BACKGROUND: Burnout is a common problem for interns and residents. It may be related to medical error, but little is known about this relationship. The purpose of this study was to determine the association between burnout and perceived medical errors among interns and residents. METHODS: The study group consisted of interns and residents working in a university hospital in Busan. Data were provided by 86 (58.5%) of 147 interns and residents. They completed a questionnaire including self-assessment of medical errors, a linear analog self-assessment of overall quality of life (QOL), fatigue, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and a validated depression screening tool. RESULTS: According to univariate logistic regression analyses, there was an association between perceived medical errors and fatigue (odds ratio [OR], 1.37 per unit increase; 95% confidence interval [CI], 1.12 to 1.69; P < 0.003) and ESS scores (OR, 1.13 per unit increase; 95% CI, 1.03 to 1.23; P < 0.009). Perceived medical errors were also associated with burnout (ORs per 1-unit change; emotional exhaustion OR, 1.07; 95% CI, 1.02 to 1.13; P < 0.005; depersonalization OR, 1.11; 95% CI, 1.02 to 1.21; P < 0.013), a negative depression screen (OR, 0.29; 95% CI, 0.11 to 0.76; P < 0.013), and overall QOL (OR, 0.80; 95% CI, 0.70 to 0.98; P < 0.033). In multivariate logistic regression analyses, an association was identified between perceived medical errors and emotional exhaustion (OR, 1.06; 95% CI, 1.00 to 1.11; P < 0.046) when adjusted for ESS, and depersonalization (OR, 1.01; 95% CI, 1.01 to 1.19; P < 0.04) when adjusted for fatigue. CONCLUSION: Higher levels of burnout among interns and residents were associated with perceived medical errors.
Depersonalization ; Depression ; Fatigue ; Logistic Models ; Mass Screening ; Medical Errors ; Quality of Life ; Self-Assessment

The irritable bowel syndrome(IBS) is a chronic functional gastrointestinal disorder, characterized by abdominal pain, bloating and bowel disturbance. The pathophysiology of IBS is very complicated. Recent studies indicate that the most important mechanisms include visceral hypersensitivity, abnormal gut motility, autonomic nervous system(ANS) dysfunction and disorder of regulation of the brain-gut axis. Patients with IBS frequently present impaired autonomic regulation. Heart rate variability(HRV) is an acknowledged tool for estimating autonomic function. We experienced two cases of increased parasympathetic nervous system by HRV in irritable bowel syndrome with diarrhea as a predominant symptom.
Abdominal Pain ; Autonomic Nervous System ; Axis, Cervical Vertebra ; Diarrhea ; Gastrointestinal Diseases ; Heart Rate ; Humans ; Hypersensitivity ; Irritable Bowel Syndrome ; Parasympathetic Nervous System

Primary carcinoma of the female urethra is relatively rare neoplasm. Urethral cancers account for less than 0.02 per cent of all neoplasms occurring In women and 0.01 per cent of all urologic malignancies. The rarity of the disease as well as the changes and improvements in the various treatment modalities have prevented unanimity of opinion with regard to its proper treatment. We report one case of transitional cell carcinoma in female urethra with brief review of the literature.
Carcinoma, Transitional Cell* ; Female* ; Humans ; Urethra* ; Urethral Neoplasms

