Students' self-assessment of achievement of terminal competency and 4-year trend of student evaluation on outcome-based education / 한국의학교육

PURPOSE@#This study was designed to allow a student at School of Medicine, Kyungpook National University (KNUSOM) to self-assess how well they had achieved competency and to analyze the differences and trends of the scores by year. Furthermore, students are asked to evaluate the need for curriculum improvement by competency, the tendency of the score is analyzed by year, and the results are reflected in the improvement of the curriculum.@*METHODS@#We conducted a questionnaire survey for fourth-year students of KNUSOM who took medical education classes from 2015 to 2018. Questionnaire items were evaluated on the basis of their current achievement of 30 subordinate competencies of competency and the degree of necessity with respect to revising the curriculum. One-way analysis of variance was performed for the yearly difference analysis.@*RESULTS@#The students' scores on the graduation competency were 2.03 to 4.06. In the yearly difference analysis, there was no significant difference in the average of 30 total competencies, but 16 of the sub-competencies showed significant year-to-year differences. The scores for the 30 graduation competencies were different for each year, but the competencies showing high scores and low scores were found to be similar each year.@*CONCLUSION@#We found that the achievement level of the students was approximately 60% to 70%. We were able to confirm the contents of the education that the students continuously demand. The curriculum trend graphs for each year showed that the students' scores improved when the curriculum was being revised. We found that it is necessary to accept the students' self-evaluation reliable as the students indicated that the contents of the curriculum should be added to the areas where the contents were lacking in the present curriculum.

Students' self-assessment of achievement of terminal competency and 4-year trend of student evaluation on outcome-based education / 한국의학교육

PURPOSE: This study was designed to allow a student at School of Medicine, Kyungpook National University (KNUSOM) to self-assess how well they had achieved competency and to analyze the differences and trends of the scores by year. Furthermore, students are asked to evaluate the need for curriculum improvement by competency, the tendency of the score is analyzed by year, and the results are reflected in the improvement of the curriculum. METHODS: We conducted a questionnaire survey for fourth-year students of KNUSOM who took medical education classes from 2015 to 2018. Questionnaire items were evaluated on the basis of their current achievement of 30 subordinate competencies of competency and the degree of necessity with respect to revising the curriculum. One-way analysis of variance was performed for the yearly difference analysis. RESULTS: The students' scores on the graduation competency were 2.03 to 4.06. In the yearly difference analysis, there was no significant difference in the average of 30 total competencies, but 16 of the sub-competencies showed significant year-to-year differences. The scores for the 30 graduation competencies were different for each year, but the competencies showing high scores and low scores were found to be similar each year. CONCLUSION: We found that the achievement level of the students was approximately 60% to 70%. We were able to confirm the contents of the education that the students continuously demand. The curriculum trend graphs for each year showed that the students' scores improved when the curriculum was being revised. We found that it is necessary to accept the students' self-evaluation reliable as the students indicated that the contents of the curriculum should be added to the areas where the contents were lacking in the present curriculum.

Implementation of problem-based learning in medical education in Korea / 한국의학교육

PURPOSE: This study aims to identify how problem-based learning (PBL) has been implemented in Korean medical education, and how it is evaluated by each medical school. METHODS: For this study, a total of 40 medical schools in Korea were surveyed via e-mail. The survey tool was a questionnaire consisting of 22 questions which was developed independently by the researchers. RESULTS: Of the 40 medical schools, 35 schools were implementing PBL programs in their medical curriculum, while five were found not currently to be running the program. A large number of the schools which introduced PBL (30 schools, 85.7%) used a hybrid PBL model. In over 70% of the medical schools surveyed, professors evaluated the effects of PBL as positive. Most medical schools (85.7%) stated they would maintain or expand their use of PBL. However, the lack of understanding and skeptical attitude of the faculty on PBL, the lack of self-study time and passive attitude of students, insufficiency of good PBL cases, and the perfunctory PBL introduction for school accreditation interfere with the successful PBL. CONCLUSION: PBL has been incorporated in Korean medical curriculum as hybrid PBL type. It is analyzed that intensive tutor training and good PBL case development are necessary for the success and effective operation of PBL.

