Background : in order to provide basic data which are necessary for the standard reference of residency training program in family medicine(F.M.), we surveyed all of 47 training hospital's current residency traing program in Korea.
Methods : There are 38 training hospitals which fulfilled the inclusion criteria among the 47 residency training hospitals registered to the Korean academic society of family practice as of March 1, 1992. Survey included general characteristics, number of staff, ratio of staff to residents, facilities in F.M. center, out-patient care by resident and preceptorship, academic activities, and curriculi. We classified and compaired them by history of hospital(less than 2 years vs, more than 3 years) and character(non-university vs. university hospital) of residency training hospita.
Results : Among 38 training hospitals, there were 13(34.2%) hospitals with less than 2 years of history, 25(65.8%) hospitals with more than 3 years of histroy. There were 23(60.5%) non-university hospitals, and 15(39.5%) university hospitals. Total number of staff was 56. There were 24(63.2%) hospitals which had only 1 staff member, 11(28.9%) were 2, 2(5.3%) were 3, and 1(2.6%) hospital which were 4. Total number of residents were 378. The number of hospitals whose ratio of staff to residents exceeded 1:6 was 14(36.8%). The percentage of Facilities which had Examining Room Resident Room, Care Room, Conference Room, Conunselling Room Clinical Lab, Record Room and Admission Room in the F.M. center were 97.4%, 84.2%, 57.9%, 57.9%, 26.3%, 23.7%, 18.4% and 55.3% each others. 28(73.7%) of teaching hospitals had outpatient care by residents and 14(36.8%) had preceptorship available. In a 3 year period, hospitals which had at least 150 inhouse conferences and 3 conferences outside the hospital were 26(68.4%). Average months of 3 year curriculum were as follows : Internal Medicaine 6.9, Pediatrics 3.7, General Surgery 3.2, Obstetrics and Gynecology 3.1, Emergency Room 0.8, Family Medicine 5.9 and Essential electives 8.7, Free electives 1.1.
Conclusion : Generally, there were some problems in the family medicine residency programs. most important is the lack of staff members and the lack of outpatient care by residents, especially in non-university hospitals which had les than 2 years history.
Background : The proportions of Korean smokers and long-term smokers(10years) are very high and the smoking related diseases such as lung cancer and ischemic heart disease are increasing. But physicians had played limited role in reducing smoking in the nation. One reason is that they don't have an effective anti-smoking method to use in their daily practics. Nicotine patch reduces withdrawal symptoms which are major barriers in somking cessation. Reports showed the nicotine patch helps 10~35% more smokers quit smoking than the placebo. The objectives of this study are to develpo physician's anti-smoking service using nicotine patch, to find out its effectiveness and side effects, and to measure compliance with patches and proper duration of patch use.
Methods : As a double blinded randomized controlled study, it was conducted in 4 hospitals in Seoul. The study subjects were men of 20 years or older, smoking more than 15 cigarrets a day for the last three years and had intention to quit smoking. The physician's anti-smoking service consisted of distributing a simple brochure on smoking cessation and a guidance note for using nicotine patch and about side effects, urging smoking cessation, and providing nicotine or placebo patches. The subjects were suggested to use patches for 6 weeks and to visit the clinic every 2 weeks. Those who failed to visit were contacted by phone and asked about smoking status and use of patches.
Results : One hundred and twenty-one subjects (80 in nicotine, 41 in placebo group) participated in the study and 17 persons (13 in nicotine, 4 in placebo group) were dropped out among them. The anti-smoking service developed for this study was used by 14 family doctors and reported to use the service in 3 minutes during their usual pracitce. Nicotine group showed significantly higher smoking cessation rate than placebo throughout 6 weeks. At the 6th week, 41.8% of nicotine group and 19.4% of placebo group stopped smoking(p=0.02). Nicotine group showed average weight gain of 0.9kg through 6 weeks whereas placebo gorup showed that of 1.1kg, side effects were very common. Seventy-seven percent in nicotine group and 68% in placebo group experienced at least one side effect. Itching and rash were most common as local reactions and nausea, headache, urticaria, insomnia and change of taste were reported as systemic reactions. Nicotine group used only 21.1 pactches out of 42 pactches supposed to use throughout 6 weeks and placebo group used 19.3 patches. The patch compliance decreased every week.
