Kosin Medical Journal

Original article

Comparative analysis of Access PCT and Elecsys BRAHMS PCT assays for procalcitonin measurements: Hyunji Choi, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):272-280. Published online December 20, 2024; DOI: https://doi.org/10.7180/kmj.24.155

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Abstract PDF PubReader ePub: Background
Procalcitonin (PCT) is a crucial biomarker for diagnosing sepsis and managing antibiotic therapy. This study evaluated the analytical performance and comparability of the Access PCT and Elecsys BRAHMS PCT assays.
Methods
The precision, detection capability, linearity, and reference range of both assays were assessed. A comparative analysis included 182 patient samples categorized into four risk groups to compare the results between Access PCT and Elecsys BRAHMS PCT assays.
Results
The Access PCT assay demonstrated precision within the manufacturer’s threshold, and its detection capabilities were verified. This assay exhibited excellent linearity and appropriate reference intervals. Comparative analysis indicated that the Access PCT assay reported higher overall PCT levels than the Elecsys BRAHMS assay, with high agreement between the assays (κ=0.941). However, the biases varied across different PCT concentration intervals.
Conclusions
Both the Access PCT and Elecsys BRAHMS PCT assays performed robustly with notable concordance but varying biases at different concentration intervals. The observed biases require careful consideration in clinical decision-making, especially when adopting novel assay systems. Standardizing the calibration across different platforms is recommended to improve assay comparability.

Review article

The ethics of using artificial intelligence in medical research: Shinae Yu, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2024;39(4):229-237. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.140

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Abstract PDF PubReader ePub: The integration of artificial intelligence (AI) technologies into medical research introduces significant ethical challenges that necessitate the strengthening of ethical frameworks. This review highlights the issues of privacy, bias, accountability, informed consent, and regulatory compliance as central concerns. AI systems, particularly in medical research, may compromise patient data privacy, perpetuate biases if they are trained on nondiverse datasets, and obscure accountability owing to their “black box” nature. Furthermore, the complexity of the role of AI may affect patients’ informed consent, as they may not fully grasp the extent of AI involvement in their care. Compliance with regulations such as the Health Insurance Portability and Accountability Act and General Data Protection Regulation is essential, as they address liability in cases of AI errors. This review advocates a balanced approach to AI autonomy in clinical decisions, the rigorous validation of AI systems, ongoing monitoring, and robust data governance. Engaging diverse stakeholders is crucial for aligning AI development with ethical norms and addressing practical clinical needs. Ultimately, the proactive management of AI’s ethical implications is vital to ensure that its integration into healthcare improves patient outcomes without compromising ethical integrity.

Original article

The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures: Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang; Kosin Med J. 2023;38(4):278-287. Published online December 29, 2023; DOI: https://doi.org/10.7180/kmj.23.150

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Abstract PDF PubReader ePub: Background
This study evaluated the effectiveness of Moodle’s “Lesson” feature as a pre-learning tool for clinical skills among medical students.
Methods
The performance of 69 fourth-year medical students during practical sessions on arterial puncture and blood transfusion was assessed. These students engaged in pre-learning activities via Moodle's “Lesson” feature. We analyzed the survey results to gauge students’ satisfaction and perceived usefulness of the pre-learning approach. Additionally, we compared the performance of the 2023 cohort, which took part in the pre-learning process, with students from 2020 to 2022 who did not have this preparatory component.
Results
Among the students surveyed, data from 59 respondents were analyzed. Satisfaction with the pre-learning segment was high, with a mean satisfaction score of 4.69 (standard deviation [SD]=0.62) and Cronbach’s alpha of 0.918. The tool's perceived usefulness was also rated highly, with a mean score of 4.77 (SD=0.53) and Cronbach’s alpha of 0.956. Students who used the pre-learning tool had a mean score of 84.20 (SD=14.74), whereas those who did not use the tool scored slightly lower, with a mean of 80.40 (SD=13.07); however, this difference was not statistically significant (p=0.196). Nonetheless, the 2023 cohort scores were generally higher across the various percentile measures than those of the 2020–2022 groups.
Conclusions
The pre-learning tool using the “Lesson” feature on Moodle proved useful and satisfactory for students learning clinical procedures. Further research with larger cohorts is required to validate these findings.

