BACKGROUND

Waiting time of patients from a consult with a primary care physician to a specialist is poorly understood. It is one indicator of health service delivery and patient satisfaction. Patients consider waiting for a specialist consult for more than three months too long and unacceptable.

To describe the sociodemographic and clinical factors associated with length of referral waiting time.

Cross-sectional retrospective chart review of patient records in a tertiary government hospital from 2015 to 2019.

A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).

Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of comorbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral.

The condition of work environment (patient room) is often out of concern to the management so that they do not meet the requirements of Regulation of Minister of Health of the Republic of Indonesia (Permenkes) No. 1204 of 2004 concerning Hospital Environmental Health Requirements. It will have implications for the performance of the doctor (specialist). This study aimed to describe the conditions of the work environment (temperature, lighting, and dust) and the doctor's performance and the relationship between the work environment and the doctor's performance. This research was a quantitative study with a cross sectional design. The research was conducted in 3 teaching hospitals in Medan, namely H. Adam Malik Hospital, dr. Pirngadi and RSU USU during April - November 2018. The study population was 236 people with a sample of 22 people taken using incidental sampling technique. The data obtained by measuring the conditions of the work environment (temperature, lighting, and dust) and interviews using a questionnaire to measure the performance of doctors. Data analysis used Fisher's Exact Test. The results showed that there was no influence of work environment conditions on the doctor's performance, however the temperature and lighting conditions did not meet the requirements. Meanwhile, the temperature of the work room affected the behavior of doctors. Thus, the hospital management needs to take corrective action on working environment conditions by replacing old air conditioners or regularly maintaining air conditioners, setting up a barrier against noise sources, and replacing the bulb with a lighter intensity. The medical committee needs to regularly supervise the work of doctors so that their performance is achieved according to the target.
effect of working environment, specialist physicians&rsquo ; , performance

BACKGROUND: The incidence of asthma exacerbation (AE) and the predictive value of spirometry and fractional exhaled nitric oxide (FeNO) in school children have not been evaluated.OBJECTIVE: We sought to evaluate the efficacy of spirometry measurement and FeNO monitoring for predicting AE in school children in the Cheongju area in Korea.METHODS: With parental agreement, we studied 170 students aged 7–12 years. Children were evaluated by an asthma specialist using baseline spirometry, skin prick test, seasonal FeNO measurement, and asthma control test. The study participants underwent a physical examination and their medical history was also evaluated by the specialist. They were assessed for asthma control status during regular doctor visits for 1 year.RESULTS: In total, 160 children (94.1%) completed follow-up and FeNO monitoring. Of which, 26 children (16.3%) had AE. AE was associated with male children and children with allergic rhinitis (p < 0.05). While, children with AE tended to have higher FeNO than those without AE, no significant difference was found. The maximum value of FeNO ≥35 ppb was associated with AE (p < 0.05). Children with AE had a significantly decreased baseline forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC), %predicted, forced expiratory flow at 25%–75% of FVC (FEF(25%–75%)). FEV₁/FVC < 80% was associated with AE in children regardless of inhalant allergen sensitization (all p < 0.05).CONCLUSION: Baseline spirometry had a predictive value of AE in school children. Sensitive spirometric parameters such as FEV₁/FVC and FEF(25%–75%) can be used as prognostic factors to predict future childhood AE. FeNO value ≥ 35 ppb during monitoring was associated with AE in school children.
Asthma ; Child ; Chungcheongbuk-do ; Follow-Up Studies ; Forced Expiratory Volume ; Humans ; Incidence ; Korea ; Male ; Nitric Oxide ; Parents ; Physical Examination ; Rhinitis, Allergic ; Seasons ; Skin ; Specialization ; Spirometry ; Vital Capacity

