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Dapagliflozin's Effects on Glycemia and Cardiovascular Risk Factors and Incidence of Adverse Events in Patients with Type 2 Diabetes.

Hye Jin LEE ; Min Jung GEUM ; Jae Song KIM ; Kim KIM ; Eun Sun SON

Korean Journal of Clinical Pharmacy.2017;27(4):214-220. doi:10.24304/kjcp.2017.27.4.214

BACKGROUND: Dapagliflozin is an oral selective inhibitor of sodium-glucose cotransporter 2(SGLT2), the kidney transporter chiefly responsible for glucose reabsorption from the glomerular filtrate. Because this mechanism does not require the action of insulin, dapagliflozin rarely causes hypoglycemia. Dapagliflozin may affect blood glucose control as well as blood pressure and the body weight which are one of the cardiovascular disease risk factors. However, dehydration and ketoacidosis are reported as the side effects of the dapagliflozin treatment and the safety issues have been occurred. The aim of this study is to analyze the effectiveness and adverse events of dapagliflozin in Korean patients. METHODS: From December 2014 to August 2015, we retrospectively reviewed the electronic medical records of type 2 diabetes patients who were prescribed dapagliflozin at Severance Hospital. RESULTS: A total of 202 Korean patients were enrolled in this study. The effectiveness in the reduction of blood glucose was statistically significant(p < 0.001). Dapagliflozin decreased 0.74% of HbA1c after 24 weeks. Significantly more participants achieved the target HbA1c level(HbA1c < 7%) after 24 weeks(n=42, 35.3%) than before taking dapagliflozin(n=21, 17.6%). Blood pressure decreased 5.7 mmHg s ystolic b lood p ressure(SBP), 1.9 mmHg d iastolic b lood p ressure(DBP) a fter 24 weeks. M ore than o ne q uarter of participants(n=35, 29.4%) experienced weight loss. Most common adverse event was genitourinary symptoms. CONCLUSION: In this study, the effectiveness of dapagliflozin in improving glycemic control, blood pressure control, and weight loss was statistically significant. However, elderly and female patients, who have higher incidence of adverse events, should use dapagliflozin cautiously.

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Efficacy and Safety of Aerosolized Colistin in the Treatment of Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis.

Minwoo PAIK ; Kyeonghye JEUNG ; Eun Young KIM

Korean Journal of Clinical Pharmacy.2017;27(4):207-213. doi:10.24304/kjcp.2017.27.4.207

BACKGROUND: It is recommended to use aerosolized (AS) colistin in patients undergoing mechanical ventilation therapy as an adjunctive in the latest guidelines, in spite of high nephrotoxicity and limited studies. In this study, systematic reviews and metaanalyzes were conducted to evaluate the safety and efficacy of AS colistin in patients with ventilator-associated pneumonia. METHODS: Two authors independently searched related literature published from Pubmed and EMBASE until July 2016 and included a study comparing adjunctive AS colistin with intravenous (IV) colistin monotherapy. The primary outcome was the clinical response rate, the secondary outcome was the overall mortality, and nephrotoxicity. The publication bias was evaluated using the Egger's test. RESULTS: Of the total 279 articles, nine were finally included in the final analysis. There was a significant difference between the adjunctive AS colistin group and the IV colistin monotherapy group for the treatment-response rate (odds ratio (OR), 1.56; 95% CI, 1.14–2.14; p = 0.005; I² = 36%), although there was no significant difference in overall mortality (OR, 0.77; 95% CI, 0.57–1.04; p = 0.09; I² = 20%). However, there was no significant difference between the two groups in nephrotoxicity (OR, 1.13; 95% CI, 0.74–1.74; p = 0.57; I² = 4%). CONCLUSION: The addition of aerosolized colistin to IV colistin monotherapy showed better results in terms of efficacy than IV colistin monotherapy and did not show any significant difference in terms of total mortality and nephrotoxicity. Additional large-scale studies of this need to be verified.

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Hormone Therapy Review for Perimenopausal Symptoms: Focused on Perimenopausal Women without Other Risk Factors.

