Background: : Effective communication between doctors and patients is very important not only for diagnosis and treatment but also for building trust. Although teaching communication skills is very important in medical schools, there are limitations such as the number of students and the uncertainty of the patient population. Therefore, this study evaluates the effect of Fishbowl method to teach communication skills to medical students, which involves the medical students communicating with standardized patients in front of a large classroom and being observed by rest of the students. Methods: : This study involves 10 weeks of educating 126 fourth grade medical students and graduates. During this period, total 8 classes were taken by subjects, where each class lasts 2 hours and is conducted by observing treatments of the standardized patients on 14 clinical topics by randomly selected medical students and giving feedback on the communication skills of the selected medical students. The educational effect was evaluated based on the scores of the clinical performance examination before and after the classes. Results: : The scores assessed for medical history taking before and after the training are increased by 2.45 (p<0.001) and the scores for patient-doctor relationship is increased by 7.56 (p<0.001). Conclusions : It is expected to improve the communication skills of medical students by large scale lectures with standardized patients.

PURPOSE: Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. MATERIALS AND METHODS: From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. RESULTS: Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). CONCLUSION: Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.
Aged ; Bone Development ; Bone Wires ; Clinical Study* ; Femur* ; Follow-Up Studies ; Fracture Fixation ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans ; Hypertrophy ; Osteolysis ; Rehabilitation ; Walking

Porcine epidemic diarrhea virus (PEDV) is a contagious coronavirus infecting pigs that leads to significant economic losses in the swine industry. Given that PEDV infection occurs in gut epithelial cells mainly via the fecal-oral route, induction of PEDV-specific immune responses in the mucosal compartment is required for protective immunity against viral infection. However, an effective mucosal vaccine against the currently prevalent PEDV strain is not available. In this study, we demonstrated that the N-terminal domain (NTD) of the spike (S) protein of PEDV represents a new vaccine candidate molecule to be applied via the mucosal route. We first established an Escherichia coli expression system producing the partial NTD (NTD231–501) of the PEDV S protein. Orally administered NTD231–501 protein specifically interacted with the apical area of M cells in the follicle-associated epithelium of Peyer's patch. Additionally, the NTD protein induced antigen-specific immune responses in both the systemic and mucosal immune compartments when administered orally. Collectively, we propose the NTD of the PEDV S protein to be a candidate mucosal vaccine molecule.
Coronavirus ; Epithelial Cells ; Epithelium ; Escherichia coli ; Immunity, Mucosal ; Porcine epidemic diarrhea virus* ; Swine

PURPOSE: To compare the scar formation after laughter therapy in facial burn scar and to make facial burn rehabilitation program. METHODS: In a prospective clinical trial, laughter therapy was done in 12 facial burn injury patients. One group pretest-posttest design was done. After 8 weeks group laughter therapy session, we measured scar condition. Facial burn scar were checked. Scars were assessed with objective measurement tools such as pigmentation, erythema, pliability, transepidermal water loss, thickness and perfusion. RESULTS: Pigmentation value was decreased significantly: 211.6+/-71.9 to 177.8+/-57.1 (p<0.05). Erythema value increased from 432.3+/-62.5 to 451.1+/-49.7 (p>0.05). Transepidermal water loss value changed from 40.7+/-15.9 g/h/m2 to 37.8+/-15.4 g/h/m2 (p>0.05). Microcirculation value was decreased significantly (0.80+/-0.05 volt to 0.43+/-0.19 volt)(p<0.05). Skin elasticity level (R0) was significantly increased (p<0.05). CONCLUSION: Laughter therapy in burn patients could be an alternative treatment to control burn scar contracture. In the future, more studies are needed how laughter therapy may affect the skin condition of the burn injuries.
Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Contracture ; Elasticity ; Erythema ; Humans ; Laughter ; Laughter Therapy ; Microcirculation ; Pigmentation ; Pliability ; Prospective Studies ; Skin

