Comparative analysis of status of safety accidents and importance-performance analysis (IPA) about precautions of safety accidents by employment type of industry foodservices in Jeonbuk area / 한국영양학회지

PURPOSE: The purpose of the study was to evaluate the status of safety accidents and importance-performance analysis (IPA) between regular and non-regular employees in industry foodservices. METHODS: The participants were regular employees (n = 119) and non-regular employees (n = 163) in industry foodservices in the Jeonbuk area. Demographic characteristics, status of safety accidents, safety education, and importance and performance status were assessed using a self-administered questionnaire. RESULTS: Approximately 66.4% of regular employees and 53.4% of non-regular employees experienced safety accidents (p < 0.05). Types of safety accidents of regular and non-regular employees were mostly burns, and causes were mostly from their own negligence. Approximately 98.3% of regular employees and 95.1% of non-regular employees experienced safety education. Approximately 88.9% of regular employees and 96.8% of non-regular employees received safety education from dietitians. Approximately 41.9% of regular employees and 50.0% of non-regular employees had difficulty applying the contents of safety education due to lack of time during work. As a result of IPA, regular and non-regular employees were aware of the importance of the following and performed them well: ‘Clean the floor of the work place’, ‘Arrange in the work area’, ‘Wear safety shoes’, ‘Check for heater cord’, and ‘Safety cooking when using oil’. On the other hand, they were not aware of the importance of the following and performed them insufficiently: ‘Check for the MSDS’, ‘Aware of chemical signs’, ‘Wear protection gloves etc.’, ‘Do stretching exercise’, and ‘Using ancillary tools’. CONCLUSION: Therefore, it is necessary to improve the consciousness of dietitians for effective application of safety education contents, development of contents, especially MSDS, and related things.

Change in Tinnitus after Treatment of Vestibular Schwannoma: Microsurgery vs. Gamma Knife Radiosurgery

PURPOSE: Tinnitus is a very common symptom of vestibular schwannoma, present in 45 to 80% of patients. We evaluated changes in tinnitus after translabyrinthine microsurgery (TLM) or gamma knife radiosurgery (GKS). MATERIALS AND METHODS: Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance Hospital from 2009-2012, 46 patients with pre- or postoperative tinnitus who agreed to participate were enrolled. Pure tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS) scores for loudness, awareness, and annoyance were measured before and after treatment. Changes of THI and VAS were analysed and compared according to treatment modality, tumour volume, and preoperative residual hearing. RESULTS: In the TLM group (n=27), vestibulocochlear nerves were definitely cut. There was a higher rate of tinnitus improvement in TLM group (52%) than GKS group (16%, p=0.016). The GKS group had a significantly higher rate of tinnitus worsening (74%) than TLM group (11%, p<0.001). Mean scores of THI and VAS scores significantly decreased in the TLM group in contrast to significant increases in the GKS group. Tumor volume and preoperative hearing did not affect the changes in THI or VAS. CONCLUSION: GKS can save vestibulocochlear nerve continuity but may damage the cochlea, cochlear nerve and can cause worsening tinnitus. In cases where hearing preservation is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can sometimes relieve or prevent tinnitus.

An Student's Evaluation of the Implementation of Problem-Based Learning / 한국의학교육

PURPOSE: The purpose of this study is to analyze the assessment of student performance in Problem-Based Learning, which was an elective course at Korea University College of Medicine, from 2001 to 2003, and to delineate effective strategies for Problem-Based Learning. METHODS: A questionnaire was given to 126 third year Korea University medical students. The questionnaire consisted of 25 items in 2001, 37 in 2002, and 64 in 2003. These items covered self-evaluation and overall evaluation of contents, learning environments, small group activity, and tutor in PBL. The respective reliability of items in scale was .67, .75, .79, and 81. Data was analyzed using the Spsswin.11.0 RESULTS: The results of this study are as follows. By most of all respondents, PBL was recognized as a more effective learning method, more interesting, and able to provide a more diverse spectrum of information than traditional lectures. Neutral or negative responses were given for educational settings. Competence of students was increased in the PBL setting. A large percentage of learning method was through the use of textbooks. Most respondents were satisfied with the small group activity and tutor. CONCLUSION: There should be sufficient educational equipments such as rooms for small group activity, textbooks, and journals for PBL. We have to consider student's characteristics carefully and to make concrete guideline and system for effective Problem based learning.

