Usefulness of two-dimensional shear wave elastography in diagnosing hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation

Purpose@#This study aimed to evaluate the usefulness of two-dimensional shear wave elastography (2D-SWE) in diagnosing hepatic veno-occlusive disease (VOD) in pediatric patients. @*Methods@#This study retrospectively included pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) between November 2019 and January 2021. All 34 patients (8.7±5.0 years) were examined using 2D-SWE for an initial diagnosis. A subgroup analysis was performed using the data from follow-up examinations of patients diagnosed with VOD. The characteristics of the initial VOD diagnosis were compared with the longitudinal changes observed in VOD patients who underwent multiple ultrasound examinations. @*Results@#In total, 19 patients were diagnosed with VOD at 17.6±9.4 days after HSCT. All VOD patients showed hepatomegaly, ascites, and gallbladder wall thickening. Liver stiffness was higher in VOD patients than in non-VOD patients (12.4±1.1 vs. 6.3±0.8 kPa, P<0.001). Liver stiffness values above 7.2 kPa showed 84.2% sensitivity and 93.3% specificity in distinguishing VOD from non-VOD (area under the curve, 0.925; 95% confidence interval, 0.780 to 0.987; P<0.001). A subgroup analysis of 11 patients showed a linear decrease in liver stiffness values after VOD diagnosis with treatment (first, second, and third follow-ups; 13.5±1.7, 11.3±1.4, and 9.5±0.8 kPa, respectively), but without statistical significance in the pairwise analysis. @*Conclusion@#Liver stiffness measured using 2D-SWE increased in pediatric patients who develop VOD after HSCT. Therefore, liver stiffness can be a predictive and quantitative parameter for diagnosing VOD.

Determinants Used to Justify the Strength of Recommendations among Korean Clinical Practice Guidelines

BACKGROUND: A standardized systematic approach to grade evidence and the strength of recommendations is important for guideline users to minimize bias and help interpret the most suitable decisions at the point of care. The study aims to identify and classify determinants used to make judgement for the strength of recommendations among 56 Korean clinical practice guidelines (CPGs), and explore strong recommendations based on low quality of evidence. METHODS: Determinants used in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach among 34 CPGs which have reported both strength of recommendations and level of evidence were reviewed. RESULTS: Five of 34 CPGs (14.7%) considered quality of evidence, benefits and harms, patients' values and preferences, and costs. And 24 of 34 CPGs (70.6%) considered both magnitude of effect and feasibility as additional determinants. Judgement table was not widely provided for use to translate evidence into recommendations. Eighty-two of 121 recommendations (67.8%, ranged 20.0% to 100.0%) among 11 CPGs using the same judgement scheme showed ‘strong’ strength of recommendations based on low or very low quality of evidence. Among 5 paradigmatic situations that justify strong recommendations based on low or very low evidence, situation classified as ‘potential equivalence, one option clearly less risky or costly’ was 87.8% for 82 strong recommendations. Situation classified as ‘uncertain benefit, certain harm’ was 4.9%. CONCLUSION: There is a need to introduce and systematize an evidence-based grading system. Using judgement table to justify the strength of recommendations and applying the 5 paradigmatic situations mentioned above is also recommended in the near future.

What Factors Impact Consumer Perception of the Effectiveness of Health Information Sites? An Investigation of the Korean National Health Information Portal

Lay public's concerns around health and health information are increasing. In response, governments and government agencies are establishing websites to address such concerns and improve health literacy by providing better access to validated health information. Since 2011, the Korean government has constructed the National Health Information Portal (NHIP) website run in collaboration with the Korean Academy of Medical Sciences (KAMS). This study therefore aimed to 1) examine consumer use of NHIP, with respect to the usage patterns, evaluation on health information provided, and perceived effectiveness of the site; and 2) identify factors that may impact perceived effectiveness of the site. An online survey was conducted with 164 NHIP users, recruited through a popup window on the main screen of the portal website from October to November 2015. The significant predicting factors supported by the data include the relevance of health information on the site, the usefulness of information in making health decisions, and the effective visualization of information. These factors can inform future efforts to design more effective health information websites, possibly based on metadata systems, to further advance the lay public's information seeking and health literacy.

