복와위 상태 중환자에서의 영양공급에 따른 임상적 예후 분석

이연주 ( Yeonju Lee ),김형숙 ( Hyung-sook Kim ),남궁형욱 ( Hyungwook Namgung ),이은숙 ( Eun Sook Lee ),김은경 ( Euni Lee ),조영재 ( Young-jae Cho ),이연주 ( Yeon Joo Lee ) 한국정맥경장영양학회 2018 한국정맥경장영양학회지 Vol.10 No.1

Purpose: Enteral nutrition is recommended in critically ill patients. On the other hand, the recommendation of nutritional support is limited and often controversial in critically ill patients in the prone position. Therefore, this study evaluated the clinical outcomes of nutritional support in critically ill patients in the prone position. Methods: A retrospective evaluation of the electronic medical records was conducted, including adult patients who were in the medical intensive care unit (ICU) in the prone position in Seoul National University Bundang Hospital from May 1, 2015 to June 30, 2017. The patients’ characteristics, nutritional support status while they were in the prone position, mortality in ICU and during hospitalization, ICU length of stay, mechanical ventilation days, and complications, such as ventilator associated pneumonia (VAP) and vomiting were collected. Results: In total, 100 patients were included. Of these, 12 received enteral nutrition and parenteral nutrition and 88 received only parenteral nutrition. The groups were similar in terms of age, sex, number of comorbidity, weight, PaO₂/FiO₂, hours of prone position, Simplified Acute Physiology Score II (SAPS II), Acute Physiologic and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score. No differences were observed in ICU mortality (75.0% vs. 46.6%; P=0.065), hospital mortality (83.3% vs. 58.0%; P=0.081), ICU length of stay (22.2±14.6 vs. 18.2±21.2; P=0.128) and mechanical ventilation days (19.3±14.8 vs. 14.5±19.1; P=0.098). In addition, there were no differences in the possible complications of the prone position, such as VAP (8.3% vs. 4.5%; P=0.480) and vomiting (8.3% vs. 1.1%; P=0.227). Conclusion: No significant differences in the clinical outcomes were observed. Further studies will be needed to confirm the way of nutrition support while in the prone position.

Intravenous Fluid Selection for Unruptured Intracranial Aneurysm Clipping : Balanced Crystalloid versus Normal Saline

Kang, Jian,Song, Young Joo,Jeon, Sujeong,Lee, Junghwa,Lee, Eunsook,Lee, Ju-Yeun,Lee, Euni,Bang, Jae Seung,Lee, Si Un,Han, Moon-Ku,Oh, Chang Wan,Kim, Tackeun The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.4

Objective : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

Association Between Asthma and Periodontitis: Results From the Korean National Health and Nutrition Examination Survey

Lee, Seok-Woo,Lim, Hoi-Jeong,Lee, Euni Wiley (John WileySons) 2017 Journal of periodontology Vol.88 No.6

<P>Conclusions: Findings from the current study show a positive association between periodontitis and current asthma condition. In addition, patients taking scheduled antiasthmatic medications are less likely to be diagnosed with periodontitis. Due to limitations of study design and available data from the national survey, well-designed follow-up studies are needed to confirm these findings.</P>

A Case Study of Curriculum Change in U.S. Pharmacy Education : (미국 약학교육과 교과과정 변경의 사례)

LEE Eunkyung Euni 大韓藥學會 2010 大韓藥學會 總會 및 學術大會 Vol.2010 No.1

Current Status of Outpatient Parenteral Antimicrobial Therapy in Korea: Experience of a Single University-Affiliated Acute-Care Hospital

Heo Eunjeong,Choi Yoonhee,Kim Hyung-sook,Namgung Hyung Wook,Lee Eunsook,Lee Euni,Lee Ju-Yeun,Jung Jongtak,Kim Eu Suk,Kim Hong Bin,Song Kyoung-Ho 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.2

Background: Systematic protocols for the management of outpatient parenteral antimicrobial therapy (OPAT) and information on the current status of a prescription of parenteral antibiotics for outpatients and referred patients are lacking in the Korea. This study aimed to describe the current status of OPAT at a tertiary care hospital in Korea. Materials and Methods: This was a retrospective study of outpatients and referral patients who were prescribed parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, indications for antimicrobial therapy, institution administering the antimicrobial injections, and pre- and post-prescription management. Results: Of the 577 prescriptions assessed in this study, 399 (69.2%) and 178 (30.8%) were delivered using the referral and outpatient models, respectively. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem [26.0%], ceftriaxone [12.8%], kanamycin [11.8%], amikacin [10.1%], and cefazolin [8.5%]) accounted for 69.2% of the total OPATs. Urinary tract (27.3%), respiratory (20.8%), and intra-abdominal (15.9%) infections were the most frequent indications for OPAT. After prescription, there were 295 (73.9%) and 150 (84.3%) follow-up visits in the referral and outpatient models, respectively (P <0.05). Laboratory tests necessary for monitoring were fully performed for 274 (47.5%) prescriptions. Conclusion: We found that a significant number of OPATs were prescribed, follow-up visits were not performed in the case of about a quarter of prescriptions, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering the limited resources and the distribution of OPAT prescriptions, an effective strategy may be to select the frequently-used antibiotics or frequently-prescribing departments and start the program with them.

