BACKGROUND: This study was performed to evaluate the validity of triage of non-urgent ambulatory patients using Triage Tool, the Emergency Severity Index-4 by a family medicine resident in the emergency room (ER). METHODS: A total of 790 ambulatory patients who visited an urban ER between March and April 2007 were enrolled. A family medicine (FM) resident and emergency medicine (EM) residents independently evaluated the severity of patients with ESI-4, and reviewed the basic characteristics and disposition of the patients. Concurrent validity and predictive validity were measured using weighted kappa analysis and chi-square analysis. RESULTS: Concurrent validity was good. The weighted kappa value was 0.910 between an FM resident and EM residents. The hospitalization rate was 75% in catergory 2 and 19.6%, 2.5%, 0.05% in category 3 through 5, respectively. More severe category patients of ESI-4 had higher rate of hospitalization rate. CONCLUSION: Triage by a family medicine resident, using the Emergency Severity Index-4 in ambulatory patients of emergency room (ER) is a useful screening tool for non-urgent patients.
Emergencies ; Emergency Medicine ; Hospitalization ; Humans ; Mass Screening ; Triage ; Walking

BACKGROUND: Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians' attire, attitude and greeting. We aimed to investigate the difference between patients' and physicians' preferences to attires and greetings in clinics. METHODS: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians' dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. RESULTS: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P<0.001). Both the patients and the physicians preferred physicians'to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. CONCLUSION: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians' attire and attitude were strongly associated with their professionalism.
Hospitals, University ; Humans ; Outpatients ; Surveys and Questionnaires

BACKGROUND: This study was designed to evaluate the effectiveness of brief group education on improvement of readiness to change in heavy drinkers. METHODS: We selected 37 heavy drinkers categoriged in the state of precontemplation and contemplation stage according to readiness to change questionnaire (RTCQ). The readiness to change was re-evaluated after 4 sessions of drinking education. RESULTS: The mean (+/-SD) frequency of participation in group education was 3.5 (+/-0.6). According to the stage of readiness to change, the subjects were distributed into 11 (29.7%) in the stage of precontemplation and 26 (70.3%) in contemplation before participation in the program. After completion of educational program, the readiness to change in the subjects was significantly (P<0.001) changed into 1 drinker (2.7%) in the stage of precontemplation, 16 (43.2%) in contemplation and 20 (54.1%) in action. The influential factors associated with the improvement of the status of readiness to change was family APGAR score (odd ratio 1.75, 95% CI 1.02-3.03). CONCLUSION: Above results suggested that the readiness to change in heavy drinkers can be improved by brief group education program.
Apgar Score ; Drinking ; Humans ; Surveys and Questionnaires

BACKGROUND: The purpose of this study was to examine the association between the change of parental weight status and the change of their child's weight status over 2 years. METHODS: A total of 379 children ages 11??13 years were measured their height and weight in 2001 and 2003. Their parents completed a questionnaire including self-reported parental weight and height during the same period. Parental weight status was classified as overweight (BMI> or =25 kg/m(2)) and non-overweight (BMI<25 kg/m(2)). Children's weight status was classified as overweight and non-overweight using the age and gender-specific BMI established by the Korean Academy of Pediatrics. The weight status over 2 years was categorized as a group of persistent overweight, persistent non-overweight, shifting overweight to non-overweight, and shifting non-overweight to overweight. RESULTS: After adjusting for the child's gender and the father's weight status, the odds ratio for being persistently overweight over 2 years in a child having a mother with persistent overweight was 2.8 (95% CI: 0.9-8.5) compared to a child having a mother with persistent non-overweight. Likewise, the odds ratio for being persistently overweight over 2 years in a child having a father with persistent overweight was 2.9 (95% CI: 1.4-6.1) compared to the child having a father with persistent non-overweight. CONCLUSION: Parental weight status over 2 years was associated with the 2-year weight status in children. The parents- and family-based intervention are needed to prevent and manage childhood obesity.
Child ; Fathers ; Humans ; Mothers ; Odds Ratio ; Overweight ; Parents ; Pediatrics ; Surveys and Questionnaires

BACKGROUND: It has been reported that cardiovascular factors such as hypertension, smoking, diabetes and obesity are related to decrease in heart rate variability (HRV). This study purposed to examinate the association of HRV with Framingham risk score in non-obese males and the affecting factors of HRV. METHODS: The study was carried out in 323 males who visited a health care center from June to August, 2004, None had previous cardiovascular and cerebral diseases, diabetes, or obesity (BMI> or =25 kg/m(2)). The subjects were divided into three groups by Framingham risk score and we compared the means of HRV parameters including the Mean Heart Rate (MHR), Standard Deviation of NN interval (SDNN), the Square Root of the Mean Squared Differences of successive NN intervals (RMSSD), Total Power (TP), Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF), and LF/HF ratio in these three groups. RESULTS: There were significant differences among the groups by age. Among HRV parameters, SDNN (P<0.001), RMSSD (P=0.001), TP (P=0.008), LF (P=0.024), and HF (P=0.003) are inversely associated with the risk score group. Multiple regression analysis revealed age, systolic blood pressure and C-reactive protein as independent explanatory variables of HRV. CONCLUSION: SDNN, RMSSD, TP, LF and HF were decreased in the higher risk group, we can suggest that autonomic function is impaired as the cardiovascular risk increases.
Blood Pressure ; C-Reactive Protein ; Delivery of Health Care ; Heart ; Heart Rate ; Humans ; Hypertension ; Male ; Obesity ; Smoke ; Smoking