Methodological Quality Appraisal of 27 Korean Guidelines Using a Scoring Guide Based on the AGREE II Instrument and a Web-based Evaluation

This study evaluated the methodological quality of CPGs using the Korean AGREE II scoring guide and a web-based appraisal system and was conducted by qualified appraisers. A total of 27 Korean CPGs were assessed under 6 domains and 23 items on the AGREE II instrument using the Korean scoring guide. The domain scores of the 27 guidelines were as following: the mean domain score was 82.7% (median 84.7%, ranging from 55.6% to 97.2%) for domain 1 (scope and purpose); 53.4% (median 56.9%, ranging from 11.1% to 95.8%) for domain 2 (stakeholder involvement); 63.0% (median 71.4%, ranging from 13.5% to 90.6%) for domain 3 (rigor of development); 88.9% (median 91.7%, ranging from 58.3% to 100.0%) for domain 4 (clarity of presentation); 30.1% (median 27.1%, ranging from 3.1% to 67.7%) for domain 5 (applicability); and 50.2% (median 58.3%, ranging from 0.0% to 93.8%) for domain 6 (editorial independence). Three domains including scope and purpose, rigor of development, and clarity of presentation were rated at more than 60% of the scaled domain score. Three domains including stakeholder involvement, applicability, and editorial independence were rated at less than 60% of the scaled domain score. Finally, of the 27 guidelines, 18 (66.7%) were rated at more than 60% of the scaled domain score for rigor of development and were categorized as high-quality guidelines.

On the life-sustaining treatment in Korea

No abstract available.

Euthanasia: a misunderstood term

Although the word 'euthanasia', a compound word of eu- (good, well) and thanatos (death) is widely known, it is greatly misunderstood. With regard to end-of-life medicine, several phrases, including death with dignity, passive euthanasia, and natural death also need to be clarified. A review of their meanings and connotations is provided along with a brief history of the discussion in Korea on forgoing life support. Korea has no law regarding the cessation of artificial ventilation, but several judgments of law courts provide us with a general principle that cessation could be applied if the patient is in an irreversible or dying condition medically, and has presented his or her intention with something like an advance directives, or is reasonably presumed to have such a will.

Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.

Expert Opinion on Death Investigation Center for Medicine Related Death / 대한법의학회지

To check expert opinion about the investigation system of medicine-related death, model for "Death Investigation Center" was suggested and related questionnaire were requested. Between 15 December 2009 and 5 April 2010, we sent e-mails of the questionnaire which asked the opinion for the new postmortem investigation system. We sent the questionnaire to 3,289 lawyers and 4,523 doctors (total 7812), and received 100 replies out of the total. All the lawyers and doctors interviewed knew the importance of the postmortem investigation system. Most of them (87%) agreed to the introduction of the new postmortem investigation system. Some of them thought that protector's agreement was necessary for the postmortem investigation (21%), and more doctors were likely to participate with legal protocol (23%). If the postmortem investigation could not be performed due to the protector's disagreement, another specialized medical investigation should be needed to figure out the cause of death (85%). The new postmortem investigation system should be performed by the specific institution, and supported by the government (44%). In many expert's opinion, nonmedical experts such as lawyers and priests should be included for the institution of investigation for objectivity and neutrality (72%). This sample study finds that the postmortem investigation performed by specialized institution is necessary to determine the cause of death in the hospital. For the operation of the system, neutrality and the operating core would be the most important.

Correlations of Communication and Interpersonal Skills between Medical Students and Residents / 한국의학교육

PURPOSE: Medical students' communication and interpersonal skills can be evaluated by standardized patients in a clinical performance examination (CPX). The purpose of this study is to investigate which communication and interpersonal skills are more closely correlated between medical students and residents. METHODS: This study included 2nd-year residents in 2009 who took the eight-station CPX as 4th-year medical students in 2006. In-patients who were cared for by the residents were asked the seven items related to interpersonal and communication skills. The correlation between the scores of these seven items in the 2006 CPX and the scores in the 2009 patient survey was evaluated. RESULTS: Twenty-six residents, 11 in medical wards and 15 in surgical wards, participated in the study. The medical students' total scores tended to be correlated with the residents' scores (r=0.381, p=0.055). There was significant correlation between the scores for students and residents for 'Explaining more explicably' (r=0.470, p=0.015), and marginally significant correlation (r=0.385, p=0.052) for 'Listening attentively.' There was no significant correlation for the other five items. CONCLUSION: 'Explaining more explicably' and 'Listening attentively', these skills were more closely correlated between medical students and residents. These basic communication skills should be included in graduate or licensing evaluations.

Effect of Patient Safety Education in Surgical Clerkship to Develop Competencies for Managing and Preventing Medical Errors / 한국의학교육

PURPOSE: The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors. METHODS: Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893. RESULTS: There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course. CONCLUSIONS: Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.

