No abstract available.
Child* ; Humans

BACKGROUND: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. METHODS: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. RESULTS: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). CONCLUSIONS: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.
Anti-Infective Agents ; Humans ; Critical Care ; Intensive Care Units* ; Korea ; Nutritional Support ; Observational Study ; Pharmacists* ; Pharmacokinetics ; Retrospective Studies

BACKGROUND: Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting. METHODS: Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists. RESULTS: A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05). CONCLUSION: The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.
Awards and Prizes ; Family Practice ; Humans ; Physician's Role ; Primary Health Care* ; Quality of Health Care ; Specialization

BACKGROUND: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. METHODS: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. RESULTS: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). CONCLUSIONS: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.
Anti-Infective Agents ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Nutritional Support ; Observational Study ; Pharmacists ; Pharmacokinetics ; Retrospective Studies

BACKGROUND: The aim of this study was to investigate the value of colonoscopy for assessment of colonic mucosal lesions and for microbial identification in patients with acute diarrhea. METHODS: From March 2000 to August 2000, forty-one patients with watery or bloody diarrhea lasting less than 15 days were participated after the exclusion of patients who had previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. Both biopsy specimens and colonic luminal fluid were taken during the colonoscopy and used for bacterial cultures. RESULTS: Male and female ratio was 22:19 and mean age was 45+/-20 years. The extent of acute colitis was as followed: the normal colonoscopic finding in five cases (12.2%), involvement of one segment in 3 cases (7.3%), involvement of two or more segments in 14 cases (34.1%), pancolitis in 10 cases (24.4%) and pancolitis with terminal ileitis in 9 cases (22.0%). In culture study, identification of more than one pathogen was in 19/41 (46.3%) and the common pathogens were Enterobacter (11 cases), Salmonella species (6 cases), Citrobacter freundii complex (2 cases), Klebsiella oxytoca (2 cases) and Morganella morganii (1 case). Pathogen could be identified in 11.8% with stool specimen, 46.2% with biopsy specimen and 62.5% with intraluminal fluid, but without statistical significance. CONCLUSION: Colonoscopy was useful in the evaluation of extent and severity of acute infectious colitis. Obtaining the biopsy specimens and intraluminal fluid during colonoscopy seemed to assist in identifying the pathogen in patients with acute diarrhea.
Biopsy* ; Citrobacter freundii ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy* ; Crohn Disease ; Diarrhea* ; Enterobacter ; Enterocolitis, Pseudomembranous ; Female ; Humans ; Inflammatory Bowel Diseases ; Klebsiella oxytoca ; Male ; Morganella morganii ; Phenobarbital ; Salmonella

BACKGROUND/AIMS: The aim of this study was to investigate the value of colonoscopy for Salmonella-Shigella culture of biopsy specimen and intraluminal fluid during colonoscopy in patients with acute diarrhea. METHODS: From March 2001 to August 2001, sixty-six patients with watery or bloody diarrhea lasting less than 15 days were participated after exclusion of the patients with previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. The biopsy specimen was taken and colonic luminal fluid was aspirated during colonoscopy for Salmonella-Shigella cultures. RESULTS: Male and female ratio was 1:1.3 and mean age was 45 17 years. The normal colonoscopic finding was showed in twelve cases (18.2%). The severity of acute colitis was mild in 25 cases (25/54, 46.3%), moderate in 9 cases (9/54, 16.7%), and severe in 20 cases (20/54, 37.0%). The extent of acute colitis was as followed: involvement of one segment in 9 cases (16.7%), involvement of two or more segments in 26 cases (48.1%), pancolitis in 7 cases (13.0%), and pancolitis with involved terminal ileum in 12 cases (22.2%). In culture study, identification of Salmonella species was in 11 cases (16.7%). Salmonella species were identified in 6.0% (3/50) with stool specimen, 18.0% (9/50) with biopsy specimen, and 4.0% (2/50) with intraluminal fluid, but without statistical significance. CONCLUSION: The culture using biopsy specimens and intraluminal fluid obtained during colonoscopy may be helpful in diagnosis of cases of suggesting Salmonella-Shigella infection.
Biopsy* ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy* ; Diagnosis ; Diarrhea* ; Enterocolitis, Pseudomembranous ; Female ; Humans ; Ileum ; Inflammatory Bowel Diseases ; Male ; Phenobarbital ; Salmonella

