BACKGROUND: Androgenetic alopecia (AGA), one of alopecias, requires continuous treatment in order to prevent or stop it, and patient's compliance is very important. Currently, only two drugs (finasteride, minoxidil) have been approved for AGA by Food and Drug Administration of United States (US FDA). However, another alpha-2 reductase inhibitor, dutasteride, is approved by Korea Ministry of Food and Drug Safety (MFDS) through a phase III trial. For treatment, pharmacotherapy of AGA usually combines topical minoxidil 7% with one of oral alpha-2 reductase inhibitor. OBJECTIVES: We evaluated the comparative efficacy and adverse effect between topical minoxidil 7%/finasteride 1 mg and topical minoxidil 7%/dutasteride 0.5 mg pharmacotherapy for outpatients with AGA. Also we evaluated the relationship between therapeutic effect and regular hospital visit. METHOD: This study was performed retrospectively based on electronic medical record (EMR) data of total 98 patients (topical minoxidil 7% with dutasteride 0.5 mg (Avodart(R)) or finasteride 1 mg (Alopecia(R), Propecia(R)) with diagnosis of AGA from department of dermatology at a secondary hospital from January 1st, to May 31st, 2014. RESULTS: The efficacy and adverse event of topical minoxidil 7%/dutasteride 0.5 mg (DUTA group) were 100% and 45.7%, and of topical minoxidil 7%/finasteride 1 mg (FINA group) were 92.1% and 33.3%, respectively. The mean onset time of responses and adverse events in the FINA group were 3.86 months and 4.43 months. Those in the DUTA group were 3.97 months and 5.06 months. CONCLUSION: Both FINA and DUTA group were highly effective, but the DUTA group showed higher efficacy and adverse effects than those in the FINA group. Dutasteride may be another alternative in AGA treatment.
Alopecia* ; Compliance ; Dermatology ; Diagnosis ; Drug Therapy ; Electronic Health Records ; Finasteride ; Humans ; Korea* ; Minoxidil ; Outpatients ; Oxidoreductases ; Retrospective Studies* ; United States ; United States Food and Drug Administration ; Dutasteride

BACKGROUND: Primary warm autoimmune hemolytic anemia (AIHA) is a relatively rare hematologic disorder resulting from autoantibody production against red blood cells. There has been very few studies about primary warm AIHA in South Korea because of its low incidence. We retrospectively analyzed the treatment outcome of primary warm AIHA. METHOD: We reviewed retrospectively the medical records of 9 primary warm AIHA patients from December 2002 to January 2015. We analyzed the causes and clinical characteristics of primary warm AIHA patients. We retrospectively analyzed the clinical data in electronic medical records for 9 Korean patients with AIHA patients who were diagnosed during the period from December 2002 to January 2015 at the Regional University Hospital in Korea. The study protocol was approved by the Institutional Review Board (IRB #2015-08-007, Chosun University Hospital IRB). RESULTS: The mean age was 52 years (range 27~78), the mean hemoglobin level was 5.0 g/dL (range 2.5~6.4 g/dL). All patients received steroids at therapeutic dosages (corticosteroid 1 mg/Kg) as first line treatment. Eight of them showed complete response (5/8, 62.5%) and partial response (3/8, 37.5%), one patient required second-line treatment with rituximab. Two patients who responded first line treatment were relapsed at 86 weeks and 24 weeks after response, respectively. Only one patient of them was retreated with corticosteroid because of anemic symptoms. CONCLUSION: This study indicates that oral corticosteroid is an effective therapy for primary warm AIHA.
Adrenal Cortex Hormones ; Anemia, Hemolytic, Autoimmune* ; Electronic Health Records ; Erythrocytes ; Ethics Committees, Research ; Humans ; Incidence ; Korea ; Medical Records ; Retrospective Studies* ; Steroids ; Treatment Outcome ; Rituximab

OBJECTIVE: Polypharmacy is one of the main causes of inappropriate medication use, adverse drug-related events and cost. It aimed to investigate the status of polypharmacy and potentially inappropriate medication (PIM), the factors affecting polypharmacy and cost in elderly outpatients. METHOD: A pharmacy claim data were retrospectively analyzed with elderly patients prescriptions at a pharmacy located near a top tier general hospital. The numbers of medications per person, prevalence of polypharmacy and PIM according to the 2012 Beers criteria and Korea PIM list, medication cost and the factors affecting polypharmacy were investigated. RESULTS: Forty-six percentages of the elderly outpatients received polypharmacy and over 21% of them had medications listed in Beers or Korean PIM. In multiregressional analysis, we found that age, gender and insurance types were affective factors of polypharmacy. (p < 0.001, 0.047, 0.009, respectively). The cost of polypharmacy with PIM in elderly outpatients was increased with age. Various approaches of interventions would be further required.
Aged* ; Beer ; Hospitals, General* ; Humans ; Insurance ; Korea ; Outpatients ; Pharmacies* ; Pharmacy ; Polypharmacy* ; Prescriptions ; Prevalence ; Retrospective Studies ; Risk Factors*

