Background : When research based evidence is not sufficient, clinical practice guidelines can be based on opinions. In such situations, formal consensus development methods, often based on the modified nominal group techniques are widely used. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries.
Methods : To develop evidence based guidelines for osterarthritis pharmacotherapy, a consensus expert panel consisting of internists, family physicians, methodologists, and orthopedic surgeons were convened. After an extensive structured literature searching and evaluation, evidence statements for key question were developed. Rating methods for consistency, generalizability, applicability of statement were adopted from those jointly developed by Rand and the University of California, Los Angeles.
Results : We developed 27 evidence statements in 17 question domains. Among 72 rating items, 62 items reached agreement. Among 15 recommendations, 10 recommendation grading were A, 2 were B, and 3 were C.
Conclusion : When research based evidence is not sufficient, clinical practice guidelines can be based on formal consensus of experts, especially modified nominal group techniques. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries.
Background : Family practice academic dissertations are the product of family practice research in the school of medicine. This paper was intended to evaluate the status of family practice academic dissertations, analyze the basic data and suggest directions for family practice research in the school of medicine.
Methods : The total number of masters' and doctoral dissertations from 1992 to February, 2005 was 124. of those, 120 were collected. They were analyzed in terms of research area, subjects, collected data, methodology, and statistical methods.
Results : In terms of research area, health promotion/ disease prevention was the most common (42.5%). For study subjects, out-patients and in-hospital patients were the most prevalent (38.0%), followed by health promotion center visitors and community residents (28.7%). When it came to research methodology, analytic study was the most common by a wide margin (70.8%). Among analytic studies, cross-sectional studies were the most frequent, followed by case-control studies and cohort studies. The most commonly-used data were medical records and questionnaires.
Conclusion : Many advances have been made in research methodology and academic dissertation numbers since 1992. Many research topics, however, were not relevant to primary care. Much research was done in general hospital instead of primary-care facilities. These results must improve in the future.
Background : Systematic care is not well provided in patients with terminal cancer and their families in Korea. Unnecessary hospitalization, multiple emergency room visits for controlling acute symptoms and the use of unqualified alternative care services are typical health care utilization patterns in such patients. We operated home-based hospice-palliative care services to help these patients and their families at a university-based family practice setting. Our experience is presented for the development of care model of hospice-palliative care services.
Methods : We investigated the demographic characteristics, the clinical findings and the utilization of medical care services of 72 terminally ill cancer patients before and after enrollment to hospice-palliative care unit from April 25, 2003 to April 21, 2005.
Results : The frequency of emergency room visits and the number of hospitalizations were decreased by Wicoxon Signed Ranks Test after the enrollment to home-based hospice-palliative care service unit. The duration of emergency room visits decreased from 7.7 hours to 0.3 hours and the duration of hospitalization decreased from 6.5 days to 0.0 days in median. The cost per emergency room visits decreased from 268,801 won to 153,816 won and the cost per hospitalization decreased from 285,491 won to 106,294 won in median.
Conclusion : Home-based hospice-palliative care services can be an efficient and effective model for the care of terminally ill cancer patients at a low cost.
Background : Renal function in patients, who undergo medical examination, is usually evaluated by the serum creatinine level. However this numerical value does not always represent the entire renal function because the values increases only when the renal function has decreased more than 50%. The purpose of this study was to find the prevalence of renal diseases through the GFR (Glomerular filtration rate) using MDRD (Modification of Diet in Renal Disease) equation and to analyze the risk factors related to renal diseases.
Methods : We reviewed all the clinical records of 440 patients who had visited for medical examination between January 1, 2004 and December 31, 2004. We have calculated the GFR for each group using the MDRD equation and then figured out the correlation between the GFR and its risk factors.
Results : Patients haing GFR of less than 60 mL/min/1.73 m2 were 19 (7.2%), 60∼90 mL/min/1.73 m2 were 123 (46.4%) and more than 90 mL/min/1.73 m2 were 123 (46.2%). The correlation between the GFR and age, obesity, hypertension and diabetes melitus were observed as negative results in univariate analysis of variance (P＜0.05). Age and diabetes melitus were independent factors affecting the GFR (OR=3.1, 2.2 respectively, P＜0.05) in multiple logistic regression analysis.
Conclusion : It is a well known fact that the declined renal function is related to the aging process and diabetes melitus. Therefore, the mortality rate caused by renal failure and its complications should be decreased through the control of diabetes melitus, aging process and other risk factors.
