포스터 발표 : 말기 신부전 환자에서 나타나는 영양실조에 대한 경구 Megestrol Acetate의 효과

김소영 ( Kim So Yeong ),김귀숙 ( Kim Gwi Sug ),손인자 ( Son In Ja ),손정민 ( Son Jeong Min ),김주원 ( Kim Ju Won ),오국환 ( O Gug Hwan ),서옥경 ( Seo Og Gyeong ),신완균 ( Sin Wan Gyun ),안규리 ( An Gyu Li ),이정상 ( Lee Jeong Sang 대한신장학회 2003 춘계학술대회 초록집 Vol.22 No.1

의약분업 시대의 병원약사

손인자 약업신문사 2001 의약정보 Vol.2001 No.10

병원약제부의 업무량측정척도와 적정약사인력에 관한 연구

손인자,허정 서울大學校保健大學院 1995 國民保健硏究所硏究論叢 Vol.5 No.1

The shortcomings of the current medical law which determines the full number of hospital pharmacists based on daily number of prescribed drugs (chojaesoo) per pharmacist was discussed. The purpose of this thesis is to estimate the daily number of dispensed drugs (chojaegunsoo), as well as daily number of dispensed drugs (chojaejaesoo, the sum of each prescribed drug multiplied by prescribed days)handled by each hospital pharmacist whose main duty is dispensing. The final purpose of this thesis is to establish the most reasonable way to estimate the full number of hospital pharmacists to perform their duty efficiently. The number of dispensing jobs performed by each hospital pharmacist were obtained by the following methods and were compared to the current medical law; 1) Questionnaires from pharmacists working at 70 different hospitals. 2) Investigating 7 hospital pharmacy with more than 400 beds. The results on the questionnaires from hospital pharmacists working at 70 hospitals are as follows: 1) Each pharmacist was in charge of 59(20-294) beds. 2) Each pharmacist handled 158(20-601) chubangmaesoo, 272(45-1,046) chojaegunsoo and 1,111(162-4,475) chojaejaesoo per day. 3) Each prescription included 1.77(0.92-3.16) chojaegunsoo and 8.06(1.93-28.1) chojaejaesoo. 4) Compared to the current medical law, the actual full number of hospital pharmacists averaged to only 58%(8-400) while the total full number employed in pharmacy, including part-time pharmacists, intern pharmacists and technicians, exceed by 16%(116%). 5) Items investigated tended to show a fair amount of correlation, especially the number of beds vs the total full number employed in pharmacy, chubangmaesoo vs chojaegunsoo, and chubangmaesoo vs number of pharmacists based on medical law. 6) Comparing with the actual number of pharmacists, the total full number employed in pharmacy showed the highest correlation, with the number of bed, chubnangmaesoo, chojaegunsoo, number of pharmacists based on medical law, and chljaejaesoo following(r=0.969∼0.802). In addition, the actual amount of dispensing jobs conducted at 7 hospitals with more than 400 beds were investigated to be as follows; 1) Each pharmacist was in charge of 29 beds. 2) Each pharmacist handled 103 chubangmaesoo, 205 chojaegunsoo and 1,049 chojaejaesoo per day. 3) Each prescription included 2.03 chubangmaesoo, and 11.63 chojaejaesoo. 4) Compared to the current medical law, the actual full number of hospital pharmacists averaged to only 44%(27-68) while the total full number employed in pharmacy, including part-time pharmacists, intern pharmacists and technicians, was only 75%. 5) Items investigated showed higher correlation than between those in the questionnaire, especially the chubangmaesoo, vs chojaegunsoo, chubangmaesoo vs number of pharmacists based on medical law, chubangmaesoo vs chojaejaesoo, chojaegunsoo vs chojaejaesoo, and number of pharmacists based on medical law vs chojaejaesoo, et al. 6) Camparing with the actual number of pharmacists, the total full number employed in pharmacy showed the highest correlation, with chubangmaesoo, chojaejaesoo, chojaegunsoo, number of pharmacists based on medical law, and the number of bed, orderly decreasing in correlativity(r=0.977∼0.944).

