WCIM 2014 SEOUL KOREA 207
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0615 Others
Are We Losing Empathy in the Medical Profession?
G. Halina KUSZ1, Jami FOREBACK1, Anne DOHRENWEND1 Mclaren-Flint/Michigan State University, USA1
Background: There are many valuable skills in the medical profession, and empathy is the one most sought by patients from their physicians. Despite strong support from medical education, empathy in medical residents’ declines with years of training. The primary objective for our study is to evaluate the empathy level among our internal medicine residents.
Methods: Our program is a community-based, university-affi liated residency program with 12 residents in each post-graduate year (PGY) 1-3. We developed and implement- ed behavioral science and geriatric medicine curricula with the main goal to teach and provide empathetic patient care. From May to October 2013 we administered to all of our residents a voluntary, self-reported, validated and standardized empathy survey.
The empathy scores and statistical analysis were obtained from the Jefferson Scale of Physician Empathy report.
Results: Twenty-two participants (45%) responded to the survey. There were men responding (67%) than women (33%), ages ranged from 21-30 years (71%) and 31- 40 years (28%). The range of possible physicians’ empathy scores are between 50-140 with a mean of 120 and standard deviation (SD) of +/- 12. Our sample scores ranged between 96-136, with a mean of 117.4 and SD of 10.1. The mean for PGY1-3 and new coming residents were 117.2, 114.3, 124.0 and 109.7 respectively. There was no statis- tical difference between males and females and between PGY-1 and PGY-2 residents.
However, a statistically signifi cant difference in mean empathy scores was found be- tween PGY-3 and new, incoming residents.
Conclusions: Although results based on such a small sample size may not be reliable, our survey showed that empathy scores in our program are higher with a higher level of training. We conclude that empathy is teachable, can be evaluated and we strongly support teaching empathy in residency programs.
PS 0616 Others
Improving Screening and Supplementation with Vita- min B12 Among Our Older Diabetic Patients on Chronic Metformin Therapy
G. Halina KUSZ1, Michael ROXAS1, Suba PATHMANATHAN1, Joseph RAMZY1, Ahmad AL-TAWEEL1, Tessa ANTALAN1
Mclaren-Flint/Michigan State University, USA1
Background: Dementia continues to be a growing concern that affects millions of Americans. Vitamin B12 defi ciency is one of reversible causes of cognitive impairment.
Metformin is a widely used fi rst choice agent to manage diabetes. One of its side ef- fects is vitamin B12 defi ciency. Due to a lack of awareness of this side effect, patients are often left undiagnosed and untreated.
Methods: The goal of our QI project is to educate our physicians and advocate the annual screening and supplementation with vitamin B12 all IMRGP older, diabetic pa- tients who are on metformin therapy. Our aim is that within next three months we will increase in our clinic screening for B12 defi ciency and supplementation with vitamin by 50%. We retrieved data from the clinic “Diabetic Registry”, and selected all diabetic patients 65 years and older. From an online prescribing list we selected patients who are on chronic metformin therapy and who have prescribed vitamin B12. Educational efforts such as QI Forum presentations are ongoing. Clinic posters and chart reminders are incoming.
Results: In our clinic we have a total of 729 diabetic patients from ages 20-97were.
246 patients (34%) were over 65 years old. 90 patients (36.6%) were on metformin, and 41 of them (45%) were on chronic therapy. None of them has documented pre- scribed vitamin B12. A baseline screening rate and vitamin supplementation is current- ly calculated from manual chart review. The pending results will be included.
Conclusions: We hope that through all educational efforts and increasing awareness, we achieve a 50% increase in screening rate and supplementation with vitamin B12 all older diabetic patients on chronic metformin therapy to prevent cognitive impair- ment and subsequently to improve health–related quality of life for our patients.
PS 0617 Others
Four-Year Trend of Inpatients in the Second-Line Hospital Before and After the Great East Japan Earth- quake
Kuni SHIINA1, Shinpei YAMASHITA1, Yuta TEZUKA1, Hiroko SAKURAI1, Hisanori GAMADA1, Toru YOSHIDA1
Iwate Prefectural Senmaya Hospital, Japan1
Background: Iwate Prefectural Senmaya Hospital (Senmaya Hospital) adjoins the coastal area where seriously damaged by the Tsunami on 2011.3.11. From the disaster, we are working as the second-line hospital. We perform this study to verify the role of the second-line hospital of tsumami disaster, for taking better steps to deal with the future disasters.
