OBJECTIVE: To evaluate the characteristics of cricopharyngeal dysfunction (CPD), the frequency, and correlation with a brain lesion in patients with first-ever ischemic stroke, and to provide basic data for developing a therapeutic protocol for dysphagia management. METHODS: We retrospectively reviewed the medical records of a series of subjects post-stroke who underwent a videofluoroscopic swallowing study (VFSS) from January 2009 to December 2015. VFSS images were recorded on videotape and analyzed. CPD was defined as the retention of more than 25% of residue in the pyriform sinus after swallowing. The location of the brain lesion was assessed using magnetic resonance imaging. RESULTS: Among the 262 dysphagic patients with first-ever ischemic stroke, 15 (5.7%) showed CPD on the VFSS. Patients with an infratentorial lesion had a significantly higher proportion of CPD than those with a supratentorial lesion (p=0.003), and lateral medullary infarction was identified as the single independent predictor of CPD (multivariable analysis: odds ratio=19.417; confidence interval, 5.560–67.804; p < 0.0001). Compared to patients without CPD, those with CPD had a significantly prolonged pharyngeal transit time, lower laryngeal elevation, and a higher pharyngeal constriction ratio and functional dysphagia scale score. CONCLUSION: Overall, the results support the notion that an impaired upper esopharyngeal opening is likely related to the specific locations of brain lesions. The association of CPD with lateral medullary infarction can be explained based on the regulation of the pharyngolaryngeal motor system by the motor neurons present in the dorsal nucleus ambiguus. Overall, the results reveal the relation between CPD and the problems in the pharyngeal phase as well as the severity of dysphagia.
Brain ; Constriction ; Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Humans ; Infarction ; Magnetic Resonance Imaging ; Medical Records ; Medulla Oblongata ; Motor Neurons ; Pharyngeal Muscles ; Pyriform Sinus ; Retrospective Studies ; Stroke* ; Videotape Recording

Endoscopic ultrasound (EUS) has been recently established as an indispensable modality for the diagnosis and management of pancreatobiliary and gastrointestinal (GI) disorders. EUS proficiency requires both cognitive and technical abilities, including an understanding of the appropriate indications, the performance of appropriate evaluations before and after the procedure, and the management of procedure-related complications. An increasing demand for skills to handle a growing range of interventional EUS procedures and a continual shortage of EUS training programs are two major obstacles for EUS training. Acquiring the skills necessary to comprehend and conduct EUS often requires training beyond the scope of a standard GI fellowship program. In addition to traditional formal EUS training and preceptorships, regular short-term intensive EUS training programs that provide training at various levels may help EUS practitioners improve and maintain EUS-related knowledges and skills. Theoretical knowledge can be acquired from lectures, textbooks, atlases, slides, videotapes, digital video discs, interactive compact discs, and websites. Informal EUS training is generally based on 1- or 2-day intensive seminars, including didactic lectures, skills demonstrated by expert practitioners through live video-streaming of procedures, and hands-on learning using animal or phantom models.
Animals ; Compact Disks ; Diagnosis ; Education ; Endoscopy* ; Endosonography ; Fellowships and Scholarships ; Learning ; Lectures ; Preceptorship ; Training Support ; Ultrasonography* ; Videotape Recording

PURPOSE: The purpose of this study was to conduct a grounded theoretical analysis on the hospital accreditation experience of head nurses in order to understand their behavior on the adaption of this new system. METHODS: The participants were 8 head nurses with more than 3 years of experience. The data were collected through in-depth interviews using audiotape recording analyzed by the constant comparative method described in Strauss and Corbin's methodology. RESULTS: There were 113 concepts, 26 subcategories and 12 categories identified through the open coding process. In the axial coding, the following paradigm model was proposed: 1) the causal conditions were ‘hardware problem’ and ‘software problem’, 2) the contextual conditions were ‘vertical relationship’, ‘individual preference’, and ‘family support’, 3) the intervening conditions were ‘passive conditions’ and ‘active conditions’, 4) the action/interaction strategies were ‘leading role’ and ‘dependent role’, 5) the consequences were ‘positive acceptance’ and ‘negative acceptance’, 6) the central phenomenon was ‘difficult situation’ and 7) the core category was ‘leading in harmony’. CONCLUSION: The new system led head nurses having difficulties as the middleman between the hospital administration and general nurses, but they made a continuous effort to overcome and adapt to it through a number of strategies.
Accreditation* ; Clinical Coding ; Grounded Theory ; Head* ; Hospital Administration ; Hospitals, General* ; Methods ; Nursing, Supervisory* ; Tape Recording

