• Title/Summary/Keyword: Patient Prescription

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Actual situation and prescribing patterns of opioids by pain physicians in South Korea

  • Kim, Min Jung;Kim, Ji Yeon;Lim, Yun Hee;Hong, Sung Jun;Jeong, Jae Hun;Choi, Hey Ran;Park, Sun Kyung;Kim, Jung Eun;Lee, Min Ki;Kim, Jae Hun
    • The Korean Journal of Pain
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    • v.35 no.4
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    • pp.475-487
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    • 2022
  • Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions: The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

Case Report of Hemiplegia after apoplexy in a Patient with Monoplegia on Right upper Extremity Treated with Herbal Prescription (우상지(右上肢) 단마비(單痲痺)가 주증(主症)인 풍비 환자의 만금탕가미방(萬金湯加味方) 투여 호전 1례)

  • Jeong, Byeong-Ju;Woo, Sung-Ho;Kim, Byung-Chul;Kim, Yong-Ho;Seo, Ho-Seok;Hwang, Gyu-Dong;Jang, Ha-Jeong;Nam, Hyo-Ick;Kim, Hoi-Young;Kim, Jin-Won
    • The Journal of Internal Korean Medicine
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    • v.27 no.1
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    • pp.288-293
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    • 2006
  • Background : Monoplegia is the paralysis of a limb. It is commonly caused by an injury to the cerebral cortex, and rarely caused by injury to the internal capsule, brain stem, or spinal cord. Most problems with cerebral cortex is derived from the occlusion of a brain cortex blood vessel due to thrombus or embolus. Objectives : This study is to see if there is a significance in thermal differences of acupoints in diagnosis and treatment of monoplegia on an upper extremity to test the validity of acupuncture and herbal treatment for it. Methods : By using Digital Infrared Thermographic Imaging(DITI), thermal differences$({\Delta}T)$ of acupoints on the upper extremity in a patient with monoplegia on the right upper extremity were measured after an attack of the disease. By giving Mangeum-tang(萬金湯) and treating the patient with acupuncture. the temperature changes of the upper extremity were examined through DITI and improvement was observed. Results : Compared with the left arm which suffered no such injury, the right recovered about 80% of sensation, and the grade of monoplegia improved from Grade O to Grade V. Also, the temperatures of right palmar-dorsal hand and the region of Weiguan(外關, Waiguan, TE5) were $1^{\circ}C$ and $1.45^{\circ}C$ higher than the same left region on admission day, but the thermal differences$({\Delta}T)$ narrowed to $0.5^{\circ}C$ by the last day. Conclusions : Results suggest that DITI screening is a reliable method of prognosis and that the time required for treatment can be estimated through this method in cases of monoplegia to an upper extremity. Also, progress in treatment is reflected in thermal differences of acupoints of the monoplegic upper extremity in accordance with the theory of meridian. This supports a role for acupuncture and herbal treatment for monoplegia.

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A Study on the Surface Dose Distribution by Scattered and Leakage Radiation in Radiation Therapy (방사선 치료 시 산란선 및 누설선에 의한 표면선량 분포에 관한 연구)

  • Kang, Jongsu;Jung, Dongkyung;Kim, Yongmin
    • Journal of the Korean Society of Radiology
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    • v.12 no.3
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    • pp.351-357
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    • 2018
  • During radiation therapy, the patient is exposed to secondary radiation by scattered and leakage radiation. For the diagnostic radiation, guidelines for reducing the patient's exposure as the diagnostic reference level are provided. However, in the case of therapeutic radiation, even though the radiation dose by the secondary radiation is considerable, the prescription dose is not limited because of the reason of the therapeutic efficiency. The purpose of this study was to evaluate the secondary radiation that the patient could be received at the peripheral tissue during the radiotherapy using the linear accelerator with the radiophotoluminescent glass dosimeter. In addition, we measured the degree of saturation of the luminescent amount according to the build-up characteristic of the radiophotoluminescent glass dosimeter. As a result of carrying out this study, the exposure dose decreased drastically farther away from the treatment field. When the head was irradiated with 1 Gy, the neck could be exposed to 18.45 mGy. When the same dose was irradiated at the neck, 15.55 mGy of the head and irradiated at the chest, 14.26 mGy of the neck and irradiated at the pelvis, 1.14 mGy of the chest were exposed separately. The degree of saturation of the luminescent intensity could be overestimated by 1.8 ~ 4.8% depending on time interval for 3 days.

