의약분업 및 의약품분류에 대한 의사와 약사의 태도

이석기,박재용 慶山大學校 保健福祉硏究所 2000 保健福祉硏究 Vol.4 No.-

경상북도 일부지역(5개시군) 의사 110명과 약사 106명을 대상으로 1998년 4월 1일부터 4월 30일까지 우편설문지법으로 의약분업에 대한 견해를 조사하였다. 의약분업 실시에 대하여 '분업 내용에 따른 조건부 찬성'이 의사 51.8%, 약사 50.9%로 비슷하였으나 의사는 '무조건 찬성'이 30.0%인 반면에 약사는 7.5%였다. 의사는 1999년부터 의약분업을 실시해야 한다는 의견이 25.5%였으나 약사는 5.8%에 불과하였다. 의사는 주사제를 제외한 전문의약품까지 적용하는 '2단계까지 점진적으로 실시'에 대해 36.4%가 찬성하였고 약사는 제한적 전문의약품만 적용하는 '1단계까지만 의약분업 실시'하는 것을 가장 많이(25.5%) 찬성하였다. 현재 분업실시 가능한 대상의약품으로는 의사, 약사 모두 '제한적 전문의약품에 한해 실시되어야 한다는 의견이 각각 40.0% 및 71.7%였다. 제한적 전문의약품의 종류에 의사의 73.6%가 항생제를 포함시켜야 한다고 하였으나 약사는 24.3%만 포함시켜야 한다고 하였다. 처방전발행 방법에 대해서 의사는 69.1%가 '상품명'과 '상품명' 또는 일반명'으로 해야 한다고 응답한 반면 약사는 89.6%가 '일반명' 그리고 '성분명'으로 해야 한다고 하였다. 처방의약품을 동일성분의 다른 회사 제품으로의 대체 투약에 관해서는 의사의 60.9%가 '처방전 발행의사의 동의를 받아야 한다'고 응답한 반면, 약사의 75.5%는 '약사가 판단하여 투약 도는 처방의약품 대체 조제장부에 기록 후 투약할 수 있어야 한다'고 하였다. 약사가 처방전 없이 전문의약품을 조제할 수 있는 항목 중에서 '경구용 전염병 예방접종약 및 진단용의약품을 투여하는 경우' 대해서는 의사는 19.1%만 찬성하였고 약사도 46.2%의 찬성율을 보였을 뿐이다. 한편 의사 자신이 직접 전문의약품을 조제 할 수 있도록 하는 7가지의 의약분업 예외규정 중에서 '입원환자에 대한 조제를 예외로 인정하는 경우'와 '보건소(지소)에서의 조제를 예외로 인정하는 경우'에 대해서 의사는 각각 76.4%와 75.5%의 찬성율이었으나 약사는 각각 26.4%와 18.9%로 매우 낮은 찬성율을 보였다. 의약 분업시 의사의 45.5%는 수입이 조금 감소할 것이다 하였고 약사의 62.3%는 많이 감소할 것으로 생각하고 있었다. 의약품 분류에 관해서 의사의 43.6%는 4분류를 선택하였고 약사의 36.8%는 3분류(제한적 전문의약품, 전문 및 일반의약품)를 선택하였다. 약4국 이외의 장소에서 자유 판매할 수 있는 의약품의 종류에 대하여 의사는 소화제 55.1%, 자양강장제 43.6%를 지적하였고 제형으로 드링크제 80.9%를 지적하였는 반면 약사는 대다수(72.6%)가 의약품의 자유판매를 반대하였다. 이상의 결과를 종합해 보면 아직도 이해 당사자인 약사의 반대율이 높아 의약분업 실시 전에 적극적으로 설득할 필요가 있으며, 약사법에 규정된 1999년에 실시하는데 대해 의·약사 모두 찬성율이 낮아 많은 어려움이 있을 것이기 때문에 철저한 준비가 선행되어야 할 것이다. 의약분업을 실시할 경우 대상의약품은 제한적 전문의약품으로 한정할 필요가 있다. 그리고 처방전 발행방법 등에 관해서는 의사와 약사의 견해가 상당한 차이가 있기 때문에 이 부문에 대해 합의가 도달될 수 있도록 충분한 현실적, 경제적, 정책적 고려가 있어야 할 것이다. 또한 의약품 분류는 단순의약품을 의약부외품으로 허가하여 3분류체계로 하는 것을 고려해야 할 것이다. The purpose of this study is to investigate the attitude of physicians and pharmacists on the functional division of prescription and dispensation and classification of medical drugs. Questionnaires asking general characteristics, opinions on the separation of dispensary from medical practice and classification of medical drugs, were mailed to 249 physicians and 205 pharmacists in five cities and countries in Kyungpuk Province from April 1 to 30, 1998. 110 physicians and 106 pharmacists answered the questionnaires. Speaking of the opinions on the pros and cons of enforcing functional division between physicians and pharmacists, 30.0 percent of physician preferred pros, 51.8 percent conditional pros and 11.8 percent cons, but 7.5 percent of pharmacist preferred pros, 50.9 percent conditional pros and 38.7 percent cons. consequently, the physicians have affirmative views towards division of prescription and dispensation, and pharmacists negative ones. Regarding practicing phases of medical care improvement committee to enforce functional division between physician and pharmacist, 36.4 percent of physicians insisted on gradually-practiced phases and 25.5 percent of pharmacists selected one phase system. 40.0% percent of physicians and 71.7% percent of pharmacists assented that possible objective medicines of primary functional division must be only limited professional medicines, which contains steroid hormone, antibiotics, habitual drugs and a poisonous medicine. In addition, 73.6% percent of physicians wanted to include antibiotics, but only 24.3 percent of pharmacists did. Concerning the method of prescription, if functional division is enforced, most physicians(69.1%) preferred generic name or brand name, but most pharmacists(89.6%) preferred ingredient name or generic name. About the responsibility of medicine-injured accident occurred unexpectedly under functional division, 38.2 percent of physicians answered that the government