PURPOSE: The modified Yale Preoperative Anxiety Scale (mYPAS) was developed for evaluating the level of preoperative anxiety in children. The purpose of this study was to develop a Korean version of the mYPAS (K-mYPAS) and to establish its validity and reliability based on the Korean preoperative pediatric patients. METHODS: K-mYPAS was made through stringent back-translation procedure. Total enrolled 102 patients answered questionnaires of Korean version of State-Trait Anxiety Inventory for Children (K-STAIC), and were videotaped for 2 to 5 minutes before induction of anesthesia. Three observers of experienced psychiatrist, surgeon, and nurse analyzed videotape with K-mYPAS comparing to K-STAIC. The inter- and intraobservers reliability, concurrent and construct validity, sensitivity, specificity, and predictive value were analyzed. RESULTS: The value of Cronbach alpha for interobservers reliability was 0.939 and intraobserver reliability was statistically significant (P < 0.001). Concurrent and construct validity were also statistically significant (P < 0.001 and P < 0.001, respectively). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.3%, 91.4%, 81.3%, 91.4%, and 88.2%, respectively. CONCLUSION: The K-mYPAS had good psychometric properties and can be used as a reliable and valid instrument for the assessment of preoperative anxiety in children.
Anesthesia ; Anxiety* ; Child ; Humans ; Psychiatry ; Psychometrics ; Reproducibility of Results* ; Sensitivity and Specificity ; Videotape Recording

As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual's death is the last and most significant choice in one's life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.
Advance Care Planning* ; Decision Making ; Decision Support Systems, Clinical ; Decision Support Techniques ; Hope* ; Humans ; Lifting* ; Nimodipine ; Palliative Care ; Shock ; Terminal Care ; Videotape Recording

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 +/- 0.60, after 2.73 +/- 0.72), 'timeline' (before 2.82 +/- 0.68, after 3.18 +/- 0.73), 'positive verbal reinforcement' (before 2.24 +/- 0.56, after 2.61 +/- 0.90), and the total score (before 21.70 +/- 2.62, after 23.39 +/- 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.
Arizona ; Checklist ; Humans ; Outpatients ; Referral and Consultation ; Schools, Medical ; Videotape Recording

OBJECTIVE: Easy triggering of trauma-related episodic memory fragments caused by perceptual cues is tied to strong perceptual priming in the implicit memory system. And among benzodiazepines, only lorazepam has been consistently reported to have an atypical suppression effect on perceptual priming processes. The aim of this study was to investigate the effects of single doses of lorazepam, diazepam, and a placebo on intrusive memories after exposure to a distressing videotape and to explore whether the anti-intrusive effect of lorazepam is acquired as a result of the suppression of perceptual but not conceptual priming processes. METHODS: Under prospective, randomized, and double-blind conditions, we compared the anti-intrusion effect of a single dose of lorazepam (n=22) with that of diazepam (n=22) and a placebo (n=21) in young healthy Korean college students following exposure to a traumatic videotape. RESULTS: We present the first finding for an anti-intrusion effect of lorazepam. One day after the medication, lorazepam, rather than diazepam or the placebo, significantly reduced the extent of intrusion and data-driven processing of the traumatic information. There were no differences among the three conditions in state anxiety, depression, and an arousal scale throughout the experiment. CONCLUSION: Results from this study suggest the possibility of lorazepam as a candidate anti-intrusion drug, as well as the cautious use of diazepam in the treatment of PTSD patients. The anti-intrusive effect of lorazepam is directly related to its atypical inhibitory effect on implicit perceptual priming processes. The present study provides support for the enhanced perceptual priming hypothesis of PTSD.
Benzodiazepines ; Cues ; Diazepam ; Humans ; Lorazepam* ; Memory ; Memory, Episodic ; Prospective Studies ; Stress Disorders, Post-Traumatic ; Videotape Recording

