Exploring the strategies for successfully building e-portfolios in medical schools / 한국의학교육

Purpose@#The purpose of this study is to examine the characteristics of resistance among medical students toward e-portfolios and find the strategies for them to successfully prepare e-portfolios. @*Methods@#Participants were a group of 258 medical students. The questionnaire comprised 13 items developed based on the innovation resistance theory. The data were analyzed using descriptive analysis and Spearman’s correlation analysis using PASW SPSS version 18.0 (SPSS Inc., Chicago, USA). @*Results@#Students perceived that e-portfolios have a high degree of relative advantage, trialability, and complexity as their innovation resistance characteristics. Regarding perceived risk, they did not want others to see their information, but they had a high degree of demand for communication with their professors. @*Conclusion@#The successful use of portfolios can serve as a tool for student management and assessment that can reflect their introspection, personal development, and academic performance. This study proposed the strategies to promote the use of e-portfolios by strengthening education on the need for them, specific feedback of instructors, and students’ autonomy.

Exploring the strategies for successfully building e-portfolios in medical schools / 한국의학교육

Purpose@#The purpose of this study is to examine the characteristics of resistance among medical students toward e-portfolios and find the strategies for them to successfully prepare e-portfolios. @*Methods@#Participants were a group of 258 medical students. The questionnaire comprised 13 items developed based on the innovation resistance theory. The data were analyzed using descriptive analysis and Spearman’s correlation analysis using PASW SPSS version 18.0 (SPSS Inc., Chicago, USA). @*Results@#Students perceived that e-portfolios have a high degree of relative advantage, trialability, and complexity as their innovation resistance characteristics. Regarding perceived risk, they did not want others to see their information, but they had a high degree of demand for communication with their professors. @*Conclusion@#The successful use of portfolios can serve as a tool for student management and assessment that can reflect their introspection, personal development, and academic performance. This study proposed the strategies to promote the use of e-portfolios by strengthening education on the need for them, specific feedback of instructors, and students’ autonomy.

A Nationwide Survey of Inhalant Allergens Sensitization and Levels of Indoor Major Allergens in Korea

PURPOSE: The higher prevalence of respiratory allergic disease may be due to increased exposure to inhalation allergens. We conducted a survey of allergic diseases in autumn and winter with detection of major indoor allergens in major cities in Korea. METHODS: We enrolled 110 subjects from the fourth Korea National Health and Nutrition Examination Survey with stratified, cluster, and systematic sampling procedures. All participants answered a health questionnaire as well as underwent a skin prick test (SPT) and ImmunoCAP for 11 indoor major allergens. We also measured the levels of 5 major allergens (Der f 1, Der p 1, Can f 1, Bla g 1, and Asp f 1) in fine indoor dust from the houses of 60 subjects with a 2-site ELISA. RESULTS: The prevalence of allergic rhinitis and asthma were 25.5% and 7.3%, respectively. The most common sensitized allergens identified by SPT and ImmunoCAP were Dermatophagoides farinae (40.9%, 36.8%), followed by cockroach (23.6%, 19.5%), mugwort (13.6%, 22.9%), oak (9.1%, 22.9%), Japanese hop (9.1%, 8.6%), and dog dander (8.2%, 6.9%). There was a modest discrepancy between SPT and ImmunoCAP. Der f 1 and Der p 1 were detected in 91.7% and 45.0% of the enrolled houses, respectively. Der f 1 indicated high concentrations in all specific provinces in Korea; however, Der p 1 measured high only in the south. Dog dander allergens were present in 71.7% of houses; however, Bla g 1 was present in only 11.7% of houses and Asp f 1 was not detected in any houses. CONCLUSIONS: The most important inhalant allergens in Korea are house dust mites followed by cockroach, mugwort, oak, Japanese hop, and dog dander in indoor environment, in which The dominant species of house dust mites were different according to region.

