Heart Rate Variability in Major Depressive Disorder

In foreign country, lots of studies were reported about the relationship between heart rate variability (HRV) and cardiac mortality. Lower HRV has been identified as a independent risk factor for sudden death. By the time, the study of HRV is confined to physically diseased state such as myocardial infarction or diabetic neuropathy. However recently the tendency of HRV has been toward to make clear the relationship of HRV and psychological problem. It is well known that depressed person is affected frequently by cardiovascular disease compared with normal people. However the mechanism that depression increases cardiovascular disease is not definitely found even though the autonomic dysfunction measured in HRV is suggested a factor for this mechanism. Depressed person has decreased HRV, decreased low frequency which reflects sympathetic activity, decreased high frequency which reflects parasympathetic activity. It means they have lower autonomic activity, so they have high cardiac mortality. Few physician knows about the utility of heart rate variability and in my thought, especially short time analysis and frequency domain method is first introduced in Korea. So we introduce this case for as many as physician know the utility of HRV.

An Experience of OSCE for Introducing Clinical Performance Assessment to Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.