Multicenter Retrospective Risk Assessment of Esophageal Variceal Bleeding in Patients with Cirrhosis: An Acoustic Radiation Force Impulse Elastography-Based Prediction Model

( Ja Yoon Heo ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Won Young Tak ),( Young Oh ),( Kweon ),( Kwang-hyub Han ),( Soo Young Park ),( Seung Up Kim ) 대한간학회 2019 Gut and Liver Vol.13 No.2

Background/Aims: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. Methods: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI-spleen diameter-to-platelet ratio scores (ASPS) were calculated. Results: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×109/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). Conclusions: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50. (Gut Liver 2019;13:206-214)

Combination of Transient Elastography and an Enhanced Liver Fibrosis Test to Assess the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B

Ja Yoon Heo,김범경,박준용,김도영,안상훈,Hyon-Suk Kim,Young Nyun Park,한광협,Kijun Song,김승업 거트앤리버 소화기연관학회협의회 2018 Gut and Liver Vol.12 No.2

Background/Aims: Liver stiffness (LS) was assessed using transient elastography, and the enhanced liver fibrosis (ELF) test was performed to accurately assess fibrotic burden. We validated the LS-ELF algorithm and investigated whether the sequential LS-ELF algorithm performs better than concurrent combination of these analyses in chronic hepatitis B (CHB) patients. Methods: Between 2009 and 2013, 222 CHB patients who underwent liver biopsy (LB), as well as LS measurement and the ELF test, were enrolled. Results: Advanced fibrosis (≥F3) and cirrhosis (F4) were identified in 141 (63.6%) and 118 (53.2%) patients, respectively. Areas under receiver operating characteristic curve for LS predictions of ≥F3 (0.887 vs 0.703) and F4 (0.853 vs 0.706) were significantly higher than the ELF test (all p<0.001). Based on the LS-ELF algorithm, 60.4% to 71.6% and 55.7% to 66.3% of patients could have avoided LB to exclude ≥F3 and F4, respectively, whereas 68.0% to 78.7% and 63.5% to 66.1% of patients could have avoided LB to confirm ≥F3 and F4, respectively. When confirmation and exclusion strategies were applied simultaneously, 69.4% to 72.5% and 60.8% to 65.3% of patients could have avoided LB and been diagnosed as ≥F3 and F4, respectively. The proportion of patients who correctly avoided LB for the prediction of ≥F3 (69.4% to 72.5% vs 42.3% to 59.0%) and F4 (60.8% to 65.3% vs 23.9% to 49.5%) based on the sequential LS-ELF algorithm was significantly higher than the concurrent combination (all p<0.05). Conclusions: The sequential LS-ELF algorithm conferred a greater probability of avoiding LB in CHB patients to diagnose advanced fibrosis and cirrhosis, and this test performed significantly better than the concurrent combination.

PE-168: Risk Assessment of Esophageal Variceal Bleeding in Patients with Liver Cirrhosis Using Acoustic Radiation Force Impulse Elastography-based Prediction Model: A Multi-center Retrospective Cohort Study

( Ja Yoon Heo ),( Soo Young Park ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Won Young Tak ),( Young Oh Kweon ),( Kwang-hyub Han ),( Seung Up Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Background/Aims: Periodic endoscopic screening for esophageal varices (EVs) is recommended for patients with liver cirrhosis. Acoustic radiation force impulse(ARFI)elastography can predict the presence of EV and high risk EV (HEV). We investigated whether ARFI-based prediction model can assess the risk of future EV bleeding (EVB). Methods: In a 5-year period (2008-2013), a total of 242 patients with liver cirrhosis due to varying etiologies who underwent ARFI elastography and endoscopic surveillance for EV were recruited for retrospective analysisin two tertiary medical centers (Severance hospital and Kyungpook National UniversityHospital). The major end-point was the first EVB event. ARFI-spleen diameter to platelet ratio score (ASPS)was calculated [ASPS=ARFI velocity (m/s)×spleen diameter (cm)/platelet count (109/L)]. Results: The median age of the study population (156 men and 86 women) was 56.5 years. Hepatitis B virus was the most common etiology (n=157, 64.9%). The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.86 m/s, 10.0 cm, 146 109/L, and 0.11, respectively. Among all study participants, the optimal cutoff value was 0.15, a point maximizing the sum of sensitivity (90.5%) and specificity (61.1%)from receiver-operating characteristic (ROC) curves (area under ROC curve=0.758), and 90.0% negative and 90.0% positive predictive value by ASPS<0.13/ ASPS≥0.90 were provided for predicting the presence of EV at enrollment. Among patients with EV (n=72), 21 experienced their first EVBs during follow-up period (median 37 months). To differentiate EVBriskamong patients with EV, we divided them into ASPSlowEV group (ASPS <0.42) and ASPShighEV group (ASPS ≥0.42) according to ASPS 0.42, a point maximizing the sum of sensitivity (33.3%) and specificity (95.6%) from time-dependent ROC curves (area under ROC curve=0.731). ASPShighEV groupshowed significantly higher cumulative incidence rates of EVB than ASPSlowEV group(p=0.021 by log-rank test). Multivariate analysis found that higher ASPS(>0.42)was the only predictor of EVBamong patients with EV (hazard ratio 3.420, 95% confidence interval 1.043-9.983, p=0.042). Conclusions: ASPS is a reliable predictor for the presence of EV and the future EVB risk. According to risk stratification, prophylactic treatments should be considered in patients with ASPS ≥0.42.

