Purpose: This study aims to verify whether the Reflective Practice Questionnaire (RPQ) developed by Priddis and Rogers is valid in the Korean context to identify the level of reflection of medical students in clinical practice. Methods: A total of 202 third- and fourth-year medical students from seven universities participated in the study. After receiving approval for use from the authors, a survey was conducted on the students through an adaptation process. The original scale consists of 10 factors with 40 items. The Self-efficacy in Clinical Performance Scale (SECP), Korean Self-reflection and Insight Scale (K-SRIS), and Reflection-in-Learning Scale (RinLS) were used to validate the scale. Exploratory factor, confirmatory factor, correlation, and reliability analyses were used for data analysis. Results: As a result of exploratory factor analysis, 10 subfactors were extracted (Kaiser-Meyer-Olkin=0.856, Bartlett’s test: χ 2 =5,044.337, degrees of freedom=780, p<0.001). Among the 40 items, one that showed a high overlapping load for other factors was excluded. As a result of confirmatory factor analysis, the 10-factor structure model was found suitable (χ 2 =1.980, comparative fit index=0.859, Tucker-Lewis index=0.841, root mean square error of approximation=0.070). As a result of the criterion validity test, most of the subfactors of the Korean version of the RPQ (K-RPQ) showed a positive correlation with K-SRIS, RinLS, and SECP. The reliability of 10 subfactors was satisfactory, ranging from 0.666 to 0.919. Conclusion The K-RPQ was confirmed to be a reliable and valid tool to evaluate the level of reflection among Korean medical students in clinical clerkship. This scale can be used as a tool to provide feedback on each student’s level of reflection in clinical clerkship.

Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677–0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611–0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715–0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. Conclusion In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.

OBJECTIVES: The objective of this study was to investigate the relationship between coronary artery calcification and risk factors of cardiovascular disease with multidetector computed tomography. METHODS: Data were collected from 5,899 males between 30 and 59 years old by interview, survey, physical examination, blood test, and multidetector computed tomography in the university hospital from January 2010 to December 2011. We confirmed the coronary artery calcium scores of subjects by multidetector computed tomography and identified risk factors of cardiovascular disorders. We investigated the relationship between coronary artery calcification and risk factors of cardiovascular disorders. RESULTS: Mean calcium score of the coronary arteries in 5,899 participants was 8.20, and 773 participants (13.1%) exhibited coronary artery calcification. The presence of coronary artery calcification was correlated to risk factors of cardiovascular disease (age, blood pressure, triglyceride, HDL cholesterol, LDL cholesterol, glucose, Apolipoprotein A-1, Apolipoprotein B, body mass index, waist circumference) and risk assessment tools of cardiovascular disorders. Significant predicted factors of coronary artery calcification had different patterns in each age group (30-39, 40-49, 50-59 years old). CONCLUSIONS: We confirmed the relationship between coronary artery calcification and either typical risk factors of cardiovascular disease or risk assessment tools of cardiovascular disease. In addition, we also observed that the pattern of these factors varied according to age. Therefore, age-related variation needs to be considered in management strategies to prevent cardiovascular disease.

OBJECTIVE: To determine the effects of mattresses and positioning on interface pressure (IP) and skin blood flow in young healthy persons. METHOD: Ten healthy subjects were included. Three types of mattresses including standard hospital mattress, alternating pressure pump and pad, and alternating pressure air mattress (APAM) and four positions including supine, 30 degree trunk elevation, 30 degree leg elevation, and right 90 degree lateral position were evaluated. IP over the buttock was measured with force sensing array (FSA) pressure mapping system for every subjects lying in four positions on each mattresses. Skin blood flow was measured with laser doppler flowmeter probes that placed over the sacrum and right greater trochanter. RESULTS: IP was significantly lower on the APAM than on the other types of mattresses in all positions. In the right 90 degree lateral position, the IP was significantly higher on all mattresses than that in the other positions, and in the 30 degree leg elevation, the IP was significantly lower on standard hospital mattress and APAM than that in the supine position. There were significant differences in the skin blood flow over the greater trochanter between the APAM and the other types of mattresses, while there were no significant differences over the sacrum on all mattresses. CONCLUSION: APAM is likely to be the most effective as a preventive and treating measure for pressure ulcers. However, combined use of the APAMs with periodic position change might be necessary over the trochanter for effective pressure relief.
Beds ; Buttocks ; Deception ; Femur ; Flowmeters ; Humans ; Leg ; Pressure Ulcer ; Sacrum ; Skin ; Supine Position

Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse effects ; Antibodies, Monoclonal/*adverse effects ; Anticoagulants/*adverse effects ; Cardiac Tamponade/*etiology/therapy ; Emergency Medical Services ; Hemorrhage/*etiology/therapy ; Humans ; Immunoglobulin Fab Fragments/*adverse effects ; Korea ; Male ; Pericardiocentesis ; Pericarditis/*etiology/therapy ; Platelet Aggregation Inhibitors/*adverse effects ; Risk Factors

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.
Adult ; Colonic Diseases/pathology/radiography ; *Colonography, Computed Tomographic ; Humans ; Intestinal Mucosa/pathology ; Male ; Pneumatosis Cystoides Intestinalis/*pathology/radiography

BACKGROUND AND OBJECTIVES: A cerebrospinal fluid (CSF) gusher during cochlear implantation can produce surgical difficulties and postoperative life threatening morbidities such as meningitis. Authors reviewed cases of CSF gushers during cochlear implantation, and assessed the radiologic characteristics of CSF gushers. SUBJECTS AND METHOD: From November 1988 to March 2004, 72 congenital deaf children with inner ear malformation underwent cochlear implantation in Seoul National University Hospital. Among these, 15 patients showed CSF gush intraoperatively. The medical records, the preoperative tem-poral bone HRCT and IAC MRI were reviewed retrospectively. RESULTS: Eighty percent (12/15) of CSF gushers had cochlear malformation. One case with a common cavity (100%), 6 of 15 cases of cochlear hypoplasia (32%) and 5 of 27 cases of incomplete partition (18.5%) showed CSF gush. The total or a partial defect of the modiolus significantly increased the risk of CSF gush. During the surgery, promontory mucosa around the cochleostomy opening was removed by electrocauterization and soft tissue pieces were packed in the posterior tympanum around the cochleostomy site after insertion of the active electrodes. Some additional procedures such as mastoid or middle ear obliteration were performed in two patients with intractable CSF gush. No lumbar drains were used. Postoperative meningitis developed in one case 7 months after cochlear implantation without a history of CSF leak. However, there were no evidences of CSF leak in all cases during the postoperative follow-up period (3-49 months, mean 24 months). CONCLUSION: Cochlear implant surgeons should be prepared to cope with CSF gusher during the cochlear implantation procedure in cases with congenital inner ear malformation, particularly if the patient has radiological evidence of modiolar defect.
Cerebrospinal Fluid* ; Child ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner ; Ear, Middle ; Electrodes ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Medical Records ; Meningitis ; Mucous Membrane ; Retrospective Studies ; Seoul

STUDY DESIGN: This study is a prospective evaluation of the results of the standard discectomy and microdiscectomy of the herniated lumbar disc. OBJECTIVES: The purpose of this study is to compare the clinical results between the standard discectomy and microdiscectomy groups in the herniated lumbar disc. SUMMARY OF LITERATURE REVIEW: Many spine surgeons believe that everything that can be accomplished through the standard discectomy can be accomplished more easily with the assistance of the microscope. So the standard laminectomy and discectomy is gradually being replaced by the microdiscectomy. MATERIALS AND METHODS: One hundred and seventy-three patients with lumbar disc herniations were evaluated. Ninty-six patients were operated through the standard method and seventy-seven patients were operated with the aim of the microscope. These operations were taken by one surgeon and the clinical results were undertaken by a doctor who was not involved in the operation using a proven outcome assessment scale. RESULTS: There were significant differences between the standard discectomy and the microdiscectomy groups in terms of complications and revision rates. In microdiscectomy group, clinical result was less favorable than standard discectomy group. CONCLUSION: In microdiscectomy groups the incidence of infection and rate of revision operation were higher than in standard discectomy groups. The standard discectomy is still thought better than the microdiscectomy in the operative treatment of herniated lumbar disc.
Diskectomy* ; Humans ; Incidence ; Intervertebral Disc Displacement ; Laminectomy ; Prospective Studies ; Spine

OBJECTIVE: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain. METHOD: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group. RESULTS: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale. CONCLUSION: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.
Adult ; Ankle Joint ; Arm ; Humans ; Injections, Intramuscular ; Muscles ; Myalgia* ; Myofascial Pain Syndromes ; Neck ; Pain Measurement ; Pain, Referred ; Shoulder Joint ; Superficial Back Muscles ; Trigger Points

OBJECTIVE: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics. METHOD: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not). RESULTS: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group. CONCLUSION: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.
Compensation and Redress ; Disability Evaluation* ; Humans ; Low Back Pain* ; Magnetic Resonance Imaging ; Pain Measurement ; Psychometrics* ; Surveys and Questionnaires ; Weights and Measures