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.

OBJECTIVES: The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea. METHODS: We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data. RESULTS: We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092–1.183) for diagnosis of diabetes, 1.278 (1.278–1.386) for diagnosis of dyslipidemia, 0.940 (0.904–0.977) for diagnosis of arthritis, 0.785(0.736–0.837) for treatment of arthritis, 1.159 (1.116–1.203) for diagnosis of cataracts, and 1.285(1.200–1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p<0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p<0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly. CONCLUSION Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

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: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries. METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation. RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis. CONCLUSION Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.

BACKGROUND: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.CONCLUSION: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.
Constriction, Pathologic ; Female ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy ; Logistic Models ; Medical Records ; Multivariate Analysis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Ureter

BACKGROUND AND OBJECTIVES: Globus pharyngeus is a sensation of foreign body in the throat. There are many studies evaluate relationships between globus pharyngeus and organic diseases such as laryngopharyngeal reflux, esophageal motility disorders as well as psychotic causes. But, Also many patients without etiologic causes complain of globus sensation. The authors performed a study that evaluate association between oral water intake and symptoms of globus sensation on the basis of a belief that pharyngeal dehydration due to lack of oral water intake causes globus sensation. MATERIALS AND METHODS: A survey using visual analogue scale to evaluate symptoms was performed with 73 patients with globus pharyngeus. RESULTS: Patients who drink water less than 500 mL per day (p=0.04) and less than five times per day (p=0.02) were improved after 6 months due to education and doctor's recommendation. CONCLUSION: Frequent and enough water intake should be recommended to resolve symptoms of globus sensation.
Dehydration ; Drinking* ; Education ; Esophageal Motility Disorders ; Foreign Bodies ; Humans ; Laryngopharyngeal Reflux ; Pharynx ; Sensation ; Water*

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

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

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