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Background/Aims@#Recently, 1 L of polyethylene glycol (PEG) plus ascorbic acid (Asc) has been introduced in Korea as a colonoscopy preparation agent. Data on its efficacy and safety in older adults have been limited. We aimed to evaluate the safety and efficacy of 1 L PEG/Asc in older adults by comparing it with oral sulfate solution (OSS). @*Methods@#A prospective multicenter randomized study was conducted with subjects aged ≥ 65 years who underwent colonoscopy. The participants were randomized to receive 1 L PEG/Asc or OSS. The primary endpoint was successful bowel preparation, defined as total Boston Bowel Preparation Scale ≥ 6, and ≥ 2 at each segment. Patient satisfaction, adverse events, and renal function changes were compared between the groups. @*Results@#Among the 106 patients, 104 were finally included in the analysis. Overall, successful bowel preparation was achieved in 96.2% of both 1 L PEG/Asc and OSS groups. The satisfaction scores for taste, total amount ingested, overall feeling, and willingness to repeat the same regimen were not significantly different between the groups. Adverse events of moderate or higher severity occurred in 16 and 10 cases in the 1 L PEG/Asc and OSS group, respectively. There were no significant changes in electrolyte levels or renal function from baseline. @*Conclusions@#The successful bowel preparation rate was > 90% in both groups without severe adverse effects and significant changes in renal function. As a new low-dose preparation regimen for colonoscopy in older adults, 1 L PEG/Asc, is as effective and safe as OSS.
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Objectives@#This study determines the effects of comorbidity of mood disorder and alcohol use disorder on suicide behavior. @*Methods@#We converted data from the electronic medical records of one university hospital into a common data model and utilized it in our analysis. We selected 9551 patients with diagnosis codes of mood disorders or alcohol use disorders and divided them into three groups: mood disorder (MD) only, alcohol use disorder (AUD) only, and comorbidity of mood disorder and alcohol use disorder (MD+AUD). The mood disorder group was also subgrouped with depressive (DD) or bipolar affective disorder (BD) groups, and the comorbidity group was classified in the same way. Then, we applied logistic regression analysis to assess the risk of suicide attempts between the diagnostic groups. Subgroup analysis according to age also was conducted. @*Results@#The MD+AUD group had 2.7 (odd ratio [OR]=2.70, 95% confidence intervals [CI]=1.91– 3.81, p<0.0001) and the DD+AUD group had 2.78 (OR=2.78, 95% CI=1.95–3.98, p<0.0001) times higher risk of suicide attempts than the MD only and DD only group, respectively. Furthermore, according to the age subgroup, the risk of suicide attempts was the highest (OR=5.17, 95% CI=2.35–11.40, p<0.0001) in the DD+AUD group for those aged 40–59. There were no significant results in BD. @*Conclusion@#The results showed that the comorbidity of mood disorder and alcohol use disorder could increase suicide risk. This study suggested that alcohol use behavior needs to be assessed as well as mood symptoms for suicide prevention.
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Objectives@#This study determines the effects of comorbidity of mood disorder and alcohol use disorder on suicide behavior. @*Methods@#We converted data from the electronic medical records of one university hospital into a common data model and utilized it in our analysis. We selected 9551 patients with diagnosis codes of mood disorders or alcohol use disorders and divided them into three groups: mood disorder (MD) only, alcohol use disorder (AUD) only, and comorbidity of mood disorder and alcohol use disorder (MD+AUD). The mood disorder group was also subgrouped with depressive (DD) or bipolar affective disorder (BD) groups, and the comorbidity group was classified in the same way. Then, we applied logistic regression analysis to assess the risk of suicide attempts between the diagnostic groups. Subgroup analysis according to age also was conducted. @*Results@#The MD+AUD group had 2.7 (odd ratio [OR]=2.70, 95% confidence intervals [CI]=1.91– 3.81, p<0.0001) and the DD+AUD group had 2.78 (OR=2.78, 95% CI=1.95–3.98, p<0.0001) times higher risk of suicide attempts than the MD only and DD only group, respectively. Furthermore, according to the age subgroup, the risk of suicide attempts was the highest (OR=5.17, 95% CI=2.35–11.40, p<0.0001) in the DD+AUD group for those aged 40–59. There were no significant results in BD. @*Conclusion@#The results showed that the comorbidity of mood disorder and alcohol use disorder could increase suicide risk. This study suggested that alcohol use behavior needs to be assessed as well as mood symptoms for suicide prevention.
