• 한국건강관리협회지
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• 제2권2호
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• pp.154-159
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• 2004

Rheumatoid arthritis(RA) is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one percent of adults. Inflammation of the synovial membrane surrounding a joint leads to swollen, tender, and stiff joints RA has no known cure and the diagnosis is made based on clinical criteria and many different options exist for treatment. All of these factors magnify the importance of the patient-physician interaction and place a premium on the art rather than the science of medicine. The major goals of therapy for RA are to relive pain, swelling, and fatigue; improve joint function; stop joint daage, and prevent disability and disease-related morbidity. Some combination of nonsteroidal anti-inflammatory drugs(NSAIDs), steroids, and DMARDs is necessary in almost patients. In many combinations of different DMARDs or DMARDs plus biologicals are necessary for optimal control. Additionaly, all patients with RA should be educated about their disease and the therapies that will be used. Patient education is essentially early in the disease course and on going basis Much research is focused on the further development of biological agent for treatment of RA. Elucidation of the trigger or trigers for RA may allow us to begin to think about prevention of RA.

• International Journal of Computer Science & Network Security
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• 제21권2호
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• pp.171-180
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• 2021

Currently, hospitals and medical practices have a large amount of unstructured information, gathered in time at each ward or practice by physicians in a wide range of medical branches. The data requires processing in order to be able to extract relevant information, which can be used to improve the medical system. It is useful for a physician to have access to a patient's entire medical history when he or she is in an emergency situation, as relevant information can be found about the patient's problems such as: allergies to various medications, personal history, or hereditary collateral conditions etc. If the information exists in a structured form, the detection of diseases based on specific symptoms is much easier, faster and with a higher degree of accuracy. Thus, physicians may investigate certain pathological profiles and conduct cohort clinical trials, including comparing the profile of a particular patient with other similar profiles that already have a confirmed diagnosis. Involving information technology in this field will change so the time which the physicians should spend in front of the computer into a much more beneficial one, providing them with the possibility for more interaction with the patient while listening to the patient's needs. The expert system, described in the paper, is an application for medical diagnostic of the most frequently met conditions, based on logical programming and on the theory of probabilities. The system rationale is a search item in the field basic knowledge on the condition. The web application described in the paper is implemented for the ward of pathological anatomy of a hospital in Romania. It aims to ease the healthcare staff's work, to create a connection of communication at one click between the necessary wards and to reduce the time lost with bureaucratic proceedings. The software (made in PHP programming language, by writing directly in the source code) is developed in order to ease the healthcare staff's activity, being created in a simpler and as elegant way as possible.

• 보건행정학회지
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• 제24권2호
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• pp.120-127
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• 2014

Background: Since December 2010, online computerized prospective drug utilization review (pDUR) has been implemented in Korea. pDUR involves the review of each prescription before the medication is dispensed to the individual patient. The pDUR is performed electronically by Health Insurance Review & Assessment Service (HIRA), which is a Korean governmental agency, and then HIRA provides medical institutions and pharmacies with information that can be helpful to them in preventing potential drug problems such as drug/drug interactions or ingredient duplication. The aim of this study was to assess the impact of the Korean pDUR implementation on the proportion of drug-drug interactions (DDIs) using claims data from HIRA. Methods: A before-after comparison of the prevalence of DDIs between prescription was conducted, using HIRA administrative claims data of medical institution from January 2010 to December 2011. The analysis unit was the prescription issued and pairs before and after. The main outcome measures were the proportion of DDIs within- (control group) or between- physician encounters. To examine the difference, a paired t-test was applied. Results: We found that DDIs proportion between prescription decreased significantly (t=3.04, p=0.0026) after the implementation of pDUR, whereas there is no significant reduction within prescription (t=1.15, p=0.2518). With respect to the prevalence of DDIs between drug groups, the most dramatic reduction was occurred between 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors and anti-fungal agents. Conclusion: It seems effective that giving a direct feedback to prescribers by a prospective DUR. Further research is needed to assess the impact of DUR to final outcomes such as hospitalization.

