A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*

PURPOSE: This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship. METHODS: We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT. RESULTS: iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination. CONCLUSION: The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.
Discrimination (Psychology) ; Humans ; Motivation ; Reaction Time ; Retrospective Studies

PURPOSE: This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship. METHODS: We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT. RESULTS: iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination. CONCLUSION The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.

OBJECTIVE: The purpose of this study is to investigate the incidence and ratio of biphalangeal toes in Korean adult and to investigate whether this finding correlates with the evolution of human toes. METHOD: The materials used in this study consisted of 1,290 radiographs of the human feet obtained from 645 adults with foot symptom and complete osseous growth. The 1,290 radiographs consisted of anteroposterior weightbearing radiographs and nonweightbearing oblique radiographs. Those were retrospectively reviewed and carried out of detailed macroscopic examinations. RESULTS: Biphalangeal toe was observed for the 5th toe in 934 cases (72.40%), for the 4th toe in 161 cases (12.48%), for the 3rd toe in 7 cases (0.54%), and for the 2nd toe in 1 case (0.08%). Bilaterality of biphalangeal and triphalangeal toes for each toe was observed over 97.1%. CONCLUSION: Our results are in agreement with Nakashima and it is likely that over 70% of the Asian population have only two phalanges in their fifth toes, and it seems to be an example of microevolution or genetic adaptation to bipedalism.
Adult ; Asian Continental Ancestry Group ; Foot* ; Humans ; Incidence ; Retrospective Studies ; Toes* ; Weight-Bearing

Purpose: This study aimed to investigate the differences in the perception between professors and students regarding medical educators’ roles and discuss their desirable roles. Methods: A survey was administered to 116 professors and 379 students of the medical colleges from Dankook University and Hallym University. The subjects were given a self-created questionnaire designed to measure their perception of medical educators’ roles. Results: First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles. Conclusion First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.
Allied Health Personnel ; Disasters* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Fires* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Retrospective Studies ; Triage

No abstract available.
Female ; Ovarian Cysts* ; Ultrasonography*

PURPOSE: To evaluate the clinical and radiographic outcomes of high tibial open wedge osteotomy combined with arthroscopic surgery in patients with medial unicompartmental osteoarthritis. MATERIALS AND METHODS: Between January 1999 and May 2002, 29 patients with 30 cases were treated with high tibial open wedge osteotomy combined with arthroscopic surgery for the treatment of osteoarthritis. The mean age of the study group was 44.7 years old (range, 20 to 56 years old). 4 cases with more than 1 cm openings were treated by autologous bone grafts, and another 26 cases were treated by Puddu plates alone after osteotomy. The clinical assessment was performed using the Hospital for Special Surgery (HSS) knee rating system. The radiologic analysis was performed by measurement of the femorotibial angle and posterior inclination of the tibial articular surface. RESULTS: The mean knee rating score by the HSS knee rating system improved from 64.7 points (range, 52.0 to 69.5 points) to 82.4 points (range, 78 to 90) at the last follow-up. Radiologic bone union was accomplished in all cases. Preoperative varus angles of 6.3 degrees (range, 3.5 to 8.0 degrees) and posterior inclinations of 6.6 degrees (range, 5.0 to 7.3 degrees) improved, on average, to postoperative valgus angles of 8.2 degrees (range, 5 to 10 degrees) and posterior inclinations of 7 degrees (range, 5.0 to 8.5 degrees). At the last follow-up valgus angles had improved, on average, to 7.3 degrees (range, 4.5 to 9.0 degrees). CONCLUSION: High tibial open wedge osteotomy combined with arthroscopic surgery significantly improved knee joint function.
Arthroscopy* ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Osteoarthritis ; Osteotomy* ; Transplants

Purpose: This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. Methods: This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. Results: The lecture evaluation score decreased as the teaching hours per instructor in a year increased by an hour, and the number of instructors per lecture increased by one individual. During trajectory analysis, the first trajectory had lower lecture evaluation scores overall but relatively high appropriateness of the textbook and punctuality of class, whereas the second trajectory had higher lecture evaluation scores overall for all four items. Conclusion The two trajectories showed differences in teaching methods (understanding of lecture content and usefulness of the lecture) rather than in external factors (appropriateness of the textbook and punctuality of class). Therefore, to improve lecture satisfaction, enhancing instructors’ instructional competencies through lectures and adjusting the teaching hours by assigning an adequate number of instructors per lecture are recommended.

Missing observations are common in medical research and health survey research. Several statistical methods to handle the missing data problem have been proposed. The EM algorithm (Expectation-Maximization algorithm) is one of the ways of efficiently handling the missing data problem based on sufficient statistics. In this paper, we developed statistical models and methods for survey data with multivariate missing observations. Especially, we adopted the Em algorithm to handle the multivariate missing observations. We assume that the multivariate observations follow a multivariate normal distribution, where the mean vector and the covariance matrix are primarily of interest. We applied the proposed statistical method to analyze data from a health survey. The data set we used came from a physician survey on Resource-Based Relative Value Scale(RBRVS). In addition to the EM algorithm, we applied the complete case analysis, which used only completely observed cases, and the available case analysis, which utilizes all available information. The residual and normal probability plots were evaluated to access the assumption of normality. We found that the residual sum of squares from the EM algorithm was smaller than those of the complete-case and the available-case analyses.
Biostatistics ; Dataset ; Health Surveys* ; Models, Statistical ; Relative Value Scales