The medical curriculum is designed to provide a core of scientific knowledge and technical skills that ultimately enables a student to care for primary patients. In addition to specific knowledge, the school offers an environment in which students have the opportunity to acquire the habits of study, the sound attitud, and the sense of responsibility for patients that characterize the true physician. To achive these purposes, the clerkship of medical student is very important. We investigated current problems in clinical clerkship of Chonnam University Medical School, and the problems were as follow: (1) relatively short period of clinical training especially in main subjects, (2) lack of presonnels in charge of clinical training, (3) lack of objective test, (4) lack of clinical training in primary care hospital, (5) lack of opportunity of self learning. The methods to improve clinical training were to promote interests in clinical education of staffs, to prolong the duration of clinical clerkship, to select and educate the personnel in charge of clinical education, to do the objective tests, to do the elective tests, to do the elective course, to use of integrated course and problem oriented education, and to let the student care the patients under supervision.
Clinical Clerkship ; Curriculum ; Education ; Education, Medical ; Humans ; Jeollanam-do ; Learning ; Linear Energy Transfer ; Organization and Administration ; Primary Health Care ; Schools, Medical ; Students, Medical*

PURPOSE: The aim of this study was to determine the genotype frequencies of interleukin 10 (IL-10) gene polymorphisms and to investigate their association with the risk of respiratory distress syndrome (RDS) in preterm Korean infants. METHODS: Two hundred fourteen preterm infants born at Ewha Womans University Mok Dong Hospital between November 2003 and July 2008 were studied. The cord blood of preterm neonates and the corresponding maternal blood were analyzed by PCR for IL-10 gene (IL-10 -1082A/G, -819T/C, and -592A/C) polymorphisms. The clinical data of patients were collected retrospectively by chart review. RESULTS: The genotype frequencies of IL-10 genes in Korean mothers with preterm infants differ from other reports. The prevalence of two promoter SNPs of the IL-10 cytokine gene was similar but none had the IL-10-1082GG homozygote. Multiple logistic regression analysis demonstrated the risk of RDS to be significantly lower in the infants of the mothers with an IL-10-592AC/CC genotype than in those with an AA genotype (P= 0.033). The risk of RDS was significantly lower in the mother with an IL-10-819TC/CC genotype than in those with a TT genotype (P=0.030). However, IL-10 polymorphisms in the cord blood were not significantly different in preterm infants with RDS compared with the preterm infants without RDS. When we compared the incidence of RDS and each IL-10 A-1082G/T-819C/A-592C haplotype, the ACC haplotype had a protective effect on RDS (P=0.007). CONCLUSION: We conclude that the maternal IL-10-592A/C and IL-10-819T/C polymorphisms may have a role in the development of the RDS in preterm infants.
Female ; Fetal Blood ; Genotype ; Haplotypes ; Homozygote ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Interleukin-10 ; Logistic Models ; Mothers ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prevalence ; Retrospective Studies

PURPOSE: To investigate the timing of colostomy closure and the associated risk factors that affect the development of complication after colostomy closure. METHODS: We have reviewed and analyzed the results of 28 patients with colostomy closure at the Kwangju Christian Hospital from January 1993 to December 1997. We investigated to associated literatures on this subject for timing of colostomy closure, preparing a patient for colostomy closure, suture technique, wound management, underlying disease process related to the incidence of complication and experience of surgeons. RESULT: Wound infection developed in 4 patients (14.4%). Anastomotic leakage occurred in one patient (3.6%). Small bowel obstruction developed in two patients (7.2%). Overall incidence of complication was 25%. The incidence of complications in patients with trauma who underwent colostomy was 44.4% and patients without trauma, 15.8%. Complication rate was 16.6% for loop colostomies and 40% for end colostomies. The morbidity was 40% for colostomies on the left side, 18.7% for transverse colostomies, and 0% for colostomies (2 ileostomies) on the right side. The morbidity rate for closures within 6 weeks for the initial operation was 50%; for those within 6 to 12 weeks, 8.3%; and for those after 12 weeks, 16.6%. CONCLUSION: The optimal timing of closure varies from patient to patient, but closure within 6 weeks of the initial operation significantly increased the morbidity. Colostomies on the left side are associated with a higher morbidity rate than transverse colostomies or colostomies on the right side.
Anastomotic Leak ; Colostomy* ; Gwangju ; Humans ; Incidence ; Risk Factors ; Suture Techniques ; Wound Infection ; Wounds and Injuries