Young Mee LEE ; Hwi Yeol YUN

Korean Journal of Clinical Pharmacy.2017;27(4):199-206. doi:10.24304/kjcp.2017.27.4.199

As the population ages, the life of women after menopause becomes much longer than the past, and the quality of life of old age becomes increasingly principal issue. There is a period that women experience the physical symptoms of menopause, although there are differences in degree, and the management of this period is a suitable time for women to improve their quality of life. According to the menopausal hormone therapy (MHT) and Timing Hypothesis, which has been proven in the Kronos Early Estrogen Prevention Study (KEEPS) and the Early vs Late Intervention Trial with Estradiol (ELITE) study, a relatively young woman before and after menopause can benefit from long-term beneficial effects such as prevention of osteoporosis and cardiovascular disease by early initiation of hormone therapy to alleviate menopausal symptoms. MHT should be considered for all women in healthy (without other important diseases) menopausal years, expecting to improve their quality of life through symptom relief in menopausal women and, in the long term, to prevent cardiovascular disease and osteoporosis. When applying hormone therapy to individuals, it is necessary to establish various treatment strategies according to the menopausal symptoms of individual patients (individualization of treatment) and judge the suitability of clinical application.

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The Effect of Stress and Depression on Unmet Medical Needs.

Eun Hee PARK ; Eun Cheol PARK ; Daniel H OH ; Eun CHO

Korean Journal of Clinical Pharmacy.2017;27(1):44-54. doi:10.24304/kjcp.2017.27.1.44

BACKGROUND: Mental health issues such as stress and depression have been regarded as major social problems in Korea. We investigated the relationship between stress and depression with unmet medical needs (UMN). METHODS: Using the nationwide database of 2010 Korea National Health and Nutritional Examination Survey (K-NHANES), subjects aged 19 years or above were selected (n=6,055). In the K-NHANES questionnaire, subjects were asked about their UMN experience, severity of stress, and perceived depression lasting at least 2 weeks over the past year. The effects of stress and depression on UMN were analyzed in 4 models established by adding predisposing, enabling and need factors in a step-wise fashion. The risks for UMN were also assessed according to the causes of UMN. RESULTS: Individuals who felt stress ‘very often’ (odds ratio (OR) 3.28, 95% CI=2.23-4.86) and ‘often’ (OR 2.53, 95% CI=1.93-3.31) and who experienced depression (OR 1.68, 95% CI=1.35-2.10) reported significantly elevated UMN rates, and these effects were substantial especially for the individuals who had UMN due to economic constraint. Females, lower education level, lower income, unemployed status, and negative perceptions about health status were found to be additional risk factors for UMN. CONCLUSION: Our results confirmed the risks of stress and depression on UMN. It is strongly advisable to create initiatives to improve mental health, particularly stress and depression, and to fulfill individuals' medical utilization needs.
Depression* ; Education ; Female ; Humans ; Korea ; Mental Health ; Risk Factors ; Social Problems

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Success Factors for the Smoking Cessation Service of the Safe Pharmacy.

Eunjeong KANG ; Hyekyung PARK

Korean Journal of Clinical Pharmacy.2017;27(1):38-43. doi:10.24304/kjcp.2017.27.1.38

OBJECTIVE: Seoul City has implemented the Safe Pharmacy in 2013. This study aimed to ascertain the success factors of the smoking cessation service of the Safe Pharmacy. METHODS: The data for the smoking cessation registration cards were obtained from the pharmacies which participated in 2014 Safe Pharmacy. The sample included 289 smokers in 6 districts who participated at least one sessions of smoking cessation service. the service included both behavioral intervention and nicotine replacement therapy. In order to identify the effectiveness of the smoking cessation service, logistic regression analysis was used. The dependent variable was the success of quitting smoking at the 4th week. The independent variables included age, sex, employment, chronic disease, district, smoking amount, registration path, supporters for quitting smoking and number of service sessions. RESULTS: Fifty eight point eight percent of the sample successfully quit smoking at the 4th week. Unemployment, higher smoking amount, and less service sessions were negatively related to the success of quitting smoking. There were differences in the success rate across districts. Age, sex, chronic disease, registration path, and anti-smoking supporters were not related to the success rate. CONCLUSION: Pharmacy can be an effective community resource for smoking cessation. Factors that could increase the effectiveness of smoking cessation service of the Safe Pharmacy and possible ways to enhance the participation of pharmacies in smoking cessation services were also discussed.
Chronic Disease ; Employment ; Logistic Models ; Nicotine ; Pharmaceutical Services ; Pharmacies ; Pharmacy* ; Seoul ; Smoke* ; Smoking Cessation* ; Smoking* ; Unemployment

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Patient Attitudes and Considerations in Decision toward Participation in Clinical Trials of Chronic Diseases.

