• Clinical and Experimental Reproductive Medicine
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• v.29 no.4
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• pp.259-267
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• 2002

Objective: This study was performed to compare the clinical outcomes of GnRH antagonist (Cetrorelix) single dose and multiple dose protocols for controlled ovarian hyperstimulation with GnRH agonist long protocol. Materials and Method: From September 2001 to March 2002, 48 patients (55 cycles) were performed controlled ovarian hyperstimulation for ART using by either GnRH antagonist and GnRH agonist. Single dose of 3 mg GnRH antagonist was administered in 15 patients (17 cycles, single dose group) at MCD #8 and multiple dose of 0.25 mg of GnRH antagonist was administered in 15 patients (18 cycles, multiple dose group) from MCD #7 to hCG injection day. GnRH agonist was administered in 18 patients (20 cycles, control group) by conventional GnRH agonist long protocol. We compared the implantation rate, number of embryos, and clinical pregnancy rate among three groups. Student-t test and Chi-square were used to determine statistical significance. Statistical significance was defined as p<0.05. Results: There were no significant differences in ampules of used gonadotropins, number of mature oocytes, obtained embryos between single and multiple dose group, but compared with control group, ampules of used gonadotropins, number of mature oocytes, obtained embryos were decreased significantly in both groups. Clinical pregnancy rate and implantation rate were not different in three groups. There were no premature LH surge and ovarian hyperstimulation syndrome in three groups. Multiple pregnancy were occurred 1 case in multiple dose group and 2 case in control group. Conclusions: GnRH antagonist is a safe, effective, and alternative method in the controlled ovarian hyperstimulation compared with GnRH agonist. Clinical outcomes and efficacy of both single and multiple dose protocol are similar between two groups.

• Korean Medical Education Review
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• v.14 no.1
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• pp.25-36
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• 2012

For decades medical educators have continually emphasized medical professionalism, which is reflective response to the challenges of a rapidly changing medical environment. This study aimed to review the experience of implementing medical professionalism education at Yonsei University College of Medicine (YUCM). YUCM introduced a new curriculum in 2004 designed by Curriculum Development Project 2004 (CDP2004), a project that was launched in 2001. CDP2004 reorganized lectures as organ-based integrated lectures, introduced an introductory course for clinical medicine and medical humanities courses for premedical and medical students. Problem-based learning (PBL), elective courses, and self-study sessions in the afternoon were implemented in order to equip students with a self-directed learning attitude as medical professionals. Professors were asked by the CDP2004 curriculum to spend more time on student education and to adopt new teaching methods. Experiences of the CDP2004 curriculum reveals 1) difficulty of motivating professors to be PBL tutors 2) students' dissatisfaction with the medical humanities course (major critique was that the course was impractical and unrealistic), and 3) students' optimistic understanding about their future role as medical professionals in influencing and helping people in spite of their perception of the general medical environment not as promising. To foster professionalism, the following are necessary in our experiences: 1) faculty development of medical humanities and medical professionalism, 2) establishment of an environment throughout the whole institution to support medical professionalism education and to integrate the concept into praxis, 3) emphasis on the fact that medical professionalism education is not contradictory to biophysical medical education.

• Journal of Preventive Medicine and Public Health
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• v.25 no.3 s.39
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• pp.223-237
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• 1992

This study was to examine the association of the health-related behaviors and subjective symptoms with smoking. Data were collected by questionnaire survey during regular health examination from Mar. 23 to Mar. 31, 1992 for 1,615 male freshmen of a university in Kwangju City. The results obtained were as follows : 1. Among the freshmen, 26.9% reported that they were smokers. 69.4% for smokers started smoking for the recent 4 years, and 63.4% for smokers smoked 10 cigarettes or more a day. 2. Meal regularity, meat eating, use of coffee or tea and alcohol drinking were positively associated with the status, the duration and the amount of smoking while the vegetable preference was negatively associated with the status and the duration of smoking. 3. There was no evidence of familial aggregation in smoking status except that of siblings. 4. Respiratory symptoms like cough or phlegm, dyspnea were positively associated with the status, the duration, and the amount of smoking. General symptoms like chest pain, fatigue, back pain, facial edema, and weight loss were positively associated with the duration and the amount of smoking. Other symptoms like headache, dizziness, and myalgia were not associated with smoking. 5. In multivariate logistic regression analysis, cough or phlegm, dyspnea, chest pain, facial edema, and back pain were related to smoking status.

