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Objective: To explore the perception of drug utilization review (DUR) system and DUR modernization pilot project among healthcare professionals and patients. Methods: We conducted 8 times of focus group interviews (FGI) between August 1, 2019 to December 31, 2019. The healthcare professionals and patients who participated in the DUR modernization pilot project were included in the present study. Based on the type of project participation or medical institution, the participants were divided into the following four groups: group 1, hospital; group 2, clinic; group 3, pharmacy; and group 4, patient. Within each group, interviews were conducted under a pre-defined agenda to identify the implicit perceptions of the participants; the contents of the interviews were, then, categorized. Results: Healthcare professionals established a consensus on the positive aspects of the DUR system and DUR modernization pilot project. However, substantial concerns remain, such as additional workload associated with monitoring adverse events or acquiring consents from patients. Furthermore, a difference of opinion over the DUR convenience system was observed. Among 3 DUR convenience system, the personal medication history review service was highly utilized, but pop-up hold function and communication system was rarely used. Conclusion: We observed that systematic intervention using the DUR system is effective for both healthcare providers and consumers. Adverse events caused by inappropriate drug use can be prevented by continuous patient monitoring. Therefore, the role of DUR system needs to be expanded to establish a safe drug management system.

Therapeutic duplication (TD) is a serious problem that frequently occurring primarily in the ambulatory setting in Korea. Implementation of concurrent drug utilization review (DUR) is a promising way to reduce inappropriate prescription and dispensing, and improve patient safety. This study was aimed to develop the process of DUR module of TD. Sixty-five drug ingredients classified into the drug category of the antipyretic, analgesic, and anti-inflammatory drug pproved in Korea (The KFDA-dess nated classification codes of 114 or 264) were reviewed for this purpose. The drug ingredients (and products) were reclassified based on WHO's Anatomical, Therapeutic and Chemical (ATC) classification system. The clinical practice guidelines, textbooks and product labels on therapeutic uses of these drugs in Korea and several fores n countries were reviewed. If the drugs were categorized into the same therapeutically duplicable class, they were defined not to be used concurrently because the concurrent use was “therapeutically duplicated (unnecessary or even harmful)”. Among the studied drug products, the following 5 drug classes were considto beas “therapeutic duplication”: (1), on-t tooid DURnti-inflammatory drugs (NSAIDs, including s Dicylates), (2),Anilidts, (3),Opioids, (4) Ergot Dk Doids and (5) 5-HT1 receptor agonot s. Therefore, concurrent prescribing or dispensing of more than 2 drug ingredients any in the above same classes should be considered as TD and needed to be warrant for careful review by pharmacists before dispensing.

Adverse drug reactions (ADR) caused by inappropriate prescription are responsible for major socioeconomic loss. Drugdrug interactions (DDI) has been recognized as a major part of ADRs and, therefore, healthcare professionals should prevent possible DDIs to minimize preventable ADRs. This study aimed to examine DDI information in drug information references and Korea Food & Drug Administration (KFDA) drug labeling information. Drug ingredients from the formulary of Health Insurance Review and Assessment Service in Korea (HIRA) were included for the study. DDI information source used for the study were Micromedex Drugdex and Drug Information Facts (DIF) with the DDI severity level of “moderate” or more. The DDI information in KFDA drug labeling were collected and compared. Drug ingredients were classified with KFDA Drug Classification and ATC Classification of WHO for the analysis. Among the total 1,355 drug ingredients satisfying inclusion criteria, 738 ingredients involved at least one DDI, which was described in Micromedex and/or DIF. Drug Ingredients of 176 involved DDI only described in KFDA drug labeling, but not Micromedex nor DIF. Drug ingredients of 35 which DDIs were described in Micromedex or DIF did not have DDI based on KFDA drug labeling. Micromedex and DIF retrieved 7,582 and 3,071 DDIs, respectively 57.6% and 58.5% of DDIs were also described in KFDA drug labeling. Central nervous system (CNS) drugs, cardiovascular system(CVS) drugs and the antiinfectives appeared to have higher frequency of DDIs among all drug classes. The highest number of DDIs with high severity level (“contraindicated” or “major”) were the DDIs of CNS drugs. The antiinfectives are the second drug group having serious DDIs. The DDI pairs of the CNS drug and the antiinfective had the highest contraindication risk (13.6%). DDI information from Micromedex and DIF were not consistent with the result that only 465 ingredients' DDIs are common in both literature (total DDI numbers were 715 vs 488, respectively). And 1,652 DDI information are common in both references among 7,582 vs 3,071 DDIs, respectively. Only 55.2% of DDI information in the database contained in the KFDA drug labeling. Prescribers and pharmacists should pay attention to the drugs for CV system, CNS and infections because of higher risk of possible DDIs compared to other drug classes. KFDA drug labeling is not likely to be recommended as a good information source for DDI due to significant inconsistency of information. Drug information providers should be aware that DDI information from different sources are not consistent and therefore multiple references should be used.

