A Study on User Satisfaction regarding the Clinical Decision Support System (CDSS) for Medication / 대한의료정보학회지

OBJECTIVES: Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety. METHODS: The study was based on survey data from 218 users (103 doctors, 103 nurses, and 15 pharmacists) at a university hospital that uses the CDSS. In order to identify the factors influencing user satisfaction with the CDSS, a multiple linear regression was performed. In order to compare the satisfaction level among the professional groups, an analysis of variance (ANOVA) was performed. RESULTS: The reliability of information, decision supporting capability, and departmental support were significant factors in influencing user satisfaction. In addition, nurses were the most satisfied group, followed by pharmacists and doctors according to the ANOVA. Areas for further improvement in enhancing drug safety were real time information searching and decision supporting capabilities to prevent adverse drug events (ADE) in a timely manner. CONCLUSIONS: We found that the CDSS users were generally satisfied with the system and that it complements the nationwide drug utilization review (DUR) system in reducing ADE. Further CDSS evaluation in other hospitals is needed to improve user satisfaction and drug safety.

Analysis of Normal and Cancer Tissue in the Stomach Using Raman Spectroscopy

PURPOSE: Raman spectroscopy is a vibrational spectroscopic technique, which is capable of providing details on the chemical composition, molecular structure and molecular interactions in cells and tissues. The primary objective of this study was to explore Raman spectroscopy for the detection of spectral changes between normal and cancer tissue in the stomach. METHODS: Tissue specimens were obtained from the resected stomach of advanced gastric cancer patients. The normal gastric and cancer tissues were harvested from the middle, lower portion of the stomach and from the tumor mass, respectively. 19 sets (antrum, body and cancer) of spectral data, with clearly defined histopathological findings, were selected in this study. FT-Raman spectroscopy (Bruker Inc., Karsruhe, Germany) was used for tissue Raman studies, with excitation at 1, 064 nm. The Raman spectra from the gastric tissue specimens were obtained with a 20 minute signal acquisition time. RESULTS: In the range 700~1, 900 cm-1, the Raman spectra of gastric antral tissue were dominated by a number of vibrational modes of biomolecules, such as proteins, lipids and nucleic acids. The Raman spectrum pattern of gastric body tissue was similar to that of the antrum, suggesting the structure and composition between the gastric antrum and body are much the same. The Raman spectra differed significantly between the normal and malignant cancer tissues, with cancers showing higher percentage signals for protein, lipid and nucleic acid compared to normal tissue (P<0.05). Difference were observed in the shapes of the Raman spectra between the normal and cancer tissues, particularly in the spectral ranges 1, 250~1, 255, 1, 330~1, 340 and 1, 440~1, 450 cm-1, which contain signals relating to protein and lipid conformations and CH2 bending mode of nucleic acids. CONCLUSION: This study demonstrates the ability of Raman spectroscopy to detect biochemical changes in malignant gastric tissue, and may become a useful adjunct to pathological diagnosis allowing guided biopsies and assessment of adequacy of resection margins.

Plasma Ghrelin Level According to Extent of Gastric Resection

PURPOSE: Total gastrectomy is followed by weight loss in the majority of patients, but the reason for this is not clear. Ghrelin, a novely isolated gastric hormone, exerts orexigenic activity. If a circulating ghrelin participates in the adaptive response to weight loss, the weight loss induced by total gastrectomy may be accompanied by impaired ghrelin secretion. METHODS: The blood was collected from gastric cancer patients who have undergone gastric resection, preoperatively and immediately after resection, on the 1st, 3rd and 7th postoperative day. The correlation of the preoperative plasma ghrelin concentration with gender, age and BMI were analyzed. The concentration changes of plasma ghrelin were observed serially after dividing gastrectomized patients into the subtotal gastrectomy group, the total gastrectomy group, and the proximal gastrectomy group. RESULTS: Although statistically not significant, the plasma ghrelin concentration was negatively correlated with age and BMI. In the subtotal gastrectomy group, nadir ghrelin was 48.4 +/- 23.6% of the preoperative value after gastric resection and then gradually increased to 82.4 +/- 19.9% on the 7th postoperative day. In the total gastrectomy group, nadir ghrelin was 36.9 +/- 10.4% of the preoperative value after gastric resection and remained 20.9 +/- 10.9% on the 7th postoperative day. In the proximal gastrectomy group, nadir ghrelin was 29.4 +/- 4.6% after gastric resection, which was followed by a gradual recovery. However, the recovery rate was steadier than compare to the subtotal gastrectomy group, as the concentration was 41.8 +/- 23.1% even on 7th postoperative day. CONCLUSION: The principal site of the ghrelin synthesis is stomach which contributes 60~70% to the circulating concentration of ghrelin. In the case of subtotal gastrectomy, ghrelin production is compensated by the remnant stomach. For this reason total gastrectomy is associated with suppressed ghrelin levels and it possibly contribute to the weight loss.