The purpose of this study is to suggest improvement measures to solve the problems of governance within the Korean Medical Association (KMA), and to outline future tasks to implement these measures. The following measures are proposed to improve the governance of the KMA: a new representative system, the revision of the term of officers, new qualification requirements for representatives and officers, a clear business division for vice presidents, the organization and operation of councils by professional fields, and an organization of a top decision making committee. Future tasks to apply these measures in practice include the establishment of the direction of improvement of the KMA‘s governance, organization and operation of the presidential committee, and active participation and support of the KMA members. In order to improve the KMA‘s governance, the bodies of the KMA must avoid conflicts and criticisms; taking collective decisions about all tasks and policies should be made an essential principle. In conclusion, the bodies of the KMA must cooperate with each other while constantly considering and discussing the purpose of the establishment of the KMA. These measures will ensure the improvement of KMA’s governance.

This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.

This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.

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.

Twenty-eight patients with 20 tibia fractures and 8 femur fractures were treated with external fixation. The average age at fracture was 10 years 10 months ranging from 5 years to 17 years 6 months. Of 28 fractures, 6 were closed fractures and 22 were open fractures. The average follow-up of these children was 23 months. Monofixators were used in 12 fractures and Ilizarov fixators in 16 fractures. The average time to healing of the fractures was 14.6 weeks(range, 6 to 44 weeks). Seven segmental bone defects(range, 2 to 17cm) were treated with the Ilizarov method of internal bone transport using the transport ring and bone grafting at the docking site. The average healing index for callus distraction was 25 days per centimeter. Seven patients had 10 major complications that necessitated additional operative procedures. There were 4 nonunions. Three patients had an infected nonunion, which was treated with the Ilizarov fixator and polymethyl-methacrylate antibiotic beads. One patient had a hypertrophic nonunion which was treated with plate fixation. Three patients who had an epiphyseal injury had shortening with angular deformity, which was treated by callus distraction. Three patients had a joint contracture, which was treated by the percutaneous tenotomy and Ilizarov fixator. The selection of the type of external fixator depends on the fracture pattern and the Ilizarov fixator is recommended for complicated fracture with severe comminution or segmental bone loss.
Bone Transplantation ; Bony Callus ; Child ; Congenital Abnormalities ; Contracture ; External Fixators ; Femur ; Follow-Up Studies ; Fractures, Bone ; Fractures, Closed ; Fractures, Open ; Humans ; Ilizarov Technique ; Joints ; Surgical Procedures, Operative ; Tenotomy ; Tibia

BACKGROUND: Scabies outbreaks have been reported in long-term care facilities, but less commonly in acute care facilities. We experienced an outbreak of scabies that occurred in neurosurgery-intensive care unit of a general hospital, Seoul, Korea. METHODS: An outbreak of scabies was noticed on September 2006 when hospital staffs of NICU were diagnosed with scabies. The infection control nurse reviewed medical records and interviewed all of patient in NICU and health care workers. The epidemic spread of scabies from a patient to other patient, hospital employees and their families and associates was identified from historical, clinical, and microbiologic skin preparation data. RESULTS: Forty-three NICU patients and 22 health care workers were investigated. Five scabies cases were identified in total of 42 cases who are exposed to index case with attack rate of 11.9%. The attack rate of scabies in health care workers and NICU patients were 10% and 13.6%, respectively. Tertiary cases also occurred among the family members of workers, with a tertiary attack rate of 44%. CONCLUSION: The patient of acute care facilities also have chances of being exposed to scabies outbreak, since sensorimotor deficits or cognitive disorders make it difficult for individuals to communicate and understand the implication of risky contacts.
Delivery of Health Care ; Disease Outbreaks ; Hospitals, General ; Humans ; Infection Control ; Long-Term Care ; Medical Records ; Scabies ; Skin

