Earticle

Background and objective: Pravastatin has been shown to have favorable risk-benefit profile when it is administered to hypercholesterolemic subjects to prevent cardiovascular events. However, subjects with impaired OATP1B1 activity may be more susceptible to pravastatin-induced muscle toxicity than subjects with normal OATP1B1 activity. A systematic review was conducted to evaluate the effect of SLCO1B1 genetic polymorphism on pharmacokinetics of pravastatin. Method: Medline® and Embase® were searched for relevant studies until July 2013. The search terms used were pravastatin AND (SLCO1B1 OR OATP1B1 OR LST1 OR SLC21A6) AND (gene OR genetic* OR genomic* OR pharmacogenet* OR pharmacogenom* OR polymorph*). Results: A metaanalysis of the area under the concentration-time curve (AUC) of pravastatin in SLCO1B1*15 and SLCO1B1*1a/ *1a was conducted. Five studies met all the inclusion criteria and methodological requirements. There was no statistically significant difference in the AUC value between SLCO1B1*15 and SLCO1B1*1a/*1a (p=0.728). However, SLCO1B1*15 participants exhibited significantly higher AUC values than SLCO1B1*1b/*1b carriers (p<0.001). In case of SLCO1B1*15*15 carriers, they had significantly higher AUC value than SLCO1B1*1a/*1a subjects (p=0.002). Lastly, compared with to the subjects of SLCO1B1*1a/*1a, the carriers of heterozygous SLCO1B1*15 increased the AUC value of pravastatin statistically significantly in Asian population (p=0.014). Conclusion: The present meta-analysis suggests that subjects with SLCO1B1*15 are associated with increased AUC of pravastatin.

Objective: Undernutrition is common amongst esophageal cancer patients and therefore appropriate nutrition support is critical. Nevertheless, the effectiveness of enteral nutrition (EN) versus parenteral nutrition (PN) is still controversial. The aim of this study was to investigate the effect of EN and PN on the nutritional state and the length of hospital stay for patients who underwent an Ivor-Lewis (IL) esophagectomy. Method: A retrospective clinical analysis was performed that utilized the electronic medical records of patients who underwent IL esophagectomy during a 3-year period between January 2010 and December 2012 at a tertiary teaching hospital located in Seoul, Korea. The EN group and PN group were analyzed by comparing the nutrition supply, postoperative complications, length of hospital stay, and weight variation. Results: After an IL esophagectomy, the complication rate between the EN group and PN group was insignificant and the length of hospital stay was significantly shorter for the PN group compared to the EN group (14 vs. 16 days, respectively; p<0.001). At the time of discharge, those in the PN group lost less weight postoperatively (p=0.003). Conclusion: PN may be considered as safe nutrition support for esophageal cancer patients who underwent an esophagectomy.

Objective: It was surveyed how to help patients get better treatment for their disease by making complements based onthe survey outcomes when the pharmacists guide how to administer medicine. Methods: A total of 142 gastroesophagealreflux disease (GERD) patients answered the self-answering questions consist of 15 items about their generalcharacteristic, lifestyle and dietary style. The frequency of survey materials was analyzed to find out specific figures ofsurveyed patient’s general characteristic, lifestyle and eating habits. Results: Based on the outcomes on analysis therewas no difference between female and male patients. The characteristic based on the age group, as ones grow older, thenumber of GERD patients also increased. In case on the characteristic in lifestyle, many patients had improper habit totreat GERD. The items were smoking habits, stress control habit, sleeping postures and the way in wearing outfits. Incase of postures after having a meal, they had right lifestyle. Patients had improper habit in eating food. They enjoyedpungent food and drinks which can hinder the treatment. In case of the time of having meal, eating habit of meat andvegetables and eating food less than an hour before go to bed, this research showed that they have the right lifestyle. Conclusion: This research indicate that pharmacists give guidance GERD patients to stop smoking that is causative ofGERD and guide patients have mental stability, and patients avoid pungent food and drinks such as coffee, soda, chocolatesand mint candies.