or medical care insurance company must be responsible for it, but 50.9 percent of pharmacists answered that the doctor who writes the prescription ought to be blamed for it. From an affirmative point of view, the enforcement of the functional division of physician and pharmacist is expected to cause the decrease of mis-use or abuse of medicine, rise of a feeling of satisfaction for the profession, improvement of the quality of medical service and increase of the number of times of medical examination and treatment etc. On the contrary, from a negative point of view, it is expected to bring about lower frequency of the preparation of medicine in pharmacy, conflicts about the prescriptions between physicians and pharmacists, rise of medical expenses, reduction in income of the hospitals and the pharmacy, and change for the worse of the relations between the patients and physicians, patients and pharmacists etc. Physicians and pharmacists assented that the considerable problem is recognition and interest of people, balance of medical association and pharmaceutical association, government's willing for practive, etc. Many physicians and pharmacists support most of exceptional items in the pharmaceutical affairs law. but only 19.1 percent of physicians and 46.2 percent of pharmacists agreed that pharmacists had better prescribe oral preventive medicine to an epidemic, diagnostic medicine without doctor's directions. and 76.4 percent of physicians and 26.4 percent of pharmacists wanted to allow the physicians to prepare medicine for patient in the hospital. In addition, 76.4 percent of physicians and 26.4 percent of pharmacists approve of doctor's compounding of medicine in local public health care office. in comparison with other exceptional items, the above support percentages are relatively low. Regarding the opinions on the maintenance of pharmacy medical insurance, 32.7 percent of physicians answered that the maintenance of pharmacy medical insurance must be kept just before the first phase is enforced. but 23.6 percent of pharmacists answered that the maintenance of pharmacy under medical insurance must be kept before the third phase, 23.6 percent of physician asserted immediately while 61.3 percent of pharmacists answered that the maintenance of pharmacy medical insurance must be kept continually. As to the viewpoint of free over-the-counter medicine sale, 55.1 percent of physicians assented the free sale of digestives, 80.9 percent of physicians assented that of some kinds of drink, but most of pharmacists(72.6%) objected to the free over-the-counter medicine sale. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the government should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health. The results of this study can be summarized as follows ; 1. According to the answers to the questionnaires, The physicians consider the separation of dispensary from medical practice affirmative, the pharmacists answered in the negative. it is desirous that the enforcement of the separation of dispensary from medical practice starts from the first phase, that is limited professional medicine(steroid, antibiotics, habitual drugs, poisonous drug). 2. The medicines are now classified by two groups. but through the questionnaires, physicians wanted the medical drugs to be divided into four groups, in other words, limited professional medicines, professional medicines, general medicines and simple medicines. pharmacists wanted the medical drugs to be divided into three groups(limited professional medicines, professional medicines, general medicines). For us to manage the functional division efficiently, it will be good to permit 'simple medicines' as goods outside medical drugs.

