Patient safety management in the medication use process: prevention and management of medication error

Medication errors, resulting in risks to patient safety, occur throughout the entire medication use process, and include prescribing errors, dispensing errors, administering errors, and patient compliance errors. The results of many reports and studies on medication errors in several countries including the United States show that medication errors occur commonly, are costly and are often preventable. Medication errors involve a breakdown in more than one aspect of the medication use system such as lack of knowledge, standard performance and mental lapses, and defects or failure in the organizational system. Such medication errors compromise patient confidence in the healthcare system and increase healthcare costs. Hospitals must take a medication error prevention approach and also prepare various methods of managing medication errors once they have occurred. The necessity of a medication error reporting system should be emphasized. In Korea, with regard to medication errors, we have a long way to go. We have no documented data available on error rates, no published studies, and no error reporting system. In conclusion, medication errors are no longer a guarded, guilty-ridden professional secret in Korea. They should be considered problems in public healthcare policy. Therefore, we need to establish a medication error prevention and management system at the national level including a national error reporting system in the near future.

Immunologic Characterization of Newly Found Koreans as HIV Seropositives by the Year / 감염

BACKGROUND: Although HIV is introduced relatively late into Asia, the amount of HIV-positive population has been continuously growing in this area. UNAIDS/WHO estimate that 6.5 million people are living with HIV in the Asia/Pacific region at the end of 1999. To expect the HIV/AIDS epidemic in the 21st century in Korea, it is necessary to monitor the changes of the number of newly found HIV-infected individuals and their immune status by year including their epidemiological data. METHODS: We have selected 591 HIV-infected individuals whose first CD4 count was checked within 6 months from the time of diagnosis of HIV infection from 1990 to 1999. For the measurement of CD4+T and CD8+T cells, blood samples of HIV-1 infected individuals were collected into three potassium ethylene diamine tetra-acetic acid (K3EDTA)-treated tubes and stained within at least 24 hours after drawing and analysed by flow cytometer (FACStar or FACScount). The immune status were classified into 4 groups as follows: group I (> or =500 CD4+T cells/mm3), group II (201~499 CD4+T cells/mm3), group III (51~200 CD4+T cells/mm3), and group IV (< or =50 CD4+T cells/mm3). RESULTS: The mean of number of CD4+T cells of HIV-infected individuals at the time of HIV diagnosis was 677 cells/mm3 and the percentage of CD4+T cells was 22.5% in 1990~1991 but 350 cells/mm3 and 14.7% in 1999, respectively. The number of newly found HIV-infected individuals belong to Group III increased rapidly from 1997 to 1999. Also, the proportion of newly found HIV-infected individuals having the CD4+T cell counts of < or =50 cells/mm3 increased slowly by the time of diagnosis of HIV infection. The proportion of newly found HIV-infected individuals who were found in general hospitals increased during the second half of the 1990s. CONCLUSION: These results show that not only the number of newly found HIV-infected individuals has increased annually but also their immune status at the time of HIV diagnosis have been more depressed by the year. Therefore, we should enforce education for prevention of HIV/AIDS about general population as well as high risk groups.

The Altered Pattern of CD28 Expression on T Cell Subsets in HIV-Infected Koreans / 대한면역학회지

The CD8(+)CD28(+) T cells have known to mediate major histocompatibility complex class I-restricted cytolysis and to secret an HIV-1 inhibitory factor. As HIV infection lead to dramatic changes within the cellular immune system, the cellular cytotoxicities decrease in the duration of the HIV infection. To determine the importance of the cellular cytotoxicities in long-term nonprogression, we tried to compare CD28 expression on total T, CD4(+) T, and CD8(+) T cells as one of methods for cellular cytotoxicity measurements between long-term nonprogressor and normal person or between long-term nonprogressor and rapid progressor. The median percentages and counts of CD4(+) T cells of the norrnal, the long-term nonprogressor, and the rapid progressor groups were 39.9 and 0.96 * 10(9) cells/L, 24.6 and 0.58 * 10(9) cells/L, 9.9 and 0.15 * 10 cells/L, respectively. As a result of comparison of the cells having CD28 surface molecules on CD8(+) T cells in the long-term nonprogressor and the rapid progressor group, they showed over 5 times lower than that in the normal group. Especially, the long-term nonprogressor regarded to the healthy HIV-infected patient showed much lower CD28 expression on total T, CD4(+) T, and CD8(+) T cells than those of the normal person. The proportions of CD4'CD28 T and CD3CD28 T cell subsets showed the significant difference between the LTNP and the RP group. In conclusion, although HIV-infected patients were LTNPs having the steady CD4(+) T cell counts and no clinical symptoms, we suggested that HIV led to abnormality within the lymphocyte subsets such as the altered expression of CD28 molecules on various T cell subsets and this result would cause deficiency of host immune function and failure of control of HIV replication by anergy in T cell subsets.

Phylogenetic Analysis of env Gene V3-V5 Region of HIV-1 Subtype A Isolates from Korean

Phylogenetic analysis was conducted to monitor transmission of HIV and to investigate the genetic structure of primary isolates from 12 HIV-1 subtype A infected Koreans. The individuals infected with subtype A viruses had been diagnosed as HIV-1 seropositives during the period 1987 to 1995 and blood samples have been collected from 1991 to 1997. DNA of each individual was isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 rev gene was amplified by nested polymerase chain reaction and the PCR products were sequenced. The mean value of the divergence of nucleotide of HIV-1 euv V3-V5 fragment was 17.0+/-4.06% (8.6~25.8%) within HIV-1 subtype A isolates from Koreans. This diversity was higher than those of African isolates (13.7+/-2.66%). In the phylogenetic tree, Korean subtype A isolates were not grouped together, but intermingled into African isolates. The results of this study suggested that HIV-1 subtype A variants be introduced from multiple sites of Africa into Korea and the big genetic diversity of Korea HIV-1 subtype A isolates may be further influenced by the range of geographic locations in which the infection occurred rather than the elapsed time between infection and collection of samples and the disease progression.

Phylogenetic Analysis of env Gene V3-V5 Region of HIV-1 Subtype A Isolates from Korean

Phylogenetic analysis was conducted to monitor transmission of HIV and to investigate the genetic structure of primary isolates from 12 HIV-1 subtype A infected Koreans. The individuals infected with subtype A viruses had been diagnosed as HIV-1 seropositives during the period 1987 to 1995 and blood samples have been collected from 1991 to 1997. DNA of each individual was isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 rev gene was amplified by nested polymerase chain reaction and the PCR products were sequenced. The mean value of the divergence of nucleotide of HIV-1 euv V3-V5 fragment was 17.0+/-4.06% (8.6~25.8%) within HIV-1 subtype A isolates from Koreans. This diversity was higher than those of African isolates (13.7+/-2.66%). In the phylogenetic tree, Korean subtype A isolates were not grouped together, but intermingled into African isolates. The results of this study suggested that HIV-1 subtype A variants be introduced from multiple sites of Africa into Korea and the big genetic diversity of Korea HIV-1 subtype A isolates may be further influenced by the range of geographic locations in which the infection occurred rather than the elapsed time between infection and collection of samples and the disease progression.