PURPOSE: We studied this study to see the effect of hearing music on response to pain during needling. We hypothesized that music would reduce pain in newborns. METHODS: Twenty term and near-term newborns were enrolled for the study. They were admitted to neonatal intensive care unit of Hanyang University Guri Hospital from May 1, 2011 to September 30, 2011. We evaluated pain response to needling, such as arterial puncture or heel prick, by using Neonatal Infant Pain Scale (NIPS; facial expression, crying, breathing patterns, arms, legs, state of arousal) and duration of crying through video recording. We started video recording when the newborns were stable with 0 score of NIPS, and continued for 3 minutes after needling. Each newborn took video-recordings in 2 separate periods. One was done with hearing music (Music group) and the other without music (Control group). Two observers reviewed the videotapes and gave final scores in agreement. T-test was done for comparisons of pain scale and duration of crying between music and control groups. RESULTS: Mean age and hospital days at test of the subjects were 6+/-5 days of life (1-16 days of life) and 3+/-2 days, respectively. Twenty-one of 40 needlings (52.5%) for blood sample were from radial arterial puncture and 19 (47.5%) from heel prick. The music group had lower NIPS score than the controls (5.6+/-1.1 vs 6.5+/-0.7, P=0.006). Among the NIPS parameters, the music group had lower scores in crying and arm (crying, 1.6+/-0.5 vs 1.9+/-0.3, P=0.028; arm, 0.3+/-0.5 vs 0.7+/-0.5, P=0.01) parameters. The remaining parameters such as facial expression, leg, breathing patterns and state of arousal, and duration of crying were not significantly different in 2 groups. CONCLUSION: c reduced pain response to needling in newborns. Music could be one of modalities to relieve pain during routine medical procedures in newborns.
Arm ; Arousal ; Crying ; Facial Expression ; Hearing* ; Heel ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Korea ; Leg ; Music* ; Punctures ; Respiration ; Video Recording ; Videotape Recording

PURPOSE: This research was a descriptive study of nursing activities observed in nursing simulation during a senior nursing student practicum. Content and frequencies of nursing activities during the simulation practice were identified. METHODS: Thirty-six episodes of pediatric nursing simulation were videotaped. Both verbalizations and descriptions of nonverbal behaviors were recorded from the videotapes. The data were coded and analyzed. The coded nursing activities were evaluated for frequency and purpose of interaction. RESULTS: Average time per simulation episodes was 27 minutes and ranged from 3.30 to 32.54 minutes. Nursing activities in these simulation episodes included nursing assessments such as vital sign measurement, associated symptom assessment, and check of patient condition, nursing interventions such as medication, tepid water massage, fluid therapy, provision of oxygen, suctioning, hyperglycemia and hypoglycemia management, communication such as parent education, procedure guidance, and communication among providers. Activities in assessment were most frequent, and among them, vital sign measurement and check of patient condition were more frequent than others. CONCLUSION: Students showed enhanced nursing activities such as more frequent nursing assessment, communication and interventions in their simulation experience. Therefore simulation experience can be considered as one strategies to provide nursing students with better and more intense practicum experience.
Education, Nursing ; Fluid Therapy ; Humans ; Hyperglycemia ; Hypoglycemia ; Massage ; Nursing Assessment ; Oxygen ; Parents ; Patient Simulation ; Pediatric Nursing ; Students, Nursing ; Suction ; Symptom Assessment ; Videotape Recording ; Vital Signs

PURPOSE: Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient-centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX). METHODS: During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students' CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC). RESULTS: The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7), and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other. CONCLUSION: Medical educators must emphasize the importance of exploring a patient's illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.
Clinical Clerkship ; Humans ; Outpatients ; Patient-Centered Care ; Physician-Patient Relations ; Students, Medical ; Videotape Recording