Last one quarter century has witnessed the enlightenment of social and behavioral science in medicine. The aims of incorporating social and behavioral science in medical education are to equip future physicians with nonbiomedical clinical competencies. The contents of this "soft science of medicine" include mind-body interactions in health and disease, patient behavior, physician role and behavior, physician-patient interactions, social and cultural issues in health care, helath policy and economics, etc. Up to now, the integration of social and behavioral science in medical school curriculum are of less than satifaction due to several barriers. By broadening the perspectives of various domains of social and behavioral science and by collaborating with the professionals from other fields of medicine, psychiatrists should potentially play important roles in educational leadership.
Behavioral Medicine* ; Behavioral Sciences ; Curriculum* ; Delivery of Health Care ; Education, Medical ; Humans ; Interpersonal Relations ; Leadership* ; Physician's Role ; Psychiatry* ; Schools, Medical

Last one quarter century has witnessed the enlightenment of social and behavioral science in medicine. The aims of incorporating social and behavioral science in medical education are to equip future physicians with nonbiomedical clinical competencies. The contents of this "soft science of medicine" include mind-body interactions in health and disease, patient behavior, physician role and behavior, physician-patient interactions, social and cultural issues in health care, helath policy and economics, etc. Up to now, the integration of social and behavioral science in medical school curriculum are of less than satifaction due to several barriers. By broadening the perspectives of various domains of social and behavioral science and by collaborating with the professionals from other fields of medicine, psychiatrists should potentially play important roles in educational leadership.
Behavioral Medicine* ; Behavioral Sciences ; Curriculum* ; Delivery of Health Care ; Education, Medical ; Humans ; Interpersonal Relations ; Leadership* ; Physician's Role ; Psychiatry* ; Schools, Medical

PURPOSE: The purpose of this research was to identify the effectiveness of a standardized patient (SP) instructor. The study was performed to compare the effects of two types of instruction on breast examination skills by an SP instructor and a professor. METHODS: Fifty-four medical students in the third year and 4 SPs participated in the study. In a pretest, each student was judged by the SP individually in performing a breast examination and completed a questionnaire about perception. Next, students were randomly assigned to 2 experimental groups (small-group instruction by an SP instructor or professor). A posttest of performance and perception was administered using the same procedures as in the pretest. To identify the effectiveness of the SP instructor, differences in student scores between the groups were analyzed by t-test. RESULTS: In the posttest of student performance on the breast examination, there was no significant difference between the groups (p=0.270). With regard to student perception, scores on self-confidence in the breast examination were significantly different (p=0.026) between the groups, of which students who received instruction from the professor showed a higher level. Additionally, there was a significant effect on students' perceived reliability of instruction by the SP instructor (p=0.011), and students who were instructed by the SP demonstrated higher reliability compared with professor-taught students. CONCLUSION: Instruction by an SP instructor has the same effectiveness as instruction by a professor. SP instructors have very powerful effects on student performance and perception.
Breast ; Humans ; Patient Simulation ; Physical Examination ; Students, Medical ; Surveys and Questionnaires

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.

A 43-year-old woman who had received kidney transplantation 2 years before was admitted for masses on both axilla. Masses had variable sizes, and were round or oval-shaped with echogenicity on breast ultrasound. Pathologic examination using fine needle aspiration showed masses were fibroadenoma, fibroadenoid hyperplasia, and fat necrosis. We switched cyclosporine to tacrolimus. After 6 months of conversion, breast masses decreased in size on the follow-up breast USG.
Adult ; Axilla ; Biopsy, Fine-Needle ; Breast ; Cyclosporine ; Fat Necrosis ; Female ; Fibroadenoma ; Follow-Up Studies ; Humans ; Hyperplasia ; Kidney ; Kidney Transplantation ; Tacrolimus ; Transplants

INTRODUCTION: Pericardiocentesis is a potentially life-saving procedure. We compared two low-cost models-an agar-based model and a novel model, Centesys-in terms of ultrasound image quality and realism, effectiveness of the model, and learners' confidence and satisfaction after training. METHODS: In this pilot randomised 2x2 crossover trial stratified by physician seniority, participants were assigned to undergo pericardiocentesis training either with the agar-based or Centesys model first, followed by the other model. Participants were asked to rate their confidence in performing ultrasound-guided pericardiocentesis, clarity and realism of cardiac structures on ultrasound imaging, and satisfaction on a 7-point Likert scale before and after training with each model. RESULTS: Twenty participants with median postgraduate year of 4 (interquartile range [IQR] 3.75-6) years were recruited. Pre-training, participants rated themselves a median score of 2.5 (IQR 2-4) for level of confidence in performing pericardiocentesis, which improved to 5 (IQR 4-6) post-training with Centesys ( CONCLUSION Centesys achieved greater learner satisfaction as compared to the agar-based model, and was an effective tool for teaching ultrasound-guided pericardiocentesis and drain insertion.

Hypertonia is a neurological dysfunction associated with a number of central nervous system disorders, including cerebral palsy, Parkinson's disease, dystonia, and epilepsy. Genetic studies have identified a homozygous truncation mutation in Trak1 that causes hypertonia in mice. Moreover, elevated Trak1 protein expression is associated with several types of cancers and variants in Trak1 are linked to childhood absence epilepsy in humans. Despite the importance of Trak1 in health and disease, the mechanisms of Trak1 action remain unclear and the pathogenic effects of Trak1 mutation are unknown. Here we report that Trak1 has a crucial function in regulation of mitochondrial fusion. Depletion of Trak1 inhibits mitochondrial fusion, resulting in mitochondrial fragmentation, whereas overexpression of Trak1 elongates and enlarges mitochondria. Our analyses revealed that Trak1 interacts and colocalizes with mitofusins on the outer mitochondrial membrane and functions with mitofusins to promote mitochondrial tethering and fusion. Furthermore, Trak1 is required for stress-induced mitochondrial hyperfusion and pro-survival response. We found that hypertonia-associated mutation impairs Trak1 mitochondrial localization and its ability to facilitate mitochondrial tethering and fusion. Our findings uncover a novel function of Trak1 as a regulator of mitochondrial fusion and provide evidence linking dysregulated mitochondrial dynamics to hypertonia pathogenesis.
Adaptor Proteins, Vesicular Transport ; metabolism ; Animals ; HeLa Cells ; Humans ; Membrane Fusion ; Mice ; Mitochondria ; metabolism ; Mitochondrial Proteins ; deficiency ; metabolism ; Muscle Proteins ; deficiency ; metabolism ; Tumor Cells, Cultured