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1.
Am J Ther ; 29(1): e18-e25, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34994347

RESUMO

BACKGROUND: Advances in drug therapy for atrial fibrillation (AF) have had a significant impact on the quality of life of a substantial majority of affected persons, which has contributed to a remarkable decrease in the frequency and severity of thromboembolic complications, hospitalizations, and mortality. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of AF in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of AF, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of AF in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS: AF was consistently described in Cecil Textbook of Medicine as the most common sustained arrhythmia in adults. The authors emphasized its thromboembolic complications and potential for hemodynamic deterioration. Rate control with digitalis and rhythm control with quinidine were the standard in 1927. The pharmacological advances have focused on atrioventricular nodal blocking for rate control, conversion to and maintenance of sinus rhythm, and preventive anticoagulation. The first new class of drugs for rate control was beta-adrenergic receptor blockers, starting with propranolol which was introduced in 1979, followed by the calcium channel blocker verapamil in 1988. Rhythm control with amiodarone, a potassium channel blocker, has been recommended since 2004, and the sodium channel blockers propafenone and flecainide became part of standard therapy in 2008. Anticoagulation with warfarin was recommended starting in 2000, followed by the introduction of direct thrombin inhibitor in 2012 and factor Xa inhibitors in 2016. CONCLUSIONS: The pharmacological management of AF was unchanged for more than 50 years (1927-1979), a period during which the devastating effects of thromboembolic complications were not addressed. The major therapeutic advance is represented by preventive anticoagulation with the newer, safer, and more user-friendly direct thrombin and factor Xa inhibitors.


Assuntos
Amiodarona , Fibrilação Atrial , Adulto , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Prova Pericial , Humanos , Propafenona , Qualidade de Vida
2.
Eur J Anaesthesiol ; 39(1): 33-41, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397508

RESUMO

BACKGROUND: Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur. OBJECTIVE: The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period. DESIGN: Retrospective structured analysis of a database of medical liability claims. SETTING: Hospitals at all levels of care in Germany. PATIENTS: The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation. INTERVENTIONS: None (retrospective database analysis). MAIN OUTCOME MEASURES: Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports. RESULTS: The 30 deaths were analysed in detail at the case and document level. They included high proportions of 'potentially avoidable' deaths, at 86.6%, and what are termed 'never events', at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a 'human factor' in 50% of the cases. CONCLUSION: The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.


Assuntos
Anestesia , Anestesiologia , Anestesia/efeitos adversos , Prova Pericial , Alemanha/epidemiologia , Humanos , Estudos Retrospectivos
3.
JAMA Netw Open ; 4(12): e2140998, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34964853

RESUMO

Importance: Novel therapies, including cell and gene therapies, can radically improve outcomes among patients with rare disorders, especially if provided early. Newborn screening (NBS) could support early access to novel therapies, but the speed of new therapy development is a disruptive event for which the public health NBS system and state newborn screening programs are unprepared. Objective: To identify and evaluate possible solutions for modernizing NBS. Design, Setting, and Participants: In this survey study, NBS experts representing clinical research, federal or state advisory boards, patient advocacy groups, industry, or state laboratories completed an online survey in which they considered 20 potential solutions for modernizing NBS and rated each. Exposures: Participants considered 20 potential solutions in the 5 following domains: (1) timeliness of disorder review, (2) alternative mechanisms to offer screening for new disorders not currently part of NBS, (3) expanded data collection, (4) support for states, and (5) emerging methods of screening and their consequences. Main Outcomes and Measures: Mean ratings for each solution on efficacy, acceptability, feasibility, and sustainability. Results: The survey was completed by 40 NBS experts (median [range] age, 54 [37-73] years; 22 [55.0%] women). Participants acknowledged that substantial change is needed to prepare the NBS system for rapid expansion of novel therapies; on a scale of 0 (no change) to 10 (extensive change), the median (range) score was 8 (2-10), with 18 respondents (45.0%) believing that the NBS would need many new components or an entirely new system to accommodate the changes. All solutions for modernization were considered potentially efficacious by at least 23 respondents (57.5%). The 2 most strongly endorsed were to establish mechanisms for cross-state data coordination for provisional disorders (38 respondents [95.0%]) and create a network of regional screening laboratories (36 [90.0%]). These were closely followed by aligning programs across federal agencies (35 [87.5%]), expanding funding for research (34 [85.0%]), expanding funding to states (34 [85.0%]), building capacity to identify genetic variants and an associated clinical database (34 [85.0%]), and conducting surveillance to study long-term outcomes (34 [85.0%]). Conclusions and Relevance: In this study, there was consensus among experts that NBS needs to change if the system is to be prepared for a rapid increase in transformative therapies. To our knowledge, this is the first systematic inventory of potential solutions for modernizing NBS and expert perceptions of each. The findings suggest that the modernization of NBS will require the integration of highly rated solutions, strategic planning, and coordination among multiple stakeholders.


