Job stress and burnout affecting the mental health of Korean medical faculty members: constructing causality among latent variables / 한국의학교육

Purpose@#This study aims to examine whether perceived levels of job stress, burnout, and mental health are different according to demographic characteristics and working conditions and to investigate the direct and indirect effects of job stress and burnout on the mental health of medical faculty members. @*Methods@#The study sample consists of 855 faculty members in 40 medical schools nationwide in the 2020 Burnout of Faculty Members of Medical Schools in Korea data with a grant from the Korean Association of Medical Colleges. This study employed structural equation modeling to construct causality among latent variables in addition to t-test, analysis of variance, and correlation coefficients for bivariate analyses. @*Results@#Perceived job stress, burnout, and mental health levels of medical faculty members showed significant group differences by demographic characteristics and working conditions. Job stress directly affected mental health (β=0.215, p<0.01) and indirectly affected mental health via burnout (β=0.493, p<0.001). Thus burnout significantly mediated the relationship between job stress and the mental health of medical faculty members. @*Conclusion@#This study found that job stress has direct and indirect effects on the mental health of medical faculty members, and burnout partially mediated this relationship. Further studies need to intervene in job stress and burnout to prevent the adverse mental health of medical faculty members and to introduce proper measures to improve working conditions affecting job stress and burnout.

Needs and gaps of faculty development for medical schools / 한국의학교육

Purpose@#Current faculty development (FD) programs are mostly limited to medical education and often lack a comprehensive and systematic structure. Therefore, the present study aimed to explore the current status and needs of FD programs in medical schools to provide a basis for establishing FD strategies. @*Methods@#We conducted an online survey of medical school FD staff and professors regarding FD. Frequency, regression, and qualitative content analyses were conducted. FD programs were categorized into the classification frameworks. @*Results@#A total of 17 FD staff and 256 professors at 37 medical schools participated. There are gaps between the internal and external FD programs offered by medical schools and their needs, and there are gaps between the programs the professors participated in and their needs. Recent internal and external FD programs in medical schools have focused on educational methods, student assessment, and education in general. Medical schools have a high need for leadership and self-development, and student assessment. Furthermore, professors have a high need for leadership and self-development, and research. The number of participants, topics, and needs of FD programs varied depending on the characteristics of individual professors. @*Conclusion@#Medical schools should expand their FD programs to meet the needs of individuals and the changing demands of modern medical education. The focus should be on comprehensive and responsive programs that cover various topics, levels, and methods. Tailored programs that consider professors’ professional roles, career stages, and personal interests are essential for effective FD.

Factors Associated with Reaching Mid-Parental Height in Patients Diagnosed with Inflammatory Bowel Disease in Childhood and Adolescent Period

Background/Aims@#The recent update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease initiative has added normal growth in children as an intermediate target in Crohn’s disease and ulcerative colitis. We aimed to investigate factors associated with reaching midparental height (MPH) in patients diagnosed with inflammatory bowel disease in childhood and the adolescent period. @*Methods@#This multicenter retrospective observational study included pediatric patients with inflammatory bowel disease that had reached adult height. Factors associated with reaching MPH were investigated by logistic regression analyses. @*Results@#A total of 166 patients were included in this study (128 Crohn’s disease and 38 ulcerative colitis). Among them, 54.2% (90/166) had reached their MPH. Multivariable logistic regression analysis revealed that height Z-score at diagnosis and MPH Z-score were independently associated with reaching MPH (odds ratio [OR], 8.45; 95% confidence interval [CI], 4.44 to 17.90;p<0.001 and OR, 0.11; 95% CI, 0.04 to 0.24; p<0.001, respectively). According to the receiver operating characteristic curve analysis, the optimal cutoff level of "height Z-score at diagnosis minus MPH Z-score" that was associated with reaching MPH was –0.01 with an area under the curve of 0.889 (95% CI [0.835 to 0.944], sensitivity 88.9%, specificity 84.2%, positive predictive value 87.0%, negative predictive value 86.5%, p<0.001). @*Conclusions@#Height Z-score at diagnosis and MPH Z-score were the only factors associated with reaching MPH. Efforts should be made to restore growth in pediatric patients who present with a negative “height Z-score at diagnosis minus MPH Z-score.”

