Evaluating the effectiveness of educational programs involves measuring learning processes as well as outcomes.It is essential to study cohorts of students and graduates to evaluate the long-term effects of educational programs with data generated both during education and after graduation. The purpose of this study was to establish cohorts of students and graduates to evaluate their performance, thereby providing a basis for evaluating the social accountability of medical education. In this study, student and graduate cohorts were built for both students currently enrolled and graduates at Inje University College of Medicine (IUCM). A model involving the process of cohort establishment and an evaluation indicator framework was developed. In the process of cohort establishment, the following steps were conducted: defining the goals and objectives of the student and graduate cohorts, organizing a cohort committee, developing regulations, registering cohorts, acquiring consent, and building a database. A framework of evaluation indicators according to the graduate roles of IUCM was developed by adapting Kirkpatrick’s evaluation model. Next, items to be collected in student and graduate cohorts were selected, and the current status of existing data was analyzed. Moreover, a preliminary analysis was conducted, including analyses of the evaluation indicators and graduates’ performance. This study suggests that it is necessary to include additional evaluation indicators considering students’ learning environment and well-being in student cohorts and to develop strategies or methods for graduates to continue participating in data collection for a long-term study.

Educational program evaluation can improve the quality of the curriculum, instructional methods, and resources and provide useful data for making educational decisions and policies. Developing and implementing a program evaluation system is essential in competency-based medical education. The purpose of this study was to explore and establish an educational program evaluation system adapting an integrated program evaluation model to promote competency-based medical education. First, an Educational Evaluation Committee was organized, consisting of faculty, staff members, and students. The committee established an integrated program evaluation model, combining Stufflebeam’s Context, Input, Process, and Product (CIPP) model of a process-oriented approach and Kirkpatrick’s four-level model of an outcome-oriented approach. Kirkpatrick’s model was applied to the product evaluation of the CIPP model. The committee then developed evaluation criteria, indicators, and data collection methods according to the components of the CIPP model and the four levels (reaction, learning, behavior, and results) of Kirkpatrick’s model, and collected and analyzed data. Finally, the committee reported the results of evaluation to a Medical Education Quality Improvement Committee, and the results were used to improve the curriculum and student selection. To enhance the quality of education, identifying educational deficiencies and developing various elements of education in a balanced way through educational evaluation will be needed. Furthermore, it will be necessary to listen to opinions of various stakeholders, work with all members involved in education, and communicate with decision-makers in the process of educational evaluation.

OBJECTIVES: The author investigated the relationship between the environmental tobacco smoke exposure during mid-pregnancy and early childhood and neurobehavioral outcomes of preschool children and if there is any effect of the genetic polymorphism of glutathione S-transferase (GST) M1 and T1 on this relationship. METHODS: The participants were the pregnant women (week 24-28) who visited the obstetrics and gynecology department (between 2001 and 2004). They had been evaluated for their sociodemographic data including direct and environmental tobacco smoke exposure history and the urine specimen had been sampled for the measurement of cotinine. The offsprings' urine specimen and blood sampling had been done and the socioeconomic data including the environmental tobacco smoke exposure history was evaluated at age 3. The cotinine level of urine specimen was measured and GST polymorphism was analyzed. The offsprings completed Korean-Childhood Behavioral Check List (K-CBCL) at age 4-5. RESULTS: The environmental tobacco smoke exposure during mid-pregnancy based on urine cotinine level has a significant association with increased total score and externalizing problem score of K-CBCL (p<0.05). The environmental tobacco smoke exposure based on urine cotinine level at age 3 is associated increased total score, externalizing problem score and internalizing problem score of K-CBCL with no statistical significance. The environmental tobacco smoke exposure after controlling for tobacco smoke exposure during pregnancy, however, is significantly associated with the increased externalizing problem scores (p=0.04). The environmental tobacco smoke exposure is associated with increased total score, externalizing problem score and internalizing problem score of K-CBCL with GSTM1 null type or GSTT1 null type at age 3 although there was no statistical significance. CONCLUSION: The environmental tobacco smoking exposure during pregnancy and at early childhood is associated with childhood behavioral problems. The clinical implication of this study is that it is important to avoid the environmental tobacco smoke exposure during pregnancy and early childhood and to monitor the possible emergence of behavioral problems of children.
Child ; Child, Preschool ; Cotinine ; Female ; Glutathione ; Glutathione Transferase ; Gynecology ; Humans ; Obstetrics ; Organothiophosphorus Compounds ; Polymorphism, Genetic ; Pregnancy ; Pregnant Women ; Smoke ; Smoking ; Tobacco