Immune checkpoint inhibitors (ICIs) have been changing the paradigm of cancer treatment. However, immune-related adverse effects (irAEs) have also increased with the exponential increase in the use of ICIs. ICIs can break up the immunologic homeostasis and reduce T-cell tolerance. Therefore, inhibition of immune checkpoint can lead to the activation of autoreactive T-cells, resulting in various irAEs similar to autoimmune diseases. Gastrointestinal toxicity, endocrine toxicity, and dermatologic toxicity are common side effects. Neurotoxicity, cardiotoxicity, and pulmonary toxicity are relatively rare but can be fatal. ICI-related gastrointestinal toxicity, dermatologic toxicity, and hypophysitis are more common with anti- CTLA-4 agents. ICI-related pulmonary toxicity, thyroid dysfunction, and myasthenia gravis are more common with PD-1/PD-L1 inhibitors. Treatment with systemic steroids is the principal strategy against irAEs. The use of immune-modulatory agents should be considered in case of no response to the steroid therapy. Treatment under the supervision of multidisciplinary specialists is also essential, because the symptoms and treatments of irAEs could involve many organs. Thus, this review focuses on the mechanism, clinical presentation, incidence, and treatment of various irAEs.
Autoimmune Diseases ; Cardiotoxicity ; Homeostasis ; Incidence ; Myasthenia Gravis ; Organization and Administration ; Specialization ; Steroids ; T-Lymphocytes ; Thyroid Gland

PURPOSE: We used a questionnaire to explore perceptions and clinical practice patterns of Korean pediatric ophthalmologists in terms of amblyopia.METHODS: From September to November 2018, we conducted a web-based questionnaire survey of 99 specialists of the Korean Association for Pediatric Ophthalmology and Strabismus who operated ophthalmology clinics in Korea. We received 56 responses (56.57%) and retrospectively analyzed the data.RESULTS: The average specialist age was 44.0 ± 9.7 years. The mean age of treated amblyopia patients was 3 to 5 years (69.6%); the most common amblyopia was refractive anisometropic amblyopia (75.0%). On average, treatment commenced at 4 years of age (53.6%); child and parent co-operation most significantly influenced treatment success (46.4%). The preferred test was cycloplegic refraction (96.4%) and the preferred treatment occlusion therapy (100%) with glasses correction (98.2%). Occlusion therapy was most commonly performed for 2 hours/day (69.6%); the minimum age for eyeglasses prescription was 2.10 ± 1.18 years. Only three respondents (5.36%) prescribed contact lenses and only one (1.79%) performed refractive surgery.CONCLUSIONS: In Korea, amblyopia treatment is based on occlusion therapy and glasses correction. However, the time of treatment commencement, the duration of occlusion therapy, and the glasses used for correction varied. It is necessary to develop guidelines for amblyopia treatment; these should reflect current medical conditions.
Amblyopia ; Child ; Contact Lenses ; Eyeglasses ; Glass ; Humans ; Korea ; Ophthalmology ; Parents ; Practice Patterns, Physicians' ; Prescriptions ; Refractive Surgical Procedures ; Retrospective Studies ; Specialization ; Strabismus ; Surveys and Questionnaires

BACKGROUND/AIMS: School nurses’ knowledge of inflammatory bowel disease (IBD) has not been evaluated. We aimed to investigate school nurses’ knowledge of IBD and determine whether education could improve this knowledge. METHODS: School nurses were invited to complete self-reported questionnaires on IBD. Then, IBD specialists from tertiary referral hospitals provided a 60-minute lecture with educational brochures on two occasions, with a 3-month interval. Within 6 months after the educational interventions, school nurses were asked to complete the same IBD questionnaire via e-mail. RESULTS: Among 101 school nurses who were invited to participate, 54 nurses (53.5%) who completed two consecutive questionnaires were included in this study (median age, 45 years; range, 25 to 59 years; 100% female); 11.1% and 7.4% of the study participants had no knowledge regarding ulcerative colitis and Crohn’s disease, respectively. They had heard of IBD most frequently from doctors (33.3%), followed by internet sources (25.9%). After 6 months, the number of nurses who could explain IBD to students with over 30% confidence increased from 24 (44.5%) to 42 (77.8%) (p < 0.001). Most nurses (81.5%) reported that the educational intervention was helpful for managing students with abdominal pain or diarrhea. The number of students who received IBD-related welfare services from the Daegu Metropolitan Office of Education doubled when compared with the corresponding number during the prior educational year. CONCLUSIONS: There is room for improvement in school nurses’ knowledge of IBD. A systematic educational program on IBD should be implemented for these nurses.
Abdominal Pain ; Colitis, Ulcerative ; Crohn Disease ; Daegu ; Diarrhea ; Education* ; Electronic Mail ; Humans ; Inflammatory Bowel Diseases* ; Internet ; Pamphlets ; Schools, Nursing ; Specialization ; Tertiary Care Centers