Selection of Tasks for Assessment of Pharmacy Clinical Performance in Korean Pharmacist Licensure Examination: Results of an Expert Survey (약사국가고시 실기시험 영역 선별을 위한 전문가 조사)

  • Han, Nayoung;Lee, Ju-Yeun;Gwak, Hye Sun;Lee, Byung Koo;Lee, Young Sook;Lee, Sukhyang;Yong, Chul-Soon;Kim, Joo Hee;Oh, Jung Mi
    • Korean Journal of Clinical Pharmacy
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    • v.27 no.3
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    • pp.119-126
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    • 2017
  • Background: As the demands of pharmacist's role and quality performance have increased, the verification of pharmacist's ability has been required. In this study, we aimed to select appropriate items for assessment of pharmacist's knowledge, attitude and performance. Methods: Based on the pharmacist job analysis, we selected duties and tasks in consideration of applying pharmacy practical examination through brainstorming of internal researchers and group discussion with experts. Survey was conducted to evaluate the tasks according to the criteria detailed below: Realistic, Understandable, Measurable, Behavioral and Achievable (RUMBA). The subjects included professors at colleges of pharmacy and instructors of institutional or community pharmacy settings. Results: Nine duties including 41 tasks were drawn for the survey through primary internal researchers. Of the 90 respondents, 95.6% were professors or preceptors who was engaged in practical training, and 62.2% had more than five years of practical experience. As a result of survey and discussion with expert panel, selected seven duties were selected as followings: 'Patient (customer) reception', 'Drug preparation and distribution', 'Patient care', 'Administration', 'Patient counseling', 'Non-prescription medication counseling', and 'Provision of drug information'. The final 20 tasks from seven duties were chosen to assess skills that a pharmacist should be able to perform. Conclusion: This is the first study to select the items that can be included in pharmacist practical examination in the future, based on the RUMBA criteria. As a next step, it is necessary to study how to implement these items.

The Current State of Lens Care in Contact Lens Wearer (콘택트렌즈 착용에 따른 사용자 실태조사)

  • Ryu, Geun Chang;Kim, In Suk
    • Journal of Korean Ophthalmic Optics Society
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    • v.7 no.1
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    • pp.15-20
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    • 2002
  • The Hydroxyethyl methacrylate(HEMA) was developped in 1960's and later the use of contact lenses increased. At present more and more people use RGP contact lenses. Due to the wide range of optical corrections available and due to their high oxygen transmission Japanese and Korean people like them. Nevertheless one of nine CL users(beginners) stopped wearing the CL within the first year. We conducted a survey to evaluate the level of patient compliance in lens care and maintenance and to assess practitioner knowledge of contact lens information. Generally 6% of contact lens wearers drop out per year. The aim of this research was to find out what opticians can do to reduce the drop-out rate by getting information on handling, on general data of the patient and on optical prescription. Lens wearer were asked to complete a 10 question survey that focused on lens care-wear modality, lens replacement, storage, symptoms and case disinfection. There were total 180 participants in the study. Most of contact lens wearers have an inadequate understanding of contact lens care system. Therefore, it is important that contact lens specialists place more emphasis on practitioner education about general contact lens fields and reinforce patient education during the dispensing visit.

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The Nature of Patient's Disagreement with Doctors among Some Rural Residents (일부 농촌주민에서 의사에 대한 환자의 의견불일치)

