BACKGROUND: Research of clinical contents and proper development of education program is essential in family medicine. Therefore, this study is carried out to obtain data for residency training, and to provide references to family physicians who give primary health care in rural community by analyzing prospectively the clinical contents of new patients in a local family practice clinic. METHODS: The authors visited family practice clinic in a rural area practiced by a family physician board certified in family medicine. There were 3,126 new patients from Jan. 1996 to Dec. 1996 evenly distributed by month and area, 1,000 patients were sampled randomly and the collected data were classified according to the ICPC(International Classification of Primary Care) coding system. RESULTS: Among the selected 1,000 patients, males were 432(43.2%) and females were 568(56.8%). Age distribution was highest In the fifties(50-59 years old) (20.7%). The total number of Reason For Encounter(RFE) was 1,417, the average RFE was 1.41 per patient and the kind of RFEs was 93, among which cough was the most frequent RFE by 233 cases(16.4% ). The 87 kinds of diagnoses were used and URl(Upper Respiratory Infection) accounted for the major portion by 287 cases(21.9%). The diagnostic examination per patient was 0.42. The most frequently used test was x-ray of an extremity by 68 cases(16.1% ). Referrals to other departments were made in 3.3% of visitors of which Internal Medicine was highest(39.4%). CONCLUSIONS: The clinical contents were classified more comprehensively by using ICPC with given code RFE, care process, and diagnosis. More study on ICPC is necessary for classification to help analyze clinical contents in primary care.
Age Distribution ; Classification ; Clinical Coding ; Cough ; Diagnosis ; Education ; Extremities ; Family Practice* ; Female ; Humans ; Internal Medicine ; Internship and Residency ; Male ; Physicians, Family ; Primary Health Care ; Prospective Studies ; Referral and Consultation ; Rural Population

BACKGROUND: The goal of this study is to define the relationship between the decreased renal function and anemia, and also to determine whether this relationship is different in male and female patients. METHODS: We conducted a retrospective study of 289 patients (male:female=157:132) who were followed at the department of internal medicine at Chonnam National University Hospital. General linear models were used to analyze the relationship between the hemoglobin concentration and Modification of Diet in the Renal Disease formula estimated Glomerular Filtration Rate (mL/min/1.73 m2). RESULTS: Among all patients, the mean hemoglobin concentration and hematocrit of the men with a Glomerular Filtration Rate of 50~59 mL/min/1.73 m2 was an absolute change of 0.8 g/dL (p=0.021) and it was 2.6% (p=0.011) lower than those of the patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.635, Hct.: r=0.640, all p<0.001). Among the male patients, the mean hemoglobin concentration and the hematocrit of men with a Glomerular Filtration Rate of 40~49 mL/min/1.73 m2 was an absolute change of 1.7 g/dL (p<0.01) and it was 4.4% (p<0.01) lower than those of the male patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.698, Hct: r=0.689, all p<0.001). Among the female patients, the mean hemoglobin concentration with a Glomerular Filtration Rate of 60~69 mL/min/1.73 m2 was an absolute change of 0.9 g/dL (p<0.01) and the mean hematocrit was 2.8% (p<0.01) lower than those of the female patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.672, Hct.: r=0.687, all p<0.001). CONCLUSIONS: A decrease in the hemoglobin concentration was statistically significant in the patients of both genders, along with a moderately decreased Glomerular Filtration Rate (< or =60 mL/min/1.73 m2).
Anemia ; Diet ; Female ; Filtration ; Glomerular Filtration Rate ; Hematocrit ; Humans ; Internal Medicine ; Jeollanam-do ; Kidney Failure, Chronic ; Linear Models ; Male ; Retrospective Studies

BACKGROUND: As ischemic heart disease is the major cause of death in chronic renal failure patients, screening tests are clinically important. Although coronary angiography is considered the gold standard for the diagnosis of coronary artery disease, other noninvasive tests are usually used to avoid this potentially dangerous and costly procedure. METHODS: We retrospectively determined the sensitivity, specificity, and positive and negative predictive values for electrocardiography, echocardiography, cardiac enzyme determination, and Technetium 99m tetrofosmin (TF) single photon emission computed tomography (SPECT) in 61 chronic renal failure patients who underwent coronary angiography. RESULTS: Nineteen patients (31.1%) were undergoing chronic hemodialysis, seven patients (11.4%) were undergoing peritoneal dialysis, and thirty five patients (57.3%) were undergoing conservative treatment. 99mTc SPECT had a sensitivity of 96% and specificity of 19%. Although echocardiography and tronponin-T had a relatively lower sensitivity of 69 % and 56% than 99mTc SPECT, they had a higher specificity of 63% and 63%, respectively. 99mTc SPECT had the highest sensitivity of 88% and echocardiography had the highest specificity of 78% in renal replacement group. 99mTc SPECT had the highest sensitivity of 100% and Troponin T had the highest specificity of 71% in conservative treatment group. CONCLUSION: Noninvasive test for coronary artery disease in patients with chronic renal failure, especially 99mTc SPECT is of limited value because of their low specificity, so echocardiography and troponin T may helpful for diagnosing coronary artery disease.
Cause of Death ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Echocardiography ; Electrocardiography ; Humans ; Kidney Failure, Chronic* ; Mass Screening ; Myocardial Ischemia ; Peritoneal Dialysis ; Renal Dialysis ; Retrospective Studies ; Sensitivity and Specificity ; Technetium ; Tomography, Emission-Computed, Single-Photon ; Troponin ; Troponin T

BACKGROUND: Peritoneal mesothelial cells are the most important intraperitoneal cells quantitatively and have the capability to secret different types of substances. It may therefore be essential to have information on the mesothelial cell mass during peritoneal dialysis. Cancer Antigen 125 (CA125) is a 22KDa glycoprotein which is a clinically useful tumor marker of non-mucinous epithelial ovarian carcinoma. Recently, other cells including pleural and peritoneal mesothelial cell have been proved to express CA125. This study was undertaken to determine whether CA125 can be used as a marker of mesothelial cell mass in clinically stable 39 CAPD patients. METHODS: We checked serum and peritoneal dialysate CA125 level, D/P creatinine and D/Do glucose after 4 hours dwell in 39 stable continuous ambulatory CAPD patients. RESULTS: No statistically significant correlation was seen among the patient's age, sex, serum and dialysate levels of CA125. The dialysate CA125 levels correlated with the duration of CAPD, negatively (r=-0.345, p=0.039) and a significant positive correlation was seen between the duration of CAPD and D/Do glucose at 4 hours (r=0.523, p=0.001). But there were not a correlation between the dialysate CA125 levels and D/P creatinine after 4 hours dwell nor between the dialysate CA125 levels and D/Do glucose after 4 hours dwell. CONCLUSION: Although the duration of CAPD affects CA125 levels in dialysate, no specific alteration in peritoneal membrance transport properties can be detected or predicted by changes in dialysate concentration of CA125. However longitudinal follow-up of changes in concentration of dialysate CA125 may be useful in evaluating mesothelial cell mass in stable CAPD patients.Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Creatinine ; Follow-Up Studies ; Glucose ; Glycoproteins ; Gwangju ; Humans ; Internal Medicine ; Jeollanam-do ; Korea ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Schools, Medical