This study explored the public’s response to an incident involving publicity about how physicians broke bad news to a terminal cancer patient by analyzing 1,960 comments from three online news websites that reported on this event using Braun and Clarke’s theme analysis methods. Three themes and 10 subthemes emerged from the public’s responses to the way the physicians broke the bad news. Theme 1 (a physician is a person who tells the facts) contained the following subthemes: physicians are responsible for delivering facts, but it is a matter of consideration for patients to deliver bad news to them, empathy and consolation should be expected from people other than physicians, and physicians who say what patients want to hear are cheaters. Theme 2 (there is a problem with physicians) included the following subthemes: the physicians’ empathy or personality and problems with their communication methods. Theme 3 (there are obstacles to communication with dying patients) had the following subthemes: physicians become emotionally dull and find it very stressful to break bad news, giving hope to dying patients can lead to medical disputes, and empathy and consolation are also costly. When breaking bad news, the physicians delivered factual information, but they did so inappropriately, and emotional support for the patient was insufficient. In medical communication education, it is necessary to emphasize training in emotional support. In the medical field, an environment should be created where physicians can communicate as they have learned.

No Abstract Available.

Sodium picosulfate and magnesium citrate are widely used low volume bowel cleansing agents considered to be effective and relatively safe. We describe a case of a woman who presented with an upper airway and esophageal injury after ingestion of a sodium picofulfate and magnesium citrate. A 63-year-old woman presented to emergency department complaining of throat pain and hoarseness after ingestion of sodium picosulfate and magnesium citrate as preparation for colonoscopy. This powder is dissolved in a low volume of water. She had ingested the substance that was not completely dissolved. After ingestion, she experienced a burning sensation in the throat. Promptly, neck radiography and computed tomography (CT) were performed. Radiography revealed epiglottis swelling and narrowing airway. Computed tomography demonstrated diffuse soft tissue edema and thickening with increased enhancement in the upper airway and entire esophagus. She was admitted and treated with parenteral nutrition, intravenous proton pump inhibitor, empirical antibiotics, and steroids. Nine days after the admission, she underwent an esophagogastroduodenoscopy (EGD). Esophageal multiple ulcerative lesions with exudate were observed. Twelve days after admission, she was discharged from the hospital with improvement of pain in her throat and toleration to a solid diet.
Anti-Bacterial Agents ; Burns ; Caustics ; Citric Acid* ; Colonoscopy* ; Detergents ; Diet ; Eating* ; Edema ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Epiglottis ; Esophagitis ; Esophagus ; Exudates and Transudates ; Female ; Hoarseness ; Humans ; Magnesium* ; Middle Aged ; Neck ; Parenteral Nutrition ; Pharynx ; Proton Pumps ; Radiography ; Sensation ; Sodium* ; Steroids ; Ulcer ; Water

With the industrial development, vehicle, wars, and natural disasters, there are increasing chsnces of mass casuaities, it is very important to classify the injured patients by their severity, to give them immediate emergency care and to transfer them to the other medical facilities effectively. And it is more essential in the army. But in practice, there is no objective and comprehensive scale for injury severity yet. So we devised a method of comprehensive description for the injuredpatients. It is based on Abbreviated Injury Scale and Injury Severity Score and is composed of five parts of the body (General, Head & Neck, Chest, Abdomen, Extremities) and five degrees of severity (Grade I, Il, III, IV, V). For example, a description of a patient with multiple injuries such as generalized abrasion and cotusion, semicomatose mentality with skull fracture, hemoperitoneum, and fracture of right femoral shaft is very diffcult to understand quickly. But, with our method of description, the above is described as follows ; G(I)+(IV)+A (IV)+E(III), ISS =4+4+3 =41. And the high score is described as ISS makes it clear that the patient is very dangerous, even to death, so intensive care is immediately needed. Using this method, we reviewed 1,256 cases of passenger acidents of vehicles treated at our hospital during the last 2 years. The results were as follows ;1. The average ISS of 56 cases of dead is 33. 2. There are only 2 cases of death below 16 of ISS, and 84% mortality above 40 of ISS. 3. The average ISS of passengers in vehicles such as motocycles is 12, taxies 11, bongo 9, and buses 8. 4. We recommend our method of description for mass casualties, especially in the army. Because it is very useful to the injured patients by their severity, to give them immediate emergency care, to transfer them to the other medical facilities and to comprehend the whole condition of all patients.
Abbreviated Injury Scale ; Abdomen ; Critical Care ; Disasters ; Emergency Medical Services ; Head ; Hemoperitoneum ; Humans ; Industrial Development ; Injury Severity Score ; Mass Casualty Incidents ; Methods ; Mortality ; Motor Vehicles ; Multiple Trauma ; Neck ; Skull Fractures ; Thorax