Clinical Experiences and Selection of Accessory Devices for Pediatric Endoscopic Foreign Body Removal: A Retrospective Multicenter Study in Korea

Background@#Swallowing of foreign bodies (FBs) is the most common indication of therapeutic endoscopy in children. Endoscopic removal may be necessary depending on the type of FB, age of the child, and location of the FB. We attempted to analyze the characteristics of each device used for the endoscopic removal of FBs in children. @*Methods@#Medical records of the patient’s age, sex, weight, type, location, size, shape, type of device used for endoscopic removal, and endoscopic time were retrospectively collected. @*Results@#A total of 424 FB removal procedures were analyzed. The average age of the patients at the time of FB removal was 4.1 ± 3.7 years. Coins were the most common FBs (192, 45.3%). The most common locations of the FBs were the esophagus (45.7%) and the stomach (48.3%), respectively. For a total of 371 cases, forceps were used in 96 cases (25.9%) for esophageal FBs and in 25 cases for gastric FBs (6.7%), while nets were used in 250 cases (67.4%) for gastric FBs retrieval; the average durations of the procedures were 7.2 ± 7.4 minutes, 8.5 ± 7.2 minutes, and 5.7 ± 7.3 minutes, respectively (P = 0.003). The procedure time was significantly shorter, in the group of patients with low body weights, when nets were used than when forceps were used to remove gastric FBs (P = 0.001). @*Conclusion@#The endoscopic procedure duration, in low-weight children, was shorter when retrieval nets were used than that with forceps.

The Optimal Time for Initiating Probiotics for Preterm and VeryLow-Birth-Weight Infants: A 10-Year Experience in a Single Neonatal Intensive Care Unit / 대한소아소화기영양학회지

Purpose@#The starting time for probiotic supplementation in preterm infants after birth varies widely. This study aimed to investigate the optimal time for initiating probiotics to reduce adverse outcomes in preterm or very low birth weight (VLBW) infants. @*Methods@#Medical records of preterm infants born at a gestational age (GA) of <32 weeks or VLBW infants in 2011–2020 were reviewed respectively. The infants who received Saccharomyces boulardii probiotics within 7 days of birth were grouped into an early introduction (EI) group, and those who received supplemented probiotics after 7 days of birth were part of the late introduction (LI) group. Clinical characteristics were compared between the two groups and analyzed statistically. @*Results@#A total of 370 infants were included. The mean GA (29.1 weeks vs. 31.2 weeks, p<0.001) and birth weight (1,235.9 g vs. 1491.4 g, p<0.001) were lower in the LI group (n=223) than in the EI group. The multivariate analysis indicated that factors affecting the LI of probiotics were GA at birth (odds ratio [OR], 1.52; p<0.001) and the enteral nutrition start day (OR, 1.47; p<0.001). The late probiotic introduction was associated with a risk of late-onset sepsis (OR, 2.85; p=0.020), delayed full enteral nutrition (OR, 5.44; p<0.001), and extrauterine growth restriction (OR, 1.67; p=0.033) on multivariate analyses after adjusting for GA. @*Conclusion@#Early supplementation of probiotics within a week after birth may reduce adverse outcomes among preterm or VLBW infants.

Clinical features of croups caused by severe acute respiratory syndrome coronavirus 2 and by other respiratory viruses: analysis in a tertiary hospital in Jinju, Korea during the period of dominance of the Omicron variant (B.1.1.529)

Purpose@#Croup is a clinical manifestation of coronavirus disease 2019 (COVID-19) in children. The Omicron variant of severe acute respiratory syndrome coronavirus 2 usually causes an upper respiratory tract infection. We investigated the differences between croups caused by COVID-19 and by other respiratory viruses (ORV). @*Methods@#We reviewed clinical characteristics, therapeutic measures, and the Westley Croup Score of children with croup who visited the emergency department of Gyeongsang National University Hospital from January 1 through April 7, 2022. According to the laboratory-confirmed viruses, they were divided into 2 groups: COVID-19 and ORV. Between the 2 groups, we compared the abovementioned features. Moderate-to-severe croup was defined by a Westley Croup Score of 3 or higher. @*Results@#A total of 20 children were diagnosed with croup caused by COVID-19 (n = 11; median age, 18 months) or by ORV (n = 9; 7 months). Median Westley Croup Score was higher in the COVID-19 group than in the ORV group (5.0 [range, 0-10.0] vs. 2.0 [1.0-5.0]; P = 0.031). Among the components of the scoring system, only stridor showed a significant difference (e.g., “stridor at rest”: COVID-19, 8 of 11 vs. ORV, 2 of 9; P = 0.046). Median C-reactive protein concentration was higher in the COVID-19 group (3.2 vs. 0.4 mg/L; P = 0.007). Severity of the COVID-19 group was marginally higher than that of the ORV group in terms of the median oxygen saturation (95% vs. 98%; P = 0.056) and the proportions of moderate-to-severe croup (9 of 11 vs. 3 of 9; P = 0.065) and application of high-flow nasal cannula (4 of 11 vs. 0 of 9; P = 0.094). @*Conclusion@#Croup caused by COVID-19 during the period of dominance of the Omicron variant outbreak might be more severe than croup caused by ORV.