의료기관에서의 손 소독제 사용현황

배혜정,이미옥,이용화,박경호,손인자 韓國病院藥師會 2004 병원약사회지 Vol.21 No.2

Hand hygiene of health-care workers in health-care settings is essential for the control and prevention of hospital acquired infections. The study was conducted to investigate the usage of hand antiseptic agents in general hospitals, and reviews their appropriate usage to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients. Questionnaire studies were conducted in 35 general hospitals with more than 500 beds to investigate hand antiseptic agent types, amount and location in use. The study reports the most commonly used antiseptic products were chlorhexidine gluconate, povidone iodine and alcohol, and as for the hospital preparations, various concentrations of chlorhexidine gluconate and alcohol mixtures. The amount of antiseptic agents consumed in hospitals were relatively low as most number of hospitals, fourteen, used between 100ml~300ml of antiseptic agents per month. As for the location of usage, 14 hospitals used them in all hospital wards and 11 in some wards, but 5 of these hospitals had plans to expand the usage to all hospital wards. When asked, what is the factor behind the low usage of hand antiseptic agents, 11 hospitals answered lack of awareness.

약사의 중재활동에 의한 약반납 감소효과에 관한 연구

조윤숙,한현주,손인자,엄고혜,이주연,조윤희 韓國病院藥師會 2006 병원약사회지 Vol.23 No.3

The prescriptions and dispenses for inpatients are conducted on a daily basis at Seoul National University Hospital (SNUH). The prescriptions for inpatients are received according to order sites and types of prescriptions. And in some cases, more prescriptions can be ordered than those needed actually, so returned-medications will be occurred, and also increased. Then the purposes of these studies are to analyze the states of returned medications in inpatients, and to make strategies to reduced those at SNUH Pharmacy. As the methods of the studies, we made the lists of returned-medications during April 11~15. 2005, and analyzed current conditions and reasons of returned medications. The results of the studies are as follows. The total prescriptions of returned-medications were 2,732 cases which were 5.14% of all prescriptions. There were 15 kinds of reasons to returned-medications. Among them, three reasons were in charge of 67% of all returned-medication, such as 765 cases of canceled prescriptions after dispense, 535 cases of overlapped prescriptions before and after operations and 527 cases of excessive PRN orders, respectively. Except those reasons, there were 196 cases of left medications caused by a daily basis prescription, 174 cases caused by discharges or deaths of inpatients, and 82 cases caused by continuous prescriptions of multiple use drugs, etc. The strategies to decrease returned-medications were established as follows. First, The one more - checking system was applied whether prescription was canceled or not before transferring UDS carts to nurse stations. Second, if prescriptions before and after operations were overlapped, those of post-operation were canceled. Third, in cases of multiple use drugs, we confirmed medical histories of inpatients, and canceled the prescriptions in which the multiple use drugs were continuously prescribed. In order to check the effectiveness of three strategies, we made second studies which were same as first studies during september 5~9, 2005 after introductions of these strategies to dispensing services for inpatients. The total prescriptions of returned-medications were 2,314 cases which were 3.97% of all prescriptions. The 22.8% of cases of returned-medications were decreased after interventions. From the results of these studies, it was noted that three strategies established on the steps of dispense for inpatients were effective to decrease returned-medications.

TPN 사용 후 간효소치 상승에 대한 고찰

유성희,이현정,김귀숙,손인자,신완균 한국병원약사회 2002 병원약사회지 Vol.19 No.3

Despite the incidence of the out range in biochemical liver function are related with TPN therapy, the etiology and clinical significance remain unclear. Therefore, the identification of factors most predictive of liver abnormality is necessary for the prevention of this complication. A retrospective review was undertaken to determine the incidence rate and risk factors of the liver abnormality secondary to TPN. Medical records of 497 adult patients who had TPN have been reviewed. This study included only 72 patients, who received TPN, and had no underlying hepatobiliary disease. Out range of liver normal function values were detected in 36(50%) of the 72 total adult patients studied. And, there were no significant differences in the initial LFTs between both groups. It shows that patients with increased LFTs received a higher amount of total daily calories/BEE, carbohydrate per weight for minute or protein per weight. They also had a longer duration of TPN, when compared with patients who had normal LFTs during TPN. These results indicated that calories should not be excessive and close monitoring should be required for patients with massive calories.

