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진규복,김태희,김영훈,김양욱 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.2
Background/Aims: Magnesium (Mg) is an essential element for vascular function and blood pressure regulation. Several studies have demonstrated that Mg concentration is inversely associated with blood pressure, and that Mg supplementation attenuates hypertension. The purpose of this study was to evaluate the effect of dietary Mg supplementation on the blood pressure effects of an angiotensin II receptor blocker (ARB) in hypomagnesemic rats. Methods: Fifty male Sprague-Dawley rats were randomly divided into Mg-deficient (n = 30), normal diet plus Mg (n = 10), and control groups (n = 10). Mg-free, high-Mg, and normal-Mg diets were respectively fed to the rats. After 14 weeks, 10 of the 30 Mg-deficient rats were treated with Mg, 10 Mg-deficient rats received an ARB, and 10 Mg-deficient rats received an ARB plus Mg for 4 weeks. Results: Systolic blood pressure was significantly higher in the Mg-deficient rats than in the control rats at week 14. Hypomagnesemic rats exhibited decreased systolic blood pressure after treatment with Mg, and systolic blood pressure showed a greater decrease after ARB treatment. Treatment with the ARB/Mg combination resulted in the greatest decrease in systolic blood pressure. Mg deficiency did not affect the serum angiotensin II level, but did increase the serum aldosterone concentration. Concomitant Mg/ARB supplementation significantly decreased the elevated serum aldosterone level in hypomagnesemic rats. Kidney tissues of the hypomagnesemic rats revealed mild to moderate inflammatory infiltrates. Mg and/or ARB treatment did not reverse the inflammatory reaction in the kidneys of hypomagnesemic rats. Conclusions: Concurrent dietary Mg supplementation can enhance ARB-induced blood pressure reduction in rats with hypomagnesemic hypertension.
항균제 사용에 대한 감염내과의사의 의견에 대한 담당의사의 순응도와 단기효과
김백남,진규복,홍윤석 대한감염학회 2004 감염과 화학요법 Vol.36 No.3
crobial utilization density로 환산하여 분기별로 비교하였다. 결과 : 부적절한 처방사례는 전체의 85.6%이었으며, 치료적 사용인 경우 73.7%가 부적절하였으며, 예방적 사용인 경우는 모두 부적절하였다. 감염내과의사의 의견에 대한 담당의사의 순응도는 46.5%이었으며, 외과계에 비해 내과계 지료과에서(64.2% vs. 43.1%, P=0.005), 예방적 사용에 비해 치료적 사용인 경우(54.7% vs. 36.5%, P=0.001) 순응도가 높았다. Aminoglycoside계열 향균제는 2002년 1사분기 때 269.1 AUD에서 2003년 2사분기 때 171.8 AUD로, antipseudomonal cephalosporin계열 항균제는 112.1 AUD에서 64.5 AUD로 감소하였으며, 입원환자 전체에서 정주용 항균제의 사용은 2002년 1사분기 때 770.8 AUD에서 2003년 2사분기 때는 626.8 AUD로 감소하였다(모두, P<0.01). 결론 : 순응도가 비교적 낮은데도 이와 같은 방법으로 항균제 사용량의 감소가 관찰되었지만, 적절한 항균제 사용을 유도하기 위해서는 더 효과적이고 효율적인 항균제 관리 체제의 개발과 수용이 필요하다. Background : Many strategies have been developed to guide more appropriate and cost-effective antibiotic use in hospitals. This study was done to evaluate compliance and short-term impact of targeted antibiotic advisory consult implemented in our hospital since October 2002. Materials and methods : A total of 339 prescriptions in 187 patients were retrospectively reviewed and antimicrobial utilization density was compared quarterly from January 2002 through June 2003. Results : Overall, 85.6% of prescriptions were inappropriate, with 73.7% being inappropriate for therapeutic regimens and 100% for prophylactic regimens. Overall compliance was 46.5%. The compliance was higher in the medical services than in the surgical services (64.2% vs. 43.1%, P=0.005) and for therapeutic use than for prophylactic use (54.7% vs. 36.5%, P=0.001). From 1Q 2002 to 2Q 2003, use of aminoglycosides was reduced from 269.1 AUD to 171.8 AUD, and that for antipseudomonal cephalosporins from 112.1 AUD to 64.5 AUD (both, P<0.01). Overall, inpatient use of parenteral antibiotics was decreased from 770.8 AUD to 626.8 AUD (P<0.01). Conclusion : Targeted antibiotic advisory consult resulted in substantial reduction in antibiotic use despite relatively poor compliance. This type of antibiotic control program can be an alternative for hospitals with limited human resources trying to implement an antibiotic policy.
