• 제목/요약/키워드: Clinical Use

검색결과 6,004건 처리시간 0.038초

투여 항생제군과 Clostridium Difficile-Associated Diarrhea의 위험인자 분석 (Risk Factor Analysis of Clostridium Difficile Associated Diarrhea and Antibiotics Administration)

  • 오경선;이숙향
    • 한국임상약학회지
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    • 제20권1호
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    • pp.78-84
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    • 2010
  • Background: Clostridium difficile is the primary reason of the nosocomial diarrhea. The antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile associated diarrhea (CDAD). Although nearly all classes of antimicrobial agents have been associated with CDAD, clindamycin and the third-generation cephalosporins have traditionally been considered to the greatest risk factor. Recent studies have also implicated fluoroquinolones as high-risk agents due to increasing use of the agents. This study was to determine the incidence and the risk factors of CDAD related to the administered antibiotics and to assess the therapeutic regimen of metronidazole or vancomycin based on the C. difficile toxin assay Methods: A retrospective study was performed in patients with Clostridium difficile toxin assay at I Hospital (Incheon, South Korea) during the period from January 2007 through December 2007. Administrative, laboratory, and pharmacy data were collected from Electronic Medical Databases. Results: The analysis included 129 reported C.difficile toxin assay results, with 42 positive cases and 87 negative cases. Significant antibiotic risk factors for CDAD included the use of the fourth-generation cephalosporinse (OR=5.97, 95% CI 1.37-25.98, P=0.017). Administration of metronidazole was protective against CDAD (OR=0.30, 95% CI 0.12-0.74, P=0.009). Prolonged antimicrobial therapy has been associated with an increased risk of CDAD. The third-generation cephalosporins (OR=3.81, 95% CI 1.08-13.41, P=0.037) and aminoglycoside (OR=5.50, 95% CI 1.43-21.10, P=0.013) demonstrated greater risk for CDAD over 15 days than 8days or less days of treatment duration. Conclusions: The fourth and third generation cephalosporin, aminglycoside were the significant risk factors compared with other antibiotics, whereas metronidazole appears to be protective. The longer duration of antiobiotic use increased CDAD.

진단법의 임상시험연구와 진단정확도 (Clinical Trials and Accuracy of Diagnostic Tests)

  • 이유경;이상무
    • Journal of Genetic Medicine
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    • 제8권1호
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    • pp.28-34
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    • 2011
  • 대부분의 의사들은 임상시험을 치료약제개발 후 의료현장에서 사용하기 위해 진행되는 과정으로 생각할 것이다. 실험실에서 개발된 기술이 진단검사로써 도입되기 위해서는 치료약제의 경우와 유사한 임상시험 과정을 거쳐 그 안정성과 유효성에 대한 검증을 필요로 한다. 치료약제의 효과검증에서 가장 우수한 근거를 얻을 수 있는 연구방법은 무작위대조연구 방법이지만, 이를 검체진단검사에 그대로 적용하기는 어렵다. 검체진단검사의 경우 비교연구가 진단정확도의 검증을 위해 현실적으로 사용할 수 있는 연구방법이지만 대상군의 모집 방법과 구분 방법, 질환대상자의 질환 심각도, 참고표준의 선택과 적용, 눈가림 여부 등 여러 요인들이 진단정확도 지표에 직접적인 영향을 주기 때문에, 좋은 근거수준의 연구결과를 얻기 위해서는 이러한 요소들을 고려한 잘 고안된 연구디자인이 중요하다. 또한 검체진단검사는 치료약제의 경우와 달리 결과를 얻기 위한 검사과정이 사용자인 일선 검사실에 의해 계속 생산되어야 하고, 검사의 개발과 발전의 속도가 빠르며, 일선검사실이 최종사용자이자 개발자인 경우가 흔하다는 특성이 있다. 저자들은 이러한 검사의 특성을 고려하여 검사법 자체의 수행능력에 대한 검증으로부터 검사법 성능평가를 위한 질환확진군과 정상군에 대한 비교연구, 일련의 질환의심자 대상의 진단정확도 평가와 임상 효과성 평가, 도입 후 일상감시로 이어지는 임상시험의 진행단계를 제안하고자 한다.