소아에게 처방되는 정제의 투여 용이성 조사

문정연,김귀숙,문순란,한현주,손인자 한국병원약사회 2003 병원약사회지 Vol.20 No.4

In the Children's Hospital of Seoul National University Hospital it is general practice to prepare and administer powder or liquid formulations to children under 6 and tablet formulations to those older. However, pulverizing tablets to administer powder formulations causes loss of content, change in bioavailability, and difficulty in identification. Consequently, a new principle of dividing highly water-soluble tablets down to quarter segments without having to change formulation type and administrating them even to children under 6 has been established and practiced for instances that allow despite the fact that they may be easily pulverized. This study was performed to classify and investigate the feasibility of original tablet form administration by investigating the solubility of commonly prescribed pediatric medicines. The study has been executed using 51 medicines(sugar, film coated tablets, capsules, coated tablets, powder formulations) out of 116 possible pediatric medicines commonly pulverized for children under 6. Primary research was done with surveys completed by 50 guardians of children who have visited the pediatric clinic. This study has utilized tablet medicines that dissolve under 1 minute on the basis of 42 of these guardians(84%) reporting their preference of waiting no more than 1 minute for a tablet to dissolve before administering to their child. First, tablets were placed in ambient sterilized distilled water and observed in 20-second intervals for solubility. Tablets that took longer than 1 minute to dissolve were stirred 2 times per second as a secondary measure to observe those that took less than a minute to dissolve. In order to establish an objective standard, a shaker was utilized at 950rpm in the verification process. 8(16%) of the test tablets dissolved within the first interval, 11(22%) dissolved within the second interval, none dissolved within the last interval, and 2(4%) dissolved after 60 seconds or within 60 seconds with the aid of the stirrer. Therefore, 21(41%) out of 51 test tablets were determined as capable of being administered in tablet form because of its superior water-solubility. It can be expected that problems from pulverization can be improved with administration of any of these 21 test tablets in its original formulation even to children under 6 while also promoting convenience in the preparation and dispensing of pediatric prescriptions.

내과계 중환자실의 다빈도 사용 약물에 의한 유해 사례 조사 연구

김경애,정선회,이혜숙,손인자 한국병원약사회 2009 병원약사회지 Vol.26 No.2

Abstract: The patients in the intensive care unit(ICU) are known to have more Adverse Drug Events(ADEs), but there are few voluntary ADE reports from ICU. The objective of this study was to form the basis of active ADE monitoring system by reviewing the charts of medical ICU patients who took high-use drugs in a university hospital rcu. We reviewed charts of patients who were in the MICU between January 1^(st) and July 31^(st) in 2007, and obtained ADEs for high-use drugs. High-use drugs were defined as the top fifty percent drugs of the quantities of prescrip-tion except for fluids , and they were dopamine, midazolam, salbutamol nebulizer, ipratropium nebulizer, vecuronium, furosemide, dobutamine, norepinephrine, nafamostat, NaHC03, ambroxol and KCl. Adverse drug events were defined as adverse drug reactions on Drug Information Handbook and CCIS. Probability and the severity of the ADE were decided by the Naranjo algo-rithm and Common Terminology Criteria for Adverse Events(CTCAE) version 3. We checked patients who matched for the ADE laboratory test signal which was set in the hospital. 37(12.2%) of 303 patients went through 44 ADEs(1O.6 events per 1000 patient days). The average age of ADE-suffering-patient was 65.1 , 20(54.1%) patients were women. The medication which is asso-ciated with the most ADEs(14 , 31.8%) was furosemide and the most frequent event(5, 11.4%) was hypokalemia. All the ADEs were possible or probable at Naranjo scale, and 36(8 1.8%) cases were moderate or severe in severity. There were 5(11.4%) cases that might be preventable Adverse Drug Events. Therefore it would be possible to use drugs more safely if Adverse Drug Events are moni-tored systemically in the ICU.

