Experiences and perspectives on patient-centered education of medical students in Korea

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

Good Glycemic Control Is Associated with Better Survival in Diabetic Patients on Peritoneal Dialysis: A Prospective Observational Study

BACKGROUND: The effect of glycemic control after starting peritoneal dialysis (PD) on the survival of diabetic PD patients has largely been unexplored, especially in Asian population. METHODS: We conducted a prospective observational study, in which 140 incident PD patients with diabetes were recruited. Patients were divided into tertiles according to the means of quarterly HbA1C levels measured during the first year after starting PD. We examined the association between HbA1C and all-cause mortality using Cox proportional hazards models. RESULTS: The mean age was 58.7 years, 59.3% were male, and the mean follow-up duration was 3.5 years (range 0.4-9.5 years). The mean HbA1C levels were 6.3%, 7.1%, and 8.5% in the 1(st), 2(nd), and 3(rd) tertiles, respectively. Compared to the 1(st) tertile, the all-cause mortality rates were higher in the 2(nd) [hazard ratio (HR), 4.16; 95% confidence interval (CI), 0.91-18.94; p = 0.065] and significantly higher in the 3(rd) (HR, 13.16; 95% CI, 2.67-64.92; p = 0.002) tertiles (p for trend = 0.005), after adjusting for confounding factors. Cardiovascular mortality, however, did not differ significantly among the tertiles (p for trend = 0.682). In contrast, non-cardiovascular deaths, most of which were caused by infection, were more frequent in the 2(nd) (HR, 7.67; 95% CI, 0.68-86.37; p = 0.099) and the 3(rd) (HR, 51.24; 95% CI, 3.85-681.35; p = 0.003) tertiles than the 1(st) tertile (p for trend = 0.007). CONCLUSIONS: Poor glycemic control is associated with high mortality rates in diabetic PD patients, suggesting that better glycemic control may improve the outcomes of these patients

Short-Term Effects of Combined Serial Casting and Botulinum Toxin Injection for Spastic Equinus in Ambulatory Children with Cerebral Palsy

PURPOSE: The purpose of this paper is to test the hypothesis that combination therapy of serial cast and botulinum toxin type A (BTX-A) injection can further enhance the effects of a BTX-A injection in ambulant children with cerebral palsy (CP) who have an equinus foot. MATERIALS AND METHODS: Children in group A (30 legs of 21 children) received a serial casting application after an injection of BTX-A, and children in group B (25 legs of 17 children) received only a BTX-A injection. Assessments were performed before the intervention and 1 month after the intervention. RESULTS: After the intervention, there were significant improvements in tone, dynamic spasticity, and passive range of motion (ROM) in both groups. However, the changes were greater in group A than in group B. Dimension D (standing) in Gross Motor Function Measure (GMFM)-66 was significantly improved in group A but not in group B. On the other hand, there were no significant changes in dimension E (walking, running, jumping) in GMFM-66 in either group. CONCLUSION: The results of our study suggest that a serial casting application after BTX-A injection can enhance the benefits of BTX-A injection in children with cerebral palsy.ope

The Association Between Mastication and Mild Cognitive Impairment In Korean Adults

Currently, a few of studies revealed that there is an association between mastication and cognitive impairment. There is no study of Korean adult representative samples in relation to mastication and cognitive decline. This study was to investigate the relationship between mastication and mild cognitive impairment in Korean adults. A population-based cross-sectional study was conducted in which a total of 7029 subjects (2987 men and 4042 women) over 45 years old were surveyed from the Korea Longitudinal Study on Aging (KLoSA), Round 5th survey. Logistic regression analysis was performed for the study data controlling for confounding factors such as age, gender, education, income, smoking, drinking, exercise, wearing denture, and the number of chronic diseases. Decreased chewing function is associated with mild cognitive impairment (odds ratio [OR] = 3.24, 95% confidence interval [CI] = 2.67–3.93) after controlling for confounding variables. In the participants who did not wear dentures, the reduction of chewing function was strongly correlated with mild cognitive impairment (OR = 3.97, 95% CI = 3.11–5.08). Mastication was associated with mild cognitive impairment. To prevent cognitive decline, health specialists should pay more attention to the decline of the mastication in people without dentures

Development of an approximate construction duration prediction model during the project planning phase for general office buildings

Accurate prediction of the construction duration is imperative to the reliable cash flow analysis during the project planning phase when feasibility analysis is carried out. However, lack of information and frequent changes that occur as a result of a negotiation process between the owner and the designer in defining the project scope make it difficult to compute real-time construction duration. Domestic and foreign models for calculating the construction durations cannot be readily applied to computation of construction duration for general office buildings in Korea specifically during the project planning phase as there is a limit in its applicability due to numerous restrictions. Moreover, there are no preceding studies suggesting different computational approaches to predict the entire construction duration for office buildings with the approximate construction duration concept during planning phase. Therefore, based on the collected performance data, this study proposes a multiple linear regression model that facilitates reliable prediction of approximate construction duration for office buildings in the project planning phase. The model will allow the owner and other stakeholders to predict the real-time construction duration using the basic information on office buildings and to assess the construction durations incorporating frequent changes during the project planning phase