A resident is a preliminary specialist with a medical license. It is also the status of an employee at a training hospital who is trained by clinical faculty. This duality makes the role of a resident unique, because its interpretation differs dramatically depending on whether one focuses on a resident's status as a trainee or as an employee. Issues regarding patient safety have emerged as residents have come to emphasize their role as employees in discussions of how to balance their work duties with their learning responsibilities. The workload that was taken for granted is no longer considered natural. Two years have elapsed since the enactment of the resident law, which was passed to improve the training environment and working conditions of residents, and limits them to 80 hours of work per week. However, confusion persists in the field. In order to solve problems regarding resident education, new education program with hospitalists and the financial and administrative support from hospitals and the government are important.
Education ; Financing, Organized ; Hospital Medicine ; Hospitalists ; Humans ; Internship and Residency ; Jurisprudence ; Learning ; Licensure ; Patient Safety ; Specialization

A primary mission of the Korean pancreatobiliary association (KPBA) is to promote high quality patient care and safety in the field of pancreatobiliary diseases. Among these, endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important procedure among various endoscopic procedures. The purpose of this document is to provide a current Korean medical detailed and departmental specialty system that should be considered before preparing of privileging and credentialing for ERCP subspecialty and making suitable framework for determining the competency of practicing endoscopists and for the granting of privileges to perform ERCP. As such, this document provides current situation of Korean medical specialty and subspecialty system to assist KPBA in making credentialing organizations especially for ERCP subspecialty.
Cholangiopancreatography, Endoscopic Retrograde ; Credentialing ; Financing, Organized ; Patient Care

Academic medicine is built from a foundation of education, research, and patient care. Since good patient care results from the application of medical research and continuous education, these three components cannot be separated for medical development to occur. In Korea, many obstacles hinder the achievement of academic medicine, such as an inefficient medical delivery system, limitations of primary care, low insurance prices, and no long-term health care plan. Medical education has changed to outcome-based education, but presented temporal integration status. Governance of healthcare research is not centralized, and Korea is awarded relatively fewer grants than other countries. Medical professors have reached a burnout state due to patient care responsibilities in addition to research and education duties. Many medical systems, including the medical delivery system and insurance problems, may contribute to distrust between doctors and patients. The government is not involved in a long-term health care policy. The multitude of factors mentioned here are hindering the achievement of academic medicine in Korea.
Awards and Prizes ; Delivery of Health Care ; Education ; Education, Medical ; Financing, Organized ; Health Services Research ; Humans ; Insurance ; Korea ; Patient Care ; Primary Health Care

Despite the high efficacy of direct acting antivirals (DAAs) not all patients successfully clear hepatitis C virus infection, in fact, approximately 1–3% fail to reach a sustained virological response 12 weeks after end of treatment. DAA failures are characterized by advanced liver disease, specific genotypes/subtypes and resistance associated substitutions to the DAA class they have been treated with. Current European Association for the Study of the Liver guidelines recommend three therapeutic options for such patients. The first is a 12 week course of sofosbuvir (SOF), velpatasvir (VEL) and voxilaprevir (VOX), which has shown to be effective in 90–99% of patients and was granted A1 level recommendation. The second option, reserved for patients who have predictors of failure consists in 12 weeks regimen with glecaprevir (GLE) and pibrentasvir (PIB), effective in 90–97%. Finally, although not supported by published data, for especially difficult to treat patients there should theoretically be a benefit in prolonged combinations of SOF+GLE/PIB or SOF/VEL/VOX±ribavirin. This review presents the latest evidence from both clinical trials and real-life on such therapeutic strategies.
Antiviral Agents ; Financing, Organized ; Hepacivirus ; Hepatitis C ; Hepatitis ; Humans ; Liver ; Liver Diseases ; Sofosbuvir ; Treatment Failure

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine carcinoma of the skin that shows locoregional or distant metastasis. Metastasis of MCC to body cavity effusion is extremely rare; only three cases have been reported so far. Metastatic MCC in effusion cytology shows small blue round cells with fine stippled chromatin like other small blue round cell tumors such as small cell lung carcinoma or lymphoma. The diagnosis of metastatic MCC can grant patients good chances at recently advanced therapeutic options. Here, we present a case of metastatic MCC to pleural effusion with characteristic single file-like pattern.
Carcinoma, Merkel Cell ; Carcinoma, Neuroendocrine ; Chromatin ; Diagnosis ; Financing, Organized ; Humans ; Lymphoma ; Neoplasm Metastasis ; Pleural Effusion ; Skin ; Small Cell Lung Carcinoma

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.
Aging ; Awards and Prizes ; Delivery of Health Care ; Education ; Financing, Organized ; Humans ; Mentors ; Osteoporosis ; Practice Guidelines as Topic ; Taiwan

The acknowledgement was missed without intention. The authors ask to add the acknowledgement ‘This work was supported by a 2-Year Research Grant of Pusan National University.’ in an appropriate section.
Busan ; Financing, Organized ; Intention ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin*

p-Cresol, found at high concentrations in the serum of chronic kidney failure patients, is known to cause cell senescence and other complications in different parts of the body. p-Cresol is thought to mediate cytotoxic effects through the induction of autophagy response. However, toxic effects of p-cresol on mesenchymal stem cells have not been elucidated. Thus, we aimed to investigate whether p-cresol induces senescence of mesenchymal stem cells, and whether melatonin can ameliorate abnormal autophagy response caused by p-cresol. We found that p-cresol concentration-dependently reduced proliferation of mesenchymal stem cells. Pretreatment with melatonin prevented pro-senescence effects of p-cresol on mesenchymal stem cells. We found that by inducing phosphorylation of Akt and activating the Akt signaling pathway, melatonin enhanced catalase activity and thereby inhibited the accumulation of reactive oxygen species induced by p-cresol in mesenchymal stem cells, ultimately preventing abnormal activation of autophagy. Furthermore, preincubation with melatonin counteracted other pro-senescence changes caused by p-cresol, such as the increase in total 5′-AMP-activated protein kinase expression and decrease in the level of phosphorylated mechanistic target of rapamycin. Ultimately, we discovered that melatonin restored the expression of senescence marker protein 30, which is normally suppressed because of the induction of the autophagy pathway in chronic kidney failure patients by p-cresol. Our findings suggest that stem cell senescence in patients with chronic kidney failure could be potentially rescued by the administration of melatonin, which grants this hormone a novel therapeutic role.
Aging* ; Autophagy* ; Catalase ; Cell Aging ; Financing, Organized ; Humans ; Kidney Failure, Chronic ; Melatonin* ; Mesenchymal Stromal Cells* ; Phosphorylation ; Protein Kinases ; Reactive Oxygen Species ; Renal Insufficiency, Chronic ; Sirolimus ; Stem Cells

OBJECTIVE: To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis.METHODS: We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest.RESULTS: There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively).CONCLUSION: When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.
Bias (Epidemiology) ; Bone Density ; Bone Transplantation ; Chemotherapy, Adjuvant ; Decompression ; Financial Management ; Financing, Organized ; Humans ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Radiotherapy ; Risk Factors ; Spinal Injuries ; Spine ; Transplants ; Walking

No abstract available.
Financing, Organized