The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic.
Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship.
External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01).
Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.
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Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting.
Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists.
A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05).
The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.
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Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients.
This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation.
One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states.
Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy.
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To compare the prevalence and metabolic characteristics of metabolically healthy but obese (MHO) individuals according to different criteria.
We examined 186 MHO middle-aged men (age, 37.2 years; body mass index [BMI], 27.2 kg/m2). The following methods were used to determine MHO: the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria, 0-2 cardiometabolic abnormalities; the Wildman criteria, 0-1 cardiometabolic abnormalities; the Karelis criteria, 0-1 cardiometabolic abnormalities; the homeostasis model assessment [HOMA] criteria (lowest quartile of HOMA). After dividing the overall subjects into two age groups, we compared the prevalence and clinical characteristics between MHO and at-risk groups according to four different criteria.
The prevalence of MHO using the NCEP, Wildman, Kaleris, and HOMA criteria were 70.4%, 59.7%, 28.5%, and 24.2%, respectively. The agreement between the groups according to the NCEP and Wildman criteria was substantial (kappa = 0.8, P < 0.001). Among individuals 35 years or younger, and regardless of method, the MHO subjects had significantly lower weight, waist circumference, BMI, body fat percentage, insulin, HOMA, alanine aminotransferase, triglyceride (TG), and TG/high density lipoprotein cholesterol (HDL-C) ratio than the at-risk subjects (P < 0.05); However, among individuals older than 35 years old, and regardless of method, the MHO subjects had different insulin, HOMA, HDL-C, and TG/HDL-C levels than the at-risk subjects (P < 0.05).
The differences in metabolic profile between MHO and at-risk groups varied according to age. MHO prevalence varies considerably according to the criteria employed. Expert consensus is needed in order to define a standardized protocol for determining MHO.
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Association Metabolic Obesity Phenotypes with Cardiometabolic Index, Atherogenic Index of Plasma and Novel Anthropometric Indices: A Link of FTO-rs9939609 Polymorphism
BATHE, the acronym for background, affect, trouble, handling, and empathy, is an interview approach that can be applied in the out-patient setting whereby questions belonging to each of the 5 categories are asked in the above order. As we have been taught to believe that BATHE raises the level of patient satisfaction and the quality of medical treatment overall, this study was designed to test the validity of the claim that applying BATHE heightens patient satisfaction.
Each of the 5 doctors was assigned 10 patients (5 in the BATHE group and the other 5 in the control group) with each patient being randomly assigned to either of the groups. The control group was interviewed as usual and the BATHE group was interviewed using BATHE. Immediately after the interview, each patient anonymously filled out a patient satisfaction questionnaire. Whether the questions asked were appropriate for each category of the protocol was evaluated by the researcher through video clips taped during the interviews.
On 7 out of 10 items on the patient satisfaction questionnaire, the BATHE group was found to experience higher level of satisfaction than the control group in a statistically significant manner. The questions asked the BATHE group were confirmed to be more appropriate for each category of the protocol except empathy than those asked the control group.
As applying the BATHE approach was found to achieve higher level of patient satisfaction, we recommend using it in the out-patient setting.
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The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care.
In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis.
Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals.
Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
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Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves.
This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria.
The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05).
For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
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