PURPOSE: Residents' duty-hour regulations and the evolution of minimally invasive surgical techniques require more effective and efficient surgical skill teaching models. We used frozen-thawed human tissue remnants harvested during abdominoplasty or abdominal tissue-based breast reconstruction to allow for a medium-sized group workshop program, simulating a realistic surgical environment and visual/haptic feedback. METHODS: Full-thickness abdominal tissue (skin and subcutaneous fat) were donated from patients who underwent autologous breast reconstruction and gave consent to use their tissue for comprehensive research and medical educational purposes. Anonymized tissue was frozen-preserved and then thawed the day of the surgical skills workshop. A total of 53 residents completed 50-minute hands-on training in 3-to-5 person modules in four sessions of the workshop program. RESULTS: Thawed tissue regained almost normal texture and consistency. Structural integrity was also histologically confirmed. All participants were generally satisfied with the program, especially regarding the suture material provided. CONCLUSION: Frozen-thawed tissue remnants from abdominoplasty or autologous breast reconstruction could be preserved and used as a suture education material in medium-group workshops for surgery residents or medical students given anonymity and with proper consent guaranteed. This approach provided an excellent model maintaining relatively real anatomic structure and consistency with minimal cost.
Abdominoplasty ; Anonyms and Pseudonyms ; Education ; Female ; Humans ; Internship and Residency ; Mammaplasty ; Social Control, Formal ; Students, Medical ; Sutures ; Training Support

OBJECTIVE: This study examined the incidence of workplace violence (WPV) in an emergency department (ED), and its influence on ED workers' mental health. METHODS: A cross-sectional, anonymous survey was conducted on ED workers employed in a local emergency medical center during August 2018. The survey respondents' data on the demographic characteristics, WPV episode, Korean-translated Brief Encounter Psychosocial Instrument (BEPSI-K), stress questionnaire for Korean National Health and Nutrition Examination Survey (KNHANES), and Patient Health Questionnaire-9 (PHQ-9) were obtained. The results of the stress (BEPSI-K, KNHANES) and depression (PHQ-9) score were compared with the WPV experience of ED workers. RESULTS: A total of 104 of 120 ED workers (86.7%) were exposed to WPV. ED workers that experienced physical violence within the past year had higher KNHANES, BEPSI-K, and PHQ-9 than the workers, who did not experience such violence (P≤0.001). In addition, this survey demonstrated that a physical violence episode within the past year was associated with above moderate depression (P≤0.001; odds ratio, 19.597). CONCLUSION: Recent physical violence can cause psychiatric disorders in ED workers, such as depression or stress disorder. Therefore, policies are needed to prevent WPV in ED and support ED workers who have experienced WPV.
Anonyms and Pseudonyms ; Depression ; Emergencies ; Emergency Service, Hospital ; Humans ; Incidence ; Mental Health ; Nutrition Surveys ; Odds Ratio ; Physical Abuse ; Violence ; Workplace Violence

BACKGROUND AND OBJECTIVES: Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. MATERIALS AND METHOD: An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. RESULTS: Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pre-treatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. CONCLUSION: Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.
Anonyms and Pseudonyms ; Clothing ; Demography ; Diagnosis ; Employment ; Humans ; Judgment ; Korea ; Linguistics ; Methods ; Voice

BACKGROUND/AIMS: The aim of this study is to describe the outcome of the national survey and to determine the endoscopic retrograde cholangiopancreatography (ERCP) quality in Korea by comparing with the quality indicators. METHODS: We used the database of Health Insurance Review & Assessment Service and then performed anonymous national survey. RESULTS: Completed questionnaires were returned by 129 of 157 ERCP endoscopists. In Korea, annual ERCP rates have been consistently increased over years. Individual ERCP volume was high (>200 per year) in about half of ERCP endoscopists. Most ERCP endoscopists performed all of level I procedures. However, manometry, cholangiopancreatoscopy, and pancreatic procedures were performed mostly in institutions with high hospital volume. The rate of overall success was more than 90% in most ERCP endoscopists. However, the rate of precut sphincterotomy was high in more than a fourth of ERCP endoscopists. Twelve ERCP endoscopists experienced post-ERCP mortality within recent 1 year. ERCP training and radiation protection during ERCP did not meet the standard of quality indicators especially in institutions with low or moderate hospital volume. CONCLUSIONS: Technical issues during ERCP procedures in Korea fulfill the standard of quality indicators. However, a great effort is needed to improve issues about ERCP training and radiation protection.
Anonyms and Pseudonyms ; Cholangiopancreatography, Endoscopic Retrograde ; Insurance, Health ; Korea ; Manometry ; Mortality ; Radiation Protection ; Republic of Korea ; Surveys and Questionnaires

