Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

OBJECTIVE: Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.METHODS: We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.RESULTS: In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).CONCLUSION: Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
Anoxia ; Area Under Curve ; Blood Pressure ; Brain Injuries ; Capillaries ; Fires ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hospital Mortality ; Humans ; Hypotension ; Korea ; Mortality ; Observational Study ; Oxygen ; Quality Improvement ; Respiratory Rate

PURPOSE: Aim of this study was to assess effects of InsureGraf® (SK-Bioland Co., Korea), an artificial dermis developed by using tissue engineering technology in severe burn patients. METHODS: To examine the clinical effectiveness of InsureGraf®, we transplanted them in patients with severe burns. A total of 14 joint regions in 8 patients received InsureGraf® graft selectively from July to December, 2014. The graft results were determined after confirming the take rate of the transplanted skin graft on top of the InsureGraf®. Take rates were examined twice, at 7 and 14 days after grafting. Photographs of the skin grafts were evaluated individually by two burn surgeon specialists, and the mean values were recorded. RESULTS: The take rate was 99% after day 7 and 100% after day 14 respectively. CONCLUSION: InsureGraf® can be used successfully as an artificial dermis that allows one-stage operation in severe burn patients, exhibiting a successful early-stage graft take rate that is close to 100%.
Burns ; Collagen* ; Dermis ; Humans ; Joints ; Skin ; Specialization ; Tissue Engineering ; Transplants ; Treatment Outcome*

PURPOSE: The purpose of this study was to compare the accuracy of postoperative maxillary cyst (POMC) diagnosis by panoramic radiographs versus computed tomography (CT) and by oral and maxillofacial radiologists versus non-specialists. MATERIALS AND METHODS: Sixty-five maxillary sinuses with POMCs and 63 without any lesion were assessed using panoramic radiographs and CT images by five oral and maxillofacial radiologists and five non-specialists on a five-point scale. The areas under receiver operating characteristic (ROC) curves were analyzed to determine the differences in diagnostic accuracy between the two imaging modalities and between the two groups of observers. The intra-observer agreement was determined, too. RESULTS: The diagnostic accuracy of CT images was higher than that of panoramic radiographs in both groups of observers (p<0.05). The diagnostic accuracy of oral and maxillofacial radiologists for each method was higher than that of non-specialists (p<0.05). CONCLUSION: The use of CT improves the diagnosis of POMC, and radiological training and experience leads to more accurate evaluation.
Diagnosis ; Maxillary Sinus ; Pro-Opiomelanocortin ; Radiography, Panoramic ; ROC Curve

Brunner's gland hyperplasia, also known as Brunner's gland adenoma, polypoid hamartoma, or Brunneroma, is a rare proliferative lesion arising from the Brunner's glands of the duodenum. These lesions have been described previously as benign, with no malignant potential. We report a case of Brunner's gland hyperplasia in the duodenum that was discovered incidentally during the endoscopic evaluation of anal bleeding. Histopathological examination of this Brunner's gland hyperplasia revealed well-marked, low-grade dysplasia. This case suggests a dysplastic stage with malignant potential in the natural history of Brunner's gland hyperplasia.
Adenoma ; Brunner Glands ; Duodenum ; Hamartoma ; Hemorrhage ; Hyperplasia ; Natural History

No abstract available.
Breast ; Peptococcus

Behcet disease is a multisystemic disorder characterized by a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration, and ocular inflammation. The onset of Behcet disease is rare in old age as is whole colon involvement. We recently saw a 78-year-old female patient examined to have intestinal Behcet disease with diffuse colon ulcers. She was admitted due to multiple oral ulcers, genital ulcers, low abdominal pain, and hematochezia. Colonoscopy showed multiple well-demarcated, large, deep, bleeding ulcers from the cecum into the descending colon. The patient was diagnosed with Behcet disease and treated with steroid, colchicine, and mesalazine. This paper describes a case of Behcet disease with unusual intestinal distribution.
Abdominal Pain ; Aged ; Behcet Syndrome ; Cecum ; Colchicine ; Colon ; Colon, Descending ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Inflammation ; Mesalamine ; Oral Ulcer ; Ulcer

The percutaneous endoscopic gastrostomy is used for nutritional support in patients requiring prolonged tubal feeding. Unfortunately, numerous complications, such as infection, stomal leak, fever, local pain, ileus and tube occlusion, have been reported since its introduction. The buried bumper syndrome is a rare but well-recognized long-term complication. The tight anchorage between the internal and external bumpers leads to gastric mucosal erosion and embedding of the internal bumper into the gastric wall, obstructing feeding. Our case involves an elderly patient with a buried bumper syndrome complicated by an abdominal wall abscess. A similar case has not been reported in Korea before. This article reports our findings and management with a review of the literature.
Abdominal Wall ; Abscess ; Aged ; Fever ; Gastrostomy ; Humans ; Ileus ; Korea ; Nutritional Support

Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.
Abdominal Pain ; Abscess ; Colon, Descending ; Colonoscopy ; Foreign Bodies ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intrauterine Devices

Dexamethasone ; Durapatite ; Mandible ; Osteoblasts ; Osteogenesis ; Rabbits ; Silver Staining ; Transplants