• Korean Journal of Clinical Pharmacy
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• v.22 no.4
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• pp.347-355
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• 2012

본 연구의 목적은 약국을 방문하는 만성질환을 가진 노인 환자의 건강보조식품 복용여부와 그 종류 및 복용 양상을 알아보고 개별 환자의 처방의약품 목록과 함께 분석하여 발생 가능한 건강보조식품과 처방의약품의 상호작용을 평가하는 데 있다. 본 연구는 지역 약국을 방문한 만 65세 이상의 만성질환을 가진 노인환자를 대상으로 하였다. 먼저, 만성질환 노인환자의 건강보조식품 복용실태 파악을 위해, 설문 조사를 실시하였다. 처방의약품과 건강보조식품 간의 상호작용 여부 및 정도를 파악하기 위한 문헌검색은 2011년 4월까지 출간된 논문을 대상으로 PubMed를 통하여 이루어졌으며, 설문에 응답한 환자의 처방의약품 목록을 검토하여, 현재 동시 복용중인 건강보조식품과 처방의약품이 상호작용을 유발할 가능성이 있는지 파악하였다. 설문에 응답한 만성질환 노인환자 65명(45.5%)이 건강보조식품을 최근 6개월간 꾸준히 복용하고 있었으며 그 중 홍삼이 가장 많은 비율로 34명(31.8%)이 복용 중 이었다. 설문에 응답한 환자의 처방의약품 목록과 복용 중인 건강보조식품 목록을 분석한 결과, 건강보조식품을 복용 중이라고 응답한 65명 중 13명(20.0%)의 환자가 현재 복용하는 처방의약품과 잠재적 (potential) 또는 가능한 (possible) 상호작용이 있는 건강 보조식품을 동시에 복용하고 있는 것으로 나타났다. 건강보조식품과 처방의약품간의 상호작용에 대한 적극적인 복약지도와 실태 조사를 통해 만성질환 노인 환자에서의 상호작용 발생을 예방함으로써 보다 안전하고 효과적인 의약품 사용이 가능해 질 것으로 사료된다.

• Korean Journal of Clinical Pharmacy
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• v.26 no.3
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• pp.230-237
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• 2016

Background: Since the use of opioid analgesics is frequent in operation rooms (OR), the risk of medication error is high; however the use of medication in the OR has been operating independently with the hospital pharmacy. Therefore, the assessment on management of medication use in operation and the pharmacist's role is needed. Methods: We conducted the literature review and survey from anesthesiologists, operating nurses at Chung-Ang Hospital on management of medication for operation use, awareness on need for medication management efficiency, need for satellite pharmacy in the operating room and its effect. Results: 56% of medical staffs responded that management of medication in the operating room is efficient; however, 82.6% responded that they felt the inconvenience in medication delivery to the OR when additional prescription was ordered. 51.5% also responded that extra time was required for management of narcotics and inventory/record keeping. 80% agreed that there could be lost costs due to prescription missed. Medical staffs responded improving the drug management system could increase the OR efficiency (87%), and eventually bring the increase in hospital revenue (80.4%). Those who responded that implementation of OR satellite pharmacy was needed include physicians (84.6%), nurses (63.6%), and also responded that it'd bring more profit to the hospital by increasing the efficiency in OR (60.9%). Conclusion: For efficient management of medications, implementation of OR satellite pharmacy would lead to improved drug management and increased efficiency in OR and reduced cost and improved patient care.

• YAKHAK HOEJI
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• v.51 no.5
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• pp.327-335
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• 2007

This study was to evaluate economic impact of a comprehensive pharmaceutical care intervention provided by community pharmacists on drug-related morbidity and mortality in the elderly population, in a societal perspective. Clinical outcomes of pharmaceutical care included compliance increase, inappropriate medication discontinuation, and subsequent drug-related morbidity and mortality reduction. Economic outcomes included cost savings from direct medical costs reduction such as medication and healthcare resource utilization. Input costs for pharmaceutical care included pharmacist time and computerized prescription review supporting program costs. Model parameters of outcomes were derived from published literatures, and costs were from literatures and health insurance statistical data in Korea. Annual costs and benefits were estimated in the year 2005. Current usual care and standardized pharmaceutical care required 0.3 and 2.0 hours per year respectively, for elderly outpatient using average 4.4 prescription drugs per visit and average annual frequency of 17.8 pharmacy visits. Comprehensive pharmaceutical care provided to overall elderly outpatients at community pharmacies would have cost of \74,994 mil. and benefit of \357,002 mil. per year. Benefit:cost ratio was 4.8:1 and net benefit was \282,008 mil/year. It was corresponded to net benefit of \73,816/year for individual elderly patient. In addition, pharmaceutical care was estimated to reduce 1,531 drug-related deaths/year. Conclusively this study, a first attempt in Korea to evaluate an economic value of pharmaceutical care at community pharmacies, proved that it was a cost-effective intervention having significant economic benefit.