서울대학교병원에서의 희귀의약품 사용현황 분석

홍은정,유성희,정선회,박경호,손인자,조윤경,구현민,장영수 韓國病院藥師會 2004 병원약사회지 Vol.21 No.2

Orphan drugs are used for rare disease, the number of domestic patients suffering from such disease being no more than 20,000 or for disease for which no treatment or no alternative medicine is yet. Orphan drugs are supplied by pharmaceutical companies or by Korea Orphan Drug Center(KODC). Presently, there are total 93 kinds of orphan drugs designated as such by the relevant laws, and Seoul National University Hospital(SNUH) has 49 kinds(53%) of them(as of June 2003). The purpose of this study was to analyze usage of orphan drugs prescribed by SNUH and to improve of the related pharmacy services for effective treatment of patents of the rare disease. We analyzed usage of orphan drugs inside and outside of SNUH, gender of patients, related clinical departments and frequency of use for the period from Jan. 2001 to June 2003. For the purpose, we used KODC data of use by patients in SNUH. The use of orphan drugs in SNUH sharply increased from 2000 through 2001 and was steadily increasing since then. The ratio of usage inside to outside SNUH was 92 to 8(as of June 2003). The clinical department that prescribed the orphan drugs most frequently was the internal medicine department(74~84%). The most frequently used drugs were antiviral agents(74%, oral drug) and antineoplastics(58%, injectable drug). KODC supplied 6 kinds of orphan drugs in 2002 and 4 kinds in the first half of 2003 to SNUH patients. The proportion of SNUH patients to the total patients who used orphan drugs supplied by KODC was very variable. (dantrolen 0.46% ~ ganciclovir 50.5%).

약사위원회 운영 현황조사 및 비교검토

원소라,조윤희,이용화,박경호,손인자 한국병원약사회 2003 병원약사회지 Vol.20 No.3

Pharmacy and Therapeutics Committee (PTC) is responsible for advisory and educational roles about the policies for rational drug uses and pharmaceutical affairs in the hospital. To promote the drug appropriate and effective drug uses, PTC may give interventions to the medical and administrative staffs by the formulary restriction, therapeutical substitution policy, medical staff education and so on. The most of 3^(rd) Korean hospitals have PTC, but their performances had not been reviewed. This survey was aimed to compare the present functions of PTC in Korean hospitals, and also compare to the services of PTC in American hospital. Questionnaires related to services of PTC were made and sent to 63 hospitals which were reported to have PTC, and the data on the organization, activities, subcommittes and so on of PTC were collected. The response rate was 79.4%. Members of PTC consists of physicians, pharmacists and other members. PTCmeeting was an average of four times per year and responsibilities of the v were to develop and manage formulary, drug use policy, monitoring of adverse drug reaction, drug use evaluation and so on. Almost of hospitals reported most important therapeutic efficacies in their hospital's formulary-system management process. While 10.4% of all hospitals reported PTC, drug use evaluation and 4% of those involved adverse drug reaction., ASHP national survey(2001) reported drug use evaluation 77.9%, adverse drug reaction 95.8%. PTC have traditionally evaluated new drug products on the basis on their safety, efficacy and pharmaceutical characteristics. It is increasingly important that PTC committees base their decisions on quality of life and usual pharmacoeconomic considerations. Currently this either dose not exist or performed by selected PTC. Future PTC will include the clinical outcomes information for various treatment alternatives and pharmacoeconomic data about new drug, which may be utilised by these committees in making their recommendations for formulary addition. And PTC will include the evaluation of clinical outcomes information for various treatment alternatives, CQI (Continuous Quality Improvement) for current therapeutic recommendations. For this, it is necessary that guidelines of PTC committees must be estabilished and informations derived from healthcare system utilised by other hospitals are exchanged.