Students' perceptions and satisfaction level of hybrid problem-based learning for 16 years in Kyungpook National University School of Medicine, Korea / 한국의학교육

PURPOSE: Kyungpook National University School of Medicine has been implementing hybrid problem-based learning (PBL) since 1999. The aim of this study was to investigate the changes in the students' perceptions and satisfaction levels of hybrid PBL. METHODS: The target period of our study was from 1999 to 2014, and target subjects were second-year medical students in Kyungpook National University School of Medicine. The survey was conducted at the end of semester. We had a focused interview with group leaders and some volunteer students. RESULTS: As for the scores regarding students' overall satisfaction with PBL, there was significant improvement in 2005 compared to 2002, but the scores decreased and no differences between the survey years noted after 2005. The students' preference ratio for the once a week PBL sessions, tutor presence, synchronization of contents, and arrangement of PBL sessions and related lectures was 60%–80%, 50%–90%, 52%–96%, and 78%–93%, respectively. CONCLUSION: In order to increase students' satisfaction with hybrid PBL and to improve the perception of it, firstly, it is necessary to arrange the date and the time of PBL sessions so that students can concentrate on PBL. Secondly, PBL cases should be selected and arranged to be well synchronized with the ongoing lectures. Finally, it is important to create a safe atmosphere so that students can engage actively in PBL sessions.

Analysis on Teaching Evaluation of Clinical Clerkship at Korean Medical Schools / 한국의학교육

PURPOSE: The purpose of this study was to investigate the teaching evaluation of clinical clerkship at Korean medical schools, and to suggest a desirable improvement for the clinical teaching evaluation in the future. METHODS: A questionnaire survey was conducted with a total of 9 multiple-choice questions and 1 essay-type question. The multiple-choice questions were analyzed by the frequency analysis using SPSS 17.0, and the essay-type question was coded by the content analysis. RESULTS: Survey results were as follows: First, clinical teaching evaluations via online (51.35%) were implemented once a year (94.59%) in most medical schools. Second, the self-made questionnaires by medical school (64.86%) rather than borrowing or adaptation (35.14%) were being used more often as teaching evaluation tool. Third, 37.84% medical schools used the specific form by class type, whereas 62.16% medical schools took the general form regardless of class type. Finally, evaluation tool (n=8), lack of concern and attention to teaching evaluation (n=4), formalities of evaluation (n=4), etc. were exposed as problems of clinical teaching evaluation. With regard to evaluation items, the development of specific questions was required. CONCLUSION: Teaching evaluation can be used as effective educational tools to improve the clinical clerkship program. To this end, clinical teaching evaluation tools reflecting the characteristics of clinical practice need to be developed.

Complementary and Alternative Medicine (CAM) Education and Medical Students' Attitudes toward CAM / 한양의대학술지

Complementary and alternative medicine (CAM), also referred to as complementary medicine describes those unconventional healthcare practices that are not considered standard medical approaches. The increasing popularity and use of CAM modalities by consumers indicate a high need to integrate CAM education into conventional medical curriculum and evaluate CAM-related educational outcomes including the medical students' attitudes towards CAM. The number of Korean medical schools offering courses in CAM has risen sharply in recent years. Educational courses of study in CAM have developed. The Korean Society of Complementary and Integrative Medicine proposed a standard 16-hour CAM curriculum for medical students. The CAM Health Belief Questionnaire (CHBQ) is useful in measuring the medical students' attitudes toward CAM theories and practices. The students have shown positive attitudes toward CAM. The findings of positive attitude/beliefs toward CAM is useful for guiding future CAM curriculum development. The didactic CAM instruction curriculum appeared not to have additionally impacted on already positive attitudes toward CAM. It seems that we have to collect information on changes in CAM knowledge and skills to demonstrate an increase in these domains of learning.

Investigation of the Requirements of 'Good Teaching' to Improve Teaching Professionalism in Medical Education / 한국의학교육

PURPOSE: The purpose of this study is to survey the awareness of faculty (F) and students (S) on 'good teaching' and to analyze an example of good lesson, finally to identify the requirements of 'good teaching' in medical education. METHODS: Quantitative and qualitative methods were applied simultaneously. First, survey using a questionnaire was analyzed by frequency analysis and verified using chi-square-test, Mann-Whitney test. Second, the case of good teaching and qualitative data were analyzed by 'priori codes coding' and 'open coding'. RESULTS: The results of survey are as follows: Both faculty and students regarded lessons that taught important content easy to understand (F: 50%; S: 69.1%); Lessons that allow students make sure important information (F: 48.6%; S: 51.4%); Lessons that prepare and plan considering the student's level and interest (F: m=3.78; S: m=3.76) were good lessons. Faculty wanted lessons that improve student's academic achievement (35.7%), while students choose lessons that deliver curriculum effectively using appropriate teaching method (47.1%). According to the results of case analysis, it turned out that characteristics of good teaching were as follows: Thorough plan and preparation of content, various teaching methods and materials, encouragement of intellectual inquiry and curiosity, active interaction between faculty and students, clear feedback and reasonable evaluation. CONCLUSION: Requirements of good teaching are open to faculty at school of medicine and are to be utilized as guidelines to monitor and improve their instruction.

