• Journal of Microbiology and Biotechnology
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• v.31 no.8
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• pp.1060-1068
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• 2021

Community-associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is notorious as a leading cause of soft tissue infections. Despite several studies on the Agr regulator, the mechanisms of action of Agr on the virulence factors in different strains are still unknown. To reveal the role of Agr in different CA-MRSA, we investigated the LACΔagr mutant and the MW2Δagr mutant by comparing LAC (USA300), MW2 (USA400), and Δagr mutants. The changes of Δagr mutants in sensitivity to oxacillin and several virulence factors such as biofilm formation, pigmentation, motility, and membrane properties were monitored. LACΔagr and MW2Δagr mutants showed different oxacillin sensitivity and biofilm formation compared to the LAC and MW2 strains. Regardless of the strain, the motility was reduced in Δagr mutants. And there was an increase in the long chain fatty acid in phospholipid fatty acid composition of Δagr mutants. Other properties such as biofilm formation, pigmentation, motility, and membrane properties were different in both Δagr mutants. The Agr regulator may have a common role like the control of motility and straindependent roles such as antibiotic resistance, biofilm formation, change of membrane, and pigment production. It does not seem easy to control all MRSA by targeting the Agr regulator only as it showed strain-dependent behaviors.

• Korean Journal of Clinical Pharmacy
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• v.20 no.2
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• pp.145-150
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• 2010

In order to investigate the antibiotic prescription pattern for upper respiratory infections (URI), the prescription sheets for outpatients from July 2008 to June 2009 were collected from 7 community pharmacies in Ulsan City, and the prescription pattern of Pediatric and ENT physicians was analyzed. The antibiotic prescription rates of Pediatric and ENT physicians were 63.8% and 61.7%, respectively. It was also observed that the oral antibiotic prescription was 95.6% in Pediatrics and 97.6% in ENT. The most favorable antibiotics by Pediatric physicians were penicillins (21.5%) penicillin-clavulanate (36.4%) and cephalosporins (16.5%), macrolides (11.6%), quinolones (3.5%), and nifuroxazide (3.5%). In case of ENT, the commonly prescribed antibiotics were also penicillin-clavulanate (47.6%), cephalosporins (31.6%), macrolides (11.9%) and sulfonamide (1.3%). The antibiotic combination rate was 7.6% in Peditrics and 1.9% in ENT, among antibiotic prescriptions. The combination of more than two oral antibiotics was examined as 66.8% in Pediatrics and 44.2% in ENT. The common oral antibiotic combination in Pediatrics was prescriptions of two ${\beta}$-lactam antibiotics (54.3%). Among them 83% was the combination of amoxicillin-clavulanate (7:1) and amoxicillin, which could be judged as antibiotic overuse. The next highly prescribed oral antibiotic combination was ${\beta}$-lactam/macrolide antibiotic combination probably for URI (11.3%) and ${\beta}$-lactam/nifuroxazide combination (10.0%) presumably for acute diarrhea. Comparatively the oral antibiotic combination prescribed by ENT physicians was negligible except one physician. In conclusion, the antibiotic over-prescription rate by antibiotic combination was much higher in Pediatrics than ENT, even though both clinical departments showed nealy the similar antibiotic prescription rates.

• YAKHAK HOEJI
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• v.58 no.2
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• pp.107-111
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• 2014

Unused medication disposal is a problem due to the cost of disposing as well as potential risk of inadvertent dosing. Investigating medication returns is expected to suggest areas for targeting interventions to reduce medication waste. Therefore, the aim of this study was to examine types of medications and identify the expiration date of the medications returned to the community pharmacies through "Drug-Take Back" program. Method: From October 10, 2012 to November 14, 2012, the medications returned to the 58 community pharmacies in Korea were examined. Results: A total of 22,160 g of pill medications were collected; 52.8% for prescription drugs and 47.2% for non-prescription drugs, respectively. The weight of the expired pill medications was more than 5 times that of the non-expired pill medications. On the other hand, 6,168 ml of liquid medications were returned; 80.0% for prescription medication and 20.0% for non-prescription medications, respectively. Of the total oral liquid medications, the volume of the expired medications was more than 5 times that of the non-expired medications. Conclusion: The majority of medications returned to the community pharmacies were prescription drugs rather than non-prescription drugs. In addition, most of the drugs were expired when they returned.

