Neuropathic shoulder arthropathy or Charcot's shoulder is an extremely rare disease, and sometimes it is associated with cervical syringomyelia. Clinical symptoms of the disease include edema of the shoulder and restriction in range of motion. Radiological diagnosis can be made through plain radiography through a characteristic, atrophic destruction of the joint. We experienced a Charcot's joint of the shoulder wherein destruction of the joint progressed extremely quickly and reviewed the literature concerning this condition.
Arthropathy, Neurogenic ; Diagnosis ; Edema ; Joints ; Radiography ; Range of Motion, Articular ; Rare Diseases ; Shoulder* ; Syringomyelia*

OBJECTIVES: Dance therapy can be applied as one of various psychiatric rehabilitation programs in clinical situations. This study was aimed to investigate applicability of dance therapy to schizophrenic outpatients, in regard to improving social adjustment and quality of life for these patients. METHODS: Twenty one psychiatric outpatients enlist who met DSM-IV criteria for schizophrenia were studied. We conducted dance therapy session once a week, totally 8 sessions. The assessments were done before and after dance therapy. Patients reported Self & Others Representation Inventory-Adjective Checklist (SORI), Self-esteem Scale, and Relationship Change Scale (RCS) and Doctors assessed Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and Quality of Life Scale (QoLS) in interview. RESULTS: After 8 sessions of dance therapy, patients showed significant improvements in sociability in SORI, satisfaction, intimacy, sensitiveness, openness, comprehensiveness in RCS, and significant decrease of symptoms in BPRS, SANS. QoLS also was improved significantly. There was no significant change in Self-esteem Scale. CONCLUSION: These results suggested that dance therapy could be applied to schizophrenic outpatients in clinical situations, and it helped to improve self-representation, interpersonal relationship, and quality of life.
Brief Psychiatric Rating Scale ; Checklist ; Dance Therapy ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Outpatients ; Quality of Life ; Schizophrenia ; Social Adjustment

PURPOSE: This study investigated the attitudes of medical students toward physicians and the roles which the doctors and patients should play in the health care process. METHODS: Attitudes toward the patient-doctor relationship of 436 medical students of the K university in Seoul were measured using the Patient-Practitioner Orientation Scale(PPOS), a validated instruments designed to measure individual preferences toward various aspects of the patient-doctor relationship. The PPOS was composed of Sharing(sharing information, take part in decision making) and Caring(respect one's feelings, interpersonal relationship) subscale. Total PPOS scores can range from patient-centered(egalitarian, whole person oriented) to disease- or doctor-centered(paternalistic, less attuned to psychosocial issues). Socio-demographic data including gender, age, school year, marital status, undergraduate major, student's and her/his family medical background and specialty choice were collected and it was investigated the possible impact of socio-demographic factors on students' attitudes. RESULTS: The PPOS score was 3.82. The Sharing and Caring scores were 3.74 and 3.90, respectively. Female gender and students of graduate entry program were significantly associated with patient-centered attitudes. Age, school year, marital status, academic background, student's and her/his family medical background, and specialty choice did not show significant associations with PPOS scores. CONCLUSION: Female and graduate students showed more patient-centered attitudes than male and undergraduate students, respectively. Given the emphasis placed on patient-centered care in the current medical environment, our results suggest further research to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centered care.
Delivery of Health Care ; Education, Medical ; Female ; Humans ; Male ; Marital Status ; Patient-Centered Care ; Seoul ; Students, Medical

Neuropathic shoulder arthropathy or Charcot's shoulder is an extremely rare disease, and sometimes it is associated with cervical syringomyelia. Clinical symptoms of the disease include edema of the shoulder and restriction in range of motion. Radiological diagnosis can be made through plain radiography through a characteristic, atrophic destruction of the joint. We experienced a Charcot's joint of the shoulder wherein destruction of the joint progressed extremely quickly and reviewed the literature concerning this condition.
Arthropathy, Neurogenic ; Diagnosis ; Edema ; Joints ; Radiography ; Range of Motion, Articular ; Rare Diseases ; Shoulder ; Syringomyelia

OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA > or =80%) rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.
Adult ; Aged ; Antihypertensive Agents/*administration & dosage ; Comorbidity ; Disabled Persons/*statistics & numerical data ; Drug Utilization ; Female ; Health Services Accessibility ; Humans ; Insurance Claim Review ; Korea/epidemiology ; Logistic Models ; Male ; Middle Aged ; National Health Programs ; Patient Compliance/*statistics & numerical data ; Residence Characteristics ; Socioeconomic Factors

