There is concerns about the perceived decline in the knowledge of gross anatomy of the medical students and postgraduate trainees. It is partly caused by the introduction of integrated medical curriculum and the shortage of basic medical science program and the extension of clinical clerkship consequently. There is widespread variability in the teaching style and anatomical curricular content at the medical school in Korea. Despite these changes in the anatomical education, there have been few attempts to assess the opinions of senior clinical teachers on the state of anatomical knowledge of students and the place of anatomy teaching within the curriculum. We sought the views of the clinical teachers on the adequacy of the anatomical knowledge of current students and recent graduates of 5 medical schools in Pusan and Gyeongsang-Nam do areas. Most of the clinical teachers were of the opinion that current medical students have an insufficient anatomical knowledge. They indicated the causes of decline were the clinical irrelevant anatomical teaching content and weakness of identity of anatomy by the introduction of the integrated medical education program. There was widespread support for both the concepts of spreading anatomy teaching throughout the medical course, and an optional, clinically related final year student project in the anatomy.
Busan ; Clinical Clerkship ; Curriculum ; Education ; Education, Medical ; Humans ; Korea ; Schools, Medical ; Students, Medical*

PURPOSE: The purpose of this research was to describe our group counseling methods for medical students with drop-out experiences. METHODS: Group counseling was offered to 11 medical students with drop-out experiences in their previous second semester. All subjects provided written informed consent before participating and completed a 2-day group counseling program using the Gestalt approach. The self-assertiveness training group counseling program consisted of 6 sessions, each of which lasted 90 minutes. Experience reports by participants after the program and data from semi-structured qualitative interviews were qualitatively analyzed. RESULTS: Program participants reported that they were moderately satisfied with the program regarding its usefulness and helpfulness on self-awareness, understanding, and reminding them of attempts to change behavior. Most students showed heightened levels of sincerity perceptions and positive attitudes in every session. The results demonstrated significant changes in experience in self-esteem, self-recognition, and interpersonal relationships. CONCLUSION: A group counseling program using the Gestalt approach could help medical students with drop-out experiences to adjust with 1 year their juniors, enhance their self-esteem, contribute to their psychological well-being, and prevent student re-failure through effective stress management and improved interpersonal relationships.
Counseling ; Humans ; Informed Consent ; Students, Medical

Insulin therapy is indicated in the treatment of gestational diabetic women and overt diabetic pregnant women for hyperglycemia after failure to respond to the diets and exercise regimens. The insulin is administered to mimic normal pancreatic function. The normal pancreas secretes 50% of the total daily insulin as mealtime boluses. This delivery may be mimicked by four-injection-per-day of combination of NPH and regular insulin (RI). Hypoglycemia is a well-recognized complication of intensive insulin therapy in patients with Type II diabetes. Recently, it has been reported that insulin-lispro, an analogue of regular human insulin with a peak insulin action achieved with a 1 hour after injection improves postprandial glucose concentration in non-pregnant diabetic patients. Treatment of gestational or diabetic pregnant women with NPH and insulin-lispro has significantly lower postprandial glucose levels without an increase in hypoglycemic events. Here, we report 2 cases of hyperglycemic control with four times daily administration of NPH & insulin-lispro on diabetes in pregnancy, with brief reviews.
Diabetes Mellitus ; Diet ; Female ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia* ; Insulin Lispro* ; Insulin* ; Meals ; Pancreas ; Pregnancy* ; Pregnant Women

PURPOSE: The purpose of this research was to analyze drinking on the day of injury, usual drinking pattern, factors associated with the injury and socioeconomic factors for patients who visited the emergency room (ER) for injuries. METHODS: From among all the trauma patients who visited ER, this research included 474 patients who were over 18 years of age and who visited the ER within 48 hours of their injury. Questionnaire surveys, telephone surveys, and serologic tests were conducted for all the patients. RESULTS: The drinking rate before injury was 51.9% among the 337 drinkers. The rate of drinkers was 72.2% (male 85%, female 42.6%), and the rate of habitual drinkers was 22.4% among the 466 subjects. The rates of habitual drinkers and nonhabitual drinkers were 31.5% and 68.5%, retrospectively, among the 337 drinkers. Such groups as assaulted patients, patients operated on under local anesthesia, patients injured indoor or outdoor except on roads, patients diagnosed as laceration, and patients injured between midnight and 8 a.m., and between 4p.m. and midnight had significantly higher incidents of drinking on the day of the injury (p=0.00~0.02). Such groups as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients had significantly higher numbers of habitual drinkers (p= 0.00 ~ 0.04 ). CONCLUSION: This study suggests that alcohol use is an important factor for patients who visit the ER for injuries and alcohol drinking. But it can not be concluded that there is a causal relation between alcohol use and injury. Such groups who visit the ER for injuries as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients need to be screened for alcohol misuse.
Alcohol Drinking ; Anesthesia, Local ; Drinking* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Lacerations ; Male ; Surveys and Questionnaires ; Retrospective Studies ; Serologic Tests ; Socioeconomic Factors ; Telephone

