Since the implementation of the national medical insurance service in 1979, it has become necessary to reconsider medical services from the geographical point of view. As more medical professionals have been concentrated in the metropolitan and urban areas, publicly hired medical practitioners have been appointed to less populated regions (e.g., farms and fisheries) and public medical service has been reinforced. During the past 10 years, the government and the ruling parties have been dragged around by strikes and collective actions of medical organizations, who have been rather dissatisfied with the new policy, namely, the separation of dispensary from medical practice. In an attempt to hold such efforts into check, the government, who has lost its "pride as a leftist," saw the needs to implement the public medical service. Consequently, new regulations were focused on the expansion of both the quantity and shares in the medical service market of the public medical service, which can be directly controlled. The government has either misunderstood the needs for urban public medical service or diverted its underlying principles. Despite some studies that reported the financial loss of urban public medical service as unavoidable, the government established seven exemplary public medical services in November 2005. The inefficiencies of such medical service were first brought to the public attention by the municipal congress of Cheonan City. Moreover, there have been some cases of distorted medical practices in the Seoul area, caused by efforts to record amplified hours of services. Owing to the financial loss and lack of effectiveness of the public medical service, such wrongful actions have been well expected. The government should first institute the underlying concepts of public medical service. The current inefficient public medical service should be scrapped, if the purpose of such service is a "public service," per se. If the public medical service only fills blanks left out by private medical service, the current public institutions have to carry out their responsibilities. The needs for current public medical service should be addressed if the quality and details of such service is to remain inferior to private medical service and keeps wasting tax.
Insurance ; Social Control, Formal ; Strikes, Employee ; Taxes

The situations of health expenditures in Korea and their causes need to be understood and it needs to be reviewed whether DRG is suitable as an alternative for the payment system. Also, we want to present the problems and alternatives for the additional fee for medical institutions and the 'doctor-selecting' system. The current health expenditures in Korea is relatively low compared to the ones in other OECD countries, but they are rapidly increasing from the main causes of the expansion of long-term care and the increase of expenditures for medicines. When considering the particular situation of Korea, there is a concern that DRG can rapidly increase the health expenditures in a short time. The additional fee for medical institutions has irony in that the national health insurance corporation provides more benefits to the patients using bigger hospitals, and the 'doctor-selecting' system has a problem in that patients cannot actually choose doctors. Korean-specific DRG needs to be developed, the national health insurance corporation should give equal payments, and the 'doctor-selecting' system should be changed into another system. Studies on the empirical analysis on the situations of healthcare insurance and collection of diverse opinions of experts are required. Present promotion project on the healthcare insurance system cannot achieve the objective so the fundamental situations about this needs to be perceived and the alternatives need to be prepared.
Delivery of Health Care ; Diagnosis-Related Groups ; Fees and Charges ; Health Expenditures ; Humans ; Insurance ; Insurance, Health ; Korea ; Long-Term Care ; National Health Programs

OBJECTIVES: To compare eating behavior according to the shift work and to find the factors associated with the abnormal eating behavior in university hospital's nurses. METHODS: For this assessment, a cross-sectional study was conducted with 300 university hospital's nurses. Nurses were questioned with self-reported questionnaire forms. After excluding cases with incomplete data, 276 cases are enrolled in the study. To find the factors associated with the abnormal eating behavior, we conducted multiple logistic regression analysis. RESULTS: The proportions of shift work nurses were 63.77%(176 cases). The proportions of abnormal eating behavior among shift work nurses were 22.73%(40 cases), but only 6.00%(6 cases) among non-shift work nurses had the abnormal eating behavior. Considering the shift work period, the proportions of abnormal eating behavior were 31.25%, 22.92% and 17.50% in case of shift work period were less than 1 year, 1~3 years and more than 3 years, respectively. The abnormal eating behavior was associated with having shift work, doing exercise, more weekly working hours, being on a diet and having perception of overweight. But age and body mass index were not influenced the abnormal eating behavior. CONCLUSIONS: In this study, we found that the factors associated with the abnormal eating behavior are the shift work, exercise, weekly working hours, perception of overweight and diet.
Body Mass Index ; Cross-Sectional Studies ; Diet ; Eating* ; Feeding Behavior* ; Logistic Models ; Overweight ; Surveys and Questionnaires

Purpose: This study aims to design that using formative assessment as an instructional strategy in real-time online classes, and to explore the application of Bloom’s taxonomy in the development of formative assessment items. Methods: We designed the instruction using formative assessment in real-time online classes, developed the items of formative assessment, analyzed the items statistically, and investigated students' perceptions of formative assessment through a survey. Results: It is designed to consist of 2–3 learning outcomes per hour of class and to conduct the formative assessment with 1–2 items after the lecture for each learning outcome. Formative assessment was 31 times in the physiology classes (total 48 hours) of three basic medicine integrated. There were nine “knowledge” items, 40 “comprehension” items, and 55 “application” items. There were 33 items (31.7%) with a correct rate of 80% or higher, which the instructor thought was appropriate. As a result of the survey on students’ perceptions of formative assessment, they answered that it was able to concentrate on the class and that it was helpful in achieving learning outcomes. Conclusion The students focused during class because they had to take formative assessment immediately after the learning outcome lecture. “Integration of lesson and assessments” was maximized by solving the assessment items as well as through the instructor’s immediate explanation of answers. Through formative assessment, the students were able to utilize metacognition by learning what content they understood or did not understand. Items that consider Bloom’s taxonomy allow students to remember, understand, and apply to clinical contexts.

