The Korean Society of Gynecologic Oncology (KSGO) had been making an effort to standardize and enhance the quality of domestic uterine corpus cancer treatment by developing updated clinical practice guidelines in 2021. The KSGO revised the guidelines based on a literature search using 4 key elements: Population, Intervention, Comparison, and Outcome framework. These elements include the evaluation of the efficacy and safety of immune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patients who have failed platinum-based chemotherapy, as well as the effect of combined treatment with trastuzumab in patients with HER2eu-positive endometrial cancer. Additionally, the guideline assessed the efficacy and safety of omitting lymph node dissection in low-risk endometrial cancer patients, investigated the effect of sentinel lymph node mapping in early-stage endometrial cancer surgery, addressed the outcome of chemoradiation therapy as a postoperative treatment in patients with advanced (stage III–IVA) endometrial cancer, and explored the impact of initial treatment with immune checkpoint inhibitors on survival in patients with advanced or recurrent endometrial cancer patients.

The Korean Society of Gynecologic Oncology (KSGO) had been making an effort to standardize and enhance the quality of domestic uterine corpus cancer treatment by developing updated clinical practice guidelines in 2021. The KSGO revised the guidelines based on a literature search using 4 key elements: Population, Intervention, Comparison, and Outcome framework. These elements include the evaluation of the efficacy and safety of immune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patients who have failed platinum-based chemotherapy, as well as the effect of combined treatment with trastuzumab in patients with HER2eu-positive endometrial cancer. Additionally, the guideline assessed the efficacy and safety of omitting lymph node dissection in low-risk endometrial cancer patients, investigated the effect of sentinel lymph node mapping in early-stage endometrial cancer surgery, addressed the outcome of chemoradiation therapy as a postoperative treatment in patients with advanced (stage III–IVA) endometrial cancer, and explored the impact of initial treatment with immune checkpoint inhibitors on survival in patients with advanced or recurrent endometrial cancer patients.

The Korean Society of Gynecologic Oncology (KSGO) had been making an effort to standardize and enhance the quality of domestic uterine corpus cancer treatment by developing updated clinical practice guidelines in 2021. The KSGO revised the guidelines based on a literature search using 4 key elements: Population, Intervention, Comparison, and Outcome framework. These elements include the evaluation of the efficacy and safety of immune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patients who have failed platinum-based chemotherapy, as well as the effect of combined treatment with trastuzumab in patients with HER2eu-positive endometrial cancer. Additionally, the guideline assessed the efficacy and safety of omitting lymph node dissection in low-risk endometrial cancer patients, investigated the effect of sentinel lymph node mapping in early-stage endometrial cancer surgery, addressed the outcome of chemoradiation therapy as a postoperative treatment in patients with advanced (stage III–IVA) endometrial cancer, and explored the impact of initial treatment with immune checkpoint inhibitors on survival in patients with advanced or recurrent endometrial cancer patients.

Background/Aims: Although a management fee for hospitalist service was established in Korea, the number of hospitalists required for the system to run remains outmatched. Methods: In January 2020 and February 2022, before and after the establishment of the hospitalist fee system respectively, cross-sectional online surveys were conducted among internal medicine board-certified hospitalists. Results: There were 59 and 64 respondents in the 2020 and 2022 surveys, respectively. The percentage of respondents who cited financial benefits as a motive for becoming a hospitalist was higher in the 2022 survey than in the 2020 survey (34.4% vs. 10.2%; p = 0.001). The annual salary of respondents was also higher in the 2022 survey than in the 2020 survey (mean, 182.9 vs. 163.0 million in South Korean Won; p = 0.006). A total of 81.3% of the respondents were willing to continue a hospitalist career in the 2022 survey. In multivariate regression analysis, the possibility of being appointed as a professor was found to be an independent predictive factor of continuing a hospitalist career (odds ratio, 4.00; 95% confidence interval, 1.09–14.75; p = 0.037). Conclusions Since the establishment of the hospitalist fee system, monetary compensation has improved for hospitalists. The possibility of being appointed as a professor could predict long-term work as hospitalists.

Adnexal masses detected during pregnancy require a prompt and accurate diagnosis to ensure fetal safety and good oncological outcomes. Computed tomography is the most common and useful diagnostic imaging modality for diagnosing adnexal masses; however, it is contraindicated in pregnant women because of the teratogenic effect of radiation on the fetus. Therefore, ultrasonography (US) is commonly used as the main alternative for the differential diagnosis of adnexal masses during pregnancy. Additionally, magnetic resonance imaging (MRI) can assist in the diagnosis when US findings are inconclusive. As each disease has characteristic US and MRI findings, understanding these features is important for the initial diagnosis and subsequent treatment. Thus, we thoroughly reviewed the literature and summarized the key findings of US and MRI to apply these in real-world clinical practice for various adnexal masses detected during pregnancy.

Background: The symptoms of adrenal insufficiency (AI) overlap with the common effects of advanced cancer and chemotherapy. Considering that AI may negatively affect the overall prognosis of cancer patients if not diagnosed in a timely manner, we analyzed the incidence, risk factors, and predictive methods of AI in cancer patients. Methods: We retrospectively analyzed the medical records of 184 adult patients with malignancy who underwent a rapid adrenocorticotrophic hormone stimulation test in the medical hospitalist units of a tertiary hospital. Their baseline characteristics and clinical features were evaluated, and the risk factors for AI were identified using logistic regression analysis. Results: Of the study patients, 65 (35%) were diagnosed with AI, in whom general weakness (63%) was the most common symptom. Multivariate logistic regression showed that eosinophilia (adjusted odds ratio [aOR], 4.28; 95% confidence interval [CI], 1.10–16.63; P = 0.036), history of steroid use (aOR, 2.37; 95% CI, 1.10–5.15; P = 0.028), and history of megestrol acetate use (aOR, 2.71; 95% CI, 1.38–5.33; P = 0.004) were associated with AI. Baseline cortisol levels of 6.2 μg/dL and 12.85 μg/dL showed a specificity of 95.0% and 95.4% for AI diagnosis, respectively. Conclusion AI was found in about one-third of patients with cancer who showed general symptoms that may be easily masked by cancer or chemotherapy, suggesting that clinical suspicion of AI is important while treating cancer patients. History of corticosteroids or megestrol acetate were risk factors for AI and eosinophilia was a pre-test predictor of AI.Baseline cortisol level appears to be a useful adjunct marker for AI.