Assuntos
Prova Pericial , Triagem Neonatal/normas , Serviços de Saúde da Criança/normas , Feminino , Humanos , Recém-Nascido , Gravidez , Melhoria de Qualidade , Inquéritos e Questionários , Estados Unidos
4.
Fortschr Neurol Psychiatr ; 89(11): 578-592, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34740280

RESUMO

The diagnostic criteria of PTSD differ in the ICD-10, ICD-11 and DSM-5 manuals. The main diagnostic criteria are presented. The psychopathological findings obtained in a structured interview are essential for the diagnosis. Three case studies are used to illustrate the expert assessment in criminal law, accident insurance and victim compensation law.


Assuntos
Classificação Internacional de Doenças , Transtornos de Estresse Pós-Traumáticos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Prova Pericial , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico
5.
Curr Med Res Opin ; 37(sup2): 17-26, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34726093

RESUMO

OBJECTIVE: To qualitatively explore the perceptions and opinions of experts dealing with systemic sclerosis (SSc) and patients with SSc on the impact of the disease and pulmonary complications on economic status, psycho-social wellbeing and the diagnostic and therapeutic journey, and to identify which strategies/interventions may be useful to address patients' and their family's needs. METHODS: An expert meeting was conducted using the NGT to discuss the consequences of pulmonary complications on the Italian SSc community. The direct experience of five patients with SSc and pulmonary complications was described through in-depth interviews conducted by psychologists. RESULTS: The experts' meeting and patients' in-depth interviews underline the complexity of SSc and the consequences of pulmonary involvement on patients' and caregivers' health-related quality of life, working ability, psychological wellbeing and social interactions. Panellists suggest that improved communication between physicians, associations and institutions could help protect the working status of patients with SSc. Granting patients disability benefits, providing access to part-time jobs and productivity-focused training could also help decrease the economic burden of the disease. A multidisciplinary approach is recommended to reduce treatment burden, together with the implementation of standard diagnostic and therapeutic paths and increased use of telemedicine via platforms that ensure secure health data sharing. Both patients and caregivers may benefit from psychological support. CONCLUSION: SSc and pulmonary fibrosis have profound consequences on patients' and caregivers' health-related quality of life, working ability, psychological wellbeing and social interactions. Some activities may help patients and families deal with these aspects of the disease.


Assuntos
Qualidade de Vida , Escleroderma Sistêmico , Cuidadores , Comunicação , Prova Pericial , Humanos , Escleroderma Sistêmico/complicações
6.
Am J Ther ; 28(6): e631-e637, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34757964

RESUMO

BACKGROUND: Advances in drug therapy for myasthenia gravis have had a significant impact on the quality of life and work potential of a substantial majority of affected persons and has contributed to a remarkable decrease in the frequency and severity of complications, hospitalizations, and mortality. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of myasthenia in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of myasthenia gravis, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of myasthenia gravis in the 26 editions of Cecil Textbook of Medicine published from 1927 to 2020. RESULTS: Adequate feeding, absolute rest in bed, and "tonics" were the only interventions recommended for the care of patients with myasthenia gravis in 1927. Ephedrine and glycine were used in the early 1930s. Treatment with the anticholinesterases physostigmine and neostigmine was recommended in 1937, 3 years after Mary Walker discovered it in the United Kingdom. Immunosuppressant pharmacological interventions with prednisone and azathioprine have been considered the standard since 1975, and intravenous immune globulin was added to usual care in 1996. The newer immunosuppressant drugs mycophenolate, cyclosporine, and tacrolimus have expanded the arsenal since 2008, and the monoclonal antibodies rituximab and eculizumab have been mentioned in the textbooks published in 2012-2020. The first randomized clinical trial of drug therapy for myasthenia gravis was published in 1987. CONCLUSIONS: The pharmacological management of myasthenia gravis was revolutionized by the epiphany of an astute clinician in the 1930s. Immunosuppressant treatment was a logical step once the autoimmune nature of the condition was established. The major therapeutic advances highlight the values of empiricism and persistent attention to detail in treating relatively rare chronic disorders.


