• 제목/요약/키워드: Therapeutic compliance

검색결과 95건 처리시간 0.024초

Protein Drug Oral Delivery: The Recent Progress

  • Lee, Hye-J.
    • Archives of Pharmacal Research
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    • 제25권5호
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    • pp.572-584
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    • 2002
  • Rapid development in molecular biology and recent advancement in recombinant technology increase identification and commercialization of potential protein drugs. Traditional forms of administrations for the peptide and protein drugs often rely on their parenteral injection, since the bioavailability of these therapeutic agents is poor when administered nonparenterally. Tremendous efforts by numerous investigators in the world have been put to improve protein formulations and as a result, a few successful formulations have been developed including sustained-release human growth hormone. For a promising protein delivery technology, efficacy and safety are the first requirement to meet. However, these systems still require periodic injection and increase the incidence of patient compliance. The development of an oral dosage form that improves the absorption of peptide and especially protein drugs is the most desirable formulation but one of the greatest challenges in the pharmaceutical field. The major barriers to developing oral formulations for peptides and proteins are metabolic enzymes and impermeable mucosal tissues in the intestine. Furthermore, chemical and conformational instability of protein drugs is not a small issue in protein pharmaceuticals. Conventional pharmaceutical approaches to address these barriers, which have been successful with traditional organic drug molecules, have not been effective for peptide and protein formulations. It is likely that effective oral formulations for peptides and proteins will remain highly compound specific. A number of innovative oral drug delivery approaches have been recently developed, including the drug entrapment within small vesicles or their passage through the intestinal paracellular pathway. This review provides a summary of the novel approaches currently in progress in the protein oral delivery followed by factors affecting protein oral absorption.

덱사메타손 21-아세테이트를 함유한 콘드로이틴 설페이트/젤라틴 마이크로스피어의 제조 및 평가 (Preparation and Evaluation of Chondroitin Sulfate/Gelatin Microspheres Containing Dexamethasone 21-Acetate)

  • 용철순;김영주;오두만
    • Journal of Pharmaceutical Investigation
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    • 제26권4호
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    • pp.273-280
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    • 1996
  • Chondroitin sulfate/gelatin microspheres containing dexamethasone 21-acetate were prepared by complex coacervation method and their release patterns were examined in vitro. Microspheres prepared with a small amount of crosslinking agent had smooth surface and few pores, but those with a large amount of crosslinking agent were more porous and less spherical. In vitro release patterns were varied by changing polymer/drug weight ratio and amount of crosslinking agent. The release rate of dexamethasone 21-acetate in the presence of collagenase was faster than that in the absence of collagenase. Anti-inflammatory effect of dexamethasone 21-acetate microspheres was more efficient than that of dexamethasone 21-acetate solution in carrageenan-induced arthritis in the rat. On the basis of the above results, we might expect the degradation and drug release rate of these microspheres to be regulated by the degree of crosslinking and the level of enzymes. In patients with severe rheumatoid arthritis who have high concentration of collagenase, more drug would be released from the microspheres. An intra-articular injection therapy of rheumatoid arthritis with desired release kinetics could be developed to enhance patient compliance and therapeutic index.

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항우울제의 사용과 체중 (Usage of Antidepressants and Weight)

  • 이웅;조성준
    • 생물정신의학
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    • 제27권2호
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    • pp.58-63
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    • 2020
  • Depressive disorder is a very common disease, clinical manifestations vary, and the mechanism is not clear. Therefore, a pharmacotherapy is very important to achieve sufficient therapeutic effect, but the choice of drug is not easy due to the occurrence of side effects of treatment and confusion with clinical features. It is easy to overlook the side effects of weight gain with antidepressants compared with antipsychotics, but they are frequently observed in clinical settings. The first-generation antidepressants have higher weight gains than selective serotonin reuptake inhibitors. Serotonin norepinephrine reuptake inhibitors are observed to have less weight gain, and dopamine norepinephrine reuptake inhibitors have weight loss effect due to decreased appetite. Mirtazapine, an atypical antidepressant, has a strong histamine H1 blockade, and gains weight gain from short-term use. The effects of desvenlafaxine, vortioxetine, and agomelatin on weight, which have recently been increasing in use, have not been largely identified. For better compliance, studies on weight gain due to the use of antidepressants are needed.

