• 한국임상약학회지
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• 제20권2호
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• pp.159-164
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• 2010

Radiofrequency ablation (RA) is being used to manage atrial fibrillation (AF) with patients failed at the $1^{st}$-line anti-arrhythmic medications. Patients undergoing this procedure are at increased risk of thromboembolism after ablation, and anticoagulation management surrounding the ablation remains controversial. Although no conclusive recommendations can be made, published guidelines and data support therapeutic anticoagulation with warfarin. The purpose of this study was to analyze effectiveness of current therapy and to find factors fluctuate International Normalized Ratio (INR) values in patients undergone RA followed by anticoagulation service (ACS). Retrospective review was conducted utilizing database in a hospital. Among 110 patients under warfarin around ablation between January 2006 to September 2007, 54 patients were selected and allocated into 2 groups: Group A included 47 who discontinued warfarin after ablation, while 7 in B continued the medication. Information on demographics, amount and length of warfarin dosing, INR values and measuring frequencies, and the causing factors on INR fluctuation were abstracted. Differences were analyzed using chi-squared test, Fisher's Exact test, and unpaired Student t-test. Mean amount of warfarin before and after surgery was 4.0 mg, 4.1 mg in Group A and was 5.1 mg, 4.6 mg in Group B, respectively. Average duration of warfarin doing before ablation was 73.7 days in Group A, 129.9 days in B with no significant difference (p = 0.312). The duration time of warfarin on groups after ablation lasted several months. The number of checking INRs was 4.1 and 7.6, respectively. Inter-individual variability of INR fluctuations were $2.1{\pm}0.6$ in Group A and $2.2{\pm}0.7$ in B which were not significantly different (p = 0.062). 164 cases of decreased INR were: 'omission in taking medication, stressfulness and headache, 'increased intake of high vitamin K foods', 'lifestyle change of increased physical activities', and 'increase of food-intakes'. To the contrary, 36 cases of increased INR were: 'reduce of food-intake', 'use of non-prescription drugs', 'reduction in physical activities', and 'excessive restriction on food-intake', consecutively. In conclusion, the study validated therapeutic outcomes of RA patients who we treated with standard guideline and demonstrated 9 factors of INR fluctuations in the patient. A well-trained, pharmacist-monitored anticoagulation service could reduce the risk of adverse effects and prevent complications in patients with AF around RA operation.

• 한국의사학회지
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• 제26권2호
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• pp.175-185
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• 2013

Purpose : The current Medical Law and the Pharmaceutical Affairs Act, which are incapable of utilizing the research results and the advanced academic, clinical, and pharmaceutical system of the present-day Korean (Oriental) medicine, have limitations and create a paradox by provoking social conflict among the professionals in the field. The aim of this study was to find out the legal and systematic problems that contributed to a complicated conflict amongst Korean (Oriental) medicine doctors, doctors, pharmacists, and Korean (Oriental) pharmacists regarding the classification of their functions. Methods : We reviewed the history and characteristics of the legislation regarding the duties of Korean (Oriental) medicine doctors and Korean (Oriental) pharmacists as well as the relevant and important public health policies since the enactment of the National Medical Services Law in 1951. We focused on the laws and regulations that are made in the process of the separating functions of physicians and pharmacists and the dispute between the Korean (Oriental) medicine doctors and the Korean (Oriental) pharmacists in the 1990s and 2000s. Results : The legislations and amendments of the medical and pharmaceutical laws and regulations that reflect the modern academic, clinical, and pharmaceutical system of the Korean (Oriental) medicine and the research results could be summarized as follows: 1) A partial amendment of the Medical Law in 1987, which added the provision of "Oriental health guidance" as one of the duties of Korean (Oriental) medicine doctors, assured a place for Korean (Oriental) medicine doctors in the field of public health. 2) A partial revision of Pharmaceutical Affairs Act in 1994 established a new system for Korean (Oriental) pharmacists, bringing about the creation of dualistic pharmaceutical system that complements the dualistic medical system. 3) The Promotion of the Research and Development of Wonder Drugs by Using Natural Substances Act was legislated in 2000 in order to stimulate research and development of Korean (Oriental) medicine and its industrialization. 4) Oriental Medicine Promotion Act in 2003 was enacted to lay foundation to specify and promote technology and industry that are related to Korean (Oriental) medicine. Discussions and conclusions : Although the dualistic medical and pharmaceutical system is set up by the Medical Law and Pharmaceutical Affairs Act, it is shown that the relevant regulations have been developed from a perspective of the western medicine.