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For the past 20 years, the medical education accreditation program of the Korean Institute of Medical Education and Evaluation (KIMEE) has contributed significantly to the standardization and improvement of the quality of basic medical education in Korea. It should now contribute to establishing and promoting the future of medical education. The Accreditation Standards of KIMEE 2019 (ASK2019) have been adopted since 2019, with the goal of achieving world-class medical education by applying a learner-centered curriculum using a continuum framework for the 3 phases of formal medical education: basic medical education, postgraduate medical education, and continuing professional development. ASK2019 will also be able to promote medical education that meets community needs and employs systematic assessments throughout the education process. These are important changes that can be used to gauge the future of the medical education accreditation system. Furthermore, globalization, inter-professional education, health systems science, and regular self-assessment systems are emerging as essential topics for the future of medical education. It is time for the medical education accreditation system in Korea to observe and adopt new trends in global medical education.
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Objective@#Early detection and proper management of mental illness can help to prevent severe deterioration. However, with limited financial and human resources of community mental health services, it is not practical to carry out all conventional screening tools simultaneously. In this study, we aimed to develop and validate a brief but comprehensive screening questionnaire for four common mental illnesses of the elderly. @*Methods@#The brief screening for four mental illnesses of elderly (BS4MI-elderly) is a 14-item binary response questionnaire that covers dementia, depressive disorder, sleep disorder, and hwa-byung. To test validity, we compared conventional scale scores for three groups of participants classified using the BS4MI-elderly. The sensitivity, specificity, predictive value of positive test, likelihood ratio of positive test and internal consistency of the BS4MI-elderly were assessed. Finally, a correlation analysis between the BS4MI-elderly and general mental health scales was conducted. @*Results@#A total of 254 participants aged over 65 years were recruited. The BS4MI-elderly showed moderate to high sensitivity for the test that distinguishes the normal group from the risk and disorder groups (dementia: 0.61, depressive disorder: 0.88, sleep disorder: 0.85, hwa-byung: 0.94) and high specificity for the test that distinguishes the disorder group from the normal and risk groups (dementia: 0.91, depressive disorder: 0.93, hwa-byung: 0.84, sleep disorder: 0.84). The BS4MI-elderly also exhibited good internal consistency and significant correlations with general mental health scales. @*Conclusion@#The BS4MI-elderly, a brief but comprehensive screening tool, could be a useful instrument for screening the elderly in community mental health services.
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For the past 20 years, the medical education accreditation program of Korean Institute of Medical Education and Evaluation (KIMEE) has contributed greatly to the standardization and improvement of the quality of basic medical education in Korea. Now, it contributes to establishing and promoting the future of medical education. Since its inception in 2019, Accreditation Standard of KIMEE 2019 (ASK2019) aims to achieve world-class medical education through the application of learner-centered curriculum using a continuum framework for the three phases of formal medical education: basic medical education, post-graduate medical education, and continuing professional development. ASK2019 also promotes medical education which meets community needs and employs systematic assessments throughout the education process. These are important changes that can be used to gauge the future of the medical education accreditation system. Furthermore, internationalization, interprofessional education, health systems science, and on-going, permanent self-assessment systems in every medical school are emerging as important topics for the future of medical education. It’s time for the medical education accreditation system in Korea to observe and adopt new trends in global medical education.