교감신경자극시 Norepinephrine에 대한 신혈관 반응에 변화

이석호,민영기,양훈모 순천향의학연구소 2002 Journal of Soonchunhyang Medical Science Vol.8 No.1

To determine to effect of angiotensin Ⅱ(ANG Ⅱ)-induced hypertension on the renovarcular respones to norepinephrine (NE), six anesthetized dogs instrumented for monitoring of renal blood flow (RBF) were subjected to step increases every 2 minutes in the rate of norepinephrine infusion into the renal artery during 1) control condition(C), 2) servocontrol of renal arterial pressure (RAP) at levels expected to be achieved during acute captopril administration(C+S), 3) acute captopril administration(CEI), 4) angiotensin Ⅱ infusion simultaneously with captopril at concentrations which restored RAP toward control (CEI+A), and 5) servocontrol of RAP during captopril and angiotensin Ⅱ (SEI+A+S). Whether the plasma levels of ANG Ⅱ were allowed to increase(C, C+S) or not (CEI+A, CEI+A+S) with NE infusion, there were no differences in RBF respones to NE infusion between C and C+S and between CEI+A and CEI+A+S, which implies that RAP does not play an important role in modulating the renovascular response to NE. However, when captopril was administered without ANG Ⅱ replacement (CEI), RBF induced severe renal ischemia at much lower rates of NE infusion than occurred when the sufficient concentration of ANG Ⅱ were present in the plasma. Since this enhanced sensitivity to NE did not occur at RAP's lower than those achieved during acute captopril administration once ANG Ⅱ was present in the plasma in sufficient concentrations, it is likely that ANG Ⅱ exerts a protective effect on the kidney during renal adrenergic stimulation through a mechanism other than increasing systemic arterial pressure.

로보트 음성 인식 시스템의 설계에 관한 연구

이기원,홍석교,이광원 亞洲大學校 1986 論文集 Vol.9 No.-

In this paper, a speech recognition system of robot was designed and constructed with speaker dependent system. Speech was recognized by using zero-crossing period, log energy and speech magnitude, and filter bank method. Minimum distance of unknown speech was recognized. Speech recognition system was constructed with parallel processing for real time discrimination. By using hadshaking method, the data was transferred between main computer, "APPLE" and auxiliary processor. The rate of speech recognition was about 80% to 90%, which had some variance for reference pattern. This system was designed for HERO-1 robot. But, by modification of interface circuit any other robot will be controlled.