Use of <i>Wisteria Floribunda</i> Agglutinin-Positive Human Mac-2 Binding Protein in Assessing Risk of Hepatocellular Carcinoma Due to Hepatitis B Virus

Heo, Ja Yoon,Kim, Seung Up,Kim, Beom Kyung,Park, Jun Yong,Kim, Do Young,Ahn, Sang Hoon,Park, Young Nyun,Ahn, Sung Soo,Han, Kwang-Hyub,Kim, Hyon-Suk Williams & Wilkins Co 2016 Medicine Vol.95 No.14

<P><B>Abstract</B></P><P><I>Wisteria floribunda</I> agglutinin-positive human Mac-2 binding protein (WFA<SUP>+</SUP>-M2BP) is a serologic marker corresponding with degree of hepatic fibrosis. We evaluated its accuracy in assessing hepatic fibrosis and in predicting the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).</P><P>In a 5-year period (2009–2013), a total of 95 CHB patients with available serum WFA<SUP>+</SUP>-M2BP assay and transient elastography assessment [to assess liver stiffness (LS)] who had undergone liver biopsy were recruited for retrospective analysis.</P><P>Areas under the receiver operating characteristic curve for predicting fibrosis stages via serum WFA<SUP>+</SUP>-M2BP level were as follows: ≥F2, 0.688; ≥F3, 0.694; and F4, 0.704 (all <I>P</I> < 0.05). During the follow-up period (median, 45 months), HCC developed in 7 patients (7.4%). In patients with HCC, age, use of antiviral therapy, test parameters (HBV DNA, WFA<SUP>+</SUP>-M2BP, and LS determinations), and histologic stage of fibrosis were all significantly greater than in those free of HCC, whereas platelet count was significantly lower (all <I>P</I> < 0.05). On multivariate analysis, WFA<SUP>+</SUP>-M2BP was found independently predictive of emergent HCC [hazard ratio (HR) = 2.375; <I>P</I> = 0.036], although LS and histologic stage of fibrosis were not (<I>P</I> > 0.05). Risk of developing HCC was significantly greater in patients with high WFA<SUP>+</SUP>-M2BP levels (≥1.8) (adjusted HR = 11.5; <I>P</I> = 0.025). Cumulative incidence rates of HCC were also significantly higher in patients with high (vs. low) levels of WFA<SUP>+</SUP>-M2BP (log-rank test, <I>P</I> = 0.016).</P><P>WFA<SUP>+</SUP>-M2BP determination significantly reflected degree/extent of hepatic fibrosis and independently predicted the risk of developing HCC in patients with CHB.</P>

Risk Assessment of Developing Hepatocellular Carcinoma Using Wisteria Floribunda Agglutinin-positive Human Mac-2 Binding Protein in Chronic Hepatitis B Patients

