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Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic.

Chang Li TANG ; Dung Hyun MOON ; Myoung Ho HONG ; Kyung Hwan CHO ; Youn Seon CHOI ; Do Kyung YOON ; Jeong A KIM ; Young Mee LEE ; June Young LEE

Journal of the Korean Academy of Family Medicine.2002;23(1):40-59.

BACKGROUND: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine is implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic. METHODS: The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence - Based Medicine Center in Oxford. The Patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. ln case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels. RESULTS: There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%) . As a result, 80.4% of the total 144 pairs were regarded as evidence - based medicine. CONCLUSIONS: The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.
Ambulatory Care Facilities* ; Clinical Medicine ; Diagnosis ; Evidence-Based Medicine ; Evidence-Based Practice ; Hope ; Humans ; Outpatients* ; Specialization

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The variability of blood pressure according to the number of measurement for diagnosis of hypertension.

Cang Ho YOUN ; Tae Jung KWON ; Dong Hyun KIM ; Jung Bum LEE

Journal of the Korean Academy of Family Medicine.2002;23(1):33-39.

BACKGROUND: Hypertension is a common, chronic disease that poses as a main risk factor of coronary artery disease. Therefore, it requires accurate diagnosis. This study attempted to examine the problem of misclassification and accurate diagnosis of hypertension in primary care settings and to consider the relationship between variability of blood pressure and number of measurements. METHODS: Among the 168 patients with initially high blood pressure who visited health screening center of one university hospital from May to November, 1999, 97 persons who corresponded to the following conditions were chosen for this study. We classified hypertension as stage 1 and 2. The subjects were not previously diagnosed as hypertensive and had no past history of use of antihypertensive medication. Blood pressure was measured according to 1999 WH0/1SH Hypertension Guideline, and two or more measures were performed at each visit on five separate occasions at one week intervals RESULTS: The mean of initial blood pressure was 169.6 mmHg in systole, 96.3 mmHg in diastole. The mean of subsequent blood pressure was 165.0 mmHg, 146.1 mmHg, 143.4 mmHg, 138.7 mmHg in systole and 92.5 mmHg, 88.4 mmHg, 87 mmHg, 85.1 mmHg in diastole, which showed the tendency to be lower. In both systole and diastole, the mean differences between first and second measurements, second and third measurements were significant, but insignificant between third and forth measurements, and forth and fifth measurements. We divided systolic and diastolic pressures into two subgroups according to stage 1,2 classification of hypertension. In stage 1 subgroup, the means of blood pressures were lower from 151.3mmHg to 135.4 mmHg in systole, from 95.1 mmHg to 85.3 mmHg in diastole, but there were not significant. In stage 2 subgroup, the mean blood pressure was lower from 169.7 mmHg to 142.5mmHg in systole, from 105.4 mmHg to 87.8 mmHg in diastole, and the mean differences between first and second measurements, second and third measurements were significant, but not significant between third and forth measurements, and forth and fifth measurements. CONCLUSION: Blood pressure tends to be checked significantly lower until subsequent third measurements, but not thereafter. We think that more studies to find out how many blood pressure measurements are needed for diagnosing hypertension in consideration of patient's blood pressure level and risk factors.
Blood Pressure* ; Chronic Disease ; Classification ; Coronary Artery Disease ; Diagnosis* ; Diastole ; Humans ; Hypertension* ; Mass Screening ; Primary Health Care ; Risk Factors ; Systole

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Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic.

In Soo PARK

Journal of the Korean Academy of Family Medicine.2002;23(1):23-32.

No abstract available.
Ambulatory Care Facilities* ; Humans ; Outpatients*

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Post-stroke Complication.

Jung Bin SHIN

Journal of the Korean Academy of Family Medicine.2002;23(1):13-22.

No abstract available.

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Cerebrovascular disease.

Sung Ryung LIM

Journal of the Korean Academy of Family Medicine.2002;23(1):1-12.

No abstract available.

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A Case of High Grade B-Cell Type Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Found in Patient with Weight Loss.

Tae Seong LEE ; Myung Seop BYUN ; Hyung Sam KIM ; Jae Hong CHOI ; Hwa Sook JEONG ; Tae Keun KANG ; Joong Kyeum PARK

Journal of the Korean Academy of Family Medicine.2006;27(10):830-834.