발전된 방사선 치료에 관한 고찰 (A Study for Advanced Radiation Therapy)

  • 장은성;백성민;고성진;강세식
    • 대한방사선치료학회지
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    • 제20권2호
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    • pp.115-122
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    • 2008
  • 목 적: 암 치료를 위한 방사선치료 기술은 끊임없이 발전되어 왔으며 특히, 컴퓨터와 전자기 공학의 발달과 더불어 급속하게 방사선 치료분야에서 많은 발전을 하게 되었다. 따라서 본 연구에서는 발전된 치료기술에 대한 치료 원리와 방법들을 중심으로 그 특징들을 고찰하려고 한다. 대상 및 방법: 발전된 치료기술에 관한 이론적인 고찰을 위하여 관련된 문헌조사를 실시하였으며 임상에서의 자료를 광범위하게 조사 연구하였다. 결 과: 방사선을 이용한 암에 대한 치료는 눈부신 발전을 거듭하고 있다. 과거에는 2차원적인 방법으로 방사선치료를 하였으나 현재는 3차원적인 입체조형치료, 세기변조방사선치료를 병행한 4차원적인 치료기술이 도입되었으며 이는 과거 방사선치료의 난제였던 정상조직보호와 방사선에 의한 합병증 해결을 가능하게 하였다. 결 론: 발전된 방사선치료인 3, 4차원적 현대적 치료는 방사선치료의 목적에 부합되고 있으며 정상조직의 보호가 거의 완벽하게 이루어지고 있으며 방사선을 이용한 암 치료에 대한 평가도 다시 되어야 한다고 사료된다.

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폐결핵 환자의 치료 순응과 관련된 요인 (Factors Influencing Compliance with Anti-Tuberculosis Therapy)

  • 김천태;이경수;강복수
    • Journal of Preventive Medicine and Public Health
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    • 제29권1호
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    • pp.79-90
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    • 1996
  • 항결핵치료 시작 후 3개월간의 치료 경과와 치료 순응과의 관련성을 조사하기 위하여 3개 보건소(대구시 달성군, 경주시, 구미시)에 1995년 10월 15일 현재 단기 6개월 표준처방으로 치료 시작 후 3개월 이상 경과된 초치료 결핵환자 중 계속적인 추적관찰에서 누락된 10명을 제외하고 104명의 자료를 분석한 결과는 다음과 같다. 연구 대상자 104명 중 호전군은 80.8%였고, 비호전군은 19.2%였다. 호전군과 비호전군간에 성, 연령, 교육 수준, 직업, 동반 가족유무, 흡연 및 음주습관의 변화 등에 유의한 차이는 없었고, 평균 연령은 비호전군이 51세로 호전군 42세보다 많았으나 유의 한 차이는 아니었다. 호전군에서는 약제의 복용을 식전과 식후 30분에 복용하는 경우(p<0.05), 약의 복용을 잊지 않도록 가족들이 챙겨 주는 경우(p<0.05), 약을 규칙적으로 복용하는 경우(p<0.01), 항결핵치료 도중 의문점을 가족이나 결핵담당자와 상의하는 경우(p<0.01) 등이 유의하게 많았다. 비호전군에서는 당뇨병이나 위장 질환 등을 않고 있는 경우가 유의하게 많았다(p<0.01). 결핵에 대한 지식점수는 호전군이 12.9로 비호전군 10.6보다 유의하게 높았고(p<0.01), 지식정도의 문항에 대한 신뢰도 검증 결과 신뢰성$(Cronbach'\alpha:0.703)$이 있었다. 치료경과를 호전군과 비호전군으로 나누어 종속변수로 놓고 시행한 다중 지수형 회귀분석에서는 약의 복용을 잊지 않도록 가족들이 챙겨주는 경우(p<0.05)가 유의한 변수로 채택되었고, 결핵에 대한 지식이 높은 경우(p=0.054), 약을 규칙적으로 복용하는 경우(p=0.062), 항결핵치료 도중 의문점을 가족이나 결핵담당자와 상의하는 경우(p=0.075)는 경계역의 변수로 채택되었다. 결론적으로 약을 규칙적으로 복용할 수 있도록 항결핵치료에 대한 신념을 불어넣고 경각심을 높임으로써 환자의 치료 결과를 향상시킬 수 있을 것으로 생각되며, 향후 단기 6개월 표준요법에 의한 치료에 있어서 치료시작 후 3개월간의 치료 경과로 치료 결과를 예측하고 환자의 치료순응을 평가하기 위한 변수로 사용하기 위해서는 보다 많은 결핵환자를 대상으로 한 연구가 필요할 것으로 생각된다. 또한 환자의 치료 순응을 높이기 위하여 환자에 대한 교육과 의사 또는 결핵관리자와 환자, 조력자간의 강한 유대 관계의 형성에 도움을 줄 수 있는 방안의 모색이 필요할 것으로 생각된다.

