A gap in the number of physicians caring for inpatients is expected in 2014 based on the restricted working hours for Korean medical residents. One potential solution is the use of hospitalists. The US hospitalist movement has proliferated due to high-quality care and economics. This movement has brought positive changes including a shorter length of hospital stay, increased quality of care, and greater patient satisfaction. Because the Korean government controls all suppliers and maintains a low financial compensation level for universal coverage, hospitals do not have the financial resources to introduce hospitalists. Therefore, in contrast to the US, the use of hospitalists must be developed as a cost-compensated system in Korea. Institutional strategies must be introduced to develop a hospitalist system in Korea. A hospitalist system in Korea would be distinct from that in the US. Further studies and specific strategies are needed that consider Korea's circumstances to effectively introduce a hospitalist system.
Compensation and Redress ; Hospital Medicine ; Hospitalists* ; Humans ; Inpatients ; Korea ; Length of Stay ; Patient Satisfaction ; Universal Coverage

OBJECTIVES: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. METHODS: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. RESULTS: In serum lipid profile test, MDD group showed higher cholesterol (197.68+/-42.94 mg/dL vs. 176.85+/-34.68 mg/dL, p=0.044), TG (139.45+/-92.54 mg/dL vs. 91.4+/-65.68 mg/dL, p=0.018), LDL (130.03+/-33.18 vs. 106.62+/-27.08, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant (32.82+/-14.33 ms vs. 40.36+/-21.40ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group (1.13+/-0.11 vs. 0.91+/-0.18, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). CONCLUSION: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.
Anxiety ; Autonomic Pathways ; Cholesterol ; Depression ; Depressive Disorder, Major ; Heart ; Heart Rate ; Humans

Incarceration of the gravid uterus is a rare but serious complication of pregnancy. Reported is the case of a gravid 2, para 0, abortus 1 with known uterine subserosal myoma(5.3 x5.5cm sized) 26-year-old woman presented with acute dysuria and urinary retention. The patient was 14 weeks and 3 days pregnant and presented several week history of urinary frequency and sensation of incomplete bladder emptying. Examination revealed a retroflexed uterus with cervical opening pointing toward the anterior abdominal wall. An ultrasound revealed a thin, elongated maternal bladder and a uterus incarcerated between the sacral promontary and the pubis. The incarceration was successfully reduced by tenaculum traction of the cervical posterior lip without surgical intervention and had a normal infant of appropriate weight at term.
Abdominal Wall ; Adult ; Dysuria ; Female ; Humans ; Infant ; Leiomyoma ; Lip ; Myoma* ; Pregnancy ; Sensation ; Traction ; Ultrasonography ; Urinary Bladder ; Urinary Retention ; Uterine Retroversion ; Uterus*

PURPOSE: The purpose of this study was to identify the mediating effect of head nurses' emotional leadership as perceived by nurses in the relationship between nurses' job stress and job satisfaction. METHODS: Study participants were 278 staff nurses currently working at two university hospitals in Busan, Korea. SPSS/WIN 21.0 program was used for data analysis to analyze descriptive statistics, t-test, correlation, and stepwise multiple regression. The significance level was set at p<.05. RESULTS: Nurses' job satisfaction had a significant correlation with job stress (r=-.31, p<.001) and emotional leadership of nurse managers as perceived by nurses (r=.53, p<.001). Also, head nurses' emotional leadership experienced by nurses had a partial mediating effect in the relationship between nurses' job stress and job satisfaction. CONCLUSION: The results of this study show that the nurse managers' emotional leadership has an important influence on nurses' job stress and job satisfaction. Therefore, head nurses' emotional leadership is very important for effective human resource management and the hospital should offer education and training to booster head nurses' leadership by developing emotional intelligence to promote staff job satisfaction.
Busan ; Education ; Emotional Intelligence ; Head* ; Hospitals, University ; Humans ; Job Satisfaction* ; Korea ; Leadership* ; Negotiating* ; Nurse Administrators ; Statistics as Topic

Minocycline is a semi-synthetic, broad-spectrum, antimicrobial agent that was first introduced into clinical practice in 1967. Its primary indication is for the treatment of acne vulgaris, where its success has been attributed to a combination of its bacteriostatic and anti-inflammatory activities. There has been recent interest in minocycline use in the treatment of various other chronic inflammatory and immune-mediated diseases such as Behcet's disease and recurrent apthous ulceration. A well-recognized side effect of minocycline treatment is pigmentation, which has been reported in multiple tissues including skin, nail beds, sclera, bone, the thyroid, and teeth. However, pigmentation of the tongue caused by minocycline is very rare. We report four cases of actual pigmented lesions on the tongue and finger nails due to minocycline therapy, followed by a discussion of minocycline-induced hyperpigmentation.
Acne Vulgaris ; Fingers ; Hearing Loss, Sensorineural ; Hyperpigmentation* ; Minocycline ; Pigmentation ; Sclera ; Skin ; Thiram ; Thyroid Gland ; Tongue* ; Tooth ; Ulcer

