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베타-락탐 항생제 알레르기: 일개 지역병원의 실제 임상
김혜림 ( Hyerim Kim ),이재천 ( Jaechun Lee ),김세진 ( Sejin Kim ) 대한내과학회 2021 대한내과학회지 Vol.96 No.1
목적: 베타-락탐 항생제는 약물이상반응의 흔한 원인 약물이다. 베타-락탐 알레르기는 처방 패턴에 따라 크게 다른 양상을 보이지만, 이에 대한 최근 국내 연구는 없다. 방법: 베타-락탐 항생제를 포함한 약물에 의한 약물이상반응 사례에서 베타-락탐 알레르기의 임상 양상을 후향적으로 조사하였다. 결과: 175명 중 약물이상반응의 원인약물로 베타-락탐 항생제가 가장 흔했다. 베타-락탐 알레르기가 확진된 79명(45.1%, 여자 53.2%, 나이 49 ± 14세) 중 두 명(2.5%)은 처방 약물조사로, 33명(41.8%)은 항생제 특이 IgE 항체 검사로, 29명(36.7%)은 피부시험으로, 15명(19.0%)은 약물유발 검사로 확진되었다. 소양감이 가장 흔하였고, 두드러기, 호흡곤란, 혈관부종, 저혈압 등의 증상 및 징후를 보였고, 대부분(61명, 77.3%) 투약 후 1시간 이내 발생하였다. 아나필락시스가 67%에서 발생하였고, 이 중 절반은 응급실을 방문하였다. 흔한 원인약물은 세파클러와 아목시실린 순이었다. 베타-락탐 항생제 이외에는 진통소염제(nonsteroidal anti-inflammatory drugs) 및 퀴놀론계 항생제가 흔한 원인약물로 확인되었다. 결론: 베타-락탐 항생제를 포함한 약물에 의해 발생하는 약물이상반응의 흔한 원인은 베타-락탐 항생제다. 응급실 방문을 요하는 아나필락시스가 흔히 발생하며, 다성분 처방으로 원인약물 확정에 어려움이 있다. Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research. Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed. Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones. Conclusions: BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits. (Korean J Med 2021;96:42-47)
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사회인구학적 요인이 CERAD-K의 15항목 단축형 보스톤 이름대기 검사의 각 항목별 결과에 미치는 영향
김혜림(Hyerim Kim),원승희(Seunghee Won),이승재(Seung Jae Lee),장성만(Sung Man Chang),김병수(Byung-Soo Kim) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.1
Objectives:The purpose of this study was to investigate the influence of sociodemographic factors on the results of each item of the 15-item Modified Boston Naming Test in the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet(BNT-KC) in a clinical sample. We also explored the usefulness of each item in BNT-KC for the diagnosis of Alzheimer’s disease(AD). Methods:Data of BNT-KC from 261 outpatients aged over 60 years, including 150 diagnosed with AD and 111 with normal cognitive function, were analyzed. Logistic regression analyses were performed to investigate the association of age, gender, and education with the results of each item in BNT-KC controlling for cognitive function. The relationship between each item of BNT-KC and the diagnosis of AD were examined using logistic regression analyses controlling for age, gender, and education. Results:Failing to answer ‘Mermaid’ was associated with low education level(≤6 years). Failing to answer ‘pomegranate’ was associated with the male gender, whereas failing to answer ‘compass’ or ‘dinosaur’ was associated with the female gender. Four items(‘hand’, ‘red pepper’, ‘wind-bell’, and ‘monk’s hat’) were not associated with the diagnosis of AD in this sample. Conclusions:Several items of BNT-KC are affected by sociodemographic factors and some items are not useful for the diagnosis of AD. This finding will help to develop a revised edition of BNT-KC to improve the accuracy of dementia diagnosis.