일 간호대학의 지역사회 방문간호사업 사례

강윤숙,최양자,고영애,전시자,조갑출,이옥철,주혜경,신기수,안은숙 적십자간호전문대학 2000 적십자간호전문대학논문집 Vol.22 No.-

대황황련해독탕의 사염화탄소 유발 간장해 보호효과 미치 급성독성

김영석,정은아,장종철,양형길,김남재,조기호,배형섭,이경섭,김동현 WHO COLLABORATING CENTRE FOR TRADITIONAL MEDICINE 2002 東西醫學硏究所 論文集 Vol.2002 No.-

ABSTRACT - This study was performed to evaluate hepatoprotective effect of daewhang-whangryunhaedok-Tang(DWT) on liver injured rats induced by CCI_4 and the acute oral toxicity of it in mice. The activities of serum transaminase(ALT/AST), alkaline phosphatase(ALP) and lactic dehydrogenase(LDH), the levels of serum total cholesterol(TC) and triglyceride(TG), change of liver enlargement, and inhibitory activities of lipid perotidation, catalase and glutathione-S-transfrease(GST) in liver microsome were determined in hepatotoxic rats induced by CCI_4. DWT was significantly reduced the serum ALT, AST, ALP, LDH. TC and TG lecels. And, the increase of lipid peroxidation, decrease of catalase and GST activities in the liver microsome of CCI_4-intoxicated rat were significantly improved by the treatment of DWT. Male and female mice were administered maximum dosages of 5.000 mg/kg b.w. of DWT. After single oral administration of DWT to mice, we observed them daily for 2 weeks.DWT did not induce any toxic signs in the mortalitie, clinical signs, body weight changes, and gross necropsy finfings of mice. Based in these results. It is concluded that DWT may have the hepatoprotective effect on CCI_4 induced hepatotoxicity in rats. Also. DWT may have no side effect and its LD_50 value may be over 5.000mg/kg b.w. in mice.

대황황련해독탕의 항고지혈증 작용

김영석,정은아,장종철,양형길,김남재,조기호,배형섭,이경섭,김동현 경희대학교 동서의학연구소 2001 東西醫學硏究所 論文集 Vol.2001 No.-

Whangryunhaedok-Tang (WT) is formulated with Coptidis Rhizoma, Phellodendri Cortex, Scutellariae Radix and Gardeniae Fructus, and Daewhang-whangryunhaedok-Tang (DWT) is made by the combination of Rhei Rhizoma, a wellknown anticostipation drug in WT. Therefore, DWT has been evaluated for antihyperlipidemic effects on experimental hyperlipidemic rats and mice induced by corn oil and high cholesterol-diet. Oral administration of DWT significantly inhibited the increase of serum triglyceride and LDL-cholesterol levels, and the decrease of serum HDL-cholesterol levels in hyperlipidemic rats induced by corn oil. Also, oral administration of DWT significantly prevented the increase of serum total cholesterol, triglyceride and LDL-cholesterol, and liver total cholesterol and triglyceride in 1% cholesterol-diet fed mice. These results suggest that DWT is effective for the treatment of hyperlipidemia.

L - NAME 주입시 신 교감신경이 신혈류량 변화에 미치는 영향

민영기,양훈모,이석호,김종규 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2

Recently it is known renal medullar will be play a important role of blood pressure control and pressure natriuresis. Renomedullary antihypertensive mechanism is activated by increasing perfusion pressure of kidney and can be inhibited by sympathetic nerve stimulation or blockade of nitric oxide(NO) formation. It is important to know what is affect on renal regional blood flow, especially renal medullary blood flow(MBF). For the purpose of investigating the effect of the renal sympathetic nerve on regional blood flow during infusion of blocking NO synthesis(by N^(ω)-nitro-L-arginine methylester:L-NAME) in spontaneous hypertensive rat(SHR) and Wistar rats normal control, Mean arterial pressure(MAP), total renal blood flow(TRBF), midcortical blood flow(CBF), inner medullary blood flow were measured in innervated or denervated renal sympathetic nerve group of SHR and Wister rats. All group that received the L-NAME were seen increasing MAP while TRBF, CBF and MBF decreased and the decrease of TRBF in SHR is more marked than in Wistar rat. In spite of increasing the MAP, MBF in all four group decreased, respectively C: 220 ± 3 U, 205 ± 2 U Wi : 215 ± 4 U, 165 ± 12 U Wd :218 ± 3 U, 170 ± 10 U Si :195 ± 4 U, 98 ± 15 U Sd : 200 ± 3 U, 120 ± 14 U, especially the most remarkable decrease about 50 % in SHR innervated group. Thus, according to these result, NO seems to maintain the MBF and the partial interaction between renal sympathetic nerve and NO in medullary blood flow can be suggested in innervated SHR.

