Eui-Kyung Lee

Ru(II)-catalyzed selective C-H amination of xanthones and chromones with sulfonyl azides: synthesis and anticancer evaluation.

A ketone-assisted ruthenium-catalyzed selective amination of xanthones and chromones C-H bonds with sulfonyl azides is described. The reactions proceed efficiently with a broad range of substrates with excellent functional group compatibility. This protocol provides direct access to 1-aminoxanthones, 5-aminochromones, and 5-aminoflavonoid derivatives known to exhibit potent anticancer activity.

Food away from home and body mass outcomes: Taking heterogeneity into account enhances quality of results

OBJECTIVES The aim of this study was to explore the heterogeneous association of consumption of food away from home (FAFH) with individual body mass outcomes including body mass index and waist circumference over the entire conditional distribution of each outcome. METHODS Information on 16,403 adults obtained from nationally representative data on nutrition and behavior in Korea was used. A quantile regression model captured the variability of the association of FAFH with body mass outcomes across the entire conditional distribution of each outcome measure. Heavy FAFH consumption was defined as obtaining ≥1400 kcal from FAFH on a single day. RESULTS Heavy FAFH consumption, specifically at full-service restaurants, was significantly associated with higher body mass index (+0.46 kg/m2 at the 50th quantile, 0.55 at the 75th, 0.66 at the 90th, and 0.44 at the 95th) and waist circumference (+0.96 cm at the 25th quantile, 1.06 cm at the 50th, 1.35 cm at the 75th, and 0.96 cm at the 90th quantiles) with overall larger associations at higher quantiles. Findings of the study indicate that conventional regression methods may mask important heterogeneity in the association between heavy FAFH consumption and body mass outcomes. CONCLUSION Further public health efforts are needed to improve the nutritional quality of affordable FAFH choices and nutrition education and to establish a healthy food consumption environment.

Effects of computerized physician order entry on medication turnaround time and orders requiring pharmacist intervention

BACKGROUND Previous studies have demonstrated that computerized physician order entry (CPOE) of prescriptions reduces both turnaround time (TAT) and medication errors. However, these studies have been performed primarily in large academic centers with a relatively small number of medication orders. As such, many studies investigating the impact of CPOE on the level of pharmacist intervention have yielded conflicting results. OBJECTIVE The objective of this study was to examine the effects of CPOE on medication order TAT and the frequency of medication orders requiring pharmacist intervention in a community-based medical center. METHODS A prospective cohort study was conducted at a community-based medical center. A total of 24,767 prescriptions written for 940 patients over a six-month period were stratified into CPOE or non-CPOE (handwritten) cohorts. TAT between cohorts were tested using analysis of variance and Tukeys Honestly Significant Difference test. The number of orders requiring pharmacist intervention was compared between cohorts and tested using chi-square test or Fishers exact test. Medication orders requiring pharmacist intervention were stratified by patient characteristics, therapeutic class, and types of medication error. RESULTS Medication orders not using CPOE were approximately 8 times more likely to require pharmacist intervention (2.26% versus 0.29%; P < 0.001), with the majority of pharmacist interventions performed to prevent medication errors. The overall mean TAT for medication orders was significantly shorter in the CPOE group in comparison with the non-CPOE group (22.2 ± 86.5 min versus 81 ± 256.7 min; P < 0.001). CPOE orders nearly eliminated medication errors with wrong dosage forms and formulary issues. CONCLUSIONS Medication orders entered via CPOE are associated with a significant reduction in medication TAT and less likely to require pharmacist intervention. Use of CPOE may improve quality of patient care and efficiency of health care delivery.

A Comparison of Preferences of Targeted Therapy for Metastatic Renal Cell Carcinoma between the Patient Group and Health Care Professional Group in South Korea

OBJECTIVES To evaluate the preferences of health care professional groups and patient groups with respect to efficacy, adverse events, and administration method for targeted agents of metastatic renal cell carcinoma. METHODS A total of 485 respondents including cancer patients and health care professionals (medical oncologists, nurses, and pharmacists) were surveyed by using a discrete choice experiment in South Korea. Through a literature review and expert consultation, six attributes--progression-free survival, four adverse events (bone marrow suppression, hand-foot skin reaction, gastrointestinal perforation, and bleeding), and administration--were selected. This study employed the conditional logit regression model. RESULTS The six attributes are statistically significant for the patient group and health care professional group. The two groups, however, present differences in progression-free survival, hand-foot skin reaction, gastrointestinal perforation, and administration. The relative importance of adverse events is greater for the patient group, while that of efficacy and administration is greater for the health professional group. For doctors, the relative importance of efficacy is as high as 31%, compared with 7% for the patient group. If progression-free survival is prolonged by 1 month, the acceptable level of bone marrow suppression is 1.3% for the patient group and 9.6% for doctors and that of hand-foot skin reaction is 1.0% and 11.8%, respectively, for the patient group and doctors. CONCLUSIONS This study demonstrates substantial differences in the preference for a targeted drug between the patient group and the health care professional group. Doctors prefer effective and orally administered drugs while patients show more reluctant attitudes about adverse events than do health care professionals.

Gender Differences in the Impact of Obesity on Health-Related Quality of Life.

This study investigated the association between health-related quality of life (HRQoL) and obesity stratified by sex in 34 935 Korean adults. We used data from the Korea National Health and Nutrition Examination Survey, a cross-sectional, nationwide, population-based survey, from 2007 to 2012. Individuals with higher than average health value scores using the EQ-5D-3L to measure HRQoL were classified as being in good health. Multiple logistic regressions were used to determine the association between obesity and good health. Of the 34 935 adults, 28.0% (9767) were classified as obese, 3.8% (1326) as severely obese, and 23.6% (8249) as overweight. Through multiple logistic regressions after adjustments, women who were severely obese had 31% significantly lower HRQoL than women with normal weight (95% confidence interval = 1.12-1.53). However, the same trend was not found in men. Additional interventional studies would be needed to better understand the causality of the association between obesity and HRQoL in women.