• Korean Medical Education Review
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• v.23 no.1
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• pp.56-67
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• 2021

Educational program evaluation can improve the quality of the curriculum, instructional methods, and resources and provide useful data for making educational decisions and policies. Developing and implementing a program evaluation system is essential in competency-based medical education. The purpose of this study was to explore and establish an educational program evaluation system adapting an integrated program evaluation model to promote competency-based medical education. First, an Educational Evaluation Committee was organized, consisting of faculty, staff members, and students. The committee established an integrated program evaluation model, combining Stufflebeam's Context, Input, Process, and Product (CIPP) model of a process-oriented approach and Kirkpatrick's four-level model of an outcome-oriented approach. Kirkpatrick's model was applied to the product evaluation of the CIPP model. The committee then developed evaluation criteria, indicators, and data collection methods according to the components of the CIPP model and the four levels (reaction, learning, behavior, and results) of Kirkpatrick's model, and collected and analyzed data. Finally, the committee reported the results of evaluation to a Medical Education Quality Improvement Committee, and the results were used to improve the curriculum and student selection. To enhance the quality of education, identifying educational deficiencies and developing various elements of education in a balanced way through educational evaluation will be needed. Furthermore, it will be necessary to listen to opinions of various stakeholders, work with all members involved in education, and communicate with decision-makers in the process of educational evaluation.

• Korean Medical Education Review
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• v.25 no.3
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• pp.212-228
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• 2023

Systems thinking, a linking domain of health systems science (HSS), is an approach that investigates specific problems from a holistic perspective. It supports improving patients' health, fulfilling their health needs, and anticipating issues that threaten patient safety within the healthcare system. It also helps solve problems through critical thinking and ref lection. This study aimed to develop an curriculum on systems thinking, explore the effectiveness of the course, and investigate the applicability of HSS education at individual universities. In this study, the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was utilized to design, develop, implement, and evaluate an elective course on systems thinking. In the design process, learning outcomes and goals were developed, and educational content, teaching-learning methods, and student evaluation methods were linked. In the development process, class materials and evaluation materials were prepared. In the implementation process, the course was implemented, and the evaluation process analyzed the results of learning performance and curriculum assessments. The evaluation found the following results. First, the students in the study realized the importance of systems thinking and experienced the need for systems thinking through non-medical and medical situations. Second, the students were very satisfied with the learning activities in the course (mean=4.84), and the results of the self-competence evaluation, conducted before and after the course, also showed a significant improvement. This study confirmed the effectiveness of the elective course, and its results can serve as a reference for developing an HSS curriculum.

• Korean Medical Education Review
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• v.26 no.2
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• pp.155-166
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• 2024

This study utilized cohort data, student lifestyle surveys, and mental health examination results from a medical school to investigate the impact of factors such as hometown, alcohol use, smoking, university life adaptation, and aptitude on academic failure, with mental health serving as a mediator. We analyzed data from 409 of the 549 incoming students at Keimyung University School of Medicine, excluding 140 individuals with missing data, from the academic years 2015 to 2021. Significant differences were found according to hometown in feelings of depression, suicidal tendencies, and internet addiction. There were also significant differences based on university life adaptation in feelings of depression, suicidal tendencies, and internet addiction, as well as significant differences according to academic aptitude in feelings of depression and internet addiction. Academic failure showed significant differences based on hometown, university life adaptation, and academic aptitude. Furthermore, students' hometown had a complete mediating effect on academic failure together with feelings of depression, suicidal tendencies, and internet addiction. University life adaptation exhibited a complete mediating effect with suicidal tendencies and a partial mediating effect with feelings of depression and internet addiction. Academic aptitude demonstrated partial mediating effects on feelings of depression, suicidal tendencies, and internet addiction. Based on these results, we suggest establishing counseling programs tailored to the characteristics of medical students, and various programs for university life adaptation are necessary. There is also a need for diverse programs not only for clinical training, but also for different career paths.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.252-259
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• 2023