Objectives: This study examined the influence of adult attention-deficit/hyperactivity disorder (ADHD) and insomnia on the risk of unintentional minor musculoskeletal injuries (UMMI). Methods: A prospective observational study was carried out in a single unit of the army in South Korea. One hundred and seventy-seven subjects participated in the study. The Adult ADHD SelfReport Scale (ASRS-v1.1) and Insomnia Severity Index (ISI) was used to screen. The risk of UMMI during one-week winter ranger training was investigated. Results: All subjects were male and aged 21.75 (standard deviation 1.5). Approximately 9.6% of subjects had clinically relevant adult ADHD symptoms. Subjects with ADHD had a higher stress index and higher rates of insomnia than those without symptoms. After adjusting for age, rank, service months, obesity, history of UMMI, sleep time, and risk of the task, the ADHD group was 4.90 times more likely to have UMMI than the control group. Insomnia increased the risk of UMMI 8.14 fold. Conclusion These results suggest that an evaluation and intervention for adult ADHD and insomnia should be made in people engaged in other tasks that may result in UMMI.

Objective: Maumgyeol Basic service is a mental health evaluation and grade scoring software using the 2 channels EEG and photoplethysmogram (PPG). This service is supposed to assess potential at-risk groups with mental illness more easily, rapidly, and reliably. This study aimed to evaluate the clinical implication of the Maumgyeol Basic service. Methods: One hundred one healthy controls and 103 patients with a psychiatric disorder were recruited. Psychological evaluation (Mental Health Screening for Depressive Disorders [MHS-D], Mental Health Screening for Anxiety Disorders [MHS-A], cognitive stress response scale [CSRS], 12-item General Health Questionnaire [GHQ-12], Clinical Global Impression [CGI]) and digit symbol substitution test (DSST) were applied to all participants. Maumgyeol brain health score and Maumgyeol mind health score were calculated from 2 channel frontal EEG and PPG, respectively. Results: Participants were divided into three groups: Maumgyeol Risky, Maumgyeol Good, and Maumgyeol Usual. The Maumgyeol mind health scores, but not brain health scores, were significantly lower in the patients group compared to healthy controls. Maumgyeol Risky group showed significantly lower psychological and cognitive ability evaluation scores than Maumgyeol Usual and Good groups. Maumgyel brain health score showed significant correlations with CSRS and DSST. Maumgyeol mind health score showed significant correlations with CGI and DSST. About 20.6% of individuals were classified as the No Insight group, who had mental health problems but were unaware of their illnesses. Conclusion This study suggests that the Maumgyeol Basic service can provide important clinical information about mental health and be used as a meaningful digital mental healthcare monitoring solution to prevent symptom aggravation.

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.
Axis, Cervical Vertebra ; Education, Medical, Undergraduate ; Educational Measurement ; Evidence-Based Medicine ; Humans ; Korea ; Mental Competency ; Students, Medical ; Surveys and Questionnaires

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.
Axis, Cervical Vertebra ; Education, Medical, Undergraduate ; Educational Measurement ; Evidence-Based Medicine ; Humans ; Korea ; Mental Competency ; Students, Medical ; Surveys and Questionnaires

PURPOSE: The "standardization" of standardized patients (SP) is one of the most crucial factors for a successful clinical performance examination (CPX). This study aimed to examine the inter-rater reliability among SPs who portrayed the same case during a CPX. METHODS: The context was a CPX conducted under the supervision of CPX Seoul-Gyeonggi Consortium in K medical school in August 2007. K medical school ran 12 stations consisting of duplicated sets of 6 cases. In total, thirty SPs participated with 5 SPs acting each of the 6 cases. The SPs evaluated the student's performances in addition to portraying the cases. ANCOVA (analysis of covariance) was used to compare scores rated by the different SPs. The dependent variables were the case scores and the 4 subcomponent (history taking, physical examination, Clinical courtesy, and Patient-physician interaction) scores for each case; the independent variable was the SPs; and the covariate was the CPX total score. RESULTS: The Headache and Cough stations showed an acceptable level of reliability. Otherwise, Weight Loss and Facial Flushing failed to show consistent scores in all 4 subcomponents. Diarrhea and Lt. hemiparesis showed partial consistency. In terms of the subcomponents, the physical exam scores were most consistent and the patient-physician interaction scores were most inconsistent. CONCLUSION: This study tested the level of "standardization" of one set of CPX cases with mixed results. The authors hope that our results will contribute to quality assurance of CPX.
Cough ; Diarrhea ; Flushing ; Headache ; Humans ; Organization and Administration ; Paresis ; Physical Examination ; Schools, Medical ; Weight Loss