Finding Meaning in Life Threatening Illness / 한국호스피스완화의료학회지

This paper aims to explore how to help terminally ill patients and their families find meaning in their suffering from the logotherapeutic perspective, which is the essence of palliative care. For this purpose, this paper examines the main concepts and principles of logotherapy, and specific approaches based on the logotherapeutic perspective to help terminally ill patients and their families find meaning in life are presented. Emphasizing the will to meaning as the primary motive to explain human behaviors and based on its unique perspective of the human being, which is called the dimensional ontology, logotherapy considers the human being to consist of the body, the mind, and the spirit. The dimensional ontology implies that the human being “has” the body and the mind, but the human being “is” the spirit itself. Therefore, even though a human being can be sick physically or psychologically, Accordingly, it is essential to help these patients realize that they are not their illnesses, but just have them, and to rise above themselves to reach out toward something meaningful or someone to love; despite their suffering, they can still do something meaningful, even in a small way. Above all, the most important thing for these patients is to acknowledge that they have already lived a meaningful life and to believe that their meaningful work has been safely preserved in the past and nothing can take it from them, for as spiritual beings, their lives have been meaningful unconditionally.

Development of the Korean Form of the Premonitory Urge for Tics Scale: A Reliability and Validity Study

Objectives@#This study aimed to evaluate the reliability and validity of the Korean Form of the Premonitory Urge for Tics Scale (K-PUTS). @*Methods@#Thirty-eight patients with Tourette’s disorder who visited Jeonbuk National University Hospital were assessed with the K-PUTS. Together with the PUTS, the Yale Global Tic Severity Scale (YGTSS), the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the attention-deficit/hyperactivity disorder (ADHD) rating scale (ARS), and the Adult ADHD Self-Report Scale (ASRS) were implemented to evaluate concurrent and discriminant validity. @*Results@#The internal consistency of items on the PUTS was high, with a Cronbach’s α of 0.79. The test-retest reliability of the PUTS, which was administered at 2 weeks to 2 months intervals, showed high reliability with a Pearson correlation coefficient of 0.60. There was a significant positive correlation between the overall PUTS score and the YGTSS score, showing concurrent validity. There was no correlation between the PUTS, CY-BOCS, and ASRS scores, demonstrating the discriminant validity of the PUTS. Factor analysis for construct validity revealed three factors: “presumed functional relationship between the tic and the urge to tic,” “the quality of the premonitory urge,” and “just right phenomena.” @*Conclusion@#The results of this study indicate that the K-PUTS is a reliable and valid scale for rating premonitory urge of tics.

Progression of Right Ventricular Systolic Dysfunction Detected by Myocardial Deformation Imaging in Asymptomatic Preterm Children

BACKGROUND: To detect progression of right ventricular (RV) systolic dysfunction (RVSD) in asymptomatic preterm children from infancy to 24-month corrected age, using velocity vector imaging (VVI). METHODS: Retrospective study comparing sequential RV longitudinal peak systolic strain (LPSS) from 24 children born at 16% at the first exam, and only 2/7 of these children had a history of moderate or severe bronchopulmonary dysplasia. CONCLUSION: In asymptomatic preterm children, routine echocardiographic screening using VVI could detect RVSD which could progress from 4–24 month corrected age.

Outcome of Early Initiation of Peritoneal Dialysis in Patients with End-Stage Renal Failure

Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone.

Relationships between Cognitive and Learning Styles of Premedical Students / 한국의학교육

PURPOSE: We investigated the relationship between cognitive and learning style by comparing the Cognitive Styles Analysis (CSA) with the Index of Learning Styles (ILS). We assessed whether cognitive styles correlated with learning styles with regard to their corresponding dimensions. METHODS: One hundred two second-year premedical students participated, and data from ninety-four students were analyzed. One student's data file was lost during data collection, and six students were excluded because their correct response rates on the CSA were lower than 50%. Both scales were presented on a computer item by item, and the assessment was conducted in the computer lab as a group. For analysis, responses and reaction times were recorded. RESULTS: Distributions of the styles were generated. We correlated the verbal-imagery dimension of the CSA with the visual-verbal dimension of the ILS and found no correlation. There was no correlation between the wholist-analytic dimension of the CSA with the sequential-global dimension of the ILS. Excluding intermediate students in the verbal-imagery dimension of the CSA, however, there appeared to be a marginally significant correlation between the verbal-imagery dimension of the CSA and the visual-verbal dimension of the ILS. CONCLUSION: In the visual (imagery)-verbal dimension, there was some correlation between cognitive and learning styles.

