[Show abstract][Hide abstract] ABSTRACT: Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 µg), and to identify factors associated with efficacy.
A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement.
A total of 370 patients were included in final analysis. The median BMD was 0.81 ± 0.12 g/cm(2) at pre-treatment and 0.84 ± 0.13 g/cm(2) after one year. The average BMD improvement was 3.4% ± 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia.
Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy.
Full-text · Article · Nov 2012 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: 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.
Full-text · Article · Nov 2012 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Colonoscopy is the best method for the diagnosis, treatment, and follow-up of colorectal cancer. Although it is generally considered a safe procedure, complications during colonoscopy may occur. The most serious complication is iatrogenic perforation of the colon. Although rare, it can be potentially lethal, especially when it is not recognized and treated immediately. The traditional management of iatrogenic colonic perforation is surgical repair, either by laparotomy or laparoscopy. However, with the recent improvement of endoscopic devices and techniques, endoscopic repair of iatrogenic colonic perforation using endoclips is considered to be both feasible and effective. We successfully used endoscopic clipping to treat a patient with a large perforation of the colon during diagnostic colonoscopy. We believe that the endoscopic repair avoids unnecessary surgery and reduces medical costs.
Preview · Article · May 2012 · The Journal of the American Board of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: During colonoscopic examination, epithelial lesions, such as adenomatous polyps, are frequently encountered, unlike subepithelial lesions, such as leiomyomas, which are uncommon. A colonic leiomyoma is a rare tumor, originating either from the mucularis mucosa or from the proper muscle, and accounts for only 3% of all gastrointestinal leiomyomas. Colonic leiomyomas are usually benign and asymptomatic. However, they can sometimes cause symptoms, ie, abdominal pain, intestinal obstruction, hemorrhage, and perforation. The traditional management option for a colonic leiomyoma is surgical resection. Recently, with the development of endoscopy devices and techniques, the endoscopic resection has been considered as an alternative treatment option. We experienced a patient with a leiomyoma that was diagnosed during colonoscopy. The leiomyoma was resected endoscopically without complication. We report this case with a review of the literature.
Preview · Article · Aug 2011 · Journal of the Korean Society of Coloproctology
[Show abstract][Hide abstract] ABSTRACT: Carcinoid is a neuroendocrine tumor and contains many peptide substances and biological active amines, so if it is released, it can cause carcinoid syndrome. However, most carcinoid tumors are unfortunately asymptomatic, and it is difficult to find one smaller than 1 cm because it doesn't have prominent mucosal elevation and change. We can reduce expenses and recovery period of the patient by using a relatively noninvasive endoscopic mucosal resection, unless it has distant organ and lymph node metastasis. Colonoscopy is an optimizing diagnostic tool for early detection of asymptomatic carcinoids. But according to colonoscopic guidelines of many institutes, they recommend to perform a screening colonoscopy in the asymptomatic fifties if there are no risk factors. However, a careful examination of colonoscopy is needed, because possibility of malignant tumor in aymptomatic young age. The authors report four cases of carcinoid tumor in asymptomatic thirties with review of several literatures.
Preview · Article · Feb 2011 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Trichuris trichiura (T. trichiura) is soil-transmitted parasite and widely spreads all over the world. High infection rates occur especially in the poor hygiene area. T. trichiura is transmitted by the water and food contaminated with T. trichiura eggs. Most of mildly infected individuals could be asymptomatic, whereas heavily infected patients manifest with anemia, diarrhea, nausea, vomiting, abdominal pain, and weight loss. Serious manifestations such as intestinal obstruction and perforation were reported to be caused by Trichuriasis. Diagnostic methods are stool examination of T. trichiura eggs and eosinophil count in blood. Sometimes, colonoscopy can be useful diagnostic tool and treatment. We observed that the North Korean refugee with chronic abdominal pain and the patient with abdominal pain and loose stool have been diagnosed as T. trichiura infection confirmed by colonoscopy. After treatment, the patient's symptom has improved. Therefore we report two cases of trichuriasis with literature review.