Purpose: This study aims to design that using formative assessment as an instructional strategy in real-time online classes, and to explore the application of Bloom’s taxonomy in the development of formative assessment items. Methods: We designed the instruction using formative assessment in real-time online classes, developed the items of formative assessment, analyzed the items statistically, and investigated students' perceptions of formative assessment through a survey. Results: It is designed to consist of 2–3 learning outcomes per hour of class and to conduct the formative assessment with 1–2 items after the lecture for each learning outcome. Formative assessment was 31 times in the physiology classes (total 48 hours) of three basic medicine integrated. There were nine “knowledge” items, 40 “comprehension” items, and 55 “application” items. There were 33 items (31.7%) with a correct rate of 80% or higher, which the instructor thought was appropriate. As a result of the survey on students’ perceptions of formative assessment, they answered that it was able to concentrate on the class and that it was helpful in achieving learning outcomes. Conclusion The students focused during class because they had to take formative assessment immediately after the learning outcome lecture. “Integration of lesson and assessments” was maximized by solving the assessment items as well as through the instructor’s immediate explanation of answers. Through formative assessment, the students were able to utilize metacognition by learning what content they understood or did not understand. Items that consider Bloom’s taxonomy allow students to remember, understand, and apply to clinical contexts.

BACKGROUND: An essential prerequisite for successful procurement of sufficient peripheral blood stem cells (PBSC) for engraftment is the optimal timing of collection. The Sysmex SE-9000 automated hematology analyzer provides the immature information (IMI) channel for the identification and counting PBSC. In this study, The optimal timing of PBSC collection was studied using IMI channel. METHODS: 193 peripheral blood stem cell collections were performed from 52 patients with hematologic disorders or solid tumors and 15 donors. Pre-harvest peripheral blood WBC, mononuclear cells (MNC) and IMI were tested and compared with CD34+ cell count and CFU-GM count of harvested products. RESULTS: Peripheral blood WBC and MNC count showed a weak correlation with CD34+ cell yield (r=0.38, P<0.0001 and r=0.38, P<0.0001) and peripheral blood IMI had a stronger correlation (r=0.58, P<0.0001) with collected CD34+cells than did WBC and MNC count. A receiver operating characteristic (ROC) curve was drawn for cutoff value of IMI and predictive values of the chosen cutoff value of IMI for different target CD34+ cell collections were calculated. The ROC curve showed that the best cutoff value of IMI was 465/microliter for the target CD34+ cells >1x10(6)/kg with sensitivity of 88.7%. Positive and negative predictive values of IMI >465/microliter for CD34+ cell >1x10(6)/kg were 65.5% and 87.5%, respectively. CONCLUSIONS: The automated IMI might be used as a simple and efficient indicator of PBSC mobilization and applying variable cutoff values of IMI would be a useful tool to predict the optimal timing of PBSC collection.
Cell Count ; Granulocyte-Macrophage Progenitor Cells ; Hematology* ; Humans ; ROC Curve ; Stem Cells* ; Tissue Donors

OBJECTIVE: The purpose of this study was to review the clinical features, treatments and prognosis of the borderline malignant tumors of the ovary. METHODS: Thirty-two patients with borderline malignant tumors of the ovary were admitted, operated and confirmed with postoperative histopathological study at department of obstetrics and gynecology, Yonsei University Wonju Christian Hospital. The data were collected retrospectively and all charts were reviewed. RESULTS: The incidence of borderline malignant ovarian tumor was 19.2% (32/167). Age distribution revealed between 18 and 77 years old, the mean age was 43.1 years old. As for the parity distribution of borderline malignant tumor, nulliparity was most common (43.8%). The most common chief complaint was abdominal distension (34.4%). Histologic subtypes were mucinous in 19 cases (59.4%), serous in 13 cases (40.6%). According to FIGO classification, 28 cases (87.5%) were stage I, 1 case (3.1%) was stage II, 3 cases (9.4%) were stage III. Sixteen cases (50%) underwent conservative surgery (unilateral salpingooophorectomy or cystectomy). Sixteen cases (50%) were treated with total abdominal hysterectomy and bilateral salpingooophorectomy. Fifteen cases (46.9%) received adjuvant postoperative chemotherapy. Excluding 5 cases lost to follow up, patients were alive and were followed from 9 months to 100 months. (mean 36 months).
Age Distribution ; Aged ; Classification ; Drug Therapy ; Female ; Gangwon-do ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lost to Follow-Up ; Mucins ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies

