Evaluation of Residency Program Using the Result of in-training Examination / 한국의학교육

BACKGROUND: There has been widespread use of in-training examination for the evaluation of clinical competence of residents. The result of in-training examination seems to be helpful for improving the quality of residency programs using feedback system, further. We evaluated the relationship between residency program and the result of in-training examination. METHODS: Reports on the contents of residency program(82 programs) which were submitted in 1999 and in-training examination scores of 516 family medicine residents in 1998 were linked each other through the name of resident. Correlation analysis, t test, ANOVA analysis, and the multiple linear regression analysis were used. RESULTS: Mean score acquired by residents of tertiary hospital residency program(59.4+/-7.79) was significantly higher than that of secondary hospital(56.4+/-8.45) among all three residency years. Residents who have seen their own patients in ambulatory care clinic(58.5+/-8.14) and were given feedback by peer review of teaching faculty(60.2+/-7.71) acquired significantly better results compared to those who have not(56.1+/-8.35, 57.5+/-8.27). Residents in programs with moderate ratio of the number of residents to teaching faculty acquired significantly better results compared to those with smaller or larger ratio; the score were 56.2+/-6.90, 59.2+/-8.64, 58.7+/-7.90, 57.1+/-8.82 for the ratio of < or =3, 4-6, 7-9, and 9 <, respectively. Statistically significant but low correlation coefficients(less than 0.25) were observed between in-training examination score and the period of rotation to learn family medicine, general medicine, dermatology, musculo- skeletal problem, and the neuro-sensory problem. After controlling probable confounders, third year of residency, residency program in tertiary hospital, and the moderate ratio of residents to teaching faculty were significantly associated with the better result of in-training examination. CONCLUSION: For improving clinical competence of residents in family practice, limiting the ratio between residents and teaching faculty in residency program to appropriate level and substantiality in contents of hospital teaching rotation program should be needed.

Preferred place of death of elderly women in seoul

BACKGROUND: The present it is getting to be on aged society there is increasing that hospital has higher rate for place of death than home. Because we can expect that many patients who are faced with death come to hospital or hospice in the future, we have studied preferred place of death with an old women in seoul to have essential material of plan to understand asking for medical service of death, to divide medical manpowers and equipments and to supplement and to revise of medical educations. METHODS: Through the internet, 71 schools for the elderly. Of 277 an old woman who attending the schools out of 7 schools. We research into preferred place of death by self answering way through the June to July in 2000. RESULTS: The average age was 72.4 years. Of 277 respondents, 87 respondents(32.46%) reply their homes as a place of death and 166(61.94%) reply hospital, 15(5.6%) reply hospice, missing is 9. Statistical significance has connections with only level of education. The highest reason(47.5%) why respondents choose the hospital or hospice is only to reduce their children's burdens. Unlike respondents that education attending period is below 6 year, the relative risk of choosing the hospital or hospice between respondents who are 6 9year and above 9 year is each of 3.66, 5.58. CONCLUSION: This research shows that an elderly women in seoul prefer hospitals or hospice to homes as their place of death.

The effectiveness of a letter reminder on the compliance with periodic follow-up examination in chronic HBsAg-positive patients

BACKGROUND: For Chronic HBsAg-positive patients are a well-known high risk group of primary liver cancer necessitating periodic follow-up examination. This study was performed to evaluate the effectiveness of a reminding letter on the compliance with scheduled follow-up examination in chronic HBsAg-positive patients. METHODS: A randomized controlled clinical trial was conducted at a Family Practice Clinic in Samsung Medical Center located in Seoul from February 1998 to January 1999. A total of 176 HBsAg-positive patients who had no other clinical illnesses and were scheduled to take follow-up examination were randomly assigned to a control (88 subjects) and a letter reminder group (88 subjects). The outcome measure and attendance at the scheduled follow-up examination were determined through the medical chart review and telephone. Demographic and clinical characteristics were checked through the medical chart review. RESULTS: The attendance rate was 62.2% among the 82 patients who were actually receiving the letter reminders. Compared to the attendance rate of 37.5% among the control group, it was significantly higher. Even after controlling the demographic and clinical characteristics through the multiple logistic regression analysis, the letter reminder was significantly related to the increased compliance for a scheduled follow-up examination. Frequency of previous visit was also positively related to increased compliance. CONCLUSION: These results suggest that the letter reminder can significantly improve compliance with a scheduled follow-up examination in HBsAg-positive patients.