The utility score of epilepsy with partial seizure measured by TTO, VAS, and EQ-5D in the general Korean population

PURPOSES This study aimed to measure utilities, which are quantitative terms incorporating preferences, for various health states of epilepsy with partial seizure in the general population in South Korea. It also aimed to find socio-demographic characteristics associated with the utility scores. METHODS Utility scores using Time Trade-Off (TTO), Visual Analog Scale (VAS), and EuroQol five Dimension (EQ-5D) were obtained from 300 people aged 16 and over by face-to-face interviews. We measured utilities for three hypothetical health states of epilepsy for which scenarios were defined based on the frequency of partial seizure: seizure-free, seizure reduction, and withdrawal. We compared utilities with varying seizure frequency using a repeated-measures ANOVA, and analyzed the association between utilities and socio-demographic characteristics using a generalized estimating equation (GEE). RESULTS The mean utility scores for withdrawal state, seizure reduction state, and seizure-free state were 0.303, 0.493, and 0.899, respectively, when measured by TTO. VAS yielded the mean utility scores of 0.211, 0.424, and 0.752 for respective health states, and corresponding scores with EQ-5D were 0.261, 0.645, and 0.959. The utility scores for the three health states were statistically different in TTO, VAS, and EQ-5D. The withdrawal state had the lowest utility scores. There were differences in mean utilities for the three health states across the three methods. Utilities by EQ-5D tended to have higher values than those by TTO and VAS. Utilities by VAS had the lowest values. In GEE analysis, the severity of epilepsy and household income were significantly related to utility scores. CONCLUSION The withdrawal state of epilepsy had the lowest utility value and the seizure-free state had the highest by all three techniques of utility measurement used. There were significant differences in utilities between one severity level of epilepsy and another. Utility was associated with household income and the severity of disease. Utility scores for distinct epilepsy states obtained in this study could facilitate health economic analyses of epilepsy treatments and thus help decision making in resource allocation.

Comparative safety for cardiovascular outcomes of DPP-4 inhibitors versus glimepiride in patients with type 2 diabetes: A retrospective cohort study

Abstract Concerns about the cardiovascular safety of dipeptidyl peptidase-4 (DPP-4) inhibitors persist. This study sought to determine whether there is a differential risk of hospitalization for cardiovascular diseases (CVDs) between DPP-4 inhibitors and glimepiride. We conducted this retrospective cohort study by using the Korean National Health Insurance Service database from December 1, 2008, to December 31, 2013. The study subjects were new users of DPP-4 inhibitors or glimepiride for type 2 diabetes. Outcome was defined as hospitalization for CVDs, including angina pectoris, myocardial infarction, transient cerebral ischemic attack, heart failure, or cerebrovascular disease or any procedure involving coronary artery bypass grafting or percutaneous coronary intervention. We used a Cox proportional hazard model to estimate the adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs), to assess the risk of CVDs associated with the use of DPP-4 inhibitors compared with glimepiride. The cohort consisted of 1,045,975 patients, with 6504 in the DPP-4 inhibitors group and 13,447 in the glimepiride group. No significant increased risk of total CVDs was found (aHR, 0.87; 95% CI, 0.75–1.01) in the DPP-4 inhibitors versus glimepiride group. A decreased risk of hospitalization for CVDs was found among patients with a history of visit for CVDs (aHR, 0.73; 95% CI, 0.56–0.97) or with >2.5 years’ duration of type 2 diabetes (aHR, 0.77; 95% CI, 0.66–0.91) in the DPP-4 inhibitors versus glimepiride group. DPP-4 inhibitors did not increase cardiovascular risk compared with glimepiride regardless of CVD history and diabetes duration.

Health Care Utilization and Direct Costs in Mild, Moderate, and Severe Adult Asthma: A Descriptive Study Using the 2014 South Korean Health Insurance Database

PURPOSE Although asthma exacerbation comprises a large burden of the total asthma-related costs, few studies have examined the frequency and cost of acute exacerbation according to asthma severity. This study investigated asthma-related health care utilization and costs according to the severity of asthma. METHODS We conducted a descriptive study using the national health insurance claims database between January 1 and December 31, 2014. We included adult patients with asthma (18 years of age and older) who had ≥2 claims with for an asthma diagnosis and were prescribed ≥1 asthma medications. They were classified into 3 asthma severity levels (level 1 = mild, level 2 = moderate, and level 3 = severe), based on individual medication prescriptions. Acute exacerbation was defined as having a corticosteroid burst, an emergency department visit, or hospitalization. Health care utilization, acute exacerbation, and direct costs associated with asthma were compared according to asthma severity levels. FINDINGS Of the 36,687 adult asthma patients, level 1 had the largest proportion of patients (81.2%), followed by level 2 (18.2%), and level 3 (0.6%). The average number of asthma-related outpatient visits was 4.5 for level 1, 7.2 for level 2, and 11.9 for level 3 (P < 0.01). The estimated asthma-related direct cost per patient was

Economic Burden of Hypoglycemia in Patients with Type 2 Diabetes Mellitus from Korea

174 for level 1,

Cost-Benefit Analysis of Posaconazole Versus Fluconazole or Itraconazole as a Primary Antifungal Prophylaxis in High-Risk Hematologic Patients: A Propensity Score-Matched Analysis

634 for level 2, and