극소 저출생 체중아에서 SMOFlipid의 투여가 미숙아 질환 예방에 미치는 영향: Cholestasis 예방 중심으로

김문진 ( Moon Jin Kim ),배혜정 ( Hye Jung Bae ),조윤숙 ( Yoon Sook Cho ),김귀숙 ( Kwi Suk Kim ),김향숙 ( Hyang Suk Kim ),이혜숙 ( Hye Suk Lee ),이주영 ( Ju Young Lee ),김이경 ( Ee Kyung Kim ),김한석 ( Han Suk Kim ) 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.2

Purpose: Very low birth weight infants (VLBWI) are found to have a higher incidence of cholestasis due to long-term total parenteral nutrition (TPN). Although there have been some studies on relationships between omega-3 fatty acids and reduced incidence of cholestasis, the advantages that the fatty acids provide for premature infant diseases have not yet been fully understood. The aim of this study was to evaluate the advantages of SMOFlipid, a lipid emulsion product that contains omega-3 over other lipid emulsion products that do not. Methods: The medical records of 182 newborn (127 boys and 55 girls) were reviewed retrospectively between April 2010 and August 2012. These infants were born with a birth weight of <1,500 g and administered either of lipid emulsions (Intra MCT 20% or SMOFlipid) from birth to a full-feeding condition at our neonatal intensive care unit. Cholestasis is defined as serum direct bilirubin (DB) >1.0 mg/dL when total bilirubin (TB) is <5 mg/dL or DB/TB ratio is >20% when TB >5 mg/dL. Results: The incidence of cholestasis was found to be lower in the SMOFlipid group than in the medium-chain triglyceride/long chain triglyceride (MCT/LCT) group (7.3% [4/55] versus 18.9% [24/127], P=0.046). At the start of lipid emulsion administration (day 0), the baseline bilirubin level showed no significant difference between the two groups. However, the maximum value of DB on days 7∼ 14 was lower in the SMOFlipid group than in the MCT/ LCT group (0.8 [0.3∼2.2] versus 1.1 [0.3∼2.8] mg/dL, P= 0.030). The DB/TB ratio was also lower in the SMOFlipid group than in the MCT/LCT group (10.2% [4.9%∼40.0%] versus 24.1% [5.1%∼62.5%], P=0.002). Conclusion: This study concluded that SMOFlipid was effective in the prevention of cholestasis in VLBWI. Therefore, omega-3-containing lipid emulsion can be highly recommended in premature babies, especially in VLBWI who require TPN support. (JKSPEN 2013;5(2):67-75)

항암치료에서 약사처방중재의 경제적 편익분석

김귀숙(Kwi Suk Kim),서성연(Sung Yun Suh),임정미(Jung Mi Lim),이주연(Juyeun Lee),고영일(Youngil Koh),서혜선(Hae Sun Suh) 대한약학회 2020 약학회지 Vol.64 No.3

This study analyzed the economic benefits of pharmacists’ prescription intervention in appropriate chemotherapeutic efficacy and safety. We analyzed the types of prescription interventions and the severities of prescription errors by reviewing electronic medical record and intervention reports for anticancer patients from May 1st 2013 through December 31st 2014. Total of 114,536 prescriptions were reviewed during the study period and 3,305 (2.9%) prescription interventions were conducted. The evaluation of the economic values for prescription arbitration was calculated by the amount of prevention of drug loss, the risk avoidance cost against inappropriate prescriptions, and the cost of preventing unnecessary preparations. The labor cost of pharmacists for prescription interventions was 15,758,479 won. When we estimated the savings due to pharmacist’s prescription intervention, the cost of risk avoidance of using the Probability of Harm (POH) resulted from inappropriate prescriptions was estimated to be 2,514,652,575 won. The prevention cost of loss was 586,560,148 won, whereas reduction cost of the unnecessary preparation was 3,944,242 won. Consequently, the net benefit of clinical pharmacy services in oncology during 20 months was estimated to be 3,089,398,486 won when we used the method of POH. Overall, the pharmacist’s prescription arbitration appeared to be beneficial not only for the patient’s safety but also for the economic benefits.

Home Total Parenteral Nutrition의 활성화 전략

김귀숙 ( Kwi Suk Kim ) 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.3

Since the 1970s, introduction of home parenteral nutrition (HPN) has been possible for patients with gastrointestinal tract malfunction and is a more cost-effective treatment at home than in a hospital or a skilled nursing facility. It has allowed for enhancement of the quality of life and avoidance of repeated hospitalizations and long-term hospitalization. In determining the target subject of HPN, its benefit is evaluated. Management of the environment should be evaluated. If an HPN subject is determined, he is prepare to receive the central venous catheter and the HPN regimen is determined. In addition, education of patients and caregivers on the complications associated with HPN is very important. Regular monitoring of the stability of HPN should be conducted. HPN must be activated in order to increase the patient`s quality of life and to reduce the national medical costs, however, there are several limiting factors for HPN expansion. It may be summerized in five points. 1) Home Nutrition Support Team configuration, 2) Patient education guidelines, 3) System for delivery of HPN, 4) The preparation connection system of HPN between the Korean Society for Parenteral and Enteral Nutrition members, 5) Outsourcing of HPN. Efforts of the Nutrition Support Team and national support are needed in order to resolve the limitations. (J Korean Soc Parenter Enter Nutr 2013;5(3):96-101)

