Communication with a noncooperative patient and his/her family / 의료커뮤니케이션

Difficult patients who meet in the clinic may have a negative effect on the patient’s clinical outcomes by leading to difficulties in history taking, relationship building, diagnosis and treatment. Factors that contribute to non-cooperative patients include physician factors, patient factors, environmental factors, and communication factors. In order to communicate with non-cooperative patients, efforts to prepare for interviews and build relationships, self-reflective attitudes, empathic listening, the use of preceptors or reflective teams, and the maintenance of identity as medical professionals should be emphasized. Multi-party conversations, including family members, may be difficult in patient interviews, and physician should check the emotional responses and expectations that families feel about patient care. Within a family, there are many hidden strengths that could become valuable resources for healing the patient. But they will most likely to come out when families are faced with challenges for which their present repertoire of responses seems inadequate. Health care providers can become a significant part of this process that can result in better patient care and rewarding relationships with families.

The Association of Relative Handgrip Strength with Impaired Fasting Glucose among Koreans Aged more than 20 Years Old

Background@#The prevalence of impaired fasting glucose (IFG) in Korea is increasing. Few studies have investigated the relationship between handgrip strength (HGS) and type 2 diabetes among Koreans; however, no study has investigated the relationship between IFG and HGS among Koreans. Therefore, we examined the relationship between relative IFG and HGS to evaluate HGS as a marker of prediabetes. @*Methods@#This cross-sectional study analyzed data from participants aged 20 years or older (n=9,190) who did not have diabetes and had had their body mass index, fasting plasma glucose (FPG), and HGS measured in the 2016–2017 Korea National Health and Nutrition Examination Survey. The association between relative HGS and IFG was analyzed using complex sample logistic regression analyses after adjusting for age, education, strengthening exercise, aerobic exercise, smoking, excessive drinking, and chronic diseases. @*Results@#The prevalence of IFG was 31.5 (0.9)% and 19.6 (0.7)% for men and women, respectively. According to the increase in quartile of relative HGS, FPG and HbA1c significantly decreased in both men and women (Ptrend<0.001). In multivariate logistic regression, the odds of IFG significantly decreased with the increase in quartile of relative HGS in both men and women (Ptrend=0.001 for men, Ptrend=0.002 for women). @*Conclusion@#This population-based, nationally representative study suggests that higher relative HGS is associated with a decreased risk of IFG for both men and women.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS: We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Physicians' Perspectives on the Smoking Cessation Service for Inpatient Smokers

BACKGROUND: Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services. METHODS: We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively. RESULTS: The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser. CONCLUSIONS: The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.

Physicians' Perspectives on the Smoking Cessation Service for Inpatient Smokers

BACKGROUND@#Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services.@*METHODS@#We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively.@*RESULTS@#The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser.@*CONCLUSIONS@#The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND@#Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world.@*METHODS@#We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes.@*RESULTS@#There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%.@*CONCLUSIONS@#We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention / 가정의학회지

BACKGROUND: The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. METHODS: The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,”“methods of intervention,”“measurement of outcomes,”“future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. RESULTS: For priority populations, the panel favored “elementary,”“preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. CONCLUSION: According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

Compliance and Effectiveness of Smoking Cessation Program Started on Hospitalized Patients / 가정의학회지

BACKGROUND: Varenicline is now very useful medication for cessation; however, there is only little result of researches with varenicline for cessation of hospitalized patients. This research attempted to analyze the cessation effect of medication and compliance of hospitalized patients. METHODS: This research included data for 52 patients who were prescribed varenicline among 280 patients who were consulted for cessation during their admission period. This research checked whether smoking was stopped or not after six months and analyzed their compliance, the factors for succeeding in smoking cessation. RESULTS: One hundred and ninety hospitalized patients participated in smoking cessation counseling among 280 patients who included consultation from their admission departments. And varenicline was prescribed for only 80 patients after counseling. Nineteen smokers were successful in smoking cessation among 52 final participants representing the rating of success of 36.5%. The linkage between compliance of varenicline and rate of smoking successful has no statistical significance. The factors for succeeding in smoking of hospitalized patients are admission departments, diseases, and economic states. CONCLUSION: Smoking cessation program has low inpatient compliance. Cooperation of each departments is very important for better compliance. Success rate of cessation was relatively high (36.5%). Cessation attempt during hospitalization is very effective strategy.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

Patients' Perceived Quality of Family Physicians' Primary Care with or without 'Family Medicine' in the Clinic Name / 가정의학회지

BACKGROUND: Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting. METHODS: Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists. RESULTS: A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05). CONCLUSION: The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.

The Korean guideline for cervical cancer screening

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papilloma virus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The combination test (cytology with HPV test) is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within ten years (recommendation D).

The Korean guideline for cervical cancer screening / 부인종양

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).