국내 노인 파킨슨병 환자에서의 잠재적으로 부적절한 약물사용 현황에 대한 연구 (Assessment of Potentially Inappropriate Medication Use in Korean Elderly Patients with Parkinson's Disease)

  • 서미경;배민경;이인향;전성실;윤정현
    • 한국임상약학회지
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    • 제25권4호
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    • pp.254-263
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    • 2015
  • Objectives: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. Method: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. Results: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. Conclusion: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.

의약품 허가외사용 관리 체계 발전 방안 (Development of Regulation System for Off-Label Drug Use)

  • 이인향;서미경;이영숙;계승희;김현아;이숙향
    • 약학회지
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    • 제58권2호
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    • pp.112-124
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    • 2014
  • This study aimed to develop a regulation system for off-label drug use to secure the safe use of marketed drugs. We searched governmental documents for national and global regulating systems of off-label drug uses and a body of academic literature to explore current regulating trends. We included European Union, United Kingdom, United States of America, Australia and Japan, and critically reviewed the regulation of off-label drug use in four issues, which were a regulatory structure, safety control before and after off-label use, and information management. The findings of the present investigation called for several measures in off-label drug uses: enhancing prescribers' self-regulation, providing up-to-date information to prescribers for evidence-based practice and to patients for their informed consent, making evidence with scientific rigor, building an official registering process for off-label use in good quality and extending the role of pharmaceutical industry in pharmacovigilance. At last, we proposed a new system so as to regulate and evaluate off-label drug uses both at national and institutional level. In the new system, we suggested a clear-cut definition for clinical evidence that applicants would submit. We newly introduced an official 'Off-Label Drug Use Report' to evaluate the safety and clinical efficacy of a given off-label drug use. In addition, we developed an algorism of the regulation of off-label drug use within an institution to help set up the culture of evidence-based practices in off-label drug uses.

소아환자 보호자의 소아 대상 약물사용 관련 지식, 태도, 행동 분석 연구 (Analysis of Knowledge, Attitudes, and Practices for Safe Medication Use in Caregivers for Pediatric Patients)

  • 문순지;김경임;최경희;유기연
    • 한국임상약학회지
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    • 제33권2호
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    • pp.106-112
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    • 2023
  • Background: The safe use of medication in children is important, as it can have significant implications for their health and wellbeing. Parents or caregivers play a crucial role in the medication administration process. Therefore, this study would evaluate the needs and current status (knowledge, attitude, and practice) of caregivers for children on the safe use of medication. Methods: We conducted questionnaires on 150 caregivers with children under nine years old and asked about their knowledge, attitude, and practice regarding the safe use of medication and their needs. Each question was conducted on a 5-point scale. Results: Of the 150 respondents, 128 were women, 75 were in their 30s, and 63 were in their 40s. Among them, 29 parents answered that they had been educated about the safe use of medicines, and 26 (84%) were satisfied with the education. Knowledge, attitude, and practice assessments on drug safety use (mean±SD) were found to be 3.83±0.44, 3.67±0.38, and 3.53±0.45, respectively. There were significant differences between the educated group and the uneducated group in knowledge and practice, not attitude. Conclusion:To provide appropriate education to caregivers of pediatric patients is necessary to ensure the safe and effective use of medication in children. Moreover, appropriate education can improve caregivers' understanding of medication use and lead to proper administration. Therefore, it is imperative to develop educational materials and strategies for medications that incorporate both specialized knowledge and practical applications for pediatric patients.

