Objectives of this study are to investigate transition history of pharmacist license examination in Korea and to compare three suggestions for new examination system proposed by National Health Personnel Licensing Examination Board, Korean Association of Pharmacy Education, and Korean Pharmaceutical Association. Future task to help the examination system meet global standard is also discussed. Regulations on the examination system were retrieved from the sources posted in Ministry of Government Legislation homepage. Efforts devoted by the three organizations to make amendment on the regulations were collected from reports, official documents, minutes, and handout materials issued by the organizations. Ministry of Health and Welfare made amendment on the examination system in 2013 by rearranging the existing natural science-based eleven subjects to two subjects along with addition of a new subject named clinical-practical pharmacy. Unfortunately, however, the amendment stipulates that the new subject should include manufacturing and quality control of pharmaceuticals as part of contents in the examination. It is strongly urged that the contents of the examination should focus on professional competency as pharmacist in clinical situation. Future task to make revision on this issue is warranted to help new pharmacist enable to provide pharmaceutical care service to patients.

The study objectives were to investigate the attitude of Ajou University pharmacy students toward pharmaceutical care and to identify their perceived barriers to its provision. Secondarily, their career choices and influential factors for career decision were assessed. Method: A cross-sectional survey of Ajou University pharmacy students in all professional years was conducted in May 2014. Results: Over 2 weeks, a total of 123 students participated in the study (100% response rate). All respondents agreed that pharmaceutical care is the right direction for the provision to be headed and that pharmaceutical care will improve patient health. However, professional year was inversely associated with the degree of positive attitude toward pharmaceutical care. Highly perceived barriers to pharmaceutical care included poor image of pharmacist's role in society (67%) and lack of access to the patient medical record in the pharmacy (65%). Work environment, benefits, and salary were top three influential factors for career plans, and $6^{th}$ year students considered salary most important. Patient-oriented practices (hospital and community pharmacy) were the most preferred career choices among $6^{th}$ year students. Conclusion: Pharmacy clerkships appeared to have a positive influence on career choices of those students. Efforts should be exerted to improve pharmacy clerkships and to promote pharmaceutical care.

Learning portfolio is a collection of evidence that learning has taken place. It has gained its reputation as a useful assessment tool in the education of health professionals. The purpose of this study is to describe the pharmacy students' experiences and perceptions upon the introduction of a learning portfolio into the Introductory Pharmacy Practice Experience course. Methods: Fifty five students from one pharmacy school who used a learning portfolio to document their progress in the IPPE course participated in 16-item questionnaire exploring opinions and experiences of learning portfolio preparation, assessment, and personal and professional development and reflection. Results: Most students agree that a learning portfolio is a valuable tool in promoting self-directed and reflective learning. However most of them (46/55) also feel developing a portfolio is time-consuming, and when compared to their effort, an appropriate reward has not been given. Conclusion: To make the use of learning portfolios successful students should receive clear guidelines on their purpose, content and structure. Also the assessment criteria should be provided before the introduction of learning portfolio and their effort in developing learning portfolio should be rewarded.

Purpose: The aim of this study was to compare retrospectively the efficacy of anti-osteoporotic agents (RAL-Raloxifene 60 mg, ALD-weekly alendronate 70 mg, RSD-weekly risedronate 35 mg, AVD3-weekly alendronate 70 mg/vitamin $D_3$ 2800IU, IBD-quarterly IV ibandronate 3 mg/3 ml, ZLD-yearly IV zoledronate 5 mg/100 ml) in postmenopausal patients with osteoporosis or osteopenia. Method: This study retrospectively reviewed medical record and compared the lumbar spine BMD percentage changes of each medicine group one year later from the baseline. 209 patients (27, 50, 60, 30, 35, and 7 patients in RAL, ALD, RSD, AVD3, IBD, and ZLD groups, respectively) are within the inclusion criteria for the study. Results: From baseline to month 12, lumbar spine BMD increased significantly larger with bisphosphonate groups, compared to SERM (p < 0.05). In all bisphosphonate groups, the lumbar spine BMD were increased significantly from baseline. Of the bisphosphonates, the changes from baseline in BMD of IV bisphosphonates were more larger than those of oral bisphosphonates, and yearly, quarterly bisphosphonates yielded significantly greater BMD gains, compared with weekly bisphosphonate groups (p<0.05). In addition, patients receiving 70 mg weekly alendronate+vitamin D3 had greater gains in BMD than alendronate Single preparation (p<0.05). Conclusion: Bisphosphonates yielded significantly greater BMD gains than SERM. Of the bisphosphonates, the changes from baseline in BMD of yearly, quarterly IV bisphosphonates yielded significantly greater BMD gains, compared with weekly oral bisphosphonate groups. In addition, vitamin D3 plays an significant role in BMD gains.