Exploration of a Leadership Competency Model for Medical School Faculties in Korea / 한국의학교육

PURPOSE: To adapt to rapid and turbulent changes in the field of medicine, education, and society, medical school faculties need appropriate leadership. To develop leadership competencies through education, coaching, and mentoring, we need a leadership competency model. The purpose of this study was to develop a new leadership competency model that is suitable for medical school faculties in Korea. METHODS: To collect behavioral episodes with regard to leadership, we interviewed 54 subjects (faculties, residents, nurses) and surveyed 41 faculties with open-ended questionnaires. We classified the behavioral episodes based on Quinn and Cameron's leadership competency model and developed a Likert scale questionnaire to perform a confirmatory factor analysis. Two hundred seven medical school faculties responded to the questionnaire. RESULTS: The competency clusters that were identified by factor analysis were professionalism, citizenship, leadership, and membership to an organization. Accordingly, each cluster was linked with a dimension: self, society, team (that he/she is leading), and organization (to which he/she belongs). The clusters of competencies were: professional ability, ethics/morality, self-management, self-development, and passion; public interest, networking, social participation, and active service; motivating, caring, promoting teamwork, nurturing, conflict management, directing, performance management, and systems thinking; organizational orientation, collaboration, voluntary participation, and cost-benefit orientation. CONCLUSION: This competency model that fits medical school faculties in Korea can be used to design and develop selection plans, education programs, feedback tools, diagnostic evaluation tools, and career plan support programs.

Certificate or License / 한국의학교육

No abstract available.

Development of the Korean Academy of Medical Sciences Guideline for Rating Physical Impairment

Systematic and effective welfare for the disabled is possible when there are scientific and objective criteria demonstrating either presence or severity of the impairment. We need our own scientific criteria suitable for our culture and society, since the impairment is influenced by them. In 2007, we established the Developing Committee of Korean Academy of Medical Sciences (KAMS) Guideline for Impairment Rating under KAMS supervision. We included all fixed and permanent physical impairments after a sufficient medical treatment. The impairment should be stable and medically measurable. If not, it should be reevaluated later. We benchmarked the American Medical Association Guides. The KAMS Guideline should be scientific, objective, valid, reasonable and practical. In particular, we tried to secure objectivity. We developed the KAMS Guideline for Impairment Rating.

Analysis of Breath Alcohol Degradation and Alcohol Metabolic Enzymes in a Korean Male Population / 대한법의학회지

To evaluate the concentration-time profiles of breath ethanol in degradation phase in proportion to the amount of alcohol, we carried out the controlled drinking study for 24 healthy males. Studies are performed three times in the interval of two weeks. Before the experiment, we analyzed alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) to compare with the degradation rate. All subjects are classified into three groups considering past alcohol-drinking history. Group A subjects (n = 6) consumed 0.25, 0.5 and 0.75 g ethanol kg of body weight, group B subjects (n = 9) 0.5, 0.75 and 1.0 g, and group C subjects (n = 9) 0.75, 1.0 and 1.25 g in fasting state, respectively. Breath alcohol samples were examined from 30 minutes to 5 hour every 30-60 minutes after the alcohol intake. Statistical analysis of breath alcohol concentration (BrAC) values obtained. Concentration-time profiles of alcohol were plotted for each subject and the rate of degradation of breath was determined using linear regression analysis. According to the mean of corrected regression lines, disappearance rate of BrAC is calculated in A group: 0.0101 +/- 0.000232% (v/v), B group: 0.0093 +/- 0.000133% (v/v), C group: 0.0099 +/- 0.000121% (v/v).

Skill training in internal medicine student clerkship at a university hospital / 대한내과학회지

BACKGROUND/AIMS: This study evaluated medical students' experience performing basic clinical skills with real patients in a tertiary hospital and their response to clinical skill training in the Skills Center during their clerkship in internal medicine. METHODS: We surveyed 169 third-year students at the end of the internal medicine clerkship. The questionnaire included questions on their experience sampling blood and inserting intravenous (IV) catheters with real patients, success with their first patient, and the usefulness of the Skills Center during the clinical clerkship. RESULTS: Of the 169 students, 145 (86%) answered the questionnaire. Two (5%) of 39 students had not sampled blood and 22 (56%) had not inserted an IV catheter during the 8 weeks of the internal medicine clerkship. Two (6%) of 35 students had not sampled blood and 8 (23%) had not inserted an IV catheter during 32 weeks of the 3rd-year clinical clerkships. The partial or complete success rate for performing the skills with real patients was 93% for blood sampling and 79% for IV catheter insertion. Ninety (62%) students stated that skill training in the Skills Center during the clinical clerkship improved their basic clinical skills and 62 (43%) agreed that it increased their confidence to perform those skills on real patients. CONCLUSIONS: A significant number of medical students do not experience basic clinical skills with real patients during the clinical clerkship in a university hospital, although they had relatively high success rates performing those skills.