  • Lee, Moo-Sik;Cho, Hyong-Won;Kim, Eun-Young;Chun, Byung-Chul;Shin, Dong-Hoon
    • Journal of agricultural medicine and community health
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    • v.24 no.2
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    • pp.315-329
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    • 1999
  • Recently, dissatisfaction with aspects of health care has been complemented by directly at complaints such as informal, formal and litigation. But some people take action and other not in spite of feeling of dissatisfaction. This study was to investigate an accounts of patient's disagreement with doctor's care from a community sample, and make a distinction between felt disagreement and disagreement actions. This study was done in six hundred forty residents in Sungjoo County of Kyungbuk Province and Nonman city of Chungnam Province. The questionnaires of interview included sociodemographic data, health status data, a nature of patient's disagreement with doctor and actions taken following or during the disagreement episode. Approximately sixteen percent of sample reported a disagreement, and nine percent reported action taken following or during the disagreement episode. Age, educational attainment, income and area were significantly related with experience of disagreement episode in univariate analysis. In people who experienced the disagreement episode, nearly forty-one percent reported on disagreement about the diagnosis related, twenty-eight percent reported doctor-patients relationship related, twenty percent reported treatment related, and eleven percent reported prescription drug related. In people who experienced actions taken following or during the disagreement episode, nearly fifty-four percent acted as 'sought a second opinion or visit other doctor', thirty-six percent acted as 'verbally challenged the doctor', thirty-two percent acted as 'stopped prescribed treatment or medication', twenty-nine percent acted as 'made repeat visits to the same doctor', twenty-five percent acted as 'eventually left and changed doctor'. Results of multivariate analysis, age, marital status, have or haven't chronic disease, and general satisfaction with health service were significantly related with experience of disagreement episode and marital status was significantly related with experience of actions taken following or during the disagreement episode. This study is experimental and exploratory trial about a relationship between patient's disagreement with doctor and actions taken following or during the disagreement episode in some community of Korea. We find that patient's disagreement with doctor and actions taken following or during the disagreement episode is latent in our community. We suggest that the relationship between felt disagreement and disagreement action is more complicated and worthy of further study.

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Acne Treatment Cases with Hwangryeonhaedok-tang (황련해독탕가미방(黃連解毒湯加味方) 발효한약으로 치료한 여드름 환자 증례)

  • Oh, Chung-Sun;Kim, Mi-Sun;Kim, Il;Kim, Hye-Yoon;Park, Sung-Ik;Choi, Seung-Il;Hong, Dae-Sung
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.22 no.3
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    • pp.228-236
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    • 2009
  • Objectives : Acne, one of the most common disorders in dermatology clinic, is a chronic inflammatory disease which has the symptoms of comedones, papules, pustules, cysts, nodules and scars mainly on the face. Although some of pathologic findings are suggested, but the exact causes and mechanisms are not yet known in Western Medicine. Hwangryeonhaedok-Tang(HRHDT) is an antiinflammatory, antipyretic and detoxifying herb decoction. In this report, we would like to share our experience of acne treatment with HRHDT. Methods : We had treated several patients with acne, facial flushing and uprising febrile sensation on face using oral administration and external application of HRHDT. HRHDT is basically made up with Scutellariae Radix, Coptidis Rhizoma, Phellodendri Cortex and Gardeniae Fructus. In this trial, several other herbs were added according to the individual patient's accompanying symptoms. After the decoction of herbs in amount for 10 days, $Yogourmet^{(R)}$ Kefir Starter 10 g was added to the herbal solution that was then fermented in an incubator at $25^{\circ}C$ for 72 hours, and divided into 30 doses. Results : Photographies were taken before and after the treatment. The severities of acne were evaluated with these photos according to the Korean Acne Grading System(KAGS). As results, we observed dramatic clinical improvements and the decreases of KAGS grades after the average treatment period of 8 weeks. The medication was orally administered 3 times a day and the external treatment was applied average twice a week during the whole treatment period. Conclusions : From these results, HRHDT may be considered as a good prescription for the febrile and toxic type of acne patients.

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Structuralistic Analysis for Establishment of Concept and Variables of Shanghan Diseases (상한병(傷寒病)의 개념(槪念)과 논치근거(論治根據) 확립을 위한 구조주의적 분석)

  • Chi, Gyoo Yong
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.29 no.2
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    • pp.127-132
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    • 2015
  • In order to grasp the clear concepts and variables to treat Shanghan diseases which has complex meaning by each medical literature, several concepts and analytic method of structuralism from early to late stage encompassing Saussure and Derrida were used. Main concepts are langue and parole, signifiant and signifie, syntagme and paradigme, denotation and connotation, synchronie and diachronie, identity of structure and differance etc. and methods are substituting these concepts to historical Shanghan theories from Zhongjing to Ming-Qing dynasty and comparisons of synchronie about their era. Essential qualities of Shanghan diseases are pathologic phenomena under the order of unification of nature and man formed through concrescence between individual human body and geo-climatico-socio-cultural environmental conditions, neither injuries by cold pathogen nor five types of exopathogenic febrile diseases. The former environmental elements can be inferred from general traits of desires and public pathological aspects of social members, and the latter personal factors from corresponding features to those pathogenic variables. In addition, the concepts of Shanghan disease are added successively up to now via Jin-Yuan's four great masters and Wenbing masters, and thus the new concepts of denotation became another connotation obtaining new signifiant. In this way, for the treatment of Shanghan diseases, new theories should be made for ranging prescription over the wenbing field; reflecting not only climatical variables but also each patient's physio-pathological features and sociocultural variables. Thereby an appropriate and reasonable therapeutical systems can be designed and can guide research direction hereafter.

