Earticle

The preventive effect of Salvia miltiorrhiza extracts (SM) with or without high molecular weight soluble kitosan (K) on the progress of bone loss induced by ovariectomized (OVX) was studied in rats. From light microscopic analyses in histochemistry data, trabecular bone area in OVX rats was significantly decreased compared with that in sham rats. The decrease was regulated by administration of SM and especially the combination of SM and K (SM + K) for 7 weeks. In addition, the numbers of osteoblasts and osteoclasts were regulated in SM + K-administered rats but not different from those in either SM or K-administered rats. In OVX rats, free Triiodothyronine (T3) and Thyroxine (T4) were similar to control, ruling out the involvement of abnormal thyroid hormone. Although serum calcium is similar among all the groups, estrogen level was higher especially in SM+K-administered rats. These results strongly suggest that SM+K are effective in preventing the development of bone loss induced by OVX in rats.

Objectives: With more and more health economic evaluations being performed in many countries, the question of whether the results from the foreign studies can be transferred to other country is becoming important. The objective of this study was to conduct a case study using three transferability diagnosis tools for economic evaluation on rheumatoid arthritis. Methods: Three diagnosis tools were used to assess transferability: Welte’s tool, Boulenger’s and Urdahl’s. Five researchers who have experience on economic evaluation made consensus on the evaluation through the semi-delphi method. Results: With Welte’s tool, absolute and relative prices in healthcare, practice variation, health-status preference, productivity and work-loss time were evaluated as biased. The transferability information score by Boulenger’s was 85.9%, which means qood quality reporting. In case of Urdahl’s, research questions were well defined and reporting was transparent and explicitly stated. However, both the relevance of data inputs to Korea and robustness of model were relatively low. In conclusion the UK study on rheumatoid arthritis could be partially transferable to Korea, and will need modeling-based adjustments.

Gemtuzumab ozogamicin (GO) is an antibody-targeted chemotherapeutic agent consisting of calicheamicin, a potent cytotoxic antibiotic linked to a recombinant humanized anti CD33 monoclonal antibody directed against the CD33 antigen present on leukemic myeloblasts in most patients with acute myeloid leukemia (AML). GO is indicated for the treatment of patients with CD33 positive AML in first relapse who are 60 years of age or older and who are not considered candidates for cytotoxic chemotherapy. GO has shown moderate activity as a single agent in patients with CD33-positive refractory or relapsed acute myeloid leukaemia, with more promising results in acute promyelocytic leukaemia. The side effect profile may be an improvement on conventional chemotherapy, except for a higher frequency of veno-occlusive disease or sinusoidal obstructive syndrome, especially after a subsequent haematopoietic stem cell transplantation. Because of the different mechanisms of action and non-overlapping toxicities, the integration of this immunoconjugate with standard chemotherapy is a rational approach.

배경: 당뇨병 환자에게 관상동맥심질환은 생존률, 건강 상태 유지 및 삶의 질에 주요한 영향을 미치는 합병증이며 적극적인 당뇨병 치료는 이러한 심혈관 합병증을 예방할 수 있으나 당뇨병의 적극적 치료와 관리에는 많은 비용이 소요된다. 목적: 제2형 당뇨병 환자를 대상으로 메트포르민과 글리메피리드 병합요법과 메트포르민과 피오글리타존 병합요법의 비용-효과성을 비교하고자 하였다. 연구방법: 마르코프 코호트 프로세스(Markov Cohort Process Model) 모형을 이용하여 비용-효과분석을 실시하였다. 연장된 수명 (life years gained, LYG)과 삶의 질(quality)을 보정하여 증가된 QALYs를 주요 효과 지표로 측정하였고, 총비용으로는 직접의료비용과, 환자와 가족의 교통비를 직접비의료비용으로 고려하였고 환자와 가족의 시간비용을 간접비용으로 포함하였다. 연구결과: 비용-효과분석 결과, 메트포르민과 글리메피리드 병합요법의 경우 총 비용은 5,962,288원, 효과는 7.94LYG, 6.43QALY이었다. 반면 메트포르민과 피오글리타존 병합요법은 총 비용 10,982,243원, 효과 8.62LYG, 6.99QALY으로, 점증적 비용-효과비(ICER)는 7,402,663원/LYG과 8,934,546원/QALY 이었다. 결론: 우리 사회의 연장된 수명(LYG)에 따른 지불의사가 700만원 이하인 경우는 메트포르민과 글리메피리드 병합요법이 비용-효과적인 대안이며 700만원 이상인 경우에는 메트포르민과 피오글리타존 병합요법이 비용-효과적인 대안이 될 수 있다.

