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

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

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

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

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*

The term juxta-facet cyst has been used to characterize two types of periarticular cystic alterations, synovial and ganglion, that can occur in the paraspinal region. Synovial cysts arise from synovial outpouchings through the weakened or destroyed capsular tissue.Ganglion cysts are commonly found about the wrist and hand.But theoretically they can occur at any site in the body where periarticular connective tissue is present. In spinal canal these cysts may cause pressure on adjacent nerve root to produce a variety of neurological symptoms. The clinical features indicated an acute onset of symptoms favoring a diagnosis of disc herniation, so differential diagnosis is important.We have experienced two cases of the intraspinal extradural cysts connected to posterior longitudinal ligament by a sheath, causing nerve root compression. those were managed with excision of the cyst, and no recurrence has been identified during follow up evaluation.
Connective Tissue ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Ganglion Cysts ; Longitudinal Ligaments ; Radiculopathy ; Recurrence ; Spinal Canal ; Synovial Cyst ; Wrist

Chronic cavities of the dorsum of the foot often have bare bone and are unsuitable for free skin grafting. Local Flaps are often impossible because of surrounding scar tissue and dead space. A simple method is presented; it consists of the excision of the lesion, filling the cavity by a two staged random-pattern de-epithelialised turn over flap, and skin graft.
Cicatrix ; Foot ; Methods ; Skin ; Skin Transplantation ; Transplants

The aim of this study was to compare widely used quantitative sensory tests to evaluate the diabetic neuropathy(DN). We tested plantar sensation of 40 patients with diabetes mellitus(Group I: 20 with neuropathic symtom, Group II: 20 without symptom) using Semmes-Weinstein monofilament(touch sensation), Biothesiometer(vibration sensation) and EMG. This result was also compared with that of the control group. Eighty percent of Group I and thirty percent of Group II had abnormal EMG findings. Group I had decreased vibration and touch sensation. Comparison of vibration perception threshold(Biothesiometer) with touch pressure sensation(Semmes-Weinstein monofilament) showed that the test with Biothesiometer was relatively accurate, however it was complicated, time consuming and that the test with monofilament was simple and easily performed in the field even though it was relatively crude. 5.07 monofilament could be very effective in the eearly detection of diabetic neumpathy. In conclusion, we recommend 5.07 monofilament as a screening method of diabetic neuropathy and biothesiometer as its follow-up method.
Diabetic Neuropathies ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Peripheral Nervous System Diseases ; Sensation ; Vibration

The standard treatment of adult femoral shaft fractures is the closed intramedullary nailing using a fracture table, but in polytraumatized patients, this method may be difficult due to concomitant adjacent injury. So, we report on the technique of closed intramedullary nailing without a fracture table for adult femoral shaft fracture using "joystick" technique on radiolucent table in supine position. Among 15 cases, two were open fractures, three were proximal 1/3, seven were middle 1/3, two were distal 1/3, and theree were segmental fractures. According to the Winquist Hansen classification, five type I, four type II, three type III, three were type IV. The eleven patients out of the fifteen were operated within 48 hours. The average operation time was 105 minutes, and the amount of bleeding was below 300cc. Forty-seven percent was anatomically reduced, forty percent had below five degree of angular deformity or below five milimeter of shortening, thirteen percent had above five degree of angular deformity of above five milimeter of shortening. The closed intramedullary nailing of femoral shaft fractures without fracture table using radiolucent table and "joy stick" technique is an effective and safe method in multiple injuries. And it reduced the operation time by reducing the preoperation time including preparing of a fracture table.
Adult ; Classification ; Congenital Abnormalities ; Femoral Fractures ; Fracture Fixation, Intramedullary ; Fractures, Open ; Hemorrhage ; Humans ; Methods ; Multiple Trauma ; Supine Position