Background: Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians. Methods: From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area. Results: The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%. Conclusion In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.

PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.
Age Distribution* ; Aged ; Bone Marrow* ; Humans ; Occipital Bone ; Parietal Bone ; Retrospective Studies ; Skull* ; Spine ; Veins

Background: On September 25, 2023, the law requiring the mandatory installation and operation of closed circuit television (CCTV) in the operating room went into effect. In this study, doctors’ perceptions of the law were re-examined on September 23, 2023 (just prior to the law’s enforcement), following a survey conducted on July 21, 2021 (before the re-examination of the bill). This study aimed to confirm doctors’ perceptions of the infringement of fundamental rights of this law, the collapse of essential medical services due to the avoidance of surgery, and other concerns and priority solutions ahead of the law’s enforcement. Methods: The survey was conducted from 8 to 18 September, 2023, by the Korean Medical Association Doctor Survey; a total of 1,267 doctors responded to the survey. Results: Out of 1,267 respondents, 1,156 (91.2%) said “yes,” and 111 (8.8%) said “no” to issue concerning constitutional violations of fundamental rights–such as the freedom of medical personnel to practice their profession–and moral rights. A total of 1,149 (90.7%) respondents agreed with the concern regarding the collapse of essential medical care due to the avoidance of surgeons. Conclusion Sufficient guidance should be provided, along with guidelines that provide explicit standards for the installation and operation of the CCTV systems, along with safety management measures. Medical disputes and the heavy legal responsibility of medical personnel are the main reasons as to why essential medical care collapses, given the avoidance of surgery. Medical disputes should be avoided in order to prevent essential medical care collapse, as the video is used as evidence for criminal sanctions.

Background: A bill for the mandatory installation of closed-circuit television (CCTV) in operating rooms, still likely in breach of the constitution, was approved. When a bill infringing on individuals’ fundamental rights is drafted, alternative means of minimizing the infringement of the offender’s rights should be considered ahead of the draft. To this end, alternatives on the bill identified through the consciousness of the offender would be most realistic and much more effective. Thus, this study examined doctors’ consciousness on the mandatory installation of CCTV in operating rooms, the appropriateness of punishment for members who commit immoral and unethical behaviors, and doctors’ alternative ideas to CCTV installation in operating rooms. Methods: The online survey was conducted for a week from July 9, 2021, to July 16, 2021, by the Korean Medical Association Doctors News, and 2,345 doctor members responded to the investigation. Results: According to the survey, the following alternatives to CCTV installation in operating rooms were proposed: strengthening punishment for performing ghost surgery (38.3%), placing cameras at the entrance of the operating room (21.8%), mandatory written consent (pledge) (13.7%) to prevent ghost surgery for medical staff participating in the surgery, promoting self-purification (whistle-blowing) (11.5%), and a biometrics function for entering operating rooms (8.8%). Conclusion The revised medical law delegated legislative devices to subordinate statutes for minimizing infringement. Thus, new regulations should be set to reduce infringement of fundamental rights. It is hoped that doctors’ consciousness on new law could be preliminary data to regulate new rules in discussing lower statutes.

PURPOSE: The purpose of this study was to compare the cost using different methods of costing nursing activities for patients with chronic otitis media having surgery. METHOD: Data were collected from 30 patients who had mastoidectomy and tympanoplasty. To compare the cost, the researchers used three different costing methods; consumed time, resource based relative value scale (RBRVS), and critical pathway (CP). RESULTS: Twenty-six nursing activities for surgical patients with chronic otitis media were found. Total cost was 83,843.7 won using RBRVS. The costliest activity was recording at 9,734.4 won, followed by confirmation of doctors' orders at 9,302.4 won, and injection with infusion pump at 9,072.0 won. There was a difference in nursing activities performed according to the length of hospital stay, and the cost was highest on the surgery day at 13,417.8 won. Comparatively, the total cost was 72,014.4 won using CP. CONCLUSIONS: Nursing activities are performed in various forms according to the disease and patient's condition, and different nursing activities are executed according to the length of hospital stay. In order to measure the load of nursing activities and distribute it appropriately, it is necessary to analyze the cost of nursing activities by the process of nursing services performed.
Costs and Cost Analysis ; Critical Pathways ; Humans ; Infusion Pumps ; Length of Stay ; Nursing Services ; Otitis ; Otitis Media ; Relative Value Scales ; Tympanoplasty

Sustained downgaze mostly occurs in association with lesions affecting the dorsal midbrain. We report sustained downgaze in a patient with hepatic encephalopathy. The sustained downgaze existed for seven more days after she regained her consciousness. The persistent downgaze even after regaining full consciousness indicates localized pretectal dysfunction rather than diffuse encephalopathy as the mechanism of sustained downgaze in our patient. The ocular motor dysfunction in hepatic encephalopathy may be due to localized dysfunction of the brainstem