Student Cognition before and after Introduction of a 'Patient-Doctor-Society' Course / 한국의학교육

PURPOSE: The purpose of this study is to evaluate cognitive changes in medical students before and after introduction of a 'Patient-Doctor-Society' course into the curriculum of a medical school. METHODS: Self-questionnaires that evalutated medical student congnition in the areas of medical humanities and sociology were answered by graduates-to-be who had experienced a new or previously implemented curriculum. The questionnaires included 28 questions using seven Likert scales. Student t-test was used to compare the scores between students who were educated using the new or old curriculum. RESULTS: In 405 medical students, 349 (86%) answered the questionnaires. For nine (32%) questions, students who partook of the new curriculum had higher scores than those in the older curriculum, and in 19 (68%) questions, there was no statistically significant difference. The questions that revealed differences between the groups were related to professionalism, care, personal and social communication, and ethics. CONCLUSION: Introduction of the 'Patient-Doctor-Society' course into the curriculum of a medical school was associated with cognitives change in medical students with regard to medical humanities and sociology.

Experimental Estimation of Widmark Factor in A Korean Male Population / 대한법의학회지

The Widmark formula has been widely used in forensic fields since the early decades of 20 the century. When the calculation of blood-alcohol concentrations (BAC) from given quantities of alcoholic beverages consumed was required, Widmark equation has been applied. However, some modern experimental results have reported that the Widmark factor, r showed discrepancy between individuals. Furthermore, Widmark equation was derived from Caucasian to the calculation of blood alcohol concentration. To estimate and compare Widmark factor of blood with breath ethanol metabolism in Koreans, we performed the controlled drinking study for 50 healthy male. All subjects are classified into three groups considering alcohol-drinking history (frequency and quantity in the past year). Group A subjects (n=20) consumed 0.5 g ethanol per kilogram of body weight, group B subjects (n=18) 0.8 g, and group C subjects (n=12) 1.0 g in fast state, respectively. Biological specimens of blood and breath were obtained for alcohol experiment from 60 minutes to 6 hour every 30-60 minutes after the alcohol intake. Concentration-time profiles of alcohol were plotted for each subject and the Widmark values (C0 and r0) from blood and breath were extrapolated using linear regression analysis. We determined the practical factors, rpeak at peak blood alcohol concentration. The evaluated data of Widmark factor for Korean male are 1.19 (group A), 1.06 (group B), and 0.75 (group C), respectively, showing the unreliability and inaccuracy of Widmark formula to the male Korean population. Our findings suggest that Widmark equation could be applied only for gross approximation, and no accuracy must be offered.

State of Individual Identification Using Genetic Polymorphism in Korea: Step to Criminal DNA Bank / 대한법의학회지

There have been several attempts for criminal DNA profiling in Korea, but ended without any fruitful results. Recently new movement for the profiling has just been started. Many have to be solved in advance, which can be divided largely into two, technical aspects and legal system which could support the application. To build up profiling for any purpose, work for the standardization must be driven, because many are involved in the work. Authors have checked the status of the DNA typing in Korea and have reviewed its quality by statistical approach. All the popular forensic journals, Korean or international covering from 1997 to 2004, were reviewed to check whether it contains articles on Korean. All the articles containing genetic data on Korean were selected and their results were compared statistically. Total 67 articles were chosen. Articles were on 116 loci, among which 54 were autosomal, 32 were Y chromosomal and the remaining were X chromosomal. Among 32 Y chromosomal loci, 11 were bi-allelic. For the 50 loci two or more lab reported separately. For these loci the results from different lab were compared. There was no statistically significant difference for most of the loci, but some of the loci, especially on Y chromosomal STR loci, showed some differences. Data were showed with some review.

Selection of Autopsy Method Depending on Situation / 대한법의학회지

Traditionally autopsy has been classified as legal autopsy and pathology autopsy. For this classification, the purpose of the autopsy was the criteria. That is under what condition autopsy was performed decided the nature of the autopsy. From the point of MD who actually perform the autopsy, there seems little difference between legal and pathology autopsy. Our society expands as time goes on, and it has become more complex. With this there have been many situations that does not coincide with the conventional way of thinking. Under these circumstances there have been some situations that conventional way for the autopsy classification bears problem. System for the postmortem investigation in Korea are deeply linked with these. Authors report these cases with the review of our postmortem investigation system and discuss what MD can do right now.

Heteroplasmy Pattern Within D-loop Region of Mitochondrial DNA in Koreans / 대한법의학회지

Mitochondrial DNA (mtDNA) sequencing has been validated as a useful tool in forensics. However, there are several aspects that need to be considered in order for it to be used as firm evidence in a courtroom. Heteroplasmy is one of those. Heteroplasmy means the status that different mtDNA populations exist in a single individual, tissue, cell or even mitochondrion. As the underlying phenomenon of heteroplasmy and polymorphism is similar, care must be taken in analyzing the data from the samples with heteroplasmy. Heteroplasmy can reinforce the use of mtDNA however if we know a lot about it. For this much has to be revealed. In this we screened 494 unrelated Korean using DGGE for the D-loop to determine how frequent heteroplasmy is, and the heteroplasmy pattern was confirmed through sequencing. This paper discussed the results of a comparison with other reports along with several aspects of heteroplasmy.