Purpose: To determine the extent and rate of prescription drug therapy, especially polypharmacy and the prevalence of potentially inappropriate medication use in Korean elderly ambulatory patients based on an explicit criterion. Methods: Performed a retrospective study of 65 years or older ambulatory patients visiting a university hospital based clinic from January 2002 to April 2004. Study determined the patterns of drug prescription per Anatomical Therapeutic Chemical Classification and the potentially inappropriate medication usage based on explicit Beers criteria. Results: Of the 4,042 elderly patients the mean number of prescription was , which was similar between genders and all age groups within the elderly. 10.7% of patients were prescribed with more than 5 medications concurrently. The most frequently prescribed medication was the drugs used for treating nervous system diseases (44.3%), followed by alimentary tract/metabolism disorders (27.6%), cardiovascular disease (10.7%), blood/blood forming disorders (4.3%), respiratory disorders (6.5%), and musculoskeletal diseases (3.2%). A total of 511 elderly (13%) was prescribed with medication that met the criteria for=1 potentially inappropriate drugs for the elderly. This proportion was similar between genders and all age groups within the elderly. Among these 511 elderly patients the mean number of potentially inappropriate drugs prescribed was drugs. Potentially inappropriately prescribed drugs included amitriptyline (76 cases), diazepam (69 cases), ketorolac (57 cases), short acting nifedipine (44 cases), triazolam (38 cases), and hydroxyzine (38 cases). Conclusion: Potentially inappropriate drug prescribing in Korean ambulatory elderly patients are common. Education programs and interventions aimed at optimizing the prescribing and dispensing of the most appropriate drugs are needed.

This study explores Gandhi’s characteristics such as Satyāgraha(眞理把持, holding firmly to truth), stubbornness and conviction by analyzing his declaration to suspend the Non-Cooperation Movement in the 1920s, his opposition to separate electorates for Untouchables in the 1930s, and his prayer meetings for Hindu-Muslim unity in the 1940s. Gandhi’s conviction, as reflected in these activities, can be interpreted as follows: In the 1920s, his conviction aligned with the spirit of satyagraha. In the 1930s, regarding the political rights of Untouchables, elements of duragraha began to emerge alongside satyagraha, showing a mix of both stances. By the 1940s, his focus on alleviating Hindu-Muslim tensions resulted in a practical loss of balance between conviction and stubbornness. The historical perspective and philosophical evaluation of Gandhi in this study may be an arbitrary diagnosis of his stubborn beliefs. However, the significance of this research lies in rediscovering the footsteps of a saint who sought truth and contemplated what was best for India.