The Effects of Intrapatient Variability in Tacrolimus on Clinical Outcomes in Patients with Liver Transplantation during Early Stage

( Eun Ji Kim ),( Bo Ram Kim ),( Jung Won Cho ),( Jung Hwa Lee ),( Eun Sook Lee ),( Yun Mi Yu ),( Ho-seoung Han ),( Yoo Seok Yoon ),( Jai Young Choi ),( Euni Lee ),( Youngrok Choi ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Tacrolimus has a narrow therapeutic range requiring concentration monitoring. The purpose of this study is to evaluate the effect of tacrolimus intrapatient variability (IPV, %) on clinical outcomes in liver transplantation. Methods: A retrospective analysis using electronic medical records of liver transplant recipients from 2009 to 2016 was conducted in Seoul National University Bundang Hospital. IPV was calculated by using individual tacrolimus concentration and averaged tacrolimus concentration. Patients were divided into two groups based on the median IPV; high variability (HV) and low variability (LV) groups. The rate of deviation from the therapeutic range, the incidence of acute rejection, and post-transplant diabetes, the number of infection and estimated glomerular filtration rate (eGFR) within 6 months after transplantation were compared between two groups. Results: Of 82 study subjects, HV group (17.3%) has more frequently deviated from the therapeutic range than the LV group (4.5%) (P<0.001). There was no significant difference in the incidence of acute rejection, post-transplantation diabetes and eGFR in both groups, but the number of infection was significantly lower in LV group (0.4 times) than in HV group (0.9 times) for 6 months (P=0.039). The multivariate regression analysis showed that the number of infection was significantly increased as the IPV increased (P=0.003). Conclusions: We compared the clinical outcomes between HV and LV groups within 6 months after liver transplantation. High IPV of tacrolimus concentration was strongly associated with increased frequency of deviation from the therapeutic range and the number of infection.

Denosumab (Prolia^®)의 투여 간격 및 칼슘·비타민 D 복합제제 처방 여부에 따른 임상적 결과 평가

김유경,김정현,도현정,정영미,이정화,이주연,김은경,Kim, Youkyeong,Kim, Junghyun,Doh, Hyunjeong,Jeong, Young Mi,Lee, Jeonghwa,Lee, Ju-Yeun,Lee, Euni 한국임상약학회 2022 한국임상약학회지 Vol.32 No.3

Background: Denosumab (Prolia®) is administered every 6 months for osteoporosis treatment. Co-administration of calcium and vitamin D is required to minimize hypocalcemia risk. We evaluated clinical outcomes based on the administration interval of denosumab and co-prescription with calcium-vitamin D combination products. Methods: A retrospective study was conducted using electronic medical records from 668 patients who started denosumab therapy between January 1 and December 31, 2018, at Seoul National University Bundang Hospital. Clinical outcomes, as measured by changes in T-score, were evaluated by the intervals and concurrent prescriptions with calcium-vitamin D combination products. Results: Of the 668 patients, 333 patients met the eligibility criteria. These patients were divided into two groups based on appropriateness of the administration interval: "Appropriate" (304 patients, 91.3%) and "Inappropriate" (29 patients, 8.3%). T-score changes were significantly higher in the "Appropriate" than in the "Inappropriate" group (0.30±0.44 vs. 0.13±0.37, p=0.048). At the beginning of the treatment, 221 patients (66.4%) were prescribed calcium-vitamin D combination products, but the changes in T-scores were not significantly different by the prescription status of the product (0.29±0.46 vs. 0.28±0.38, p=0.919). Conclusion: T-scores were significantly improved in patients with appropriate administration intervals. No significant changes in T-scores were observed by the prescription status with calcium-vitamin D combination products. For optimal treatment outcomes, prescribers should encourage adherence to the approved prescription information on dosage and administration, and pharmacists should provide medication counseling for patients.