• The Journal of Internal Korean Medicine
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• v.34 no.2
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• pp.192-203
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• 2013

Objectives : To investigate the incidence of drug-induced liver injury (DILI) by combined-prescription of Korean herbal medicine (KHM; prescribed herbal medicine by doctors of traditional Korean medicine) and Western medicine on liver function. Methods : Sixty-nine in-patients who took KHM and Western medicine for various conditions were enrolled for prospective observational study. All subjects were given liver and renal function tests at the start of hospitalization to establish a baseline. After taking KHM and Western medicine, tests were done at approximately 4-week intervals afterwards. Results : Fifty-three subjects showed normal liver function test (LFT) at baseline, 50 subjects (72.5%) remained within the normal range at the second test, while 3 subjects (4.3%) tests revealed slight increase of LFT. However not a single patient had a high enough raised LFT to indicate liver injury. Sixteen of 69 subjects had abnormal baseline, 11 subjects recovered to normal levels and 5 subjects remained at abnormal level. Among all subjects, there was no statistically significant increase in LFT level between the first and second tests. Conclusions : This study shows that the combined-prescription of KHM and Western medicine did not cause any DILI. In some cases, combined treatment increased LFT levels but those increases were not high enough to have statistical significance. Additional large scale and systematical studies are required for more conclusive proof and results.

• The Journal of Korean Medicine
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• v.30 no.4
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• pp.64-78
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• 2009

Objectives: To research Korean oriental medical doctors' use of uninsured herbal extracts and how to bring about the insurance coverage of such herbal extracts. Methods: We surveyed Korean oriental doctors about the following issues from October 17th to November 15th, 2008: (1) Korean oriental medical doctors' knowledge about herbal extract insurance and the circumstances of oriental medicine in Korea, (2) their opinion on the coverage of currently uninsured herbal extracts and the dispensing of herbal extracts from pharmacies rather than from their clinics, (3) their use of herbal extracts, and (4) how to bring about insurance coverage of uninsured herbal extracts. Results: Over 70% of the respondents said that herbal medicine prescriptions have been reduced recently and that the existence of herbal medicine is in danger. In addition, 63.64% respondents agreed with expanding insurance coverage to include currently uninsured herbal extracts in spite of the fact that patients might have to obtain herbal extracts from pharmacies rather than from Korean oriental medical clinics. The average patient number per month of uninsured herbal extracts was 13.64 people, the average dosage was 5.64g, the average cost per day was 3,859 won, and the average prescription period was 2.65 days. Korean oriental medical doctors asked an average of 12,486 won for the medical examination-prescription fee and 3,292 won in fees for prescriptions obtained outside the hospital. If insurance coverage expands to include these herbal extracts, their usage is expected to increase 2.31 times. Conclusions: This study shows Korean oriental medical doctors' use of herbal extracts and their opinions about execution of herbal extracts' insurance. A periodic study such as this one will hopefully aid in establishing polices for uninsured herbal extracts' insurance.

• Journal of Oriental Neuropsychiatry
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• v.23 no.4
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• pp.11-36
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• 2012

Objectives : Sleep Disorders are very common in clinical stages and there are many reports and papers regarding this subject. I try to understand the present state of sleep research in JON (The Journal of Oriental Neuropsychiatry) for the benefits of clinical practice. Methods : We searched and read every article on JON from 1990 to 2012 and selected ones that are related to Sleep Disorder; then analyzed the data to 5 categories, like literature study, case study, Clinical Data-Analysis study, experimental study, and clinical trial. Results : 1. We Found 41 articles relating to sleep disorder in JON form 1999 to 2012, and there were 9 literature studies, 13 case studies, 13 Clinical Data-Analysis studies, 4 experimental studies, and 2 clinical trials. 2. There were Sa-Am Acupuncture Method, Pharmacopuncture, electroacupuncture, and Auricular acupuncture to treat Sleep Disorder. 3. There were many additional treatments like Purgative Therapy, etc. 4. They reported the ordinary sleep pattern of Soeumin and Soyangin, too. 5. In the experimental study, they reported several herbs, herbal prescription on the expression of melatonin receptors, and Punsimgeimgamibang on insomnia, anxiety, emotionality in rats. 6. There were 2 clinical trials, one for Hwabyung-patient with insomnia by acupuncture treatment and another for insomnia in the elderly by ETF-I program. 7. There were 2 case of other sleep disorder (enuresis, sleepwalking) and 2 literature study of dream. Conclusions : In JON regarding sleep disorder, the majority was due to insomnia. Therefore, we also have to expand our sight into other sleep diseases. We need more clinical trials and experimental researches for the construction of EBM Sleep Disorder in Oriental Neuropsychiatry.