Background : Drug Utilization Review (DUR) offers patients’ medication records and real-time alerts by prescreening for inappropriate drug use in prescriptions and dispensing, aiming to enhance drug safety and prevent misuse. Since 2004, Samsung Medical Center (SMC) has implemented its own DUR system to manage contraindicated drugs. This system has undergone continuous modifications in line with the expansions of the DUR system by the Health Insurance Review & Assessment Service (HIRA). However, a systematic retrospective evaluation of the appropriateness of override reasons has yet to be conducted. The purpose of this study is to analyze the patterns of DUR override reasons related to contraindicated drug-drug interactions and identify ways to improve the SMC DUR system. Methods : We conducted a retrospective analysis of 67,291 DUR override cases for contraindicated drug drug interactions submitted to HIRA from January to December 2023. Key texts of the override reasons were extracted and classified into four standard categories: Significant, Insufficient, Inappropriate, and Meaningless reasons. The severity of contraindicated combinations was assessed using Micromedex and Lexicomp Online. Results : The most frequently encountered contraindicated combination for inpatients was ketorolac-NSAIDs (60.2%), while for outpatients, it was cyclosporine-statins (22.0%). The analysis of the appropriateness of override reasons revealed that 95.7% were categorized as significant reasons, while 4.3% were insufficient reasons. Notably, 69.6% of the insufficient reasons were associated with combinations that had high interaction severity. Conclusion : This study retrospectively analyzed data from the SMC DUR system to evaluate the appropriateness of override reasons for contraindicated drug-drug interactions. Based on the findings, we recommend reorganizing the operational criteria for high-severity interactions and specifying the override reasons for prescriptions. These improvements are anticipated to enhance the appropriateness of override reasons for contraindicated drug-drug interactions and strengthen the SMC DUR system.

The kidney is an excretory organ that eliminates substances from outside or produced in the body via renal excretory process. In addition, the kidney has an important role in the process that eliminates drugs or their metabolites. Thus, impaired renal function may induce the change in drug effects or adverse effects. Therefore, dosage or dosing interval adjustment is important in the consideration of impaired renal function. In Severance hospital, there are many in patients with severe disease or who are receiving a number of drugs. The frequency of drug usage that needs taking into account the patients’renal function is also high. Thus, it is recommended that dosage or dosing interval adjustment needs to depend on drug guidelines and the role of pharmacists is important in intervention. This study represented the results of drug evaluation using Severance hospital’s DUR (Drug Utilization Review) program by pharmacists from January 1 to January 31, 2011. The result represents that appropriate drug usage was 49.0% taking into account patients’renal function. Based on this study, we suggest that doctors should monitor drug usage more carefully in renal impairment and pharmacists should intervene more actively using the DUR program.

While multiple medication is an important global medication safety issue, ununified concomitant medication by multiple prescriptions may cause more severe problems by the fact that those are neither intended nor watched. This could cause therapy duplication and severe drug interaction and etc. Korean Government made region wide scale programs twice to detect such problems and give warnings to pharmacists and doctors through the internet system in 2009-2010, which are called Drug Use Review Services Pilot Project. This study is an analysis and comparison of the results of the two DUR pilot projects. There were 5.0 and 4.2 cases of severe drug interaction by the concomitant medication of multiple doctors' prescriptions per 10 thousand prescriptions, while only 0.37 and 0 cases by the medication of same doctor's prescription(s). There were 426 and 381 cases of drug duplication by the concomitant medication of multiple doctors' prescriptions per 10 thousand cases, while only 197 and 23 cases by medication of same doctors' prescription(s). Doctors‘participation to those projects improved at Jejudo the later one compared to Goyangsi the former, which means the efforts of them to make less prescription problems succeeded to decrease the number of cases caused from same doctor's prescription. But they could not decrease the number of problem cases caused from concomitant medication by multiple doctors prescriptions enough. The findings support the issue of strengthening and widening the project nation wide and the issue of recommending the patients to designate their own pharmacy, which can provide them counseling for unified and safety controlled medication.