Conclusion : The physician's anuti-smoking service using nicotine patch was significantly more effective in smoking cessation than placebo. side effects were common, but the subjects rarely stopped using patches because of those. Even though patches were supposed to use for 6 weeks, the patch complinance was moderate.
Background : Knowledge and experience of the family physician who sees patient for the first contact care have an effect on the referral content and outcome. So we carried out this study to determine the relationship between the knowledge and experience of the physician and the referral content and outcome by comparing the physician according to grade.
Methods : We select March, May, September and December according to the seasons in order to stand for one year, from June 1991 to May 1992. We review the medical record of the 449 patients who visited our OPD of family medicine then referred to other specialties.
Results : Total referral rate was 3.7%. Compared referral rate according to grade, 3rd-year residents had lower referral rate than 2nd-year residents and staff has lower referral rate than residents.(P<0.05, P<0.001 respectively) The most common reason for referral was for diagnosis and treatment(29.4%), and then for treatment(24.1%), request by the patient(23.6%). The most frequently referred specialty was Internal Medicine(33.5%), and then Orthopedis, neurology. There was a trend to increase the treatment rate and relationship between the referral and minor problem by rising the grade of the physician.(P<0.001, P<0.01 respectively) Agreement rate of diagnosis before and after referral was 63.3%. There was no significant difference according to grades. In the outcome of referral, no follow-up patient was most common(43.9%), and then improved(31.2%), admitted(18.9%).
Conclusion : There were significant differences according to grade in the treatment rate, relationship between referral and main problem before referral. But there were no significant differences in the reasons for referral, referred specialties, agreement rate of diagnosis before and after referral. In the referral rate, there were significant differences between 2nd-year residents and 3rd-year residents, and between residents and staff. Many biases may be in the study of the referral, so the study to minimize these biases is needed.
Background : Urinary tract infection is important in children, since untreated or undertreated urinary tract infection has an incidious progressive course resulting in renal damage and a tendency to shorten life. In child, gastrointestinal symptoms, such as nausea, vomiting, poor feeding, loose stool, diarrhea and pyrexia may be the only manifestation of urinary tract infection. As primary care physician, we must detect urinary tract infection as early as possible.
Methods : Clinical, laboratory, bacteriologic and radiologic studies were performed in 387 infants and children with gastrointestinal symptoms who were admitted to the Department of Pediatrics, Dong Incheon Gil Hospital from January 1991 to December 1991.
Results : 387 cases with gastrointestinal symptoms under the age of 15 years were studied for the evidence of urinary tract infection. 51(13.4%) had urinary tract infection. 27 out of 51(52.9%) were male and 24 out of 51(47.1%) were female. Urinary tract infection was more prevalent under the age of 1 year(84.3%).(P<0.005)
Conclusion : An early detection of urinary tract infection in neonates can be done by screening the cases with gastrointestinal symptoms and a routine examination of urine in all such cases.
Background : The facial nerve is unique among motor nerves in that it has the longest course through a narrow bone canal of any nerve in the body and because of this is paralyzed more often than any other nerve. The disability resulting from facial palsy is especially distressing because of the grotesque disfigurement accenturated by those emotions that lend beauty to normal countenace, that is smilling and laughter. The family physician who often first sees the patient must be reminded of the dictum of the celebrated neurologist Gowers that a complete unilateral palsy of the face without other symptome must mean disease of the nerve as it passes through the temporal bone.