Assuntos
Prova Pericial , Miastenia Gravis , Humanos , Miastenia Gravis/tratamento farmacológico , Prednisona , Qualidade de Vida , Rituximab
7.
J Assoc Physicians India ; 69(10): 11-12, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34781659

RESUMO

Ticagrelor is a potent, oral P2Y12 inhibitor used as a part of dual antiplatelet therapy (DAPT) in acute coronary syndromes (ACS). New evidence has emerged for its use in ACS, which may be crucial for the Indian context. This brought together nearly 150 experts in ACS management across the country who reviewed the current evidence and discussed the same through a series of 10 meetings on an online platform. With all experts' agreement, the key expert opinions for the P2Y12 inhibitors use in ACS management were finalized. These include the following. In ACS patients aged <75 years, with diabetes, a history of stroke/transient ischemic attack, and chronic kidney disease, ticagrelor may be preferred over other P2Y12 inhibitors. It may also be preferred in the elderly above 75 years with clopidogrel is a suitable alternative in patients at high-risk of bleeding. Rates of stent thrombosis are lower with ticagrelor than clopidogrel. In patients managed with fibrinolysis, use ticagrelor after 48 hours if streptokinase was the fibrinolytic agent or it can be used after 12 to 24 hours if fibrin-specific fibrinolytic was used. Rates of major bleeding in patients treated with fibrinolysis are similar to clopidogrel. Prehospital administration may be preferred over in-hospital administration with expected bleeding rates similar to clopidogrel. Switching among P2Y12 inhibitors should be done with due consideration of their pharmacodynamics. At present, DAPT should be continued for 12 months with discontinuation after three to six months in patients with high bleeding risk. The use of low dose ticagrelor may be considered in cases with high-bleeding risk. DAPT or ticagrelor continuation beyond one year should be individualized considering ischemic and bleeding risks. Dyspnea is a common, mild, and transient and does not necessitate ticagrelor discontinuation. Severe dyspnea should be investigated thoroughly. In conclusion, ticagrelor (180 mg, 90 mg, and 60 mg doses), a potent antiplatelet is expected to reshape the antiplatelet use in the management of ACS.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/tratamento farmacológico , Idoso , Prova Pericial , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Cloridrato de Prasugrel , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticagrelor/uso terapêutico , Resultado do Tratamento
8.
Kardiologiia ; 61(10): 99-103, 2021 Oct 30.
Artigo em Russo | MEDLINE | ID: mdl-34763644

RESUMO

The article presents recent data on possibilities of a broader use of mineralocorticoid receptor antagonists for existing indications and of expanding indications for the use of this pharmaceutical group in the context of the novel coronavirus infection COVID-19. The authors discussed prospects for expanded detection of aldosteronism using a new diagnostic approach, including an additional evaluation of blood pressure response to spironolactone.


Assuntos
COVID-19 , Hipertensão , Prova Pericial , Humanos , Antagonistas de Receptores de Mineralocorticoides , SARS-CoV-2 , Espironolactona
10.
G Ital Cardiol (Rome) ; 22(11): 894-899, 2021 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-34709228

RESUMO

The coronavirus disease (COVID-19) pandemic has caused 2.69 million deaths and 122 million infections. Great efforts have been made worldwide to promptly develop effective vaccines and reduce morbidity and mortality rates from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Available vaccines have proven highly effective at preventing symptomatic disease in clinical trials and real-world reports and are playing an essential role in flattening the epidemiology curve and, mostly, in reducing COVID-19 hospitalizations. Some concerns have been raised after very rare cases of myocarditis and pericarditis recently reported by the Centers for Disease Control and Prevention (CDC) as potentially associated with COVID-19 mRNA vaccinations, namely the Pfizer-BioNTech mRNA vaccine (BNT162b2) and the Moderna mRNA vaccine (mRNA-1273). Therefore, the aim of this document is to explore the possible link between COVID-19 mRNA vaccination and the development of myocarditis and/or pericarditis by performing a critical analysis of available data and to provide indications for specific subgroups of individuals.