Jooyon YI ; Hongwon JANG ; Jeong Hyun YOON ; Sandy Jeong RHIE

Korean Journal of Clinical Pharmacy.2017;27(1):30-37. doi:10.24304/kjcp.2017.27.1.30

BACKGROUND: We investigated the impact of financial compensation on patients' decision of participation in clinical trials and the related factors with patients' attitudes and considerations. METHODS: A survey questionnaire was placed from October 31 to November 16, 2017 to the subjects who were enrolled in the trials of chronic diseases. Patients' socio-demographic characteristics were collected and the potential reasons for participating in the trials were assessed using 5-likert scores. RESULTS: Sixty eight of 110 respondents (61.8%) indicated to participate clinical trials regardless of financial compensation. The differences were found between patients who were unwilling to participate without compensation and those who were willing to participate regardless of compensation in mean ages (43.9 years vs. 52.0 years, p<0.05), marital status (married, 47.6% vs 79.4%, p<0.01), religions (yes, 45.2% vs 67.6%, p<0.05) and monthly income (≥3 million won, 19.0% vs 45.6%, p<0.01). The potential reasons for participation in the trials between two groups were doctor's suggestion (52.4% vs. 77.9%, p<0.01), the expectation of health improvement (54.8% vs. 73.5%, p<0.05), the types and numbers of procedure (33.3% vs. 16.2%, p<0.05) and the duration of clinical trials (59.5% vs. 27.9%, p=0.001). In regression analysis, the monthly income of ≥ 3 million won (odd ratio, OR=3.221, p=0.026,) and the duration of trials (OR=0.290, p=0.017) were related to the group with the willingness to participate regardless of compensation. CONCLUSION: This stady showed that more than half of study subjects would participate in the clinical trials of chronic diseases regardless of financial compensation.
Chronic Disease* ; Compensation and Redress ; Humans ; Marital Status ; Surveys and Questionnaires

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Risk Factors for Vancomycin-Associated Nephrotoxicity in Elderly Patients.

Ha Nui KIM ; Hae Sook KIM ; Yang Hyun LEE ; Kyeong Ju LEE ; Seung Woo SHIN ; Seon Cheol PARK ; Yu Jeung LEE

Korean Journal of Clinical Pharmacy.2017;27(1):22-29. doi:10.24304/kjcp.2017.27.1.22

OBJECTIVE: Infection is very common in the elderly, so there is a high prevalence of antibiotics use among this population. Especially, due to the emergence of resistant bacteria, the use of vancomycin is growing. The purpose of this study was to evaluate risk factors associated with vancomycin-induced nephrotoxicity in elderly patients. METHODS: The subjects of this study were patients over 18 years old who received intravenous vancomycin in a general hospital located in Gangneung-si, Korea between August 1, 2013 and July 31, 2015. Data collection regarding vancomycin use and baseline characteristics was conducted using computerized hospital database. Logistic regression analysis was used to identify risk factors associated with vancomycin-induced nephrotoxicity. RESULTS: A total of 290 patients were finally included, and 191(66%) out of these patients were age 65 or older. The incidence of vancomycin-induced nephrotoxicity was 11.0%, 12.6%, and 7.0% in the all adult patients, the elderly patients, and the non-elderly patients, respectively. There were significant differences in comorbidities between patients with nephrotoxicity and patients without nephrotoxicity in the all adult patients, and there were significant differences in vancomycin duration, comorbidities, and number of nephrotoxic agents between patients with nephrotoxicity and patients without nephrotoxicity in the elderly patients. However, according to the logistic regression analysis, there was no significant risk factor that increases the incidence of vancomycin-induced nephrotoxicity in all three age groups. CONCLUSION: There were no differences in risk factors that increase the incidence of vancomycin-induced nephrotoxicity between all adult patients, elderly patients, and non-elderly patients. Further studies with larger sample sizes to identify risk factors associated with vancomycin-induced nephrotoxicity in the elderly to improve the outcome of pharmacotherapy are required.
Acute Kidney Injury ; Adult ; Aged* ; Anti-Bacterial Agents ; Bacteria ; Comorbidity ; Data Collection ; Drug Therapy ; Hospitals, General ; Humans ; Incidence ; Korea ; Logistic Models ; Prevalence ; Risk Factors* ; Sample Size ; Vancomycin

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Evaluation of Perioperative Antithrombotic Management in Patients Undergoing Moderate to High Risk Surgery.