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간호사의 업무수행상의 권한과 행사전략 (Nurse's Power and Tactics in Nursing Practice)

  • 한혜자
    • 간호행정학회지
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    • 제5권1호
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    • pp.23-37
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    • 1999
  • This study is to understand and to describe the power that a nurse experiences on nursing practice and then. to present a basic data for nurse's power-development, power improving and empowering. Ethnography was used to understand and to describe experience on exercising various powers occurred on nursing practice. and to analyze and to understand the meaning of a nurse's power. The objects was nurses. Ten nurses who have more than three year's experience were selected as objects from Cuniversity's hospital in Seoul from May of 1996 to August of 1997 through in-depth interview. participant observation, and phone interview. Instruments werw a portable recorder and field notes. I described a case appeared in a data using Agar's 'Pencil and scissors' method right after collecting materials. Then, Idescribed a theme discovered commonly. Followings are the results of the study. 1. There were three categories of relationships with main objects when nurses exercised their power on their practices: a therapeutic caring relationship with patients, a relationship of companion, vertical cooperation, and a constituent person with a doctor, and a relationship of cooperation, and a constituent person with administrative workers and medical technicians. 2. There were many types of nurse's power, tactics and various patient's responses about them. 1) Types of nurse's power to patients were giving information, controling environment, helping for cure, emotional support, and performing discretion. 2) Nurse's tatics for performing power were positive tactics neutral tactics, and negative tactics. 3) Patient's responses were appeared as compliance and noncompliance. Compliance were agreeing. taking nurse's advice, trusting, understanding, being admitted, exposuring himself, and appreciating. 3. There were types of nurse's power and performing tactics. 1) Types of power to a doctor were advice, informing, demanding and mediation. 2) Performings of tactics to a doctor were positive tactics, neutral tactics, and negative tactics. 3) Doctor's responses were appeared as accepting and unaccepting. Acceptings were taking in and appreciating, and unacceptings were denying nurse's advice and authoritative. 4. There were types of nurse's power and tactics about administrative workers and medical technicians and responses about them. 1) Types of power about administrative workers and medical technicians were suggestions and demands. 2) Power performings tactics were positive tactics.neutral tactics, and negative tactics. 3) Responses of administrative workers and medical technicians about nurse's power performing were appeared appeared as accepting and unacce pting. Acceptings were taking in, and unacceptings were denying. Therefore, it can be said that types of nurse's power and performing tactics on nursing practice and nurse's power based on responses of a patient, a doctor, an administrative worker, and a medical technicians are power or influence for agreeing, taking advice, trusting, understanding, exposuring himself, appreciating, and taking in to objects. The results of this study helped to understand nurse's power. I expect that this study will improve nure's power by using expert power, referent power, and legitimate power effectively among powers acmpanied with the origin and that nurses make ef-ort to improve professional knowledge and human nature so that they use this study as a chance to develope expert nursing practice.