The 68-year-old man who have no particular symptom except 10 kg weight loss was received the gastroscopy as a part of diagnostic tests. On his gastroscopic examination, it was ascertained as high grade B-cell type mucosa-associated lymphoid tissue (MALT) lymphoma from the biopsy of the erosive lesion on the angle of stomach. This lesion, after pharmacotherapy for Helicobacter pylori, was visible the normal mucosal pattern at the gastroscopic follow-up. Hereupon the writer tried to review the clinical aspect, the diagnosis, the treatment, and the prognosis, along with the literature investigation regarding MA LT lymphoma.
Aged ; B-Lymphocytes* ; Biopsy ; Diagnosis ; Diagnostic Tests, Routine ; Drug Therapy ; Follow-Up Studies ; Gastroscopy ; Helicobacter pylori ; Humans ; Lymphoid Tissue* ; Lymphoma* ; Prognosis ; Stomach ; Weight Loss*

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Dietary Underreporting from the 2001 Korean National Health and Nutrition Survey.

Hyun Ah PARK ; Jung Sun LEE ; Sook Mee SON

Journal of the Korean Academy of Family Medicine.2006;27(10):822-829.

BACKGROUND: Underreporting in self-reported dietary survey is a potential source of bias in nutritional epidemiology. We assessed if dietary underreporting existed in the 2001 Korean National Health and Nutrition Survey (KNHANS) and evaluated the health related factors and nutrients associated with dietary underreporting. METHODS: The subjects were 2,552 men and 3,335 women, 18 years of age or older, with a complete 24 hour recall and physical examination data including height and weight. Basal metabolic rate (BMR) was calculated from weight and height using WHO equations. Questionnaire to assess daily physical activity and regular exercise was done. EI/BMR ratio was used to evaluate dietary underreporting. RESULTS: The mean EI/BMR ratio of Korean men and women were 1.43+/-0.56 and 1.41+/-0.57, respectively. Among the total, 20.6% of men and 22.8% of women reported their energy intake lower than their BMR. Age was negatively related with EI/BMR ratio only in women (P<0.001). Body mass index, education level, and household income were negatively and daily physical activity was positively associated with the EI/BMR ratio in both sexes. Lower EI/BMR ratio was significantly associated with lower reported fat energy density (% of energy intake) and higher reported carbohydrate and protein energy densities. The EI/BMR ratio was related negatively with nutrient energy densities of Vitamin C, Calcium, and Iron. CONCLUSION: We could confirm selective dietary underreporting in the 2001 KNHNS. Caution should be paid on the interpretation of the nutrition survey data and efforts should be exercised to reduce dietary underreporting at data collection stages.
Ascorbic Acid ; Basal Metabolism ; Bias (Epidemiology) ; Body Mass Index ; Calcium ; Data Collection ; Education ; Energy Intake ; Epidemiology ; Family Characteristics ; Female ; Humans ; Iron ; Male ; Motor Activity ; Nutrition Surveys* ; Physical Examination ; Surveys and Questionnaires

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Visceral Abdominal Fat as a Determinant of Arterial Stiffness in Overweight and Obese Women.

Ji Weon LEE ; Hye Ree LEE ; Jaeyong SHIM ; Sang Hwan KIM ; Jee Aee IM ; Duk Chul LEE

Journal of the Korean Academy of Family Medicine.2006;27(10):815-821.

BACKGROUND: Increased abdominal obesity is clearly associated with metabolic diseases and associated with increased risk for atherosclerosis and cardiovascular diseases. But the mechanisms underlying these associations are not completely understood. The aim of this study was to correlate the regional body composition with pulse wave velocity in the overweight and obese women. METHODS: We investigated 104 overweight and obese participants. Regional body composition was distinguished by anthropometry, dual-energy X-ray absorptiometry, and computed tomography (CT). For estimates of arterial stiffness, we measured brachial ankle pulse wave velocity (baPWV). Fasting blood glucose, lipid parameters, CRP, and free fatty acid were measured. Pearson's correlation analysis and multiple regression analysis were conducted to identify the relationship between baPWV and regional body composition. RESULTS: Average age, fasting blood sugar, HDL-cholesterol, triglyceride, HOMA-IR, abdominal visceral fat area measured by CT, visceral fat area/ subcutaneous fat area (VSR), and visceral fat area/midthigh muscle area (VMR) were all significantly higher in the visceral obesity group than the subcutaneous obesity group. BaPWV was positively correlated with age, blood pressure, triglyceride, waist circumference, waist hip ratio, abdominal visceral fat area measured by CT, and VSR and inversely correlated with thigh subcutaneous fat area. In multiple regression models, after adjustment for confounding factors, baPWV was independently correlated with abdominal visceral fat area measured by CT (R2=0.560, P=0.006). CONCLUSION: Abdominal visceral fat area measured by CT was the only measurement positively associated with baPWV which explains the relationship of regional body composition and arterial stiffness.
Abdominal Fat* ; Absorptiometry, Photon ; Ankle ; Anthropometry ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Body Composition ; Cardiovascular Diseases ; Fasting ; Female ; Humans ; Intra-Abdominal Fat ; Metabolic Diseases ; Obesity ; Obesity, Abdominal ; Overweight* ; Pulse Wave Analysis ; Subcutaneous Fat ; Thigh ; Triglycerides ; Vascular Stiffness* ; Waist Circumference ; Waist-Hip Ratio

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Association between Insulin Resistance and Metabolic Syndrome in Healthy Adults: Comparison of the NCEP-ATP III and New IDF Definition.