Review article

Do we need Moodle in medical education? A review of its impact and utility: Seri Jeong, Hyunyong Hwang; Kosin Med J. 2023;38(3):159-168. Published online September 22, 2023; DOI: https://doi.org/10.7180/kmj.23.139

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Various learning management systems (LMSs) are available to facilitate the development, management, and distribution of digital resources for both face-to-face and online instruction. In recent decades, these methods have shown potential for greater efficiency compared to traditional "chalk and talk" approaches. Additionally, they have paved the way for the establishment of ubiquitous learning environments, marking a new era in education. In a trend accelerated by the coronavirus disease 2019 pandemic, LMSs have been increasingly adopted to overcome the restrictions inherent to in-person education. In medical education, LMSs such as Moodle, Canvas, Blackboard Learn, and others have been introduced and used to support teaching, learning, and assessment activities. Of these, Moodle stands out as the most popular choice for many medical schools and institutions, primarily due to its flexibility, functionality, and user-friendliness. The learning environment is gradually transforming from traditional in-person teaching to a hybrid educational approach, driven by the need to fulfill diverse educational demands. Numerous research studies have examined the usability of Moodle in medical education, demonstrating its effectiveness in addressing challenges related to adaptive personalized learning, collaborative learning, blended learning, and more. Consequently, Moodle has emerged as a valuable solution for medical educators seeking a versatile and robust platform to enhance their teaching methodologies. The present review focuses on the practical utilization of Moodle in medical education and the advantages it offers to this field.

Citations

Citations to this article as recorded by

Exploring structural equations modelling on the use of modified UTAUT model for evaluating online learning
Stephen Gbenga Fashoto, Yinusa Akintoye Faremi, Elliot Mbunge, Olumide Owolabi
Educational Technology Quarterly.2024; 2024(3): 319. CrossRef
Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review
Oluwadamilola Ogundiya, Thahmina Jasmine Rahman, Ioan Valnarov-Boulter, Tim Michael Young
Journal of Medical Internet Research.2024; 26: e60312. CrossRef
The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures
Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2023; 38(4): 278. CrossRef

Original articles

Evaluation of automated calibration and quality control processes using the Aptio total laboratory automation system: Namhee Kim, Yein Kim, Jeongeun Park, Jungsoo Choi, Hyunyong Hwang; Kosin Med J. 2022;37(4):342-353. Published online December 22, 2022; DOI: https://doi.org/10.7180/kmj.22.144

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Abstract PDF PubReader ePub: Background
The objective of this study was to determine whether manually performed calibration and quality control (QC) processes could be replaced with an automated laboratory system when installed analyzers fail to provide automated calibration and QC functions.
Methods
Alanine aminotransferase (ALT), total cholesterol (TC), creatinine (Cr), direct bilirubin (DB), and lipase (Lip) items were used as analytes. We prepared pooled serum samples at 10 levels for each test item and divided them into two groups; five for the analytical measurement range (AMR) group and five for the medical decision point (MDP) group. Calibration and QC processes were performed for five consecutive days, and ALT, TC, Cr, DB, and Lip levels were measured in the two groups using automated and manual methods. Precision and the mean difference between the calibration and QC methods were evaluated using the reported values of the test items in each group.
Results
Repeatability and within-laboratory coefficients of variation (CVs) between the automated system and the conventional manual system in the AMR group were similar. However, the mean reported values for test items were significantly different between the two systems. In the MDP group, repeatability and within-laboratory CVs were better with the automation system. All calibration and QC processes were successfully implemented with the Aptio total laboratory automation system.
Conclusion
The Aptio total laboratory automation system could be applied to routine practice to improve precision and efficiency.

How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning: Chi Eun Oh, Hyunyong Hwang; Kosin Med J. 2022;37(3):228-235. Published online September 27, 2022; DOI: https://doi.org/10.7180/kmj.22.118

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Background
We investigated how quiz activities can improve summative assessment outcomes by analyzing the relationship between them.
Methods
We used 217 first-year medical students’ medical informatics data from 3 consecutive years. We analyzed summative assessment outcomes between quiz completion and incompletion groups, one-time and multiple-time quiz learning groups, and three combined comparisons between subgroups of quiz learning activity frequencies: 1 versus 2, 3, 4, and 6 (group 1), 1 and 2 versus 3, 4, and 6 (group 2), and 1, 2, and 3 versus 4 and 6 (group 3). We then analyzed correlations between the final quiz scores and summative assessment outcomes.
Results
The summative assessment means for students who completed quizzes and those who did not were 87.16±8.73 and 83.22±8.31, respectively (p=0.001). The means for the one-time and multiple-time quiz learning groups were 86.54±8.94 and 88.71±8.10, respectively (p=0.223). The means for combined subgroups were not significantly different between groups (p>0.05), although a statistically significant increasing trend was found from groups 1 to 3 (0.223>0.203>0.075 using the t-test and 0.225>0.150>0.067 using the Mann-Whitney test, respectively). Summative assessment scores were not significantly correlated with quiz scores (r=0.115, p=0.213).
Conclusions
Quizzes helped students who used self-directed learning obtain better summative assessment outcomes. Formative quizzes presumably did not provide students with direct knowledge, but showed them their weak points and motivated them to work on areas where their knowledge was insufficient.