Obesity Is a Related Factor With Severe COVID-19 Pneumonia in Children: A Case Series

A small proportion of children with coronavirus disease 2019 (COVID-19) develop severe pneumonia. We reported the severe COVID-19 pneumonia in children aged <18 years with COVID-19 treated with remdesivir and dexamethasone from August 2021 to November 2021 by a retrospective review of their medical records. Eight children were included (5 males and 3 females). Their median age was 16 years (range: 9 to 17 years) and their median body mass index was 30.5 kg/m 2 (range: 22.8–38.5 kg/m 2 ). All patients had fever and dyspnea with hypoxia. Chest radiographic findings were variable and included diffuse or multifocal consolidation, nodules, and ground-glass opacities in the lungs. After receiving intravenous remdesivir and dexamethasone, 7 of the 8 children experienced an improvement in their symptoms within 2 days. In our case series, obesity was present in 6 out of 8 children with severe COVID-19 pneumonia.

Burnout of Faculty Members of Medical Schools in Korea

Background@#There is no national survey on medical school faculty members’ burnout in Korea. This study aimed to investigate burnout levels and explore possible factors related to burnout among faculty members of Korean medical schools. @*Methods@#An anonymous online questionnaire was distributed to 40 Korean medical schools from October 2020 to December 2020. Burnout was measured by a modified and revalidated version of the Maslach Burnout Inventory-Human Service Survey. @*Results@#A total of 996 faculty members participated in the survey. Of them, 855 answered the burnout questions, and 829 completed all the questions in the questionnaire. A significant number of faculty members showed a high level of burnout in each sub-dimension: 34% in emotional exhaustion, 66.3% in depersonalization, and 92.4% in reduced personal accomplishment. A total of 31.5% of faculty members revealed a high level of burnout in two sub-dimensions, while 30.5% revealed a high level of burnout in all three sub-dimensions.Woman faculty members or those younger than 40 reported significantly higher emotional exhaustion and depersonalization. Long working hours (≥ 80 hours/week) showed the highest reduced personal accomplishment scores (F = 4.023, P = 0.018). The most significant stressor or burnout source was “excessive regulation by the government or university.” The research was the most exasperating task, but the education was the least stressful. @*Conclusion@#This first nationwide study alerts that a significant number of faculty members in Korean medical schools seem to suffer from a high level of burnout. Further studies are necessary for identifying the burnout rate, related factors, and strategies to overcome physician burnout.

Recent Changes in the Treatment of Helicobacter pylori Infection in Children and Adolescents

Treatments aimed at eradicating Helicobacter pylori (H. pylori) infections in children and adolescents should be clearly beneficial. According to the updated guidelines, a 14-day triple therapy or bismuth-based triple therapy is the first choice for treatment of children based on the results of antimicrobial sensitivity testing. Though culturing H. pylori using biopsy specimens is not always feasible, it should be performed for establishing empirical rescue therapy for patients not responding to first-line eradication therapy. The European and North American therapeutic strategies for children and adolescents with H. pylori infections may not be appropriate for treating children and adolescents in other countries owing to regional differences in epidemiological characteristics of H. pylori. The existence of clarithromycin-resistant H. pylori is an important factor involved in eradication failure. The development of new treatment-related allergies, treatment failure, side effects, and alteration of the gut microbiome have been highlighted as factors potentially outweighing the possible benefit of preventing future peptic ulcers or gastric cancer. Drug compliance can be improved by providing a detailed explanation of the reason for therapy, duration, and routes of drug administration. Physicians should understand the mechanisms underlying eradication treatment and explain drug prescriptions in detail to both parents and children to increase compliance. Herein, we reviewed the indications for and various modalities of eradication treatment in children with H. pylori infections in accordance with a review of recently published articles.

Recent Changes in the Treatment of Helicobacter pylori Infection in Children and Adolescents

Treatments aimed at eradicating Helicobacter pylori (H. pylori) infections in children and adolescents should be clearly beneficial. According to the updated guidelines, a 14-day triple therapy or bismuth-based triple therapy is the first choice for treatment of children based on the results of antimicrobial sensitivity testing. Though culturing H. pylori using biopsy specimens is not always feasible, it should be performed for establishing empirical rescue therapy for patients not responding to first-line eradication therapy. The European and North American therapeutic strategies for children and adolescents with H. pylori infections may not be appropriate for treating children and adolescents in other countries owing to regional differences in epidemiological characteristics of H. pylori. The existence of clarithromycin-resistant H. pylori is an important factor involved in eradication failure. The development of new treatment-related allergies, treatment failure, side effects, and alteration of the gut microbiome have been highlighted as factors potentially outweighing the possible benefit of preventing future peptic ulcers or gastric cancer. Drug compliance can be improved by providing a detailed explanation of the reason for therapy, duration, and routes of drug administration. Physicians should understand the mechanisms underlying eradication treatment and explain drug prescriptions in detail to both parents and children to increase compliance. Herein, we reviewed the indications for and various modalities of eradication treatment in children with H. pylori infections in accordance with a review of recently published articles.

