• Health Policy and Management
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• v.21 no.4
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.2
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• pp.103-112
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• 2009

Objectives : This study was to evaluate the pharmacological effect of Korea Red Ginseng aqueous extract (KRGE) on serum-deprived apoptosis of neuronal-like pheochromocytoma PC12 cells and to investigate its underlying action mechanism. Methods : KRGE was prepared by extracting Korea Red Ginseng with hot water and concentrating using a vacuum evaporator. Cell viability was determined after incubation of cells with KRGE or chemical inhibitor in serum-deprived medium for 60 h by counting intact nuclei following lysing of the cell membrane. Caspase activities were measured using chromogenic substrates and signal-associated protein phosphorylation and cytochrome c release were determined by Western blot analyses using their specific antibodies. Results : Serum deprivation induced PC12 cell death, which was accompanied by typical morphological features of apoptotic cell, such as nuclear fragmentation, caspase-3 activation, and cytochrome c release. This apoptotic cell death was significantly inhibited by KRGE and caspase-3 inhibitor, but not by the addition of NMA, ODQ, and PD98059. KRGE promoted phosphorylation of Akt and Bad, and this phosphorylation was inhibited by the PI3K inhibitor LY92004. In addition, this inhibitor also reversed KRGE-mediated protection of PC 12 cells from serum deprivation. These results suggested that KRGE protects PC12 cells from serum deprivation-induced apoptosis through the activation of PI3K/Akt-dependent Bad phosphorylation and cytochrome c release, resulting in caspase-3 activation. Conclusions : KRGE should be considered as a potential therapeutic drug for brain diseases including stroke induced by apoptosis of neuronal cells.

• Korean Journal of Medicinal Crop Science
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• v.25 no.3
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• pp.165-174
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• 2017

Background: Traditional plant drugs, are less toxic and free from side effects compared to general synthetic drugs. They have been used for the treatment of diabetes and associated renal damage. In this study, we evaluated effect of Hachimi-jio-gan against diabetic renal damage in a rat model of type 1 diabetic nephropathy induced by subtotal nephrectomy plus streptozotocin (STZ) injection, and in Otsuka Long-Evans Tokushima Fatty (OLETF) rats and db/db mice as a model of human type 2 diabetes, and its associated complications. To explore the active components of Hachimi-jio-gan, the antidiabetic effect of corni fructus, a consituent of Hachimi-jio-gan, and 7-O-galloyl-${{\small}D}$-sedoheptulose, a phenolic compound isolated from corni fructus, were investigated. Methods and Results: We conducted an extensive literature search, and all required data were collected and systematically organized. The findings were reviewed and categorized based on relevance to the topic. A summary of all the therapeutic effects were reported as figures and tables. Conclusions: Hachimi-jio-gan serves as a potential therapeutic agent to against the development of type 1 and type 2 diabetic nephropathy. From the results of characterization active components of corni fructus, 7-O-galloyl-${\small}D$-sedoheptulose is considered to play an important role in preventing and/or delaying the onset of diabetic renal damage. 7-O-Galloyl-${\small}D$-sedoheptulose is expected to serve as a novel therapeutic agent against the development of diabetic nephropathy.

• Herbal Formula Science
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• v.7 no.1
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• pp.121-130
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• 1999

Oriental medicine prescription has been used for the treatment of various clinical symptoms associated with cerebral apoplexy. However, single herb drug does not used cerebral apoplexy and there mechanisms of action have not been defined, and it is not yet known what effects they have on the hemodynamics of cerebral circulation. The study was aimed to investigate the effect batryticatus bombycis(BB) on the vascular systems including changes in blood pressure (BP), and regional cerebral blood flow (rCBF) and of male Sprague-Dawely rats. The changes in rCBF were determinated by laser-Doppler flowmetry. 1. Blood pressure was not affected by BB in rats. 2. rCBF was increased by BB in a dose-dependent manner. 3. Pretreatment with methylene blue(1mg/kg), and propranolol(1mg/kg) did not inhibited BB induced increased in rCBF. 4. Pretreatment with propranolol(1mg/kg) was increased by BB in a dose-dependent manner in blood perssure. 5. Pretreatment with ODQ($10{\mu}g/kg$) and L-NNA(1mg/kg) were inhibited BB induced increased in rCBF. 6. Pretreatment with L-NNA(1mg/kg) was increased rCBF in a dose-dependent manner. These results suggest that BB causes a diverse response of blood pressure and regional cerebral blood flow(rCBF). The increased in rCBF is also mediated by nitric oxide synthease and guanylate cyclase.

• Journal of Microbiology and Biotechnology
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• v.20 no.12
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• pp.1764-1768
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• 2010

In this study, the prevalence of antibiotic resistance was examined among 74 Staphylococcus pseudintermedius strains recently isolated from clinical cases of canine pyoderma and otitis externa at the veterinary teaching hospital at Konkuk University, Korea. Bacterial resistance to the nine commonly used antibiotics was evaluated by a standard disk diffusion technique based on the guidelines of the Clinical and Laboratory Standards Institute. The results demonstrated that most S. pseudintermedius isolates were resistant to penicillin (95.9%) or tetracycline (91.9%), but highly susceptible to amoxicillin/clavulanic acid (90.5%). Among the 74 isolates, 13 mecA-positive and methicillin-resistant S. pseudintermedius (MRSP) strains were identified, displaying a high level of resistance (84.6-100%) to each of the individual antibiotics evaluated, with the exception of amoxicillin/clavulanic acid (46.2% resistance). Notably, all of the MRSP isolates exhibited simultaneous resistance to four or more different antibiotics, indicating that they are multiple drug resistant (MDR) strains. Taken together, these results imply that more careful selection or prescription of antibiotics for canine pyoderma and otitis externa should be required for reducing the emergence and/or spread of MDR strains, especially MDR-MRSP isolates, in veterinary pet clinics in Korea.

