Do Kyong Kim

A phase II study of irinotecan with biweekly, low dose leucovorin and bolus and continuous infusion 5-fluorouracil (modified FOLFIRI) as first line therapy for patients with recurrent or metastatic gastric cancer.

Background:To determine the activity and toxicities of a low-dose leucovorin plus 5-fluorouracil (5-FU) regimen, combined with irinotecan and administered every 2 weeks (modified FOLFIRI), as a first-line therapy for patients with advanced gastric cancer. Method:Patients were treated with cycles of 150 mg/m2 irinotecan on day 1 plus 50 mg of LV, followed by a 400 mg/m2 5-FU bolus and a 22-hour continuous infusion of 600 mg/m2 5-FU on days 1 and 2. Results:The median patient age was 55 years (range, 29–75 years), and 77% (34/44) of the patients had a performance status (Eastern Cooperative Oncology Group) of 0 or 1. Of the 44 patients evaluated for their tumor response, 3 patients (6.8%) and 14 patients (31.8%) achieved a complete and partial response, respectively, with an overall response rate of 38.6% (95% confidence interval, 23.7%–53.6%). 13 patients (29.6%) evidenced a stable disease, and 14 patients (31.8%) progressed during the course of the treatment. The median time to progression and overall survival time were 4.9 months (range, 0.9–22.8 months) and 10.3 months (range, 1.2–29.0 months) from the start of the chemotherapy, respectively. A total of 293 cycles were assessed for toxicity. The major hematologic toxicities included grade 1 to 2 anemia (27.6%), neutropenia (48.8%), and grade 3 to 4 neutropenia (12.6%). There were 7 cycles of neutropenic fever. Nonhematological toxicities were observed grade 3 vomiting (6.8%), grade 3 diarrhea (4.5%), and grade 3 mucositis (2.3%). We noted no treatment-related deaths. Conclusions:The modified FOLFIRI regimen—lowering of irinotecan and LV doses—is a safe and feasible regimen as a first-line therapy for patients with recurrent or metastatic gastric cancer.

Effects of low-dose niacin on dyslipidemia and serum phosphorus in patients with chronic kidney disease

Background Niacin supplementation improves dyslipidemia and lowers serum phosphorus levels in patients with chronic kidney disease (CKD). We evaluated whether low-dose niacin supplementation can improve dyslipidemia, lower serum phosphorus levels, and be administered with a low frequency of adverse effects in patients with CKD. Methods We retrospectively analyzed the clinical records of patients with CKD who had taken niacin from January 2009 to June 2011. We excluded patients with CKD stage 1 and 5. We then enrolled 31 patients with CKD who had taken niacin at a fixed dose of 500 mg/day for 6 months. We also randomly selected 30 patients with CKD who had been taking statin for 9 months as a control group. Results Among the 34 patients with CKD who were prescribed niacin, five (14%) complained of adverse effects, and three (8%) discontinued niacin. The proportion of patients in the niacin group who had been taking a statin or omega-3 fatty acids was 67.7% and 48.8%, respectively. In the niacin group, high-density lipoprotein cholesterol level was significantly increased and triglyceride level was significantly decreased at 12 and 24 weeks compared with baseline levels (P<0.05). In the niacin group, phosphorous level (P<0.05) was significantly decreased, and glomerular filtration rate (GFR) was significantly increased (P<0.05) at 24 weeks compared with baseline values. Conclusion Low-dose niacin had a low frequency of adverse effects and also improved dyslipidemia, lowered serum phosphorus level, and increased GFR in patients with CKD. Further studies are needed to evaluate the long-term effects of low-dose niacin for renal progression of CKD.

Medical students’ clinical performance of dealing with patients in the context of domestic violence

Purpose The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV). Methods The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students’ performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator’s psychosocial state (P), checking the victim’s condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I). Results Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator’s state and patient’s physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N. Conclusion Medical students showed poor clinical performance in the DV station. They performed an ‘event oriented interview’ rather than ‘patient centered’ communication. An integrated educational program of DV should be set to improve students’ clinical performance.

Authenticity, acceptability, and feasibility of a hybrid gynecology station for the Papanicolaou test as part of a clinical skills examination in Korea

Purpose The objective of this study was to evaluate the authenticity, acceptability, and feasibility of a hybrid station that combined a standardized patient encounter and a simulated Papanicolaou test. Methods We introduced a hybrid station in the routine clinical skills examination (CSE) for 335 third-year medical students at 4 universities in Korea from December 1 to December 3, 2014. After the tests, we conducted an anonymous survey on the authenticity, acceptability, and feasibility of the hybrid station. Results A total of 334 medical students and 17 professors completed the survey. A majority of the students (71.6%) and professors (82.4%) agreed that the hybrid station was more authentic than the standard CSE. Over 60 percent of the students and professors responded that the station was acceptable for assessing the students’ competence. Most of the students (75.2%) and professors (82.4%) assessed the required tasks as being feasible after reading the instructions. Conclusion Our results showed that the hybrid CSE station was a highly authentic, acceptable, and feasible way to assess medical students’ performance.

Factors Influencing Survival According to Elapsed Time in Peritoneal Dialysis Patients

The survival of patients undergoing peritoneal dialysis (PD) has improved over the past decade, but their mortality rate remains high. The aim of the current study was to identify correctable and uncorrectable factors influencing survival according to the elapsed time in patients undergoing PD. We retrospectively analyzed data from medical records of 118 patients who had undergone PD for >6 months. We analyzed laboratory findings at three time points (point of PD initiation, 6-month point of PD and 3-month point prior to death or last follow-up) during PD treatment and prescribed medications taken for >50% of the follow-up period. Three-year survival group was younger, had lower prevalence rates of ischemic heart disease (p = 0.024) and heart failure (HF) (8.5% vs. 34.6%, p = 0.003), higher serum albumin levels (albumin 2) at the 6-month point of PD, and higher serum albumin (albumin3) and creatinine (creatinine3) levels at the 3-month point prior to death or last follow-up than nonsurvival group. Patients without underlying HF, patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers during the last 6 months (p = 0.0042), and those having creatinine 3 >9.5 mg/dL (p = 0.0029), and albumin 2 (p = 0.0209) and albumin 3 >3.5 g/dL (p = 0.0003) showed significantly higher survival curves. HF and albumin 3 were found to be independent factors for 3-year survival and long-term survival, respectively, by the multivariate Cox regression model. In conclusion, HF was useful information for predicting 3-year survival, and low serum albumin levels according to elapsed time should be corrected for survival of PD patients.