상급종합병원 병동담당약사 업무 현황 및 의료인의 인식과 기대 분석

김정은,백시진,최나예,전수정,남궁형욱,이정화,김은경,이주연,Kim, Jeongun,Baek, Sijin,Choi, Nayae,Jeon, Sujeong,Namgung, Hyung Wook,Lee, Junghwa,Lee, Euni,Lee, Ju-Yeun 한국임상약학회 2022 한국임상약학회지 Vol.32 No.1

Background and objective: The Seoul National University Bundang Hospital (SNUBH) implemented ward-based clinical pharmacy system with designated pharmacists in 10 general wards. Designated pharmacists conduct inpatient medication review, medication intervention, and medication consultation, and provide drug information for health care providers. This study aimed to evaluate the clinical pharmacy services and to examine the perception and expectations of health care providers on the services provided by the designated pharmacists in general wards. Methods: A survey was constructed to include questions on the health care providers' recognition, satisfaction, and perceived needs of designated pharmacists. We determined the frequency and type of interventions of ward pharmacist and their acceptance rate through a retrospective observational study using electronic medical records. Results: A total of 59 health care providers responded the questionnaire and 79.7% of the respondents reported moderate to high levels of satisfaction. Satisfaction with the services was positively associated with clinical interventions and nutrition support team (81.4%). Of 59 respondents, 88.1% agreed that preventing drug-related problems by designated pharmacists' activities were effective. The most common interventions included inadequate dosage (27.4%), omission and additional prescription (14.6%) and inadequate drug form (9.6%). The acceptance rate of intervention was 91.5%, and 151 potentially serious risks and 523 significant risks were prevented by the intervention. Conclusion: Positive results were confirmed in the awareness, satisfaction, and perceived needs of the health care providers for designated pharmacists. Expansion of the ward-based clinical pharmacy system with designated pharmacists to other wards may be considered.

Coordinating ability of anions: 3-D silver(I) coordination polymers of <i>C</i>₃-symmetric <i>N,N′,N″</i>-tris(2-pyridinylethyl)-1,3,5-benzenetricarboxamide

Kim, Euni,Kim, Doeon,Lee, Young-A,Jung, Ok-Sang Gordon and Breach Science Pub 2014 Journal of coordination chemistry Vol.67 No.21

Suprachannels via a Molecular Array of 2D Networks: Solvent Effects, Anion Exchange, and Physicochemical Properties of Silver(I) Complexes Bearing <i>N</i>,<i>N</i>′,<i>N</i>″-Tris(2-pyridinylethyl)-1,3,5-benzenetricarboxamide

Kim, Euni,Lee, Haeri,Noh, Tae Hwan,Jung, Ok-Sang American Chemical Society 2014 Crystal Growth & Design Vol.14 No.4

<P>The solvent effects on suprachannel formation via a molecular array of 2D networks were studied. The basic structure of the [Ag<SUB>3</SUB>L<SUB>2</SUB>](X)<SUB>3</SUB> (X<SUP>–</SUP> = NO<SUB>2</SUB><SUP>–</SUP>, NO<SUB>3</SUB><SUP>–</SUP>) 2D network consists of hexagonal (Ag<SUB>6</SUB>L<SUB>6</SUB>) motifs formed via self-assembly of Ag(I) with <I>C</I><SUB>3</SUB>-tridentate <I>N</I>-donors. The 2D networks are arranged in an eclipsed mode in aqueous solution, thus forming suprachannels (5.2 × 7.3 Å<SUP>2</SUP>, 6.2 × 7.7 Å<SUP>2</SUP>) of [Ag<SUB>3</SUB>L<SUB>2</SUB>(H<SUB>2</SUB>O)<SUB>2</SUB>](X)<SUB>3</SUB>, whereas they are arranged in a staggered <I>abab</I>... mode in nonaqueous solution, thus forming semisuprachannels (3.1 × 5.1 Å<SUP>2</SUP>) of [Ag<SUB>3</SUB>(NO<SUB>3</SUB>)<SUB>2</SUB>L<SUB>2</SUB>](NO<SUB>3</SUB>). The suprachannel structure of [Ag<SUB>3</SUB>L<SUB>2</SUB>(H<SUB>2</SUB>O)<SUB>2</SUB>](NO<SUB>3</SUB>)<SUB>3</SUB> is soluble in methanol; contrastingly, the semisuprachannel structure of [Ag<SUB>3</SUB>(NO<SUB>3</SUB>)<SUB>2</SUB>L<SUB>2</SUB>](NO<SUB>3</SUB>) is insoluble in that solvent. In the present study, significant differences in molecular recognition and anion exchangeability between [Ag<SUB>3</SUB>L<SUB>2</SUB>(H<SUB>2</SUB>O)<SUB>2</SUB>](NO<SUB>3</SUB>)<SUB>3</SUB> and [Ag<SUB>3</SUB>(NO<SUB>3</SUB>)<SUB>2</SUB>L<SUB>2</SUB>](NO<SUB>3</SUB>) were found.</P><P>The solvent effects on suprachannel formation via a molecular array of 2D networks and their significant differences in photoluminescent recognition and anion exchangeability were investigated.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/cgdefu/2014/cgdefu.2014.14.issue-4/cg500025k/production/images/medium/cg-2014-00025k_0007.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/cg500025k'>ACS Electronic Supporting Info</A></P>