Objective: The aims of this study are to investigate the total volume of prescribed medicines against Alzheimer’s disease(AD) and the trends of usage by analyzing the claims-data from the Korea National Health Insurance Service. Method: The demographic and claims-data were included the major AD treating medicines such as donepezil, galantamine,rivastigmine and memantine, and analyzed during the period of 2010~2012. The assessing criteria were gender,age, habitation, types of medical institution, code of ingredients, outcomes of treatment, volume and amount of claims,and the numbers of patients with dementias. After trimming the data, it were analyzed by the market size, demographictraits, characteristics of medical service, characteristics of each anti-AD medicine, etc. Results: Among the chosen4 medicines, donepezil had the top prescription volumes. Most prevalent prescribing preparations of donepezil wereconventional types. However, among the non-conventional types, oro-dispersible formulation is the fast increasing onein both volume and growth rate. This specialized preparations to improve both toleration and adherence, tend to beingprescribed generally at the tertiary medical institutions. While the younger patients with mild-to-moderate AD mostlytreated by expensive medicines in resident at the tertiary hospitals, the rest older patients with severe AD have beentreated non-expensive one at long-term care facilities. Conclusion: AD is a chronic illness therefore, long-term use oftherapeutic medications are highly important. If an anti-AD treatment was applied steadily in the earlier stages, it wouldbe achieved not only improving the quality of life of patient but also reducing the expenses in the medical and nursingcares. As the socioeconomical impacts of AD is expanding, healthcare professionals need to aware the importance ofpharmacotherapy and to improve sociopolitical fundamentals.

Objective: This study aims to explore the perception of off-label use of medications and the provision of informed consentsfrom the general public’s perspective. Methods: The study subjects (n=291) were recruited from 7 cities in Koreathrough a convenience sampling method. The self-administered questionnaire with 13 items was issued and collected. The study subjects who have had a pharmaceutical job were excluded. Results: The total of 231 respondents wasincluded. Only 23% of respondents were familiar with the concept of off-label use of medications. Eighty five percentof respondents (n=196) stated that the prescribers should explain the off-label use of a medication to their patients. Thepreferred method for delivering the message was the oral explanation (n=122, 53%), followed by oral explanation plusa pamphlet (n=94, 41%). The safety issue is the most concerned aspect regarding the off-label drug use, also effectivenessand insurance coverage. The majority of respondents (n=217, 94%) agreed that the prescriber should get a consentfrom patients before prescribing medications for off-label use. They preferred written consent to oral consent (140vs. 77). Conclusion: This study demonstrated general publics are infrequently aware of off-label use of medications. Itis important to raise public awareness of the off-label use of medications and to openly discuss its pros and cons forsafe and effective drug therapy.

Objective: The provision of pharmaceutical care service in compliance with good pharmacy practice (GPP) standards isimportant, but there is lack of studies to investigate the barriers that significantly hinder community pharmacies inKorea from adhering to the standards. This study was aimed to identify the major barriers to provision of pharmaceuticalcare service in compliance with the proposed pharmacy practice standards which have been developed based on theGPP standards recommended jointly by WHO and FIP. Methods: Questionnaires reviewed by the expert committeewere posted for 32 days on the website which is most frequently accessed by community pharmacists. The respondentscompleted them by checking the scores (Max=5, Min=1) for major barriers to provision of pharmaceutical care servicefocusing on patient information management and drug use review process in prescription fillings. The answered scoreswere automatically collected using online data processing. Mean differences between scored data were assessed byANOVA. Results: Total 321 pharmacists participated in the survey. Results indicated that ‘difficulty of diagnosis identification’(m=3.92, SD=1.21), ‘lack of time’ (m=3.48, SD=1.22) and ‘lack of updated clinical information’ (m=3.17,SD=1.10) were the major barriers to provision of pharmaceutical care service in patient information management. Themain barriers to drug utilization review were ‘lack of time’ (m=3.32, SD=1.21), ‘lack of updated clinical information’(m=3.11, SD=1.17), and ‘negative feedbacks or refusals from prescribers’ (m=3.00, SD=1.38). There were significantdifferences among the groups by location, employed number of pharmacists and acceptability to the proposed GPP standards. Conclusion: Difficulties in managing patient clinical information and lack of time were found to be the majorbarriers in providing pharmaceutical care services in community pharmacies in Korea. Further research is recommendedto determine ways to reduce these barriers in order to provide quality pharmaceutical care service that is incompliance with the internationally recognized GPP guidelines.

Korea. Survey on the current pharmaceutical care service provision was performed by PM2000 XE, a real-time pharmacymanager program, operated by Korea Pharmaceutical Information Center beginning November 4, 2013 untilDecember 6, 2013 towards all community pharmacies throughout the nation which use the program. Method: The surveyquestionnaire consisted of four sections: pharmacy type, time-based accessibility, item-based accessibility, and spatialaccessibility for non-prescription drugs. Results: Number of pharmacy responded to the survey was 331, and sizeof the responding pharmacy was mostly medium-scale (66.47%) with 30-99 prescription fillings a day. Proportion ofpharmacy with opening hour of 12 hours or longer was only 53.77% and it was less than 25% during saturdays andholidays. Item-based accessibility was generally acceptable for prescription and non-prescription drugs, medical devices,and health supplements. However, spatial accessibility for non-prescription drugs was problematic because only onequarter of the drugs was displayed over the counter, and most of the drugs were behind the counter so that customerscould not reach out. Conclusion: Based on the survey result, current situation for accessibility of pharmaceutical careservice in Korea is concluded inadequate and therefore needs multidimensional efforts to improve accessibility of theservice at national level such as Korea Pharmaceutical Association and Ministry of Health and Welfare.