Background: In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19. Methods: This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient’s EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports.The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ 2 test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19. Results: A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 ( P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021. Conclusion After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported.However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

The purpose of this study was to examine the mediating effects of sense of coherence and social support in the relationship between uncertainty and health-related quality of life (HRQoL) in elderly patients who underwent with total knee arthroplasty. Methods: A descriptive study was conducted with 186 patients who underwent total knee arthroplasty. Data were collected from September 17 to October 16, 2019 through structured questionnaires and analyzed with descriptive statistics, the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and a parallel redundant mediated model in the PROCESS macro using SPSS version 27.0. Results: The mean scores of uncertainty, sense of coherence, social support, and HRQoL were 100.72, 49.77, 93.77, and 41.61. The direct effect of uncertainty on HRQoL and the indirect effect of uncertainty, mediated by sense of coherence and social support, on HRQoL were statistically significant. Conclusion: These results indicate that in order to increase the HRQoL of elderly patients who undergo total knee arthroplasty, it is necessary to develop an intervention program that focuses both on reducing uncertainty and on improving patients’ sense of coherence and social support.

PURPOSE: Standardized patients (SPs) tend to rate medical students’ communication skills subjectively and comprehensively, in contrast to such objective skill set defined in the clinical performance examination (CPX). Meanwhile, medical school instructors have a different approach in their evaluation of students’ communication skills. We aim to analyze medical students’ verbal communication skills using objective methods, and to determine the contributing factors of a patient–physician interaction (PPI) score. METHODS: Students with high- and low-ranking scores for PPI in CPX were selected. The Roter interaction analysis system was used to compare verbal communication behaviors of the students and SPs. Patient-centeredness scores (PCSs), physician’s verbal dominance, and number of utterances were compared between the two groups. RESULTS: PCSs and physician’s verbal dominance had no difference between the groups. The number of utterances during the limited time of 5 minutes of CPX was higher for the high-ranking students. They tended to employ more paraphrase/check for understanding, and closed questions for psychosocial state and open questions for medical condition. The SPs interviewed by high-ranking students gave more medical information and requested for more services. CONCLUSION: In the case of the routine checkup, smooth conversations with more frequent utterances were detected in the high-ranking students. More medical information exchange and requests for services by SPs were higher for the high-ranking students. Medical communication instructors should keep in mind that our results could be indicators of a high PPI score.
Education, Medical ; Health Information Exchange ; Humans ; Schools, Medical ; Students, Medical ; Verbal Behavior

The endoscopic fine needle aspiration cytology may add to the diagnostic accuracy of endoscopic biopsy and brush cytology. It is also of particular value in submucosal, infiltrative and ulceronecrotic tumors. Endoscopic fine needle aspiration cytology was done with sclerotherapy needle(23 gauge) in. the 17 patients with submucosal tumor(18 cases), extrinsic compression(2 cases), infiltrative gastric cancer(one case) and cancer of the ampulla of Vater(one case) on the upper gastrointestinal endoscopy. Endoscopic fine needle aspiration cytology established the diagnosis in 6 cases(submucosal tumor of the stomach; 2 cases, submucosal tumor of the duodenum; one case, extrinsic mass of the duodenum; one case, infiltrative cancer of the stomach; one case, and the cancer of ampulla of Vater; one case) of 17 cases. There were negative results for malignancy in 7 cases and material insufficiency in 4 cases. Five cases of the positive results with endoscopic fine needle aspiration cytology were not diagnosed with endoscopic forceps biopsies. There was no complication. We conclude that endoscopic fine needle aspiration cytology is a simple and safe technique and is of particular value in submucosal tumor, extrinsic compression of the upper gastrointestinal tract by tumor, and infiltrative gastric cancer.
Ampulla of Vater ; Biopsy ; Biopsy, Fine-Needle* ; Diagnosis* ; Duodenum ; Endoscopy, Gastrointestinal ; Humans ; Sclerotherapy ; Stomach ; Stomach Neoplasms ; Surgical Instruments ; Upper Gastrointestinal Tract