Methods : the study was carried out in 59 cases, in the view of age, sex and etiologic distributions, the results of nerve excitability test, topographic diagnosis, and treatment for 5 years.
Results : The highest age incidence showed in 5th decade, and sex distribution was more in male (2:1). The causes were idiopathic, traumatic and infectious in order. Electric excitability test revealed signs of nerve degeneration at the initial visit in 4 cases. Topographically, the most comon site of lesions was intratemporal between geniculate ganglion and chorda tympani(34 case). 44 Cases were treated with conservation therapy and 15 cases with surgical therapy most of our cases with conservation therapy was idiopathic. In result of follow-up 50 cases of normal recovery and 5 cases of mild dysfunction in the nondegeneration 55 cases. 12 cases of normal recovery and 3 cases of mild dysfunction in the operated cases.
Conclusion : The most frequent type of facial paralysis is the idiopathic(Bell's palsy). In majority of our cases, we selected conservative treatment. But surgical management consisted of nerve decompression, nerve graft and repair is neessary for the traumatic and some infectious ongin(Chronic otitis media). The aggressive treatment will prevent the degeneration and gain good result.
Background : Ultrasound is used as screening test of the human body according to the wide spread of ultrasound apparatus. Especially, abdominal ultrasound is used widely as one of test articles of general health examination, but ther is few thesis about the validity of ultrasound as screening test in our country. So, we studied the validity of ultrasound as screening test though the review of the patient's chart.
Methods : We surveyed the value of abdominal ultrasound as screening test through the review of 221 patients' chart performed abdominal ultrasound as one of the test articles of the general health examination in the department of family medicine of kyung Hee Medical Center from January to December in 1991.
Results : The frequency of abnormal findings is 38.5% in male and 27.8% in female with 33.0% in average. The frequency is increased as the age go up. So, the frequency over 60 years old is 63.2%. Among 73 cases with abnormal findings, 14 cases have two kinds of abnormality. Among them, 4 cases(1 acute hepatitis, 1 clonorchiasis, 1 liver cirrhosis, 1 antral gastritis) are thought to be normal by other laboratory tests and physical examination. The cases which can get help for the improvement of prognosis and the prevention of disease progress by abdominal ultrasound in spite of normal findings of other laboratory tests and physical examination are 9 cases(3 fatty liver, 1 polyp of gall bladder, 2 renal stones, 1 polycystic kidney, 1 horse-shoe kidney, 1 kidney atrophy of one side), which are 4.1% of all examiners i.e., 12.3% of those with abnormal findings.
Conclusion : We recommend to perform ultrasound in case abnormal findings are found in the other laboratory tests or physical examination in view of the fact that we should consider time, cost and effectiveness in a test. But if the cost is low, the value of abdominal ultrasound as screening test will be probably high.
Background : Obesity is a very important and serious health problem because it itself is no only the independent risk factor of coronary heart disease. But it is also related to many other disorders and increased mortality rate. The purpose of this study is to assess the effects of multidisciplinary educations, including behavior modification, diet therapy, and exercise, on body weight reduction in obese patients.
Methods : The study subjects were eighty-four in number who visited to Obesity Clinic of AMC from Oct. 1991. to May. 1992. Observations for body weight changes were carried on after five months period to whom previously received individualized multidisciplinary educations for each behavior modification, diet therapy, and exercise. Those who did not revisit for follow-up were evaluated by telephone questionaires.