Spontaneous Reporting of Adverse Drug Reactions through Electronic Submission from Regional Society Healthcare Professionals in Korea

PURPOSE: Pharmacovigilance Research Network built a spontaneous reporting system and collected adverse drug reactions (ADRs) by electronic submission (e-sub) in Korea. We analyzed ADRs spontaneously reported through e-sub from regional health professionals. MATERIALS AND METHODS: Nine hundred and thirty three ADR cases were collected and analyzed from January to December in 2008. "A matter" was defined as one symptom matched to one culprit drug included in an ADR case. We collected and analyzed e-sub ADR cases and matters to determine common culprits and organ specified ADR matters. RESULTS: There were 3,049 matters in 933 ADR cases for 1 year, and 3.3 matters per case were reported. In organ specific ADR classification, skin reactions which took the first place in 866 matters (28%) included urticaria and rash. The next cases were neurologic symptom (624 matters, 21%) and gastrointestinal symptom (581 matters, 19%). Doctor (53%) and pharmacist (31%) were the most important participants in e-sub spontaneous reporting system, and 3% of ADR cases were reported by patients or their guardians. WHO-Uppsala Monitoring Center causality assessment results showed certain 10.6%, probable 37.7%, possible 41.7% and below unlikely 10.0%. Culprit drugs were antibiotics (23.4%), neurologic agents (14.7%) and non-steroidal anti-inflammatory drugs (9.4%). CONCLUSION: In our study, antibiotic was most common culprit drug, and skin manifestation was most common symptom in e-sub ADRs collected from regional healthcare practitioners in Korea.

Tuberculous Peritonitis in a Patient with Rheumatoid Arthritis Treated with Infliximab

One of the severe adverse reactions to anti-tumor necrosis factor (TNF)-alpha therapy is the reactivation of tuberculosis. We present a case of tuberculous peritonitis in a 57-year-old woman with rheumatoid arthritis (RA) that appeared during treatment with infliximab. Confirming a diagnosis of tuberculous peritonitis is difficult and can be delayed because of the nonspecific symptoms, the rarity of the disease and the low detection rate of mycobacteria in ascites fluid. This case illustrates that prompt anti-tuberculous therapy is needed for suspected cases of tuberculous peritonitis in RA patients treated with infliximab.

Multicenter Analysis of the Current Status of Unproved Complementary/Alternative Medicine Other than Herbal Medication in Allergy Patients / 대한내과학회지

BACKGROUND/AIMS: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. METHODS: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. RESULTS: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included "improved" in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but "worse" in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was 'hope to improve my constitution'. CONCLUSIONS: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed.

A Case of Hemangioendothelioma of the External Auditory Canal / 대한이비인후과학회지

Hemangioendothelioma (HE) is a group of vascular neoplasms that may be considered benign or malignant in their activity. HE is differentiated by both its characteristic behavior and histologic appearance into benign (hemangioma) and malignant tumor (angiosarcoma). The tumor is characterized by neoplastic proliferation of epitheloid or histiocytic endothelial cells, and it commonly occurs in the soft tissues of extremities and liver, lung, but rarely in the external auditory canal. Surgical excision is the treatment of choice and the prognosis is generally good. The authors report, along with a review of related literatures, a 66 year-old male patient with HE of the right external auditory canal.

Juvenile Xanthogranuloma in the External Auditory Canal / 대한이비인후과학회지

Juvenile xanthogranuloma (JXG) is a benign, self-limiting disease, which is a subtype of class II histiocytosis that occurs most frequently in infants and children, but sometimes also affects adults. This condition usually presents with cutaneous lesions in the head and neck area, trunk, extremities, but is very rare in the external auditory canal. Occasionally, it can be found as extracutaneous lesions, including oral cavity, nasal cavity, trachea, glottis, subglottis and other visceral organs. In most cases, no treatment is required because of the self-regressive nature of skin lesions, but recurrence after excision has been reported in some cases of the adult type JXG or in oral cavity lesions. We report, with a review of the related literature, a case of JXG located in the right side of external auditory canal.