Assuntos
COVID-19 , Cardiologia , Miocardite , Pericardite , Vacinas contra COVID-19 , Prova Pericial , Humanos , Itália/epidemiologia , Miocardite/etiologia , Pericardite/etiologia , RNA Mensageiro , SARS-CoV-2 , Vacinação
11.
Kardiol Pol ; 79(10): 1178-1191, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34611879

RESUMO

Tricuspid regurgitation (TR) is a common acquired valvular heart disease (VHD). TR has progressive character and is associated with impaired long-term survival in both symptomatic and asymptomatic subjects. Despite this knowledge, the overall number of tricuspid valve surgeries is very low worldwide and many patients with clear indications for intervention are left untreated. The development of less invasive transcatheter techniques may offer new treatment options in this growing population of patients. Out of various percutaneous methods proposed, tricuspid edge-to-edge repair has recently gained considerable attention. The article summarizes available data regarding this new treatment method.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Cateterismo Cardíaco , Ecocardiografia , Prova Pericial , Humanos , Seleção de Pacientes , Polônia , Fatores de Tempo , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
12.
Epilepsy Behav ; 123: 108270, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34509033

RESUMO

Clinical trial results have demonstrated that adjunctive cenobamate (CNB) substantially decreases seizure frequency in adults with uncontrolled focal onset seizures with an acceptable and well-identified safety profile. This manuscript summarizes an expert panel's recommendations regarding optimized CNB treatment of epilepsies with focal onset seizures. Cenobamate, when slowly titrated to the target maintenance dose, represents an effective new antiseizure medication (ASM) with a comparatively high rate of seizure freedom relative to existing treatment options. This paper reviews selection of suitable CNB treatment candidates, realistic treatment expectations and goals, appropriate CNB target doses, and methods to mitigate or avoid potential adverse events. Cenobamate can be a promising therapeutic choice for adult people with epilepsy with focal onset seizures who do not reach adequate seizure control despite treatment with conventional ASMs.


Assuntos
Epilepsias Parciais , Prova Pericial , Adulto , Anticonvulsivantes/uso terapêutico , Carbamatos/uso terapêutico , Clorofenóis , Quimioterapia Combinada , Epilepsias Parciais/tratamento farmacológico , Humanos , Tetrazóis
15.
PLoS One ; 16(9): e0256919, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473784

RESUMO

Structured protocols offer a transparent and systematic way to elicit and combine/aggregate, probabilistic predictions from multiple experts. These judgements can be aggregated behaviourally or mathematically to derive a final group prediction. Mathematical rules (e.g., weighted linear combinations of judgments) provide an objective approach to aggregation. The quality of this aggregation can be defined in terms of accuracy, calibration and informativeness. These measures can be used to compare different aggregation approaches and help decide on which aggregation produces the "best" final prediction. When experts' performance can be scored on similar questions ahead of time, these scores can be translated into performance-based weights, and a performance-based weighted aggregation can then be used. When this is not possible though, several other aggregation methods, informed by measurable proxies for good performance, can be formulated and compared. Here, we develop a suite of aggregation methods, informed by previous experience and the available literature. We differentially weight our experts' estimates by measures of reasoning, engagement, openness to changing their mind, informativeness, prior knowledge, and extremity, asymmetry or granularity of estimates. Next, we investigate the relative performance of these aggregation methods using three datasets. The main goal of this research is to explore how measures of knowledge and behaviour of individuals can be leveraged to produce a better performing combined group judgment. Although the accuracy, calibration, and informativeness of the majority of methods are very similar, a couple of the aggregation methods consistently distinguish themselves as among the best or worst. Moreover, the majority of methods outperform the usual benchmarks provided by the simple average or the median of estimates.


Assuntos
Agregação de Dados , Prova Pericial , Processos Grupais , Julgamento , Modelos Estatísticos , Conscientização , Teorema de Bayes , Previsões/métodos , Humanos , Psicologia/métodos , Opinião Pública , Pesquisadores/psicologia , Estudantes/psicologia
16.
J Am Acad Psychiatry Law ; 49(3): 422-427, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34489245

Assuntos
Prova Pericial , Humanos
17.
Front Public Health ; 9: 698995, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34490183