Congenital adrenal hyperplasia(CAH) is a recognized cause of precocious pseudopuberty. Some children with CAH also develop true precocious puberty with early maturation of the hypothalamic-pituitary-gonadal axis. We review a case of CAH who eventually developed central precocious puberty nine months after initial treatment with corticosteroid. A 3-year-old boy visited complaining of rapid growth, a large penis and frequent penile erections. This patient was diagnosed with CAH with elevated 17-OH progesterone and cortical hypertrophy of adrenal gland on CT scan. His gonadotropin levels were within the normal prepubertal range. Even on treatment with corticosteroid he grew rapidly and had testicular enlargement, pubic hair development and rapid bone maturation. At second admission, his gonadotropin levels were elevated both basally and in response to LHRH stimulation, suggesting that the CAH led to early activation of pubertal gonadotropin secretion(true precocious puberty). He was treated with monthly depot injections of a LHRH analog in addition to the hydrocortisone. His second sexual characteristics regressed gradually and rate of linear growth and bone maturation decreased.
Adrenal Glands ; Adrenal Hyperplasia, Congenital* ; Axis, Cervical Vertebra ; Child ; Child, Preschool ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Hair ; Humans ; Hydrocortisone ; Hypertrophy ; Male ; Penis ; Progesterone ; Puberty, Precocious* ; Tomography, X-Ray Computed

PURPOSE: Periventricular leukomalacia(PVL) is associated with various neurologic sequelae such as cerebral palsy and cortical blindness. The aim of this study was to analyse the correlation between the degree of PVL on MRI and clinical features or its severity. METHODS:Thirty-eight children with PVL on MRI among children brought to Pusan National University Hospital between January 1996 and August 1999 with development delay, cerebral palsy or epilepsy were included into the study group. We reviewed medical records of the patients including the gestational age, birth weight and neurologic sequelae. The grade for PVL was divided into 1 to 3, and it was based on abnormally increased signal intensity in periventricular white matter or a reduced amount of periventricular white matter or both, and compensatory focal ventricular enlargement. We analysed the relationship of the grade of PVL and various clinical findings. RESULTS: The age ranged from 11 months to 13 years old with a mean of 42 months. History of cesarean delivery and ventilator care were significantly frequent for the severe grade of PVL. Birth weight was significantly lower according to grade of PVL. Gestational age was lower according to the grade of PVL, but was not significant statistically. Incidence of cerebral palsy was significantly higher on the severe grade of PVL. Incidence of epilepsy and mental retardation were 34.2Yo and 23.9M, not associated with the grade of PVL. CONCLUSION: Incidence of cerebral palsy was associated with the severe grade of PVL, so we think MRI can be helpful in predicting neurodevelopmental outcome. (J Korean Pediatr Soc 2000;43 798-805)
Adolescent ; Birth Weight ; Blindness, Cortical ; Brain* ; Busan ; Cerebral Palsy ; Child ; Epilepsy ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Intellectual Disability ; Leukomalacia, Periventricular* ; Magnetic Resonance Imaging* ; Medical Records ; Ventilators, Mechanical

BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

OBJECTIVES: This study was conducted to identify factors that affect medical service performance in rural health sub-centers and to develop a method to improve health sub-center performance that takes advantage of these insights. METHODS: This study included 1,242 South Korean health sub-centers that had been in operation at least since December 31, 2009 as units of analysis. After adjusting for population differences between areas, the performance of medical service among health sub-centers was analyzed according to medical services performed per person. We performed t-tests, ANOVA, Scheffe's tests and multiple regression analyses. RESULTS: The following were significant variables affecting the medical service performance of rural health sub-centers: number of hospitals and clinics, presence of community health practitioner posts, distance from health sub-centers to main public health centers, distance from health sub-centers to the nearest emergency medical facilities, and proportion of the local population aged 65 and over. In contrast, the proportion of the local population between ages 0-4 and the placement of public health doctors that had already completed their internship were not significant variables. CONCLUSIONS: The medical service performance of health sub-centers located in rural areas is significantly affected by local population and health care environment characteristics, and therefore, it is imperative to develop strategies to provide differentiated service based on these factors.
Aged ; Delivery of Health Care ; Emergencies ; Humans ; Imidazoles ; Internship and Residency ; Nitro Compounds ; Public Health ; Rural Health