The thoracic spine is rigidly stabilized by the ribs, anterior and posterior longitudinal ligaments, and a sagittal orientation of the facet joints that resists axial rotation and horizontal translation. Thus, a significant force is required to cause a fracture and dislocation in the thoracic spine. A 32-year-old man was involved in a motor-vehicle accident and presented with complete paraplegia and spondyloptosis on the 8th thoracic vertebral segment. He also suffered with hypoxia and hypovolemic shock. Posterior reduction and fixation with pedicle screw was achieved with the anatomic alignment and rigid stability. This posterior technique for thoracic spondyloptosis is believed to be sufficient to make good alignment and solid fixation.
Adult ; Anoxia ; Dislocations ; Humans ; Longitudinal Ligaments ; Paraplegia ; Ribs ; Shock ; Spine ; Zygapophyseal Joint

OBJECTIVE: To evaluate the performance and reproducibility of a computer-aided detection (CAD) system in mediolateral oblique (MLO) digital mammograms taken serially, without release of breast compression. MATERIALS AND METHODS: A CAD system was applied preoperatively to the full-field digital mammograms of two MLO views taken without release of breast compression in 82 patients (age range: 33-83 years; mean age: 49 years) with previously diagnosed breast cancers. The total number of visible lesion components in 82 patients was 101: 66 masses and 35 microcalcifications. We analyzed the sensitivity and reproducibility of the CAD marks. RESULTS: he sensitivity of the CAD system for first MLO views was 71% (47/66) for masses and 80% (28/35) for microcalcifications. The sensitivity of the CAD system for second MLO views was 68% (45/66) for masses and 17% (6/35) for microcalcifications. In 84 ipsilateral serial MLO image sets (two patients had bilateral cancers), identical images, regardless of the existence of CAD marks, were obtained for 35% (29/84) and identical images with CAD marks were obtained for 29% (23/78). Identical images, regardless of the existence of CAD marks, for contralateral MLO images were 65% (52/80) and identical images with CAD marks were obtained for 28% (11/39). The reproducibility of CAD marks for the true positive masses in serial MLO views was 84% (42/50) and that for the true positive microcalcifications was 0% (0/34). CONCLUSION: The CAD system in digital mammograms showed a high sensitivity for detecting masses and microcalcifications. However, reproducibility of microcalcification marks was very low in MLO views taken serially without release of breast compression. Minute positional change and patient movement can alter the images and result in a significant effect on the algorithm utilized by the CAD for detecting microcalcifications.
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/radiography ; Calcinosis/radiography ; False Positive Reactions ; Female ; Humans ; Mammography/*methods ; Middle Aged ; *Radiographic Image Interpretation, Computer-Assisted ; Reproducibility of Results ; Sensitivity and Specificity

The relationship between the post-tetanic count(PTC) and the response of tracheal intubation after vecuronium-induced neuromuscular blockade was studied in 99 cases who were ASA 1 or 2 adult patients. All patients were premedicated with glycopyrrolate 0.2mg and hydroxizine 1 mg/kg IM 1 hour before induetion, and were inducted with pentothal sodium Smg/kg and O2- N2O(50%) enflurane(2%). The patients were randomly divided to two groups according to dose of vecuronium applied after inducion ; 0.08 mg/kg(n=54) group and 0.12 mg/kg(n=45) group. Neuromuscular blockade was monitored by stimulation of the ulnar nerve at the wrist with single twitch using INNERVATOR(Fisher and Paykel Co.). Post tetanic count(PTC) was counted at different times, i.e., 0, 10, 20, 25, 30 and 35 seconds, 9 persons respectively at each time, after disappearance of single twitch. Tracheal intubation was performed immediately after counting of PTC. The response of tracheal intubation was appreciated based on vocal cord reflex, coughing or barking and patient movement. The time from administration of vecuronium to disappearance of single twitch was 167.8+/-23.4 seconds in 0.08mg/kg group and 163.7+/-51.1 seconds in 0.12mg/kg group and there was no statistical difference. After complete disappearance of single twitch, the PTC was zero at 35 seconds in 0.08 mg/kg group and at 25 seconds in 0. 12 mg/kg group. While the PTC was lowering, the lower intubation condition score should be expected, but the 0 of PTC did not coin-cided with the 0 of intubation condition score. However, the 0 of PTC did not always indicated that response to tracheal intubation could be disappear completely. Profound neuromuscular blockade did not reduce the hemodynamic responses to tracheal intubation.
Adult ; Cough ; Glycopyrrolate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Reflex ; Sodium ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords ; Wrist

