BACKGROUND: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, their is no adequate medical service at present. We studied terminal cancer patients'behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families. METHODS: From 271 patients'families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we able to had been contact were interviewed by three student nurses with a structured questionnaire. RESULTS: The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service. CONCLUSIONS: There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.)
Agaricales ; Complementary Therapies ; Delivery of Health Care* ; Emergencies ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Medicine, East Asian Traditional ; Outpatients ; Quality of Life ; Telephone ; Ulmus ; Surveys and Questionnaires

In an effort to evaluate the usage of preceptorship in a department of family medicine, we analyzed the data which gathered during 10 months, from July 1990 to April 1991. The analyzed results were as follows ; 1. The number of precepting per preceptor was 3.5 during one day. 2. In the clinical learning, the residents needed instruction most frequently in the process for diagnosing the problems of their patients. 3. For the purpose of evaluating the teaching behavior of preceptors, we asked to 21 residents and 8 preceptors of the department who experienced the preceptorship for responding a questionnaire, which contained 30 questions. Residents perceived that the most contributable teaching behavior was "deals with students in a friendly, outgoing manner". Preceptors answered that behavior as "emphasizes problem solving approaches rather than solution per se". About the least contributable teaching behavior, residents and preceptors agreed that it was "emphasis on his/her personal research". For further improvement in clinical instruction and its evaluation, it would be necessary to develop a collaborative methodology for clinical instruction and to organize an ongoing professional communication.
Humans ; Learning ; Preceptorship* ; Problem Solving ; Surveys and Questionnaires

No abstract available.

BACKGROUND: Atrial fibrillation (AF) has been linked to an increased risk for in-hospital and long-term mortality rates in patients with acute myocardial infarction (AMI). Obesity and metabolic syndrome (MS) are known to play an important role in cardiovascular morbidity and mortality. However, it is uncertain whether obesity and MS increase the risk of AF in patients with AMI. Therefore, we investigated independent risk factors for the occurrence of new-onset AF in patients with AMI who received optimal percutaneous coronary intervention (PCI). METHODS: We prospectively analyzed the association between MS and the incidence of cardiac arrhythmia in 146 patients with AMI who underwent PCI. Twenty-four-hour Holter monitoring was performed 3 days after AMI. We divided the patients into two different groups based on the development of AF and analysed their obesity based on body mass index (BMI) (kg/m2) and evaluated the existence of MS, as well as visceral obesity with fat computed tomography. RESULTS: Seventy-five patients (51.4%) were obese (BMI > or = 25) and 64 (44%) had MS. AF occurred in 33 (22.6%) patients. Age, MS, and visceral obesity were significantly associated with AF (p = 0.001, p = 0.003, and p = 0.03, respectively). There was no difference between obese and non-obese patients in the incidence of AF and VT. Multivariate analysis revealed that age and MS were independent risk factors of post-AMI AF. CONCLUSIONS: MS is an important and modifiable risk factor for new-onset AF especially in patients with AMI who underwent PCI.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Body Mass Index ; Electrocardiography, Ambulatory ; Humans ; Incidence ; Multivariate Analysis ; Myocardial Infarction ; Obesity ; Obesity, Abdominal ; Percutaneous Coronary Intervention ; Prospective Studies ; Risk Factors