Development of Computer-Based Test (CBT) and Student Recognition Survey on CBT / 한국의학교육

PURPOSE: The purpose of this study is to understand student recognition of CBT as well as its strengths and weaknesses, and to explore the improvement methodologies for the effective development and implementation of CBT. METHODS: A questionnaire survey was conducted twice (before and after implementation of CBT) with a total of 17 multiple-choice and 2 essay-type questions. The multiple-choice questions were analyzed by frequency analysis and the essay-type questions were coded by content analysis. RESULTS: The results are as follows. First, the overall satisfaction with CBT was shown to be high. Second, students listed the merits of CBT as follows: simple correction of answers (before: 89.4%; after: 80.8%), presentation of realistic materials (before: 72.9%; after: 84.7%), prompt feedback on grades (before: 60.3%; after: 71.1%), shortened exam time and effective time scheduling (before: 86.5%; after: 66.4%), accurate estimation of abilities (before: 70.2%; after: 36.6%), and assistance in academic improvement (before: 70.9%; after: 22.1%). Drawbacks of CBT were: inconvenience of review (before: 70.9%; after: 22.1%), inconvenient screen organizations (before: 0%; after: 48.1%), possibility of cheating (before: 73.9%; after: 31.8%), and equality issue of test (before: 47.3%; after: 17.3%). CONCLUSION: Assessment paradigms are currently shifting from summative evaluation to formative evaluation, from one-off assessment to continuous assessment, and from output assessment to process assessment. Therefore, CBT must be expanded to move from result-oriented summative evaluation to formative evaluation continuously monitoring the student learning process.

Surgical Correction of Total Anomalous Pulmonary Venous Connection without Total Circulatory Arrest / 대한흉부외과학회지

BACKGROUND: Circulatory arrest under deep hypothermia is an important auxiliary means for surgical correction of total anomalous pulmonary venous connection (TAPVC). However, cardiac operations under deep hypothermic circulatory arrest are associated with the risk of post-arrest neurologic abnormalities. The purpose of this study is to evaluate the results of the surgical correction of total anomalous pulmonary venous connection without the total circulatory arrest. MATERIAL AND METHOD: Between April 2000 and October 2004, hospital records of 10 patients were reviewed retrospectively. RESULT: The locations for abnormal anatomical connections were supracardiac in 7 cases, cardiac in 1 case, and infracardiac in 2 cases. The mean cardiopulmonary bypass time and aorta cross clamp time were 116.8+/-40.7 and 69.5+/-24.1 minutes. There was no surgical mortality. Postoperative complications were post-repair pulmonary venous stenosis in 1 case, pneumonia in 1, pneumothorax in 1, wound infection in 1, and diaphragmatic paralysis in 1. All patients without pulmonary venous stenosis were in NYHA class I at mean follow-up of 16.6 months (3~49 months) CONCLUSION: We could obtain excellent results by repair without the total circulatory arrest for total anomalous pulmonary venous connection.

Endoscopic Radial Artery Harvest: Techniques & Results / 대한흉부외과학회지

BACKGROUND: The radial arteries are being used more often for coronary artery bypass grafting. We tried to the endoscopic radial artery harvest to reduce the cosmetic problems and neurologic complications of the conventional open harvesting and report the techniques and early results. MATERIAL AND METHOD: The 86 patients underwent coronary artery bypass grafting between May 2003 and April 2005 had their nondominant radial artery endoscopically removed through a 2 cm incision at the wrist. The radial pedicle was dissected and was divided at antecubial area through a 5 mm counterincision. RESULT: The 23 patients complained of neuralgias on territory of superficial raidal nerve but no one complained of neuralgias on territory of lateral antebrachial cutaneous nerve. There was no functional impairment of the hand. There was no wound complication except a localized hematoma. All patients were contacted by telephone after postoperative 7.9+/-3.6 months. The 4 patients still complained of neuralgia. All the patients were satisfied with the aesthetics of the wounds. The multidetectional tomography was done on the 66 patients for the estimation of early patency of radial artery. There were 2 cases of stenosis and a case of occlusion. CONCLUSION: Endoscopic radial artery harvest had no functional impairment of the hand, lesser rate of neurologic complications and outstanding aesthetics. The results of early patency of the radial artery was similar to conventional methods. Therefore, we think that endoscopic radial artery harvest is the optimal procedure.

