Delirium in the Final Weeks of Terminally Ill Cancer Patients / 가정의학회지

BACKGROUNDS: In terminally ill cancer patients, delirium must be considered to be important clinically and for the quality of life. We reviewed cases of delirium in hospitalized cancer patients with the aim to recognize and treat delirium. METHODS: We reviewed retrospectively the medical records of patients admitted with terminal cancer from April 2003 to April 2004 in the department of family medicine, National Health Insurance Corporation Ilsan Hospital. A total of 71 patients were evaluated with age, sex, oncological diagnosis, metastases, morphine (oral morphine equivalents/day, OME) use and amount, sedatives use, duration from delirium to death, and laboratory fi ndings. Analysis was conducted to fi nd the characteristics of delirium patients and to quantify the relationship between delirium and predicting factors. RESULTS: Among 71 cases, those patients who developed delirium were 41 (57.7%). Among them, gastric cancer was the most common diagnosis with 10 patients (24.4%), followed by colon and lung cancers (9: 22%, 5: 12.2%). The patients receiving sedatives or morphines were 24 (58.5%) and 28 (68.3%), respectively. The mean amount of morphine was 168.6 +/- 125.5 mg OME/day. Hyperbilirubinemia (4.2 +/- 9.2 mg/dL) and hyponatremia (132.5 +/- 4.5 mM/L) were found. Not only bone metastasis and the use of morphine or sedatives but serum Na were significant (P = 0.047; P < 0.001; P = 0.069; P = 0.029). By logistic regression analyses, the occurrence of delirium was increased with decreased serum Na (odds ratio [95% CI] 0.798 [0.649-0.981]) and increased use of sedatives (5.955 [1.080-32.835]). CONCLUSION: In terminally ill cancer patients, the risk factors of delirium were bone metastasis, the use of morphine or sedatives, and serum Na level. Among these, the use of sedatives and serum Na level were independent risk factors.

Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People

The phentermine, an appetite suppressant, has been widely applied in Korea since 2004. However, there have been relatively few reports about the efficacy and the safety of phentermine in Korea. The aim of this study is to verify the effect of phentermine on weight reduction and the safety in Korean patients. This randomized, double-blind, placebo- controlled study had been performed between February and July, 2005, in Seoul on 68 relatively healthy obese adults whose body mass index was 25 kg/m2 or greater. They received phentermine-HCl 37.5 mg or placebo once daily with behavioral therapy for obesity. The primary endpoints were the changes of body weight and waist circumference from the baseline in the intention-to-treat population. Mean decrease of both body weight and waist circumference in phentermine-treated subjects were significantly greater than that of placebo group (weight: -6.7 +/- 2.5 kg, p < 0.001; waist circumference: -6.2 +/- 3.5 cm, p < 0.001). Significant number of subjects in phentermine group accomplished weight reduction of 5% or greater from the baseline and 10% or more (p < 0.001). There were no significant differences in systolic and diastolic blood pressure between the groups (p = 0.122 for systolic BP; p = 0.219 for diastolic BP). Dry mouth and insomnia were the only statistically significant adverse events that occurred more frequently in phentermine group. Most side effects of phentermine were mild to moderate in intensity. Short-term phentermine administration induced significant weight reduction and reduction of waist circumference without clinically problematic adverse events on relatively healthy Korean obese people.

Primary Care Physicians' Attitudes to Community-Based Medical Education and the Wave Model as a New Teaching Method in Ambulatory Care Settings / 한국의학교육

PURPOSE: In order to expand and improve community-based medical education (CBME), we attempted to delineate the characters of the primary care physicians interested in medical education and their opinions on the new medical teaching method for ambulatory care settings, Wave model. METHODS: Through mailed questionnaires, we asked the Seoul members of the family physician association and the internal medicine physician association about their interest and opinions of CBME and the Wave model. RESULTS: We received 186 replies from the total 1088 questionnaires (17.1%) sent out. Many of the primary care physicians (141/186; 75.8%) had no experience with CBME. However, 127 (68.7%) were interested in CBME and 121 (65.4%) answered that they were interested in teaching students in their clinic. There were 128 (69.2%) affirmative responses to the Wave model, which was much higher than that to the observation-centered method, 53 (30.3%) (p < 0.0001). Primary care physicians who have affirmative attitudes to adopting the Wave model would select this model as their CBME program (p < 0.0001). Primary care physicians willing to teach students tend to be males (p=0.0085) and younger in age (p=0.0003), have examination rooms for student-patient contact (p < 0.0001), and possess positive attitude to adopting the Wave model (p= 0.0018). CONCLUSION: There are many primary care physicians eager to participate in CBME. They view the Wave model as an effective teaching method. Factors associated with the desire to work as a preceptor include being male and younger in age. having examination rooms for student-patient contact, and possessing a positive attitude to adopting the Wave model.