Characteristics of Medical Students' Learning Styles and Their Relationships to GPA / 한국의학교육

PURPOSE: The present study examines the characteristics of medical students' learning styles and their relationships to the GPA. METHODS: One hundred 2nd year medical students took the revised version of the Index of Learning Styles (ILS) by Felder-Silverman, which was computerized. The ILS classifies individual preferences for information processing into 16 categories based on four dichotomous dimension: active/reflective, sensing/intuitive, sequential/global, visual/verbal. The GPA from the previous semester was used. RESULTS: The most frequent learning styles were reflective, sensing, sequential, and visual, covering 25% of the class. For the relationship with the GPA, we compared group means. The sensing students showed significantly higher grades than the intuitive students. Other than this result, there seemed to be no particular relationship between learning styles and GPA. This relationship should be further studied. CONCLUSIONS: In this study, medical students were categorized based on individual differences in information processing. Learning styles are expected to be helpful in designing effective learning strategies and thereby enhancing medical students' performance.

Exploring Sources of Life Meaning among Koreans / 신경정신의학

OBJECTIVES: The purpose was to explore sources of Koreans' life meaning and determine its structure that is reflective of Koreans' unique culture and values. METHODS: The study consisted of both qualitative and quantitative research methods. To this end, two sample data sets were collected. Study One was an exploratory study in which the qualitative component was conducted in order to gather all possible attributes of sources of life meaning among Koreans. All possible sources of life meaning were extracted through content analysis. Study Two was a quantitative study using a closed questionnaire and conducted in order to determine the structure of Koreans' life meaning by measuring Koreans' current level of life meaning. For the study, factor analysis was carried out. RESULTS: From Study One, 106 attributes of all possible sources of Koreans' life meaning were extracted. In Study Two, factor analysis with the responses from 638 subjects reduced 106 attributes to 53 attributes and ten factors were extracted as Koreans' sources of life meaning: Achievement, Security, Religion, Acceptance & Affirmation, Relationship, Self-Transcendence, Good Character, Self-Discipline, Physical Health and Intimate Friend. CONCLUSION AND IMPLICIATIONS: Among the ten factors extracted from this study, the factors of Security, Acceptance and Affirmation, Good Character, Self-Discipline, and Physical Health are Koreans' unique factors of Life Meaning, while Achievement, Religion, Relationship, Self-Transcendence and Intimate Friend are comparable to Wong's1) Personal Meaning Profile for Canadians. It implies that it is necessary to develop Koreans' own measurement tool in order to assess their life meaning properly. However, because this study was an exploratory in developing Koreans' life meaning mea-surement and had several limitations, in order to determine structure of Koreans' life meaning, further study must be necessary.

Performance Rate of Thrombolytic Therapy and Acute Prognosis of Hyperacute Ischemic Stroke

BACKGROUND: Tissue plasminogen activator (tPA) is known to be effective if given within 3 hours after the onset of ischemic stroke. However, no study has been performed regarding what proportion of patients with acute ischemic stroke are actually given tPA within this time window. We therefore tried to figure out the performance rate of thrombolytic therapy and acute prognosis in hyperacute ischemic stroke patients. METHODS: We prospectively registered all the acute ischemic stroke patients. Thrombolyic therapy was decided strictly according to the NINDS tPA protocol and clinical monitoring was done by the NIH Stroke Scale (NIHSS). If tPA was not given, the reason was recorded. RESULTS: Among 613 acute stroke patients during a period of 2.5 years, there were 146 (23.8%) hyperacute ischemic stroke patients within 3 hours after onset. Even in the 29 cases of in-hospital stroke, the rate of early detection and management was only 27.6% (8 cases). Among the hyperacute stroke population, 56 (38.4%) patients were treated with the thrombolytic agent and 27 patients showed positive responses. Thrombolytic therapy was not tried in the remaining 90 patients. The most common reason was expectation of favorable outcome without thrombolysis. But among these patients, subsequent neurological worsening was noticed in 9 patients, particularly in those with vertebrobasilar stroke. CONCLUSIONS: Urgent notice and management of ischemic stroke needs to be more emphasized not only to the general public, but also to medical personnel. More close observation is especially needed in vertebrobasilar stroke cases (J Korean Neurol Assoc 19(5):447~451, 2001)