Effect of an Air Cleaner with Electrostatic Filter on the Removal of Airborne House Dust Mite Allergens

PURPOSE: The effects of air cleaners on the removal of airborne indoor allergens, especially house dust mites (HDM), are still controversial. The objective of this study is to evaluate the effect of an air cleaner with an electrostatic filter on the removal of airborne mite allergens. MATERIALS AND METHODS: A dried HDM culture medium that contained mite body particles and excretions was dispersed in a chamber equipped with an electrostatic air cleaner. The number of airborne particles was recorded continuously by a dust spectrometer for 60 minutes. Airborne particles in the chamber were collected on a sampling filter at a flow rate of 10 L/min and the Der f 1 concentration in the filter extracts was measured by two-site ELISA. RESULTS: The air cleaner efficiently removed airborne HDM particles. The air cleaner removed airborne HDM particles (size 2-12.5 microm) 11.4 +/- 2.9 fold (cleaner operating for 15 minutes), 5.4 +/- 0.7 fold (cleaner operating for 30 minutes), and 2.4 +/- 0.2 fold (cleaner operating for 60 minutes) more than the removal of HDM particles by natural settle down. Removal kinetics differed according to the particle size of the airborne particles. The air cleaner decreased the concentration of Der f 1 in the extraction of airborne particles collected on the air sampling filter by 60.3%. CONCLUSION: The electrostatic air cleaner can remove airborne HDM allergens and may be useful as a supplementary environmental control tool for HDM sensitized respiratory allergic patients.

Occurrence and Persistence of Tinnitus after Acute Acoustic Trauma by Gunshot / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute acoustic trauma (AAT) by gunshot can be the cause of hearing loss and tinnitus. Tinnitus after AAT frequently disappears with time. But the prognosis of this injury is very difficult to predict. This study tried to identify the factors influencing on tinnitus to occur and persist after AAT. SUBJECTS AND METHOD: A group of 268 military subjects who get the gunshot training with K-2 rifle once after conscripted was asked to answer the questions: age, otologic history, number of firing, usage of earplugs, presence of tinnitus after gunshot and its characteristics, relapsed time after firing, Tinnitus Severity Index (TSI) questionnaire. Physical examination and pure tone audiometry were conducted to the subjects with existing tinnitus on the questionnaire. RESULTS: 95 patients (36.4%) experienced tinnitus immediate after gunshot among 261 subjects. It is obvious that wearing earplugs could prevent immediate tinnitus after AAT. There was statistical significance between tinnitus with earplug and without it (p=0.000). At the time of questionnaire, 27 (10.3%) were complaining of tinnitus. Among factors such as age, number of firing, wearing earplugs, severity of tinnitus and relapsed time after firing, only severity of tinnitus has the significant effect with the persistence of tinnitus (p=0.046). CONCLUSION: Wearing earplugs can prevent tinnitus immediately after AAT, but does not seem to be the factor decreasing the prevalence of tinnitus. It was the only factor related to severity of tinnitus and to existing tinnitus.

A Case of Dual Ectopic Thyroid / 대한이비인후과학회지

Ectopic thyroid is defined as any thyroid tissues not located in the usual site of the thyroid gland, which is anterolateral to 2-4th tracheal rings in the lower neck. These tissues could be present anywhere along the descending tract of a developing thyroid primordium. It is rare for dual ectopic thyroid to have two ectopic foci simultaneously. Twenty-seven cases of dual ectopic thyroid have been reported in the English literature. Physical examinations are usually performed for oral cavity, oropharynx and anterior neck to test for thyroid function, and CT scanning and thyroid scintigraphy are usually performed for the diagnosis of these entities. We report a 19-year-old male with dual ectopic thyroid tissues in lingual and suprahyoid regions but without thyroid tissue in its normal area.