Antibiotics prescription pattern of family practitioners for respiratory tract infections

BACKGROUND: Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections. METHODS: In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview. RESULTS: The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI=1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)posssibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%). CONCLUSION: Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influence by patient's age, number of clinic-visit, and clinical symptoms and signs.

Cognition and performance rate for adult immunization among urban general population

BACKGROUND: Although adult immunization is as important as childhood immunization, is being inadequately performed. However, previous studies concerning adult immunization could not be sufficiently evaluate because studies were restricted to the residents in rural area or those who have visited a doctor. METHOD: We conducted a study by telephone interview which included 201 household(375 adult family members) selected by systematic sampling from the yellow pages of Kangnam-gu and Sungbuk-gu districts of Seoul. The types of immunization covered in this study were immunizations against hepatitis B, influenza, pneumococcus, and hemorrhagic fever with renal syndrome(HFRS). Immunization status of all adult household members, cognition of the feed for immunization and of interviewees were surveyed. Sex, age, area of residency, education medical history of study subjects were considered as factors related to the cognition of the need for immunization and immunization performance. RESULT: The cognition rates of immunization were as follows: hepatitis B 85.1%, influenza 45.8% pneumonra 38.3%, and HFRS 38.3%. In the people over 65 years old, the cognition rate against influenza and pneumococeus were 6.25%, 6.25% respectively and for those she have chronic disease.80.0%, 20.0%, respectively. The cognition rates of immunization was significantly higher among those subject who were young, well educated, and those residing in Kangnam-gu district. The immunization performance rate of hepatitis B was 6.5%, influenza 5.6%, pneumonia 0.8%, and HFRS 1.1%. 75.5% of subjects vaccinated against hepatitis B had received at least three titles. The immunization performance rate of influenza and pneumococcus by the immunization indication are as follows 8.0%, 0.0%, respectively in the subjects over 65 years old, and 11.1%, 0.0,% respectively in the people who have chronic disease. The immunization performance rate of hepatitis B was higher among young, well educated subjects living in Kangnam-gu district. But age, education, area of residency played no apparent role in the case of other types of immunization. The immunization performance rate of those who felt the need for immunization as significant1y higher then that of those who did not. To assess the factors which re]ate to the correct cognition for immunization necessity, we used a multiple logistic regression test. For all types of immunization surveyed, sex(femals) and age (young) seemed to be significantly related to the correct necessity cognition. Medical history of chronic disease was also related to the correct necessity cognition for immunization against hepatitis B and influenza. CONCLUSION: This study reveals that among living in urban area the immunization performance rate and the correct cognition rate concerning the necessity for adult immunization was generally very low. Therefore, an active publicity and pubic education will be needed to increase the level of correct necessity cognition for immunization in which the disease status, sex, and age of vaccinee are considered. And more active effort to increase the cognition for immunization necessity performance is required.

Prescription of Digestive System Drugs to the Patients with No Digestive Symptoms

BACKGROUND: In Korea, doctors are tend to prescribe digestive system drugs to the patients who have no digestive symptoms. The purpose of this study was to describe the prescription tendency toward digestive system drugs among residents of family practice. METHODS: Among outpatients who were consulted by residents of family practice in S hospital from Jan. 1995 to Jul. 1996, the patients without digestive symptoms were selected and their medical records were reviewed about prescribed drugs. RESULTS: The total number of eligible patients were 308. The number of residents who examined the eligible patients were 25 and they consulted average 12.3(S.D 5.1, range 521) patients. The proportion of patints who were given digestive system drugs was 43.2%. The proportions were 48.3%, 35.4% and 54.8% in patients who were examined by 1st, 2nd and 3rd grade reridents, respectively. There were no differences in the proportions between patients sex groups, among patients age groups, and also among groups of number of major drugs. The proportion was 58.6% in patients with common cold, 39.4% in patients with respiratory diseases other than common cold, 70.2% in patients with musculoskeletal diseases, 50.0% in patients with headache, 45.0% in patients with neurosis. The three most common categories of digestive system drugs were enzyme digestives, motility regulators and antacids. The proportion of total prices of digestive system drugs to total price of prescribed drugs was 19.8 % in all patients and 36.3% in patients who were given digestive system drugs. CONCLUSIONS: Residents of family practice in S hospital were tend to prescribe digestive system drugs to the patients who have no digestive symptoms and therefore there need more efforts to improve prescription behavior.