• Journal of Preventive Medicine and Public Health
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• v.56 no.4
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• pp.319-326
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has increased the workload of healthcare workers (HCWs), impacting their health. This study aimed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and identify factors associated with poor sleep among HCWs in Vietnam during the COVID-19 pandemic. Methods: In this cross-sectional study, 1000 frontline HCWs were recruited from various healthcare facilities in Vietnam between October 2021 and November 2021. Data were collected using a 3-part self-administered questionnaire, which covered demographics, sleep quality, and factors related to poor sleep. Poor sleep quality was defined as a total PSQI score of 5 or higher. Results: Participants' mean age was 33.20±6.81 years (range, 20.0-61.0), and 63.0% were women. The median work experience was 8.54±6.30 years. Approximately 6.3% had chronic comorbidities, such as hypertension and diabetes mellitus. About 59.5% were directly responsible for patient care and treatment, while 7.1% worked in tracing and sampling. A total of 73.8% reported poor sleep quality. Multivariate logistic regression revealed significant associations between poor sleep quality and the presence of chronic comorbidities (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.17 to 5.24), being a frontline HCW directly involved in patient care and treatment (OR, 1.59; 95% CI, 1.16 to 2.16), increased working hours (OR, 1.84; 95% CI,1.37 to 2.48), and a higher frequency of encountering critically ill and dying patients (OR, 1.42; 95% CI, 1.03 to 1.95). Conclusions: The high prevalence of poor sleep among HCWs in Vietnam during the COVID-19 pandemic was similar to that in other countries. Working conditions should be adjusted to improve sleep quality among this population.

• Korean Journal of Clinical Pharmacy
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• v.22 no.4
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• pp.347-355
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• 2012

본 연구의 목적은 약국을 방문하는 만성질환을 가진 노인 환자의 건강보조식품 복용여부와 그 종류 및 복용 양상을 알아보고 개별 환자의 처방의약품 목록과 함께 분석하여 발생 가능한 건강보조식품과 처방의약품의 상호작용을 평가하는 데 있다. 본 연구는 지역 약국을 방문한 만 65세 이상의 만성질환을 가진 노인환자를 대상으로 하였다. 먼저, 만성질환 노인환자의 건강보조식품 복용실태 파악을 위해, 설문 조사를 실시하였다. 처방의약품과 건강보조식품 간의 상호작용 여부 및 정도를 파악하기 위한 문헌검색은 2011년 4월까지 출간된 논문을 대상으로 PubMed를 통하여 이루어졌으며, 설문에 응답한 환자의 처방의약품 목록을 검토하여, 현재 동시 복용중인 건강보조식품과 처방의약품이 상호작용을 유발할 가능성이 있는지 파악하였다. 설문에 응답한 만성질환 노인환자 65명(45.5%)이 건강보조식품을 최근 6개월간 꾸준히 복용하고 있었으며 그 중 홍삼이 가장 많은 비율로 34명(31.8%)이 복용 중 이었다. 설문에 응답한 환자의 처방의약품 목록과 복용 중인 건강보조식품 목록을 분석한 결과, 건강보조식품을 복용 중이라고 응답한 65명 중 13명(20.0%)의 환자가 현재 복용하는 처방의약품과 잠재적 (potential) 또는 가능한 (possible) 상호작용이 있는 건강 보조식품을 동시에 복용하고 있는 것으로 나타났다. 건강보조식품과 처방의약품간의 상호작용에 대한 적극적인 복약지도와 실태 조사를 통해 만성질환 노인 환자에서의 상호작용 발생을 예방함으로써 보다 안전하고 효과적인 의약품 사용이 가능해 질 것으로 사료된다.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.120-126
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• 2020

Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions: Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.

• Korean Journal of Clinical Pharmacy
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• v.28 no.1
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• pp.1-9
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• 2018

Polypharmacy is increasing owing to an increase in the elderly population and multimorbidities associated with the increased risk of administration of potentially inappropriate medications (PIMs). The negative effects of polypharmacy on various health conditions and aspects, such as fall, fracture, mortality, cognitive function, and dementia, have been reported. The management of excess and inappropriate polypharmacy through proper interventions and local or national guidelines has been highlighted. The purpose of polypharmacy management is to appropriately prescribe medicines that are essential to treat diseases in patients and to avoid inappropriate polypharmacy, such as interactive or duplicate medicines under prescription and PIMs for specific diseases. Community pharmacists in Australia, the EU, USA, and Japan are collaborating with prescribers to review medications to ensure that the patients can be prescribed appropriate medications. The service cost is reimbursed by public or private insurers. A study in the United States has shown that even with medication review costs, the overall medication cost has reduced. In Korea, various projects such as Drug Utilization Review service and safe use of medicines have been conducted; however, no national guidelines or management measures have been established. It is necessary to implement a national long-term plan on polypharmacy management. Furthermore, a phased implementation plan is required. Shortly, active medication review services and education programs for healthcare professionals with the support of the government should be considered in Korea with reference to other countries in order to raise awareness of seriousness and risks of inappropriate polypharmacy.