In July 2008, The National Police Hospital has developed the CPOE system(Computerized Physician Order Entry system) which links the medicine master and introduced the new program for the injectable antimicrobial agents. After introducing new system, we wanted to check the management of oral antimicrobial agents. Because new system has limitation that new system control only the use of the injectable antimicrobial agents. So we tried to evaluate the use of oral levofloxacin, which was chosen by a medical specialist of the infection. We retrospectively analyzed the appropriateness of oral levofloxacin through EMR(Electric Medical Record) of 72 inpatients who received oral levofloxacin in National Police Hospital in December 2008. We applied the modified ASHP(American Society of Health- System Pharmacists) DUE(Drug Use Evaluation) criteria, which is composed of justification of drug use, critical indicators, complications and outcome measures. Acceptable cases of use of levofloxacin were 67(93.01%) and 57cases(79.2%) showed good outcome. However critical indicators were not performed very well. We want to suggest the new system for the management of the medical therapeutics by the pharmacist in charge.

Medication compliance is essential to improve person's health status through pharmacotherapy. Since separation of dispensing and prescription has been implemented, the importance of pharmacist's role on medication counseling have been emphasized, especially among outpatients. The objective of this study is to investigate the effect of patient's satisfaction with pharmacist's medication counseling on medication compliance among outpatients. We used the 2005 Korea National Health and Nutrition Survey data to examine medication compliance of persons who visited pharmacy. Ordered logistic regression analysis was conducted to assess whether patient's satisfaction with pharmacist's medication counseling was associated with medication compliance. Overall, 86.17% of study subjects(5,494) reported to take the prescribed medicines correctly and 80.54% of respondents were satisfied with pharmacist's medication counseling. Logistic regression analysis presents patient's satisfaction with pharmacist's counseling is significantly associated with medication compliance after controlling patient's characteristics(proxy-measured by age, family income, educational attainments, comorbid conditions). Interestingly, even patients who are dissatisfied with pharmacist's counseling have slightly higher odds of better compliance to medication therapy than those without pharmacist's counseling. In addition, higher educational attainments and older age groups are associated with better medication compliance. In conclusion, pharmacist's medication counseling appears to be effective in improving medication compliance. Further research that assess medication counseling in detail needs to develop strategies to improve medication adherence.

The objective of this study was to analyze and to improve therapeutic drug monitoring(TDM) service of vancomycin in a local hospital. Patients with TDM service between September 2005 and December 2008 were included and the data were collected for vancomycin use and components of TDM. During that period, 421 cases of TDM service of vancomycin in 236 patients were retrospectively reviewed. The first dosages of vancomycin were appropriate in 135(57.2%) patients and administration of vancomycin was discontinued in 126(53.4%) patients due to therapeutic failure or adverse drug reaction. MRSA was identified in 191(80.9%) patients and 135(70.7%) samples for the identification were sputum. According to the TDM reports, 232(55.1%) serum samples were obtained at the steady-state conditions and 55.5% of the samples that were drawn before the steady-state was due to the physician's inappropriate knowledge about the steady-state. Based on the time of vancomycin administration, 35.8% of the samples were not obtained at the recommended sampling time. For the patients in general wards, the most common reason for the incorrect samples was routine serum sampling by the laboratory medicine phlebotomists between 6 and 8 a.m. except sunday. In contrast, samples drawn by nurses or physicians at inappropriate time were the most common reason for the incorrect samples with patients in the intensive care units. Physicians accepted 68.5% of the recommendations for vancomycin dosage and administration. In conclusion, TDM service of vancomycin needs to be improved in inappropriate sampling time and vancomycin dosage. For solving these problems, current team made of TDM pharmacists and physicians of laboratory medicine can be expanded to include a physician of infectious diseases, nurses and laboratory medicine phlebotomists as new members. Through the TDM service of vancomycin by the new team, we can settle the problems and make the guideline for the scientific controversies associated with therapeutic monitoring of vancomycin.

Background: Medication counseling is important to improve qualify of pharmaceutical care, but there are lack of studies to investigate satisfied counseling practice in community pharmacies. Purpose: This study was to investigate current medication counseling provided by community pharmacists. Method: Questionnaires to assess medication counseling practices were ailed to nationwide 1,269 community pharmacists who were Sookmyung Women's University alumni. Result: One hundred sixty five pharmacists were responded to the questionnaires (response rate 13.63%). 16.8% of them all respondents had counseling room in their pharmacies. 75% and 29.9% of respondents provided patient counseling always for new and refilled prescriptions, respectively. Counseling was provided primarily by verbal, but especially for drug name, usage and storage, it was provided in written concurrently. 31.1% of respondents was satisfied with counseling practices by themselves, and a major barrier of unsatisfied counseling was lack of time in 64.6% of respondents. Majorities of respondents (66.3% and 76.3%) spent 1-3 minutes and <1 minute, for new prescription and refilled prescription, respectively. Approximate 99% of respondents presented necessity of standardized patient counseling information for drugs and 97.6% responded that quality of patient counseling would be improved by using software containing counseling information. Old respondent group had higher accumulative patient counseling practice scores and pharmacy owner group took much time for counseling, resulting in higher scores too. Conclusion: This study showed that qualified patient counseling practice has not been reached in community pharmacies. Much more discussion to seek ways to improve the quality would be necessary.

