Objectives: This study was conducted to identify the level of mental health and burnout of medical staff at hospitals and public health centers, which responded to the coronavirus disease 2019 (COVID-19) in South Korea and to suggest appropriate management plans. Methods: The mental health and burnout levels of medical staff responding to COVID-19 were evaluated through an online survey conducted during the period July 1–14, 2021. To analyze the mental health status of the participants according to their demographic characteristics, the chisquare test, t-test, and an analysis of variance were conducted, followed by Scheffe post-hoc tests for pairwise comparisons. Results: A total of 773 participants were included in the study. An analysis of the clinically significant symptoms of the group showed that 29.5% had posttraumatic stress symptoms, 30.6% had depression, 15.8% had anxiety, 39.8% had somatic symptoms, and 4.5% were seen to be at risk of suicide. The average scores for burnout were as follows: 3.55±1.75 for emotional exhaustion, 2.68±1.73 for depersonalization, and 3.89±1.40 for personal accomplishment. Mental health problems and burnout were found to be high in women, those in the 20–39-year age bracket, those with less than 5 years of work experience, and public health center workers. Conclusion The medical staff responding to COVID-19 were observed to experience high levels of mental health and burnout problems. Work-related characteristics, such as younger age, lower work experience, and employment at a public health center, may have a negative impact on mental health and cause burnout. Therefore, individualized and systemic support for mental health and to prevent the burnout of medical staff responding to cases of COVID-19 is needed.

Objectives: This study was conducted to evaluate burnout and its associated factors among coronavirus disease 2019 (COVID-19) frontline healthcare workers. Methods: We analyzed the nationwide burnout evaluation scale data collected from 774 COVID-19 frontline healthcare workers in South Korea from July 1 to 14, 2021. Along with demographic variables and work-related information, the Maslach Burnout Inventory–General Survey and the list of stress factors were used to assess burnout and its associated stressors. Results: The study participants were predominantly female (86.2%) and the majority were nurses (78.8%). Among them, 53.0% felt emotionally exhausted, 34.5% were cynical, and 45.5% experienced decreased professional efficacy. The most common stressors were “insufficient rewards” (85.0%) and “excessive workload” (72.5%). Factors such as excessive workload, interpersonal relationships at work, and stress from insufficient rewards were correlated with higher levels of exhaustion and increased cynicism. Insufficient rewards and stress about family infection were associated with increased professional efficacy. Conclusion Stress related to the work environment, rather than that from potential infection, was associated with exhaustion and cynicism in the COVID-19 frontline healthcare workers.

Purpose: This study aimed to evaluate the efficacy of additional radiofrequency ablation (RFA) treatment for benign thyroid nodules. Methods: Electronic medical records at a single institution from September 2008 to August 2016 were searched, and consecutive patients treated with RFA due to benign thyroid nodules with cosmetic or symptomatic problems were enrolled. All patients were followed up for at least 30 months. The nodules were divided into three groups: group 1 included nodules that met the criteria for additional treatment and underwent additional treatment, group 2 included nodules that met the criteria but did not undergo additional treatment, and group 3 included nodules that did not meet the criteria. The ablation results were compared among the three groups in terms of the initial ablation ratio (IAR) and volume reduction ratio (VRR). Results: Ninety nodules from 88 patients were included in the study. At the last follow-up, group 1 showed a significantly smaller nodule volume and larger VRR (2.5 mL and 84.6%, respectively) than group 2 (8.1 mL and 39.8%, respectively, P<0.001), but did not present a significant difference from group 3 (0.9 mL, P=0.347, and 92.8%, P=0.238). The IAR was significantly higher in group 3 (94.5%) than in the other two groups (group 1, 81.1%; group 2, 82.8%; P<0.001). Conclusion Multiple treatment sessions achieve greater VRR. Therefore, additional treatment could be considered for patients who meet the corresponding criteria.

An allergy skin test is used to diagnose certain allergies by identifying sensitized allergens. In other words, it is a test for patients who are already sensitized to certain allergens. Because of the prevailing perception that beta-lactam allergy can be dangerous and potentially lethal, the intradermal test has long been routinely performed before use to screen beta-lactam allergy in Korea. The prevalence of penicillin allergy is estimated to be 1% to 2%. However, only 14% of the subjects with perceived penicillin allergy is considered to have true penicillin allergy. Moreover, it is difficult to justify performing a skin test on subjects who are very unlikely to be sensitized to beta-lactam, such as those who never used beta-lactam or never experienced allergy after previous use of beta-lactam.Therefore, allergists recommend beta-lactam skin testing in those who have allergy after the use of beta-lactam. Nevertheless, many hospitals in Korea are conducting routine skin tests on patients regardless of a history of beta-lactam allergy, which are not clinically validated but consume considerable human and material resources. False-positive results can consequently result in inappropriate labeling of beta-lactam allergy, leading to the unnecessary restriction of medication prescriptions and the increase in medical expenses. Herein, the drug allergy working group affiliated with the Korean Academy of Asthma, Allergy, and Clinical Immunology announces an expert opinion on the preuse beta-lactam skin test for subjects without a history of beta-lactam allergy based on the objective evidence from the literature and clinical relevance.