Purpose: Recent investigations suggest that the antiplatelet effect of clopidogrel may be decreased when this medication is taken together with certain proton pump inhibitors (PPIs). However, there has been no study conducted in Korea regarding the clinical effect of clopidogrel-PPI interaction. This study targeted patients who received stents to investigate the effect of the concomitant use of clopidogrel and PPIs on the occurrence of adverse cardiovascular events in Korean patients. Methods: The patients who received a stent insertion at the Yeouido St. Mary's Hospital between January 2010 and April 2011 were included. The patients were divided into two groups, clopidogrel and clopidogrel + PPI, and followed for 12 months after the date of stent insertion using prescription history and medical records. The recurrence rates of the cardiovascular events among the two patient groups were statistically analyzed. Results: There was no difference between the two groups in the basic characteristics of the 157 patients in the clopidogrel group and the 62 patients in the clopidogrel+PPI group. Simple logistic regression showed a significantly higher rate of re-hospitalization in the clopidogrel+PPI group (OR=1.893, 95% CI 1.040-3.445, p=0.037). However, the results of the multivariate logistic regression of the variables found to have statistical significance by crosstabulation showed no significant difference in the rate of adverse cardiovascular events or re-hospitalization between the two groups. Conclusions: There was no significant difference between the clopidogrel and clopidogrel+PPI group among new patients with cardiovascular stents with respect to the occurrence of revascularization procedures, stent thrombosis, or chest pain, or with respect to the re-hospitalization rate for all cardiovascular events.

Purpose: The purpose of the present study was to assess the incidence of the potentially inappropriate medication (PIM) use in Korean elderly patients with heart failure, and to evaluate factors that influence PIM use. Method: Korean National Health Insurance claims database between January 2009 and December 2009 was used. Using 2012 updated Beers criteria, PIM use in heart failure patients aged 65 years or older was examined. Result: The incidence of PIM use in elderly heart failure patients was higher than in overall elderly patients. Among the 12,759 elderly patients with heart failure, 46.2% of study subjects were prescribed PIM(s) at least once. The number of PIM per 10 medications that patients received per patient was 1.53. The most commonly used PIMs in elderly heart failure patients were benzodiazepines (30.9%), non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors (16.3%), digoxin (9.9%), and spironolactone (9.0%). Women (odds ratio, 1.20; 95% CI, 1.17-1.24), medical aid (odds ratio, 1.11; 95% CI, 1.08-1.13), and long-term facilities (odds ratio, 2.69; 95% CI, 2.44-2.96) were revealed to be important factors associated with PIM use. In addition, patient's age also seems to influence PIM use. Conclusion: Elderly heart failure patients are at a greater risk for adverse drug events attributed by inappropriate medication use. Efforts to increase awareness of PIM use in elderly heart failure patients are needed. In addition, various comprehensive strategies and policies to identify and prevent PIM use should be established nationwide.

Purpose: This study was aimed to examine the financial effect of 2-tiered copayment system on annual expenditure of pharmacy benefit in the National Health Insurance (NHI) of Korea, focusing on oral antidiabetic medications. Methods: 284 oral antidiabetic products with 14 different active single ingredients listed in the National Formulary of NHI (August 2009) were assigned to tier 1 or tier 2 according to the selected criteria. 10 different combinations of coinsurance rates were selected to estimate the changes in drug expenditure cost of NHI. Results: The annual drug cost was estimated based on the drug price per unit listed in the National Formulary and the used amount of products in 2009 from the IMS Health data of Korea. In the combinations of coinsurance rate of 20% for tier 1 and 40% for tier 2, the total annual drug cost was estimated to be reduced by 1.3% in the case of no change of generic and original drug consumptions, and to be reduced by 4.3% in the case of 10% increased generic drug consumptions. Conclusion: The tiered copayment system with optimal coinsurance rates appears to be a potential strategy to reduce the financial burden of NHI in Korea by promoting the use of generic products.

Purpose: Aim of this study was to gather and evaluate perceptions of investigators, IRB members, and IRB administrators on the appropriateness of IRB review process and bioethical oversight system of national R&D (NR&D) projects. Method: Investigators, IRB members, and IRB administrators at 17 different institutions were surveyed using convenience sampling and survey questionnaires were partially group-specialized to consider any differences between the groups. Results: Participants included 29 investigators, 37 IRB members, and 17 administrators with response rate of 100% (83 of 83). According to the responses obtained, insufficient preparation time for constructing protocol and gaining IRB approval was one of the main problems in the IRB review process (investigator 79.3%, IRB administrator 88.2%). Also, discrepancy between NR&D and IRB's protocol formats was another major issue (IRB members 96.4%, IRB administrator 100%) and most investigators (89.7%) had to modify the original NR&D protocol to obtain IRB approval. Moreover, it was reported that 13.8% of investigators and 31.3% of IRB administrators did not submit midyear reports to IRB and for bioethical issues of NR&D projects, 17.2% of investigators did not include information on project status and safety issues in the annual reports. Conclusion: In conclusion, for successful and ethical completion of R&D projects, revision of both IRB review process and NR&D project protocol formats as well as implementation of appropriate bioethical oversights are necessary.

Purpose: This study aimed to investigate the correlation between the health behaviors and the aggression in Korean high school students. Methods: This was a cross-sectional study conducted with a survey of 2,676 high school students. Aggression was measured in four categories (physical aggression, verbal aggression, anger and hostility) using the Aggression Questionnaire, a modified hostility inventory by Buss and Perry. Result: Univariate analysis showed that sex, smoking, alcohol, caffeine, pain pills and gastrointestinal drugs were significantly associated with aggression scores. Boys scored higher than girls in terms of physical and verbal aggression. With respect to the habit of self-medication, students who took pain pills in the last 30 days revealed higher scores in all four aggressive constructs. From multivariate analysis, it was found that alcohol, caffeine, smoking, pain pills, sex and gastrointestinal drugs were independently associated with total aggression score in the order of importance. Alcohol and caffeine, among these factors, had strong correlation with all aggressive characteristics. Conclusion: This study identified a consistent association between the aggression of the students and health behavioral factors, but causal relationship remains to be proven.