PURPOSE: High-quality hospice and palliative medicine curricula are necessary in Korean medical schools. This study evaluated changes in students' knowledge and attitudes toward both hospice and palliative care following the completion of a course on these topics, as well as the course's overall role in the basic medical education curriculum.METHODS: Questionnaires measuring knowledge and attitudes were collected before and after the course from 76 fourth-year medical students, who had received instructions integrating both hospice and palliative care in 2016.RESULTS: The questionnaire item “Select the correct answer on the use of opioid pain control in hospice and palliative care” changed the most in terms of number of correct answers pre- and post-course (3.50 and 5.32, respectively; P<0.001). Pre- and post-course, the numbers of students who answered “Strongly Agree” and “Agree” to questions concerning their attitudes toward hospice and palliative care (“I know the purposes and roles of hospice and palliative care”) were 17 (22.4%) and 65 (85.6%), respectively (P≤0.001). Affirmative responses also increased for “As a pre-physician, I know when to describe and advise hospice and palliative care to patients”, from 22 (28.9%) to 65 (85.6%; P≤0.001).CONCLUSION: This study showed that comprehensive hospice education in the form of an integrated educational course might promote changes in medical students' knowledge and attitudes toward hospice and palliative medicine.
Curriculum ; Education ; Education, Medical ; Hospice Care ; Hospices ; Humans ; Palliative Care ; Palliative Medicine ; Schools, Medical ; Students, Medical

Purpose: This study investigated the impact of the guide hole height on the accuracy of implant placement using CAD/ CAM-fabricated surgical guides in resin models. The hypothesis is that decreasing the height of the guide hole reduces placement accuracy. Materials and Methods: Ten identical partially edentulous maxillary models were each fitted with surgical guides featuring guide hole heights of 1 mm, 3 mm, and/or 5 mm. Using a surgical guide and drill kit, implants were placed in six predetermined sites per model. Placement accuracy was evaluated by comparing the actual implant positions with the planned positions using digital scanning and computer software analysis. Statistical analyses were performed using ANOVA and Kruskal-Wallis tests to determine the significance of deviations at both the coronal and apical positions. Results: The average deviations were 0.75±0.33 mm at the coronal position and 1.10±0.51 mm at the apical position. Placement accuracy didnot differ with different guide hole heights. Additionally, errors were consistent regardless of the guide hole height and were not influenced by the type of support or the implant placement site. Conclusion In this rotro study, varying the height of the guide hole did not significantly affect the accuracy of implant placement. The results suggest that guide hole height within the tested range does not have a substantial impact on placement errors. Our findings indicate that factors other than the guide holeheight may play a more critical role in implant placement accuracy.

Purpose: This study investigated the impact of the guide hole height on the accuracy of implant placement using CAD/ CAM-fabricated surgical guides in resin models. The hypothesis is that decreasing the height of the guide hole reduces placement accuracy. Materials and Methods: Ten identical partially edentulous maxillary models were each fitted with surgical guides featuring guide hole heights of 1 mm, 3 mm, and/or 5 mm. Using a surgical guide and drill kit, implants were placed in six predetermined sites per model. Placement accuracy was evaluated by comparing the actual implant positions with the planned positions using digital scanning and computer software analysis. Statistical analyses were performed using ANOVA and Kruskal-Wallis tests to determine the significance of deviations at both the coronal and apical positions. Results: The average deviations were 0.75±0.33 mm at the coronal position and 1.10±0.51 mm at the apical position. Placement accuracy didnot differ with different guide hole heights. Additionally, errors were consistent regardless of the guide hole height and were not influenced by the type of support or the implant placement site. Conclusion In this rotro study, varying the height of the guide hole did not significantly affect the accuracy of implant placement. The results suggest that guide hole height within the tested range does not have a substantial impact on placement errors. Our findings indicate that factors other than the guide holeheight may play a more critical role in implant placement accuracy.

Purpose: This retrospective study compared the maxillary sinus floor augmentation techniques (lateral and transcrestal approaches) to assess the impact of bone grafting, graft materials, and initial residual bone height (RBH). Materials and Methods: Fifty patients who underwent maxillary sinus floor augmentation for posterior maxillary implant placement were included. Panoramic radiographs were obtained before surgery (T0), immediately after surgery (T1), and 6-10 months post-surgery (T2). Length measurements on panoramic radiographs were performed using a digital caliper at T1 and T2. Statistical validation included one-way ANOVA, t-tests, Mann-Whitney U tests, and correlation analyses. Multivariate linear regression was used to assess associations after adjusting for confounding factors. Results: Of the 50 patients, 35 underwent a transcrestal approach and 15 underwent a lateral approach. The results showed significant endosinus bone gain (ESBG) differences between allogeneic and xenogeneic grafts and no grafts (p < .001). Osteotomy sinus floor elevation without grafting yielded 3.24 ± 1.42 of ESBG. When divided into three groups based on initial RBH, RBH 1 had 27 patients, RBH 2 had 12 patients, and RBH 3 had 11 patients. Within the RBH group 1 (RBH under 4), the lateral approach had significantly greater ESBG than the transcrestal approach (p < .001). Multivariate linear regression analysis confirmed statistically significant associations between the studied variables after adjusting for confounding factors. Conclusion When the RBH is < 4 mm, lateral-approach sinus augmentation and bone grafting should be performed to attain significant ESBG. The RBH, bone graft materials, and sinus elevation techniques vary considerably in ESBG.