Ok Yeon NAM ; Sung Hee LEE ; Jae Heon KANG ; Cheol Hwan KIM ; Seong Keol KIM

Journal of the Korean Academy of Family Medicine.2006;27(10):807-814.

BACKGROUND: Currently, several definitions for metabolic syndrome are in use. For epidemiological and clinical purposes, universally accepted definition would be needed. International Diabetes Federation (IDF) has introduced a new diagnostic criteria for the metabolic syndrome (MS). We analyzed the association between insulin resistance and MS using both the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition and new IDF definition, in order to compare the clinical utility of these two different definitions. METHODS: The subjects of this study included 206 men, aged 29~65 years, who visited a health promotion center located in Seoul. Among the subjects, we excluded hypertensive or diabetic patients. We measured their waist circumference, blood pressure, fasting glucose, insulin and lipid profiles. The metabolic syndrome was diagnosed using both ATP III and IDF definitions. We used the multiple logistic regression method to estimate odds ratio for MS according to the level insulin resistance measured by HOMA-IR. RESULTS: The prevalence of metabolic syndrome was 14.1% according to the NCEP-ATP III defintion, and 12.6% according to the IDF definition. After adjusting for age, alcohol, smoking and exercise, the odds ratios for insulin resistance of metabolic syndrome group defined by NCEP-ATP III criteria and IDF criteria were 3.04 (95%CI 1.28~7.22) and 2.33 (0.95~5.76) respectively. CONCLUSION: New IDF definition does not seem to be as sensitive as ATP III definition with respect to insulin resistance. Studies using the new IDF definition for metabolic syndrome are still scarce and therefore further investigations will be required.
Adenosine Triphosphate ; Adult* ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Education ; Fasting ; Glucose ; Health Promotion ; Humans ; Insulin ; Insulin Resistance* ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Seoul ; Smoke ; Smoking ; Waist Circumference

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Prevalence of the Metabolic Syndrome in Korean Children and Adolescents: Korea National Health and Nutrition Survey 2001.

Min Jeong SEO ; Jeong Won SEONG ; Keun Joo SOHN ; Byung Joon KO ; Jee Hye HAN ; Seon Mee KIM

Journal of the Korean Academy of Family Medicine.2006;27(10):798-806.

BACKGROUND: As the metabolic syndrome represents a constellation of cardiovascular risk factors,its prevention is very important. Especially, child and adolescent obesity and metabolic abnormalities track into adulthood and it may promote the development of the metabolic syndrome in adults. however, in Korea there are only few studies about the metabolic syndrome of children and adolescents. Therefore, the objective of this study was to determine the prevalence and distribution of the metabolic syndrome in Korean children and adolescents. METHODS: The Korean National Health and Nutrition Survey (KNHNS) 2001 was a nation representative survey with a stratified multistage sampling design. Data from a comprehensive questionnaire, physical examination, and blood sample were obtained from 1,090 Korean children and adolescents (567 boys, 523 girls), aged 10 to 19 years. The metabolic syndrome was determined by using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition modified for age. RESULTS: The prevalence of the metabolic syndrome in Korean children and adolescents was 7.1% (9.2% in boys, 4.8% in girls). The syndrome was present in 36.6% of overweight children and adolescents (body mass index [BMI] > or = 95th percentile) compared with 11.2% of at-risk children and adolescents (BMI 85th to <95th percentile) and 2.5% of those with a BMI below the 85th percentile (P<0.001). A multivariate logistic regression model showed a significant increase in risk of the metabolic syndrome in association with gender and BMI. CONCLUSION: Overall, 7.1% of children and adolescents and 36.6% of overweight children and adolescents in Korea met the criteria for the metabolic syndrome. These findings emphasize the need for both public health and clinical interventions to improve the detection, prevention, and treatment of the metabolic syndrome, especially in obese children and adolescents.
Adolescent* ; Adult ; Cardiovascular Diseases ; Child* ; Cholesterol ; Education ; Humans ; Korea ; Logistic Models ; Nutrition Surveys* ; Obesity ; Overweight ; Pediatric Obesity ; Physical Examination ; Prevalence* ; Public Health ; Surveys and Questionnaires

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