Journal of Korean Medical Science最新文献

Background: The Korean National Cancer Screening Program (NCSP) for gastric cancer requires economic evaluation due to the low sensitivity of upper gastrointestinal series (UGIs) and the associated low cancer survival rate. This study aimed to ascertain the most cost-effective strategy for the NCSP.

Methods: The hypothetical target population of this study was aged 40 years or older, and no actual participants were involved. Markov simulation models were constructed for 25 strategies, combinations of 1) screening methods (UGIs or endoscopy vs. endoscopy-only), 2) screening intervals (one, two, or three-year), and 3) upper age limit of screening (69, 74, 79 years old, or "no limit"). Costs, utility, and other input parameters were extracted from various databases and previous studies. Cost-utility, sensitivity, and scenario analyses were conducted.

Results: The endoscopy-only strategy with a three-year interval with an upper age limit of 69 was the most cost-effective strategy with an incremental cost-utility ratio of KRW 13,354,106 per quality-adjusted life years. According to the probabilistic sensitivity analysis, the uncertainty of the result was significantly small. Scenario analysis is showed that as the screening rate increased, the endoscopy-only strategy saved more costs compared to the current NCSP. Therefore, it is important to maintain a high screening rate when altering the NCSP strategy.

Conclusion: Endoscopy-only screening was more cost-effective method than UGIs for the NCSP. Furthermore, a three-year interval with an upper-age limit of 69 years was the most cost-effective strategy. Efforts to improve cost-effective screening guidelines will support the efficient use of medical resources. Additionally, maintaining a higher screening rate may maximize the impact of the modification in strategy on cost-effectiveness.

Collective actions by physicians have occurred frequently worldwide, including in Korea. The literature primarily focuses on justifying industrial actions or assessing their impact on clinical outcomes. However, few studies have examined physicians' actions in response to government health policies. A comprehensive review of this literature could provide valuable insights into how physicians can effectively address and resolve conflicts with governments. This study aimed to investigate the existing literature on physicians' collective actions against government health policies and identify research gaps. A scoping review was conducted based on the methodology proposed by Arksey and O'Malley. We searched for terms related to physicians (e.g., doctors, trainees) and strikes (e.g., protests, walkouts) in PubMed, Embase, Scopus, Web of Science, KMbase, and RISS on March 25, 2024. A total of 5,248 articles published between 1974 and 2023 were screened, and 26 articles were selected for analysis. The authors of these studies were predominantly from the fields of social sciences, history, jurisprudence, and public health administration. Physician collective actions were documented in 16 countries across various levels of development. Physicians engaged in collective action for five main reasons: 1) Opposition to socialized medicine policies, 2) Opposition to healthcare privatization policies, 3) Dissatisfaction with poor or stagnant public healthcare systems and infrastructure, 4) Resistance to unreasonable medical reforms, and 5) Protests against inequitable health workforce policies. Government responses to physician strikes followed four main strategies: 1) Unilateral policy enforcement, 2) Instigation of conflicts, 3) Suppression of physicians through unwarranted use of governmental power, and 4) Use of mediators to negotiate resolutions. These strategies were employed regardless of whether the government was authoritarian or democratic. Physicians' strategies against government policies were categorized as 1) Strengthening physician organizations, 2) Improving public relations, 3) Disrupting government policy implementation, and 4) Reducing the available medical workforce. In conclusion, this study highlights the need for more theory-based research and greater integration of social sciences into physicians' education. We recommend that Korean physicians reflect on the strategies used by both governments and physicians in other countries and prepare for potential conflicts.

Background: We aimed to examine the prevalence of burnout among imaging cardiologists in Korea and to identify its associated factors.

Methods: An online survey of imaging cardiologists affiliated with university hospitals in Korea was conducted using SurveyMonkey^® in November 2023. The validated Korean version of the Maslach Burnout Inventory-Human Service Survey was used to assess burnout across three dimensions: emotional exhaustion, depersonalization, and lack of personal accomplishment. Data on demographics, work environment factors, and job satisfaction were collected using structured questionnaires.

Results: A total of 128 imaging cardiologists (46.1% men; 76.6% aged ≤ 50 years) participated in the survey. Regarding workload, 74.2% of the respondents interpreted over 50 echocardiographic examinations daily, and 53.2% allocated > 5 of 10 working sessions per week to echocardiographic laboratory duties. Burnout levels were high, with a significant proportion of participants experiencing emotional exhaustion (28.1%), depersonalization (63.3%), and a lack of personal accomplishment (92.2%). Younger age (< 50 years) was correlated with higher emotional exhaustion risk, while more research time was protective against burnout in the depersonalization domain. Factors, such as being single, living with family, and specific job satisfaction facets, including uncontrollable workload and value mismatch, were associated with varying levels of burnout risk across different dimensions.

Conclusion: Our study underscores the high burnout rates among Korean imaging cardiologists, attributed to factors such as the subjective environment and job satisfaction. Hence, evaluating and supporting cardiologists in terms of individual values and subjective factors are important to effectively prevent burnout.

Image and video articles have been increasingly used in scientific literature. These articles provide an improved understanding of a specific topic, enhance accessibility for people with reading difficulties, and play significant role in educational, scientific, and social contexts. Nevertheless, the quality of the articles still needs considerable improvement. The current article aims to review the role of image and video articles in scientific communication, discuss the technical and ethical aspects of creating image and video content, and provide recommendations for authors, reviewers, and editors. In terms of technical aspects, clear and high-resolution visuals, as well as adherence to the requirements (video structure, acceptable formats, etc.) of the targeted journal are required in image and video articles. In terms of ethical aspects, the existence of a statement on patient(s)' written informed consent for the publication of their visual data should be ensured. In order to enhance science communication, submission of image and video articles should be encouraged.