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김혜림(Hyerim Kim),김병수(Byung-Soo Kim),장성만(Sung Man Chang) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.2
Anticholinergic drugs are commonly prescribed for treatment in specific clinical conditions in the elderly. Despite these therapeutic benefits, the use of anticholinergic drugs is limited due to central or peripheral anticholinergic side effects. Especially in the elderly, since long-term use of anticholinergic drugs is related to mild cognitive impairment and dementia, it is necessary to prescribe anticholinergic drugs appropriately. In this review, we try to cover pathophysiology, prevalence of anticholinergic drugs, measuring tools of anticholinergic activity. Also, the negative effects on cognitive function, psychiatric symptoms, delirium, hospitalization, functionality and mortality, and the benefits and limitations of discontinuing anticholinergic drugs are discussed. Finally, we suggest appropriate prescriptions of anticholinergic drugs for the elderly in various clinical conditions.
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김혜림(Kim, Hyerim),이미자(Lee, Mijar) 학습자중심교과교육학회 2017 학습자중심교과교육연구 Vol.17 No.5
최근 교사들의 수업전문성 신장을 위한 여러 방안 중 스스로 자기수업성찰 경험과 역량을 기르는 것이 매우 중요시되고 있다. 이러한 맥락에서 이 연구는 초임교사의 자기수업성찰 경험이 수업에 대한 관점에 어떤 변화를 가져오는지 살펴보고자 하였다. 연구방법으로 연구자는 연구자이면서 동시에 스스로 수업성찰 대상자였다. 수업 성찰을 위해 2015년 10-12월 사이에 총 11차시의 수업을 세 단계(수업실행 및 촬영 -수업성찰-다음 수업설계에 반영) 과정을 순환적으로 거치며 성찰하였다. 수업에 대한 관점 변화를 관찰하기 위해 이 과정에서 수업동영상 촬영, 수업일지 작성, 수업전문가와 면담, 그리고 학생들과 면담 등을 활용하였다. 연구결과 자기수업성찰을 통해 주로 3가지 큰 변화가 관찰되었다. 첫째, 연구자는 학생을 성취도에 따라 구분되는 집단구성원으로 바라보던 관점에서 벗어나 고유한 개성과 인격을 가진 개개인으로 파악하게 되었다. 둘째, 연구자는 수업 중 의사 결정 상황에서 교사가 사전에 수립한 계획을 기준으로 삼기보다 학생의 학습 행위를 기준으로 의사를 결정하게 되었다. 셋째, 연구자는 차시 학습목표 달성 여부를 좋은 수업의 기준으로 여기는 관점에서 나아가 학생의 삶에 연속적으로 영향을 미치는 수업을 좋은 수업의 기준으로 고려하게 되었다. 이 연구를 통해 연구자는 효율적, 효과적으로 가르치는 교사의 역할에 주목하는 것에서 더 나아가 함께 수업을 만들어가는 학생의 위치와 역할을 새롭게 들여다보는 것으로 수업에 대한 시각이 확대되고 있음을 알게 되었다. 또한 자기수업성찰이 교사가 자신의 수업을 객관적으로 들여다보고 개선할 수 있는 효과적인 방법임을 직접 경험할 수 있었다. In teachers’ expertise, teaching expertise is one of the most important components. There are many ways to enhance teachers lecturing expertise, and it is very crucial for them to introspect their own teaching and raise competence. In this context, this study is going to examine how newly appointed teachers’ self-class introspection changes their perspective about teaching. As a study method, this author became a researcher and subject of class introspection at the same time. For class introspection, class was provided once or twice a week, total 11 sessions, for three months in the second semester of 2015. Three steps, class provision and video recording, class introspection, and reflecting it to designing the next class, were applied circularly. To observe how the perspective about class changed, the process applied video recording, class journal writing, interviewing with teaching experts, and interviewing with students. According to the study results, with self-class introspection, three major changes were observed. First, the researcher regarded students as group members distinguished by their achievement but later as individuals equipped with their own unique personality and character. Second, the researcher had the attitude of making decisions during a class based on the pre-established plan but later based on students’ learning behavior more. Third, the researcher thought a good class should be determined by whether each session’s learning objectives were attained or not but later by whether the class would influence students’ lives continuously. To sum up the results above, this researcher focused on the roles of a teacher giving lectures efficiently and effectively but later broadened horizons about the position and roles of students making class together as another subject of it. Moreover, this author could experience in person that self-class introspection would be an effective way to introspect class objectively and use it for betterment.
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