Background: The purpose of this study was to identify demographics and risk factors associated with unplanned 30-day readmission and reoperation following open procedures for shoulder instability and examine recent trends in open shoulder instability procedures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 23455, 23460, and 23462 to find patients who underwent shoulder instability surgery from 2015 to 2019. Independent sample Student t-tests and chi-square tests were used in univariate analyses to identify demographic, lifestyle, and perioperative variables related to 30-day readmission following repair for shoulder instability. Multivariate logistic regression modeling was subsequently performed. Results: In total, 1,942 cases of open surgical procedures for shoulder instability were identified. Within our study sample, 1.27% of patients were readmitted within 30 days of surgery, and 0.85% required reoperation. Multivariate logistic regression modeling confirmed that the following patient variables were associated with a statistically significant increase in the odds of readmission: open anterior bone block/Latarjet-Bristow procedure, being a current smoker, and a long hospital stay (all P<0.05). Multivariate logistic regression modeling confirmed statistically significant increased odds of reoperation with an open anterior bone block or Latarjet-Bristow procedure (P<0.05). Conclusions: Unplanned 30-day readmission and reoperation after open shoulder instability surgery is infrequent. Patients who are current smokers, have an open anterior bone block or Latarjet-Bristow procedure, or a longer than average hospital stay have higher odds of readmission than others. Patients who undergo an open anterior bone block or Latarjet-Bristow procedure have higher odds of reoperation than those who undergo an open soft-tissue procedure. Level of evidence: III.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.13-17
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• 2001

Objectives: This study was done to determine the prevalence of radiographic ankle osteoarthritis (OA) in Korean women with clinical primary ankle OA. Methods: This analysis involved 160 Korean women who visited our out patient clinic due to ankle joint pain. Ankle AP and lateral weight-bearing radiographs were evaluated retrospectively to check whether they have radiographic OA or not. Radiographs were read for features of ankle OA using School classification. Demographic factors and radiographic findings in both radiographic ankle OA group and non-radiographic ankle OA group were analyzed by the student t-test, the chi square test and the Pearson's analysis. A p value <0.05 was considered significant. Results: The prevalence of radiographic ankle OA in Korean women is 18.2 % in patient between 18 and 39 years and is 55.6 % in patient over 40. There was significant difference between two groups with age (P<0.001) and relatively strong correlation between radiographic OA and age (r=0.474, P<0.001). Conclusion: These results show that the prevalence of Korean women with radiographic changes of ankle OA was 45 % and there was relatively strong correlation between age and radiographic ankle OA.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.195-199
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• 2007

Objective : Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability. these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. Methods : A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and non parametric tests were used to determine cross-sectional differences between two groups. Results : No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II. there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. Conclusion : Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.34-44
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• 2022

Purpose:We investigated physicians' responses to a series of clinical vignettes consisting of patient safety incidents, with and without disclosure of patient safety incidents (DPSI). Methods: An anonymous survey was conducted to investigate physicians' responses to the DPSI via online communities of physicians, and additional participants were recruited using a snowballing sampling method. We evaluated physicians' responses to the DPSI using eight hypothetical scenarios (HS) from the following perspectives: thoughts regarding medical errors, revisiting the physician, recommendation, lawsuit, criminal prosecution, trust score, and compensation amounts. We used the chi-square test to evaluate the overall differences in response rates among the scenarios. Statistical analyses were performed using the Student's t-test to compare the trust scores and compensation amounts. Results: A total of 910 physicians participated in this survey. An overall comparison of trust scores among HS showed that HS 1 (unclear medical errors, minor harm, and DPSI) had the highest trust score. In contrast, in the opposite scenario, HS 8 (clear medical errors, major harm, and DPSI not conducted) received the lowest scores. Cases with minor harm to patients (HS 1, 2, 5, and 6) showed lower compensation amounts than the others (HS 3, 4, 7, and 8). Physicians were more likely to think of situations with DPSI as not having medical errors (53.1% vs. 55.2%). In addition, the scenarios with DPSI were evaluated favorably in terms of intention to revisit, recommend, suit, and engage in criminal proceedings. Physicians showed higher trust scores (6.2 vs 5.4) and gave lower compensation amounts ($27.7 million vs $28.1 million), although there was no significant difference in terms of compensation amounts to the physician conducting DPSI. Conclusion: Our study showed overall positive perceptions regarding DPSI among Korean physicians.