Ketotifen, a benzocycloheptathiophene, has an orally effective antiallergic as well as antihistaminic properties. In pervious studies, Ketotifen has shown encouraging results on patient with allergic rhinitis, either perennial or seasonal. 39 patients with allergic rhinitis had been treated with Ketotifen 1 mg twice daily for 8 weeks. And we obtained following results. 1) The efficacy rate in sneezing attack was 73.5%, in nasal discharge 71%, in nasal obstruction 58%. 2) Some improvements in at least one of three-major symptoms were noted within 1 week in 30.7%, within 2 weeks in 55.8%, within 3 weeks in 66.7%, within 8 weeks in 87.2%. 3) Physical findings such as colour, swelling of turbinate, character of rhinorrhea were not improved significantly. 4) Side effect was observed only in one patient with abdominal pain and diarrhea, which was subsided after interruption of administration. These results suggested that Ketotifen was effective in treatment of allergic rhinitis.
Abdominal Pain ; Diarrhea ; Humans ; Ketotifen* ; Nasal Obstruction ; Rhinitis, Allergic* ; Seasons ; Sneezing ; Turbinates

Dryness has harmful effect on the harvested autogenous bone. But there was no report how the bone cells response to the drying condition and recuperate after exposure. Cytotoxic effect of dryness on the osteoblast-like cells were examined from 18- day chick calvaria. The cells were rinsed with lactated Ringer solution or lactated Ringer solution with 10% fetal bovine serum to see whether the added serum could help the cells live longer. Cultured cells were exposed to room air for period of time ranging from 0 minute to 35 minutes and viability was determined using the MTT test. Cultured cell death increased with the increase of exposure time to air between 25 and 30 minutes. No live cells existed after 35 minutes exposure. Lactated Ringers solution containing 10% fetal bovine serum did not prolong the survival time of osteoblast-like cells compared with lactated Ringers solution alone. These results suggest that the drying of bone cells that occurs in the operating room, especially after a prolonged reconstructive procedure, may severely damage the cell viability of exposed bone or grafted bone and thereby compromise the fusion rate.
Cell Survival* ; Cells, Cultured ; Operating Rooms ; Skull ; Transplants

The possibility that immediate neurovascular injury will follow fracture of the clavicle has been generally known. A case of delayed involvement of the subclavian vein following a nonunion of clavicular fracture is reported emphasizing the proper reduction and union of the clavicle fracture is essential if delayed neurovascular complication are to be avoided or treated.
Clavicle ; Subclavian Vein ; Thrombosis* ; Veins*

Chondrocytes isolated from the articular cartilage of rabbit knee joint were cultured in vitro within fibrin glue carrier for 2 weeks. Histochemical and electromicroscopical approaches were used to study chondrocytes behavior and phenotypic expression. In vitro study, chondrocyte assumed a rounded morphology, accumulated metachromatic matrix and took on the cytological characteristics of in vivo cartilage cells. Allogenic cultured chondrocyte in fibrin glue was transplanted into osteochondral defect in rabbit joint. The contralateral knee joint served as a control in which the defect was left empty. This in vivo study was performed for the investigation of the chondrogenic potential of cultured chondrocytes embedded in fibrin glue. Grafted defects was filled with cartilage in gross finding, repaired tissue consisted of differentiated chondrocytes and matrix resumed that of hyaline cartilage. At sixteen week after transplantation, subchondral region was partially transformed into bone without loss of overlying articular cartilage, but in control group, defect did not heal successfully. Repaired articular cartilage was thicker than host cartilage and tide mark was not shown up to 24 weeks. Some of repaired tissue was degraded partially. These results suggest that fibrin glue provides suitable environment for differentiation of chondrocyte and allograft of cultured chondrocyte in fibrin glue transplanted into large osteochondral defect improves cartilage repair.
Allografts ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Fibrin Tissue Adhesive ; Hyaline Cartilage ; Joints ; Knee Joint ; Rabbits* ; Transplantation ; Transplants*

Cutaneous adverse drug reactions are common and produce easily identifiable clinical symptoms. These may range from mild maculopapular rashes to severe reactions associated with systemic disease.Current Concepts: The most common presentation of a drug eruption is in the form of a maculopapular rash or exanthematous skin eruption, followed by fixed drug eruptions and urticaria. Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms, which are rare but potentially life-threatening. Recently, it has emerged that cutaneous adverse drug reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, may induce a variety of cutaneous manifestations.Discussion and Conclusion: Although certain drugs, such as antimicrobials and anticonvulsants, can frequently cause drug eruptions, their effects may change, depending on the situation and timing. Therefore, in order to resolve symptoms and prevent complications, early diagnosis, drug identification, and appropriate treatment should be performed, in consideration of the various factors involved.