Academic Medicine Is Patient-Centered Medicine

The tripartite mission of ‘academic medicine’ is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on ‘a patient-centered approach,’ which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries’ healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.ope

Implantable Cardioverter-Defibrillator (ICD) Therapy: Initial Clinical Experience in 6 Patients

Sudden cardiac death accounts for approximately half of all cardiovascular mortality in the industrialized countries and ventricular tachyarrhythmia is the most common mechanism for this event. Implantable cardioverter-defibrillator (ICD) has been effectively used for prevention of sudden cardiac death in patients with life-threatening ventricular tachyarrhythmias since 1980. Clinical experience with ICD device now exceeds 100,000 implants worldwide and the number of implantation is increasing. In Korea, there is also increasing trend of ICD implantation. The authors report the initial experience of of ICD implantation in 6 patients who had high risk of sudden cardiac death.ope

A Case of Torsades de Pointes Induced by Cisapride

Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.ope

Is the Accreditation in Medical Education an Opportunity or a Burden?

The accreditation process (AccP) is both an opportunity and a burden for medical schools—which one it becomes depends on how medical schools recognize and utilize the AccP. In other words, if a medical school recognizes the AccP only as a formal procedure or as a means for continuing medical education, it will be a burden for the medical school. However, if a medical school recognizes the real and positive value of the AccP, it can be both an opportunity and a tool for developing medical education. The educational value of the AccP is to improve the quality, equity, and efficiency of medical education, along with increasing the options of choice. In order for the AccP to contribute to the development of medical education, accrediting agencies and medical schools must first be recognized as part of an “educational alliance” working together towards common goals. Secondly, clear guidelines on the accreditation standards should be periodically reviewed and shared. Finally, a formative evaluation using self-evaluation as a system that can utilize the AccP as an opportunity to develop medical education must be introduced. This type of evaluation system could be developed through collaboration among medical schools, academic societies for medical education, and the accrediting authority.ope

Electrophysiologic and Clinical Characteristics of Antidromic Reentrant Tachycardia in Ventricular Preexcitation Syndrome

Background：Antidromic reentrant tachycardia(ART), in which an accessory atrioventricular pathway is used as the anterograde limb of an atrioventricular reentrant tachycardia, has been documented clinically in less than 10% of patients with the Wolff-Parkinson-White(WPW) syndrome. The wide QRS complex makes the distinction between antidromic AV reentrant tachycardia and ventricular tachycardia somewhat difficult. The purpose of this study is to evaluate the clinical and electrophysiologic characteristics of the antidromic reentrant tachycardia. Methods and Results：During the electrophysiologic study of 355 patients, from December 1986 to April 1995, referred for evaluation of Wolff-Parkinson-White syndrome, 18(5.1%) patients had preexcited reciprocating tachycardia. 1) The age of the antidromic reentrant tachycardia patients ranged from 15 to 53 years(28±12), and the mean age was younger than that of orthodromic reentrant tachycardia(ORT) patients(p<0.05). 2) Thirteen were male patients, five were females. 3) There were associated heart diseases in 3 cases. Two patients had Ebstein’s anomaly and one had valvular heart disease. 4) The locations of accessory pathways(APs) documented on surface ECG were 7 left side(39%), 9 right side(50%), 1 posteroseptal side(5.5%) and 1 anteroseptal side. 5) Multiple bypass tracts were documented by electrophysiologic study in 7/18(38.9%) cases with ART, more common than cases with ORT(20/337(5.9%))(p<0.05). 6) 25 accessory pathways were documented by EPS in 18 patients(10 left side, 11 right side, 2 posteroseptal side and 2 anteroseptal side). ART patients had more right sided AP(11/25, 44%) than those with ORT(98/357, 27.5%), but ART patients had less posteroseptal AP(2/25, 8%) than those with ORT(63/357, 17.6%).ope

A Case Report of Percutaneous Transluminal Angioplasty with Stenting in Treatment of Superior Mesenteric Artery Stenosis

Percutaneous transluminal angioplasty(PTA) was first described by Dotter and Jukins in 1964 and subsequently modified by Gruentzig and Hoff in 1974. PTA has proved a safe and effective treatment for focal atherosclerotic disease of the aorta and its major extremity branches. The complications of PTA of the peripheral vessels are less frequent and less serve than those associated with the comparable surgical procedure. Intestinal angina is a clinical syndrome compromising postprandial abdominal pain, nausea, vomiting, diarrhea, weight loss, and eventually fear of eating. The syndrome is thought to be due to visceral ischemia, with stenosis or occlusion of the three visceral arteries being necessary for the syndrome to occur. Although the first report of mesenteric PTA appeared in 1980, the series of PTA with stenting of the visceral arteris reported in the literature have been small or included limited follow-up. We report a case of a intestinal angina due to superior mesenteric arterial stenosis. A 69-year-old male complained of serve postprandial pain, chronic diarrhea for 1 year. PTA with stening in superior mesenteric artery results in recannulation of obstructed artery and relief of symptom.ope

Medical Students’ Perceived Changes in Life, Mental Health Problems, and Strategies for Coping with Stress during the COVID-19 Pandemic