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child

Web in common bile duct (CBD web) is very rare. It is usually asymptomatic and detected incidentally during surgery for other causes in adults. It can be congenital or acquired, however congenital CBD web is extremely rare. Currently, despite its invasiveness and complications, endoscopic retrograde cholangiopancreatography (ERCP) is considered as a useful diagnostic and therapeutic modality in children with hepatobiliary pancreatic diseases as in adults. Herein we report a case of congenital CBD web presenting with acute pancreatitis and choledocholithiasis in a 4-year-old girl which was diagnosed and treated using balloon dilation under ERCP. After balloon dilation of the web, a common pancreatobiliary channel was observed. To the best of our knowledge, a case of congenital CBD web with pancreatobiliary junctional abnormality treated using ERCP in a child has not been reported to date.

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child

Web in common bile duct (CBD web) is very rare. It is usually asymptomatic and detected incidentally during surgery for other causes in adults. It can be congenital or acquired, however congenital CBD web is extremely rare. Currently, despite its invasiveness and complications, endoscopic retrograde cholangiopancreatography (ERCP) is considered as a useful diagnostic and therapeutic modality in children with hepatobiliary pancreatic diseases as in adults. Herein we report a case of congenital CBD web presenting with acute pancreatitis and choledocholithiasis in a 4-year-old girl which was diagnosed and treated using balloon dilation under ERCP. After balloon dilation of the web, a common pancreatobiliary channel was observed. To the best of our knowledge, a case of congenital CBD web with pancreatobiliary junctional abnormality treated using ERCP in a child has not been reported to date.

Evaluation of Ultrasonography and CT for Imaging of Head and Neck Pilomatricoma in Children and Adolescents / 대한이비인후과학회지

Background and Objectives@#Pilomatricoma is a frequently diagnosed skin lesion of the head and neck that may often be misdiagnosed as other skin lesions. This study evaluated whether ultrasonography (USG) or computed tomography (CT) is the most helpful imaging modality for the accurate preoperative diagnosis of pilomatricoma in head and neck regions of children and adolescents.Subjects and Method A retrospective review was conducted for 59 patients with pilomatricoma under the age of 19 years. All cases were pathologically confirmed with pilomatricoma in the head or neck. @*Results@#Preoperative imaging examinations were performed with USG in six cases and with CT in nine cases. The accuracy of preoperative diagnosis was compared between three groups: 1) with clinical findings only, 2) with USG, and 3) with CT. The correct preoperative diagnosis was made in 18 (30.5%) of the total of 59 cases. Using only clinical findings, 10 (22.7%) out of 44 patients were diagnosed as pilomatricoma. With the addition of USG, pilomatricoma was diagnosed in 1 (16.7%) out of six cases, whereas with the addition of CT, 7 (77.8%) out of 9 cases (77.8%) were diagnosed correctly. Preoperative diagnosis of pilomatricoma with CT imaging was more accurate than clinical findings only (vs. CT; odds ratio [OR]=11.900, 95% confidence interval [CI] 2.126-66.615; p=0.001) or USG (vs. CT; OR=17.500, 95% CI 1.223-250.357; p=0.020). @*Conclusion@#In the preoperative diagnosis of pilomatricoma, imaging modalities such as CT and USG are helpful, with CT offering higher diagnostic accuracy and USG procedural benefits in younger children.

Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Nationwide “Pediatric Nutrition Day” survey on the nutritional status of hospitalized children in South Korea

BACKGROUND/OBJECTIVES@#To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. @*SUBJECTS/METHODS@#This first cross-sectional nationwide “Pediatric Nutrition Day (pNday)” survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. @*RESULTS@#At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively.During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. @*CONCLUSIONS@#Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Severe Gastrointestinal Hemorrhage in a Child after Taking an Improper Oral Rehydration Solution / 대한소아소화기영양학회지

Oral rehydration solution (ORS) is safe and effective for the prevention and treatment of dehydration in children. It has been commercially available as a small packaging unit that needs to be taken with a specified amount of water. Intake of incorrectly formulated ORS results in side effects, such as electrolyte imbalance and upper gastrointestinal (GI) disturbance. We experienced a case of severe GI hemorrhage from gastric and duodenal ulcers in a previously healthy child following intake of incorrectly formulated ORS. GI hemorrhage in children is often life threatening and reaching a diagnosis may be challenging. Commercially manufactured packets of powdered oral rehydration salts have been widely used and GI hemorrhage associated with an improperly diluted ORS has been rarely reported. Caution and education for proper preparation of ORS are imperative.