Background: This study investigated trends in national expenditures on anticancer and immunomodulating agents from 2013 to 2022.

Methods: Information was obtained from the National Health Insurance claims data spanning a period of 10 years, from 2013 to 2022. The subjects of this study are patients diagnosed with cancer who used anticancer agents between January 1, 2013, and December 31, 2022. Trends were examined across various categories, including sex, age groups, routes of healthcare use, and types of healthcare institutions. We calculated the compound annual growth rate in both the number of patients and expenditures by year.

Results: In 2013, pharmaceutical expenditures amounted to USD 11,984 million, representing 25.5% of the total healthcare expenditures, which were USD 46,984 million. Within this pharmaceutical expenditure, anticancer medications constituted USD 584 million, or 4.9%. By 2022, pharmaceutical expenditures had risen to USD 22,093 million, accounting for 22.8% of the total healthcare expenditures of USD 96,904 million. Of this amount, USD 1,566 million was allocated to anticancer drugs, which represented 7.1% of the total pharmaceutical expenditures. Between 2013 and 2022, total healthcare expenditures experienced a significant increase of 106.2%, reaching USD 49,920 million. Concurrently, pharmaceutical expenditures rose by 91.1% to USD 10,919 million, while expenditures on anticancer drugs surged by 168.2% to USD 982 million. In 2022, the category with the highest expenditures was ATC L01FF, which includes programmed cell death protein 1/death ligand 1 inhibitors such as nivolumab, totaling USD 266.2 million. This was followed by L01FD at USD 198.8 million and L01EA at USD 140.4 million. Since 2018, however, spending on immune checkpoint blockers targeting cell death proteins or ligands has continued to rise and currently ranks first.

Conclusion: The number of patients using anticancer drugs and the associated drug expenditures have risen between 2013 and 2022. As the share of anticancer drugs in total drug expenditures grows, so too do the overall expenditures. This escalating financial burden highlights the necessity for policymakers to thoroughly understand the appropriate and cost-effective usage of anticancer drugs, as it directly influences the affordability and accessibility of healthcare services.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE).

Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023.

Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% post-intervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, -0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P = 0.571) or trend (P = 0.720).

Conclusion: Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt's iconic painting 'The Kiss' represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings.

Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer's perceptions of the red discs in 'The Kiss.' The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair. Among the visitors, 69.3% of the participants were female, and the most common age group was 30-49 years old.

Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman's dress in Klimt's painting closely resemble RBCs as depicted in early 20th-century scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as 'The Kiss,' demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting.

Conclusion: This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in 'The Kiss' but the entire composition. Klimt's work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Background: This survey examined healthcare professionals' knowledge, views, and perceptions of the responsibilities and functions of Research Ethics Committees (RECs). The study aimed to analyze ethical principles and operational issues faced by RECs and guide researchers, journal editors, and publishers on publication ethics notes.

Methods: A cross-sectional survey was conducted using the SurveyMonkey.com platform to assess healthcare professionals' knowledge, views, and practices concerning RECs' responsibilities, functions, and roles. The survey focused on REC definitions, functions, research types that require REC approval, and research protocols' evaluation time frames. It also reflected on ethics considerations and REC adaptations during the coronavirus disease 2019 (COVID-19) pandemic, REC member qualifications, evaluation periods, and additional challenges confronting RECs. Convenience sampling was adopted, and the survey was distributed via social media platforms.

Results: The survey was based on an analysis of questionnaires filled by 182 responders (104 females [57.1%] and 76 males [41.8%]), with a median age of 36. The survey respondents were from 28 different countries. The top three countries with most responders were Kazakhstan (n = 83), Türkiye (n = 33) and Poland (n = 10). Most participants (n = 128, 70.3%) were familiar with the definition of RECs and recognized the importance of REC approval for clinical trials and interventional research. Research study protocols should be submitted for REC evaluation and approval during the planning phase, according to 145 responders (79.7%). Participants emphasized the significance of formal ethics training for REC members. The involvement in research approved by RECs was also viewed as an important precondition for membering RECs. Participants suggested online submissions (n = 127, 69.8%), virtual meetings (n = 99, 54.4%), and fast evaluation schedules for low-risk research protocols (n = 77, 42.3%) during the COVID-19 pandemic.

Conclusion: Healthcare professionals comprehend the basics of REC duties and responsibilities. However, improvements in the consistency and efficiency of ethics evaluations are still warranted. The COVID-19 pandemic stressed the importance of adaptive REC procedures; researchers, editors, and publishers learned a vitally important lesson. More efforts are warranted to increase REC member training, simplify administrative procedures, and define standard operating procedures in times of crisis. Continuous progress in these areas will allow RECs to maintain high ethical standards while supporting productive research. Editors and publishers will greatly benefit from related advances in research ethics considerations.

Cartoons in scholarly publishing are effective ways to improve communication and engagement. They can transform scientific concepts into visually interesting and easy-to-understand formats, thereby helping the concepts reach to larger groups more easily. Depending on the type of cartoons (concept cartoons, humor illustrations, and editorial cartoons), benefits may vary. It is recommended to maintain relevance, elegance, and quality in cartoon presentations. Potential insults must be carefully avoided to maintain respectful communication. The objectives of the current article were to examine the complex roles of cartoons in scholarly publishing, to provide recommendations for drawing scientific cartoons, and to discuss challenges in incorporating cartoons into scientific publishing.