Citations

Citations to this article as recorded by

Do we need Moodle in medical education? A review of its impact and utility
Seri Jeong, Hyunyong Hwang
Kosin Medical Journal.2023; 38(3): 159. CrossRef
The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures
Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2023; 38(4): 278. CrossRef

Performance comparison between Elecsys Anti-SARS-CoV-2 and Anti-SARS-CoV-2 S and Atellica IM SARS-CoV-2 Total and SARS-CoV-2 IgG assays: Seri Jeong, Yoo Rha Hong, Hyunyong Hwang; Kosin Med J. 2022;37(2):154-162. Published online June 27, 2022; DOI: https://doi.org/10.7180/kmj.22.114

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Background
Although serological severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests from several manufacturers have been introduced in South Korea and some are commercially available, the performance of these test kits has not yet been sufficiently validated. Therefore, we compared the performance of Elecsys Anti-SARS-CoV-2 (ACOV2) and Anti-SARS-CoV-2 S (ACOV2S) and Atellica IM SARS-CoV-2 Total (COV2T) and SARS-CoV-2 IgG (sCOVG) serological tests in this study.
Methods
A total of 186 patient samples were used. For each test, we analyzed the positive rate of serological antibody tests, precision, linearity, and agreement among the four assays.
Results
The positive rates of COV2T, sCOVG, and ACOV2S were high (81.7%–89.2%) in total, with those for ACOV2S being the highest, while those of ACOV2 were as low as 44.6%. This may be related to the high completion rate of vaccination in Korea. The repeatability and within-laboratory coefficients of variation were within the claimed allowable imprecision; however, further research is needed to establish an allowable imprecision at low concentrations. COV2T showed a linear fit, whereas sCOVG and ACOV2S were appropriately modeled with a nonlinear fit. Good agreement was found among COV2T, sCOVG, and ACOV2S; however, the agreement between ACOV2 and any one of the other methods was poor.
Conclusions
Considering the different antigens used in serological SARS-CoV-2 antibody assays, the performance of the tested assays is thought to show no significant difference for the qualitative detection of antibodies to SARS-CoV-2.

Citations

Citations to this article as recorded by

Comparative analysis of Access PCT and Elecsys BRAHMS PCT assays for procalcitonin measurements
Hyunji Choi, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2024; 39(4): 272. CrossRef
Evaluation of automated calibration and quality control processes using the Aptio total laboratory automation system
Namhee Kim, Yein Kim, Jeongeun Park, Jungsoo Choi, Hyunyong Hwang
Kosin Medical Journal.2022; 37(4): 342. CrossRef

A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography: Kwang Il Seo, Hyunyong Hwang, Byung Cheol Yun, Hyung Hwan Moon, Young Il Choi, Dong Hoon Shin, Myunghee Yoon; Kosin Med J. 2022;37(2):146-153. Published online June 24, 2022; DOI: https://doi.org/10.7180/kmj.22.110

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Background
Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI.
Methods
This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system.
Results
In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively.
Conclusions
Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.

Citations

Citations to this article as recorded by

Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi, Dong Hoon Shin
Journal of Clinical Medicine.2024; 13(2): 381. CrossRef

New approach to learning medical procedures using a smartphone and the Moodle platform to facilitate assessments and written feedback: Sang-Shin Lee, Haeyoung Lee, Hyunyong Hwang; Kosin Med J. 2022;37(1):75-82. Published online March 25, 2022; DOI: https://doi.org/10.7180/kmj.22.010