PURPOSE: After discharge from the hospital, very low birth weight infants require care consultation, information, and interaction and so forth, due to sequelae, different growth and developmental pattern; which increase the burdens and the worries of patients in nurturing them. With the counseling of experts in the related fields, the authors and the Food for the Hungry have run a department of childcare for a year, emphasizing on more family support than extreme early detection of disabilities. This study reports on relieving child care anxiety, promoting growth and development, educating parents on home treatment of sequelae, finding and coping with minor disabilities. METHODS: The subjects were chosen among infants under 1,500 g of birth weight and younger than a corrected age of 6 months. Meetings were held once in a month for a year. Infant care support classes were taught by experts in their fields including a music therapist (with play program), neonatologist, a children's nurse, a child-care director, a clinical psychologist, a rehabilitation therapist, a social worker and, a nutritionist. Within the self-dependent groups, the families were able to share their concerns and experiences on child-caring. Second home visits were carried out to monitor home oxygen therapy, tube feeding, cerebral palsy signs, and to find neglect or abuse in suspected cases. RESULTS: Fifty-one infants participated; the average weight was 1,060 g, the average gestational age was 27 weeks and 2 days. Eighteen were boys and 23 girls. The average age of the mothers was 33.4, and there were 26 appropriate for gestational age, 8 small for gestational age, and, 5 large for gestational age. Twenty three were first-born, 13 were second-born, 1 was third-born, and twins were 4 pairs. Home visits were done in 33 families, and secondary visits were done in 6 families. The depression score of mothers in the attendant group decreased from 10.47+/-5.18 to 8.18+/-5.87 (P=0.080). CONCLUSION: The depression score of mothers in the attendant group decreased after infant care support classes.
Anxiety ; Birth Weight ; Cerebral Palsy ; Child ; Child Care ; Counseling ; Depression ; Enteral Nutrition ; Female ; Follow-Up Studies* ; Gestational Age ; Growth and Development ; House Calls ; Humans ; Infant Care ; Infant* ; Infant, Very Low Birth Weight* ; Mothers ; Music ; Nutritionists ; Oxygen ; Parents ; Psychology ; Rehabilitation ; Social Workers ; Twins

PURPOSE: Rhabdomyosarcoma of the lacrimal sac is extremely rare. There has only been one case in this country, during the 30s, and to our knowledge, there are no reports of primary rhabdomyosarcoma on the lacrimal sac. We report a case of primary rhabdomyosarcoma of the lacrimal sac in a 68-year-old woman METHODS: A 68-year-old female patient presented with tearing of the right eye. A lacrimal sac mass extending to the proximal nasolacrimal duct was detected during the dacryocystorhinostomy, and incisional biopsy was performed. Histopathology revealed a rhabdomyosarcoma of the right lacrimal sac. After systemic chemotherapy, complete excision of the tumor through the medial maxilla was performed. RESULTS: The pathologic diagnosis of the excised mass was embryonal type rhabdomyosarcoma. There was no evidence of tumor recurrence in the lacrimal sac or paranasal sinus during 9 months of follow-up. CONCLUSIONS: Although rhabdomyosarcoma is very uncommon, this case provides the rationale for including it in differential diagnosis of a mass in lacrimal sac.
Aged* ; Biopsy ; Dacryocystorhinostomy ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Maxilla ; Nasolacrimal Duct ; Recurrence ; Rhabdomyosarcoma*

As the world faced a pandemic caused by the coronavirus disease (COVID-19) outbreak in 2019, telemedicine quickly spread and was widely adopted. This was the first instance where telephone consultations were temporarily allowed in Korea. We used data from the 2020 Korean Physician Survey and analyzed the physicians’ perceptions of telephone consultations, the reasons for providing these consultations, and the level of physician satisfaction after providing it.Current Concepts: A total of 6,342 respondents were selected for the final analysis of the research results. Regardless of the COVID-19 pandemic, the data showed that most physicians had a negative perception (77.1%) toward the introduction of the telemedicine system. A third (31.1%) of physicians surveyed had provided medical treatment via telephone consultation. According to the position the physicians held, professors, fellows, self-employed physicians, and public health physicians had the most experience in this method of consultation. The use of telephone consultation was highest in the field of internal medicine (44.5%) treatment. Data also showed that most physicians (83.5%) who provided such consultations experienced difficulties in making a medical judgment that could ensure their patients’ safety.Discussion and Conclusion: The results of this study verified that physicians’ opinions about the telemedicine system differed according to service, area of specialization, region, and type of medical institution. A closer review and establishment of policy alternatives are required to explore the possible expansion of teleconsultations and related medical treatments in the future.

PURPOSE: We investigated the expression of the N-myc and STAT interactor (NMI) protein in invasive ductal carcinoma tissue and estimated its clinicopathologic significance as a prognostic factor. The expression levels and prognostic significance of NMI were also analyzed according to the molecular subgroup of breast cancers. METHODS: Human NMI detection by immunohistochemistry was performed using tissue microarrays of 382 invasive ductal carcinomas. The correlation of NMI expression with patient clinicopathological parameters and prognostic significance was analyzed and further assessed according to the molecular subgroup of breast cancers. Moreover, in vitro experiments with 13 breast cancer cell lines were carried out. We also validated NMI expression significance in The Cancer Genome Atlas cohort using the Human Protein Atlas (HPA) database. RESULTS: Low NMI expression was observed in 190 cases (49.7%). Low NMI expression was significantly associated with the “triple-negative” molecular subtype (p < 0.001), high nuclear grade (p < 0.001), high histologic grade (p < 0.001), and advanced anatomic stage (p = 0.041). Patients with low NMI expression had poorer progression-free survival (p = 0.038) than patients with high NMI expression. Low NMI expression was not significantly associated with patient prognosis in the molecular subgroup analysis. In vitro, a reduction of NMI expression was observed in 8 breast cancer cell lines, especially in the estrogen receptor-positive and basal B type of triple-negative breast cancer molecular subgroups. The HPA database showed that low NMI expression levels were associated with a lower survival probability compared with that associated with high NMI expression (p = 0.053). CONCLUSION NMI expression could be a useful prognostic biomarker and a potential novel therapeutic target in invasive ductal carcinoma.