아동간호학 임상실습교육 현황 (An Analysis on Clinical Education of Pediatric Nursing)

  • 권인수
    • Child Health Nursing Research
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    • 제8권3호
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    • pp.344-356
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    • 2002
  • This study was conducted to analyse the current clinical education of pediatric nursing in baccalaurate nursing program, then to give basic data for enhancing the quality of future clinical education of pediatric nursing. Data were collected through self-reported questionnaire by mail from December 2001 to February 2002. The subjects were 29 schools of 50 baccalaurate nursing education programs. The data were analysed by double raters, researcher and assistant researcher. The results were summarized as follows: 1. Twenty-eight schools had the objectives of the clinical education of pediatric nursing, and 28 schools in pediatric ward, 23 schools in nursery, 22 schools in neonatal intensive care unit(NICU), 15 schools in objectives related to profession by clinical site. 2. Credits on clinical education of pediatric nursing were most 15 schools of 3 credits. 3. The clinical sites were mainly the hospital that sick children were admitted in. 4. The clinical teacher were 9 types including pediatric professor and field nurse. 5. On teacher's role, the professor instructed the case study and conference, and field nurse instructed the patient assignment and nursing procedures. 6. All of schools used explanation and conference as a method of clinical education, 1 or 2 schools used PBL or role play or field study. 7. On clinical education content, most of school included Apgar scoring system, physical examination in newborn assessment, respira- tion maintenance, temperature maintenance, infection prevention, nutrition, and bath in newborn care. 8. On clinical education content, most of school included care of incubator, phototheraty, infusion, gavage feeding and how to use the instruments in NICU. Eighteen schools included attachment promotion, and 20 schools case study. 9. On clinical education content, most of school included a checklist of nursing procedures, case study, assessment of growth and development in pediatric ward and other sites. 10.There were various evaluation types in scores, measuring items. In conclusion, the results of this study revealed that there were some discrepancy in the objectives and contents, clinical sites on hospital focused, teacher's role, and diversity of measurement items and ratings in clinical education of pediatric nursing. There is a need for a standardization of content, clinical site, and evaluation tool to improve a quality of clinical education of pediatric nursing based on this study.

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대학병원에서의 Teicoplanin의 사용 현황 조사 및 실태 평가 (The Evaluation of Teicoplanin Usage in a University Hospital)

  • 김은아;오정미
    • 한국임상약학회지
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    • 제11권1호
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    • pp.19-29
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    • 2001
  • Teicoplanin, a glycopeptide antibiotic, has potential for use as an alternative to vancomycin in the treatment of gram-positive bacterial infections. However, unlike vancomycin, there is a lack of study on teicoplanin's efficacy and safety and the guideline for its use is not available, yet. The objective of this study was to investigate and evaluate the pattern of teicoplanin usage in a university hospital. A retrospective study was performed on 72 adult patients, who took teicoplanin for 3 continuous days at D. University hospital from 1 January 1999 to 30 June 2000. The microorganisms treated with teicoplanin were methicillin-resistant Staphylocorcus aureus $(69\%)$, coagulase-negative Staphylococci $(12\%)$, Enterococcus $(4\%)$, vancomycin-resistant Enterococci $(2\%)$, Streptococci $(2\%)$, and Bacillus $(1\%)$. The types of infection treated with teicoplanin were surgical wound infection $(58\%)$, lower respiratory infection $(11\%)$, bactremia $(7\%)$, urinary tract infection $(5\%)$, pleural fluid infection $(4\%)$, and peritoneal fluid infection $(2\%)$. The mean duration of teicoplanin usage was 16.5 days and teicoplanin was used with 1.4 other antibiotics, which were aminoglycosides (isepamicin, amikacin, netilmicin, astromicin) or quinolones (ciprofloxacin, tosufloxacin) or the third generation cephalosporin (ceftazidime). Only 24 cases $(28.6\%)$ met with the criteria for the justification of use, and the rest of 60 cases $(71.4\%)$ did not meet the criteria. In 84 cases $(100\%)$, blood culture tests were performed prior to the initial dose of teicoplanin. In 83 cases $(99\%)$, serum creatinine were conducted before the initial doses. In 45 cases $(53.6\%)$, serum creatinine was monitored at least twice weekly. In 55 cases $(65.5\%)$, WBC was tested at least twice weekly. In 84 cases $(100\%)$, body temperature was monitored at least once per nursing shift. In 15 cases out of 56 cases, maximum temperature decreased at least 1 degree within 3 days of teicoplanin use. In 15 case out of 35 cases, WBC values were within the normal range after treatment. In 23 cases $(27.4\%)$, dosage regimen was appropriate. Drug-related adverse effects were reported in 13 cases. Nephrotoxicity (progressively increasing SCr. or sustained SCr increase of $\geq$0.5 mg/dl from baseline) was noted in five cases. Neutropenia (absolute neutrophil count <1,500 $cells/mm^3$) was noted in one case and eosinophilia (total eosinophil count >350 $cells/mm^3$) was noted in seven cases. A more strict control on use of teicoplanin is required, considering that teicoplanin is categorized as one of restricted antibiotics.