BACKGROUND: After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. METHODS: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. RESULTS: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P<0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. CONCLUSION: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician.
Humans ; Male ; Patient Satisfaction ; Physicians, Family ; Physicians, Primary Care ; Referral and Consultation ; Specialization ; Surveys and Questionnaires

No abstract available.
Nicotine ; Psychometrics ; Substance Withdrawal Syndrome ; Tobacco Use Disorder

We report a case of acute, painful polyneuropathy in a woman with newly diagnosed type I diabetes mellitus associated with a precipitous drop in hemoglobin A1c . She has had poorly controlled diabetes mellitus type I for 5 years despite diet, execise, oral therapy because she has been diagnosed type II diabetes mellitus 5 years before. She experienced diabetes ketoacidosis, and she presented with a hemoglobin A1c of 17.8% and was hospitalized for continuous subcutaneous insulin infusion. Following the initiation of continuous subcutaneous insulin infusion, the patient's hemoglobin A1c fell to 6.1% within 2 months. During this 2-month period, she developed severe burning in her hand, feet and trunk, accompanied by tingling paresthesia and dysesthesia. Nerve conduction studies were consistent with mild sensorymotor peripheral neuropathy. Initially, she required opiate analgesics for pain control because gabapetin or tramadol/acetminophen did not help. Three months after presentation, the patient showed dramatic improvement and her pain resolved. Although not well described in the neurologic literature, this case represents insulin neuritis, one of the few diabetic neuropathies that has a favorable outcome.
Acute Pain ; Analgesics ; Burns ; Diabetes Mellitus ; Diabetic Neuropathies ; Diet ; Female ; Foot ; Hand ; Hemoglobins ; Humans ; Insulin ; Ketosis ; Neural Conduction ; Neuritis ; Paresthesia ; Peripheral Nervous System Diseases ; Polyneuropathies

BACKGROUND: The revised Consolidated Standards for Reporting of Trials (CONSORT) were developed to improve the reporting of Randomized Controlled Trials. We studied to survey the extent to which RCTs report items included in the revised CONSORT recommendations. METHODS: A descriptive survey of RCTs enrolled in 2005 at KoreaMed, which is a representative database in Korea was done. The main outcome measures were the proportion of RCTs that reported each of 22 checklist items of CONSORT. RESULTS: We identified 125 RCTs from 26 journals. Random sequence implementation (0%), estimated effect size and its precision (0%), sample size determination (8.9%), method of random sequence generation (7.3%), allocation concealment (3.2%), participant flow (4.8%) and any other analysis (7.3%), generalizability of the trial findings (0.8%) were pooly reported. CONCLUSION: The proportions of following the CONSORT recommendations in Korean medical journals were very low. An effort to improve the reporting of RCTs by application and recommendation of CONSORT statement is required.
Checklist ; Double-Blind Method ; Korea ; Outcome Assessment (Health Care) ; Random Allocation ; Sample Size

BACKGROUND: Physicians rarely take patients' sexual history during routine medical visit, although it would give very helpful information to reach accurate diagnosis and proper management. This survey was conducted to assess the primary physicians' perspectives towards sexual history taking and their actual behaviors on it. METHODS: The survey questionnaire was made through the literature review, in-depth interview and pilot survey. We mailed this questionnaire to 400 primary care physicians who were randomly selected from the lists of internists and family physicians in Seoul and Gyunggi province and 73 of them responded. RESULTS: The mean age of the respondents was 44.3 years. Most of them responded that sexual history is necessary only when the patients' chief complaints are directly related to sexual issues. Among the total, 94% of them answered that he or she took sexual history in less than 25% of the patients who visited his/her own clinic during last one month. The most prevalent barriers to initiate sexual history taking were fear of patients' misunderstanding about sexual harassment or intrusion into patients' personal life (60.3%) and uncertainty to conducting sexual history taking (53.4%). They thought that they were not well educated enough to take sexual history with confidence and more structured education is needed in medical schools and postgraduate residency training. CONCLUSION: Sexual history seemed not to be taken by primary care physicians as a routine medical practice and physicians showed rather passive attitude. Beneficial effects of sexual history taking on patients' management and related communication skills should be emphasized and systematically educated.
Surveys and Questionnaires ; Humans ; Internship and Residency ; Physicians, Family ; Physicians, Primary Care ; Postal Service ; Primary Health Care ; Schools, Medical ; Sexual Harassment ; Uncertainty