• 한국임상약학회지
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• 제29권2호
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• pp.125-132
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• 2019

Objective: To examine the perceptions and attitudes toward spontaneous adverse drug reaction (ADR) reporting system among community pharmacists and identify factors that influence reporting, by implementing a survey. Methods: A structured questionnaire was developed and distributed online. Request for the survey was posted on the website of pharmacy's billing program, and the survey was conducted for 8 days. We collected the participants' response on their work environment, experience of ADR reporting, and their perception and attitude on the reporting system. Multivariate logistic regression was used to evaluate factors influencing ADR reporting. Results: A total of 382 pharmacists participated in the survey. Significant contributing factors for reporting level were age (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.84-0.96), knowledge of reporting method (OR, 53.56; 95% CI, 9.10-315.41), installation of reporting program (OR, 31.92; 95% CI, 4.16-244.75), and encouragement from the Korean pharmaceutical association (OR, 4.13; 95% CI, 1.11-15.35). Regarding the attitude toward spontaneous ADR reporting system, 'lack of time for reporting' (OR, 0.29; 95% CI, 0.15-0.53) and 'complexity of reporting procedure' (OR, 0.51; 95% CI, 0.31-0.84), were associated with a low likelihood of reporting. Conclusion: Our results indicated that the knowledge of ADR reporting method, installation of the reporting program, and encouragement from the Korean Pharmaceutical Association contribute to active reporting. It is necessary to simplify the reporting method, make the ADR reporting program user-friendly, and provide educational interventions to increase participation in spontaneous reporting by the community pharmacists.

• Clinical and Experimental Pediatrics
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• 제52권5호
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• pp.576-580
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• 2009

목 적:현재 우리나라 아동들은 키를 더 크게 하려는 여러 가지 인위적인 노력이 만연되고 있으나 그 실태 분석에 관한 연구는 드물다. 이에 본 연구에서는 성장클리닉을 방문한 아동들에서 키를 크게 하기 위해 인위적 관리 실태를 조사하고자 하였다. 방 법:상계백병원 성장클리닉을 방문한 아동 823명(남아 416명, 여아 407명)을 대상으로 키 성장을 위한 인위적 관리실태에 관한 설문지 조사를 시행하였다. 결 과:성장클리닉을 방문한 아동의 평균연령은 만 $10.4{\pm}2.6$세였고 신장의 z-score는 $-1.58{\pm}0.91$였다. 키를 크게 하기 위해 인위적인 관리를 한 경우는 전체의 33.4%였다. 키를 크게 하기 위해 인위적 관리를 받은 아동 중에서, 한의원에서 성장촉진 한약 및 성장보조약을 복용한 경우가 각각 37.8%로 가장 많았고 성장호르몬 치료를 받은 경우가 2.9%였다. 영양제나 건강보조식품을 먹인 경우 종합비타민 및 무기질제가 42.6%로 가장 많았고 키 큰다는 성장보조제(영양제+생약성분) 23.9%, 단일 칼슘제 19.1%, 클로렐라 7.7%, 초유 6.7% 순서였다. 부모님이 자녀의 키에 대해 고민을 시작한 나이는 평균 7.7세였으며 키 성장을 위한 인위적 관리를 시작한 평균연령은 한약 8.9세, 성장보조제 9.1세, 운동/기구가 9.4세, 병원치료 9.9세의 순서였다. 키 성장 관리를 시작하게 된 동기 중에는 친지의 권유가 36.0%로 가장 높았고, 인터넷 및 언론 광고 28.4%, 약국에서의 권유 16.8%, 병원 의사의 권유 5.5%였다. 사용 후 만족도는 성장호르몬치료가 29.1%로 가장 높았고 운동/기구는 6.4%, 한약은 6.6%, 성장보조제는 2.8%로 가장 낮았다. 결 론:대학 병원 성장클리닉을 내원한 아동의 1/3에서 키를 크게 하기 위한 인위적인 관리를 이미 하고 있었으나 효과에 대한 만족도는 높지 않았으며 여러 성장촉진 보조요법에 대한 의학적 견지에서의 성장 작용 및 부작용에 대한 객관적 비교분석이 조속히 이루어져야 하리라 사료된다.