PURPOSE: To compare the efficacy of the new drug calfactant with the commonly used drugs surfactant-TA and poractant alfa. MATERIALS AND METHODS: A total of 332 preterm infants at 24-31 weeks' gestation with respiratory distress syndrome (RDS) were enrolled and allocated to three groups according to the surfactant instilled; Group 1 (n=146, surfactant-TA), Group 2 (n=96, calfactant), and Group 3 (n=90, poractant alfa). The diagnosis of RDS and the decision to replace the pulmonary surfactant were left to the attending physician and based on patient severity determined by chest radiography and blood gas analysis. Data were collected and reviewed retrospectively using patient medical records. RESULTS: Demographic factors including gestational age, birth weight, Apgar score, clinical risk index for babies II score, and maternal status before delivery were not different between the study groups. Instances of surfactant redosing and pulmonary air leaks, as well as duration of mechanical ventilation, were also not different. Rates of patent ductus arteriosus, intraventricular hemorrhage (> or =grade III), periventricular leukomalacia, high stage retinopathy of prematurity, necrotizing enterocolitis (> or =stage II), and mortality were also similar, as was duration of hospital stay. Cases of pulmonary hemorrhage and moderate to severe bronchopulmonary dysplasia were increased in Group 3. CONCLUSION: Calfactant is equally as effective as surfactant-TA and poractant alfa. This was the first study comparing the efficacy of surfactant-TA, calfactant, and poractant alfa in a large number of preterm infants in Korea. Further randomized prospective studies on these surfactants are needed.
Biological Products/administration & dosage/*therapeutic use ; Birth Weight ; Bronchopulmonary Dysplasia/drug therapy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Phospholipids/administration & dosage/*therapeutic use ; Pulmonary Surfactants/administration & dosage/*therapeutic use ; Republic of Korea ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn/*drug therapy ; Retrospective Studies ; Risk ; Treatment Outcome ; Ventilator Weaning

PURPOSE: To compare the efficacy of the new drug calfactant with the commonly used drugs surfactant-TA and poractant alfa. MATERIALS AND METHODS: A total of 332 preterm infants at 24-31 weeks' gestation with respiratory distress syndrome (RDS) were enrolled and allocated to three groups according to the surfactant instilled; Group 1 (n=146, surfactant-TA), Group 2 (n=96, calfactant), and Group 3 (n=90, poractant alfa). The diagnosis of RDS and the decision to replace the pulmonary surfactant were left to the attending physician and based on patient severity determined by chest radiography and blood gas analysis. Data were collected and reviewed retrospectively using patient medical records. RESULTS: Demographic factors including gestational age, birth weight, Apgar score, clinical risk index for babies II score, and maternal status before delivery were not different between the study groups. Instances of surfactant redosing and pulmonary air leaks, as well as duration of mechanical ventilation, were also not different. Rates of patent ductus arteriosus, intraventricular hemorrhage (> or =grade III), periventricular leukomalacia, high stage retinopathy of prematurity, necrotizing enterocolitis (> or =stage II), and mortality were also similar, as was duration of hospital stay. Cases of pulmonary hemorrhage and moderate to severe bronchopulmonary dysplasia were increased in Group 3. CONCLUSION: Calfactant is equally as effective as surfactant-TA and poractant alfa. This was the first study comparing the efficacy of surfactant-TA, calfactant, and poractant alfa in a large number of preterm infants in Korea. Further randomized prospective studies on these surfactants are needed.
Biological Products/administration & dosage/*therapeutic use ; Birth Weight ; Bronchopulmonary Dysplasia/drug therapy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Phospholipids/administration & dosage/*therapeutic use ; Pulmonary Surfactants/administration & dosage/*therapeutic use ; Republic of Korea ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn/*drug therapy ; Retrospective Studies ; Risk ; Treatment Outcome ; Ventilator Weaning

PURPOSE: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. MATERIALS AND METHODS: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range 43.8~129.4 months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for Tis and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had 1~3 lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (< or =2 mm) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy (41.4~60.4 Gy) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. RESULTS: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. CONCLUSION: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.
Risk Factors ; Neoplasm Metastasis ; Breast Neoplasms

Background: We aimed to evaluate the long-term growth and neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs, birth weight < 1,500 g) born between 2013, the establishment of the Korean Neonatal Network (KNN), and 2018, both at 18–24 months of corrected age and three years of age, using a nationwide large cohort, and to evaluate whether these outcomes have improved over time since 2013. Methods: This study used data from the annual reports of the KNN for 18–24 months of corrected age (follow-up 1) and three years of age (follow-up 2). Follow-up 1 data were collected from 10,065 eligible VLBWIs born between January 1, 2013, and December 31, 2018.Follow-up 2 data were collected from 8,156 eligible VLBWIs born between January 1, 2013, and December 31, 2017. Results: The overall follow-up rates of VLBWIs at follow-ups 1 and 2 were 74.6% (7,512/10,065) and 57.7% (4,702/8,156), respectively. The overall mortality rate between discharge from the neonatal intensive care unit and follow-up 1 was 1% (104/10,065). The overall mortality rate between follow-ups 1 and 2 was 0.049% (4/8,156). Growth restrictions decreased over time, especially weight growth restrictions, which significantly decreased according to era (17% in infants born in 2013–2014 and 13% in infants born in 2017–2018). Fewer infants were rehospitalized and required rehabilitative support according to era at follow-up 1. More infants had language developmental delays and required language support according to era, both at follow-ups 1 and 2. The incidence of cerebral palsy has significantly decreased over time, from 6% in infants born in 2013–2014 to 4% in infants born in 2017–2018 at follow-up 1, and from 8% in infants born in 2013–2014 to 5% in infants born in 2017 at follow-up 2. Conclusion Long-term outcomes of VLBWIs regarding weight growth and cerebral palsy, the most common motor disability in childhood, have improved serially according to era since 2013. However, the rate of infants with language delays requiring language support has increased according to era. Further studies are required on the increased trends of language delay and language support while improving motor outcomes.