Learning Styles in Medical School / 한국의학교육

PURPOSE: The purpose of this study is to investigate the learning styles of students at Kyungpook National University(KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. METHODS: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder's Index of Learning Styles(ILS) was used, which included 49 items. Felder's ILS measures the learner's relative preference for each of the five dichotomous learning style dimensions. RESULTS: 242(42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. CONCLUSION: From these results, we suggested some effective methods of teaching-learning based on the students' preferences and some perspectives for future works.

One-stage Repair of Interrupted Aortic Arch with Ventricular Septal Defect and Valvular Aortic Stenosis: A case report / 대한흉부외과학회지

A male neonate was referred to our hospital with facial cyanosis and tachypnea at 19 days of age. Two-dimensional echocardiography showed type B interrupted aortic arch, posterior malalignment ventricular septal defect and valvular aortic stenosis. A new surgical repair was done with biventricular repair and neo-aortic arch reconstruction. Left ventricular outflow track (LVOT) was consisted of aortic valve and pulmonic valve. Right ventricular outflow (RVOT) track was reconstructed with extracardiac conduit. Postoperative two-dimensional echocardiography showed no stenosis and turbulency flow on LVOT and RVOT.

Analysis of Neurological Complications on Antegrade Versus Retrograde Cerebral Perfusion in the Surgical Treatment of Aortic Dissection / 대한흉부외과학회지

BACKGROUND: In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. MATERIAL AND METHOD: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. RESULT: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was 17.2oC and 22.8oC in the group A, and 16.0oC and 19.7oC in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. CONCLUSION: The Antegrade cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.

The Effect of the Histidine-Tryptophan-Ketoglutarate (HTK) Solution on Myocardial Protection in Isolated Rat Heart / 대한흉부외과학회지

BACKGROUND: The Histidine-Tryptophan-Ketoglutarate (HTK) solution has been shown to provide the excellent myocardial protection as a cardioplegia. The HTK solution has relatively low potassium as an arresting agent of myocardium, and low sodium content, and high concentration of histidine biological buffer which confer a buffering capacity superior to that of blood. Since HTK solution has an excellent myocardial protective ability, it is reported to protect myocardium from ischemia for a considerable time (120 minutes) with the single infusion of HTK solution as a cardioplegia. The purpose of this study is to evaluate the cardioprotective effect of HTK solution on myocardium when the ischemia is exceeding 120 minutes at two different temperature (10 to 12degrees C, 22 to 24degrees C) using the Langendorff apparatus. MATERIAL AND METHOD: Hearts from Sprague-Dawley rat, weighing 300 to 340 g, were perfused with Krebs-Henseleit solution at a perfusion pressure of 100 cm H2O. After the stabilization, the heart rate, left ventricular developed pressure (LVDP), and coronary flow were measured. Single dose of HTK solution was infused into the ascending aorta of isolated rat heart and hearts were preserved at four different conditions. In group 1 (n=10), hearts were preserved at deep hypothermia (10~12degrees C) for 2 hours, in group 2 (n=10), hearts were preserved at moderate hypothermia (22~24degrees C) for 2 hours, in group 3 (n=10), hearts were preserved at deep hypothermia for 3 hours, and in group 4 (n=10), hearts were preserved at moderate hypothermia for 3 hours. After the completion of the preservation, the heart rate, left ventricular developed pressure, and coronary flow were measured at 15 minutes, 30 minutes, and 45 minutes after the initiation of reperfusion to assess the cardiac function. Biopsies were also done and mitochondrial scores were counted in two cases of each group for ultrastructural assessment. RESULT: The present study showed that the change of heart rate was not different between group 1 and group 2, and group 1 and group 3. The heart rate was significantly decreased at 15 minutes in group 4 compared to that of group 1 (p<0.05 by ANCOVA). The heart rate was recovered at 30 minutes and 45 minutes in group 4 with no significant difference compared to that of group 1. The decrease of LVDP was significant at 15 minutes, 30 minutes and 45 minutes in group 4 compared to that of group 1 (p<0.001 by ANCOVA). Coronary flow was significantly decreased at 15 minutes, 30 minutes, and 45 minutes in group 4 compared to that of group 1 (p<0.001 by ANCOVA). In ultrastructural assessment, the mean myocardial mitochondrial scores in group 1, group 2, group 3, and group 4 were 1.02+/-0.29, 1.52+/-0.26, 1.56+/-0.45, 2.22+/-0.44 respectively. CONCLUSION: The HTK solution provided excellent myocardial protection regardless of myocardial temperature for 2 hours. But, when ischemic time exceeded 2 hours, the myocardial hemodynamic function and ultrastructural changes were significantly deteriorated at moderate hypotherma (22~24degrees C). This indicates that it is recommended to decrease myocardial temperature when myocardial ischemic time exceeds 2 hours with single infusion of HTK solution as a cardioplegia.

