Background : A standard questionnaire is usually characterized by a set of questions, a scoring method, and psychometric properties. But many studies suggested that previously translated standard questionnaire in Korea had bee used without testing translation validity, scoring system and psychometric properties.
Methods : After developing a preliminary delphi questionnaire from references by a researcher, it was modified from pretest procedure, which was performed to 6 family physicians who had experiences in translating standard questionnaires. Some experts were chosen among authors of standard questionnaire, translation articles in four questionnaire related journals and others were recommended by other experts.
Results : The total number of experts was 53 including 22 family physicians, 15 psychiatrists, 2 psychologists, 8 faculties of preventive medicine and 6 faculties of nursing. The response rates were 85%, 87%, 92% on 1st, 2nd, 3rd delphi round, respectively, and the total response rate was 69%. According to Delphi surveys, minimal requirements for a standard questionnaire translation were translation by two translators, pretest techniques, consideration of age·sex·education level in pretest procedure, reliability validation, validity validation and 0.5 or more of correlation coefficient level in convergent validity validation. Minimal requirement for reliability coefficients was 0.7 or more, but the results did not reach adequate consensus.
Conclusion : Developing minimum requirement guidelines for standard questionnaire translation using Delphi method can be done.
BACKGROUND Establishing effective communication between doctor and patient help doctors treat their patients easily and influence patient's compliance with medical regimen and treatment outcome. The objective of this study was to evaluate common characteristic of third-year medical student's behavior in their patient interview and apply these results to medical education of communication. METHODS Ninety-one third-year medical students in Hanyang University College of Medicine through their clerkship in family medicine had been instructed to perform medical interviews of patients who visited the Department of Family Medicine of Hanyang University Hospital. Video-taped records of the interviews using CCTV were done. The evaluation was done with a rating scale table consisting of 20 items. The rating scale was categorized in to 5 areas: beginning the interviews, collection of information, doctor-patient relationship, structure of interview and ending the interview. RESULTS Among the 62 students who were enrolled in the study, 55 students were males(84%). In the process of collecting information 33 students(53%) applied open-ended question at least once. Eighteen students(29%) used leading question. In the doctor-patient relationship, 3 students gave empathic verbal response among 58 records which were applicable. In the structure of interview, 25 students(40%) appropriately avoided to shift abruptly the focus of discussion. When ending their interviews, 6 students(10%) clarified the interview in whole. CONCLUSIONS We conclude that there are several deficiencies in medical students' communication skills during their process of interviews that might influence information gathering and doctor-patient relation ship.
Background : Computer can in many ways improve the quality and efficacy of medical care. The purpose of this study was to perform a comprehensive survey of present computer use and investigate the factors affecting computer use by family physicians.
Methods : 1250 family physicians were surveyed by mail from May to August, 1999. The survey protocol included demographic characteristics, opinions on computer use in medicine, present computer usages and wanted applications in the future.
Results : Of the 306 responses received, 291 responses were analysed, 91.4% replied that they used computers in the medical field, and 58.1% said they used computers during medical interview. Factors preventing computer use in medicine were cost(33%), time(16%), insufficient information(14%), the doctor-patient relationship(12%) and no perceived need(6%). While 46% of the responders who used computers in the medical field cited fellow doctors for their interest in computer use in the medical field, only 6.2% answered that medical societies or associations had promoted their interest. Present usage of computers included word processing. online communication, internet, medical insurance billing, in descending order. Factors affecting the present degree of computer use that were statistically significant, were the computer system used, factors preventing computer use and the preset form of practice.
Conclusion : Although, most family physicians use computers in the medical field, its use is still limited to a few areas.
Background : Decision about life sustaining treatments ought to be based on the patient’s in formed preferences. This study was to see if there were any differences in acceptance by patients, their primary care givers and doctors for end-of-life care according to situations, and if any, to analyse the factors related with different attitudes.
Methods : A structured questionnaire survey of end-of-life care preferences was performed on 162 cancer patients and their primary care givers in four university hospitals and one general hospital from March 1, 1999 to February 29, 2000. A similar survey was done for doctors practicing at the above, hospitals during the same period to investigate their attitudes toward providing end-of-life care to an assumed nearly bed ridden patients. ANOVA, t-test and Wilcoxon rank sum test were used to compare acceptance of intervention among the groups or according to the various situations. Factors presumed to be related to the acceptance were sought and analysed by stepwise multiple regression.
Results : The difference in acceptance of intervention between the primary care giver group and the doctor group was not significant in almost every situation, showing significantly higher than the patient group(P=0.001). All three groups showed higher acceptance when a therapeutic intervention rather than a diagnostic test was proposed(P=0.001). When expected survival was 30 days rather than 7 (P=0.01), and when the therapeutic intervention was thought as non-invasive rather than invasive (P=0.001). The less anxious the patient was , the higher the acceptance. From the patient. Patients with a religion had higher acceptance rate than non-religious patients. Primary care givers who expected sure of the disease accepted more of the postulated care than those who did not (P<0.05). Wives of mother-in-laws of patients showed lower acceptance than those in other relationship(P<0.05). The longer the patient had been diagnosed with cancer, the higher the acceptance of the primary care giver (P<0.1). Direct relatives showed higher acceptance than that of collaterals(P<0.01). Family doctors specializing in family medicine had lower acceptance than doctors of other specialties and interns(P<0.05)
Conclusion : The acceptance of intervention by patients was lower than that of primary care givers and doctors and depended on the expected survival and the type, of intervention.