Health-Promotion and Disease-Prevention Behaviors of Primary-Care Practitioners / 가정의학회지

BACKGROUND: In the 1990s the primary focus of medicine was shifted to disease prevention. Accordingly, it became the responsibility of primary-care physicians to educate and counsel the general population not only on disease prevention specifically but health promotion generally as well. Moreover, it was, and is still today, considered important that physicians provide positive examples of health-promotion behaviors to patients. The purpose of this study was to investigate physicians' health-promotion behaviors and to identify the factors that influence them. METHODS: We conducted a postal and e-mail survey of the 371 members of the Physician Association of Cheonan City between May 16th and June 25th, 2011. The questionnaire consisted of 18 items, including questions relating to sociodemographic factors, screening tests for adult diseases and cancer, and health habits. RESULTS: There were 127 respondents. The gender breakdown was 112 men (88.2%) and 15 women (11.8%), and the mean age was 47.8 years. Fifty-nine (46.4%) were family physicians or interns, and 68 (53.6%) were surgeons. Twenty-six percent (26%) were smokers, and 74.8% were drinkers; 53.5% did exercise; 37% had chronic diseases; 44.9% took periodic cancer screening tests, and 72.4% took periodic screening tests for adult diseases. CONCLUSION: It was found that general characteristics and other health-promotion behaviors of physicians do not affect physicians' practice of undergoing periodic health examination.

Premedical students' experiences in community-oriented primary care / 한국의학교육

PURPOSE: Medical students must be taught community medicine to understand common community-wide health problems and develop the skills that are needed to solve them. In this study, community-oriented primary care (COPC) projects were undertaken by premedical students in a community medicine course, and their experience was assessed. METHODS: We analyzed the final reports of 570 premedical students who completed their community group projects from 2000 to 2012. RESULTS: Eighty-nine community projects were completed by the students. The average number of students per project was 6.3 (range, 3-9). The total number of project themes was 39. Sex education for high school students, guidance on learning for low socioeconomic children, and education on smoking cessation for high school students were the most frequently selected topics. The most common subjects in the projects were high school students, preschool children, elderly people, and hospice patients. With regard to methodology, the students administered questionnaires in 58 cases and held health education programs in 48 cases. In 42 cases, students used social welfare-related community resources. In their final reports, many students felt that an understanding of their identities as future physicians and of the health care and social welfare systems was meaningful. CONCLUSION: Premedical students' experiences in COPC projects varied and were positive. Teaching community medicine in a premedical course increased students' confidence with their future role as compassionate, socially responsible physicians and their understanding of community resources in a health care network.

Comparison of Metabolic Characteristics of Metabolically Healthy but Obese (MHO) Middle-Aged Men According to Different Criteria / 가정의학회지

BACKGROUND: To compare the prevalence and metabolic characteristics of metabolically healthy but obese (MHO) individuals according to different criteria. METHODS: We examined 186 MHO middle-aged men (age, 37.2 years; body mass index [BMI], 27.2 kg/m2). The following methods were used to determine MHO: the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria, 0-2 cardiometabolic abnormalities; the Wildman criteria, 0-1 cardiometabolic abnormalities; the Karelis criteria, 0-1 cardiometabolic abnormalities; the homeostasis model assessment [HOMA] criteria (lowest quartile of HOMA). After dividing the overall subjects into two age groups, we compared the prevalence and clinical characteristics between MHO and at-risk groups according to four different criteria. RESULTS: The prevalence of MHO using the NCEP, Wildman, Kaleris, and HOMA criteria were 70.4%, 59.7%, 28.5%, and 24.2%, respectively. The agreement between the groups according to the NCEP and Wildman criteria was substantial (kappa = 0.8, P < 0.001). Among individuals 35 years or younger, and regardless of method, the MHO subjects had significantly lower weight, waist circumference, BMI, body fat percentage, insulin, HOMA, alanine aminotransferase, triglyceride (TG), and TG/high density lipoprotein cholesterol (HDL-C) ratio than the at-risk subjects (P < 0.05); However, among individuals older than 35 years old, and regardless of method, the MHO subjects had different insulin, HOMA, HDL-C, and TG/HDL-C levels than the at-risk subjects (P < 0.05). CONCLUSION: The differences in metabolic profile between MHO and at-risk groups varied according to age. MHO prevalence varies considerably according to the criteria employed. Expert consensus is needed in order to define a standardized protocol for determining MHO.