M.D.-M.B.A Joint Program Development / 한국의학교육

PURPOSE: The purpose of this study is to develop a MD-MBA joint program that will teach doctors professional hospital management and administration skills. METHODS: To assess the demand for hospital management and administration skills in the medical field, information was gathered from community physicians through a questionnaire. Personal interviews were also conducted with doctors having who graduated from a MD-MBA joint program and those working for hospital consulting firms. We visited institutions in developed countries offering this program and conducted literature reviews. Based on the data collected, a tentative plan for the introduction of a MD-MBA program in Korea was developed. RESULTS: The results of this study are as follows. Community practitioners realize the need for basic management skills and feel that hospital management should be part of undergraduate or graduate medical curriculum. In the United States, there is an annual increase in the number of institutions offering MD-MBA programs and in the number of MD-MBA graduates. These programs are run very systematically. It is apparent that the introduction of this program to Korean medical students is imminent. This program can be offered in Korea at the undergraduate level with the School of Business Administration in charge of the program, with the Medical School in charge, or as a cooperative effort between these two schools. CONCLUSION: Most private practitioners and medical professors recognize the necessity for a MD-MBA program. Systemic and experiential research must be done. Support must be given to finances, human resources and equipment in offering this program.

The Need Assessment of Management & Business Programs in Medical College / 한국의학교육

PURPOSE: In this rapid changing society and medical practice, the professionalism in the management of a hospital is being required. However, most physicians do not have the opportunity for systematic training for management and business. The difficulties perceived by private practitioners in their real practices are surveyed in order to assess the need for education course on Management & Business in medical school. METHODS: From February 3rd, 2003 to February 20th, 2003, 2, 381 private practitioners participated in the nation-wide internet questionnaire, of which the response rate was 7.1% (168 persons). The contents of the survey include 9 criteria, which consist of problems of hospital management, the present method of management, the demand for Management & Business course, and the need for commencement of education course. RESULTS: More than 50% of the physicians who answered this questionnaire expressed difficulties in some criteria such as accounting, taxation business, and management of hospital staffs. Many physicians (66 persons; 39.3%) suggested lack of knowledge of management & business or such skills as the reason for it. Most of them dealt with these difficulties by discussing these matters with their colleagues (96 persons; 57.1%) or by themselves according to their own experiences (44 persons; 26.2%). Eighty two percent of respondents approved of establishing the new subject, Management & Business course and its education. In this survey, patient management, marketing, and tax-related fields were chosen as the most needed fields for education. CONCLUSION: It was revealed that most private practitioners realized the importance of the ability in Management & Business and agreed with the need for experiencing systematic education during medical education. Therefore, it is necessary to perform the in - depth research about establishing Management & Business course in medical school.

Evaluating Clinical Teaching in Medicine / 한국의학교육

PURPOSE: Clinical teaching is at the center of medical education. To improve the quality of clerkship education, regular and structured program assessment is essential. The purpose of this study were to: 1) evaluate the effectiveness of the clerkship program at The College of Medicine at Korea University, 2000-2001, 2) to provide feedback to faculty, and 3) to improve the quality of clinical education. METHODS: The subjects of this study were the fourth year medical students who had finished all the clerkship rotation. The questionnaire consisted of items covering 6 potential dimensions considered relevant to the educational quality of clerkship. The dimensions consisted of aspects related to: clerkship contents and curriculum, evaluation, helpful vs. least helpful educational activity, the characteristics of best and worst clinical teachers and the student's self assessment for clinical competency. RESULTS: Most of students evaluated overall clerkship course contents and structure as negatively. Most helpful preceptor was revealed as residents. The characteristics of best clinical teacher were: 1) careful consideration and humanistic approach for students, 2) role modelling of good physician, 3) organized and systematic teaching, 4) enthusiam for teaching, 5) effective communication with either students or residents. CONCLUSION: The results could be used for faculty development and improving the quality of clerkship course by feedback to program director. Also, this result suggested that teaching resident to teach is need to effective clinical teaching.