Effect of nutritional supplement formula on catch-up growth in young children with nonorganic faltering growth: a prospective multicenter study

BACKGROUND/OBJECTIVES@#Inadequate nutrition in infants and young children affects physical growth and neurocognitive development. Therefore, early nutritional intervention is important to promote catch-up growth in young children with faltering growth. The aim of this study was to evaluate the effect of nutritional supplementation with a pediatric concentrated and balanced nutritional supplement formula on promoting growth and improving nutritional status in children with nonorganic faltering growth. @*SUBJECTS/METHODS@#Children aged 12–36 months whose body weight-for-age was < 5th percentile on the Korean Growth Charts were enrolled. Children born premature or having organic diseases were excluded. Children were instructed to consume 400 mL of formula per day in addition to their regular diet for 6 months. Pediatricians and dietitians educated the parents and examined the subjects every 2 months. Anthropometric parameters were measured at baseline and at 2, 4, and 6 months, and laboratory tests were done at baseline and 6 months. The good consumption group included children who consumed ≥ 60% of the recommended dose of formula. @*RESULTS@#Total 82 children completed the 6-month intervention. At baseline, there were no significant differences in all variables between the good consumption and poor consumption groups. Weight and weight z-scores were significantly improved in the good consumption group compared to the poor consumption group at the end of the intervention (P = 0.009, respectively). The good consumption group showed a significant trend for gaining weight (P < 0.05) and weight z-score (P < 0.05) compared to the poor consumption group during 6 months of formula intake. The concentration of blood urea nitrogen was significantly increased in the good consumption group (P = 0.001). @*CONCLUSIONS@#Nutritional supplementation with a concentrated and balanced pediatric nutritional formula along with dietary education might be an effective approach to promote catch-up growth in children with nonorganic faltering growth.

Clinical performance of medical students in Korea in a whole-task emergency station in the objective structured clinical examination with a standardized patient complaining of palpitations / 보건의료교육평가

This study assessed the clinical performance of 150 third-year medicalstudents in Busan, Korea in a whole-task emergency objective structured clinical examination station that simulated a patient with palpitations visiting the emergency department. The examination was conducted from November 25 to 27, 2019. Clinical performance was assessed as the number and percentage of students who performed history-taking (HT), a physical examination (PE), an electrocardiography (ECG) study, patient education (Ed), and clinical reasoning (CR), which were items on the checklist. It was found that 18.0% of students checked the patient’s pulse, 51.3% completed an ECG study, and 57.9% explained the results to the patient. A sizable proportion (38.0%) of students did not even attempt an ECG study. In a whole-task emergency station, students showed good performance on HT and CR, but unsatisfactory results for PE, ECG study, and Ed. Clinical skills educational programs for subjected student should focus more on PE, timely diagnostic tests, and sufficient Ed.

Clinical performance of medical students in Korea in a whole-task emergency station in the objective structured clinical examination with a standardized patient complaining of palpitations / 보건의료교육평가

This study assessed the clinical performance of 150 third-year medicalstudents in Busan, Korea in a whole-task emergency objective structured clinical examination station that simulated a patient with palpitations visiting the emergency department. The examination was conducted from November 25 to 27, 2019. Clinical performance was assessed as the number and percentage of students who performed history-taking (HT), a physical examination (PE), an electrocardiography (ECG) study, patient education (Ed), and clinical reasoning (CR), which were items on the checklist. It was found that 18.0% of students checked the patient’s pulse, 51.3% completed an ECG study, and 57.9% explained the results to the patient. A sizable proportion (38.0%) of students did not even attempt an ECG study. In a whole-task emergency station, students showed good performance on HT and CR, but unsatisfactory results for PE, ECG study, and Ed. Clinical skills educational programs for subjected student should focus more on PE, timely diagnostic tests, and sufficient Ed.

Risk Factors and Effects of Severe LateOnset Hyponatremia on Long-Term Growth of Prematurely Born Infants / 대한소아소화기영양학회지

Purpose@#Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called lateonset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. @*Methods@#Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. @*Results@#A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. @*Conclusion@#Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.