Purpose: The purpose of this study was to identify the possible correlations of ‘satisfaction with clinical practice (SA)’ with ‘clinical learning environment (EN)’ and ‘clinical practice stress (ST).’ We searched for the mediating effect of ‘clinical practice stress’ on ‘satisfaction with clinical practice’ when the clinical learning environment influences ‘satisfaction with clinical practice.’ Methods: This research investigated 208 medical and nursing students attending the school of medicine and nursing in Korea. The total number of nursing students was 135 (64.9%); 73 medical students participated (35.1%). We used the Korean-Undergraduate Clinical Education Environment in 24 questions for EN, ST scale in 24 questions, and SA scale in 10 questions. We performed measurement structural equation model analysis to identify a path of the model. Results: Medical students had significantly higher levels of ST. EN had a significant negative correlation with ST and a significant positive correlation with SA. The ST had a significant negative correlation with SA. The results of the goodness of fit index have fulfilled the criteria of goodness of fit. There was a significant mediating effect of ST on SA when EN influences SA. Conclusion The clinical learning environment affected satisfaction with the clinical practice directly or indirectly mediated by clinical practice stress. Therefore, educational institutes should try to increase satisfaction with clinical practice by continuously monitoring and improving the clinical learning environment in addition to taking measures for decreasing the clinical practice stress.

To identify the effects of a mobile-app-based self-management program for elderly hemodialysis patients on their sick-role behavior, basic psychological needs, and self-efficacy.

No abstract available.
Echolalia ; Serotonin Uptake Inhibitors ; Stroke

PURPOSE: To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests. MATERIALS AND METHODS: Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI). RESULTS: The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function. CONCLUSION: The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.
Aged ; Alzheimer Disease/*psychology ; Behavioral Symptoms ; Cognition ; Delusions ; Dementia/psychology ; Female ; Humans ; Male ; Neuropsychological Tests ; Regression Analysis

BACKGROUND AND PURPOSE: Although subjective cognitive impairment (SCI) is often accompanied by Parkinson's disease (PD) and may predict the development of mild cognitive impairment or dementia, longitudinal brain perfusion changes in PD patients with SCI remain to be elucidated. The current prospective study examined cerebral perfusion changes in PD patients with SCI using technetium-99m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT). METHODS: Among 53 PD patients at baseline, 30 patients were classified into the PD with SCI group and 23 patients were assigned to the PD without SCI group. The mean follow-up interval was 2.3±0.9 years. The Mini-Mental State Examination, Clinical Dementia Rating, and Global Deterioration Scale were used to assess impairments in cognitive function. Brain SPECT images were acquired at baseline and follow-up. RESULTS: Significant differences between the two groups were not found for demographic variables, PD severity, or cognitive function at either baseline or follow-up. At baseline, the PD with SCI group showed decreased perfusion in the left angular gyrus compared to the PD without SCI group. Longitudinal analysis revealed widespread perfusion reductions primarily in the bilateral temporo-parieto-occipital areas and cerebellum in the PD with SCI group. Relative to the PD without SCI group, an excessive decrease of perfusion was found in the left middle frontal gyrus of the PD with SCI patients. CONCLUSIONS: Our findings suggest that perfusion deficits in the middle frontal area may play an important role in the pathophysiology of SCI in PD.
Brain ; Cerebellum ; Cognition ; Cognition Disorders* ; Dementia ; Follow-Up Studies ; Humans ; Mild Cognitive Impairment ; Parietal Lobe ; Parkinson Disease* ; Perfusion* ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Recently, researchers at medical schools have shown increasing interest in developing a curriculum for medical humanities and improving 'humanity' in existing curriculums. This study introduces the process of developing the 'doctor & leadership' curriculum at K University from 2002. The results of the three-year implementation were analyzed. The effectivenessof the curriculum development is discussed. METHODS: The curriculum development followed the ADDIE model. A sixteen-week curriculum with three subjects was developed. The main methods of instruction were self-regulation learning and collaboration learning. The instruction method was a blended learning approach composed of both on-line and off-line instructions. Students were assessed through a portfolio assessment. 'Leadership self-assessment' and 'satisfaction index' of the overall curriculum were measured. RESULTS: The results on pre- and post- leadership self-assessment shows that leadership increased significantly after the learning process. Of the 4 sub-factors of the satisfaction index, the satisfaction indices on the blended learning, professor-student interaction, and instruction design had the greatest influence on the total satisfaction index (p<.001) CONCLUSION: Our outcome indicates that the 'doctor & leadership' curriculum is significantly effective. And generally, to increase the satisfaction index of courses, collaboration learning based on team projects and blended learning, as well as, professor-student interaction are helpful in encouraging the application of skills.
Cooperative Behavior ; Curriculum* ; Humanities ; Humans ; Leadership ; Learning ; Schools, Medical ; Self-Assessment