This study aimed to examine the influence of the coronavirus disease 2019 (COVID-19) pandemic on areas of Korean medical students’ lives, assess concerns, and investigate the strategies they used to cope with stress due to the pandemic. An online survey with a total of 53 items on the impact of COVID-19, concerns, and coping strategies was sent to medical students, and responses were collected from April 27, 2021 to May 30, 2021. In total, 1,329 students were included in the study. Analysis was performed using the chi-square test, independent-sample t-test, and one-way analysis of variance, and the post-hoc Scheffé test or Games-Howell test was performed for multiple comparisons. The main negative impacts of the pandemic were on hobbies/leisure activities and mental health, and medical students expressed the highest levels of concern regarding restriction of movement, returning to everyday life, and risk of infection for family and friends. Female students more strongly agreed that COVID-19 had increased their depressed mood and anxiety (p<0.001 and p=0.003, respectively). Furthermore, the negative impacts of the pandemic on different areas of life significantly affected current levels of depressed mood and anxiety. To cope with pandemic-related stress, students used several strategies such as talking with family or friends (91.5%), sleeping (83.1%), exercising (72.8%), using social networking services (60.8%), drinking alcohol (37.8%), and practicing meditation/mindfulness (24.4%); the effectiveness of these strategies ranged from 3.45 to 4.19 on a 5-point Likert-type scale (1–5). The study findings suggest that COVID-19 has influenced the mental health of medical students and raised concerns in many areas of their lives. Students used various strategies to cope with the pandemic-related stress; since the effectiveness of frequently used approaches varied, it is essential to guide medical students to develop effective coping strategiesope

Development and Implementation of a Learning Community in the Curriculum for Undergraduate Medical Students

Learning communities in medical education have demonstrated favorable outcomes in terms of students' learning, professional development, and wellness. Despite these strengths and the widespread adoption of learning communities in US medical schools, there has been little interest in medical learning communities in Korea. In this context, the present study examined the development and implementation of the Yonsei Medical Learning Community (YMLC) and analyzed its outcomes and areas of improvement. The Yonsei University College of Medicine has operated a learning community as part of the undergraduate medical education curriculum since 2014. The YMLC is the first program of its type in Korea. The overall structure of the YMLC consists of four distinct communities (pillars), which are named after four distinguished alumni, and each pillar is organized into five learning community classes. Each class is vertically integrated across students in different medical school years, and one faculty advisor is matched to about 30 students. As the YMLC focuses on fostering reflective practice in students and providing them with opportunities to build teamwork and experience social relatedness, two educational approaches have been adopted: reflective writing and mentoring and community activities. In this study, we obtained and analyzed second-year students' feedback on the YMLC curriculum and identified its achievements, merits, and areas that need improvement. The results have shown that over 75% and 60% of respondents reported satisfaction with reflective writing and mentoring and community activities, respectively. The educational activities of the learning community helped students regularly reflect on their learning and progress and establish close relationships with faculty advisors. However, several areas of improvement regarding content, format, and logistical issues were also identified. The present findings may provide valuable information for other institutions to develop learning communities relevant to their own context.ope

Development of Competencies for New Nurses and Verification of Content Validity through a Delphi Survey

The purpose of this study was to develop and validate a competency tool for new nurses and to pilot-test it with new nurses. A Delphi survey was conducted to develop a competency tool, and a self-evaluation was conducted among new nurses who pilot-tested the finally derived competencies. The Delphi survey panel consisted of 18 people, including adjunct professors at the College of Nursing, nursing managers, and nurses with master’s degrees. The Delphi survey asked about the validity of the competencies constructed in two rounds. After analyzing the Delphi results with mean, standard deviation, content validity ratio, degrees of convergence, and degrees of consensus, 12 core competencies and 36 enabling competencies were finally derived. The competencies consisted of clinical judgment and management (nine items), task competence (four items), patient orientation (five items), moral value orientation (three items), cooperation (two items), supply management (two items), professional development (three items), confidence (one item), self-control (two items), flexibility (two items), influence (one item), and nurturing others (two items). The finally derived competencies were pilot-tested with 229 new nurses who had worked for 2–12 months. The self-evaluation scores of new nurses were distributed differently according to their working period. In this study, the competencies required for new nurses were identified and the corresponding enabling competencies were identified. In the future, it is expected that a competency-based education program will be prepared based on these findings, and furthermore, it will be possible to provide high-quality medical and nursing services that meet patients’ needs by improving the competency of new nurses and lowering the turnover rate.ope

Comparision of the Efficacy of Propafenone and Flecainide in Patients with Atrial Fibrillation

Background：Atrial fibrillation is one of the most common cardiac arrhythmias which has been received relatively little attention until recently. Despite the variety of treatment modalities including drugs, surgery, catheter ablation and devices, the overall treatment of atrial fibrillation is not always satisfactory. Pharmacotherapy is still the most commonly used treatment though the unfavorable side effects of antiarrhythmic drugs are problematic. The purpose of this study is to compare the efficacy of class Ic antiarrhythmic drugs, propafenone versus flecainide. Methods：We treated one hundred eighteen patients with atrial fibrillation by class Ic antiarrhythmic durgs, propafenone or flecainide with/without DC cardioversion to convert to and maintain the sinus rhythm. We compared the clinical findings, drug efficacy, side effects of durgs between two groups. Results：30 patients were treated by propafenone and 88 patients by flecainide. 21 and 60 patients in each group were lone atrial fibrillation, 14 and 49 patients were paroxysmal atrial fibrillation. Mean duration of drug administration were 360.9, 339.4 days, respectively. The convesion rate to sinus rhythm by drugs was 25.0% in propafenone group and 30.7% in flecainide group(p=NS). The 300 days-manitenance rates of sinus rhythm after conversion by drugs or DC cardioversion were 63.3%, 70.4%(p=NS)respectively. The side effects of durgs were dizziness, nausea and vomitting in both group and 1st degree AV block, transient sinus node dysfunction and decreased visual acuity in flecainde group. The drugs were discontinued in 11(37.7%) and 26(29.5%) patients in each group due to recurrence of atrial fibrillation or side effects of drugs. Conclusion：This study suggests that propafenone and flecainide are comparably effective in － 861 － maintaining sinus rhythm in atrial fibrillation patients. Further prospective and large study is required to confirm this findings.ope