( Ja Yoon Heo ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Hyon-suk Kim ),( Seung Up Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Wisteria floribunda agglutinin-positive human Mac-2 binding protein (WFA+-M2BP) is a serologic marker corresponding with degree of liver fibrosis. However, to date, few studies have investigated its prognostic role. Thus, we evaluated whether serum WFA+-M2BP can predict the risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Methods: A total of 1,323 patients with CHB and avaiable WFA+-M2BP test between 2009 and 2011 were recruited for this retrospective analysis. All patients were followed up to monitor HCC development. Results: The mean age of the study population (793 men and 530 women) was 51.0 years. On-going antiviral therapy was noted in 352 (26.6%) patients. During the follow-up period (median 60.3 months), 52 (3.9%) patients experienced HCC development. In patients with HCC, age, platelet count, and the proportion of male gender, diabetes, and ultrasonographic cirrhosis were significantly higher than those of patients without HCC (all p<0.05). On multivariate analysis, along with male gender, diabetes, and ultrasonographic cirrhosis (all p<0.05), WFA+-M2BP was as independent predictor of HCC development (adjusted hazard ratio [HR] 1.143, 95% confidence interval [CI] 1.139-1.829; p=0.002). However, antiviral therapy did not influence the risk of HCC development (p>0.05). When a three-tier stratification was applied to our study population using cut-off value of 0.46 and 0.83 to calculated the relative risk of HCC development (n=441 in high group; n=436 in intermediate group; n=446 in low group), patients with high (adjusted HR 5.265, 95% CI 1.160-23.884, p=0.031) and intermediate (adjusted HR 1.561, 95% CI 0.309-7.871, p=0.590) WFA+-M2BP range were found more likely to develop HCC, compared to patients with low WFA+-M2BP range. Cumulative incidence rates of HCC at 5-years were also significantly highest in patients with high WFA+-M2BP range, middle in those with intermediate WFA+-M2BP range, and lowest in those with low WFA+-M2BP range (0.9%, 1.8%, and 6.1%, respectively; high vs. intermediate p<0.001, log-rank test; intermediate vs. low p=0.101 by log-rank test). Conclusions: WFA+-M2BP determination independently predicted the risk of developing HCC in patients with CHB. Further studies to compare WFA+-M2BP with other surrogates marker for liver fibrosis such as transient elastography are required.

PE-169: Validation of a Diagnostic Strategy of Combining Liver Stifness Value by Transient Elastography and Enhanced Liver Fibrosis to Assess Fibrotic Burden in Patients with Chronic Hepatitis B

( Ja Yoon Heo ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Seung Up Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Background/Aims: Both liver stiffness (LS) values measured by transient elastography and enhanced liver fibrosis(ELF) test can assess fibrotic burden accurately. Recently, a sequential combination of LS value and ELF test has been proposed to ensurea higher chance to avoid liver biopsy (LB). In this study, we assessed the diagnostic performance of LS and ELF, validated LS-ELF diagnosticalgorithm,and investigated whether sequential combinationof LS and ELF performs better than their concomitant combinationin treatment-naive patients with chronic hepatitis B (CHB). Methods: In a 4-year period (2009-2013), a total of 290 patients with CHB who underwent LB, along with LS measurment and ELF test, were recruited for retrospective analysis. External cutoff value from Hong Kong study to predict both F3-4 and F4 were 6.0 and 7.5 for LS and 8.4 and 8.8 for ELF, respectively. Results: The median age of the study population (men 144 and women 78) was 48 years. The median alanine aminotransferase level, HBV DNA level, LS value, and ELF test were 42 IU/L, 616,000 IU/L, 10.2 kPa, and 9.7, respectively. Advanced liver fibrosis (F3-4) and cirrhosis (F4) were identified in 23 (10.4%) and 118 (53.2%), respectively. Areas under the receiver operating characteristiccurve of LS value to predict F3-4 (0.887 vs. 0.703) and F4 (0.853 vs. 0.706) were significantly higher than those of ELF test (all p<0.001). The internal cutoff values to predict F3-4 and F4 were 9.0 kPa and 11.0 kPa for LS and 8.4 and 8.8 for ELF, respectively. Based on LS-ELF diagnostic algorithm, 60.4% (n=49) and 55.7% of patients (n=58) could avoid LB to exclude F3-4 and F4 using external cutoffs, respectively, whereas 71.6% (n=58) and 66.3% (n=69) of patients could avoid LB to exclude F3-4 and F4 using internal cutoffs, respectively. In addition, 78.7% (n=111) and 63.5% of patients (n=75) could avoid LB to confirm F3-4 and F4 using external cutoffs, respectively, whereas 68.0% (n=96) and 66.1% (n=78) of patients could avoid LB to confirm F3-4 and F4 using internal cutoffs, respectively. When LS-ELF diagnostic algorithm including confirmation and exclusion strategy was applied, 67.1-67.6% patients and 61.3-66.2% patients could avoid LB to diagnose F3-4 and F4, respectively, according to internal and external cutoff values, respectively. When the proportion of patients with correctly avoided LB in predicting F3-4 according to sequential LS-ELF diagnostic algorithm (69.4% by internal cutoffs and 72.5% by external cutoffs) was significantly higher than the proportionaccording tothe strategy of concomitant first-line use of LS and ELF which was proposed by Castera, et al (42.3% by internal cutoffs and 59.0% by external cutoffs) and Boursier et al (57.7%) (all p<0.05). Similar phenomenon was observed in predicting F4 (all p<0.05). Conclusion: The performance of LS value by TE to predict F3-4 and F4 was significantly higher than those of ELF test. The diagnostic performance of LS-ELF algorithm was validated in our study and the sequential LS-ELF diagnostic algorithm performed significantly better than their concomitantfirst-line use in terms of higher chance to avoid LB in patients with CHB.

