Background: This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea. Methods: Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited. Results: Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively. Conclusion This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients’ physical and mental symptoms, psychological support, appropriate deci-sion-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

PURPOSE: The purpose of this study was to assess the factors influencing the rescue medication decisions for breakthrough cancer patients and evaluate treatments using the factors. METHODS: Based on the results of an online survey conducted by the Korean Society of Hospice and Palliative Care from September 2014 through December 2014, we assessed the level of agreement on nine factors influencing rescue medication preference. The same factors were used to evaluate oral transmucosal fentanyl lozenge, oral oxycodone and intravenous morphine. RESULTS: Agreed by 77 physicians, a rapid onset of action was the most important factor for their decision of rescue medication. Other important factors were easy administration, strong efficacy, predictable efficacy and less adverse effects. Participants agreed that intravenous morphine produced a rapid onset of action and strong and predictable efficacy and cited difficulty of administration and adverse effects as negative factors. Oral oxycodone was desirable in terms of easy administration and less adverse effects. However, its onset of action was slower than intravenous morphine. While many agreed to easy administration of oral transmucosal fentanyl lozenge, the level of agreement was low for strength and predictability of its efficacy, long-term durability and sleep improvement. CONCLUSION: Rapid onset of action is one of the important factors that influence physicians' selection of rescue medication. Physicians' assessment of rescue medication differed by medication.
Analgesics, Opioid ; Breakthrough Pain ; Fentanyl ; Hospices ; Humans ; Morphine ; Oxycodone ; Palliative Care

BACKGROUND: We examined the association between salivary mitochondrial DNA (mtDNA) copy number and chronic fatigue combined with depression and insomnia. METHODS: This cross-sectional study included 58 healthy adults with moderate to severe fatigue (Brief Fatigue Inventory [BFI] ≥4) for longer than 6 months. Subjects were classified as those without combined symptoms, with either depression (Beck Depression Inventory [BDI] ≥13) or insomnia (Pittsburgh Sleep Quality Index [PSQI] ≥5), or with both depression and insomnia. Salivary mtDNA copy number was measured by real-time quantitative polymerase chain reaction. The association was evaluated using a general linear model. RESULTS: About 76% of participants had either depression or insomnia as additional symptoms. These subjects were predominately female, drank more alcohol, and exercised less than those without combined symptoms (P<0.05). The group with both depression and insomnia exhibited significantly higher BFI and lower mtDNA copy number than those without combined symptoms (P<0.05). After adjusting for confounding factors, significant negative associations between mtDNA copy number and usual fatigue were found in the group without combined symptoms, whereas the negative associations in the group with combined symptoms were attenuated. BDI and PSQI were not associated with mtDNA copy number. CONCLUSION: Chronic fatigue is negatively associated with salivary mtDNA copy number. Salivary mtDNA copy number may be a biological marker of fatigue with or without combined symptoms, indicating that a separate approach is necessary.
Adult* ; Biomarkers ; Cross-Sectional Studies ; Depression ; Depressive Disorder ; DNA, Mitochondrial* ; Fatigue* ; Female ; Humans ; Linear Models ; Mental Fatigue ; Polymerase Chain Reaction ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders

Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test.
Africa, Western ; Coinfection ; Diagnosis ; Fever ; Genes, rRNA ; Guinea* ; Headache ; Humans ; Korea ; Malaria ; Plasmodium ; Plasmodium falciparum ; Plasmodium malariae* ; Polymerase Chain Reaction ; RNA, Ribosomal ; Sequence Analysis

PURPOSE: For the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect. MATERIALS AND METHODS: From November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter < or =0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after. RESULTS: The transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8+/-2.8 vs. 3.7+/-2.6 and 1.1+/-0.1 vs. 1.2+/-0.2). CONCLUSION: Transcatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.
Echocardiography ; Heart Septal Defects, Atrial/pathology/*surgery ; Humans ; Middle Aged ; Postoperative Complications ; Republic of Korea ; Retrospective Studies ; Septal Occluder Device/*adverse effects ; Tomography, X-Ray Computed ; Treatment Outcome

Percutaneous device occlusion of secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. A variety of devices have been used successfully. However, all of them have limitations. We report our experience with two devices used to close multiple ASDs.
Cardiac Catheterization ; Heart Septal Defects ; Heart Septal Defects, Atrial

A left internal mammary artery to vein fistula was found incidentally in a 32-year-old woman with a continuous murmur. There was no significant history of trauma and no cardiac symptoms. A percutaneous embolization with vascular plug and coil was performed.
Adult ; Arteriovenous Fistula ; Embolization, Therapeutic ; Female ; Fistula ; Heart Murmurs ; Humans ; Mammary Arteries ; Veins

PURPOSE: The aim of this study was to determine the expressions of Rb, p16, and cyclin D1 in soft tissue sarcomas, and we also wanted to identify the prognostic factors according to the clinicalpathologic features. MATERIALS AND METHODS: We reviewed the charts and radiographic films of 66 sarcoma patients. Tissue samples were collected from these patients. Immunochemistry was performed using formalin-fixed, paraffin-embedded tissue samples to examine the expressions of p16, Rb, and cyclin D1 proteins. RESULTS: The median duration of overall survival was 47.8 months (range, 20.0 to 70.7 months) and the 5 years survival rate was 39%. As for the correlation between the degree of immunohistochemical staining for Rb protein and the histological tumor grades, there was a significant difference with a p-value of 0.019. However, no significant correlation was shown for p16 and cyclin D1. The overall survival duration of the Rb negative group (staining cell <20%) and the heterogeneous group (cell staining 20 to 80%) was 53.5+/-6.6 months and the overall survival duration of the Rb homogeneous group was 18.3+/-6.4 months, and there was a significant difference with a p-value of 0.016. However, no significant difference was shown between the survival rate according to the p16 and cyclin D1 expressions. On the multivariate analysis that was done with Rb, p16, the tumor size, grade and site, and patient age, the Rb gene expression was the most significant independent prognostic factor with a risk ratio of 3.01 (p=0.04). CONCLUSION: The expression of Rb protein was correlated with the histologic grade and overall survival of patients with soft tissue sarcomas.
Cyclin D1 ; Cyclins ; Genes, Retinoblastoma ; Humans ; Immunochemistry ; Multivariate Analysis ; Odds Ratio ; Proteins ; Retinoblastoma Protein ; Sarcoma ; Survival Rate ; X-Ray Film