Background : InBody 4.0, a bioelectrical impedance analyser (BIA) has an automatic function of printing out the measurement data of visceral fat area. The purpose of this study was to assess the usefulness of the visceral obesity measured by the InBody 4.0 and the waist circumference
Methods : A total of 124 participants who visited an obesity clinic in a university hospital were measured their waist circumference, height, weight and the visceral fat area by the InBody 4.0 and CT scan. The mean difference and agreement between the two visceral fat areas by the two methods had been analyzed according to sex, age and BMI groups. The accuracy of the visceral obesity by the BIA and the waist circumference was respectively compared with the visceral obesity by the CT scan.
Results : There was no significant difference between visceral fat area measured by the CT and the BIA in women participants under 46 years of age and below BMI 30. When comparing visceral fat area obtained from the CT with those obtained from the BIA, the 95% confidence interval for the limit agreement was higher in male subjects than in females. The waist circumference was the more sensitive method to diagnose visceral obesity than the BIA (91.80% vs. 77.94%), but the BIA method showed a higher specificity than the waist circumference (76.79% vs 52.38%).
Conclusion : Waist circumference turned out to be more useful than the BIA as a screening tool for visceral obesity. In the group of males, BMI of over 30, or the age over 46 years, it is recommended that the CT rather than the BIA for measurement of visceral fat area be utiliged.
Background : Smoking may be a factor that decreases bone mineral density. Alcohol also may be a factor that increases or decreases bone mineral density. The authors investigated the relationship among life style-related smoking and alcohol intake and the bone mineral density and the amount that may result in the incidence of osteoporosis in Korean men over forties.
Methods : In 1,650 men over forties, we compared the mean values of bone mineral density by factors. Multiple logistic regression analysis was done on the incidence of osteoporosis and the statistically significant factors after adjustment for age, body index, and daily activity.
Results : In men, who smoked over 30 pack-years, the bone mineral density of the spine (P＜.001) and the femur (ward; P=.001, neck; P=.003) was statistically significantly low before and after adjusting (spine P=.001, femur ward P=.010, femur neck P=.016) for age, body mass index, and daily activity. In men who were presently drinking alcohol, the bone mineral density of the femur increased significantly (P＜.001), but drinking alcohol only influenced the bone mineral density of the femur neck after adjustment (P=.025). In men who drank 200∼300 g per week, the bone mineral density of the femur increased significantly (ward P=.001, neck P＜.001), and it influenced the bone mineral density of the femur neck (P= .046) after adjustment. The odds ratio was 1.5 in men who smoked over 30 pack-years in the incidence of osteoporosis, and was statistically significant.
Conclusion : As the odds ratio for incidence of osteoporosis increased in men who smoked over 30 pack-years, it is important to stop smoking.
Background : Our study was done to identify the risk factors of hypertension in order to implement primary prevention strategy in Korean healthy adults.
Methods : The subjects, who had received medical examination at the Health Promotion Center of Asan Medical Center from June 1990 to February 1991, were included in the Asan Cohort Study. A total of 1,329 men and 886 women were followed up to June 2000. The subjects who initially had hypertension or coronary heart disease or were diagnosed with hypertension within 1 year after study enrollment were excluded. Incident cases were ascertained through the chart review, telephone contacts, and follow up examination. During the follow-up period, 140 male and 76 female hypertension incident cases occurred. For each case one normotensive control was selected, matched on sex, age, and follow-up period. We used conditional logistic regression for matched pairs to estimate odds ratio.
Results : For men, daily alcohol intake, family history of hypertension and body mass index (BMI) were the risk factors of hypertension. Compared with non-drinkers, men who drank alcohol 20∼29.9 g/day and over 30 g/day had adjusted relative risk for hypertension of 4.05 (95% confidence interval (CI) 1.09∼15.08) and 1.37 (0.61∼3.11), respectively. Family history of hypertension increased OR 5.35 times. Compared with men having BMI of less than 23 kg/ m2, the adjusted OR for men with BMI of 23∼24.9 kg/m2 and over 25 kg/m2 were 2.39 (1.15∼4.97) and 2.05 (0.96∼4.39), respectively. For women, BMI was a risk factor of hypertension. Compared with women having BMI of less than 23 kg/m2, OR for women with BMI of 23∼24.9 kg/m2 and over 25 kg/m2 were 3.51 (1.13∼10.89) and 2.93 (1.28∼6.72), respectively.
Conclusion : Our study proved that obesity (men and women), alcohol intake (men), and family history of hypertension (men) were risk factors of hypertension in Korean adults.
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