BACKGROUND: Respiratory viruses (RV) are important pathogen in both children and immunocompromised hosts. Rapid diagnosis of RV is important to manage patients and to implement infection control measures. To investigate the testing situation in Korea, we performed surveillance for the 95 medical institutions. Due to the paucity of long-term, multi-center data on RV epidemiology in Korea, we analyzed data from 5 university hospitals. METHODS: Surveillance questionnaires were sent to 95 members of the Korean Society for Clinical Microbiology. The RV data from 5 university hospitals, 2001 through 2005, were collected retrospectively and analyzed for the isolation rate of each virus. RESULTS: Among the 63 institutions, who replied, 49% performed RV testing and 84% of the testing institutes were university hospitals. A hundred percent institutes tested for respiratory syncytial virus (RSV), whereas 81% tested for influenza virus (Flu), 74% for parainfluenza virus (PIV) and adenovirus each, 32% for rhinovirus, 23% for coronavirus, and 36% for metapneumovirus. PCR and/or culture were employed in 42% of the institutes, immunochromatography 29%, immunofluorescent assay 23%, and enzyme immunoassay 7%. Among the total 11,131 specimens received, virus was detected in 22%, ranging from 12% to 28% by hospital. The most frequently detected virus was RSV (54%) and followed by PIV (18%), Flu (15%), and adenovirus (13%). But species distributions of these viruses were quite different by hospital or by year. CONCLUSION: It is necessary for more active implementation of the RV testing because only 55% of university hospitals and 17% of general hospitals performed this test.
Academies and Institutes ; Adenoviridae ; Child ; Coronavirus ; Diagnosis ; Epidemiology* ; Hospitals, General ; Hospitals, University* ; Humans ; Immunochromatography ; Immunocompromised Host ; Immunoenzyme Techniques ; Infection Control ; Korea* ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Republic of Korea ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Surveys and Questionnaires

Injury of the femoral artery with a femoral intertrochanteric fracture is rare, and usually occurs on the deep femoral artery during surgery. We experienced a case of preoperative injury of the superficial femoral artery by a lesser trochanteric fragment. We repaired the femoral artery through an anterior approach before internal fixation.
Femoral Artery ; Femur

Vascular complication of hip arthroplasty is relatively rare, and usually involves iatrogenic injury or thrombus formation of main vessels. No case of vascular injury associated with closed suction drainage has been reported. The current report describes an injury of a branch from the lateral circumflex femoral artery caused by a trocar of closed suction drainage in a 72-year-old man who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. We report on this case with a review of the literature in order to avoid similar complications.
Aged ; Arthroplasty ; Femoral Artery ; Femoral Neck Fractures ; Hemiarthroplasty* ; Hip* ; Humans ; Suction* ; Surgical Instruments* ; Thrombosis ; Vascular System Injuries

PURPOSE: Total body irradiation (TBI) or whole body irradiation is used to acquire immune suppression, to treat malignant lymphoma and leukemia, and as an conditioning regimen for bone marrow transplantation. For these purposes, many methods were developed to obtain homogenous dose distribution. The objective of this study was to analyze and confirm the accuracy and the homogeneity of the treatment setup, the parallel opposed lateral technique, currently used in Seoul National University Hospital. MATERIALS AND METHODS: Surface dose data, measured with a thermoluminescent dosimeter, of 8 patients among 10 patients, who were given total body irradiation with the parallel opposed lateral technique between September 1996 to August 1998, at Seoul National University Hospital were analyzed. Surface doses were measured at the head, neck, axilla, thigh, and ankle level. Surface and midline doses were measured with similar set-up and technique in the Humanoid phantom. RESULTS: Measured surface doses relative to prescribed dose for the head, neck, axilla, thigh, and ankle level were 91.3+/-7.8, 98.3+/-7.5, 95.1+/-6.3, 98.3+/-5.5, and 95.3+/-6.3%, respectively. The midline doses of the head, neck, axilla, thigh, and ankle level estimated from the surface-to-midline ratios in the Humanoid phantom were 103.4+/-9.0, 107.8+/-10.5, 91.1+/-6.1, 93.8+/-4.5, and 104.5+/-9.3%, respectively. Measured surface doses and estimated midline doses ranged from -8.9% to + 7.8%. Midline doses at the neck and the axilla level deviated more than 5% from the prescribed doses. The difference of the estimated midline doses at the neck and the axilla level and the actual doses were attributed to the thickness differences between the Humanoid phantom and the patients. CONCLUSION: Distribution of the midline doses as well as the surface doses were measured to be within -8.7 - +7.8% range. Actual dose distribution in the patient is expected to be better than the measured dose range mainly attributed to thickness difference between the patient and the Humanoid phantom.
Ankle ; Axilla ; Bone Marrow Transplantation ; Head ; Humans ; Leukemia ; Lymphoma ; Neck ; Seoul ; Thigh ; Whole-Body Irradiation*