Objective: This study aims to evaluate the safety and feasibility of laterally extended endopelvic resection (LEER) for sarcoma in the female genital tract. Methods: We prospectively recruited gynecologic cancer patients with sarcoma arising from female genital tract who underwent LEER at Seoul National University Hospital from December 2016 to March 2021. Clinicopathologic characteristics, surgical outcomes including postoperative complications and pain control, and survival outcomes of the patients were investigated. Results: A total of nine patients were registered for this study. The median age was 56 years. Carcinosarcoma (n=2, 22%), leiomyosarcoma (n=2, 22%), and undifferentiated uterine sarcoma (n=2, 22%) were common histology types. Complete resection was achieved in 88.9%. The most common location of pelvic sidewall tumors was infra-iliac acetabulum (66.7%). The pathologic outcome showed a median tumor size of 9.0 cm and internal iliac vessel resection with pelvic sidewall muscle was performed in all patients. The median estimated blood loss was 1,600 mL (range, 300-22,300), and the patients were postoperatively admitted to the intensive care unit for median 1 day (range, 0-8). Complete response was observed in 44.4% (4/9) in radiologic studies after LEER, and median progression-free survival, treatment-related survival, and overall survival were 3.3, 19.6, and 98.9 months, respectively. Conclusion LEER was feasible and safe in treating recurrent sarcoma presenting pelvic sidewall invasion with acceptable survival outcomes and manageable postoperative complications.

Purpose: This study analyzed the current status of and correlations between Korean medical students’ experiences and perspectives surrounding patient-centered medical education (PCME). Methods: A structured PCME questionnaire composed of three categories, understanding patients within social and cultural contexts, understanding patients’ individual health contexts through communication, and placement of patients at the center of medical education, was used. The students were stratified into pre-medical (Pre-med), medical (Med), and policlinic (PK) groups because of curriculum differences by grade. The χ2 test was applied to analyze the association between students’ experiences with and perspectives on PCME. A Cramer’s V of 0.200 was considered a large effect size for any association between experiences with and perspectives on PCME. Results: Among the respondents, 50.6% answered that they did not know about patient-centered medicine before the survey. With increasing school years went up from Pre-med to PK, fewer students agreed that PCME should be added to pre-clinical medicine curricula (p<0.001), that patients should be in the center throughout medical education (p=0.011), and that patients’ personal histories, values, and objectives are important PCME (p=0.001). Students who said they learned PCME for each category were more likely to consider PCME important (Cramer’s V was 0.219 and 0.271 for “with,” and “for the patients” respectively, p<0.001 for “about/with/for the patients”). Students in all groups chose clinical practice as the best method for PCME (p=0.021). Med group chose the lectures as the most effective tool to learn about the importance of communication (p<0.001). Conclusion Students who experienced PCME were likely to perceive PCME as important and it showed that experiences of PCME had positive effects on PCME perceptions. Despite students’ preferences for clinical practice as the best method for PCME, PK reported that they did not learn PCME, and regarded PCME as less important compared to students at earlier stages of their medical education. Therefore, more intensive and holistic PCME curricula rather than only clinical practice exposure may be necessary.

No abstract available.
Hospitalists ; Humans ; Korea

A hospitalist system was introduced in Korea in September in 2016 to improve the quality of in-patient care and to cope with the shortage of medical residents. This study aimed to outline the current situation of internal medicine hospitalist and to suggest a development strategy. By May 2019, the number of hospitalists in Korea had increased to 124. Patient safety issues, resident law, and the shortage of medical residents has led to an increase in the demand for hospitalists in Korea. Internal medicine hospitalist care in Korea has been associated with patient satisfaction, length of stay, and waiting time in emergency departments. There are three different hospitalist ward models in the Korean health care system, and each hospital needs the model that fits its specific situation. In the general ward model, the role of the hospitalist is similar to that of the chief residents because the wards are categorized into nine subspecialty areas, such as internal medicine (including gastroenterology, pulmonology, and cardiology). In the short-term admission ward model, patients are usually turned around within 72 hours; therefore, the hospitalist is able to care for patients independently. After that, patients are discharged or admitted to a specialty ward. In integrated care model, patients from all specialty areas are admitted to the same ward; therefore, hospitalists care for patients independently. In this model, consultation with specialists is required. There were strengths and weaknesses in each model. Therefore, the models should be considered based on the hospital's function. This study found some problems in the present hospitalist system, including undefined roles and responsibilities, unclear future employment prospects, burnout due to patient' severity of illness, and inadequate payment systems for weekend and night work. To further develop the hospitalists system in Korea, the Korean government, the Korean associated of internal medicine, hospitals, and hospitalists must work together to solve the present problems.
Delivery of Health Care ; Emergency Service, Hospital ; Employment ; Gastroenterology ; Hospital Medicine ; Hospitalists ; Humans ; Internal Medicine ; Jurisprudence ; Korea ; Length of Stay ; Patient Safety ; Patient Satisfaction ; Patients' Rooms ; Pulmonary Medicine ; Specialization