Comparison of the Naranjo and WHO-Uppsala Monitoring Centre criteria for causality assessment of adverse drug reactions / 대한내과학회지

BACKGROUND/AIMS: Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. METHODS: We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. RESULTS: The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. CONCLUSIONS: The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteria.

A case of toxoplasmosis mimicking systemic recurrence in a patient treated with breast cancer / 대한내과학회지

Left cervical lymphadenopathy was found in a 48-year-old Korean female patient who had been treated for breast cancer 3 years ago. A presumative diagnosis was lymph nodal and lung metastasis of breast cancer during chest CT and neck CT. Core needle biopsy was undertaken. Pathological examination of lymph node revealed reactive hyperplasia consistent with toxoplasmosis, and toxoplasma Ig M antibody was also positive. Finally, she was diagnosed as toxoplasmosis, not metastasis of breast cancer. As she had no symptoms, no specific treatment was necessary. Follow up chest and neck CT scan after 5 months later showed resolved lung lesion, and size decrement of cervical lymph node. So, she has no evidence of recurrence and is now under clinical follow up. Recognition that toxoplasmosis can mimic metastasis is important in reaching the correct diagnosis and treatment.

Physical and Radiological Parameters to Predict Difficult Laryngeal Exposure in Patients Undergoing microlaryngeal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although difficult laryngeal exposure (DLE) is a common problem encountered during rigid laryngoscopy, no anticipatory parameters have been formally noted as its reliable predictors. The purpose of this study is to identify physical and radiologic parameters to predict DLE according to a new classification of laryngeal exposure (LE score) suggested by authors. STUDY DESIGN: Fifty-eight patients underwent larygomicrosurgery were given LE score from grade 1 to 4 according to the glottic visualization on suspension laryngoscopy using a anterior commissure laryngoscope. Several parameters to predict DLE were investigated to compare DLE cases with control. SUBJECTS AND METHOD: All patients received physical and radiological examinations that encompassed the following sixteen measurements: sex, age, modified Mallampati index (MMI), body mass index (BMI), neck circumference, anterior mandibular height (AMH), hyoid-mental distance (HMD), thyroid-mental distance (TMD), horizontal thyroid-mental distance (HTD), vertical thyroid-mental distance (VTD), sternummental distance (SMD), vertical incisor-thyroid distance (VITD), horizontal incisor-thyroid distance (HITD), thyroid incisor angle (TIA), thyroid-mandible angle (TMA) at neutral and extended positions. Modified Cormack-Lehane score (MCLS) was obtained by an anesthesiologist. Mann-Whitney U test was used to compare the control with DLE group. RESULTS: The ages of patients ranged from 23 to 80 years with a mean of 48.7 years. The LE score was highly correlated with MCLS (r=0.676, p<.001). Among physical measurements, HMD at neutral position (p=.047) and TMD (p=.016), VTD (p=.005), SMD (p=.019) and VITD (p=.040) at extended position had a statistical significance. Among radiologic measurements, HMD (p=.008) and TMD (p=.005) at neutral position, and TMD (p=.037) and VTD (p=.034) at extended position had a statistical significance. CONCLUSION: The new classification is a reliable system to evaluate the extent of laryngeal exposure during suspension laryngoscopy. The physical and radiologic measurements can be helpful to predict the difficult laryngeal exposure.

Effect of Ebselen on Noise Induced Cochlear Damage / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advancement of modern civilization and mechanical development of society, the prevalence of noiseinduced hearing loss is increasing. There were some suggestions that noise-induced hearing loss may be reduced or prevented with antioxidant treatment. The purpose of this study is to evaluate the effect of ebselen as a free radical scavenger or antioxidant in noise-induced cochlear damage. MATERIALS AND METHOD: Thirty male Sprague Dawley rats (250-300 g) with normal auditory brainstem response (ABR) thresholds were exposed for 6 h to 115 dB SPL broad band noise. 10 mg/kg ebselen were injected intraperitoneally at 12 h before and 1h before noise exposure. After noise exposure, auditory brainstem response threshold shifts were evaluated. A study for iNOS and nitrotyrosine expressions in the cochlea was examined by immunohistochemical staining. RESULTS: After the noise exposure, auditory brainstem responses indicated that ebselen treatment reduced threshold shifts significantly. The expression of iNOS and nitrotyrosine were observed in hair cells, supporting cells of the organ of Corti, stria vascularis and spiral ganglion. The expression of iNOS and nitrotyrosine were lower in the ebselen treated group than in the non-treated group. CONCLUSION: Ebselen protects cochlea from noise by playing a role as a scavenger of reactive free radicals.