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For the past 20 years, the medical education accreditation program of the Korean Institute of Medical Education and Evaluation (KIMEE) has contributed significantly to the standardization and improvement of the quality of basic medical education in Korea. It should now contribute to establishing and promoting the future of medical education. The Accreditation Standards of KIMEE 2019 (ASK2019) have been adopted since 2019, with the goal of achieving world-class medical education by applying a learner-centered curriculum using a continuum framework for the 3 phases of formal medical education: basic medical education, postgraduate medical education, and continuing professional development. ASK2019 will also be able to promote medical education that meets community needs and employs systematic assessments throughout the education process. These are important changes that can be used to gauge the future of the medical education accreditation system. Furthermore, globalization, inter-professional education, health systems science, and regular self-assessment systems are emerging as essential topics for the future of medical education. It is time for the medical education accreditation system in Korea to observe and adopt new trends in global medical education.
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PURPOSE@#Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept.@*METHODS@#This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables.@*RESULTS@#We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation.@*CONCLUSION@#Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.
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PURPOSE: Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept. METHODS: This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables. RESULTS: We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation. CONCLUSION: Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.
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Humains , Stage de formation clinique , Programme d'études , Pratique professionnelle , Écoles de médecine , Statistiques comme sujet , Étudiant médecineRÉSUMÉ
Recently, the Korean Neuropsychiatric Association expelled one of its members on grounds of multiple ethical violations, which included a sexual boundary violation between doctor-patient relationships. However, the lack of understanding of why this is an ethical issue was found among the general population as well as psychiatric professionals. In this review article, we introduce the basic concepts of psychotherapy and psychiatrist-patient relationships, including therapeutic structure and transference/countertransference, and elaborate the reasons why boundary violations, and especially sexual boundary violations, are unethical and potentially harmful to the patient and to the psychiatric community.
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Humains , Éthique , Psychiatrie , PsychothérapieRÉSUMÉ
Graduate medical education is the most important phase among the three stages of medical education. It links basic medical education and continuing professional development. It is also a critical period in acquiring meaningful knowledge, skills and professionalism. The residents should be able to develop the core common competencies on top of their specialozeds field's expertise, in order to function as independent and qualified physicians. Despite the obvious importance of graduate medical education, the system in Korea has been designed and executed to meet the needs of the hospitals in the perspective of manpower management, rather than to educate and empower the residents. As a result, graduate medical education in Korea lacks clear educational objectives and systemic, resident-centered curriculums. Yet, we have no accreditation body to evaluate graduate medical education programs. In order to normalize graduate medical education, an integrated and unified institution that manages the whole process of the graduate medical education is desperately needed. Special attention should be given to the role of medical schools in educating the core common competencies. The Korean Association of Medical Colleges, the Korean Institute for Medical Education and Evaluation, and the Korean Academy of Medical Sciences should cooperate intimately to establish a new organization for the systemic management and development of graduate medical education.
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Agrément , 3440 , Programme d'études , Enseignement médical , Enseignement spécialisé en médecine , Corée , Professionnalisme , Écoles de médecineRÉSUMÉ
OBJECTIVE: This study aimed to investigate the effect of community-based Goal-Achieving program in geriatric depressive symptoms preliminarily. METHODS: We obtained data from elderly Korean subjects with major depressive disorder (n=51) aged 60 years or older at baseline, taking case management from community mental health center. Subjects were randomly assigned to intervention group (n=24) and control group (n=27). We investigated depressive symptoms through Short Form Geriatric Depression Scale-Korean version (SGDS-K) at baseline and every month for 3 months to all subjects. We tested interaction between group and time in SGDS-K score to evaluate the effect of program. And post hoc test examined between group differences of SGDS-K at each time points. RESULTS: In quadratic linear mixed effects model analysis, interaction between group and time was statistically significant (Total SGDS-K score : coefficient=0.29, p<0.001 ; SGDS-K dysphoria subscale : 0.18, p<0.001 ; SGDS-K hopelessness subscale : 0.05, p=0.089 ; SGDS-K cognitive impairment subscale : 0.06, p=0.003). And significant between group difference was shown in post hoc test at time points of third month (SGDS-K score of control group : SGDS-K score of intervention group=10.74±3.482 : 7.25±4.475, p=0.0184). CONCLUSION: These results may suggest that ‘Community-based the Goal-Achieving program’ has efficacy in reducing geriatric depressive symptoms.
