PURPOSE: There has been no exact criteria established for when to discontinue antiepileptic drugs (AEDs) in epileptic children who had been well controlled for a long period. This study was undertaken to evaluate the recurrence rate and predictive risk factors of relapse after discontinuation of AEDs in epileptic children who had been seizure-free. METHODS: We retrospectively studied 294 children whose discontinued AEDs therapy was after a long seizure-free period in Asan Medical Center. RESULTS: Seizure recurred in 59 patients(21.0%) after discontinuation of AEDs. The mean duration of follow-up after discontinuation was 4.0 years for the patients, the mean duration of the medication period was 3.5 years and the mean seizure-free period was 2.8 years. The factors associated with an increasing recurrence risk were old age at onset, long duration of seizure, old age at discontinuation of AEDs and abnormal radiologic findings in univariate analysis. From multivariate analysis, the factors related to higher recurrence rate were old age at onset, long duration of seizure and abnormal radiologic findings. CONCLUSION: The majority of epileptic children who are older than 10 years, who have developed seizures for longer than six years and who show abnormal radiologic findings will easily relapse. The patients who do not have the additional risk factors noted above may have an excellent chance to remain seizure-free after the discontinuation of AEDs, so patient in the latter group can consider the discontinuation of AEDs.
Anticonvulsants* ; Child* ; Chungcheongnam-do ; Epilepsy ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Seizures

There are a few reports about bradycardia or asystole caused by direct laryngoscopy. However, we encountered severe bradycardia in response to suspension laryngoscopy for laryngeal polypectomy after safely completing tracheal intubation using a direct laryngoscope with a curved blade. The tip of the curved blade of the direct laryngoscope is positioned at the vallecula (between the base of the tongue and the pharyngeal surface of the epiglottis) during tracheal intubation, while the blade tip of the suspension laryngoscope lifts the laryngeal surface of the epiglottis or supraglottic area during surgery. Therefore, suspension laryngoscopy can be said more vagotonic than curved-blade direct laryngoscopy. Because of the possibility of bradycardia induced by suspension laryngoscopy, clinicians must be careful about severe bradycardia even after safely completing intubation using direct laryngoscopy.
Bradycardia ; Epiglottis ; Heart Arrest ; Intubation ; Laryngoscopes ; Laryngoscopy ; Piperidines ; Tongue

PURPOSE: Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs). METHODS: The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores. Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group. RESULTS: Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01). Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01). CONCLUSION: Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure. Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.
Clinical Clerkship ; Clinical Competence ; Humans ; Research Subjects ; Schools, Medical ; Students, Medical ; Track and Field

OBJECTIVE: The aim of our study is to describe the experience of delivery training for medical students by using a birth simulator as an educational tool during obstetrical clinical clerkship. METHODS: Study participants were 35 third year medical students of K medical school in Seoul. We have developed birth simulation courses using the robot birth simulator (S555 Noelle(TM). Maternal Neonatal Simulation System. Gaumard scientific, Coral Gables, FL.). During 4 weeks clinical clerkship, clinical teacher gave 90 minutes delivery practice session to students by one-to-one basis with birth simulator. After 4 weeks clinical experience, clinical teacher assessed students' delivery performance using birth simulator. Also students completed self-reported questionnaires to assess satisfaction with the teaching process and their perceptions of the effectiveness of simulation practice. RESULTS: Most students ranked delivery training with birth simulator as an interesting and useful way of understanding labor process and getting skills in obstetrics. And they assessed that they had more confidence to perform a vaginal delivery after the training. CONCLUSION: Simulation training with birth simulator during obstetrical clinical clerkship is an effective way to bridge the gap between the theory and the practice and augment clinical experience.
Anthozoa ; Clinical Clerkship ; Humans ; Obstetrics ; Parturition ; Surveys and Questionnaire ; Schools, Medical ; Students, Medical