Background: The pharmacy education system in South Korea has changed from four-year degree program to two-yearpre-pharmacy program plus four-year professional degree program (a total of six years) since 2009. Objectives: The purposeof this study is to assess final year student’s satisfaction on this new pharmacy education system and to explore factorsrelated to student satisfaction. Methods: A paper-and-pencil survey instrument was administered to all final yearpharmacy students at four universities located in South Korea during September of 2014. The self-administered questionnairecontained 39 items. In part 1, the quality of education with regards to school utilities, education system, humanresources, and communication domains were measured. In part 2, overall satisfactions with the new education systemwere asked to students. Responses were recorded on a seven point Likert scale. Results: A total of 207 students wereparticipated in this study. Students showed low satisfaction on school utilities and standardization of education while theydisplayed high level of satisfaction on the quality of the faculty members and preceptors at clerkship sites. Factor analysisshowed that education service was the most significant factor that affects students’ satisfaction followed by facilities,standardized education, communication, administration, pharmacy practice (p<0.05). Conclusion: The qualification of facultyand preceptors ranked number one in students’ satisfaction and it was the most significant factor. School facilitieswere found to be the second most significant factor in students’ satisfaction while students displayed poor satisfaction. The study results might need to be reflected in future education planning to improve students’ satisfaction.

Background: The first pharmacy student practice undergoing 6 year pharmacy school curriculum have begun in thehospital pharmacy, community pharmacy, pharmaceutical company and administrative office since 2013. Although mostof practice sites have prepared the program of pharmacy student practice education for several years under guideline ofKorean Association of Pharmacy Education, generally community pharmacies which start the pharmacy student practiceeducation have difficulty in performing the desirable student practice program due to absent experience for it. Sowe reported the comparison of student practice programs between mono pharmacy and multiple pharmacies conductedby Gyeongsang National University College of Pharmacy to provide the future design information of the ideal pharmacystudent practice in community pharmacy. Method: Students who practiced both multiple (multi) and mono pharmacy(mono) programs for each 5 weeks were participated the survey to evaluate the student practice programs. Results: The results of the survey on the student practice program reported that students were much more satisfied with themultiple pharmacies program than mono pharmacy program in both practical contents (4.12± 0.72 : 3.27±1.28; multi : mono)and satisfaction (4.54±0.54 : 3.54±1.3; multi : mono) and they all gave the highest points (5.00±0.00) to multiple pharmaciesprogram for recommendation because the multiple pharmacies program was significantly helpful for their experienceto plan the future career. Conclusion: Mono and multiple pharmacy practice programs would be a great helpfulfor student’s future career. However, the disadvantages of each program should be amended gradually for the unifiedand specialized program to be established the ideal community pharmacy student practice in Korea. The results will beaffected the pharmacy practice program for students in community pharmacy and the other colleges of pharmacy todesign the ideal community pharmacy practice program.

Objective: The objective of this study was to evaluate the 6-year clinical pharmacy curriculum in Korea among 35 schools of pharmacy and to compare the pharmacy practice experience curriculum with the U.S. Methods: Data on the 6-year clinical pharmacy curriculum was collected and analyzed from 35 schools of pharmacy in Korea. Data were collected from each school’s website, or through professors in clinical pharmacy or the administrative office, when not available online. Guidance for U.S. clinical pharmacy curriculum was referenced from the Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines. Results: Pharmacotherapy was the only course that was offered in every school of pharmacy with average of 11.5±2.8 credit hours offered. Only six subjects were offered in more than half of the schools. Average pharmacy practice experience credit hours in Korea were 1.8±0.6, 7.8±1.5, 4.9±1.2, 3.5±1.1, 11.8±1.2 in introductory, hospital, community, pharmaceutical industry and administration, and intensified pharmacy practice experience, respectively. While the U.S. required introductory pharmacy practice experience (IPPE) to be conducted in the real pharmacy setting, the IPPE in Korea was conducted as an in-class simulation. The total required hours of IPPEs and APPEs were 1400 hours in Korea and 1740 (300+1440) hours in the U.S. Conclusion: Clinical pharmacy curriculum in Korea is offered through a variety of courses and the pharmacy practice experience curriculum has been adopted by every school of pharmacy. A guidance outlining the major required contents of clinical pharmacy curriculum could help standardize and advance the clinical pharmacy education in Korea.