• YAKHAK HOEJI
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• v.57 no.2
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• pp.101-109
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• 2013

Depressive disorders are the most common psychiatric problem in the elderly. Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized for limited period, particularly to elderly patients. In order to evaluate appropriate use of antidepressants and benzodiazepine, retrospective review of prescriptions was performed. The study population are older than 65 years who had been newly diagnosed with major depressive disorder in specialty mental health at a community general hospital from January $1^{st}$, 2007 to October $31^{th}$, 2012 (N=373). Initial antidepressant accounted for 89.5% with SSRI, and escitalopram accounted for 60.9% of SSRI group. 79% or more of the patients were prescribed the recommended dosage. The maintenance rate for 4 weeks of initial antidepressant was 48% and 6 weeks was 39%. Treatment-discontinuation rate was 68% at 3 month. Alprazolam (short acting benzodiazepine) was prescribed the most, followed by clonazepam (long acting benzodiazepine) and then diazepam. 55% of patients received a duplicated prescription for short acting plus long acting benzodiazepine. 61% of patients used long acting benzodiazepines. Prescribed dosages of benzodiazepines were commonly within a recommended range, while no one was prescribed a appropriate period (up to 2 weeks) except for the early discontinued patients. Appropriate use of zolpidem was only 16.2%. The depressed elderly treated in specialty mental health mostly received long-term treatment with benzodiazepines in combination with antidepressants, guideline recommendations was not followed. Multidisciplinary interventions like audit and feedback of benzodiazepine use are needed and education for the elderly is needed to properly maintain antidepressant treatment.

• Korean Journal of Clinical Pharmacy
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• v.12 no.2
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• pp.85-90
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• 2002

The aim of this study was to examine the current turnover status of hospital pharmacists and to analyze the factors which affected the turnover of them after the separation of prescribing and dispensing practice. We surveyed 19 managers of hospital pharmacies and 154 hospital pharmacists. Results are as follows. Pharmacist manpower of hospital pharmacies was only $63.99\%$ in tertiary hospitals and $76.78\%$ in general hospitals respectively of the number of pharmacists before the separation of prescription and dispensing practice. The ratio of those who left hospital pharmacies during the period of January 2000 and October 2001 was $80.23\%$ for tertiary hospitals, and $100.84\%$ for general hospitals. Decrease in the number of pharmacists brought the increase of work load and night duty. Major factors which affected the turnover of hospital pharmacists were found as following: income gap between hospital pharmacists and community pharmacists, increasing workload especially at night and on holidays, infrequent chance for the promotion, and low chance to provide clinical pharmacy services after the separation of prescribing and dispensing practice. Adequate manpower is the basic factor for providing hospital pharmacy services and improving clinical pharmacy services. The study suggested that proper number of hospital pharmacists is to be ensured through strengthening the legal requirement for the hospital pharmacists and improving health insurance reimbursement rate for the pharmaceutical services at hospital.

• Korean Journal of Clinical Pharmacy
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• v.31 no.3
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• pp.171-179
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• 2021

Background: Need for regulatory science is emerging with the development of pharmaceutical industry. It is essential to train regulatory science experts to meet the needs of technology and regulations to evaluate advanced products. Major regulatory science countries are conducting the regulatory science activities and fostering the experts. Methods: Published literature and the relevant website of European Union (EU) were reviewed and criteria were developed. In particular, we focused on in depth descriptions of the Innovative Medicines Initiative program, which was conducted twice. Results: EU is striving to provide funding and training experts for the development of the regulatory science by horizon 2020 and regulatory science to 2025. Innovative medicines initiative (IMI) is a public-private partnership aimed at the development of the pharmaceutical industry, including the regulatory science. IMI education and training projects have provided various education and training course including short-term curriculum and master and doctoral course. The difference between South Korea's regulatory science expert training project in 2021 and the EU's IMI education and training projects is participation of pharmaceutical companies. While the pharmaceutical companies participate in the IMI project to select project topics and form a community, South Korea's project is focused on the Ministry of Food and Drug Safety and universities. Conclusion: Through successful active networks with regulatory party, pharmaceutical companies, and universities, a great innovative advance of regulatory science in South Korea is expected.