Hyeon Ah LEE ; Yun Hee JO ; Yoonsook CHO ; Hyeon Joo HAHN ; Ju Yeun LEE ; Keun Hwa JUNG ; Sang Kun LEE

Korean Journal of Clinical Pharmacy.2017;27(1):15-21. doi:10.24304/kjcp.2017.27.1.15

OBJECTIVE: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. METHODS: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. RESULTS: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). CONCLUSION: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
Anticoagulants ; Aspirin ; Cohort Studies ; Coronary Artery Bypass ; Hemorrhage ; Humans ; Incidence ; Thorax ; Thromboembolism ; Thrombosis ; Warfarin

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Middle East Respiratory Syndrome Outbreak and Responsiveness of the Pharmacy Programs on the Pharmacy Practice Education.

Kyung Hee CHOI ; Kyung Suk CHOI ; Young Sook LEE ; Jaeyoun KIM ; Kyeong Hye JEONG ; Jung Mi OH ; Kyung Eob CHOI ; Hyeon Oh RA ; Euni LEE

Korean Journal of Clinical Pharmacy.2017;27(1):9-14. doi:10.24304/kjcp.2017.27.1.9

BACKGROUND: Pharmacy curriculum change was made from a 4-year program to a 2+4 year program in year 2009 in Korea. The change has resulted in more educational exposures on patient-centered practice environments for about 1,400 hours in the last year of the professional pharmacy program. When the Middle East Respiratory Syndrome (MERS) outbreak hit Seoul and suburban areas and propagated to other provinces in Korea, emergency response to avoid student infection in the pharmacy practice sites became an urgent issue. While other health professional programs such as medicine and nursing had activated emergency preparedness manuals, timely and clear guidelines were not disseminated to all pharmacy programs and protective measures largely relied on individual pharmacy program. METHODS: A survey was developed by the Committee on Pharmacy Practice Experience Programs in the Korean College of Clinical Pharmacy to document the status of pharmacy programs during the Korea MERS outbreak in 2015. The 10-question survey was distributed to the pharmacy practice experience coordinators to 34 out of 35 pharmacy schools in Korea by emails. RESULTS: Our findings showed that 82.4% of the program coordinators (28/34) responded to the survey, 96.4% of the programs did not have emergency preparedness manuals, administrative meetings were held in 89.3% of the pharmacy programs, the rotation schedules were modified or withheld in 53.6% of schools, and the changes were mostly observed from the programs classified as MERS outbreak regions. CONCLUSION: Further needs in establishing the emergency preparedness manual should be explored for pharmacy education stakeholders.
Appointments and Schedules ; Civil Defense ; Coronavirus Infections* ; Curriculum ; Education* ; Education, Pharmacy ; Electronic Mail ; Emergencies ; Health Occupations ; Humans ; Korea ; Middle East* ; Nursing ; Pharmacy* ; Schools, Pharmacy ; Seoul

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Development of a Pharmaceutical Care Service Model for Patients with Diabetes in Ambulatory Care Settings.

Jeong Hyun YOON

Korean Journal of Clinical Pharmacy.2017;27(1):1-8. doi:10.24304/kjcp.2017.27.1.1

The prevalence of diabetes and its related morbidity and mortality are being increased. Despite the advancement of evidence-based pharmacotherapy in the management of diabetes, many patients in our country do not achieve satisfied therapeutic outcomes. Pharmaceutical care service can be defined as a patient-centered clinical service provided by pharmacists to improve therapeutic outcomes and quality of life of patients, by identifying, and preventing or resolving drug-related problems (DRPs). Pharmaceutical care service is interdisciplinary team-based practice, and is provided through collaborative practice agreement (CPA) between one or more physicians and pharmacists. This article describes a model of pharmaceutical care service which can be adopted in our country for patients with diabetes in the ambulatory care settings. With the successful implementation of this service, clinical, economic, and humanistic outcomes of patients will be improved. Therefore, by actively implementing pharmaceutical care service, pharmacist should contribute to the promotion of patients' health and to the advancement of health care delivery system.
Ambulatory Care* ; Delivery of Health Care ; Drug Therapy ; Humans ; Mortality ; Pharmaceutical Services* ; Pharmacists ; Prevalence ; Quality of Life

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