• Korea Journal of Hospital Management
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• v.7 no.1
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• pp.19-40
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• 2002

The purpose of this study is to find out if there has been any change in the outpatient visit to tertiary care hospitals after the introduction of the new healthcare program that divides the roles of doctors and pharmacists and the reason for the change if there is any. Two tertiary care hospitals with the largest capacity of 1200 beds and two tertiary care hospitals with the lowest capacity of 600-700 beds were randomly selected. Data of the outpatient visits from March-May 2(xx), before the new healthcare system was adopted, were compared with the data from March-May 2001, after the new policy was adopted. Outpatient visits have decreased 5.8% after the new system. There has been a dramatic decrease, especially, in the department of OB-GYN and Pediatrics of tertiary hospitals. Decrease in re-visits is much higher than the first visits. Female patients decreased more than the male patients. Outpatient visits by economically active patients group aged 25-44 declined much. Tertiary hospitals in Seoul and Kyonggi Province, as well. Outpatient income of tertiary hospitals has dropped up to 14.7% due to the decline in outpatient visits and pharmaceutical income, and resell price system which in turn has caused the hospital financial deficits. While the new program has succeeded in lowering the use of antibiotics and injections, it has the pitfall of prescribing long days and expensive drugs. A full-fledged review of the system should be conducted for the establishment of the new system and I believe this study may be a useful references. Furthermore, more profound and overall studies on the chance in the patients use of hospitals are needed.

• YAKHAK HOEJI
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• v.55 no.4
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• pp.338-344
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• 2011

This study aimed to identify the changes in the list of drugs covered by national health insurance(NHI) after the introduction of positive list system (PLS) in Korea in December, 2006. Six-year (pre-policy:2004-2006, post-policy:2007-2009) lists of the NHI reimbursable drugs filed from Health Insurance Review and Assessment Service (HIRA) were analyzed. The total number of listed drugs as well as drug ingredients, and the average number of listed drugs per manufacturer decreased annually after the introduction of PLS. More than 8,000 drugs were delisted in the year 2007 right after the policy change. Prescription-only drugs occupied more than 85% of NHI listed drugs. The percentage of oral type of listed drugs has been increased to more than 60% after the policy change. Korean pharmaceutical manufacturers occupied more than 90% of listed drugs than multinational firms. The gap between Korean and foreign manufacturer in terms of the average number of newly listed drugs per manufacturer in each year has decreased two years after the PLS (Korean 7.7 vs. foreign 6.3 in 2009) as the price negotiation power of foreign firms has increased. The total number of listed drugs is expected to decrease in the future as the Korean government makes an effort to delist the unnecessary drugs that do not show cost-effectiveness.

• The Journal of Dong Guk Oriental Medicine
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• v.5
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• pp.231-271
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• 1996

Obstetrics and Gynecology include gynecology which is concerned with the treatment for the disease based on physiology and pathology of women, and obstetrics which is concerned with pregnancy delivery. These obstetics and gynecology can be said to date from the birth of human beings. This paper has carried on the studies about the generating and developing process of obstetics and gynecology. The results of this study are as follows : Distinction in Northern and Southern Dynasties were much more Obstetrics and Gynecology studying the Obstetrics and Gynecology books in that time, the study about "oncosis" (腫瘤) and forms of drug, pill, powder, pIaster were carried on. The highest distinction in Sui age were research and development on pathogenesis and cause of disease about Obstetrics and Gynecology disease and it was appeared representatively in "Zhubingyuanhoulun""諸病源候論" which was special book on cause of disease and pathogenesis and syndrome, And it was explained about abnormal vaginal discharge in this book. Obstetrics and Bynecology were developed on theory and clincis in Tang age when "Taiyshu"(太醫暑) was established. "Taiyshu"(太醫暑) taked complete charge of medical operation and education, published much excellent Obstetrics and Gynecology books than the past. Among them specially "Qianjinyaofang""千金要方" explained Obstetrics and Gynecology matter first in three volumes and "Qianjinyifang""千金翼方" explained this matter first in four volumes. This point indicate that Obstetrics and Gynecology's importance was established in Tang age, so Obstetrics and Gynecology's developmental history, Song age was the acme period. "Taiyju"(太醫局) was established in "xining""熙?" 9 year and Obstetrics belonged to one of nine departments under "Taiyun"(太醫局), so Obstetrics and Gynecology was separated from the other medical parts and it was prepared of it's progressing bases independently and appeared of changes in quality and increase in quantity about theory and prescription of Obstetrics and Gynecology, specially determination of treatment based on the differentiation of symptoms and sighs was taked a serious view. Besides four great physicians in Jing and Yuan dynasies diversified Obstetrics and Gynecology contents through their only medical theory and clinical treatment.

• 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.