예비 고등학생들과 고등학교 과학 교사들의 ``신소재``에 대한 인식 탐색

윤희정 ( Heo Jeong Yoon ),윤원정 ( Won Jeong Yoon ),우애자 ( Ae Ja Woo ) 한국과학교육학회 2012 한국과학교육학회지 Vol.32 No.2

본 연구의 목적은 2009 개정 교육과정에 맞추어 개편된 고등학교``과학``교과서에 새롭게 도입된``신소재``에 대한 예비 고등학생들과 고등학교 과학 교사들의 인식을 조사하여 신소재 수업을 효과적으로 진행하기 위해 필요한 기초자료를 제시하는 것이다. 서울, 인천, 경기 지역의 예비 고등학생 1,499명과 과학 교사 123명을 대상으로 설문을 진행하였으며 그 결과는 다음과 같다. 첫째, 학생들과 교사들의 신소재에 대한 태도는 긍정적이었지만 신소재에 대한 관심은 매우 낮았다. 학생들은 개정 과학 교과서의 신소재 단원에 대해 높은 관심을 보이지 않았고, 교사들도 신소재 단원 수업을 어렵게 생각하는 것으로 나타났다. 둘째, 학생들과 교사들의 신소재에 대한 인지도와 신소재 관련 지식에 대한 이해도는 낮은 편이었다. 학생과 교사 모두 다양한 경로를 통하여 신소재에 대해 접했던 것으로 나타났으나 신소재에 대해 잘 알고 있다고 응답한 학생과 교사는 많지 않았으며, 신소재에 대한 구체적인 정보를 올바르게 이해하고 있지 못한 교사들도 다수 있었다. 셋째, 학생과 교 사 모두 신소재 수업이 필요하다는 점에 대해서는 공감하고 있었다. 신소재의 용도에 대해 알 필요가 있으며 매체 활용 수업을 가장 선호한다는 공통점을 나타냈지만 학생들은 교사들보다 체험학습을 선호하는 등 교사와 학생 입장에서 원하는 수업 진행 방식에는 차이점도 있었다. 이러한 연구 결과를 바탕으로 신소재 수업을 진행하는 교사들이 필요로 하는 것과 이들이 수업을 계획하고 진행할 때 고려할 점들을 제안하였다. Prospective high school students and science teachers` perceptions of ``advanced material``, which was first introduced in the science textbooks of the 2009 revised curriculum, were surveyed. One thousand four hundred and ninety nine students and 123 teachers from Seoul, Incheon, and the Kyeonggi areas participated in this survey. The results are as follows. First, the attitude of students and teachers towards ``advanced material`` was positive, but their interests in ``advanced material`` was low, Also, some teachers mentioned that ``advanced material`` was one of the difficult subjects to teach. Second, the perception of ``advanced material`` was relatively low for both students and teachers. Both of them had heard of ``advanced material`` through various routes, however not many of them thought that they knew what ``advanced material`` was exactly. Also there were some teachers who didn`t understand the detailed information of ``advanced material``. Third, both students and teachers agreed that ``advanced material`` was worthwhile to learn and teach. However, each party had their own desire of ``what to learn``, ``what to teach``, ``how to learn`` and ``how to teach``. Based on the results, some suggestions were made for effective teaching of this new subject.