PURPOSE: The purpose of this study was to identify the relationship between the satisfaction with clinical practice and clinical performance ability by types of self-directed learning ability of nursing students. METHODS: This was a triangular study that was conducted to understand clinical performance ability. The subjects were 260 junior and senior students from a university in P city. The data were collected from April 22 to December 30, 2015. Data were collected by Q-card, Q-block an assessment tool, a structured self-reporting survey and a questionnaire. RESULTS: We classified the self-directed learning abilities into four types: Type 1: a self-reflective person; Type 2: a person who prepares for the future; Type 3: a person with a sense of responsibility and obligation; and Type 4: an enthusiastic learner. We found that clinical performance ability was higher for Type 4 than Type 3. We found that clinical performance satisfaction with clinical practice was also higher for the Type 4 individual than a Type 3 person. CONCLUSION: To improve students' clinical performance ability, we need plans and support to lead students toward becoming an ‘enthusiastic learner’ type of person with self-directed learning ability. It is necessary to increase students' satisfaction with clinical practice.
Clinical Competence* ; Humans ; Learning* ; Nursing* ; Students, Nursing*

PURPOSE: To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal. CASE SUMMARY: A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye. CONCLUSIONS: The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.
Blister ; Eye ; Female ; Glaucoma, Open-Angle ; Gonioscopy ; Humans ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Microscopy, Acoustic ; Phakic Intraocular Lenses ; Trabecular Meshwork ; Trabeculectomy

BACKGROUND: Subclavian cannulation is useful for the patients who need long-term maintenance of central venous catheters, but the inadequate location of catheters produces some complications. In pediatric populations, the abnormal placement of subclavian catheters in the internal jugular vein (IJV) is frequent because the angle formed by the subclavian vein and IJV is much larger than in adults. We would therefore propose a technique which will increase the location ratio of subclavian catheters in the superior vena cava (SVC). METHODS: One hundred twenty three patients who received elective or emergent operations were divided into 4 groups which consisted of the 'neck rotation away from the cannulation site' group (RA), 'neck rotation toward the cannulation site' group (RT), 'neck tilt away from the cannulation site' group (TA), 'neck tilt toward the cannulation site' group (TT). We cannulated each group and verified the location of the catheter tip in chest PA for each group. RESULTS: The calculation for the ratio of SVC location to the total cannulation of each group (%SVC) was done and the X2 test was done. Total %SVC was 73.2% and %SVC of each group were 64.9% for the RA group, 77.3% for the RT group, 61.8% for the TA group, and 93.3% for the TT group. A considerable difference was found for total %SVC in the X2 test. The location ratio of the TT group was higher than the others and there was no difference found between the RA, RT, TA groups. CONCLUSIONS: We can conclude that tilting the neck toward the cannulation site would produce a higher ratio of SVC location of the subclavian catheter than other neck positions.
Adult ; Catheterization* ; Catheters* ; Central Venous Catheters ; Humans ; Jugular Veins ; Neck ; Subclavian Vein ; Thorax ; Vena Cava, Superior*

OBJECTIVE: To determine the prevalence, location, and risk factors for the peripheral nerve entrapments of upper extremity among the crutch or cane users. METHOD: We performed the clinical and electrodiagnostic assessments of both upper extremities in 43 crutch or cane users and 49 able-bodied controls. RESULTS: The prevalence for the nerve entrapment of upper extremity among the crutch or cane users was 27.9% by the clinical criteria and 86.0% by the electrodiagnostic criteria. Electrodiagnostically, the median nerve entrapment was 76.7%, and the ulnar nerve entrapment was 72.1% among the crutch or cane users. The carpal tunnel was the most common site for the entrapment. Body weight, duration of disability, and duration of crutch or cane use were found to be significantly correlated with the emtrapments of median nerve, whereas duration of crutch or cane use alone was significantly correlated with the entrapments of ulnar nerve. CONCLUSION: The peripheral nerve entrapments of upper extremity is associated with the chronic crutch or cane use and the preventive strategies need to be developed for the patients with risks.
Body Weight ; Canes* ; Humans ; Median Nerve ; Nerve Compression Syndromes ; Peripheral Nerves* ; Prevalence ; Risk Factors ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes ; Upper Extremity*