Purpose: This study aimed to identify the factors influencing the health-related quality of life (HRQoL) of older adults with unmet healthcare needs. Methods: Data from the 2018 Korean National Health and Nutrition Examination Survey were used. From a pool of 7992 participants, a final sample of 153 participants was analyzed using complex descriptive statistics, independent t-test, and multiple regression analysis. Results: In general, young age, being married, employment, higher income, no hypertension, health insurance coverage as an employee, and living with someone were associated with higher the HRQoL. The following factors were significantly associated with lower HRQoL scores: activity restriction (B=-0.15, p<.001), poor perceived health status (B=-0.14, p<.001), and higher depressive symptom score (B=-0.01, p=.002). The explanatory power was approximately 58%, and the model was deemed suitable (Wald F=16.86, p<.001). Conclusion This study provides insights into the influence of various characteristics of older adults with unmet healthcare needs on their HRQoL. Healthcare providers should develop strategies to reduce these unmet healthcare needs.

Purpose: This study was conducted to gain a comprehensive and in-depth understanding of infection control nurses’ burnout experiences in hospitals during the COVID-19 pandemic. Methods: We recruited 11 infection control nurses (ICNs) who worked in hospitals in Korea through purposive sampling. Data collected through one-to-one, in-depth interviews were transcribed and analyzed using qualitative content analysis. Results: Infection control nurses’ burnout experiences were categorized into five themes and 11 sub-themes. The themes were as follows: “challenges faced while playing a pivotal role in infectious disease management,” “conflict of interest prevalent inside and outside,” “physical and mental collapse,” “a long road to achieving stability in the infection control unit,” and “source of strength to endure.” Conclusion In light of the need to better prepare for future outbreaks of emerging infectious diseases, such as COVID-19, the findings of this study highlight the need for strategic approaches, such as developing programs to provide psychological and social support for infection control nurses, as well as establishing a well-designed system of nursing care for infectious diseases to alleviate their burnout.

PURPOSE: To ascertain the factors associated with the proportion of death certificate only (DCO) cases contained in the Kwangju Cancer Registry (KCR) that are not as yet in the good range. MATERIALS AND METHODS: The distribution of DCO cases was analyzed by sex, age, cancer site, histological verification (HV) as well as the physician's death certificate status. RESULTS: All cases (n=4,243) in Kwangju diagnosed as having cancer between 1997 and 1998 were registered with the KCR. Death certificates (n=2,390) reporting cancer as the causes of death were collected from the National Statistics Office and reviewed with hospital data linkage and a total of 590 cases were registered as DCO. DCOs accounted for 12.2% (male 12.8%, female 11.5%) of all registrations in Kwangju, 1997~1998. The proportion of DCO cases was high in subjects under 15 (male13.5%,female 9.4%) as well as those 75 and over (male 20.3%, female 27.2%). For cancer sites, the proportion of DCO cases was high (over 10%) for liver, bronchus-lung, esophagus and pancreas and low (under 3%) for skin, bladder, uteri cervix and breast. The proportion of DCO cases was inversely associated with HV%. When the death certificate was issued by physician, the possibility of DCO decreased. CONCLUSION: The proportion of DCO is positively associated with increasing age and negatively associated with HV% and the issuance of a physician's death certificate. These findings suggest that further socio-cultural efforts are required to reduce the DCO proportion.
Breast ; Cause of Death ; Cervix Uteri ; Information Storage and Retrieval ; Death Certificates* ; Esophagus ; Female ; Gwangju* ; Humans ; Korea ; Liver ; Pancreas ; Skin ; Urinary Bladder ; Uterus