Operation of Tricuspid Valve Endocarditis with Pulmonary Infarction: Lobectomy with Open Heart Surgery / 대한흉부외과학회지

An eight-year-old boy was referred to our hospital with cough and high fever. His past medical history included a small sized ventricular septal defect (VSD) at birth. Transthoracic echocardiography disclosed a 10x6 mm vegetation on tricuspid valve, a small VSD and the moderate tricuspid valve insufficiency were found. Blood cultures grew methicillin-resistant staphylococcus aureus. Despite proper antibiotic therapy, fever was not controlled and his course was complicated by pulmonary infarction. The patient simultaneously underwent pulmonary resection and open heart surgery. Through the median sternotomy we performed open thrombectomy and lobectomy (right lower lobe) at first, and then vegetectomy, tricuspid valve repair, and direct closure of VSD were done under cardiopulmonary bypass.

Surgical Results of Selected Stage IIIB Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Traditionally, patients with stage IIIB non small cell lung cancer (NSCLC) have been considered inoperable due to the short-term survival rate of this disease. However, some recent papers have reported good surgical treatment results for T4 lesions in stage IIIB NSCLC. This study reports the results of stage IIIB NSCLC patients who underwent surgical treatment at our institute. MATERIAL AND METHOD: This study includes 109 patients who were diagnosed with pathological stage IIIA lung cancer and 59 patients who were diagnosed with pathological stage IIIB at our institute between 1994 to December 2001. Patients who underwent neo-adjuvant chemotherapy and radiation therapy were excluded from this study. According to the TNM classification, 13 patients from stage IIIA were classified into T3N1, 12 into T1N2, 73 into T2N2 and 11 into T3N2. Stage IIIB patients consisted of 26 patients with T4N0, 18 with T4N1, 14 with T4N2, and 1 with T4N3. RESULT: The 30-day mortality for stage IIIA and IIIB were 4.58% and 5.08% respectively. The overall survival rate at the 1st, 2nd, 3rd, and 5th year were 69.1%, 53.7%, 41.6%, and 30.7% respectively in stage IIIA and 68.8%, 55.6%, 42.9%, and 35.9% respectively in stage IIIB. Patients with satellite nodules in the same lobe& no lymph node involvement had a survival rate of 53.9% in 3 years compared with 15.2% in patients with satellite nodules in the same lobe with lymph node involvement. CONCLUSION: Surgical treatment is recommended for selected stage IIIB NSCLC patients (pathological N0 stage& completely resectable patients), particularly for patients with satellite nodules in the same lobe& no lymph node involvement.

The Achievement of Medical Students Admitted after Baccalaureate Level / 한국의학교육

PURPOSE: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. METHODS: Students' academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. RESULTS: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. CONCLUSION: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.