Background: and Purpose Screening tests for dementia such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment are widely used, but there are drawbacks to their efficient use. There remains a need for a brief and easy method of assessing the activities of daily living (ADL) that can be administered to elderly individuals by healthcare workers. We have therefore developed a new scale named the Simple Observation Checklist for Activities of Daily Living (SOC-ADL). Methods: We developed the SOC-ADL scale as a team of experts engaged in caring for individuals with dementia. This scale comprises eight items and was designed based on the Korean instrumental activities of daily living (K-IADL) scale and the Barthel activities of daily living scale (Barthel Index). The new scale was validated by enrolling 176 patients with cognitive dysfunction across 6 centers. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed. We assessed its concurrent validity by performing comparisons with the Korean-MMSE, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, K-IADL, and Barthel Index, and its criterion validity by performing comparisons between mild cognitive impairment (MCI) and dementia. We also used Cronbach’s alpha to assess the interitem reliability. The appropriate cutoff values were determined by analyzing receiver operating characteristic curves, including the areas underneath them. Results: EFA extracted one factor and CFA revealed that all of the model fits exceeded the minimum acceptable criteria. The SOC-ADL scores were strongly correlated with those of the other tools for dementia and could be used to differentiate MCI from dementia. Cronbach’s alpha values indicated that the results were reliable. The optimal cutoff value of the SOC-ADL for discriminating dementia from MCI was 3 points, which provided a sensitivity and specificity of 74.5% and 75.7%, respectively. Conclusions Our results demonstrate that the SOC-ADL is a valid and reliable tool for differentiating dementia from MCI based on an assessment of ADL. This new tool can be used for screening ADL in elderly subjects who have difficulty communicating, and to increase the efficiency of dementia screening at the population level.

BACKGROUND AND PURPOSE: High-sensitivity C-reactive protein (hs-CRP) is the most widely studied biomarker of systemic inflammation. Its level has been reported to be associated with cognitive impairment. While dementia and cognitive impairment are common non-motor symptoms in advanced idiopathic Parkinson's disease (PD), the clinical value of hs-CRP for predicting dementia in PD patients remains unclear. Therefore, the objective of this study was to clarify the relationship between hs-CRP levels and the development or progression of dementia in PD through evaluating hs-CRP levels in PD patients with or without dementia. METHODS: A total of 112 PD patients without dementia (PD-D), 103 PD patients with dementia (PD+D), and 94 healthy controls were used in this study. The levels of hs-CRP and cognitive function were analyzed among these three groups. RESULTS: The mean serum hs-CRP levels in PD-D and PD+D were 1.76+/-3.62 mg/dL and 1.44+/-2.78 mg/dL, respectively, which were significantly (p=0.02) higher than that (vs. 0.41+/-1.06 mg/dL) in healthy controls. However, the levels of hs-CRP were not significantly (p>0.05) different between PD-D and PD+D. CONCLUSIONS: Our results suggest that neuro-inflammation plays a role in the pathogenesis of PD. However, it does not significantly contribute to the development or the progression of dementia in PD patients.
C-Reactive Protein* ; Dementia* ; Humans ; Inflammation ; Parkinson Disease*

BACKGROUND AND PURPOSE: Although acetyl-L-carnitine (ALC) treatment may have beneficial effects on Alzheimer's disease (AD), its underlying neural correlates remain unclear. The purpose of this study was to investigate cerebral perfusion changes after ALC treatment in AD patients using technetium-99m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT). METHODS: A total of 18 patients with early AD were prospectively recruited and treated with ALC at 1.5 g/day for 1.4±0.3 years. At baseline and follow-up, brain SPECT, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), and Neuropsychiatric Inventory (NPI) were used to assess participants. After ALC administration, changes in brain perfusion, severity of dementia, cognitive performance, and neuropsychiatric disturbances were examined. RESULTS: After ALC administration, changes in scores of MMSE, CDR, GDS, and NPI were not statistically significant (p>0.05). Voxel-wise whole-brain image analysis revealed that perfusion was significantly (p<0.001) increased in the right precuneus whereas perfusion was reduced in the left inferior temporal gyrus (p<0.001), the right middle frontal gyrus (p<0.001), and the right insular cortex (p=0.001) at follow-up. CONCLUSIONS: Although previous studies have suggested that AD patients generally demonstrate progressive deterioration in brain perfusion and clinical symptoms, this study reveals that the perfusion of the precuneus is increased in AD patients after ALC administration and their cognitive and neuropsychiatric symptoms are not aggravated. Further studies are warranted to determine the potential association between perfusion increase in the precuneus and clinical symptoms after ALC treatment in AD patients.
Acetylcarnitine* ; Alzheimer Disease* ; Brain ; Cerebral Cortex ; Cognition ; Dementia ; Follow-Up Studies ; Humans ; Parietal Lobe ; Perfusion* ; Prospective Studies ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

This article describes a systematic roadmap master plan for advanced industrial safety and health policy in Korea, with an emphasis on. Since Korean industries had first emergence of industrial safety and health policy in 1953, enormous efforts have been made on upgrading the relevant laws in order to reflect real situation of industrial work environment in accordance with rapid changes of Korean and global business over three decades. Nevertheless, current policy has major defects; too much techniques-based articles, diverged contents in less organization, combined enforcement and punishments and finally enforcing regulations full of commands and control. These deficiencies have make it difficult to accommodate changes of social, industrial and employment environment in customized fashion. The approach to the solution must be generic at the level of paradigm-shift rather than local modifications and enhancement. The basic idea is to establish a new system integrated with a risk assessment scheme, which encourages employers to apply to their work environment under comprehensive responsibility. The risk assessment scheme is designed to enable to inspect employers' compliances afterwards. A project comprises four yearly phases based on applying zones; initially designating and operating a specified risk zone, gradually expanding the special zones during a period of 3 years (2010-2012) and the final zone expanded to entire nation. In each phase, the intermediate version of the system is updated through a process of precise and unbiased validation in terms of its operability, feasibility and sustainability with building relevant infrastructures as needed.
Commerce ; Employment ; Health Policy ; Jurisprudence ; Korea ; Punishment ; Risk Assessment ; Social Control, Formal