OBJECTIVE: This study was designed to compare pegfilgrastim and filgrastim in diffuse large B-cell lymphoma (DLBCL) patients treated with a rituximab with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen in terms of clinical efficacy and cost-effectiveness. METHOD: Clinical efficacy was measured by trough level of absolute neutrophil count (ANC), days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, duration of ANC recovery to baseline value, days of ANC less than 0.5 x 109 cells/L, and difference of peak and trough level of ANC during 1 cycle of R-CHOP regimen. To evaluate cost-effectiveness, total prices of used filgrastim and pegfilgrastim within 1 cycle of R-CHOP were analyzed. RESULTS: In terms of clinical efficacy, trough level of ANC and days to ANC recovery showed statistical significance. The median trough levels of ANC with administration of filgrastim and pegfilgrastim were 0.18 and 1.94 (p = 0.021), respectively, and the median durations of ANC recovery to baseline value were 5.5 days and 2 days (p = 0.023), respectively. For the median days of ANC under 50% of baseline value, days of ANC under 90% of baseline value, days of ANC less than 0.5 x 109 cells/L, and difference of peak and trough level of ANC during 1 cycle of R-CHOP, the pegfilgrastim group performed better than the filgrastim group. However the difference was not statistically significant. In terms of overall expense during 1 cycle of R-CHOP, pegfilgrastim is about 3.43 times more expensive than filgrastim. CONCLUSION: Pegfilgrastim is more efficient than filgrastim in terms of clinical efficacy. In terms of prices, pegfilgrastim is more expensive than filgrastim for patients, but it is more convenient in clinical use. Therefore, pegfilgrastim should be the preferred choice of G-CSF for neutropenic patients. Further comparative study of pegfilgrastim and filgrastim is needed.
Cyclophosphamide ; Granulocyte Colony-Stimulating Factor ; Humans ; Lymphoma, B-Cell ; Neutropenia ; Neutrophils ; Prednisone ; Vincristine ; Filgrastim ; Rituximab

OBJECTIVE: Pain is very common in the elderly, so there is a high prevalence of analgesic use among this population. The purpose of this study was to assess patterns of analgesic use and evaluate factors associated with analgesic use in elderly patients. METHOD: The subjects of this study were patients over 65 years old hospitalized in a teaching hospital located in Chuncheon-si, Korea between January 1, 2014 and March 31, 2014. Data collection regarding analgesic prescriptions and baseline characteristics was conducted using computerized hospital database by medical information team. Logistic regression analysis was used to identify factors related to analgesic use. RESULTS: A total of 2,394 patients were finally included. Among these patients, 700 (29.2%) took analgesics; 521 (74.4%) out of these 700 patients were received opioid analgesics and 179 (25.6%) were received only non-opioid analgesics. The most frequently prescribed opioid analgesic was pethidine (45.7%), and the most frequently prescribed non-opioid analgesic was acetaminophen (44.1%). Fracture was associated with increased odds of opioid analgesic prescriptions (OR = 2.766, 95% CI = 2.019-3.790, p < 0.001) and any analgesic prescriptions (OR = 2.394, 95% CI = 1.766-3.244, p < 0.001). Stroke or cerebral infarction was associated with decreased odds of opioid analgesic prescriptions (OR = 0.636, 95% CI = 0.471-0.858, p = 0.003). CONCLUSION: A significant proportion of hospitalized elderly patients use analgesics. Health care professionals should consider factors associated with analgesic use in this population to improve pain management.
Acetaminophen ; Aged* ; Analgesics ; Analgesics, Opioid ; Cerebral Infarction ; Data Collection ; Delivery of Health Care ; Gangwon-do ; Hospitals, Teaching ; Humans ; Korea ; Logistic Models ; Meperidine ; Pain Management ; Prescriptions ; Prevalence ; Stroke