Psychometric Analysis of Comprehensive Basic Medical Sciences Examination / 한국의학교육

PURPOSE: Since 2000, the Korea University Medical College has conducted Comprehensive Basic Medical Sciences Examination as a summative test. Summative assessment must be dependable in that it meets the highest standards of reliability and validity. The purpose of this study were to examine the validity and reliability of Comprehensive Basic Medical Sciences Examination and to improve the quality of the examination. METHODS: The subject of this study was the examination materials and scores of the test. We conducted exploratory factor analysis to testify validity. Cronbach alpha coefficient was used to examine the reliability. RESULTS: Only one factor was extracted from exploratory factor analysis. Its eigen value was 4.61 and it explained 65.93% of total variance. We could infer the extracted factor as an ability of basic medical sciences knowledge. The reliability coefficient of the test was ranged from 0.45 to 0.74. Of the total 335 item, overall acceptable items were 206(58.0%); the range of difficulty was 0.21~1.00 and discriminative indices were higher than 0.20. CONCLUSION: We confirmed the Comprehensive Basic Medical Sciences Examination in 2000 met the relative highest standards of reliability and validity. Item analysis could be of help to improve the quality of examination

Experiences of Medical Ethics Education with Case-Based Learning / 한국의학교육

PURPOSE: This paper aims at reporting and examining the experiences of medical ethics education with case-based learning and large-group discussion. METHODS: The subjects were a group of 100 students in the third year medical student. The medical ethics course was designed to minimize unidirectional lectures and to maximize interactive work with a large group at the classroom utilizing cases as teaching material. In the middle of the course, all students were divided into small group of 4~5 members. Each group was to find and, based upon group discussion, analyze each different case containing ethical dilemma, and present it as a midterm report. To examine the effectiveness of case based learning in medical ethics education in a large classroom, the authors analyze the students' feedback and evaluation delivered in survey questionnaires from 94 out of 96 students. RESULTS: Students' feedback showed that small-group discussion, interactive work in a classroom, and case-based studies were effective as well as practicable for medical ethics education for a large group.

The Effects of Pulsatilla Koreana for Anti-Inflammatory and Cellular Activity of Periodontal Tissue / 대한치주과학회지

This study was performed to define the cytotoxicity and the anti-inflammatory action of Pulsatilla koreana extracts. To analyze cytotoxic effects, gingival and periodontal ligament fibroblasts were used, and anti-inflammatory actions related to reduction of IL-1beta and PGE2 production were performed in vitro, for the suggestion of efficacy and safety on periodontal therapeutic use of Pulsatilla koreana extracts. We extracted ethylacetate and butylalcohol from well-dried and ground Pulsatilla koreana throughout multiple processing, then used different concentration solution(0.1 %, 0.2 %, 0.4 %, 0.01 %, 0.02 %, 0.04 %, 1 %, 2 %) of ethylacetate and butylalcohol extracts to examine cytotoxic effects and anti-inflammatory actions Cytotoxic effects were examined by ELISA reader using MTT(Methyl Thiazol-2-YL-2, 5-diphenyl Tetrazolium bromide)solution following culture of human gingival and periodontal ligament fibroblasts. Synthesis of IL-1beta was examined by IL-1beta enzyme-immunoassay(EIA)system after separation and culture of monocyte, and PGE2 was examined by PGE2 EIA system after culture of gingival fibroblasts. The results were as follows: 1. In the MTT test of gingival fibroblasts, the change of optical density was decreased significantly at 2 % of butylalcohol extracts and 0.04 %, 0.1 %, 0.2 %, 0.4 %, 1 %, 2 % of ethylacetate extracts.(p<0.05) 2. In the MTT test of periodontal ligament cells, the change of optical density were not differ significantly. but butylalcohol and ethylacetate extracts except from butylalcohol 0.01 % showed high cell cytotoxity. 3. Both ethylacetate and butylalcohol extracts from Pulsatilla koreana inhibited the synthesis of IL-1beta, and inhibition effect of ethylacetate extracts were higher than butylalcohol extracts. 4. Both ethylacetate and butylalcohol extracts from Pulsatilla koreana inhibited the synthesis of PGE2, and ethylacetate extracts were higher than butylalcohol extracts. In conclusion, ethylacetate and butylalcohol extracts from Pulsatilla koreana showed little cell cytotoxity for gingival and periodontal ligament fibroblasts, and the inhibition of IL-1beta and PGE2 synthesis, therefore it is considered that these extracts can be developed as the therapeutics of the periodontal disease.