Despite quantitative increases and qualitative advances in pharmacogenomics (PGx) research, the clinical implementation of PGx-based personalized therapy has still been limited. The objective of this study was to assess physicians' self-reported knowledge of PGx-based personalized therapy, and to explore the most problematic and highest priority barriers preventing physicians from applying PGx into clinical practice under the Korean healthcare system. A 36-question survey was distributed to 53 physicians with various specialties in Korea. In the physicians' self-perceived knowledge, twenty-eight physicians (53%) reported a lack sufficient knowledge about PGx. The perceived largest barrier to clinical implementation of PGx was the high cost of PGx testing, followed by a lack of PGx education for healthcare providers or lack of clinical PGx experts. Physicians without clinical PGx experience or with indirect experience reported that the largest barrier to clinical implementation of PGx was the high cost of PGx testing, while physicians with clinical PGx experience pointed out that a lack of patients' education was the major concern, followed by a lack of PGx education for healthcare providers or lack of clinical PGx experts. The highest priority problem was reported to be a lack of actionable guidelines for drug selection and dosing using PGx. In conclusion, we should increase and expand extensive educational programs for healthcare providers and patients, and to develop and establish a clinical decision support systems for PGx-based personalized therapy in Korea.

Background: We aimed to determine the current survival rate and short-term outcomes of very-low-birth-weight infants (VLBWIs) in Korea, as well as whether the survival rate and short-term outcomes have improved over time since 2013, which was when the Korean Neonatal Network (KNN) was launched. Methods: This study used data from the annual reports of the KNN from 2013 to 2020. A total of 16,351 VLBWIs born at gestational age (GA) ≥ 22 weeks between January 1, 2013, and December 31, 2020, and who were registered in the KNN were enrolled. Serial outcomes were analyzed according to era (2013–14, 2015–16, 2017–18, and 2019–20). Results: More mothers delivered by cesarean section, had diabetes or hypertension during their pregnancy, and received antenatal steroids when analyzed by era. Fewer infants were intubated at birth and had air leaks when analyzed by era. The overall survival rate of VLBWIs between 2013 and 2020 was 87%. The rate of respiratory distress syndrome was 77% and that of bronchopulmonary dysplasia was 32% between 2013 and 2020. The rates of intraventricular hemorrhage (grade ≥ 3), periventricular leukomalacia, and sepsis decreased over time. The survival rate of infants with a GA of 26 weeks has improved serially according to era. Conclusion Since the launch of the KNN in 2013, the survival rates of infants with GA 26 weeks and short-term outcomes have improved, which implies a quality improvement in antenatal and delivery room care. Further studies on the long-term neurodevelopmental outcomes of these KNN registrants are warranted.

Purpose: We evaluated the accuracy and usefulness of self-assessment of visual acuity (VA) using a smartphone application for Korean users and explored its potential application in screening eye diseases. Methods: In total, 52 participants aged ≥ 20 years were included in the study. Of these participants, 31 used Jin Yong-Han’s VA chart and the smartphone application to measure their distant visual acuity (DVA), whereas 21 used Han Chun-Seok’s near visual acuity chart and the application to measure their near visual acuity (NVA). The results and time required for VA measurement using both methods were compared. VA was converted to logarithm of the minimum angle of resolution (logMAR) for analysis. The voice recognition rate of the application for numbers 2-9 was assessed. Results: The mean NVA was 0.29 ± 0.28 using Han’s chart and 0.30 ± 0.43 using the application with no significant difference (p = 1.00). The mean DVA was 0.19 ± 5.89 using Jin's chart and 0.20 ± 0.27 using the application with no significant difference (p = 0.19). The average time spent for measuring NVA and DVA was 19 seconds (s) using Han’s and Jin's charts, whereas it was 42 and 38 s for measuring NVA and DVA using the application. The voice recognition rate of the application was 87% on average for numbers 2-9, with the highest rate for number 7 (79%) and the lowest rate for number 4 (91%). Conclusions Self-assessment of VA using a smartphone application exhibited similar results to conventional VA measurement methods. Although the measurement time varied, DVA and NVA could be measured at home using a smartphone, and would be particularly useful for those who have difficulty visiting a hospital.