Purpose : 본 연구의 목적은 항암치료로 인한 빈혈환자의 치료에서 epoetin alpha (rHuEPO) 피하주사 시, 주일회 요법과 주삼회요법의 헤모글로빈(hemoglobin, Hb) 상승 효과를 비교하는 것이다. Methods : 본 연구는 1999년 3월부터 2005년 3월까지 국립암센터에서 항암치료로 인한 빈혈로 epoetin alpha를 투여 받은 환자를 대상으로 의무기록의 자료를 후향적으로 수집하여 분석하였다. 연구에 포함된 환자는 rHuEPO 10,000 IU 주삼회투여군(n = 127)과 20,000 IU 주일회투여군(n = 81)으로 구분되었으며, 이들은 필요에 따라 경구용 철분보조제를 섭취하였다. Epoetin alpha 치료 시작 후 최대 8주까지 2주 간격으로 Hb 수치변화를 분석하였다. Results : 치료 시작 시점의 rHuEPO 10,000 IU 주삼회투여군과 20,000 IU 주일회투여군의 평균 Hb수치는 유사하였다 (9.4 g/dL vs. 9.7 g/dL). Epoetin alpha 치료 후 8주까지 두 그룹간의 헤모글로빈 수치의 상승 정도에는 유의한 차이가 없었다 (1.57±1.39 g/dL vs. 1.68±1.35 g/dL, p=0.59). 또한 경구용 철분보조제 투여여부, cisplatin 포함 항암제 투여여부 및 성별에 따른 군의 분류에 있어서도 rHuEPO 10,000 IU 주삼회투여군과 20,000 IU 주일회투여군의 평균 Hb 상승수치는 유의한 차이를 보이지 않았다. Conclusion : 한국인에서 항암치료로 인한 빈혈의 치료 시에 rHuEPO 20,000 IU 주일회투여 용법은 10,000 IU 주 삼회투여 용법과 유사한 Hb 상승효과를 가진다.

Background: Patients with chronic myeloid leukemia(CML) have different health status according to their disease conditions uch as chronic phase(CP), accelerated phase(AP), blast crisis(BC), stage with MCyR(Major Cytogenetic esponse); therefore, every patient has different quality of life related to their disease condition. Objectives: To measure he quality of life, this study compared and analyzed the utility weight in patients with CML. This study also evaluated he utility weight in order to view comparisons between the quality of life in a patient with CML to a patient with diabetes, which is a representative chronic disease. Methods: The disease scenario described 5 symptoms of the CP, AP, BC of the CML, the CML which gets the MCyR and the diabetes. Utility weight was developed using the EQ-5D method. All statistical data were analyzed by STATA 10.0 Results: 57 nurses(95%) out of 60 answered the questionnaire. In CP, the utility weight was 0.7946. In AP, it was 0.5301. and in BC, it was -0.2793. Survey data indicate that the worse the condition of a disease, the lower the utility weight. In case of the CML which gets the MCyR, the result was 0.7731(95% CI : 0.7384 - 0.8079). The general diabetes which has no complicating disease, the utility weight was 0.7481(95% CI : 0.6983 - 0.7978). Based on the result, it is evident that those with MCyR are not significantly different from people with general diabetes (p=0.4096) in views of the quality of life.

The purpose of this study was to evaluate the attitude and knowledge of community pharmacists to spontaneous adverse drug reaction (ADR) reporting. A survey was conducted in 103 community pharmacists in Seoul and Kyung-Gi Province from September to October, 2009. Almost half (53, 51.5%) and three-fourths (79, 76.7%) of respondents knew they could participate in ADR reporting in the Regional Pharmacovigilance Center (RPC) or Korean Food and Drug Administration (KFDA). However, only three of them have reported an ADR to the RPC and none of them have reported to KFDA. A majority of the respondents (96, 93.2%) felt that ADR reporting was a professional obligation for pharmacists. The purpose of an ADR reporting was incorrectly identified by most pharmacists. ADR reporting was encouraged if the reaction was serious and a new product. The most frequently mentioned barriers to reporting were: uncertainty concerning the causal relationship (86.3%) and not knowing how to report an ADR (83.2%). Only 19 (18.4 %) respondents had received education on how to report ADR. Education was the most recognized method of improving ADR reporting. This study showed the knowledge of ADR reporting among community pharmacists is inadequate. Education and training should be reinforced in order to improve ADR reporting by community pharmacists.