The Development of Exercise Therapy Protocol Applied to an Efficacy Expectation Promoting Program in Type 2 Diabetes Mellitus Patients (효능기대증진 프로그램을 적용한 운동요법 프로토콜 개발 - 제 2 형 당뇨병 환자를 중심으로 -)

  • Hwang Ae-Ran;Kim Chun-Ja
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.7 no.3
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    • pp.366-378
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    • 2000
  • Type 2 Diabetes Mellitus patients have chronic metabolic disorder and they need self care for their lifetime. But most Diabetes Mellitus patients don't know how to do a self care due to the lack of adequate support from health care professionals. It has been reported that lack of exercise therapy compliance guide is very important one. This study was conducted to develop an exercise therapy protocol applied to an efficacy expectation promoting program based on Bandura's self efficacy model for type 2 Diabetes Mellitus patients. Firstly, a conceptual framework was developed through efficacy expectation promoting Program based on Bandura's self efficacy model. In order to identify the contents of program and to design a preliminary protocol, a with the consultation experts was made. A clinical validity was tested using twenty type 2 Diabetes Mellitus patients who received follow-up care regularly through the diabetic out-patient clinic from October, 1998 to May, 2000. After this process, the final protocol was developed. The results of this study are summarized as bellows : The final exercise therapy protocol applied to an efficacy expectation promoting program for type 2 Diabetes Mellitus Patients consists of individualized exercise test and prescription, a small booklet relating personal experience with Diabetes Mellitus and a telephone coaching program for 12 weeks on performance accomplishment, vicarious experience and verbal persuasion, which are all induction modes of efficacy expectation. It is concluded that the exercise therapy protocol applied to an efficacy expectation promoting program is applicable to type 2 diabetes mellitus. And this exercise therapy protocol could show a positive effect on the exercise compliance of Diabetes Mellitus patients.

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The Effects of Planned Exercise Program on Metabolism, Cardiopulmonary Function and Exercise Compliance in Type 2 Diabetes Mellitus Patients (계획된 운동프로그램이 제 2형 당뇨병 환자의 대사, 심폐기능 및 운동이행에 미치는 영향)

  • 황애란;유지수;김춘자
    • Journal of Korean Academy of Nursing
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    • v.31 no.1
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    • pp.20-30
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    • 2001
  • This study was conducted to identify the effects of a planned exercise program based on Bandura's self efficacy model on metabolism, and the exercise compliance in type 2 diabetes mellitus patients. The study design was a nonequivalent pre-test post-test control design. Thirty four type 2 diabetes mellitus patients, who received follow-up care regularly through the diabetic out-patient clinic, were randomly sampled for this study. Twenty patients were assigned to the experimental group and fourteen patients were assigned to the control group. In the experimental group, a planned exercise program is composed of an individualized exercise prescription for 12 weeks, an individual education, and even a telephone coach program. In the case of the control group, they were instructed to continue with their usual schedules. The data collection period was from March 1999 to February 2000 Data were analyzed using SPSS/WINDOW 10.0 program. The results were as follows. 1. In the experimental group, the level of fasting blood sugar has significantly decreased from 188.20 mg/㎗ to 155.55 mg/㎗ after planned exercise program (F= 16.86, p=.000). For lipid metabolism, body fat per cutaneous decreased from 27.16% to 26.57% after planned exercise program. The score of self efficacy has increased from 64.20 to 66.65 after planned exercise program and it was statistically significant (F=4.850, p=.040) The functional vital capacity has increased from 3.28$\ell$ to 3.37$\ell$and it was statistically significant(F=7.300, p=.020). 2. In an after effect of a planned exercise program, 35 percent of the subjects who participated in a planned exercise program continued to exercise for another six months. In conclusion, the planned exercise program can improve cardiopulmonary function, glucose, and lipid metabolism. This program was show a positive effect on the self efficacy and exercise compliance.

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