The Effects of Adenoidectomy on Nasal Airway Resistance and Nasal Geometry

The primary objective of this study was to determine whether adenoid hypertrophy and subsequent adenoidectomy affect pediatric nasal airway resistance and nasal geometry. The secondary objective was to evaluate the relationships between the degree of adenoid hypertrophy and nasal airway resistance or nasal geometry. Fifty-one children, aged 5 to 10 years, selected for adenoidectomy due to chronic nasal obstruction and mouth breathing were enrolled. The size of adenoid was evaluated by cephalometric radiograph. Nasal airway resistance and nasal geometry were evaluated by active anterior rhinomanometry and acoustic rhinometry respectively. These measurements were repeated 3 months after operation. The size of adenoid was found well correlated to preoperative nasal airway resistance but was not to preoperative nasal geometry. Nasal geometry was not changed after operation. However, nasal airway resistance was reduced significantly at 3 months after operation and the size of adenoid was found well correlated to postoperative changes of nasal airway resistances.

Congenital Absence of Inferior Vena Cava as a Rare Cause of Pulmonary Thromboembolism

Interruption of the inferior vena cava IVC) with azygos continuation is an uncommon vascular anomaly that results from aberrant development during embryogenesis. We report a rare case of this anomaly, presenting with massive pulmonary embolism. Subsequent evaluation with abdominal CT scan revealed the congenital absence of retrohepatic IVC. The patient was successfully treated with anticoagulation. When deep venous thrombosis (DVT) develops in patients with no apparent risk factors, the presence of congenital IVC anomalies should be considered.

A Case of Endometrial Adenocarcinoma in a Double Uterus / 대한산부인과학회잡지

Endometrial adenocarcinoma in a double uterus has rarely been reported.We had a very rare case of double uterus with endometrial adenocarcinoma involving onehemiuterus and endometrial hyperplasia involving another hemiuterus. By report this case, wewant to share our experiance. The abnomal anatomy of the uterine cavities could have madeadequate biopsy difficult and endometrial cancer is clinically suspected but histology fails toconfirm the diagnosis.

Comparison of Maternal Serum Screening Test Efficacy for Down Syndrome / 대한산부인과학회잡지

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test.Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, beta-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.

Comparison of Maternal Serum Screening Test Efficacy for Down Syndrome / 대한산부인과학회잡지

Maternal serum alpha-feto protein(MSAFP) screening test has provided high sensitivity and specificity in detecting neural tube defects(NTD). Approximately 80~90% of NTD can be identified by this screening test.Prospective studies have shown that low levels of MSAFP can be used for Down syndrome screening test, but the detection rate for Down syndrome in combination with age is only 20% in younger women, making this screening test relatively insensitive. However recently some studies have suggested that the triple marker test with MSAFP, unconjugated estriol, beta-human chorionic gonadotropin achieved higher detection rate for Down syndrome. The purpose of present study is to compare the positive predictive values of both MSAFP and Triple test. We had 6,436 cases of MSAFP test during the year of 1994 and 7,077 cases for triple test during the year of 1995. We analyzed data with positive results by screening both tests, since our purpose is to compare positive value. The number of positive results were 290(triple test) and 206(AFP) respectively. With this study, we concluded that positive predictive value of triple marker test is 4.17 times greater than of the MSAP test.