishing in peer-reviewed journals, important considerations in submitting a manuscript, the peer-review process, the effect of electronic publishing (which leads to shorter publication times and the opportunity to preview articles), and the trend toward more open access to journals. The discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (ICF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than Europe and the United States, despite the fact that journals currently published in these regions are distributed worldwide.