The number of people living with dementia is increasing globally as a result of an ageing population. General practitioners (GPs), as the front-line care providers in communities, are important stakeholders in the system of care for people with dementia. This commentary describes a study conducted to understand GPs' attitudes and self-perceived competencies when dealing with patients with dementia and their caregivers in Singapore. A set of study information sheet and survey questionnaires were mailed to selected GP clinics in Singapore. The survey, comprising the "GP Attitudes and Competencies Towards Dementia" questionnaire, was administered. A total of 400 GPs returned the survey, giving the study a response rate of 52.3%. About 74% of the GPs (n=296) were seeing dementia patients in their clinics. Almost all the GPs strongly agreed that early recognition of dementia served the welfare of the patients (n=385; 96%) and their relatives (n=387; 97%). About half (51.5%) of the respondents strongly agreed or agreed that they felt confident carrying out an early diagnosis of dementia. Factor analysis of questionnaire revealed 4 factors representing "benefits of early diagnosis and treatment of patients with dementia", "confidence in dealing with patients and caregiver of dementia", "negative perceptions towards dementia care" and "training needs". GPs in Singapore held a generally positive attitude towards the need for early dementia diagnosis but were not equally confident or comfortable about making the diagnosis themselves and communicating with and managing patients with dementia in the primary care setting. Dementia education and training should therefore be a critical step in equipping GPs for dementia care in Singapore. Shared care teams could further help build up GPs' knowledge, confidence and comfort in managing patients with dementia.
Attitude of Health Personnel ; Caregivers ; psychology ; Clinical Competence ; Dementia ; diagnosis ; therapy ; General Practitioners ; psychology ; Humans ; Self Efficacy ; Singapore ; Surveys and Questionnaires

PURPOSE: This study aims to investigate how competitive orientation influences unethical decision-making (UDM) through relationship conflict and the moderating effect of hostile attribution bias. METHODS: This study was conducted using a self-report questionnaire. Data were collected from 727 employees in Chinese hospitals. For each variable, measures were adopted or adapted from existing literature. Data were analyzed using descriptive statistics, correlation analysis, confirmatory factor analysis, and hierarchical regression analysis. Common method variance was established using Harman's single-factor test. RESULTS: Competitive orientation is significantly and positively associated with relationship conflict (β = .36, p < .001) and UDM (β = .35, p < .001). Relationship conflict is significantly and positively associated with UDM (β = .51, p < .001). Relationship conflict partially mediates the relationship between competitive orientation and UDM. In addition, hostile attribution bias strengthens the positive relationship between competitive orientation and UDM through relationship conflict. CONCLUSION: This study provides some implications for hospital employees to deal with ethical dilemmas in decision-making. Hospital employees including nurses, physicians, and other health-care professionals should raise awareness of competitive orientation and adopt a cooperative approach to human relations. Effective training programs should be utilized to direct all hospital employees to depress hostile attribution bias whenever possible to everything in clinical practice.
Asian Continental Ancestry Group ; Bias (Epidemiology) ; Conflict (Psychology) ; Decision Making ; Education ; Ethics, Clinical ; Hostility ; Humans ; Methods

Western medicine was first introduced to Korea by Christian missionaries and then by the Japanese in the late 19th century without its historical, philosophical, cultural, social, political, and economic values being communicated. Specifically, during the Japanese colonial era, only ideologically ‘degenerated’ medicine was taught to Koreans and the main orthodox stream of medicine was inaccessible. Hence, Korean medical education not only focuses on basic and clinical medicine, but also inherited hierarchical discrimination and structural violence. After Korea's liberation from Japan and the Korean war, the Korean medical education system was predominantly influenced by Americans and the Western medical education system was adopted by Korea beginning in the 1980s. During this time, ethical problems arose in Korean medical society and highlighted a need for medical humanities education to address them. For Korean medical students who are notably lacking humanistic and social culture, medical humanities education should be emphasized in the curriculum. In the Fourth Industrial Revolution, human physicians may only be distinguishable from robot physicians by ethical consciousness; consequentially, the Korean government should invest more of its public funds to develop and establish a medical humanities program in medical colleges. Such an improved medical education system in Korea is expected to foster talented physicians who are also respectable people.
Aptitude ; Asian Continental Ancestry Group ; Clinical Medicine ; Consciousness ; Curriculum ; Discrimination (Psychology) ; Education ; Education, Medical ; Ethics, Medical ; Financial Management ; Humanities ; Humans ; Japan ; Korea ; Korean War ; Missionaries ; Rivers ; Societies, Medical ; Students, Medical ; Violence

The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%–80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making.
Adult ; Biofeedback, Psychology ; Clinical Decision-Making ; Electrophysiology ; Endosonography ; Fecal Incontinence* ; Humans ; Pelvic Floor ; Pudendal Nerve ; Spine ; Standard of Care

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.
Clinical Decision-Making ; Decision Making ; Diagnosis ; Heuristics ; Problem Solving ; Psychology ; Thinking*