Scholarly article writing and publishing in international peer-reviewed journals can become an overwhelming task for many medical, nursing, and healthcare professionals in a university setting, especially in countries whose native language is not English. To help improve their scientific writing skills and publishing capacity, a university-based editing system and writing programs can be developed as educational platforms. These are delivered by a team of specialist editors composed of tenured faculty members who have a strong medical background and extensive experience in teaching courses on medical research, editing, writing, and publishing. For the editing system, the specialist editors provide comprehensive editing, personalized consultation, full editorial support after peer review, guidance with online submissions/resubmissions, and detailed editorial review at different stages of the manuscript writing. In addition, the specialist editors can develop writing programs such as medical writing and editing internships, academic courses in medical writing or research study designs and reporting standards, special interactive lectures and sessions on predatory publishing, seminars on updated editorial guidance of global editorial associations, academic visits on medical writing and editing, medical writing mentoring program, networking programs in scholarly communication, and publication resources in medical writing and scholarly publishing. These editing system and writing programs can serve as integrated platforms for improving scientific writing skills and publishing capacity by providing continuing education in medical writing, editing, publishing, and publication ethics.
Delivery of Health Care ; Education, Continuing ; Ethics ; Humans ; Internship and Residency ; Lectures ; Medical Writing ; Mentors ; Nursing ; Peer Review ; Publications ; Specialization ; Writing*

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is standard of care. Endovascular techniques as an alternative have emerged to be appropriate first line therapy when addressing the threatened limb. We review the etiology and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.
Aortic Aneurysm, Abdominal ; Classification ; Embolism and Thrombosis ; Endovascular Procedures ; Extremities ; Humans ; Ischemia ; Mortality ; Peripheral Arterial Disease ; Specialization ; Standard of Care

PURPOSE: Anaphylaxis and asthma exacerbation could be life-threatening medical emergencies. The 119 (911 in the United States) rescue teams are at the forefront of such emergency conditions. Early recognition and proper prehospital management by 119 rescuers are important. We evaluated the awareness of 119 rescuers of anaphylaxis and asthma exacerbation in Korea. METHODS: Between May 17 and June 28 of 2018, a total of 180 rescuers were recruited from Gyeonggi-do province, Korea. The 90-minute educational sessions on anaphylaxis and asthma exacerbation were provided by an allergy specialist, which included some lectures and a hands-on workshop on self-injectable epinephrine autoinjector. A questionnaire survey with the same content was performed before and after education to assess the improvement in awareness. It had 2 domains: anaphylaxis awareness and asthma awareness. RESULTS: After education, awareness score for anaphylaxis increased from an average of 3.1 (51.7%) to 5.5 (91.7%). Particularly, the effect of education on the use of epinephrine, the most crucial treatment for anaphylaxis, was greatest. The awareness score for asthma after education increased from an average of 21.3 (78.9%) to 25.1 (93%). The effect of education on treatment and management of asthma was greatest. CONCLUSION: The 119 rescuers could be the first medical personnel at the forefront of anaphylaxis and asthma exacerbation. Hence, it is important to increase their awareness of anaphylaxis and asthma exacerbation. A simple educational activity can dramatically change the level of awareness.
Anaphylaxis ; Asthma ; Education ; Emergencies ; Epinephrine ; Gyeonggi-do ; Hypersensitivity ; Korea ; Lectures ; Rescue Work ; Specialization