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Background
To overcome communication obstacles between medical students and trainers, we designed serial learning activities utilizing a smartphone and web-based instruction (WBI) on the Moodle platform to provide clear and retrievable trainer feedback to students on an objective structured clinical examination (OSCE) item.
Methods
We evaluated students’ learning achievement and satisfaction with the new learning tool. A total of 80 fourth-year medical students participated. They installed the Moodle app (the WBI platform) on their smartphones and practiced an endotracheal suction procedure on a medical simulation mannequin while being evaluated by a trainer regarding competence in clinical skills on the smartphone app. Students’ competency was evaluated by comparing the scores between the formative assessment and the summative assessment. The degree of satisfaction and usefulness for the smartphone and WBI system were analyzed.
Results
The means (standard deviations, SDs) of the formative and summative assessments were 8.80 (2.53) and 14.24 (1.97) out of a total of 17 points, respectively, reflecting a statistically significant difference (P<0.05). The degree of satisfaction and perceived usefulness of the smartphone app and WBI system were excellent, with means (SDs) of 4.60 (0.58), and 4.60 (0.65), respectively.
Conclusion
We believe that the learning process using a smartphone and the Moodle platform offers good guidance for OSCE skill development because trainers’ written feedback is recorded online and is retrievable at all times, enabling students to build and maintain competency through frequent feedback review.

Citations

Citations to this article as recorded by

Faculty development: the need to ensure educational excellence and health care quality
Hyekyung Shin, Min-Jeong Kim
Kosin Medical Journal.2023; 38(1): 4. CrossRef
Is It Time to Revise the Competency-Based Assessment? Objective Structured Clinical Examination and Technology Integration
Haniye Mastour, Nazanin Shamaeian Razavi
Shiraz E-Medical Journal.2023;[Epub] CrossRef
Do we need Moodle in medical education? A review of its impact and utility
Seri Jeong, Hyunyong Hwang
Kosin Medical Journal.2023; 38(3): 159. CrossRef
The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures
Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2023; 38(4): 278. CrossRef
How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning
Chi Eun Oh, Hyunyong Hwang
Kosin Medical Journal.2022; 37(3): 228. CrossRef

Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy: Taek Sang Kim, Su Hwan Kang, Pil Moon Kang, Hongkoo Ha, Su Dong Kim, Jangho Yoon, Hyunyong Hwang; Kosin Med J. 2018;33(1):20-28. Published online January 21, 2018; DOI: https://doi.org/10.7180/kmj.2018.33.1.20

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Abstract PDF PubReader: Objectives
The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress.
Methods
We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery.
Results
The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P = 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P = 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery.
Conclusions
Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.

A Computer-Assisted, Real-Time Feedback System for Medical Students as a Tool for Web-Based Learning: Hyunyong Hwang; Kosin Med J. 2016;31(2):134-145. Published online January 20, 2016; DOI: https://doi.org/10.7180/kmj.2016.31.2.134

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Abstract Objectives

Medical students sometimes do not receive proper feedback from their instructors. This study evaluated a newly developed automated and personalized real-time feedback system intended to address this issue.

Methods

Third- and fourth-year medical students participated in quizzes focusing on 17 learning objectives and a five-scale survey that queried their prior knowledge related to blood transfusions. Immediately after completing the quizzes, the students received automated and personalized, real-time feedback and were instructed to take part in self-directed learning. This activity was followed by a final quiz. After completion of the final quiz, the students responded to the five-scale survey that probed the usefulness of and satisfaction with the automated, personalized, real-time feedback system.

Results

Eighty students took part in this study. The third-year group had a higher score for prior knowledge and also on the first quiz (P= 0.008, P= 0.046, respectively). There was no significant difference in final quiz scores between the third- and fourth-year groups (P= 0.633). The scores for usefulness of and satisfaction with the automated, real-time feedback system were 4.45 and 4.34, and 4.55 and 4.40 in the third- and fourth-year students, respectively.

Conclusions

The automated, personalized, real-time feedback system provided timely and effective feedback for medical students and was helpful for their self-directed learning.

Citations

Citations to this article as recorded by

Do we need Moodle in medical education? A review of its impact and utility
Seri Jeong, Hyunyong Hwang
Kosin Medical Journal.2023; 38(3): 159. CrossRef
The effectiveness of Moodle's “Lesson” feature in pre-learning about arterial puncture and blood transfusion procedures
Haeyoung Lee, Sang-Shin Lee, Hyunyong Hwang
Kosin Medical Journal.2023; 38(4): 278. CrossRef
New approach to learning medical procedures using a smartphone and the Moodle platform to facilitate assessments and written feedback
Sang-Shin Lee, Haeyoung Lee, Hyunyong Hwang
Kosin Medical Journal.2022; 37(1): 75. CrossRef
How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning
Chi Eun Oh, Hyunyong Hwang
Kosin Medical Journal.2022; 37(3): 228. CrossRef

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