의료기관 조제실제제의 안전한 관리방안 마련을 위한 연구

김향숙(Hyang sook Kim),정선회(Sun hoi Jung),김대진(Dae jin Kim),권경희(Kyeng hee Kwon) 대한약학회 2017 약학회지 Vol.61 No.6

Compounding preparations are medications that are prepared in the hospital setting when they are needed for patient care but not marketed by manufacturing or importing companies. This study was performed to investigate current proposals and actual productions of compounding preparations and management practices in hospital pharmacies nationwide, and to make suggestions for a comprehensive and effective management system by comparing and analyzing the national and foreign safety management systems. As a result of this study, we figured out 1,984 compounding preparations in the hospital setting were proposed, and 1,181 of them (59.5%) were actually produced in 2014. The majority of the preparations were reported from metropolitan areas including Seoul and Gyeonggi-do since there are many major medical centers and hospitals in this area. Majority of the compounded medications were solutions for external use, particularly antiseptic solutions. The study showed variety of status of approval procedure, regular report, information for beyond use date and managing pharmacist education in survey hospitals. Compared to other foreign countries, the range of the compounding in Korea has been limited to prescription drugs excluding narcotics, psychotropic drugs and nonprescription medications. Compounding preparations will be able to deal with the situations in which patients are not satisfied with the marketed medications and need individualized medications regimen. It is necessary to standardize safe management for production and using of compounding preparations.

동종 조혈모세포이식을 받은 환자군에서의 Fish Oil을 함유하는 정맥지방유제 공급의 효과

최지형 ( Ji Hyeong Choe ),이영주 ( Young Joo Lee ),배혜정 ( Hye Jung Bae ),정선회 ( Sun Hoi Jung ),한현주 ( Hyeon Joo Hahn ),고영일 ( Yungil Koh ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.1

Purpose: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients’immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).Methods: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records.Results: The patients’ characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs.-1.08%, P=0.245).Conclusion: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.

일부 병원 실내에서의 공기중 미생물 오염에 관한 연구

백남원,정선회 한국산업위생학회 1998 한국산업보건학회지 Vol.8 No.2

To assess biological indoor air quality in hospital, concentrations of viable airborne microbes were determined at intensive care unit(ICU), patient room (PR), outpatient waiting room(OPWR) in hospitals of large(1000 beds), middle(500 beds), small(100 beds) hospitals, respectively. Gram positive bacteria, gram negative bacteria, fungi were sampled using suctional sampling method by RCS sampler (Reuter centrifugal air sampler) and RCS GK-A agar plate. In gram positive bacteria groups, CNS(Coagulase Negative Staphylococcus), Micrococcus, Lactobacillus, S. aureus, Enterococcus, St. viridans identified. In gram negative bacteria groups, A. baumannii, Kl. peumoniae and E. coli were identified, and Penicillium was identified in fugi groups. Results of the study were as follows. 1. The highest concentrations of airborne microbes was 971 CFU/㎥ at 5:00 PM in small hospital patient room, and average concentrations of airborne microbes in large, middle and small hospitals were 282 CFU/㎥, 289 CFU/㎥ and 625 CFU/㎥, respectively. Average concentrations of airborne microbes in office(control) was 90 CFU/㎥. Thus, the small hospital showed the worst condition. 2. Representatives of 8 different genera were identified in 150 samples. The most frequently isolated organisms were Staphylococcus (73.0%), Micrococcus (20.7%) and Lactobacillus (4.7%), respectively. Pathogenic microbes isolated were A. baumannii, E. coli, Enterococcus, Kl. peumoniae, S. aureus, St. viridans and Penicillium as fungi. In office, no pathogenic microbes were identified. Average concentrations of airborne pathogenic microbes in large, middle and small hospital were 5 CFU/㎥ (2%), 11 CFU/㎥ (4%) and 12 CFU/㎥ (2%), respectively. Thus, condition in a large hospital was better than those in a middle and a small hospital.

HMG-CoA Reductase Inhibitor의 간독성 평가

이정란,정선회,이혜숙,손인자,오정미 韓國病院藥師會 2008 병원약사회지 Vol.25 No.3

First statin approved by U.S Food and Drug Administration(FDA) in 1987 was Lovastatin and the statins are now one of the most widely prescribed classes of medications. The statins have shown evidence of reducing coronary heart disease events, but on the other hand they have been implicated in causing complications in muscle, liver and kidney. There’re no papers about hepatotoxicity in Koreans even though there’re a lot of papers about muscle-toxicity at home and abroad. So we have studied to assess the risk of liver function test (LFT) abnormalities with Koreans using statin. We retrospectively reviewed of Electronic Medical Records(EMR) of 12,860 new users of six statins(Atorvastatin, Fluvastatin, Lovastatin, Pitavastatin, Rosuvastatin, Simvastatin) during the period 1 May 2003 through 30 April 2006 in Seoul National University Hospital(SNUH).The patients in their 60s were the largest population (36.6%) and 55% of them were female. The spread of patients of statins indicated 30.4%, 2.2%, 8.7%, 1.1%, 10.6% and 47.0% in Atorvastatin, Fluvastatin, Lovastatin, Pitavastatin, Rosuvastatin and Simvastatin, respectively. Assessing LFT abnormalities, among the patients, 26.1% were more than mild(AST or ALT >40), 5.6% were more than moderate(AST or ALT >80) and 1.7% were more than severe(ALT or ALT >120). Especially, we’ve analyzed the data of Severe(AST or ALT >120) LFT abnormalities by using ‘Ranking by Clinical Significance of the Definition of Liver Function Test’to estimate hepatotoxicity clearly. This trial has revealed same result that all six statins have effecting severe hepatotoxicity around 1% with papers reported abroad. Also severe hepatotoxicity was related with dose but with age(p<0.05). Severe hepatotoxicity is uncommon and is reported in less than 1% of the statins therapy but it is related with dose, it is important to check LFT periodically in case of high dose therapy.

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%).