• 한국임상약학회지
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• 제21권1호
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• pp.14-21
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• 2011

Drug Utilization Review (DUR) is known to play an important role to improve appropriateness of drug prescriptions. This retrospective, observational study was conducted to compare prescription patterns after installation of Computerized DUR Program (Drug Information Framework-$Korea^{TM}$) (Jan-Mar 2008; After) to before DUR program (Jan-Mar 2007: Before). 8 physicians affiliated in the S University Hospital were enrolled in the study and their 3 months' prescription data were analysed for drug prescription trends and DUR conflict events per 7 DUR screening modules (drugdrug interaction, therapeutic duplication, allergy, dosing, disease contra-indication, geriatric contra-indication, pediatric contra-indication). Average rate of DUR modules usage in 2008 (After) were 0.72. Average number of prescription drug per patient were reduced from 5.6 (Before) to 3.8 (After), and DUR program seemed to effect positively on physician's prescription related decision process. Overall DUR conflict events occurred by 8 physicians for 3 months were 17,923 Before and 20,057 After DUR program, and DUR conflict events per prescription were 2.8 Before and 2.9 After, respectively. Therapeutic duplication (37%), geriatric contra-indication (34%) and dosing (18%) were high ranked DUR conflicts. As the study was not sufficient to show a consistent trend to reduce DUR conflicts After, another study to confirm it's effectiveness would be recommended. This study would be of help to develop awareness of DUR program to healthcare providers.

• 한국임상약학회지
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• 제24권1호
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• pp.53-61
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• 2014

Background: The use of health functional food (HFF) is increasing and will continue to rise worldwide. Concerns about HFF-drug interactions are increasing as HFF are becoming more widely used. Therefore, awareness of consumers' perceptions and behaviors associated with HFF use may help health care providers improve their communications with patients. Purpose: The aim of this study was to assess the characteristics, perceptions, and behaviors associated with HFF use in South Korea. Method: The online survey was conducted from September 21th to October 7th, 2013. With the aid of Social Network Service (SNS) and google, the questionnaire was posted online on internet website targeting people aged 15 years or older so that self-reported data covering 4 domains were collected from 257 Koreans. Results: A total of 257 people responded the questionnaire. Among them, 81.3% reported experiences of HFF use. Female were more likely than male to use HFFs. There were no differences in demographic characteristics between HFF users and non-users in relation to age, education, and household income. Higher level of education was associated with high-level perception of HFF function (OR 3.9, 95% CI 1.48, 10.1) and a positive relationship was observed between the maximum number of HFFs used concurrently and age of the respondents. Among the HFF users, 42.6% reported concurrent HFF-medication use. However 73.3% of them did not disclose their use to physician or pharmacist and only 30.2% were informed about potential drug-HFF interactions. Pharmacy was most commonly reported as the source from which the respondents were informed about potential interactions. Conclusion: Many people had used HFF and medications concurrently while not being informed about potential HFF-drug interactions. Pharmacists and physicians should be vigilant for risk of the interactions and actively determine whether the patient is using an HFF before prescribing and administrating medications.

• 의학교육논단
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• 제14권1호
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• pp.51-56
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• 2012

Purpose: Precepted video review (PVR) has been considered one of the methods for the remediation of clinical performance examinations (CPX). This study quantified the effect of brief PVR on CPX scores. Methods: For two years, final-year students (61 students in the 1st year's cohort and 54 in the 2nd year's cohort) participated in CPXs. The scores on the initial CPX were announced to the students shortly after that CPX administration. There was no PVR after the initial CPX in the 1st year. All participants of the 2nd year were notified of the opportunity to voluntarily receive brief PVR after the initial CPX. Several months after the initial CPX, the students took the latter CPX in both years. The differences of scores between initial and latter CPX were compared in good performers and poor performers of the initial CPX. Results: Thirteen poor performers and 8 good performers received PVR in the 2nd year. In the 1st year, history taking (Hx), physical examination, and patient physician interaction (PPI) scores of the good performers of the initial CPX were significantly decreased on the latter CPX. In the 2nd year, the Hx and PPI scores of the good performers of the initial CPX, who received PVR, were significantly decreased at the latter CPX. The Hx and PPI scores of the poor performers of the initial CPX were significantly increased at the latter CPX in both years regardless of PVR. Conclusion: The changes in CPX scores according to PVR did not show any consistent trend. Brief PVR appears to be not sufficient for improving CPX scores.