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향정신성 약물치료에 대한 간호사와 환자의 지각 비교 연구 (A Study on Nurses한 and Patients한 Perceptions of Psychotropic Medication)

  • 이평숙
    • 대한간호학회지
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    • 제24권1호
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    • pp.47-57
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    • 1994
  • The purpose of this study was to examine nurses’ perceptions of medication treatment for psychiatric patients and to compare these perceptions with the perceptions held by the patients. The methodology used in this study was a descriptive design with semi-structured and open-ended interviews. This study used a convenience sample of 112 nurses who worked in, and 209 patients who were under psychiatric treatment, in four hospitals attached to a university and one national mental hospital in the city of Seoul. The collected data were analyzed by SAS, using percentages for descriptive purposes, and t-test or x$^2$ for comparing the variables. The results were as follows : 1. There was no significant differences between nurses’ and patients’ perceptions on the extent to which patients complied with their medication treatment. Generally speaking, the mean compliance scores for both nurses and patients was high(nurse : (equation omitted)=3.70, Patient : (equation omitted)=3.76). 2. There was a significant difference in nurses’ and patients’ perceptions on the reasons why patients do not take medication. The nurse group indicated that the patients did not take medication because of the “worry about side effects or habituation(49.53%)”, “boredom from long-term use of medication(26.17%)” and “distrust toward medical staff(12.15% )”, but the patient group indicated that they “did not want to be dependent on medication (25%)”, “forgot to take medication(19.7%) and “worried about side effects or habituation(15.91%). 3. As for the necessity of medication, both groups showed some different responses. Even though both groups were aware of the necessity of taking medication, the patient group(21.53%) showed a more negative response. As (or the effects of medication, both groups (nurses and patients ) showed positive responses. However, the nurse group showed a higher positive response (91.07% ) than the patient group(74.16%), 5. Both the patient and nurse group indicated that the most helpful element for the patient’s life under psychiatric treatment was interviews and conversations with therapists and nurses. However, the nurse group showed a higher response(70.15%) than the patients group(47.15%). According to the patient group, family support for the patient was another important factor for psychiatric treatment and daily struggles. In conclusion, as there were differences between the perception of nurses and patients, the nurse must consider the patients’ subjective perceptions first. They should also revaluate their false belief and prejudice concerning the patients’ perceptions. Such information can provide a base to be applied by the nurses in devloping effective mutual relationships with patients which can in turn help in compliance with medication regimen. As it was confirmed that medication was the most important factor in the patients’ recovery, a thorough education program on the therapeutic effect of medication and the necessity of their continued use after discharge is also needed.

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뇌졸중 작업치료 지침의 질 평가 (Quality Evaluation of the Occupational Therapy Guidelines for Stroke)

  • 이은영;한대성;박지혁
    • 재활치료과학
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    • 제10권3호
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    • pp.57-69
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    • 2021
  • 목적 : 본 연구는 임상지침 중 뇌졸중 환자의 작업치료를 다룬 지침을 확인하고, 확인된 지침들의 질과 특성에 대해 알아보고자 하였다. 연구방법 : 본 연구는 2008년부터 2019년까지 국내·외의 재활 치료 지침을 살펴보았으며, 검색어는 'stroke', 'guideline', 'practice guideline', 'recommendation', 'protocol compliance', 'practice guideline', '뇌졸중 가이드라인', '뇌졸중 지침' 등으로 하였다. 결과 : 검색을 통해 총 708편의 논문이 검색되었고, 자료 선정 기준에 부합한 지침 8편을 최종적으로 선정하였다. 선정된 논문은 캐나다, 미국, 영국, 한국, 호주 등에서 개발한 지침이었으며. 8개의 지침 중 1개는 작업치료 지침이었고, 나머지 7개는 재활치료 지침이었다. 지침에서 다룬 내용을 총 36개의 주제로 분류하였으며, 이 중 호주 뇌졸중 재활치료 지침은 28개, 영국과 미국심장협회(AHA)의 지침은 24개, 한국에서 개발한 뇌졸중 재활치료 지침은 23개 등의 내용을 포함하고 있었다. 결론 : 본 연구에서는 기존의 뇌졸중 환자를 위한 작업치료 지침을 확인하고, 지침들의 질과 특성을 비교해 보았다. 이는 추후 뇌졸중 작업치료 지침 개발을 위한 중요한 기초자료가 될 수 있을 것으로 사료된다.