OBJECTIVE: It is to evaluate the drug interaction monitoring program as a pilot project to develop a pharmaceutical care model in a medical intensive care unit and to analyze the influencing factors of drug interactions. METHOD: Electronic medical records were retrospectively investigated for 116 patients who had been hospitalized in a medical intensive care unit from October to December in 2014. The prevalence of adverse reaction with risk rating higher than 'D' was investigated by Lexi-Comp(R) Online database. The factors related with potential drug interaction and with treatment outcomes were analyzed. RESULTS: The number of patients with a potential interaction of drug combination was 92 (79.3%). Average ages, the length of stay in the intensive care unit and the numbers of prescription drugs showed significant differences between drug interaction group and non-drug interaction group. Opioids (14.4%), antibiotics (7.2%), and diuretics (7.2%) were most responsible drug classes for drug interactions and the individual medications included furosemide (6.4%), tramadol (4.9%), and remifentanil (4.5%). There were 950 cases with a risk rating of 'C' (84.6%), 142 cases with a risk rating of 'D' (12.6%), and 31 cases with a risk rating of 'X' (avoid combination) (2.8%). The factors affecting drug interactions were the number of drugs prescribed (p < 0.0001) and the length of stay at intensive care unit (p < 0.01). The patients in intensive care unit showed a high incidence of adverse reactions related to potential drug interaction. Therefore, drug interaction monitoring program as a one of pharmaceutical care services was successfully piloted and it showed to prevent adverse reaction and to improve therapeutic outcomes. CONCLUSION: Active participation of a pharmacist in the drug management at the intensive care unit should be considered.
Analgesics, Opioid ; Anti-Bacterial Agents ; Diuretics ; Drug Interactions* ; Electronic Health Records ; Furosemide ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Length of Stay ; Pharmaceutical Services* ; Pharmacists ; Pilot Projects ; Prescription Drugs ; Prevalence ; Retrospective Studies ; Tramadol

BACKGROUND: The protective effect of metformin against breast cancer is inconclusive. OBJECTIVE: To evaluate the effect of metformin on breast cancer risk and mortality in patients with type 2 diabetes. METHOD: A comprehensive literature search was performed for pertinent articles published prior to June 30, 2014, using PubMed and EMBASE. Study heterogeneity was estimated with I2 statistic. The data from the included studies were pooled and weighted by random-effects model. The quality of each included study was assessed on the basis of the 9-star Newcastle-Ottawa Scale and publication bias was evaluated by visual inspection of a funnel plot. RESULTS: Ten studies were included in the meta-analysis of the association of metformin and breast cancer risk. By synthesizing the data from the studies, the pooled odds ratio (OR) was 0.72 (95% CI: 0.59, 0.87) (p = 0.0005). Three cohort studies were included for meta-analysis of the association between metformin and breast cancer-related mortality. Metformin was associated with a significant decrease in mortality (Risk ratio: 0.68; 95% CI: 0.51, 0.90, p = 0.007). CONCLUSION: The present meta-analysis suggests that metformin appears to be associated with a lower risk of breast cancer incidence and mortality in patients with type 2 diabetes.
Breast Neoplasms* ; Breast* ; Cohort Studies ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Humans ; Incidence ; Metformin* ; Mortality* ; Odds Ratio ; Population Characteristics ; Publication Bias

Neonates have large inter-individual variability in pharmacokinetic parameters of many drugs due to developmental differences. The aim of this study was to investigate the factors affecting the pharmacokinetic parameters of drugs, which are commonly used in critically ill neonates. Factors that reflect physiologic maturation such as gestational age, postnatal age, postconceptional age, birth weight, and current body weight were correlated with pharmacokinetic parameters in neonates, especially preterm infants. Comorbidity characteristics affecting pharmacokinetics in critically ill neonates were perinatal asphyxia, hypoxic ischemic encephalopathy, patent ductus arteriosus (PDA), and renal dysfunction. Administration of indomethacin or ibuprofen in neonates with PDA was associated with the reduced clearance of renally excreted drugs such as vancomycin and amikacin. Therapeutic hypothermia and extracoporeal membrane oxygenation were influencing factors on pharmacokinetic parameters in critically ill neonates. Dosing adjustment and careful monitoring according to the factors affecting pharmacokinetic variability is required for safe and effective pharmacotherapy in neonatal intensive care unit.
Amikacin ; Asphyxia ; Birth Weight ; Body Weight ; Comorbidity ; Critical Illness* ; Drug Therapy ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Ibuprofen ; Indomethacin ; Infant, Newborn* ; Infant, Premature ; Intensive Care, Neonatal ; Membranes ; Oxygen ; Pharmacokinetics ; Vancomycin

Experiential education is a core curriculum of pharmacy education. In experiential education, formative feedback is an integral component of learning and teaching process. Feedback is defined as information provided by a preceptor regarding student's performance based on direct observation. With effective feedback, students can have opportunities to reinforce or correct behaviors and to acquire knowledge or skills. Students highly value and appreciate feedback. They rank provision of effective feedback as one of the most important qualities of preceptors. Preceptors, however, lack an understanding of feedback or practical skills necessary for providing effective feedback. As a result in reality, the feedback provided to students can be differentially effective in improving students' learning. This article describes a theoretical understanding of feedback including definition and value, as well as types of feedback. In addition, practical aspects in providing feedback, such as contents, timing, techniques, and models, are addressed. By understanding the value of feedback and mastering various feedback skills, preceptors will promote students' learning and enhance educational outcomes of experiential education.
Curriculum ; Education* ; Education, Pharmacy ; Formative Feedback ; Humans ; Learning ; Pharmacy* ; Students, Pharmacy

Erratum agreed to by all authors, editor in chief, publisher, and scientific society.