Inappropriate Drug Prescription for the Patients Who Visit Two or More Doctors

BACKGROUND: If two or more doctors prescribe for one patient, each doctor must be careful to minimize the number of drugs and the frequency of admistration, and also be careful to avoid duplicating drugs. The purpose of this study is to evaluate the appropriateness of prescription for the patient who visits two or more doctors. METHODS: In a tertiary hospital, outpatients who received prescriptions simultaneously from two or more doctors were selected, and the number of drugs, the frequency of admistration and duplication of drugs were evaluated. RESULTS: The number of eligible patients was 887. The number of drugs was 5.2 for patients who visited 2 doctors, and 8.1 for patients who visited 3 doctors. 13% of patients who visited 2 doctors received more than 8 drugs, and 32.6% of patients who visited 3 doctors received more than 10 drugs. The frequency of administration per day was 3.7 for patients who visited 2 doctors, and 5.0 for patients who visited 3 doctors. 12% of patients who visited 2 doctors had to take drug more than 6 times a day and 9.3% of patients who visited 3 doctors had to take drug more than 8 times a day. 9.2% of total patients received duplicated drugs. The duplication of drugs was more frequent among patients who visited 2 doctors than who visited 3 doctors. CONCLUSIONS: For the patients who visited two or more doctors, the number of drugs and frequency of admistration was inappropriate and duplication of drugs was found, therefore the doctors should make more efforts to avoid inappropriate prescription.

The Relationship Between Cholesterol Level and Mortality in Korean Women / 한국역학회지

BACKGROUND: There were many efforts to evaluate the relationship between cholesterol and mortality. But almost all of them have been performed on male western people who have higher mean cholesterol concentration than oriental people and have different disease pattern from women's. So, upto now, the relationship of cholesterol to mortality in women with low cholesterol concentration was not well known. We carried out this study to investigate the relationship in Korea women whose mean cholesterol level was lower than that of western people and men. METHOD: Study subjects included in were 100,363 Korean women aged 30-65 years. They undertook multiphasic health examination provided by Korea Medical Insurance Corporation between March 1990 and July 1990, and had no history of cancer and no significant medical illnesses which could change blood cholesterol level. Study subjects were followed for 5.5 years until December 1995 and it was determined whether each subject was dead or alive using the mortality data from the Korea National Statistical office and the Korea Medical Insurance Corporation. Nonlinear ralationship between serum total cholesterol and mortality was investigated with the use of quadratic regression and with dummy variables using the 158-180mg/dl group as the comparison group. To analyzing the relationship between cholesterol concentra-tion and mortality with controlling for age, smoking, alcohol drinking, exercise, diastolic blood pressure, body mass index, pay level, Cox propor-tional hazard model was used. RESULT: During the follow-up period, there were 369 deaths. Mean cholesterol concentration of study subjects was 182.8mg/dl There was no significant association between serum cholesterol and total mortality, but women with cholesterol concentrations below 130mg/dl showed slightly increased risk of death(RR=1.20). Cholesterol had an inverse relationship with mortality from stroke, and women with cholesterol concentrations below 130mg/dl had higher risk of death from stroke(RR=3.28). Although there was no statistical significance,risk of mortality from hemorrhagic stroke in women with very low cholesterol concentration was markedly higher than in women with cholesterol concentrations above 130mg/dl. Mortality relationship with cholesterol. And women with cholesterol concentrations higher than 203mg/dl had abruply increased risk for death from ischemic heart disease. CONCLUSION: Through this study, we could observe an inverse J shaped relationship between cholesterol concentration and mortality in Korean women. The increased risk of mortality from hemorrhagic stroke in people with very low cholesterol concentration supports the previous report which proposed low cholesterol level as a significant risk factor of hemorrhagic stroke. In spite of the lack of statistical signi-ficance, greately increased risk of mortality from ischemic heart disease in people with cholesterol higher than 203mg/dl suggests that cholesterol concentration at the upper end of distribution can be a significant risk factor of ischemic heart disease in women.

A study on injection preference of patients in a rural area

No abstract available.

A study on injection preference of patients in a rural area

No abstract available.