PURPOSE: Burn injury is among the most severe type of trauma that the body can sustain. The major burn increases energy expenditure as the result of its induction of the hypermetabolic and catabolic state. It is well-documented that nutritional support may improve morbidity and mortality after severe burn injury. Therefore, adequate nutritional support is essential in burned patients to prevent the detrimental consequences of overfeeding and underfeeding. The purpose of this study was to analyze the factors influencing resting energy expenditure on major burn patients. METHODS: In 199 patients with > or =20% total body surface area (TBSA) burn were monitored with 403 measurement of resting energy expenditure (REE) from January 2004 to December 2008 in burn center of the Hangang Sacred Heart Hospital. Gender, age, burn size, inhalation injury, ventilator were included in the factors which influence the REE of massive burn patients. RESULTS: The measured REE and REE/basal metabolic rate (BMR) were significantly higher in males (p<0.05). The measured REE and REE/body mass index (BMI) showed significant difference between age groups (p<0.01). The measured REE and REE/BMI showed significant difference between burn size groups (p<0.01). The measured REE, REE/BMR and REE/BMI for patients with inhalation injury were significantly higher than patients without inhalation injury (p<0.01). The measured REE, REE/BMR and REE/BMI for patient needs ventilator were significantly higher than the other group (p<0.01). CONCLUSION: Indirect calorimetry is useful in detecting variations in energy expenditure among individuals and in detecting changes in metabolism. Unlike indirect calorimetry measurements, static formulas may not consider hypermetabolic and catabolic states. Because adequate nutritional support is essential in burned patients, it should be considered the factors influencing resting energy expenditure on major burn patients.
Body Surface Area ; Burn Units ; Burns ; Calorimetry, Indirect ; Energy Metabolism ; Heart ; Humans ; Inhalation ; Male ; Nutritional Support ; Ventilators, Mechanical

OBJECTIVES: Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. METHODS: We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. RESULTS: Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. CONCLUSION: We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.
Attentional Blink ; Bias (Epidemiology) ; Burns ; Exercise Test ; Humans ; Stress Disorders, Post-Traumatic

PURPOSE: This study was designed to compare the quality of life and physical function after group education program in burn rehabilitation program. METHODS: In a prospective clinical trial, group rehabilitation education program was done in 20 burn injury patients. One group pretest-post test design was done. After 2 weeks group education session, we measured stress test, quality of life (Burn specific health scale) and range of motion. Stress status was assessed with objective measurement tools such as heart rate variability. RESULTS: Stress resistance and parameter value was changed significantly (P<0.05). Heart stability increased (P=0.05). Total range of motions were changed significantly (P<0.05). Quality of life evaluation using BSHS does not show significant change (P>0.05). CONCLUSION: Group therapy in burn rehabilitation patients could be an alternative rehabilitation treatment for quality of life. In the future, more studies are yet to come how group education program may affect the burn rehabilitation patients' disability.
Burns ; Exercise Test ; Heart ; Heart Rate ; Humans ; Prospective Studies ; Psychotherapy, Group ; Quality of Life ; Range of Motion, Articular

A 73-year-old woman who has been suffering from ulcer pain on left lower leg of burn scars visited our clinic for prosthesis rehabilitation. Symptom has been developed since 12 months ago. She burned herself with oil at the age of 40. Biopsy on the skin lesion revealed squamous cell carcinoma. Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Patient had undergone multiple prior split-thickness skin grafts for recurrent squamous cell carcinoma. She had undergone a trans-tibial amputation and subsequently given adjuvant chemotherapy for recurrent disease. After amputee training the patient was able to walk by herself and could perform all activities of daily living independently. Cancer induced amputees need prostheses with intensive rehabilitation training program for ambulation to prevent deterioration of physical function and mental health due to immobilization. However, she developed another recurrence and decided not to undergo further surgery and eventually died in hospice care due to progressive metastatic disease.
Activities of Daily Living ; Aged ; Amputation ; Amputees ; Biopsy ; Burns ; Carcinoma, Squamous Cell ; Chemotherapy, Adjuvant ; Cicatrix ; Female ; Hospice Care ; Humans ; Immobilization ; Leg ; Mental Health ; Neoplasms, Squamous Cell ; Prostheses and Implants ; Recurrence ; Skin ; Stress, Psychological ; Transplants ; Ulcer ; Walking