Results : Among 71 subjects in whom follow-up evaluations were possible, the number of male and female patients were 15 and 56, respectively. Changes in body weight after five months of treatment showed the statistically significant reduction in both sexes, from 84.0±10.1kg to 80.9±9.2 kg in males and 71.4±8.8 to 69.0±9.2 in female. (P<0.05) Eleven(76.3%) among the males and forth-three(76.8%) among the female showed weight reduction. There were no significant differences of sex, age, marital status, occupations, educations, socienomic status, familial history, and disease history between weight reduction group and non-reduction group. The results of weight reduction according to grading scale are as follows: One male(9.1%) and two female patients(4.7%) for over 10kg loss, two male(18.2%) and four female patients(9.3%) for between 5 to 10kg loss, eight male(72.7%) and thirth-seven patients(86.0%) for less than 5kg of loss. There were differences in weight reduction between group that did behavior modification and that did not(P<0.05). also differences between group that did diet therapy and that did not(P<0.05) by univariate analysis, but no statistical significance by multivariate analysis. There is no difference in weight reduction between group that did exercise and that did not(P<0.05)
Conclusion : We observed the effects of behavior modification, diet therapy, and exercise on weight reduction in obese patients and results are significant weight reductions favorable for both sexes(3.0±3.5kg in male and 2.3±3.4kg in female). Eleven male(73.4%) and forth-three(76.8%) female showed weight reduction.
Background : Diabetes mellitus is one of the most common chronic diseases that primary care physician meets. Therefore, we carried out this study to examime diabetic patient's state of management, patient's compliance to management according to disease duration and factors to influence on the control of blood sugar in primary care setting.
Methods : Of patients visiting seven medical centers including Daegu and Gyeongsangbukdo from may 1991 to September 1991. we selected 150 patients whose disease duration is over one year, and structured questionnaires were given to the study subject to assess diet, exercise, tablet treatment, insulin therapy, and folk therapy etc. Result: Average age of these patients was 53.2 years, and average duration of disease was 3.9 years. About a half of them have ideal body weight. although 70% of them was performing diet control, however only a few patients made use of exact calorie counter or menu of diabetes. Only 40% was doing exercise, and 47% of them have ever used insulin therapy. According to correlation coefficient, FBS was significantly with age, sex, weight and 2PPBS. 2PPBS was significantly with age, sex, weight, FBS, Exercise and duration of disease.
Conclusion : From the above results, the longer the duration of disease was and the lower compliance was, the more blood glucose increased. It was considered that education to diabetic patients is very important to increase the compliance to diabetic management strategies. Therefore, it is necessary, to develop better education and evaluation programs for diabetic patient.
Background : It is expected that Korea Medical Insurance and Health Care Delivery System made change the contents of inpatients in Family Medicine and increased the role of Family Mediine in primary care. We have tried to prove the above hypothesis by comparative study on the inpatient related seeral factors in the year of 1998 and 1991.
Methods : We examined the medical records of the patients who were hospitalized to the department of Family Medicine, Korea University Kuro Hospital from January 1. 1998 through December 31, 1988 and January 1, 1991 through December 31, 1991. We analyzed the number of patients, age, sex, living district, the length of stay, the route of admission, condition at the time of discharge, and diagnosis.
Results : A total of 95 patients were hospitalized in 1988 and those of 183 patients in 1991. The increased rate of total numbers of hospitalized patients was 92.6%. There were no significant difference in age, sex, living district distribution in between those study groups. The length of stay was increased from 5.8±3.8 days to 13.3±8.2 days. In the route of admission, the patients via out patient department was decreased from 97.8% to 91.8% and those via emergency room was increased from 2.2% to 8.2%. In patient's condition at the time of discharge, improved state was increased from 38.9% to 66.7% and unimproved state was decreased from 49.5% to 16.9%. In 1988, the most common diagnosis was chronic hepatitis of 14 cases(14.7%) and the next was neurotic disorder of 8 cases (8.4%). In 1991, the most common diagnosis was diabetes mellitus of 20 cases(11.0%) and the next was acute and subacute necrosis of liver of 12 case(6.6%).
Conclusion : It is concluded that these changes were induced by increased hospitalization for treatment compared to decreased hospitalization for diagnosis due to decreased the amount of money that patient has to pay from their own pocket besides medical insurance coverage. Also, it is believed that the increased role of family medical insurance coverage. Also, it is believed that the increased role of family medicine in primary care affected these changes.
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