Lessons Learned from Optional Elective Course / 한국의학교육

BACKGROUND: The College of Medicine at Korea University has lunched the new curriculum which incorporated optional elective courses in 2000. Optional elective course is consisted of 10 subjects. 8 subjects are conducted in classroom lectures and 2 of them are active experiences in research or community service. The purpose of this study is to identify the level of achievement of its own educational goals and objectives. Also, we tried to explore the possibilities of improving this course for the maximum educational effectiveness.. MATERIAL AND METHOD: We conducted a survey and the subjects of this study were second, and third year medical students who finished this course. RESULTS: 84.8% of respondents were aware of the goals of the course. 91.1% of them agreed this course is needed to enhance the effectiveness in undergraduate medical education. Most students agreed the course provide an opportunity to broaden their perspectives of field of medicine(81.4% of respondents). Also, this course provided good informations for students' future career choice(78.6% of respondents). However, students wanted to have more in-depth learning experience. INTERPRETATION: The implementation of the optional elective course at the Korea University, Medical College was successful. Despite of its initial success, the course has to be revised to allow students to get more in - depth study according their own interests.

The Antimicrobial Effect of Pulsatilla Koreana Extracts to Oral Micro-Organism / 대한치주과학회지

Gingivitis and periodontitis are infectious diseases in that microorganisms are the primary extrinsic cause of the diseases. the occurrence of gingivitis has been associated clearly with the presence of microorganisms at the disease site, and the histologic nature of the tissue involved is indicative of an inflammatory response induced by microorganisms. additional evidence for the microbial etiology of periodontal disease is that numerous antimicrobial agents are effective in reducing plaque accumulation and periodontal diseases. the purpose of this article is to analyze the antimicrobial effects of Pulsatilla koreana. Well-dried Pulsatilla koreana purchased from herbs distributor was ground and extracted into methanol(MeOH), ethylacetate(EtoAc), chlorform(CHCl3) and Butyl alcohol(BuOH). we have then applied each solution to the bacteria samples(Bacteroides forsythus, Streptococcus mutans, Streptococcus sanguis, Porphylomonas gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Prevotella intermedia, Actinomyces viscosus, Prevotella nigrescens, Rothia dentocariosa, Fusobacterium nucleatum, Pseudomonas aeruginosa, Staphylococcus aureus) collected from several organizations. To conduct susceptibility test(Kirby-Bauer method), plate contained each periodontopathic bacteria is spread extracted into methanol(MeOH), ethylacetate(EtoAc), chlorform(CHCl3) and Butyl alcohol(BuOH) and to measure the minimum inhibition concentration(MIC) of the bacteria against the solutions to ultimately determine antimicrobial effects of the solutions, insert bacteria sample into 20microliter/ml, 10microliter/ml, 5microliter/ml, 2.5microliter/ml of each solution and control group(not contained solution) 1. Solution extracted into methanol did not show clear zone against all bacteria samples. Only P. nigrescens, S. mutans and S. sanguis in soluton extracted into ethylacetate, S. mutans and S. anguis in solutions extracted into chlorform and Butyl alcohol showed clear zone against all bacteria samples. Solution extracted into Butyl alcohol showed clear zone against 13 types of bacteria, excluding P. gingivalis. 2. In Solution extracted into methanol, the bacteria samples grew in the highest concentrated plate, showing minimal variation from control group. 3. In Solution extracted into Butyl alcohol, S. aureus, P. intermedia, E. corrodens, A. actinomycetemcomitans, B. forsythus, P. gingivalis et al. showed decreased growth in the highest concentrated plate. P. auruginosa, R. dentocariosa, A. viscosus, P. nigrescens, S. mutans et al. showed decreased growth at MIC 20microliter/ml and S. sanguis showed decreased growth at MIC 10microliter/ml. 4. By analyzing the MIC level through considering the results from Kirby-Bauer method, Solution extracted into methanol did not reveal any antimicrobial effects and Solution extracted into Butyl alcohol showed the highest antimicrobial effects In conclusion, it can be used the extracts of Pulsatilla koreana as wide spectrum antimicrobial agent.