Bariatric surgery versus conventional therapy in obese Korea patients

Yoon-Seok Heo,Joong-Min Park,Yong-Jin Kim,Seong-Min Kim,Do-Joong Park,Sang-Kuon Lee,Sang-Moon Han,Kyung-Won Shim,Yeon-Ji Lee,Ja-Youn Lee,Jin-Won Kwon 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.6

Purpose: In Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans. Methods: In this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery. Results: Body mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean ± standard deviation, 39.0 ± 6.2 vs. 34.3 ± 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%). Conclusion: Bariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

원외처방전 검토시 발생한 문의처방 분석

허란희,이주연,임영근,조윤숙,이지영,이영희,정성훈,박종윤,소원희,진보영,한현주,이병구,손인자 한국병원약사회 2002 병원약사회지 Vol.19 No.1

The purpose of this study is to evaluate hospital pharmacist's double-check task of outpatient prescription since separation of dispensary from medical practice carried out, which is being shifted to pharmacists out of hospital gradually. We analyzed 2,613 conference call on prescription out of one-year 488,481 outpatient prescription made in SNUH(Seoul National University Hospital). And it is classified and analyzed by month, by department and by conference call item. This study can provide useful information for doctors and pharmacists. Consequently, the doctors can avoid prescription errors. And the pharmacists can promote the capacity of double-checking prescriptions.

과학 창의성 신장을 위한 교수-학습 프로그램의 개발 및 적용

윤회정(Yoon Heo jeong),우애자(Woo Ae Ja) 학습자중심교과교육학회 2011 학습자중심교과교육연구 Vol.11 No.2

본 연구의 목적은 중학생을 대상으로 과학 창의성 신장을 위한 교수-학습 프로그램을 개발하는 데 있다. 프로그램은 문제 중심 학습 모형을 기반으로 하여 6단계로 구성되었으며, 선행 연구에 기초하여 추출한 과학 창의성 요소들이 각 단계마다 적절히 포함되었다. 프로그램은 7개의 주제를 바탕으로 학생들이 토론, 실험, 과학 글쓰기와 같은 다양한 활동을 할 수 있도록 구성되었다. 학생들의 과학 창의성 변화를 알아보기 위하여 과학 창의적 문제 해결력 검사지를 이용하여 사전 검사를 실시한 뒤, 연구를 통해 개발한 과학 창의성 신장 프로그램을 중학교 2, 3학년 학생 6명을 대상으로 30차시 동안 적용한 후 사후 검사를 실시하였다. 또한 학생들의 활동지를 분석하고 설문조사를 실시하여 프로그램에 대한 학생들의 인식을 조사하였다. 연구 결과는 다음과 같다. 프로그램 적용 후, 대부분 학생들의 과학 창의성은 신장되었으며 학생들은 프로그램에 대해 긍정적인 인식을 나타냈다. 특히, 학생들은 친밀하고 익숙한 주제를 다룬 프로그램을 선호했으며, 창의적인 산출물에 대한 아이디어를 제시하는 것과 실험 활동이 포함된 프로그램에 대해 긍정적인 반응을 나타냈다. 하지만 계획했던 과정이 제대로 이루어지지 않거나 예측했던 것과 다른 실험 결과가 나왔을 때, 그러한 문제를 해결하기 위하여 새로운 방법을 모색하는 것에 대해서는 어려움을 나타냈다. 이러한 분석 결과를 바탕으로, 이와 유사한 프로그램을 개발하고 실행하려는 교사들이 고려해야 할 점을 몇 가지 제안하였다. The purpose of the study was to develop the teaching-learning program for enhancement of scientific creativity. The program was developed based on problem-based learning model. It was consisted of 6 steps, and components for scientific creativity extracted from previous studies were included in each step. Seven problems were made dealing with various scientific subject and different activities such as discussion, experiment and scientific writing were included. The program was implemented to 6 middle school students for 30 hours. After program was finished students perception were investigated using questionnaire and students learning material were analyzed. The results are described below. Generally, students showed positive attitude toward the program. Especially, they preferred to familiar subjects, laboratory activities and discussion for making creative products. However, students were discouraged when the experiment results were different from what they had expected, and the problem solving processes were not proceeded as they had planned. Based on the results, suggestions were made for those of who planned to develop a program for enhancement of scientific creativity. « Key Words : creativity, scientific creativity, model for enhancement of scientific creativity, teaching-learning program for enhancement of scientific creativity.