BACKGROUND: In family practice residency program, education of common health problems in community primary care is the most important. This study was performed to evaluate whether the trainees of current tertiary hospital family practice residency programs could sufficiently experience common health problems in community primary care. METHODS: Each of three conveniently chosen tertiary hospital family practice centers in seoul was matched with one family practice clinic by its location. Whole patients visited the three family practice clinics on one specific day of June, 2001(primary care group) and the patients seen by the trainees of tertiary hospital family practice residency programs(tertiary care group), whose number was the same as that in matched family practice clinic, were included in this study. Demographic and clinical characteristics were obtained. RESULTS: In primary care group, the proportions of patients younger than 15-year(31.62%) or older than 65-year(21.79%) were significantly higher than those in tertiary care group. Laboratory tests(34.24%:2.99%) and referral(11.79%:0.85%) were significantly more common in tertiary care group. The most common health problem assessed by physician and chief complaint of patients in primary care group was respiratory illness, while digestive illness was the most common in tertiary care group. CONCLUSION: Age distribution, performance rate of laboratory tests and referral, chief complaints, and the health problems in primary care group were significantly different from those in tertiary care group. Trainees in family practice residency program needs to be provided more chances experiencing common health problems in community primary care.
Age Distribution ; Ambulatory Care* ; Education ; Family Practice* ; Humans ; Internship and Residency* ; Primary Health Care ; Referral and Consultation ; Seoul ; Tertiary Care Centers* ; Tertiary Healthcare

BACKGROUND: The efficacy of oral anticoagulant therapy in reducing the risk of stroke and systemic embolism has been demonstrated in patients with nonrheumatic atrial fibrillation, but anticoagulation may introduce the risk for serious complications or adversely affect the patient's usual activities. Because the left atrial appendage(LAA) is the most likely site of thrombus formation in patients with nonrheumatic atrial fibrillation, evaluation of the LAA function with transesophageal echocardiography(TEE) may be helpful to deterrnine the high risk group for ischemic stroke. METHODS: Twenty patients with nonrheumatic atrial fibrillation(group I ), eighteen patients with rheumatic atrial fibillation(group II ) and twenty subjects in normal sinus rhythm without valvular heart disease(group III ) were underwent multiplane TEE examination. We measured maximal and minimal areas, ejection-fraction, and peak contraction and relaxation velocities of LAA. We also observed the presence or absence of thrombus and spontaneous echo contrast (SEC) in the left atrium or LAA. RESULTS: Maximal area of LAA was larger in group I and II compared with group III but there was no difference between group I and group II. Ejection fraction of LAA was much decreased in group I and II compared with group III. Peak contraction and relaxation velocities of LAA were over 45cm/sec in all cases from group Ill, but there was nearly negligible flow measurable in cases from group II. Patients from group I showed two distinct LAA flow patterns, either well defined saw tooth flow pattem(9 cases) or very low flow pattern like that of group II (11 cases). Therefore, patients from group I could be divided into two subgroups according to LAA flow profile. High flow profile subgroup had clear saw tooth flow pattern and revealed over 20cm/sec of peak contraction and relaxation velocities. The other low flow profile subgroup showed under 20cm/sec of both velocities. LAA ejection fraction was more increased in high flow profile subgroup but not significantly. Ischemic stroke occurred in six patients from group I, and all were in the low flow profile subgroup(p<0.05). SEC was observed in eight cases(73%) of the low flow profile subgroup but in only one case(11%) of the high profile sbugroup(p<0.05). All three cases with LAA thrombus belonged to the low flow profile subgroup. CONCLUSIONS: The assessrnent of LAA function by TEE may be helpful to discriminate the high risk group for the potential ischemic stroke in patients with nonrheumatic atrial firillation.
Atrial Appendage* ; Atrial Fibrillation* ; Echocardiography, Transesophageal* ; Embolism ; Heart ; Heart Atria ; Humans ; Relaxation ; Stroke* ; Thrombosis ; Tooth