BACKGROUND: Transfusion medicine (TM) knowledge varies widely among physician trainees. In addition, there have been few instances in which curricular changes have been meaningfully assessed for TM education in medical school. METHODS: We created and presented a novel lecture to improve TM knowledge for graduating medical students using eight objectives designed to reinforce critical information about blood management. Each objective was coded according to unique color schemes, fonts, and graphics to create visual associations while quickly and clearly presenting complex concepts. The validated BEST Collaborative exam was used to measure changes in student TM knowledge, while a survey was conducted to gauge changes in confidence for each objective. Students were asked to submit anonymous feedback about their experiences. RESULTS: The mean student post-course exam score was 50.0%, while the pre-course baseline score was 27.5% (P<0.0001). Mean confidence levels increased significantly for all objectives. Student feedback was universally positive. CONCLUSION: This study improved knowledge and confidence for graduating medical students by utilizing engaging and visually stimulating presentations to display high-impact TM material. However, further efforts are needed to optimize learning.
Anonyms and Pseudonyms ; Education ; Humans ; Internship and Residency ; Learning ; Schools, Medical ; Students, Medical ; Transfusion Medicine

OBJECTIVE: To explore current practice and influencing factors on adoption of the opportunistic salpingectomy (OS), particularly regarding the decision making, to eventually enhance the development and implementation of clear guidelines. METHODS: This nationwide cross-sectional survey study was conducted in all hospitals in the Netherlands. An anonymous online survey was sent to gynecologists with special interest in gynecological oncology, gynecological endoscopy or urogynecology and all Dutch gynecology trainees. The survey mainly focused on current practice regarding OS and identification of influencing factors on the level of innovation, organization, healthcare professional and individual patient. RESULTS: The response rate was 348 out of 597 gynecologists (58.3%) and 142 out of 340 trainees (41.8%). Current practice of discussing and performing the OS varied widely, with ovarian cancer (OC) risk reduction as most important supportive factor on innovation level. Supportive factors on the level of organization and healthcare provider were; working in a non-training hospital, knowledge of current literature and extensive work experience (in years and annual number of hysterectomies). On individual patient level, a vaginal approach of hysterectomy, negative family history for OC and the presence of firm adhesions were suppressive factors for the OS. CONCLUSION: In this study we evaluated the current practice regarding the opportunistic salpingectomy in the Netherlands and identified influencing factors on different levels to raise awareness and attribute to development of a targeted implementation strategy, on both national and international level.
Anonyms and Pseudonyms ; Cross-Sectional Studies ; Decision Making ; Delivery of Health Care ; Endoscopy ; Gynecology ; Health Personnel ; Humans ; Hysterectomy ; Netherlands ; Ovarian Neoplasms ; Primary Prevention ; Risk Reduction Behavior ; Salpingectomy*

OBJECTIVE: The suicide rate in South Korea was the second highest among the Organization for Economic Cooperation and Development countries in 2017. The purpose of this study is to understand the characteristics of people who died by suicide in Korea from 2013–2017 and to better prevent suicide. METHODS: This study was performed by the Korea Psychological Autopsy Center (KPAC), an affiliate of the Korea Ministry of Health and Welfare. According to the Korea National Statistical Office, the number of suicide victims nationwide was estimated to reach about 70,000 from 2013 to 2017. Comprehensive suicide records from all 254 police stations in South Korea were evaluated by 32 investigators who completed a 14-day didactic training program. Then, we evaluated the characteristics of suicide victims in association with disease data from the National Health Insurance Database (NHID), which is anonymously linked to personal information of suicide victims. RESULTS: Thirty-one of 254 police stations in the Seoul metropolitan area were analyzed by August 10, 2018. Findings showed that the characteristics of suicide victims differed according to the nature of the region. CONCLUSION: Our results suggest that different strategies and methods are needed to prevent suicide by regional groups.
Anonyms and Pseudonyms ; Autopsy ; Education ; Humans ; Korea ; Methods ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Police ; Research Personnel ; Seoul ; Suicide