Effects of BATHE Interview Protocol on Patient Satisfaction / 가정의학회지

BACKGROUND: BATHE, the acronym for background, affect, trouble, handling, and empathy, is an interview approach that can be applied in the out-patient setting whereby questions belonging to each of the 5 categories are asked in the above order. As we have been taught to believe that BATHE raises the level of patient satisfaction and the quality of medical treatment overall, this study was designed to test the validity of the claim that applying BATHE heightens patient satisfaction. METHODS: Each of the 5 doctors was assigned 10 patients (5 in the BATHE group and the other 5 in the control group) with each patient being randomly assigned to either of the groups. The control group was interviewed as usual and the BATHE group was interviewed using BATHE. Immediately after the interview, each patient anonymously filled out a patient satisfaction questionnaire. Whether the questions asked were appropriate for each category of the protocol was evaluated by the researcher through video clips taped during the interviews. RESULTS: On 7 out of 10 items on the patient satisfaction questionnaire, the BATHE group was found to experience higher level of satisfaction than the control group in a statistically significant manner. The questions asked the BATHE group were confirmed to be more appropriate for each category of the protocol except empathy than those asked the control group. CONCLUSION: As applying the BATHE approach was found to achieve higher level of patient satisfaction, we recommend using it in the out-patient setting.

Medical Students' Perception and Satisfaction with Medical Communication Teaching Using Electronic Modules / 한국의학교육

PURPOSE: To teach communication skills to medical students, a variety of instructional text and video materials are used. The purpose of this study was to investigate medical students' perception and satisfaction with medical communication teaching using electronic modules. METHODS: Medical communication subjects were developed for freshmen of the medical department. Each lesson was configured for the use of educational electronic modules. The modules were composed of a database of instructional materials and a program file that could link the materials. After the 2nd and 12th week of classes, the 8th and 14th practice interviews with simulated patients, and the end of the course, medical students' perception and satisfaction were assessed. RESULTS: Forty-five students participated in the survey. Students' satisfaction after the 2nd and 12th week of class was 16.2 (standard deviation [SD], 2.0) and 16.2 (SD, 2.1), respectively. The correlation between class satisfaction and awareness of the usefulness of the electronic modules was significant (p<0.05). After the end of the course, the students' average satisfaction score was 6.7 of 10 points (SD, 1.4). Satisfaction with the practice interview and evaluation using simulated patients was 7.5 (SD, 2.3). For the practice interview, empathy, building a relationship, effective questioning, and active listening could be applied. CONCLUSION: Medical student satisfaction with medical communication teaching using electronic modules was high. Students who were aware of the usefulness of the electronic modules had higher satisfaction with their classes. Many interview skills of the initial and middle phase of interviewing could be applied for the practice interview.

Smoking Cessation Rate and Related Factors of Varenicline in Clinical Practice / 가정의학회지

BACKGROUND: Varenicline is recently known as smoking cessation medicine has no results of researches conducted in the actual practice settings except for incipient clinical trials. This research attempted to analyze the factors for smoking cessation by using Varenicline prescribed in the family clinic, and the efficacy of Varenicline. METHODS: Brief smoking cessation education was conducted on 140 people who visited the Department of Family Medicine at Dankook University and Varenicline was prescribed for them. This research checked whether smoking was stopped or not after six months and analyzed the factors for succeeding in smoking cessation. RESULTS: Varenicline was prescribed for the 140 people. After six months, 46 smokers were successful in smoking cessation, representing the rate of success of 35.4%, and after 12 months, 31 people of 83 people were successful in smoking cessation, representing the rate of success of 37.3%. The group less smoke than 24.3 cigarettes/day (the average daily smoking amount) has higher quit rate than the group more smoke than 24.3 by 4.9 times. The group takes Varenicline longer than 26.7 days (the average Varenicline dosage period) has higher quit rate than the group takes Varenicline shorter than 26.7 by 4 times. Smoking-cessation rate was 4.5 times when trying to stop smoking by the doctor's recommendation. It was higher than when trying to stop smoking by self-determination. In the multivariate analysis, there were significant relationships in daily smoking amount, dosage and period of Varenicline, and motivation of visits. CONCLUSION: Varenicline is one of the useful medication for quitting smoking in family practice setting. Better compliance of medicine shows better quitting rate.

Four Cases of Carcinoid Tumor in Asymptomatic Thirties / 가정의학회지

Carcinoid is a neuroendocrine tumor and contains many peptide substances and biological active amines, so if it is released, it can cause carcinoid syndrome. However, most carcinoid tumors are unfortunately asymptomatic, and it is difficult to find one smaller than 1 cm because it doesn't have prominent mucosal elevation and change. We can reduce expenses and recovery period of the patient by using a relatively noninvasive endoscopic mucosal resection, unless it has distant organ and lymph node metastasis. Colonoscopy is an optimizing diagnostic tool for early detection of asymptomatic carcinoids. But according to colonoscopic guidelines of many institutes, they recommend to perform a screening colonoscopy in the asymptomatic fifties if there are no risk factors. However, a careful examination of colonoscopy is needed, because possibility of malignant tumor in aymptomatic young age. The authors report four cases of carcinoid tumor in asymptomatic thirties with review of several literatures.