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사상체질 임상정보 분석을 위한 웹 기반의 의사결정 나무 프로그램 개발 (Development of Decision Tree Program based on Web for Analyzing Clinical Information of Sasang Constitutional Medicine)

  • 진희정;김명근;김종열
    • 한국한의학연구원논문집
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    • 제14권3호
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    • pp.81-87
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    • 2008
  • Sasanag Contitution Medicine(SCM) is the traditional medicine theory based on constitutional medicine in Korea. It is most import ant that a personal SCM type is determined accurately ahead of applying any Sasang treatments. For this, many researches have been studied to diagnose the SCM type using constitutional clinical data. The decision tree is a tree-structured data-mining methodology. Recently, in the Korean traditional medicine society, there have been several efforts to find diagnosing tools using the decision tree method. So, we developed a decision tree program based on web for analyzing constitutional clinical information. It can use various clinical data as input data, offer filtering function to select clinical data to be used. We can find useful factor to be influential on SCM types using this program.

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알쯔하이머병(Alzheimer's disease)에서 FDG PET의 임상이용 (Clinical Application of $^{18}F-FDG$ PET in Alzheimer's Disease)

  • 유영훈
    • Nuclear Medicine and Molecular Imaging
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    • 제42권sup1호
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    • pp.166-171
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    • 2008
  • PET of the cerebral metabolic rate of glucose is increasingly used to support the clinical diagnosis in the examination of patients with suspected major neurodegenerative disorders, such as Alzheimer's disease. $^{18}F-FDG$ PET has been reported to have high diagnostic performance, especially, very high sensitivity in the diagnosis and clinical assessment of therapeutic efficacy. According to clinical research data hitherto, $^{18}F-FDG$ PET is expected to be an effective diagnostic tool in early and differential diagnosis of Alzheimer's disease. Since 2004, Medicare covers $^{18}F-FDG$ PET scans for the differential diagnosis of fronto-temporal dementia (FTD) and Alzheimer's disease (AD) under specific requirements; or, its use in a CMS approved practical clinical trial focused on the utility of $^{18}F-FDG$ PET in the diagnosis or treatment of dementing neurodegenerative diseases.

한방신경정신과 영역에서 진단기기의 활용 현황 (Present Application Status of Diagnostic Equipment in Clinical Studies in the Journal of Oriental Neuropsychiatry)

  • 이승기
    • 동의신경정신과학회지
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    • 제23권4호
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    • pp.1-10
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    • 2012
  • Objectives : This study aims to evaluate the current status of clinical use of diagnostic equipment in oriental neuropsychiatry. Methods : Thirty clinical studies using diagnostic equipment out of 223 papers in the journal of oriental neuropsychiatry in the 10 years from 2003 to 2012 were reviewed. Results : Ten diagnostic apparatuses were used in 30 papers. HRV (Heart Rate Variability) was used the most, but the results of papers were not consistent. ADS (ADHD Diagnostic System) and ERP (Event Related Potential) were effective in clinical research. Conclusions : Diagnostic equipment might be useful and effective to treat mental disorders if they are to be used properly and followed by well-designed studies.