Assessment of the Therapeutic Potential of Persimmon Leaf Extract on Prediabetic Subjects

  • Khan, Mohd M.;Tran, Bao Quoc;Jang, Yoon-Jin;Park, Soo-Hyun;Fondrie, William E.;Chowdhury, Khadiza;Yoon, Sung Hwan;Goodlett, David R.;Chae, Soo-Wan;Chae, Han-Jung;Seo, Seung-Young;Goo, Young Ah
    • Molecules and Cells
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    • 제40권7호
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    • pp.466-475
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    • 2017
  • Dietary supplements have exhibited myriads of positive health effects on human health conditions and with the advent of new technological advances, including in the fields of proteomics, genomics, and metabolomics, biological and pharmacological activities of dietary supplements are being evaluated for their ameliorative effects in human ailments. Recent interests in understanding and discovering the molecular targets of phytochemical-gene-protein-metabolite dynamics resulted in discovery of a few protein signature candidates that could potentially be used to assess the effects of dietary supplements on human health. Persimmon (Diospyros kaki) is a folk medicine, commonly used as dietary supplement in China, Japan, and South Korea, owing to its different beneficial health effects including anti-diabetic implications. However, neither mechanism of action nor molecular biomarkers have been discovered that could either validate or be used to evaluate effects of persimmon on human health. In present study, Mass Spectrometry (MS)-based proteomic studies were accomplished to discover proteomic molecular signatures that could be used to understand therapeutic potentials of persimmon leaf extract (PLE) in diabetes amelioration. Saliva, serum, and urine samples were analyzed and we propose that salivary proteins can be used for evaluating treatment effectiveness and in improving patient compliance. The present discovery proteomics study demonstrates that salivary proteomic profile changes were found as a result of PLE treatment in prediabetic subjects that could specifically be used as potential protein signature candidates.

유방암 환자의 자가관리에 대한 자기효능감 측정도구 개발 (Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B))

  • 이란;김수현;이건숙;서명경
    • 대한간호학회지
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    • 제42권3호
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    • pp.385-395
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    • 2012
  • Purpose: This purpose of this study was to develop and validate a Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B). Methods: The SESSM-B was developed and validated as follows: Item generation, pilot study, and tests of validity and reliability. Twenty-one items were developed through evaluation by 10 experts and 13 items were finally confirmed through item analysis and factor analysis. Psychometric testing was performed with a convenience sample of 303 women with breast cancer. Data were analyzed using factor analysis, Pearson correlation coefficients, and Cronbach's alpha. Results: Five factors evolved from the factor analysis, which explained 69.8% of the total variance. The first factor 'coping with psycho-informational demand' explained 17.2%, 2nd factor 'maintenance of healthy lifestyle' 14.5%. 3rd factor 'management of side-effects' 13.3%, 4th factor 'therapeutic compliance' 12.8%, and 5th factor 'sexual life' 11.9%. SESSM-B also demonstrated a concurrent validity with health-related quality of life scale, EORTC QLQ-C30 & BR23. The internal consistency, Cronbach's alpha, was .78, and reliability of the subscales ranged from .61 to .79. Conclusion: The results of this study suggest that the SESSM-B is an easy, reliable, and valid instrument to measure self-efficacy for self-management of breast cancer.