Background : Several studies have reported that muscle strength and bone mineral density have a significant positive correlation and most previous literature on muscle strength and bone mineral density examined their association. To evaluate the association between grip strength and radius bone mineral density, more precise PQCT was used rather than SPA or DEXA.
Methods : The study was performed from June to August 1999 in Pundang community with 154 postmenopausal women who undertaken osteoporosis screening program who participated in this study. Bone mineral density was measured at the radius using PQCT (peripheral quantitive computed tomography). Grip and pinch strength were measured in both the dominate and nondominant hand using a dyanometer. Other data were obtained from the questionnaire.
Results : Grip and pinch strength of the dominant hands were significantly higher than the nondominant hands. There was no significant difference in bone mineral density by exercise and fracture history. Age-adjusted partial correlation analysis indicated a significant positive correlation of radius BMD with dominant hands grip strength. Significant positive correlations also were found between radius BMD and pinch strength.
Conclusion : Subjects with stronger grip strength had a low BMD. There was a significant positive correlationship between bone mineral density and dominant hand grip strength. The data suggest that grip strength is a weak predictor of radius bone mineral density and provide a feasible way of predicting it.
Background : The study was done to examine the role of long-term diving(5-20m depth) on regional bone mineral density(BMD) in women.
Methods : We compared woman divers(n=38) with matched non-diver controls(n=38) according to age, weight, and duration of menopause. BMD(g/cm2)of the proximal femur (femoral neck, trochanter, Wards’s triangle) was assessed by dual-energy X-ray absorptiometry (DEXA, Hologic QDR-1500).
Results : There was no significant difference between groups for proximal femur BMD. But in premenopausal group, BMD of divers was higher than controls in femur neck and trochanter (P<0.05). Correlations analysis revealed that body weight of divers was significantly correlated to femoral neck BMD (P<0.05). In multiple regression analysis, menopause and age of postmenopausal divers was a predictors of femoral neck BMD in divers.
Conclusion : These result suggest that diving is has osteogenic effect on women.
Background : The modern people ilive in excessive stress. This stress seems to be related to various diseases. The increase of daily stressful life also seems to relate closely to serum lipids and antioxidants. This study attempted to show how much daily life stress affects serum lipids and antioxidants.
Methods : sixty one healthy people who visited health screening center of a university hospital were enrolled for this study from October to November, 1998. In the survey of daily life stress, the Holmes and Rahe’s Readjustment Rating Scale, which was modified by Hong and Jung were used. The subjects were interviewed about the life stress during the past one year. The levels of retinol, B-carotene, vitamin C, tocopherol, HDL-cholesterelol, LDL-cholesterol, total cholesterol, triglyceride were measured. The subjects were divided into three groups by the stress scores. Kruaskal-Wallis test was used for analysis. Dependent variables were antioxidants in each group.
Results : There was no significant meaning in the comparison between each stress groups and the level of serum lipids, and between each stress group and the level of antioxidants.
Conclusion : The level of antioxidants was not related to stress. More studies are needed for further evaluation of the results.
Background : To determine the relationship between nutrient intake and bone mineral density (BMD), we have investigated this issue by the use of a semiquantitative food-frequency questionnaire.
Methods : A total 312 women aged 33-77 was divided into two groups, 187 premenopausal and 125 postmenopausal women, Dietary intake was assessed with a food-frequency questionnaire. DMD was assessed with dual-energy X-ray absorptiometry at the lumbar spine (lumbar vertebrae 2-4). Pearson correlation and partial correlation coefficients were calculated for each nutrient at the lumbar spine MBD.
Results : The mean age of the 32 participants was 48 years, and their mean body mass index (BMI) was 23.7±2.8 kg/m² . Forty percent of the women were in postmenopausal state. The mean lumbar BMD was 1.117g/cm2. Age was negatively correlated with BMD in postmenopausal women, but smoking and exercise were not correlated with BMD. In premenopausal women, nutrient intakes were not associated with BMD. A significant association was found between intakes of fat, iron, vitamin A, vitamin C and BMD in postmenopausal women, but after adjusting for age, body mass index, energy intake, smoking, exercise, and use of hormone replacement therapy, there was no association.
Conclusion : There was no significant association between nutrient intakes and BMD of the lumbar spine.
Background : Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT).
Methods : A total of 85 menopausal women who underwent bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hosptal Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis.
Results : The average age of the subjects was 55.8 years. Only 40 women(47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore , it seems that most of out subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT.
Conclusion : The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receiver HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
First
Prev