항균제 사용에 대한 감염내과의사의 의견에 대한 담당의사의 순응도와 단기효과
김백남,진규복,홍윤석 대한감염학회 2004 Infection and Chemotherapy Vol.36 No.3
Background:Many strategies have been developed to guide more appropriate and cost-effective antibiotic use in hospitals. This study was done to evaluate compliance and short-term impact of targeted antibiotic advisory consult implemented in our hospital since October 2002. Materials and methods:A total of 339 prescriptions in 187 patients were retrospectively reviewed and antimicrobial utilization density was compared quarterly from January 2002 through June 2003. Results:Overall, 85.6% of prescriptions were inappropriate, with 73.7% being inappropriate for therapeutic regimens and 100% for prophylactic regimens. Overall compliance was 46.5%. The compliance was higher in the medical services than in the surgical services (64.2% vs. 43.1%, P=0.005) and for therapeutic use than for prophylactic use (54.7% vs. 36.5%, P=0.001). From 1Q 2002 to 2Q 2003, use of aminoglycosides was reduced from 269.1 AUD to 171.8 AUD, and that for antipseudomonal cephalosporins from 112.1 AUD to 64.5 AUD (both, P<0.01). Overall, inpatient use of parenteral antibiotics was decreased from 770.8 AUD to 626.8 AUD (P<0.01). Conclusion:Targeted antibiotic advisory consult resulted in substantial reduction in antibiotic use despite relatively poor compliance. This type of antibiotic control program can be an alternative for hospitals with limited human resources trying to implement an antibiotic policy. 배 경 : 적절한 항균제 사용을 위하여 동산의료원에서는 2002년 10월부터 일부 항균제가 투여되는 환자들을 대상으로 감염내과의사가 자문하여 사용의 적절성을 판단하고 타과의뢰서를 이용하여 의견을 제시해왔다. 이 연구에서는 이러한 항균제 관리방법의 효용성을 평가하고자 감염내과의사의 의견에 대한 담당의사의 순응도와 항균제 사용량의 변화를 알아보았다. 방 법 : 2002년 10월부터 2003년 3월까지 제한항균제(glycopeptides, carbapenems, antipseudomonal cephalosporins, aminoglycosides)의 사용에 대한 의견을 제시한 187명의 환자에서 339건의 처방사례를 후향적으로 분석하였다. 항균제 사용의 적절성은 주로 Sanford guide to antimicrobial therapy에 따라 판정하였으며, 만 3일 이내 담당의사의 순응도를 추적하였다. 2002년 1월부터 2003년 6월까지 입원 환자에서 정주용 항균제 사용량을 antimicrobial utilization density로 환산하여 분기별로 비교하였다.결 과 : 부적절한 처방사례는 전체의 85.6%이었으며, 치료적 사용인 경우 73.7%가 부적절하였으며, 예방적 사용인 경우는 모두 부적절하였다. 감염내과의사의 의견에 대한 담당의사의 순응도는 46.5%이었으며, 외과계에 비해 내과계 진료과에서(64.2% vs. 43.1%, P=0.005), 예방적 사용에 비해 치료적 사용인 경우(54.7% vs. 36.5%, P= 0.001) 순응도가 높았다. Aminoglycoside계열 항균제는 2002년 1사분기 때 269.1 AUD에서 2003년 2사분기 때 171.8 AUD로, antipseudomonal cephalosporin계열 항균제는 112.1 AUD에서 64.5 AUD로 감소하였으며, 입원환자 전체에서 정주용 항균제의 사용은 2002년 1사분기 때 770.8 AUD에서 2003년 2사분기 때는 626.8 AUD로 감소하였다(모두, P<0.01). 결 론:순응도가 비교적 낮은데도 이와 같은 방법으로 항균제 사용량의 감소가 관찰되었지만, 적절한 항균제 사용을 유도하기 위해서는 더 효과적이고 효율적인 항균제 관리 체제의 개발과 수용이 필요하다.