Laparoscopic Cholecystectomy 수술 후 Sugammadex와 Neostigmine 간에 첫 자발호흡과 부작용 발현 연구

박현숙,박문수,김민정,김귀숙,조윤숙,배성심,이정연,Park, HyunSuk,Park, Moon Soo,Kim, Min Jung,Kim, Kwi Suk,Cho, Yoon Sook,Bae, Seng Sim,Rhie, Sandy Jeong 한국임상약학회 2018 한국임상약학회지 Vol.28 No.2

Objective: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. Methods: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). Results: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p<0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p<0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p<0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p<0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p<0.05). Conclusion: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.

서울대학교 병원에서의 약품 식별업무 현황 및 제약회사 대상 실태조사

김귀숙,문순란,김민정,박경호,조남춘 한국병원약사회 1997 병원약사회지 Vol.14 No.2

When doctor meets a new patient who is administering already prescribed-medicines, it's important to identify those drugs to avoid the overdose of same drug or drugs which have same pharmacological effects. But most of tablets and capsules available in our country have no identification code on drugs, many medical doctors usually ask phrmacists to identify the drugs which patients have been administering. In present study, the importances of drug identification services in clinical units were reviewed by analyzing the Question & Answer(Q & A) services in the department of pharmacy, Seoul National University Hospital(SNUH), from 1991 to 1995. And questionnaires were conducted on drug identification coding to 209 pharmaceutical companies. From the results of Q & A services, it was noted that about 50% of questions were focused on drug identifications which were mainly requested from medical doctors. The average time to solve those questions was 14.4 minutes. If all tablets and capsules have identification code, the drug identification will be easily solved, but because most of drugs have no identification code, pharmacist contacted other hospitals and pharmacies where the drugs were prescribed. And according to the questionnaires to pharmaceutical companies, only 73 companies responded among 209 companies (34.9%), and 65 companies suggested the needs of drug identification coding, but most of companies (n=49) raised the difficulties to apply that drug identification coding system to their companies. The main reasons were technological and economic problems.

우리나라에서 사용하는 광물유(금속가공유)의 유해특성과 관리대책에 관한 연구 : 수용성 금속가공유의 유해특성과 관리대책 Control and Hazardous Characteristics of Soluble MWF

김승원,박동욱,백남원,윤충식,김신범,김귀숙 한국산업위생학회 1998 한국산업보건학회지 Vol.8 No.1

The objectives of this study were both to evaluate the level and correlations of hazardous agents and to suggest measures to control industrial hygiene problems caused by using water-soluble metalworking fluids(MWF). Geometric mean of formaldehyde(0.039 ppm) was higher than criteria of NIOSH(0.016 ppm). Fomaldehyde, originally existed in the biocide, is released and used to kill microbes in soluble MWF. Microbe concentrations were above 10⁴ No./mL in 14 MWF tanks among 20 tanks surveyed. Nitrosamines that is formed by reaction of nitrosating group and amines was detected to 18.4-47.1 ㎍/㎥. Formaldehyde concentration was low when microbes were abundant(r=0.67, p=0.011), and high when open tank area was wide(r=0.75, p=0.012). The significant relationship between pH and microbes(r=-0.76, p=0.003) was also observed. The predominant bacteria species in MWF were Pseudomonas spp., Bacillus spp., Comamonas testosteroni, Acinetobacterhaemolyticus, Bordetella bronchiseptica in order. Therefore, hazardous agents emitted by using water-soluble MWF seems to be correlated microbial growth. In order to minimize worker's exposure to several hazardous agents by an water-soluble MWF and to increase productivity, microbial growth must be controlled to the lowest level as possible. Administrative control as well as engineering control must comprehensively be applied to control microbe's growth in water-soluble MWF.

금속가공 공정에 사용하는 수용성 금속가공유에 존재하는 미생물의 특성

김귀숙,백남원 서울大學校保健大學院 1998 國民保健硏究所硏究論叢 Vol.8 No.1

Water-based metalworking fluids are excellent environments for the growth of a large variety of microorganisms. Bacterial population levels were as high as 10??/ml and some species regarded as putative pathogens have been isolated. The growth of microorganism causes deterioration of the fluids, and making many problems, in the metalworking industries. To assess concentrations and identify type of microorganisms water-based metalworking fluids from five plants were examined from April to August, 1997. After Sampling, being carried in ice box and being keeped cold storage for seven days. In the eighth day, they are inoculated in blood agar plate for bacteria and Sabouraud dextrose agar for fungi. After 48 hours incubation at 37℃, counting the number of colonies and more incubation for 5∼7 days were performed. To identify microorganism, at first Vitek Gram Negative Identification Card was used and a second time KIT(API 20NE) was used. Most of microorganism was oppotunistic pathogens. The concentrations of microorganisms were 10³∼10??/ml. So we must treat periodically water-based metalworking fluids with biocides to protect of worker's health and increase efficiency of metalworking.