BACKGROUND/AIMS: Food intolerance/malabsorption, particularly histamine intolerance (HIT), may cause nonspecific functional gastrointestinal and extraintestinal symptoms. We evaluated gastrointestinal and extraintestinal symptoms in patients with HIT. METHODS: In an analysis of outpatients' charts we identified 133 patients, who presented with recurring nonspecific functional gastrointestinal, extraintestinal symptoms, and a diamine oxidase value <10 U/mL, indicative of HIT. A standardized anonymous questionnaire with symptoms of HIT based on known symptoms and the 4 histamine receptors including gastrointestinal, cardiovascular, respiratory and skin complaints was developed, and sent by mail to the patients. RESULTS: In the 62 patients that completed the questionnaire, bloating was the most common and most serious symptom. Other commonly reported gastrointestinal symptoms were postprandial fullness, diarrhea, abdominal pain, and constipation. The presence of 2 from a list of 24 symptoms resulted in 276 various symptom combinations. From calculated 2.024 possible combinations of 3 symptoms the patients with HIT presented 1.975 combinations. CONCLUSIONS: The knowledge of this wide variability of symptoms and complex symptom combinations in patients with HIT may help to clinically recognize and diagnose HIT.
Abdominal Pain ; Amine Oxidase (Copper-Containing) ; Anonyms and Pseudonyms ; Constipation ; Diarrhea ; Gastrointestinal Diseases ; Glutens ; Histamine ; Humans ; Irritable Bowel Syndrome ; Postal Service ; Receptors, Histamine ; Skin

BACKGROUND/AIMS: Fecal incontinence (FI) is a common complaint that increases in prevalence with age. Our aim was to determine the prevalence of FI and assess its severity by self-report in a male-predominant Veteran outpatient clinic setting. METHODS: An anonymous 28 item questionnaire was administered to a convenience sample of veterans awaiting appointments. FI was defined as a loss of liquid or solid stool at least monthly. Multivariable logistic and linear models were used to identify predictors of FI prevalence and severity. RESULTS: One hundred thirty-three gastroenterology (GI) participants and 126 primary care (PC) participants completed the survey. Ninety-four of 259 participants (36.3%, 95% confidence interval [CI]: 30.4–42.5) reported an episode of FI (41.4% GI participants vs 31.0% PC participants; P = 0.078) with 33.6% having FI within the last 30 days (36.8% GI participants vs 30.2% PC participants; P = 0.122). Participants with more bowel movements per week (P = 0.005) and per day (P < 0.001) and with a higher Bristol Stool Scale form (P = 0.010) were more likely to have FI. Of participants with FI, mean Fecal Incontinence Severity Index score was 23.0 ± 9.5 with a significantly higher symptom score in GI participants compared to PC participants (25.2 ± 10.0 vs 20.1 ± 8.2; P = 0.011). Few participants had ever been asked by (35.0%) or evaluated by (18.0%) a doctor for FI symptoms. CONCLUSIONS: FI is a common complaint and under-recognized problem in the male-dominant Veteran population. Despite its prevalence, relatively few participants were asked about FI, with even less being treated. Due to the possible effects and implications on quality of life, more should be done to recognize this condition and arrange treatment.
Ambulatory Care Facilities ; Anonyms and Pseudonyms ; Appointments and Schedules ; Fecal Incontinence ; Gastroenterology ; Humans ; Linear Models ; Prevalence ; Primary Health Care ; Quality of Life ; Veterans

BACKGROUND/AIMS: Current knowledge and viewpoints regarding biosimilars among physicians in Asia are unknown, even though these were investigated by European Crohn's and Colitis Organization (ECCO) members in 2013 and 2015. Thus, this study conducted a multinational survey to assess the awareness of biosimilar monoclonal antibodies among Asian physicians.METHODS: A 17-question multiple-choice anonymous web survey was conducted with the logistic support of the Asian Organization of Crohn's and Colitis (AOCC). Randomly selected AOCC members were invited by e-mail to participate between February 24, 2017 and March 26, 2017.RESULTS: In total, 151 physicians from eight Asian countries responded to the survey. Most of the participants were gastroenterologists (96.6%), and 77.5% had cared for inflammatory bowel diseases (IBD) patients for more than 5 years. The majority of the respondents (66.2%) were aware that a biosimilar is similar but not equivalent to the originator. The majority of respondents (77.5%) considered cost saving to be the main advantage of biosimilars, but a high percentage of respondents (38.4%) were concerned about a different immunogenicity from that of the originator (92.4% and 27.1% respectively in ECCO 2015). Only 19.2% considered that the originator and biosimilars were interchangeable, and only 6.0% felt very confident in the use of biosimilars (44.4% and 28.8% respectively in ECCO 2015).CONCLUSIONS: Asian gastroenterologists in 2017 are generally well informed about biosimilars. On the other hand, compared to the ECCO members surveyed in 2015, Asian gastroenterologists had more concerns and less confidence about the use of biosimilars in clinical practice. Thus, IBD-specific data on the comparison of the efficacy, safety, and immunogenicity in Asian patients are needed.
Anonyms and Pseudonyms ; Antibodies, Monoclonal ; Asia ; Asian Continental Ancestry Group ; Biosimilar Pharmaceuticals ; Colitis ; Cost Savings ; Electronic Mail ; Hand ; Humans ; Inflammatory Bowel Diseases ; Infliximab ; Surveys and Questionnaires