Glucose Oxidase가 척수지각신경절세포에 미치는 영향과 천마의 효과에 관한 연구

송호준,이용석,손영우,이강창,정종길,신민교,홍기연 대한본초학회 2002 大韓本草學會誌 Vol.17 No.2

Objectives : To clarify the cytotoxic effect of glucose oxidase(GO) and protective effect of gastrodiae Rhizoma (GR) on spinal sensory ganglion(DRG) neurons, neurotoxicity mediated by GO was measured by MTT assay and neurofilament enzymeimmuno assay(EIA). Methods : DRG neurons were cultured in the media containing various concentrations of GO for 3 hours. In addition, neuroprotective effects of GR, on GO-induced neurotoxicity in DRG neurons were examined after DRG neurons were preincubated with various concentrations of GR for 2 hours before 15mU/ml GO for 3 hours. Results : GO decreased remarkably cell viability in dependently in these cultures, and also RG increased cell viability and amount of neurofilament in DRG neurons damaged by GO. Conclusion : It is suggested that GO has toxic effect in cultured mouse DRG neurons, and also RG was effective in the protection of GO-induced neurotoxicity in these cultures.

공간벡터 개념을 이용한 유도 전동기 기동 토크 맥동의 저감에 관한 연구

전희종,정을기,이석태,최우진 崇實大學校 生産技術硏究所 1994 論文集 Vol.24 No.-

In this investigation the PFM(Pulse Frequency Modulation) will be used for optimizing PWM inverter pulse patterns. In traditional the pulse frequency of PWM is kept constant. But modulated PWM's frequency in this study, the sinusoidal inverter's performance should be improved. The PWM pulse patterns are definitely controlled so that the time-integral function of the voltage vectors in the space vector notation may show a circular locus. Further, performance index will be minimized because of minimizing distortion of output current. Finally, these theories are realized using single-chip microprocessor.

사이토카인과 Lipopolysaccharide 자극에 의한 RAW 264.7 세포주의 nitric oxide 생성

김영덕,전창덕,이병순,이복수,박석돈,백상기,정헌택 충남대학교 생물공학연구소 1993 생물공학연구지 Vol.3 No.-

Macrophages have been implicated as a major class of effector in the host response to neoplasia. Cells of the monocyte-macrophage lineage are known to exhibit tumoricidal activity following stim-ulation by γ-interferon, tumor necrosis factor, BCG and bacterial products such as lipopoly-saccharide (LPS). While the mechanism involved remain obscure, the generation of reactive nitrogen intermediate (RNI) by activated macrophages is considered a maior participant in mediating the tumorstatic effect. But much of what is known about the induction and release of RNI has been elucidated by using freshly isolated cells from blood and other tissues of experimental animals. In this study, we used a murine macrophage cell line, RAW 264.7, and found that these cells showed above 99% positive of pan macrophage marker by immunohistochemical staining. These cells could produce nitric oxide (NO), when incubated with γ-IFN or poly I:C. Incubation of RAW 264.7 cells with γ-IFN for 48 hous in the presence of LPS agumented NO release in a dose dependent manner. Whereas, treatment of anti-TNE-α antibody or antisense TNF-α oligodeoxynucleotide inhibited the release of NO_2 by γ-IFN plus LPS activated macrophages. The production of NO was also inhibited reversibly or irreversibly by N^GMMA,NAA,arginase or DPI. Thease data suggest that RAW 264.7 cell line may be useful for the in vitro evalulation of biological response modifiers as well as the study of signal pathway of NO release by macrophages.