PURPOSE: We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. METHODS: Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. RESULTS: A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. CONCLUSIONS: External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.
Calibration ; Cohort Studies ; Dataset ; Decision Support Systems, Clinical ; Discrimination (Psychology) ; Humans ; Mobile Applications ; Nomograms ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Seoul ; Smartphone* ; Tertiary Care Centers ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Tract*

Enhanced recovery after surgery (ERAS) has been widely used in the world for near 20 years, which should be considered as the milestone of modern medicine advancement, changing the routine perioperative principle, accelerating the recovery speed following operation, minimizing the postoperative pain, and saving the medical resources. Despite the remarkable advance, the quality and application of ERAS in the west China needs further improvement if compared with international level or even some domestic hospitals. The postoperative hospital stay in west China is much longer than the reported 3 to 5 days according to published references. Several suggestions can be help: (1) Based on the published consensus and the successful experiences of ERAS in colorectal surgery, the medical institution should make great effort to extend this technique to change the profound traditional idea in medical staffs and patients. (2) The medical administrations should take the application of ERAS as a key performance index and annual work plan in hospital. (3) Multiple disciplinary team including anesthetist, surgeon, dietitian, and nurses is essential for hospital to promote the quality of ERAS. Undoubtedly, ERAS is going to be the conventional medical care in the western area of China. We may look forward to seeing more researches from western China to update the ERAS consensus.
China ; Clinical Competence ; Colorectal Surgery ; rehabilitation ; Consensus ; Digestive System Surgical Procedures ; rehabilitation ; Health Knowledge, Attitudes, Practice ; Humans ; Length of Stay ; statistics & numerical data ; Patient Care Team ; standards ; trends ; utilization ; Personnel Administration, Hospital ; methods ; Postoperative Care ; methods ; psychology ; standards ; Postoperative Period ; Quality of Health Care ; standards ; trends

INTRODUCTIONThis study examines the relationship between the clinical performance of medical students and their performance as doctors during their internships.

METHODSThis retrospective study involved 63 applicants to a residency programme conducted at the Chonnam National University Hospital, South Korea, in November 2012. We compared the performance of the applicants during their internship with the clinical performance of the applicants during their fourth year of medical school. The performance of the applicants as interns was periodically evaluated by the faculty of each department, while the clinical performance of the applicants as fourth year medical students was assessed using the Clinical Performance Examination (CPX) and the Objective Structured Clinical Examination (OSCE).

RESULTSThe performance of the applicants as interns was positively correlated with their clinical performance as fourth year medical students, as measured by CPX and OSCE. The performance of the applicants as interns was moderately correlated with the patient-physician interactions items addressing communication and interpersonal skills in the CPX.

CONCLUSIONThe clinical performance of medical students during their fourth year in medical school was related to their performance as medical interns. Medical students should be trained to develop good clinical skills, through actual encounters with patients or simulated encounters using manikins, so that they are able to become competent doctors.

Clinical Competence ; Education, Medical, Graduate ; methods ; Educational Measurement ; methods ; Female ; Humans ; Internship and Residency ; Male ; Republic of Korea ; Retrospective Studies ; Schools, Medical ; Students, Medical ; psychology

Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.
Biopsy ; Biopsy, Fine-Needle ; Clinical Decision-Making ; Diagnosis* ; Discrimination (Psychology) ; Endoscopy ; Endosonography* ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Humans ; Mucous Membrane ; Stomach ; Stomach Neoplasms

BACKGROUNDRheumatoid arthritis (RA) is a systemic inflammatory disease characterized by functional disability and pain. Although acupuncture is widely used, until now Western acupuncture studies on RA have not shown conclusive positive results. Acupuncture is regarded as a reflex therapy that has effects on the human autonomic nervous system. By establishing a traditional Chinese medicine (TCM) diagnosis first, the practitioner is able to choose acupoints according to the state of each individual patient.

METHODS/DESIGNWe are interested if acupuncture, using a classical diagnostic procedure to allocate acupoints to the patient according to the Shang Han Lun theory, can be effective in relieving pain, improving hand function and increasing health-related quality of life in RA.The authors intend to harmonize TCM diagnosis according to clinical and genetic profiles. Patients with the TCM diagnosis of a so-called Turning Point syndrome will be followed up in a randomized, prospective, double-blind, placebo-controlled, multicenter and three-armed parallel-group study with a standardized treatment in order to optimize potential therapeutic effects of acupuncture on pain, strength and muscle function of patients with RA as well as the influence on inflammation and quality of life.

DISCUSSIONThe findings of this study will provide important clinical information about the feasibility and efficacy of acupuncture treatment for RA patients. In addition, it will explore the feasibility of further acupuncture research.

TRIAL REGISTRATION NUMBERClinicalTrials.gov Identifier NCT02553005.

Acupuncture Therapy ; Arthritis, Rheumatoid ; psychology ; therapy ; Clinical Protocols ; Double-Blind Method ; Hand ; physiopathology ; Humans ; Medicine, Chinese Traditional ; Pilot Projects ; Quality of Life