Introduction To improve patient safety and appropriateness of drug usage in Korea, a DUR program has been operated by HIRA since 2008. However, the quality of the program has never been verified although it is the only DUR processing tool used nationwide. Purpose The aim of this study is to examine the sensitivity and specificity of the program focused on drug-drug interactions within and between prescriptions. Method A total of 655,928 prescriptions issued in a 650-bed hospital for 6 months were analyzed using HIRA-DUR program and a drug-interaction detection module developed by DIF-KOREATM (DI-module). In this study, the DI-module was adopted as a golden standard because it has been made up with a number of reliable references recommended by OBRA’0 and complemented with information on korean local drugs. Result The sensitivity and specificity of the HIRA program in detecting drug-interaction were 17.99% and 99.83%, respectively, when compared with the DI-module. Discussion Reasons for the differences could be speculated as follows; I) There were medicines not been checked by the HIRA program because they were not in national formulary or they were combination drugs. ii) The program did not include some pairs of active ingredients related to possible drug interaction because KFDA announced a list of them partially. iii) Certain dosage strength and forms of some KFDA-announced active ingredients were left out from the possible drug-interaction list of the HIRA program. Conclusion It is concluded that an effort to update the most recent information and to manage the possible drug-interaction list should be made on regular base by related organizations such as HIRA and KFDA to improve safety of patients in drug use.

This article explores how in Mambrú the soldiers of the Colombian Battalion represent Korea as a blank slate––that is, as a place from which all specific cultural and geographic referents have been erased. To give meaning to this empty landscape, the soldiers fill in the blanks that the destruction of the war has left behind with comparisons to Colombia’s politics and geography, and to the body of the women the see and meet in Asia. Using these referents, the soldiers draw a symbolic map of their surroundings. This is a map that allows them to navigate through the Korean ruins, avoid the threat of castration, affirm their masculinity, and dominate the other both sexually and militarily.

Este artículo explora cómo en Mambrú los miembros del Batallón Colombia representan a Corea como un espacio vacío del cual todos los referentes culturales y geográficos han sido eliminados. Para darle sentido a este paisaje, los solados rellenan los espacios en blanco que ha dejado la destrucción de la guerra a través de comparaciones tanto con la política y la geografía de Colombia, como con el cuerpo de las mujeres que ven y conocen en Asia. A partir de estos referentes, los soldados dibujan un mapa simbólico de sus alrededores. Este mapa les permite navegar a través de las ruinas coreanas, evitar la amenaza de la castración, afirmar su masculinidad y dominar, tanto sexual como militarmente, al otro.

Background Drug utilization review (DUR) is to ensure safe drug use and optimal therapeutic outcomes. Therapeutic duplication is one of the most frequently reported inappropriate drug use categories in Korea. Specific criteria of drug ingredients considered duplicate would be helpful to prevent therapeutic duplications during drug prescribing and dispensing. Objectives This study was aimed to develop therapeutic duplication criteria of 4 drug classes including lipid modifying agents, antihypertensives, antibiotics and drugs for acid-related disease and estimate the prevalence of therapeutic duplications in ambulatory setting in Korea. Method To develop therapeutic duplication criteria, WHO Anatomical, Therapeutical and Chemical (ATC) classification system was used. Any clinically accepted therapeutic duplications were excluded from this criteria after checking clinical practice guidelines and textbooks. This therapeutic duplication criteria was modified and confirmed via an expert consensus panel using a 2-phase Delphi method. The prevalence of therapeutic duplication of drugs for acid related disorder, anti-hypertensives, lipid modifying drugs, and antibacterials was examined using health insurance claims data including 40 million patients during the 12-month period form January through December 2009. Result 5.87% from prescribed medications for acid-related disease were identified as therapeutic duplication. Also, 1.5% from prescribed medication for anti-hypertensive drugs, 0.12% for anti-lipidemia drugs and 2.75% for antibacterials were identified as therapeutic duplication. Conclusion These results are expected to be helpful to prevent therapeutic duplication and improve appropriate medication use.