• Journal of Preventive Medicine and Public Health
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• v.40 no.3
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• pp.249-258
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• 2007

Objectives : The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. Methods : The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. Results : The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence $(CMA{\geq}80%)$ rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. Conclusions : The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.

• The Korean Society of Law and Medicine
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• v.15 no.2
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• pp.63-89
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• 2014

In 1976, the Dalkon Shield-intrauterine device injured several thousand women in U.S.A. which caused the changes of medical deivce regulation. The Medical Device Regulation Act or Medical Device Amendments of 1976 (MDA) was introduce. As part of the process of regulating medical devices, the MDA divides medical devices into three categories. The class II, and III devices which have moderate harm or more can use the section 510 (k), premarket notification process if the manufacturer can establish that its device is "substantially equivalent" to a device that was marketed before 1976. In 21 U.S.C. ${\S}$ 360k(a), MDA introduced a provision which expressly preempts competing state laws or regulations. After that, the judicial debates had began over the proper interpretation and application of Section 360(k) In February 2008, the U.S. Supreme Court ruled in Riegel v. Medtronic that manufacturer approved by the Food and Drug Administration (FDA)'s pre-market approval process are preempted from liability, even when the devices have defective design or lack of labeling. But the Supreme Court ruled in Medtronic Inc. v. Lora Lohr that the manufactures which use the section 510 (k) process cannot be preempted and in Bausch v. Stryker Corp. that manufactures which violated the CGMP standard are also liable to the damage of patient at the state courts. In 2009, the Supreme Court ruled in Wyeth v. Levine that patients harmed by prescription drugs can claim damages in state courts. This may cause a double standard between prescription drugs and medical devices. FDA Preemption is the legal theory in the United States that exempts product manufacturers from tort claims regarding Food and Drug Administration approved products. FDA Preemption has been a highly contentious issue. In general, consumer groups are against it while the FDA and pharmaceutical manufacturers are in favor of it. This issues also influences the theory of product liability of U.S.A. Complete immunity preemption is an issue need to be more declared.

• Translational and Clinical Pharmacology
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• v.26 no.3
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• pp.128-133
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• 2018

Appropriate prescription writing is one of the critical medical processes affecting the quality of public health care. However, this is a complex task for newly qualified intern doctors because of its complex characteristics requiring sufficient knowledge of medications and principles of clinical pharmacology, skills of diagnosis and communication, and critical judgment. This study aims to gather data on the current status of undergraduate prescribing education in South Korea. Two surveys were administered in this study: survey A to 26 medical schools in South Korea to gather information on the status of undergraduate education in clinical pharmacology; and survey B to 244 intern doctors in large hospitals to gather their opinions regarding prescribing education and ability. In survey A, half of the responding institutions provided prescribing education via various formats of classes over two curriculums including lecture, applied practice, group discussions, computer-utilized training, and workshops. In survey B, we found that intern doctors have the least confidence when prescribing drugs for special patient populations, especially pregnant women. These intern doctors believed that a case-based practical training or group discussion class would be an effective approach to supplement their prescribing education concurrently or after the clerkship in medical schools or right before starting intern training with a core drug list. The results of the present study may help instructors in charge of prescribing education when communicating and cooperating with each other to improve undergraduate prescribing education and the quality of national medical care.

• The Journal of the Institute of Internet, Broadcasting and Communication
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• v.8 no.6
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• pp.55-61
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• 2008

In this paper, we proposed a multi-agent based healthcare system (MAHS) which is the combination of medical sensor module and wireless communication technology. This MAHS provides wide services to mobile telemedicine, patient monitoring, emergency management, doctor's diagnosis and prescription, patients and doctors, information exchange between hospital workers in a long distance. Also, MAHS is connected to Body Area Network (BAN) and a doctor and hospital workers. In addition, we designed and implemented extended JADE based MAHS that reduces hospital server's burden. Agents gather, integrate, and deliver the collected patient's information from sensor, and provide presentation in healthcare environment. Proposed MAHS has advantage that can handle urgent situation in the far away area from hospital like Islands through PDA and mobile device. In addition, by monitoring condition of patient (old man) in a real time base, it shortens time and expense and supports medical service efficiently.