Purpose: This retrospective study compared the maxillary sinus floor augmentation techniques (lateral and transcrestal approaches) to assess the impact of bone grafting, graft materials, and initial residual bone height (RBH). Materials and Methods: Fifty patients who underwent maxillary sinus floor augmentation for posterior maxillary implant placement were included. Panoramic radiographs were obtained before surgery (T0), immediately after surgery (T1), and 6-10 months post-surgery (T2). Length measurements on panoramic radiographs were performed using a digital caliper at T1 and T2. Statistical validation included one-way ANOVA, t-tests, Mann-Whitney U tests, and correlation analyses. Multivariate linear regression was used to assess associations after adjusting for confounding factors. Results: Of the 50 patients, 35 underwent a transcrestal approach and 15 underwent a lateral approach. The results showed significant endosinus bone gain (ESBG) differences between allogeneic and xenogeneic grafts and no grafts (p < .001). Osteotomy sinus floor elevation without grafting yielded 3.24 ± 1.42 of ESBG. When divided into three groups based on initial RBH, RBH 1 had 27 patients, RBH 2 had 12 patients, and RBH 3 had 11 patients. Within the RBH group 1 (RBH under 4), the lateral approach had significantly greater ESBG than the transcrestal approach (p < .001). Multivariate linear regression analysis confirmed statistically significant associations between the studied variables after adjusting for confounding factors. Conclusion When the RBH is < 4 mm, lateral-approach sinus augmentation and bone grafting should be performed to attain significant ESBG. The RBH, bone graft materials, and sinus elevation techniques vary considerably in ESBG.

Purpose: This study investigated the impact of the guide hole height on the accuracy of implant placement using CAD/ CAM-fabricated surgical guides in resin models. The hypothesis is that decreasing the height of the guide hole reduces placement accuracy. Materials and Methods: Ten identical partially edentulous maxillary models were each fitted with surgical guides featuring guide hole heights of 1 mm, 3 mm, and/or 5 mm. Using a surgical guide and drill kit, implants were placed in six predetermined sites per model. Placement accuracy was evaluated by comparing the actual implant positions with the planned positions using digital scanning and computer software analysis. Statistical analyses were performed using ANOVA and Kruskal-Wallis tests to determine the significance of deviations at both the coronal and apical positions. Results: The average deviations were 0.75±0.33 mm at the coronal position and 1.10±0.51 mm at the apical position. Placement accuracy didnot differ with different guide hole heights. Additionally, errors were consistent regardless of the guide hole height and were not influenced by the type of support or the implant placement site. Conclusion In this rotro study, varying the height of the guide hole did not significantly affect the accuracy of implant placement. The results suggest that guide hole height within the tested range does not have a substantial impact on placement errors. Our findings indicate that factors other than the guide holeheight may play a more critical role in implant placement accuracy.

Purpose: This retrospective study compared the maxillary sinus floor augmentation techniques (lateral and transcrestal approaches) to assess the impact of bone grafting, graft materials, and initial residual bone height (RBH). Materials and Methods: Fifty patients who underwent maxillary sinus floor augmentation for posterior maxillary implant placement were included. Panoramic radiographs were obtained before surgery (T0), immediately after surgery (T1), and 6-10 months post-surgery (T2). Length measurements on panoramic radiographs were performed using a digital caliper at T1 and T2. Statistical validation included one-way ANOVA, t-tests, Mann-Whitney U tests, and correlation analyses. Multivariate linear regression was used to assess associations after adjusting for confounding factors. Results: Of the 50 patients, 35 underwent a transcrestal approach and 15 underwent a lateral approach. The results showed significant endosinus bone gain (ESBG) differences between allogeneic and xenogeneic grafts and no grafts (p < .001). Osteotomy sinus floor elevation without grafting yielded 3.24 ± 1.42 of ESBG. When divided into three groups based on initial RBH, RBH 1 had 27 patients, RBH 2 had 12 patients, and RBH 3 had 11 patients. Within the RBH group 1 (RBH under 4), the lateral approach had significantly greater ESBG than the transcrestal approach (p < .001). Multivariate linear regression analysis confirmed statistically significant associations between the studied variables after adjusting for confounding factors. Conclusion When the RBH is < 4 mm, lateral-approach sinus augmentation and bone grafting should be performed to attain significant ESBG. The RBH, bone graft materials, and sinus elevation techniques vary considerably in ESBG.