Methods: The data was obtained from patient record of Senmaya Hospital and as- sessed.
Results: The patient surge started on the day of the tsunami. Overall 136 patients from tsunami swept area (60% from Iwate Prefecture and 40% from Miyagi Pre- fecture, next to Iwate) was admitted to Senmaya Hospital within 1 month after the disaster. Temporally, the number of inpatients decreased on 16th, the next day of the restoration of electricity, but increased again. The average inpatient per month was 1.0-1.8 fold (average 1.3) compared with that of the previous year (before tsunami).
The highest number of the inpatients was found in February 2012, the coldest month in the fi rst winter. Then cost-free pneumococcus vaccination was introduced to the population more than 65 years old. The rate of pneumonia on admission and discharge by death were signifi cantly decreased from 2012-2013 winter.
Conclusions: The second-line hospital must receive many patients immediately after the disaster and continuously accept the excess of the inpatients at least 1 year. The pneumococcus vaccination was effective to decrease admission and hospital death by pneumonia. The second-line hospital should store additional space, equipments and goods for the immediate and continuous excess of the patients.
PS 0618 Others
Atorvastatin Inhibits Il 1 β and ER-Stress Induced, Rankl-Mediated Osteoclastogenesis by Inhibiting In- tracellular Signaling Pathway, Including PERK, IRE1, GRP78, eIF2a, C-Fos and NFATc1
Yun-Hong CHEON1, Won-Seok LEE1, Eun-Gyeong LEE1, Myung-Soon SUNG1, Myoung- Joo HONG2, Wan-Hee YOO1
Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk Nation, Korea1, Division of Pulmonalogy, Department of Internal Medicine, Presbyterian Medical Center, Korea2 Background: Statins, Hydroxymethylglutaryl-coenzyme inhibitor, have been reported to have anti-inflammatory and/or immunomodulatory effects and prophylactic and therapeutic effects in collagen-induced arthritis, an experimental model of rheumatoid arthritis (RA). IL-1ß and thapsigargin (TG)-induced endoplasmic reticulum (ER) stress modulate the receptor activator of nuclear factor kappa-B ligand (RANKL)-mediated osteoclastogenesis. This study was investigated to defi ne the effects of atorvastatin on IL-1ß and ER stress-induced, RANKL-mediated osteoclastogenesis and its mechanisms.
Methods: Bone marrow cells (BMCs) were obtained from 5-week-old male ICR mice and cultured to be differentiated into osteoclasts with M-CSF and RANKL in the presence or absence of IL-1ß, TG, or atorvastatin. The formation of osteoclasts was evaluated by tartrate-resistant acid phosphatase (TRAP) staining and resorption pit assay with dentine slice. The molecular mechanisms of the above effects of atorvastatin on osteoclastogen- esis were investigated by using RT-PCR and immunoblotting for osteoclast specifi c and ER stress signaling molecules, including PERK, IRE1, GRP78, eIF2a, c-Fos and NFATc1.
Results: IL-1ß and TG-induced ER stress increased the formation of osteoclasts by up-regulating the osteoclast specifi c signals (c-Fos, NFATc1) and ER stress-associated signaling pathways (PERK, IRE1, GRP78, and eIF2a). Atorvastatin signifi cantly inhibited IL-1ß and ER stress-induced, RANKL-mediated osteoclastogenesis by down-regulating above signal pathways, dose-dependently.
Conclusions: Atorvastatin inhibited IL-1 and ER stress-induced, RANKL-mediated oste- oclastogenesis by inhibiting intracellular signaling pathways, including PERK, IRE1, GRP78, c-Fos and NFATc1. These results suggest that atorvastatin might have disease modifying effects by inhibition of infl ammation and ER stress-induced osteoclastogenesis in the infl ammatory joint diseases, such as RA.