RESUMO

Objective: The first wave of the coronavirus SARS-COV-2 pandemic has revealed a fragmented governance within the European Union (EU) to tackle public health emergencies. This qualitative study aims: 1) to understand the current EU position within the field of public health emergencies taking the case of the COVID-19 as an example by comparing and contrasting experiences from EU institutions and experts from various EU Member States at the beginning of the pandemic; and, 2) to identify and to formulate future EU pandemic strategies and actions based on experts' opinions. Methods: Eighteen semi-structured interviews were conducted with public health experts from various European Member States and European Commission officials from May 2020 until August 2020. The transcripts were analyzed by Thematic Content Analysis (TCA), mainly a manifest content analysis. Results: This study demonstrated that the limited EU mandate in health hinders proper actions to prevent and tackle infectious disease outbreaks, such as the COVID-19 pandemic. The results showed that this limitation significantly impacted the ECDC, as the Member States' competence did not allow the agency to have more capacity. The European Commission has fulfilled its role of coordinating and supporting the Member States by facilitating networks and information exchange. However, EU intra- and inter-communication need further improvement. Although diverse EU instruments and mechanisms were found valid, their implementation needed to be faster and more efficient. The results pointed out that underlying political challenges in EU decision-making regarding health emergencies hinder the aligned response. It was stated that the Member States were not prepared, and due to the restriction of their mandate, EU institutions could not enforce binding guidelines. Additionally, the study explored future EU pandemic strategies and actions. Both, EU institutions and national experts suggested similar and clear recommendations regarding the ECDC, the investment, and future harmonized preparedness tools. Conclusion: The complex politics of public health at the EU level have led to the fragmentation of its governance for effective pandemic responses. This ongoing pandemic has shed light on the fragility of the political and structural systems in Europe in public health emergencies. Health should be of high importance in the political agenda, and robust health reforms at the local, regional, national, and EU levels are highly recommended.


Assuntos
COVID-19 , Saúde Pública , Emergências , União Europeia , Prova Pericial , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
18.
Am J Ther ; 28(5): e552-e559, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34469923

RESUMO

BACKGROUND: Advances in drug therapy for peptic ulcer have had a significant impact on quality of life and work potential of many millions of affected persons and have contributed to a remarkable decrease in the prevalence of the disease, frequency and severity of complications, hospitalizations, and mortality. STUDY QUESTION: What are the milestones of the changes in the expert approach to the pharmacological management of peptic ulcer in the past century? STUDY DESIGN: To determine the changes in the experts' approach to the management of peptic ulcer, as presented in a widely used textbook in the United States. DATA SOURCES: The chapters presenting the management of peptic ulcer in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS: Acid neutralization with alkalies was the only pharmacological intervention recommended in the textbooks published from 1927 to 1975. Atropine and other antimuscarinic agents were mainly used to relieve pain and acid secretion according to the paradigm "no acid no ulcer." The shift to the acid suppression paradigm started with the introduction of the histamine-2 receptor antagonist cimetidine in 1979, the proton-pump inhibitor omeprazole in 1988, and the prostaglandin agonist misoprostol in 1992. Finally, the eradication of Helicobacter pylori was codified in 1996. CONCLUSIONS: The pharmacological management of peptic ulcer has remained archaic well into the 20th century. Fundamental progress occurred in a very short period (1979-1996) and was due to paradigm shifts from acid neutralization to acid suppression and later the recognition of the role of H. pylori infection.


Assuntos
Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Úlcera Péptica/tratamento farmacológico , Quimioterapia Combinada , Prova Pericial , Infecções por Helicobacter/epidemiologia , Humanos , Qualidade de Vida
19.
Artigo em Inglês | MEDLINE | ID: mdl-34583502

RESUMO

PURPOSE: This follow-up study focused on 3 overarching questions: what keywords can be extracted from experts' definitions of character?; what is the operational definition of character for medical students?; and what possible solutions can be suggested to address the issues of character education that were identified in the previous study? METHODS: Sixty-three medical education experts recruited through expert sampling and 19 non-medical education experts recruited through snowball sampling answered a questionnaire that addressed the 3 major questions of the study. The responses were analyzed for descriptive statistics with supplementary keyword extraction tools, including the Cortical and Monkey keyword extractors. RESULTS: A total of 93 definitional statements were counted, and 138 keyword terms were extracted. The top 5 keyword terms mentioned by the medical education experts were "patient", "empathy", "qualities", "attitude", and "ability". These keyword terms were quite different from those mentioned by the non-medical education experts. Based on the extracted keywords, an operational definition of character education by the medical education expert group was presented as follows: the basic qualities and ability to empathize with patients affected by illness based on respect for patients and others. Various methods were proposed to solve the issue of character education, and many of them pointed to curriculum development, such as improvements in teaching and learning methods and evaluation methods, including role modeling. CONCLUSION: A clear statement of the concept of character education is the start to resolve issues of character education. Character education improvements will be possible at the institutional level according to the above results.


Assuntos
Educação Médica , Estudantes de Medicina , Currículo , Prova Pericial , Seguimentos , Humanos , República da Coreia
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