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.

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.

신생아에서의 Vancomycin 용량 가이드라인 적절성 평가

도현정,윤인경,최경숙,남궁형욱,Eunkyung Euni Lee,김은경,최창원 한국병원약사회 2016 病院藥師會誌 Vol.33 No.2

Vancomycin is the drug of choice for treatment of methicillin-resistant coagulase-negative Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICUs). Although the Infectious Disease Society of America (IDSA) and American Society of Hospital Pharmacists (ASHP) recommended that vancomycin trough concentrations remain above 10 mcg/ml in order to prevent resistance, the Neofax guidelines have not recommended a new dosing guideline to achieve the therapeutic dosing goal; this has consequently raised concerns in relation to reaching the therapeutic range. The purpose of this study was to evaluate the rate of achieving serum trough concentrations ranged 10~20 mcg/ml in NICU patients when initial vancomycin dosing was carried out as recommended by the Neofax guidelines. A retrospective chart review was conducted of 63 NICU patients at Seoul National University Bundang Hospital, for whom there was at least one piece of data relating to trough level serum concentrations between June 25, 2003 and July 31, 2015. The duration of therapy, total length of stay, dose adjustments to attain therapeutic range, total daily dose and adverse effects were evaluated. For the primary outcome, 3 patients were excluded because of renal dysfunction, 13 patients were excluded because the initial trough was drawn inappropriately, and 14 patients were excluded because vancomycin was not administrated according to the Neofax guidelines. Only 6 of 38 (15.8%) patients achieved the therapeutic range with empiric dosing following the Neofax guidelines. Postmenstrual age and weight at the beginning of vancomycin treatment were significantly associated with the achievement of the vancomycin therapeutic range. Two out of 60 (3.3%) patients experienced nephrotoxicity. In conclusion, the status of attaining therapeutic range by following the Neofax dosing guideline was suboptimal. Further studies are urgently needed to assist the development of appropriate dosing guidelines for the treatment of MRSA infections in neonates.

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.

중동호흡기증후군(MERS) 발생관련 전국 약학대학의 실무실습교육 대응현황

최경희,최경숙,이영숙,김재연,정경혜,오정미,최경업,나현오,김은경,Choi, Kyung Hee,Choi, Kyung Suk,Lee, Young Sook,Kim, Jaeyoun,Jeong, Kyeong Hye,Oh, Jung Mi,Choi, Kyung Eob,Ra, Hyeon Oh,Lee, Euni 한국임상약학회 2017 한국임상약학회지 Vol.27 No.1

Background: Pharmacy curriculum change was made from a 4-year program to a 2+4 year program in year 2009 in Korea. The change has resulted in more educational exposures on patient-centered practice environments for about 1,400 hours in the last year of the professional pharmacy program. When the Middle East Respiratory Syndrome (MERS) outbreak hit Seoul and suburban areas and propagated to other provinces in Korea, emergency response to avoid student infection in the pharmacy practice sites became an urgent issue. While other health professional programs such as medicine and nursing had activated emergency preparedness manuals, timely and clear guidelines were not disseminated to all pharmacy programs and protective measures largely relied on individual pharmacy program. Methods: A survey was developed by the Committee on Pharmacy Practice Experience Programs in the Korean College of Clinical Pharmacy to document the status of pharmacy programs during the Korea MERS outbreak in 2015. The 10-question survey was distributed to the pharmacy practice experience coordinators to 34 out of 35 pharmacy schools in Korea by emails. Results: Our findings showed that 82.4% of the program coordinators (28/34) responded to the survey, 96.4% of the programs did not have emergency preparedness manuals, administrative meetings were held in 89.3% of the pharmacy programs, the rotation schedules were modified or withheld in 53.6% of schools, and the changes were mostly observed from the programs classified as MERS outbreak regions. Conclusion: Further needs in establishing the emergency preparedness manual should be explored for pharmacy education stakeholders.

소아영양집중지원팀 활동이 정맥 영양 지원을 받는 소아 입원 환자에 미치는 영향

백시진 ( Sijin Baek ),노주현 ( Juhyun Rho ),남궁형욱 ( Hyung Wook Namgung ),이은숙 ( Eunsook Lee ),김은경,양혜란 ( Hye Ran Yang ),( Euni Lee ) 한국정맥경장영양학회 2020 한국정맥경장영양학회지 Vol.12 No.1

Purpose: Malnutrition is a common problem in hospitalized patients that can increase the risk of complications, including infections and length of hospitalization. Appropriate nutritional support is important, particularly in pediatric patients, because growth and development are closely related to the nutritional supply. This study examined the status of nutritional support for pediatric patients in general wards to determine if interventions of the pediatric nutrition support team (pNST) contribute to appropriate nutritional support and help improve their nutritional status. Methods: Between July 2016 and June 2017, all pediatric inpatients who received parenteral nutrition support at the Seoul National University Bundang Hospital were recruited and divided into the NST group and non-NST group according to the activities of pNST. The nutritional status was assessed in all subjects, and the calories and proteins delivered through nutritional support in each group were calculated and then compared with the recommended requirements in pediatric patients. Results: The number of patients recruited was 174: 100 (57.5%) in the NST group and 74 (42.5%) in the non-NST group. Significantly more calories and protein were supplied in the NST group than the non-NST group in hospitalized children aged between four and 17 years (P<0.05). In the non-NST group, the amounts of calories supplied were insufficient compared to the recommended requirements. The proportion of patients supplied with the appropriate number of calories was 60.0% in the NST group and 20.0% in the non-NST group (P<0.001), and the proportion of cases supplied with the appropriate amount of protein was 87.0% in the NST group and 62.2% in the non-NST group (P<0.001). Conclusion: Interventions of the pediatric nutrition support team contributed to the sufficient supply of calories and protein and the improvement of clinical outcomes in hospitalized children on parenteral nutrition therapy.