Purpose: This study investigated the impact of the guide hole height on the accuracy of implant placement using CAD/ CAM-fabricated surgical guides in resin models. The hypothesis is that decreasing the height of the guide hole reduces placement accuracy. Materials and Methods: Ten identical partially edentulous maxillary models were each fitted with surgical guides featuring guide hole heights of 1 mm, 3 mm, and/or 5 mm. Using a surgical guide and drill kit, implants were placed in six predetermined sites per model. Placement accuracy was evaluated by comparing the actual implant positions with the planned positions using digital scanning and computer software analysis. Statistical analyses were performed using ANOVA and Kruskal-Wallis tests to determine the significance of deviations at both the coronal and apical positions. Results: The average deviations were 0.75±0.33 mm at the coronal position and 1.10±0.51 mm at the apical position. Placement accuracy didnot differ with different guide hole heights. Additionally, errors were consistent regardless of the guide hole height and were not influenced by the type of support or the implant placement site. Conclusion In this rotro study, varying the height of the guide hole did not significantly affect the accuracy of implant placement. The results suggest that guide hole height within the tested range does not have a substantial impact on placement errors. Our findings indicate that factors other than the guide holeheight may play a more critical role in implant placement accuracy.

Purpose: We evaluated the efficacy and safety of avelumab, an anti-PD-L1 antibody, in patients with metastatic or unresectable colorectal cancer (mCRC) with mismatch repair deficiency (dMMR)/microsatellite instability-high (MSI-H) or POLE mutations. Materials and Methods: In this prospective, open-label, multicenter phase II study, 33 patients with mCRC harboring dMMR/MSI-H or POLE mutations after failure of ≥1st-line chemotherapy received avelumab 10 mg/kg every 2 weeks. dMMR/MSI-H was confirmed with immunohistochemical staining (IHC) by loss of expression of MMR proteins or polymerase chain reaction (PCR) for microsatellite sequences. POLE mutation was confirmed by next-generation sequencing (NGS). The primary endpoint was the objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors ver. 1.1. Results: The median age was 60 years, and 78.8% were male. Thirty patients were dMMR/MSI-H and three had POLE mutations. The ORR was 24.2%, and all of the responders were dMMR/MSI-H. For 21 patients with MSI-H by PCR or NGS, the ORR was 28.6%. At a median follow-up duration of 16.3 months, median progression-free survival and overall survival were 3.9 and 13.2 months in all patients, and 8.1 months and not reached, respectively, in patients with MSI-H by PCR or NGS. Dose interruption and discontinuation due to treatment-related adverse events occurred in 4 and 2 patients, respectively, with no treatment-related deaths. Conclusion Avelumab displayed antitumor activity with manageable toxicity in patients with previously treated mCRC harboring dMMR/MSI-H. Diagnosis of dMMR/MSI-H with PCR or NGS could be complementary to IHC to select patients who would benefit from immunotherapy.

Background/Aims: Endoscopic diagnosis of dysplasia or colitic cancer in patients with ulcerative colitis (UC) is more challenging than that of colorectal neoplasia in non-colitic patients. We aimed to evaluate the accuracy of the endo-scopic diagnosis of “nonpedunculated” dysplasia or colitic cancer in UC patients. Methods: Ten endoscopists from four countries were surveyed using photographs of 61 histologi-cally confirmed dysplastic or non-dysplastic lesions retrieved from the UC registry database of Asan Medical Center. The participants provided their assessment based on the given photographs and their intention to perform biopsy. Results: The overall diagnostic performance of the 10 participants is summarized as follows: sensitivity of 88.2% (95% confidence interval [CI], 84.3% to 91.5%), specificity of 34.8% (95% CI, 29.1% to 40.8%), positive predictive value of 63.0% (95% CI, 60.8% to 65.2%), negative predictive value of 70.2% (95% CI, 62.7% to 76.6%), and accuracy of 64.6% (95% CI, 60.7% to 68.4%). The interobserver agreement on the inten-tion to perform a biopsy was poor (Fleiss kappa=0.169). Of the three endoscopic characteristics of the lesions, includ-ing ulceration, distinctness of the borders, and pit patterns, only neoplastic pit patterns were significantly predictive of dysplasia (odds ratio, 3.710; 95% CI, 2.001 to 6.881). The diagnostic sensitivity and specificity of neoplastic pit patterns were 68.2% (95% CI, 63.0% to 73.2%) and 63.3% (95% CI,57.3% to 69.1%), respectively. Conclusions Diagnostic per-formance based on the endoscopist’s intention to perform a biopsy for nonpedunculated potentially dysplastic lesions in UC patients was suboptimal according to this survey-based study.