Nutrition Support Team 활동현황 조사: 2016년 vs. 2005년 비교 및 NST 수가화 이후 활동현황

조지윤 ( Ji-yoon Cho ),김정태 ( Jung-tae Kim ),김승란 ( Seoung-lan Kim ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.2

The Korean Society of Health-System Pharmacists (KSHP) and Korean Society for Parenteral and Enteral Nutrition (KSPEN) jointly performed a nation-wide questionnaire survey on the current state of Nutrition Support Team (NST) activity from March to May of 2016. The aim of the survey was to suggest ways to develop NST as well as to improve the relationship between the KSHP and KSPEN. Compared to the results of the 2005 survey, some progress was made in the activity of NST over the last decade. Not only was the activity of NST settled, but quantitative and qualitative growth was also achieved by activating rounds and regular meeting. On the other hand, the ratio of hospitals providing home care services has decreased. Therefore, further effort is needed for their revitalization.

소아 간질

김승란 약업신문사 2000 의약정보 Vol.2000 No.4

소아 약물처방 스크린 프로그램과 임상약사 활동이 drug safety 향상에 미치는 효과

김승란,김재연,안숙희,강민경,신혜영 韓國病院藥師會 2006 병원약사회지 Vol.23 No.2

신생아 집중치료를 받았던 극소 저출생체중아의 입원중 성장에 관한 연구

김승란,이재연,노서영,조영환,노환성,김애란,김기수,피수영,강위창 한국병원약사회 2002 병원약사회지 Vol.19 No.3

Pharmacists of neonatal intensive care unit(NICU) at Asan Medical Center monitored appropriateness of TPN orders from January 1999. The objective of this study was to generate growth curves and to quantify the factors associated with the growth of very small premature infants during initial hospitalization. We reviewed patient charts and daily collection forms retrospectively. Study patients included 67infants who were surviving singleton, appropriated for gestational age, weighted <1,651g at birth, born January 1st in 1999, to May 31th in 2000, who did not develop necrotizing enterocolitis. They were grouped four birth weight; <875g, 875~1,124g, 1,125~1,374g, 1,375~1,624g, respective A, B, C, D groups. The each patients'amount of macronutrient intakes, and body weight were recorded daily up to 105days of age or hospital discharge, whichever occurred first. Monitored parameters were; gestational age, sex, Apgar score, respiratory support and parenteral nutrition support duration, started day of feeding, presence of patent ductus arteriosus, infection and treatment of dexamethasone. Growth was determined as change in weight during the period. Four growth curves were generated. Postnatal ages of recovery to birth weight were 21, 20.2, 18, 12.2 days respective groups. There was positive association with respiratory support duration. Mean changes of weight were 14.4, 15.9, 16.4, 16.3g/day. There were negative associations with respiratory support and parenteral nutrition support duration, presence of the treatment of dexamethasone and positive associations with the amount of macronutrient intake. Stepwise regression explained that the growth was correlated with positive calories intake and negative parenteral nutrition support duration. The new weight curves are the reflection of current in-hospital growth trends in korean preterm babies. It is important that the pharmacist fulfills their appropriate nutrition support.

TPN 처방시스템을 이용한 약국업무 개선

조영환,김정태,김승란,백지은,김미경 한국병원약사회 2000 병원약사회지 Vol.17 No.1

As a part of a plan to improve the multifunctional hospital information system, Asan Medical Center has invented the COES (Clinician's Order Entry System) for the physicians which involves computerized TPN prescription. As an initial step, an outline of the system has been formulated after collection relevant materials from various sources including foreign materials. This project simplifies and standardizes COES between physicians and pharmacists. By introducing this system, we could minimize the possible errors during inputing the inscription and converting the requirements to the volumes to prepare the required medicine. Units of prescribed volume were automatically changed through the computerization of TPN order. This procedure can save time and man-power for preparing the medicine by using Automatic TPN Prescripter. All of these has encouraged us to seek more active TPN consultation for the systemical examination and monitor TPN inscription, and to provide patients with TPN of a good quality.

Vancomycin과 Heparin의 Compatibility 시험

김미경,정양희,김재연,김승란,노환성 한국병원약사회 1999 병원약사회지 Vol.16 No.4

Vancomycin (VANC), a glycopeptide antibiotic used for the treatment of patients with infections caused by Staphylococcal species and Streptococcal species, is incompatible with heparin (concentration > 1.0 U/㎖). Even though heparin concentration in TPN solutions administered in AMC (Asan Medical Center) is 0.25 U/㎖, beyond 1.0 U/㎖, we have stopped administration of TPN during the VANC infusion time because of the absence of experimental sources. So, we studied the compatibility of VANC and heparin in TPN. We observed the variations before and after admixing VANC and heparin (in TPN) by examining with the naked eye under a microscope of 400 magnifications, measuring the concentration of VANC and the heparin activity. RESULT : ① We could not distinguish the variations under the microscope (× 400). ② As a result of measuring the concentration of VANC by HPLC (UV detector 225㎚, C_(18) Column, Mobile phase acetonitrile : 0.01 M 1-heptane sulfonic acid = 12 : 88, Flow rate 2.0 ㎖/min), there is no significant difference between before and after (% change of peak area from standard sample : 102.61%, 101.03% respectively / P-value = 0.464). ③ However, according to the results of measuring the heparin activity by APTT, anticoagulant action of heparin in TPN was reduced by VANC. Therefore, the simultaneous administration of TPN (heparin 0.25 U/㎖) and VANC via a Y-site is judged to be inadequate.

신생아 집중치료를 받았던 극소 저출생체중아의 입원 중 영양 및 성장에 대한 연구

이재연,노서영,김승란,노환성,김애란,김기수,피수영,강위창 한국병원약사회 2001 병원약사회지 Vol.18 No.2

Low birth weight premature infants require unique nutritional supplement that can recover rapid growth within a short term. There has been an examination for correlation between growth and nutritional supplement. With this, we suggest ideal nutrition guideline for low birth weight premature infants in neonatal intensive care units (NICU) by investigating neonate nutritional status. The survey consisted of infants admitted to Asan Medical Center from 1 Jan 1999 to 31 May 2000. Data were obtained concerning all 67 infants born weighing < 1625 gm who were divided into four groups. Daily intakes of fluid, energy, and protein from all sources were determined and body weight was recorded. During the first 2 weeks of life, intake of energy averaged 87.3±12.0 ㎉/㎏/day and intake of protein averaged 2.0±0.4 g/㎏/day. From 15 to 35 days, intake of energy averaged 99.6±12.2 ㎉/㎏/day and intake of protein averaged 3.0±0.4 g/㎏/day. During the period 36 to 56 days, energy intakes were 109.8±16.4 ㎉/㎏/day and protein intakes were 3.2±0.5 g/㎏/day, respectively. Weight reached birth weight by 17.5 days of age. Subsequently, weight gains averaged 14.4, 15.9, 16.4, 16.3 g/㎏/day, in successive periods. Our data suggest that more liberal volume of intake combined with more frequent use of concentrated feedings would lead to increase in both energy and protein intake. Bur low birth weight infants are required fluid restriction therapy, so we can change in feeding practice or in composition of TPN fluid. And we can attempt early MEN (minimal enteral nutrition) a supplement to parenteral nutrition for reducing TPN toxicity by shorter time to full enteral feedings, smaller gastric residuals and less feeding intolerance and the same or faster weight gain.