BACKGROUND: Obesity not only does increase the incidence of breast cancer, but also affects the course of treatment, recurrence and mortality. This study aims to evaluate on the obesity status of Korean breast cancer survivors and their obesity-related lifestyles. METHODS: The study included 125 Korean female breast cancer survivors aged over 19 year old enrolled in the 2009-11 Korean National Health and Nutrition Examination Survey. Women who answered 'yes' to the question 'have you ever been diagnosed breast cancer by a physician?' was defined as a breast cancer survivors. Height, weight, and waist circumference were measured and Body mass index (BMI) was calculated. Body fat percent was assessed by dual X-ray absorptiometry (DXA). Standardized surveys by trained interviewers were used to investigate survivors' obesity-related lifestyles such as physical activities, sleeping hours and nutrients intake. RESULTS: 48.4% of Korean breast cancer survivors were obese. 44.7% had abdominal obesity and 89.2% had body fat percent over 30. Their physical activity level was generally low; only 22.5% maintained health-enhancing level of physical activities. Fat intake (14.4 [0.8] %) was as low and carbohydrate intake (74.2 [1.2] %) was high. However, daily dietary fiber intake was low (10.5 [1.1] g). Factors that were found to be significantly related with obesity in Korean breast cancer survivors were low education level (P=0.042), smoking (P<0.001), having chronic diseases (P=0.002) and short sleeping hours (P<0.001). CONCLUSIONS: It is mandatory for physician to evaluate obesity status of breast cancer survivors as soon as their diagnosis and give proper intervention to maintain healthy weight and healthy obesity related lifestyle.
Absorptiometry, Photon ; Adipose Tissue ; Body Mass Index ; Breast Neoplasms* ; Chronic Disease ; Diagnosis ; Dietary Fiber ; Education ; Female ; Humans ; Incidence ; Life Style* ; Metabolic Equivalent ; Mortality ; Motor Activity ; Nutrition Surveys ; Obesity* ; Obesity, Abdominal ; Recurrence ; Smoke ; Smoking ; Survivors* ; Waist Circumference

PURPOSE: This correlational study was to examine the relationships between dementia knowledge, attitude, self-efficacy and preventive behavior of low income middled-aged women. METHODS: The subjects for this study were 125 low income middle aged women living in I city. The data were collected using the questionnaires for dementia knowledge, attitude, self-efficacy and preventive behavior. The data analysis was done by descriptive statistics, t-test, ANOVA, Pearson product moment correlation and stepwise multiple regression analysis. RESULTS: The mean of dementia knowledge was 13.96 out of 20, attitude was 43.98 out of 60, self-efficacy was 54.07 out of 75 and preventive behavior was 25.98 out of 36. The positive correlations were revealed between dementia knowledge (r=.458, p=.000), attitude (r=.498, p=.000), self-efficacy (r=.573, p=.000) and preventive behavior. The influencing factors for dementia preventive behavior were self-efficacy, belief in Buddhism and attitude which accounted for 42.5% of the total variance. CONCLUSION: Dementia knowledge, attitude and self-efficacy were identified as variables that correlate dementia preventive behavior. Also, self-efficacy is the most influential factor affecting dementia preventive behavior. On the basis of these results, it is necessary for nurses to consider using dementia knowledge and mode of efficacy expectation in order to improve dementia preventive behavior.
Buddhism ; Dementia ; Female ; Humans ; Middle Aged ; Statistics as Topic ; Surveys and Questionnaires

Objective: To evaluate the radiographic characteristics of the ampulla of Vater cancer. Subjects and Methods:The authors analyzed retrospectively the US(n=25) and CT(n=15) findings in 25 cases of ampulla of Vater cancer, with emphasis on the potential of CT & US in regand to the detectibility of the mass. ERCP(n=15) and hypotonic duodenography(n=5) were also evaluated for the configuration of obstructed duct. RESULTS: The tumor was detected on sonography in only 12 cases(48%) as a small, relatively well delinated mass with slighty low echogenicity to the pancreas. The tumor was shown by CT in 8 cases(53% ) as a well delinated mass protruding into the second portion of duodenal lumen with slightly low attenuation to the pancreas. CBD was dilated in 25 cases(100%), but pancreatic duct was dilated in 15 cases(60%). Obstructed end of CBD was nipple shaped in 7 cases(47%), clubbed in 3, flat in 3, and indistict in 2 by ERCP. Hypotonic duodenogram showed irregular filling defect in the medial wall of second portion of the duodenum in 5 cases (100%). CONCLUSION: Mas detection rate crsing US or CT were not high in ampulla of Vater cancer. Except for a CT finding of a small mass protruding into the regional duodenal lumen, other finclings were nonspecific. Therefore, additional studies or more afgressive approach should be attempted for a correct diagnosis.
Ampulla of Vater* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Duodenum ; Nipples ; Pancreas ; Pancreatic Ducts ; Retrospective Studies