Kaohsiung J Med Sci
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Kaohsiung J Med Sci · May 2009
Short-term outcomes of a near-full PBL curriculum in a new Taiwan medical school.
Problem-based learning (PBL), which incorporates principles of adult learning, is an important innovation in medical education. The use of PBL in health professional curricula is becoming more widespread. The curriculum design and the ways of implementing PBL are different among schools. ⋯ The initial batches of medical students (students from the first three cohorts) had the highest passing rate for Part 1 (basic sciences in medicine) and students from the first two cohorts had a 100% passing rate for Part 2 (clinical medicine) of the Taiwan Medical Licensure Examination. A near-full PBL curriculum in Asian medical schools is feasible and could encourage students to improve their self-directed learning abilities, learn adequate knowledge in basic sciences, and experience positive effects on learning clinical medicine. Better preparation of students for integrated learning of basic and clinical sciences are still needed, as is an emphasis on tutor training to improve the effectiveness of tutorial discussions.
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Kaohsiung J Med Sci · Apr 2009
Case ReportsOrtner's syndrome--a rare cause of unilateral vocal cord paralysis: a case report.
Hoarseness attributed to vocal cord palsy is associated with injury to the recurrent laryngeal nerve. Hoarseness resulting from left recurrent laryngeal nerve palsy, cardiovocal syndrome (Ortner's syndrome), has rarely been reported. ⋯ The severity of the vocal cord paralysis was improved by surgical intervention. This case illustrates that life-threatening cardiovascular comorbidities can cause hoarseness and that an impaired recurrent laryngeal nerve might be correctable.
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Kaohsiung J Med Sci · Apr 2009
Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes.
Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. ⋯ The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
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Kaohsiung J Med Sci · Feb 2009
Case ReportsSuccessful treatment of severe lactic acidosis caused by a suicide attempt with a metformin overdose.
Metformin-associated lactic acidosis is a very rare but critical condition. It is seen in patients with type 2 diabetes mellitus who take metformin and attempt suicide with a metformin overdose. Here, we report a 43-year-old woman with type 2 diabetes mellitus and chronic renal insufficiency who developed hypoglycemia, hypothermia, tachycardia and lactic acidosis after a suicide attempt with a metformin overdose. ⋯ Although metformin does not usually cause hypoglycemia when administered as monotherapy, hypoglycemia can occur in a condition coexistent with lactic acidosis secondary to metformin overdose. Metformin intoxication should be suspected when patients present with high anion gap metabolic acidosis after attempting suicide by ingesting drugs, particularly when comorbidities such as renal failure are present. Early diagnosis and rapid correction of the metabolic acidosis using hemodialysis or hemofiltration, together with concomitant cardiovascular support, and maintenance of blood glucose and core body temperature, provide the possibility of a positive outcome.
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Kaohsiung J Med Sci · Jan 2009
Case ReportsGastric subserosal hematoma developing from focal pancreatitis: a case report.
Pancreatitis complicated by gastric wall hemorrhagic is rarely reported. The imaging findings of focal pancreatitis with gastric wall hemorrhage can mimic a disease entity of gastric origin. We report a case of gastric subserosal hematoma developing in a patient with focal pancreatitis. ⋯ Computed tomography of the abdomen revealed focal pancreatitis that had eroded the gastric wall resulting in subserosal hemorrhage. The radiologist informed the surgeon of the possibility of focal pancreatitis complicated by gastric hemorrhage. The gastric subserosal hematoma was treated with percutaneous drainage and the patient recovered uneventfully.