This in vitro study examined the effect of surface defects on cutting blades on the extent of the cyclic fatigue fracture of HEROShaper Ni-Ti rotary files using fractographic analysis of the fractured surfaces. A total of 45 HEROShaper (MicroMega) Ni-Ti rotary files with a #30/.04 taper were divided into three groups of 15 each. Group 1 contained new HEROShapers without any surface defects. Group 2 contained HEROShapers with manufacturing defects such as metal rollover and machining marks. Group 3 contained HEROShapers that had been clinically used for the canal preparation of 4-6 molars. A fatigue-testing device was designed to allow cyclic tension and compressive stress on the tip of the instrument whilst maintaining similar conditions to those experienced in a clinic. The level of fatigue fracture time was measured using a computer connected the system. Statistical analysis was performed using a Tukey's test. Scanning electron microscopy (SEM) was used for fractographic analysis of the fractured surfaces. The fatigue fracture time between groups 1 and 2, and between groups 1 and 3 was significantly different (p < 0.05) but there was no significant difference between groups 2 and 3 (p > 0.05). A low magnification SEM views show brittle fracture as the main initial failure mode. At higher magnification, the brittle fracture region showed clusters of fatigue striations and a large number of secondary cracks. These fractures typically led to a central region of catastrophic ductile failure. Qualitatively, the ductile fracture region was characterized by the formation of microvoids and dimpling. The fractured surfaces of the HEROShapers in groups 2 and 3 were always associated with pre-existing surface defects. Typically, the fractured surface in the brittle fracture region showed evidence of cleavage (transgranular) facets across the grains, as well as intergranular facets along the grain boundaries. These results show that surface defects on cutting blades of Ni-Ti rotary files might be the preferred sites for the origin of fatigue fracture under experimental conditions. Furthermore, this work demonstrates the utility of fractography in evaluating the failure of Ni-Ti rotary files.
Edible Grain ; Fatigue* ; Fractures, Stress* ; Microscopy, Electron, Scanning ; Molar

STUDY DESIGN: A prospective comparative study. PURPOSE: To describe the changes in the spinopelvic parameters on normal Koreans more than 50 years of age. OVERVIEW OF LITERATURE: There are differing opinions regarding the changes in the thoracic kyphosis, lumbar lordosis, C7 plumb with age in the elderly population. METHODS: Sagittal standing radiographs of the whole spine including the pelvis in 132 Korean adult male volunteers more than 50 years of age were evaluated prospectively. Volunteers with a history of spine operation, spinal disease, pain in their back or legs, scoliosis, spondylolisthesis, monosegment disc space narrowing, or compression fracture in radiographs were excluded. The following parameters were included: thoracic kyphosis (T5 upper end plate [UEP]-T12 lower end plate [LEP]), thoracolumbar kyphosis (T10 UEP-L2 LEP), lumbar lordosis (T12 LEP-S1 UEP), lower lumbar lordosis (L4 UEP-S1 UEP), sacral slope, pelvic incidence, and the distances from the C7 plumb to the posterosuperior endplate of S1. These parameters in the 6th, 7th and 8th decade groups were compared and the changes in these parameters according to age were examined. RESULTS: The thoracic kyphosis demonstrated significant differences in the in the three age groups (p = 0.019), and increased with age (r = 0.239, p < 0.006). The other parameters did not show any significant difference or correlation. CONCLUSIONS: Similar global sagittal balances and spinopelvic parameters may be observed in Korean males older than 50 years, with a trend towards increasing thoracic kyphosis with age.
Adult ; Aged ; Animals ; Fractures, Compression ; Humans ; Incidence ; Kyphosis ; Leg ; Lordosis ; Male ; Pelvis ; Prospective Studies ; Scoliosis ; Spinal Diseases ; Spine ; Spondylolisthesis

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.
Adrenal Cortex Hormones ; Etretinate ; Extremities ; Female ; Foot ; Hand ; Humans ; Isotretinoin ; Laser Therapy ; Nevus, Sebaceous of Jadassohn* ; Parturition ; Pruritus ; Skin