Pneumomediastinum, Subcutaneous Emphysema, Pneumoperitoneum and Pneumoretroperitoneum after Nephrectomy: A case report / 대한마취과학회지

Pneumomediastinum, air within the planes of the mediastinum, occurs in a wide variety of clinical settings. In the perioperative period, pneumomediastinum is caused by various anesthetic and surgical complications, but may appear spontaneously. When pneumomediastinum occurs with no apparent cause, it is referred to as a spontaneous pneumomediastinum. The suggested mechanism of spontaneous pneumomediastinum is rupture of marginal alveoli due to increased intraalveolar pressure and dissection of air along the bronchovascular sheath into the mediastinum. Predisposing factors include raised intrathoracic pressure, as with coughing, vomiting, and Valsalva maneuvers. The auther's case is presented of pneumomediastinum, with subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum, occurring one day postoperatively, in a 26-year-old female patient who underwent nephrectomy under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.

Pneumomediastinum, Subcutaneous Emphysema, Pneumoperitoneum and Pneumoretroperitoneum after Nephrectomy: A case report / 대한마취과학회지

Pneumomediastinum, air within the planes of the mediastinum, occurs in a wide variety of clinical settings. In the perioperative period, pneumomediastinum is caused by various anesthetic and surgical complications, but may appear spontaneously. When pneumomediastinum occurs with no apparent cause, it is referred to as a spontaneous pneumomediastinum. The suggested mechanism of spontaneous pneumomediastinum is rupture of marginal alveoli due to increased intraalveolar pressure and dissection of air along the bronchovascular sheath into the mediastinum. Predisposing factors include raised intrathoracic pressure, as with coughing, vomiting, and Valsalva maneuvers. The auther's case is presented of pneumomediastinum, with subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum, occurring one day postoperatively, in a 26-year-old female patient who underwent nephrectomy under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.

A Comparison of the Effect of Intravenous Patient - Controlled Analgesia vs. Intramuscular P.R.N Opioid Regimen on Heart Rate, Blood Pressure, Rate Pressure Product, and Visual Analogue Scale following Abdominal Hysterctomy / 대한마취과학회지

Previous studies have shown that patient-controlled analgesia(PCA) provides effective pain control in the postoperative patient. To compare the effect of pain relief on postoperative sympathetic responses and myocardial oxygen consumption, 40 healthy female patients undergoing abdominal hysterectomy were chosen randomly. They underwent pain management with either intravenous patient-controlled analgesia(IV PCA) or intermittent intramuscular opioid(IM P.R.N) regimen. Pain intensity(VAS), heart rate, blood pressure, and rate pressure product(RPP) were measured at predetermined time intervals for postoperative 72 hours after measurement of preoperative baseline values. Comparisons were then made between the two groups and among individuals within each group. IV-PCA improved postoperative pain relief(P<0.05), but did not suppress efficiently the heart rate, blood pressure, and RPP indicating sympathetic responses and myocardial oxygen consumption when compared with M P.R.N regimen. These variables were increased immediately and/or 30 minutes following the operation in both groups when compared with preoperative baseline value (P<0.05). These results suggest that improved pain relief per se by IV PCA had no mjor influence on the suppression of sympathetic responses and myocardial oxygen consumption and these responses were exaggerated during first 30 minutes after abdominal hysterectomy.