OBJECTIVE: The purpose of this study was to review the clinical features, treatments and prognosis of the borderline malignant tumors of the ovary. METHODS: Thirty-two patients with borderline malignant tumors of the ovary were admitted, operated and confirmed with postoperative histopathological study at department of obstetrics and gynecology, Yonsei University Wonju Christian Hospital. The data were collected retrospectively and all charts were reviewed. RESULTS: The incidence of borderline malignant ovarian tumor was 19.2% (32/167). Age distribution revealed between 18 and 77 years old, the mean age was 43.1 years old. As for the parity distribution of borderline malignant tumor, nulliparity was most common (43.8%). The most common chief complaint was abdominal distension (34.4%). Histologic subtypes were mucinous in 19 cases (59.4%), serous in 13 cases (40.6%). According to FIGO classification, 28 cases (87.5%) were stage I, 1 case (3.1%) was stage II, 3 cases (9.4%) were stage III. Sixteen cases (50%) underwent conservative surgery (unilateral salpingooophorectomy or cystectomy). Sixteen cases (50%) were treated with total abdominal hysterectomy and bilateral salpingooophorectomy. Fifteen cases (46.9%) received adjuvant postoperative chemotherapy. Excluding 5 cases lost to follow up, patients were alive and were followed from 9 months to 100 months. (mean 36 months).
Age Distribution ; Aged ; Classification ; Drug Therapy ; Female ; Gangwon-do ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lost to Follow-Up ; Mucins ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies

PURPOSE: To investigate the effect of combined inhibition of protein kinase B (AKT) and SRC on the growth and metastatic potential of human pancreatic cancer cells. MATERIALS AND METHODS: AKT and SRC were inhibited using 10-DEBC and PP2, respectively. The expression of their messenger RNAs were down-regulated by specific small interfering RNA (siRNA). Changes in pancreatic cancer cell growth and metastatic potential were determined using a cell viability assay and a xenotransplant model of pancreatic cancer, as well as cell migration and invasion assays. Signal proteins were analyzed by Western blot. RESULTS: The inhibitors 10-DEBC and PP2 suppressed cell proliferation in a dose-dependent fashion in pancreatic cancer cell lines MIA PaCa-2 and PANC-1. The simultaneous inhibition of AKT and SRC at low concentrations resulted in a significant suppression of cell proliferation. Knockdown of AKT2 and SRC using siRNAs also significantly decreased cell proliferation. In a pancreatic cancer model, combined treatment with 10-DEBC and PP2 also significantly suppressed the growth of pancreatic cancer. Application of 10-DEBC with PP2 significantly reduced the metastatic potential of pancreatic cancer cells by inhibiting migration and invasion. The combined inhibition suppressed the phosphorylation of mTOR and ERK in pancreatic cancer cells. CONCLUSION: Combined targeting of AKT and SRC resulted in a synergistic efficacy against human pancreatic cancer growth and metastasis.
Blotting, Western ; Cell Line ; Cell Movement ; Cell Proliferation ; Cell Survival ; Humans* ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Phosphorylation ; Proto-Oncogene Proteins c-akt ; RNA, Messenger ; RNA, Small Interfering

BACKGROUND: The purpose of this study was to evaluate whether measuring the ratio of descending aortic enhancement (DAE) to main pulmonary artery enhancement (MPAE) on pulmonary computed tomography angiography (PCTA) can predict poor outcome in patients with acute massive or submassive pulmonary embolism (PE). METHODS: We retrospectively, reviewed computed tomgraphy findings and charts of 37 patients with acute PE and right ventricular dysfunction. We divided the enrolled patients into 3 groups; group Ia (n=8), comprised of patients with major adverse event (MAE); group Ib (n=5), consisted of those with PE-related MAE; and group II (n=29), those without MAE. We analyzed the right ventricular diameter (RVD)/left ventricular diameter (LVD) and DAE/MPAE on PCTA. RESULTS: For observer 1, RVD/LVD in group Ia (1.9+/-0.36 vs. 1.44+/-0.38, p=0.009) and group Ib (1.87+/-0.37 vs. 1.44+/-0.38, p=0.044) were significantly higher than that of group II. For observer 2, RVD/LVD in group Ia (1.71+/-0.18 vs. 1.41+/-0.47, p=0.027) was significantly greater than that of group II, but RVD/LVD of group Ib was not (1.68+/-0.2 vs. 1.41+/-0.47, p=0.093). For both observers, there was a significant difference of DAE/MPAE between group Ib and group II (0.32+/-0.15 vs. 0.64+/-0.24, p=0.005; 0.34+/-0.16 vs. 0.64+/-0.22, p=0.004), but no significant difference of DAE/MPAE between group Ia and group II (0.51+/-0.3 vs. 0.64+/-0.24, p=0.268; 0.53+/-0.29 vs. 0.64+/-0.22, p=0.302). Intra-class correlation coefficient (ICC) for the measurement of DAE/MPAE (ICC=0.97) was higher than that of RVD/LVD (ICC=0.74). CONCLUSION: DAE/MPAE measured on PCTA may predict PE-related poor outcomes in patients with massive or submassive PE with an excellent inter-observer agreement.
Angiography ; Humans ; Prognosis ; Pulmonary Artery ; Pulmonary Embolism ; Retrospective Studies ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Right