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Sujet âgé , Humains , Prise en charge personnalisée du patient , Troubles de la cognition , Dépression , Trouble dépressif majeur , Santé mentaleRÉSUMÉ
OBJECTIVES: This study aimed to investigate the effects of resilience on posttraumatic stress symptoms and dissociation and whether depression mediates the relationships between resilience and posttraumatic stress symptoms and dissociation. METHODS: A total of 115 firefighters participated in the study. Data were collected via the Life Events Checklist, Impact of Event Scale-Revised, Dissociative Experience Scale, Beck Depression Inventory, and Connor-Davidson Resilience Scale. Structural equation modeling and path analysis were applied to estimate the relationships between resilience, depression, posttraumatic stress symptoms, and dissociation. RESULTS: Greater resilience was associated with lower posttraumatic stress symptoms and dissociation, and the relationship between them was fully mediated by depression. CONCLUSIONS: Specific aspects of depression may help explain the relationships between resilience and posttraumatic stress symptoms and dissociation. Tailored prevention programs and treatments based on resilience and depression may prevent posttraumatic stress symptoms and dissociation in firefighters and improve treatments outcomes among firefighters with posttraumatic stress symptoms and/or dissociation.
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Humains , Liste de contrôle , Dépression , PompiersRÉSUMÉ
OBJECTIVE: This study aims to examine association of temporal discounting with well-being of Korean community-dwelling elderly. METHODS: The subjects of this research were 4,373 community-dwelling older persons without dementia. Each subject was administered the questionnaires regarding the socio-demographic characteristics, temporal discounting which was measured using standard questions in which participants were asked to choose between an immediate, smaller payment and a delayed, larger one. Outcome variable is Korean version of the World Health Organization Five Well-Being Index (WHO-5). Statistical analyses including the Pearson's correlation test and logistic regression were performed in this study. RESULTS: At baseline, temporal discounting was negatively associated with WHO-5 in the Pearson's correlation test (r=-0.04, p=0.006). In a adjusted model for confounding variables, temporal discounting was negatively associated with WHO-5 [odd ratio (95% confidence interval)=0.57 (0.35–0.92), p=0.021]. CONCLUSION: Elderly individual with a higher temporal discounting (which indicates impulsivity) may have a lower quality of life.
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Sujet âgé , Humains , Démence , Modèles logistiques , Qualité de vie , Organisation mondiale de la santéRÉSUMÉ
OBJECTIVE: This study aims to investigate the association between alcohol use disorder and cognition in Korean community-dwelling elderly, especially the gender-specific difference. METHODS: Data obtained from 1,141 subjects (976 men and 165 women) aged above 60 years was analyzed from the Gwangju Dementia and Mild Cognitive Impairment Study. All subjects completed the study questionnaire including demographic characteristics, history of current and past illnesses, drug history, Korean Mini-Mental State Examination (K-MMSE), and cut down, annoyed, guilty feelings, eye-opener (CAGE), Short Form of Geriatric Depression Scale-Korean version (SGDS-K). RESULTS: Of the 1,141 subjects (mean age 72.17±6.20, mean educational level 6.50±4.48), 267 demonstrated alcohol use disorder (23.40%) and 874 were non-alcohol use disorder (76.60%). The mean of K-MMSE for alcohol use disorder group was 23.23±4.99, and for non-alcohol use disorder group was 23.70±3.94. When alcohol use disorder is accompanying, the decrement of K-MMSE score was 3.07 for female, and 0.35 for male. And we confirmed the interactive effect on K-MMSE score between sex and alcohol use disorder after adjusting for age, education level, depression (F=5.798, p=0.016). CONCLUSION: In conclusion, our study demonstrates an association between alcohol use disorder and cognitive impairment by gender in the elderly.