Objective: This study evaluated the anxiety, work, and socioeconomic burden of emergency physicians (EP) during the coronavirus disease 2019 (COVID-19) pandemic in South Korea. Methods: A cross-sectional observational study was conducted using data from the 2020 Korean Emergency Physician Survey that included the following domains: hospital resources of suspected COVID-19 patients, availability of personal protective equipment, levels of home and workplace anxiety, the severity of work burnout, identification of stressors, changes in personal environments, and measures to decrease stress/anxiety. Results: Totally, 855 eligible participants were enrolled in the study. A statistically significant deterioration was observed in response to decreased working income or an unstable employment situation (0.46±0.88 points). The median number of patients with confirmed COVID-19 was 2.72. The risk of infection during emergency department (ED) work was found to be significantly increased (P<0.01). Of the 751 respondents (91.4%) who reported patient contact during their survey phase, 516 (62.8%) reported having taken the COVID-19 reverse transcription polymerase chain reaction test. The major factors that affected worsening of the work burden were determined to be unsuitable inter-hospital transfer arrangements for febrile patients (3.46±1.06 before vs. 1.99±1.16 after the pandemic, P<0.01) and delayed consultation for patients with fever or respiratory symptoms in the ED (3.20±1.06 before vs. 2.66±1.10 after the pandemic, P<0.01). Conclusion During the peak phase, the COVID-19 pandemic induced substantial workplace and socioeconomic burdens for Korean EPs. The sustained impact of the pandemic on the wellness of EPs deserves further investigation to guide targeted interventions.

Purpose: To explore whether panretinal photocoagulation (PRP) improved retinal blood circulation in patients with diabetic retinopathy of various levels of severity based on changes in the retinal circulation time as measured by video fluorescein fundus angiography. Methods: We recruited patients with severe diabetic retinopathy indicated for PRP; we performed video fluorescein fundus angiography before and after PRP. We measured changes in the arterial circulation time (ACT), arteriovenous passage time (APT), and venous filling time (VFT) in patients with diabetic retinopathy of varying severity, and compared the findings. We recorded HbA1c levels and hypertension status. Results: We enrolled 33 patients, 17 with severe nonproliferative diabetic retinopathy (NPDR) and 16 with early proliferative diabetic retinopathy (PDR). After PRP, neither the ACT nor the APT changed significantly in patients with severe NPDR (p = 0.927, p = 0.138) or early PDR (p = 0.137, p = 0.268). After PRP, the VFT was significantly reduced in patients with both severe NPDR (p = 0.000) and early PDR (p = 0.022). The VFT reductions were similar in both groups (p = 0.217). Conclusions In patients with severe NPDR and early PDR, improvements in retinal blood circulation after PRP are reflected by reductions in the VFT evident on video fluorescein fundus angiography. We speculate that the improvements are similar in patients with severe NPDR and early PDR.

Purpose: To explore whether panretinal photocoagulation (PRP) improved retinal blood circulation in patients with diabetic retinopathy of various levels of severity based on changes in the retinal circulation time as measured by video fluorescein fundus angiography. Methods: We recruited patients with severe diabetic retinopathy indicated for PRP; we performed video fluorescein fundus angiography before and after PRP. We measured changes in the arterial circulation time (ACT), arteriovenous passage time (APT), and venous filling time (VFT) in patients with diabetic retinopathy of varying severity, and compared the findings. We recorded HbA1c levels and hypertension status. Results: We enrolled 33 patients, 17 with severe nonproliferative diabetic retinopathy (NPDR) and 16 with early proliferative diabetic retinopathy (PDR). After PRP, neither the ACT nor the APT changed significantly in patients with severe NPDR (p = 0.927, p = 0.138) or early PDR (p = 0.137, p = 0.268). After PRP, the VFT was significantly reduced in patients with both severe NPDR (p = 0.000) and early PDR (p = 0.022). The VFT reductions were similar in both groups (p = 0.217). Conclusions In patients with severe NPDR and early PDR, improvements in retinal blood circulation after PRP are reflected by reductions in the VFT evident on video fluorescein fundus angiography. We speculate that the improvements are similar in patients with severe NPDR and early PDR.

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

Reconstruction method choice in recurrent head and neck cancer depends on surgical history, radiation therapy dosage, conditions of recipient vessels, and general patient condition. Furthermore, when defects are multiple or three dimensional in nature, reconstruction and flap choice aimed at rebuilding the functional structure of the head and neck are difficult. We experienced successful reconstruction of recurrent laryngeal cancer requiring reconstruction of esophageal and tracheostomy stroma defects using a chimeric two-skin anterolateral thigh flap with a single pedicle.
Esophagus ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; Humans ; Laryngeal Neoplasms ; Methods ; Neck ; Thigh ; Tracheostomy