Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic

BACKGROUND: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine is implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic. METHODS: The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence - Based Medicine Center in Oxford. The Patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. ln case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels. RESULTS: There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%) . As a result, 80.4% of the total 144 pairs were regarded as evidence - based medicine. CONCLUSIONS: The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.

The Effect of Water Exercise on Stress Relief in the Aged

BACKGROUND: Because up to 80% of all illness encountered in a primary care physician's office is due to psychological stress, stress management is important for the aged who are susceptible to stress. The positive effect of exercise therapy on psychological stress has been studied for a long time, but the research related to geriatric stress and exercise is still insufficient. Therefore, we investigated the effect of aquarobics, which is known to be suitable for the aged, on the stress reduction. METHODS: The data were collected from 11 women over 60 years old who visited the Public Health Center of Seodaemun-gu Office. The subjects participated in a 3 months' water exercise program 2 times a week for 60 minutes. Before and after exercise program, they were assessed according to Modified-Korean BEPSI scores. RESULTS: The subjects exercised 31 times on average (Maximum 40). Before exercise, mean BEPSI score was 1.6, which conformed to moderate risk group, but after 3 months exercise program they showed statistically significant stress reduction when compared to pre-exercise state (P=0.0313). CONCLUSION: We conclude that 3 months water exercise program reduced stress effectively in the aged over 60 years.

A Comparison of NSAID and Intramuscular Stimulation Therapy Effectiveness in the Female Patient with Chronic Shoulder Pain

BACKGROUND: Chronic shoulder pain draws the attention of doctors since it is a very common and serious disease at primary care level. The patients with this pain usually have a tendency to see many doctors, to take an abundance of medication, and sometimes to even suffer from depression. The pain and the symp- toms thereof often disable the patients in their every day lives. This study aims to seek the most efficient way of treatment between two therapies, namely, the existing drug therapy based on NSAID and the intramuscular stimulation(herein after IMS) therapy, which has re- cently been introduced, by comparing them in accordance with the following method. METHODS: The two therapies were applied for 3 weeks to female patients aged between 50 and 70 who had visited a hospital over a period of more than 3 months due to this type of pain. The patients were randomly given each therapy although the treatment and monitoring was done by the same physiotherapist. The monitoring was performed four times, the day before the start of treatment, 1 week, 2 weeks and 3 weeks after respectively. It measured the following elements: (1) pain scale by VAS(Visual Analogue Scale), (2) Sleep hygiene scale by VAS, (3) ROM(Range of Motion), Repeated measure ANOVA was used for analysis. RESULTS: While both therapies reduced the pain significantly during the 3 weeks, the study showed that IMS was more effective than the drug therapy in every element monitored(p<0.05). IMS turned out to be more effective the 1st week in every measured element, however, the drug therapy was more effective the 3rd week if compared to the 2nd week in terms of Sleep VAS score. CONCLUSION: IMS is more effective in easing chro nic shoulder pain since it has better results than NSAID in pain VAS score, sleep VAS score and ROM.

The Development of Korean Activities of Daily Living(K-ADL) and Korean Instrumental Activities of Daily Living(K-IADL) Scale

BACKGROUNDS: Katz index of ADL and Barthel index of ADL have been used to evaluate the function of disabled elderly in Korea. But no ADL scale reflecting Korean's own language expression and culture has been developed and verified yet. METHODS: Descriptions of basic activities which needed others' help were collected from 190 Korean disabled elderly. The collected results were categorized into basic activities of daily living and instrumental activities of daily living, and then in each domain such as bathing, shopping, etc. Preliminary instrument items were selected by the judgement of the expert committee, considering the frequency of the responses and the importance of each item. A preliminary questionnaire was developed based on the selected items. The preliminary questionnaire was pretested twice, and corrected by the results. Finally a scholar on Korean literature verified the questionnaire on the grammar and context. RESULTS: A total of 408 basic activities of daily living and 242 instrumental activities of daily living were collected. The activities were categorized into 7 domains of ADL(dressing, washing face and hand, bathing, eating, transfer, toileting, continence) and 10 domains of IADL(decorating, housework, preparing meals, laundry, outgoing for a short distance, using transportation, shopping, handling money, using telephone, taking medicine) CONCLUSIONS: We developed a Korean Activities of Daily Living(K-ADL) scale and Korean Instrumental Activities of Daily Living(K-IADL) scale reflecting Korean elderly's own language expression and culture.

A Case of Plasmodium falciparum Gametocytemia Successfully Treated with Primaquine / 감염

We experienced a case of Plasmodium falciparum gametocytemia successfully treated with primaquine in a twenty seven-years old woman. The patient had been admitted due to general malaise after diagosis and treatment of P. falciparum at Tanzania one month ago. On microscopic examination, P. falciparum gametocytemia was seen and treated with mefloquine for one week but gametocytemia was not disappeared. After primaquine treatment for two weeks, she was successfully treated.