The purpose of this article is to systematically review the literature that describes training and assessment that use an integrated patient simulator (IPS). We also tried to determine how to train learners with simulators, plan, and perform research on simulator-based education. Literature searches were conducted to identify articles from PubMed, EMBASE, and KMbase that were related to training and assessment that use an IPS, published from January 1999 to September 2008. Forty articles met the criteria and were analyzed. The results were as follows: Studies on IPS are the most common in graduate medical education (GME). The impact of IPS-based education is relatively greater in GME versus undergraduate medical education (UME) or continuing medical education (CME). IPS research in GME is characterized by addressing the effectiveness of clinical application, the training of procedures, and algorithms, rather than knowledge or simple skills. And research design is more elaborate in GME than UME or CME. IPS training in CME focuses mostly on specific clinical skills. Most training sessions in UME are offered to groups, but assessment is performed for a single student. Also, inter-rater reliability is checked unsatisfactorily in UME. IPS research in UME is characterized by limitations in design due to connections to the regular curriculum. According to findings above, we propose that: more detailed research design should be performed to overcome the limitations of UME research. For GME, increasing simulator-based training opportunities is desired, because its effectiveness and adaptability are relatively high.
Clinical Competence ; Computer Simulation ; Curriculum ; Education, Medical ; Education, Medical, Continuing ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Educational Measurement ; Humans ; Research Design ; Review Literature as Topic

PURPOSE: In this study, we compared the effects of constructivist and traditional teaching strategies in teaching advanced cardiac life support (ACLS) skills during simulation-based training (SBT). METHODS: A randomized, pre- and post-test control group study was designed to examine this issue in 29 third-year emergency medical technician (EMT) students. Participants received SBT through constructivist SBT (CSBT) or traditional lecture-based SBT (TSBT) teaching strategies. We evaluated the effects of the simulation training on ACLS knowledge, and performance immediately after practice and at retention. RESULTS: The knowledge and performance of the CSBT group were higher than compared with the TSBT group (mean knowledge 33.3+/-5.03 vs. 29.5+/-5.33, p=0.36; and mean performance 12.20+/-1.85 vs. 8.85+/-3.54, p=0.010). However, there was no difference between two groups in retention between groups 1 month later (mean knowledge 31.86+/-4.45 vs. 31.50+/-4.65, p=0.825; and mean performance 12.13+/-0.99 vs. 12.57+/-1.78, p=0.283). CONCLUSION: CSBT is more effective with regard to knowledge acquisition and performance than TSBT. Further studies are needed to explore ways of improving retention and transfer of knowledge from simulated to real situations with SBT.
Advanced Cardiac Life Support ; Emergency Medical Technicians ; Humans ; Retention (Psychology)

PURPOSE: Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem. METHODS: We reviewed the medical records of 64 patients (M: F=33: 31, mean age: 6.3+/-7.5 months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care: < or =7 days (group 1: 23 cases, M: F=10: 13) and > 7 days (group 2: 41 cases, M: F=23: 18). RESULTS: The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1 (P< 0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different (P=0.082). Among underlying diseases, the most common diseases were vascular anomaly (26.2 percent) and aortic arch anomaly (26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect (22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis (in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13 (68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems. CONCLUSION: Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.
Aorta, Thoracic ; Bronchoscopy ; Cardiovascular Diseases* ; Child* ; Chungcheongnam-do ; Heart Septal Defects, Ventricular ; Humans ; Infant* ; Medical Records ; Perioperative Period ; Prognosis ; Pulmonary Atresia ; Respiratory Sounds ; Tracheal Stenosis ; Tracheomalacia ; Ventilator Weaning ; Ventilators, Mechanical ; Weaning