Preview · Article · Aug 2010 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Background: Varenicline is known to have higher effect for smoking cessation than existing pharmacotherapies, including Bupropion and Nicotine replacement therapy, however, it can also bring about adverse effects such as problems in compliance due to the complicated dosage, side effects of high frequency, and financial burden resulted from a long term treatment. Moreover, the effect for smoking cessation with group program and non-pharmacotherapy, including financial incentives, E-mails or SMS is well known, but, the study on their combination is rare. Therefore, in the present study, we tried to evaluate two things; the effect for smoking cessation with multi-modal intervention, and the compliance of Varenicline. Methods: From July 2008 to February 2009, we conducted the multi-modal smoking cessation program for 30 volunteers in Dankook university. This program consisted short course of Varenicline, financial incentives, E-mail and short message service. Results: The continuous abstinence rate for weeks 9 throught 12 was 76.7% and for weeks 9 through 24 was 43.3%. Multivariate analysis revealed that duration of Varenicline treatment was significant factor affecting 12-week continuous abstinence rate. The average duration of Varenicline treatment was 17.1 (±10.8) days and 54.0% took Varenicline as directed. The most common adverse events were nausea (40.0%) and insomnia (23.3%). Conclusion: Multi-modal intervention (short course of Varenicline, financial incentive, E-mail and short message service) was effective for smoking cessation with high continuous abstinence rates in a university. We suggest multi-modal intervention because compliance of Varenicline seems to be low in real setting.
Preview · Article · May 2010 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Background: In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. Methods: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. Results: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). Conclusion: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder.
Full-text · Article · Apr 2010 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Background: Common cold is the most frequently seen ambulatory disease in primary care clinic of Korea. This study investigated the perspectives and expected pattern of health care utilization of patients who visit a primary care clinic in order to understand patients' health care behavior for treating common cold and to consider how to educate them effectively. Methods: We surveyed 570 patients and their accompanying people who visited family medicine clinic and the health promotion center of a university hospital by questionnaire, in which we asked the patients what they think of the cause, symptom, and treatment of common cold and their pattern of health care utilization. Results: The respondents replied that the cause of common cold was a virus (446, 85.3%), a bacteria (58, 11.3%) or others (18, 3.4%). Among the total, 475 respondents (88.6%) replied that they had taken cold medicine before and 264 respondents (55.7%) reported that the symptoms took 1-2 weeks to recover. A total of 285 respondents (58.3%) replied that they prefer red to go to the doctor and 198 (40.5%) replied that they prefer to go to a pharmacy. The respondents who thought that symptoms of common cold takes longer than one week tended to choose to visit a doctor. Patients thought that antibiotics (54.4%) and those that relieved common cold symptoms earlier (30.1%) were 'strong' cold medicine. Conclusion: The results of this survey showed that the difference in patients' perspectives made an effect on the patients' treatment seeking behavior. Even though medicine did not take effect to relieve symptoms, most patients wanted to continue to visit physicians. The family physician should not give only the prescription, but also make an effort to provide pertinent information to patients and educate them to acquire appropriate perspectives.
Preview · Article · Jun 2009 · Korean Journal of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: We investigated the relationship between the clustering of risk factors for metabolic syndrome and the plasma C-reactive protein (CRP) concentration as measured by high-sensitive CRP assay. Body mass index, waist circumference, triglycerides (TGs), high-density lipoprotein cholesterol, fasting glucose, systolic and diastolic blood pressures, insulin, and CRP were measured in 1046 Korean adults (560 males; age, 18-64 years) in 2003 to 2004. There were statistically significant positive correlations for log CRP with body mass index, waist circumference, log TG, log insulin, and log homeostasis model assessment in both sexes after adjusting for age and smoking status. High-density lipoprotein cholesterol showed a significant negative correlation with log CRP in both sexes. For both sexes, the mean level of log CRP increased with increasing number of risk factors of metabolic syndrome (P for trend <.01 for males and <.001 for females). Stepwise multivariate linear regression analysis showed that waist circumference contributed the largest portion of the variance in CRP levels in both sexes. Log homeostasis model assessment and log TG were independently associated with log CRP levels only in females. These results indicate that CRP, a marker of inflammation that underlies atherosclerosis, is associated with the clustering of each metabolic syndrome risk factor and, furthermore, that abdominal obesity is the strongest predictor of CRP level in the Korean adult population.