• 대중서사연구
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• 제26권3호
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• pp.291-323
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• 2020

본 논문은 먼저 펠레그리노의 <의철학의 재탄생>에서 강조하는 현대적 의료 윤리의 가치 변화를 고찰하였다. 펠레그리노는 의료인의 윤리에 대한 인문학적 성찰을 강조해온 철학자이다. 그는 현대 사회의 변화에 따라 의료 윤리도 재정립되어야 한다고 주장한다. 이 논문은 펠레그리노의 주장을 바탕으로, 문학과 대중서사텍스트 속에서 문제적 상황을 주목하였다. 실제로 우리를 위해 의료 윤리가 무엇을 답변해야 하는지를 살펴보려 한 것이다. 의료인들은 철학적 딜레마를 겪거나 현실과 윤리 사이의 갈등을 겪어 왔다. 펠레그리노는 의료인은 질병과의 싸움에 앞서, 환자와의 상호작용을 통해 환자의 고통에 공감하고 그 요구에 응답해야 한다고 주장한다. 이것은 매우 당위적인 선언처럼 보이지만, 문학 작품과 대중서사텍스트 속의 의료인들은 이러한 윤리적 딜레마에 자주 노출된다. 이청준의 소설을 통해 의료인이 환자를 어떻게 '좋음'의 상태로 이끌어야하는 지를 성찰할 수 있으며, 메디컬 드라마들을 통해 대중들이 의료인에게 요구하는 윤리적 행위가 무엇인지를 포착할 수 있다. 코로나19로 전세계가 고통을 받고 있는 지금, 의료인들 또한 큰 고난에 처해 있지만, 동시에 대중의 존경을 받고 윤리적 존재로서의 가치를 높이고 있기도 하다. 의료가 일상의 서사가 된 지금, 우리에게 의료 윤리는 삶을 유지하기 위한 필요조건이 되고 있다. 본 논문을 통해, 의료 윤리의 중요성을 다시 인식하고, 의료 서사 속에서 구체화된 윤리적 문제를 성찰적으로 검토하는 의미를 얻을 수 있을 것이다.

• 약학회지
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• 제54권4호
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• pp.258-269
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• 2010

As people are easy to access the National Health Insurance, medical health service has been increased. It contributed to extend human's average life expectancy and to get better health care. But also increased unnecessary health service or inappropriate drug use. Therefore, DUR (Drug Use Review) is needed to induce appropriate drug use. The purpose of this study is to evaluate outpatient prescriptions by General Practitioner (GP) and Specialized Practitioner, especially indication for ENT referral including common cold which is the frequent indications that have patient see doctor. This study was reviewed retrospectively prescriptions for ENT referral collected at the A pharmacy for ENT Clinic in Cheong-Ju, B pharmacy for GP Clinic in BoEun from Feb 2nd, 2009 to Feb 28th, 2009. Each pharmacy located closed to the each enrolled clinic. The numbers of collected prescriptions were each A pharmacy (n=2501), B pharmacy (n=1343). This study was classified Drug Related Problems (DRPs) those prescriptions had as total 6 groups according to following 6 categories; 1) Unnecessary Drug, 2) Wrong Drug, 3) Low Dose, 4) Overdose, 5) Wrong Instruction, 6) Wrong Combination. In results, Specialized Practitioner's prescriptions had more DRPs than General Practitioner's prescriptions (ENT 155.34% vs GP 130.01%). In detail, Specialized Practitioner's prescriptions had more DRPs in Low Dose (ENT 16.95% vs GP 4.77%), Overdose (ENT 6.72% vs G.P 5.51%), Wrong Instruction (ENT 7.91% vs GP 5.81%), Wrong Combination (ENT 29.31% vs GP 25.09%). These DRPs would be caused from lack of consideration for dosage and drug interaction. General Practitioner's prescriptions had more DRPs in Unnecessary Drug (ENT 70.37% vs GP 78.85%), Wrong drug (ENT 4.12% vs GP 9.98%). These DRPs would be associated with drug selection. This study was assumed that Specialized Practitioner is better prescriber than General Practitioner because Specialized Practitioner complete additional intern and residency training. But, Specialized Practitioner is not always better prescriber than General Practitioner. Furthermore, prescriptions of both Specialized Practitioner and General Practitioner had many problems. In conclusion, It could be cut down the excessive medical expense and expected more efficient medical care by reducing DRPs, thus contributing to the improvement of national health. In order to pharmacist must have good professional ability of pharmacotherapy to help the physician for the drug selection.