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Sujet âgé , Femelle , Humains , Mâle , Alcools , Cognition , Démence , Dépression , Éducation , Dysfonctionnement cognitifRÉSUMÉ
OBJECTIVE: The aim of this study was to examine the relationship between late-life depression and resilience in the Korean community-dwelling elderly with depression. METHODS: The subjects were 102 depressed elderly people who lived in Suwon and Gwangju, Korea. Each subject was administered the questionnaires regarding the socio-demographic characteristics, Korean version of the Mini-Mental State Examination for Dementia Screening (MMSE-DS), Brief Resilience Scale (BRS), and Short Form Geriatric Depression Scale-Korean version (SGDS-K). RESULTS: In a cross-sectional aspect, BRS score were negatively correlated with SGDS-K score in the Pearson's correlation test (r=-0.301, p=0.002). After multivariable adjustments, linear mixed model analysis showed that subjects with baseline higher BRS score had significantly lesser SGDS-K score (β=-0.16, p=0.006). CONCLUSION: The level of resilience should be considered in predicting the change of depressive symptoms in the elderly.
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Sujet âgé , Humains , Démence , Dépression , Corée , Dépistage de masseRÉSUMÉ
OBJECTIVE: This study aims to identify self-reported stressors in the Korean community-dwelling elderly and examine their effects on subjective well-being. METHODS: The subjects of this research were 1,010 elderly people who lived in Suwon, Korea. Each subject was administered the questionnaires regarding the socio-demographic characteristics, self-reported stressors, Concise Measure of Subjective Well-Being (COMOSWB) consisting of life satisfaction, positive emotion and negative emotion, Mini-Mental State Examination for dementia screening and Short Form Geriatric Depression Scale-Korean version. Statistical analyses including the Pearson's correlation test and multiple linear regressions were performed in this study. RESULTS: In our adjusted model for confounding variables, stress from physical problems (S-PP) (ss=-0.133, p<0.001), stress from loneliness or solitude (S-LS) (ss=-0.077, p=0.007), stress from family members (S-FM) (ss=-0.083, p=0.001) were negatively associated with the total score of COMOSWB. In subscale analyses of COMOSWB, we also found that S-PP (ss=-0.184, p<0.001), S-LS (ss=-0.077, p=0.014), stress from economic problems (ss=-0.072, p=0.021) were negatively associated with life satisfaction score. While S-PP (ss=-0.140, p<0.001) and S-FM (ss=-0.079, p=0.003) were negatively associated with positive emotion score, S-FM (ss=0.105, p=0.001) and stress from friends and neighbors (ss=0.072, p=0.016) were positively associated with negative emotion score. CONCLUSION: Stresses from physical problems, loneliness, and family members might be associated with subjective well-being in the elderly. While life satisfaction appears to be affected by one's perceived physical health status, loneliness, and economic conditions, positive and negative emotions appear to be affected by relationships with family members, friends, or neighbors.
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Sujet âgé , Humains , Démence , Dépression , Amis , Corée , Modèles linéaires , Solitude , Dépistage de masse , Enquêtes et questionnairesRÉSUMÉ
OBJECTIVE: Head circumference (HC) has been reported to be an index of cognitive functioning in the elderly and in Alzheimer's patients. The object of the study is to find the relationship between HC and cognition. METHODS: A total of 7,603 subjects over 60 years of age were analyzed from preliminary data of Gwangju Dementia and Mild Cognitive Impairment Study. HC was manually measured and cognitive functioning was assessed by the Korean version of the Mini Mental State Examination (K-MMSE). RESULTS: Correlational analysis showed that HC was associated with age (r=-0.14, p<0.01), education (r=0.33, p<0.01), height (r=0.26, p<0.01), and K-MMSE (r=0.28, p<0.01). Also, even after adjusting for confounding variables (age, education, height, gender) the positive association between HC and K-MMSE score remained significant (beta=0.18, p<0.001). CONCLUSION: The results suggest that HC may play an important role in predicting cognitive impairment in the elderly.