Comparison of Cardioprotection between Histidine-Tryptophan-Ketoglutarate Cardioplegia and DelNido Cardioplegia in Isolated Rat Hearts / 대한흉부외과학회지

BACKGROUND: The aim of this study is to define the cardioprotective effects (hemodynamic, cytochemical and ultrastructural of the newly developed Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegia compared to DelNido cardioplegia. MATERIAL AND METHOD: Seventy-nine isolated rat hearts were divided into three groups on the basis of techniques of cardioplegia infusion. Twenty-eight hearts (Group 1) were flushed with cold DelNido cardioplegia with every 40 minutes for 2 hours. Twenty-seven hearts (Group 2) were flushed with cold HTK cardioplegia for once during the 2 hours. Twenty-four hearts (Group 3) were flushed with cold HTK cardioplegia with every 40 minutes for 2 hours. Heart rate, left ventricular developed pressure (LVDP), changes of +dp/dt max, coronary flow, and rate-pressure product value were measured at pre-ischemic, post-reperfusion 15 minutes, 30 minutes, and 45 minutes for hemodynamic study. Aspartate aminotransferase (AST), lactate dehydrogenase (LD), creatine kinase (CK), CK- MB, troponin-I, myoglobin, and lactate were measured at pre-ischemic and post-reperfusion 45 minutes for cytochemical parameters. Mitochondrial scores were counted in 3 cases from each group for ultrastructural assessment. RESULT: In hemodynamic study, there were no significant differences among group 1, group 2, and group 3. However, the decrease values of heart rate in group 2 and 3 exhibited significantly lower values than in group 1. In cytochemical study, there were no significant differences among group 1, group 2, and group 3. However, the increase values of lactate in group 2 and 3 exhibited significantly lower values than in group 1. In ultrastructural assessment, the mean myocardial mitochondria scores in group 1, group 2, and group 3 were 2.14+/-0.10, 1.52+/-0.57, and 2.10+/-0.16. CONCLUSION: HTK solution provides adequate myocardial protection with some advantages over DelNido solution in isolated rat hearts.

Comparison of the Injury Severity Score with the New Injury Severity Score in Trauma Patients with Chest injury

PURPOSE: The Injury Severity Score (ISS), which is defined as the sum of the squares of the single highest Abbreviated Injury Scale (AIS) score in each of the three most severely injured body regions, does not take into account multiple injuries in the same body region. The New ISS (NISS), which is defined as the sum of the squares of the AIS scores of a patient's three most severe injuries regardless of body region, has been proposed to provide a more accurate measure of trauma severity. The purpose of this study was to evaluate the ISS and the NISS in patients with chest trauma. METHODS: A retrospective study of 263 cases of trauma victims with chest injuries, who visited the emergency center of Daegu Catholic University Hospital during a 42-month-period from January 1998 to June 2001, was performed. For each patient, we calculated the ISS and the NISS. The power of the two scoring systems to predict hospital length of stay, intensive care, operation, and mortality was gauged through comparison of receiver operating characteristic (ROC) curves. RESULTS: The mean ISS was 12, and the mean NISS was 14. The areas under the curves (AUC) of the hospital length of stay (0.764 vs 0.762), operation (0.772 vs 0.764), and mortality (0.873 vs 0.860) were greater for the ISS than the NISS. CONCLUSION: The significant difference in the predictive abilities of the ISS and the NISS reported in studies of severe blunt trauma patients was not seen in this review of moderate trauma patients with chest injuries.

The Effect of Improved Operating Room and Intensive Care Unit on the Sternal Infection After Open Heart Surgery / 대한흉부외과학회지

BACKGROUND: Sternal infection after open heart surgery is a serious complication associated with high rate of mortality. We reviewed the effect of improved operating room and intensive care unit on the sternal infection by analyzing the incidence and condition of that around the movement of operating room and intensive care unit in July 1999. MATERIAL AND METHOD: We reviewed a total of 453 patients. Group I contains 237 patients who underwent open heart surgery between January 1997 and December 1998 before we moved the intensive care unit and operating room, and Group II contains 216 patients who underwent open heart surgery between January 2000 and July 2001 after we moved. We only included adult patients over age 15 who underwent cardiopulmonary bypass through median sternotomy and excluded the mortality cases except sternal infections in this study. RESULT: Sternal infection developed in 18 patients(8.0%) in Group I, and in only 1 patient(0.49%) in Group II. Emergency operation, cardiopulmonary bypass time, operation time, transfusion, tracheostomy, and reoperation are significantly associated with sternal infection among the known risk factors. The logistic regression analysis containing those six factors revealed that the movement of intensive care unit and operating room is effective on the decreasing sternal infection(p=0.029, 95% confidence interval 0.011~0.788). CONCLUSION: Although there have been studies on many risk factors associated with the sternal infection after open heart surgery, we think that the improvement of operting room and intensive care unit is a method for decreasing the incidence of sternal infection.