RUNX1, a member of the runt domain gene family of transcription factors, encodes a heterodimeric transcription factor and regulates the expression of various genes related to hematopoiesis and myeloid differentiation. RUNX1 has been one of the target genes for research into various autoimmune diseases due to its properties as a transcription factor and functional distribution for chromosomal translocation. In an effort to identify additional gene polymorphisms in which variants have been implicated in asthma, we investigated the genetic polymorphisms in RUNX1 to evaluate it as a potential candidate gene for a host genetic study of asthma and IgE production. We identified 19 sequence variants by direct DNA sequencing in 24 individuals of which four common variants were selected for genotyping in our asthma cohort (1,055 asthmatic patients, 384 normal controls). Using logistic regression analysis for association with the risk of asthma, while controlling for age, gender, and smoking status as covariates, no significant associations with the risk of asthma were detected. However, two polymorphisms in the promoter region (-2084G>C and -1282G>A) showed a marginal association with total IgE levels (0.03 and 0.03 in recessive models, respectively). Our findings suggest that polymorphisms in RUNX1 might be one of the genetic factors for the regulation of IgE production.
Sequence Analysis, DNA ; Risk Factors ; Polymorphism, Single Nucleotide ; *Polymorphism, Genetic ; Middle Aged ; Male ; Korea ; Immunoglobulin E/*blood ; Humans ; Female ; Data Collection ; Core Binding Factor Alpha 2 Subunit/*genetics ; Cohort Studies ; Child, Preschool ; Child ; Asthma/epidemiology/genetics ; Aged, 80 and over ; Aged ; Adult ; Adolescent

Thyroid hormone plays an important role in the process of implantation of a fertilized egg in the endometrium, as well as in the division and development of the fertilized egg. In addition, maternal thyroid hormone is essential for the formation and development of the fetal brain, nervous system, and bones. Therefore, when maternal thyroid hormone is insufficient, complications such as miscarriage, stillbirth, low birth weight and preeclampsia increase. Guidelines for the diagnosis and treatment of thyroid dysfunction during pregnancy were established and published by the American Endocrine Society, the American Thyroid Association, and the European Thyroid Society. The Korean Thyroid Society also published recommendations for diagnosis and treatment of thyroid disease during pregnancy and postpartum in 2014. However, since the revised guidelines of the American Thyroid Association were published in 2017, many studies, including large-scale randomized controlled trials, have been published in relation to thyroid and pregnancy, and the need to revise the existing recommendations has emerged in Korea.The main revisions of this recommendation are changes in the normal range of TSH during pregnancy, detailed description of treatment policies according to pregnant women’s autoantibodies and thyroid function status. Also, a description of the effect of thyroid autoantibodies on assisted reproductive procedures has been added.

Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels, usually presents without symptoms, and is often discovered incidentally during routine blood test. The Task Force of the Korean Thyroid Association Committee of Clinical Practice Guidelines has established a guideline to evaluate and manage SCH; the guideline emphasizes the implementation of diagnostic criteria based on the TSH reference range for Koreans and focuses on the proven health benefits of levothyroxine (LT4) treatment. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), serum TSH level of 6.8 mIU/L is considered the reference value for SCH. SCH can be categorized as mild (TSH 6.8-10.0 mIU/L) or severe (TSH ＞10.0 mIU/L), and patients are classified as adults (age ＜70 years) or elderly patients (age ≥70years) depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, along with the thyroid peroxidase antibody test, preferably 2-3 months after the initial evaluation. Usually, LT4 treatment is not recommended for mild SCH in adults; however, treatment is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and can be considered for coexisting dyslipidemia. LT4 treatment is not recommended for mild or even severe SCH in elderly patients, in general. Patients with SCH who receive LT4 treatment, the LT4 dosage should be personalized, and serum TSH levels should be monitored to ensure optimal LT4 dosage (dosage that is neither excessive nor insufficient). Patients with SCH who do not receive LT4 treatment require periodic follow-up at appropriate testing intervals determined by disease severity. The guideline also provides several educational points applicable in clinical settings.