PURPOSE: The purpose of this study was to examine the causes, clinical courses and outcomes in children with acute respiratory distress syndrome (ARDS), and evaluate the physiologic variables as prognostic factors in the patients. METHODS: Retrograde medical chart review was carried out in 24 patients who were diagnosed with ARDS at the pediatric intensive care unit (PICU) during 20-month period. RESULTS: The incidence of ARDS among all PICU admission was 3.7 percent and the mortality rate was 37.5 percent, which was 14.8 percent of overall deaths in PICU. The most common causes of ARDS were pneumonia and sepsis. We found significant differences between survivors and non- survivors in PaO2/FiO2 ratio (P/F ratio), alveolar arterial oxygen gradient and oxygenation index (OI) on the second day from the onset of ARDS. Therapies for ARDS such as high frequency oscillator ventilation (HFOV), recruitment maneuver and low dose corticosteroid improved the P/F ratio and OI, especially in survivors CONCLUSION: The mortality rate of children with ARDS was 37.5 percent; an important cause of death in PICU. HFOV, recruitment maneuver and low dose corticosteroid seemed to be effective in pediatric ARDS. The P/F ratio, alveolar arterial oxygen gradient and OI on the second day from the onset of ARDS may be useful as prognostic factors.
Cause of Death ; Child* ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Oxygen ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Sepsis ; Survivors ; Ventilation

PURPOSE: The use of mechanically-assisted ventilators at home reduces morbidity and improves the quality of life in children with chronic respiratory failure. But in Korea there is no clinical data of children with home mechanical ventilation. We investigated ventilator types, duration, the causes of failure or death, and the cost needed for care. METHODS: We retrospectively analyzed the medical records of 21 children who were admitted and who applied for home mechanical ventilation at the Pediatric Intensive Care Unit in Asan Medical Center. Phone interviews took place after discharge. and interviewed by phone after discharge. RESULTS: The median age was 31 months; the median duration with ventilator was 25 months. Underlying diseases were 16 neuromuscular diseases, one metabolic disease and four chronic respiratory diseases. The types of ventilator were pressure and volume type(16 and five patients, respectively). The frequency of ventilation failure was once per 19 months. Weaning could be performed in three cases. Frequencies of admission after receiving ventilators were 1.7 times per year; the most common cause was pneumonia. Nine patients(43%) died; four of them died because of endotracheal tube obstruction. The costs for medical care were about 1,110,000 won per month. CONCLUSION: There is an increment in the numbers of individuals who need mechanical ventilation support. The most common cause of death was endotracheal tube obstruction. The most important problem for the patients was medical cost. There needs to be more interest in patients with ventilator and social welfare systems to support their families need to be prepared.
Cause of Death ; Child* ; Chungcheongnam-do ; Humans ; Intensive Care Units ; Korea ; Medical Records ; Metabolic Diseases ; Neuromuscular Diseases ; Pneumonia ; Quality of Life ; Respiration, Artificial* ; Respiratory Insufficiency ; Retrospective Studies ; Social Welfare ; Ventilation ; Ventilators, Mechanical ; Weaning

PURPOSE: High self-awareness can promote communication and empathy. The Enneagram is a well-known personality tool to enhance self-awareness. We evaluated differences in empathy among medical students using the Enneagram typology. METHODS: This cross-sectional study included first and second grade students at the Inje University College of Medicine. The Jefferson Scale of Empathy was used to measure empathy and the Korean Enneagram Personality Type Indicator was used for examining personality characteristics. Empathy scores were analyzed according to the Triads, Hornevian group, Harmonic group, and each Enneagram type. RESULTS: The Instinctive triad, the Withdrawns, and the Positive outlook group were the most common, and the Feeling triad, the Assertives, and the Emotional realness group were the least common. Students in the Feeling triad and the Dutifuls had higher compassionate care (CC) scores as compared to their counterparts. Type 2 and 6 students showed the two highest empathy and CC scores. The empathy score of type 3 students was the lowest. Type 7 had the lowest CC score but the highest perspective taking score. CONCLUSION These differences in empathy according to Enneagram personality types can be applied to medical education to maintain and improve medical students' empathy.