Drug-Nutrient Interaction In Elderly Patients

최나예 한국정맥경장영양학회 2016 한국정맥경장영양학회 학술대회집 Vol.2016 No.-

중환자에서 영양상태 평가지표로서의 골격근량 측정 : 골격근량 측정의 유용성을 중심으로

최나예,최수안,이정화,이은숙,조영재 한국병원약사회 2013 병원약사회지 Vol.30 No.2

Malnutrition in critically ill patients is common and causes negative clinical outcome. A valid nutrition assessment is essential and facilitates optimal nutrition support for patients. However, the application of traditional nutrition assessment tools is inappropriate in critically ill patients who have acute phase response characteristics. Therefore, the purpose of this study is to identify the clinical effectiveness of skeletal muscle measurement in critically ill patients as a nutrition assessment tool. The data were collected from adult patients who stayed in a medical intensive care unit (MICU) of Seoul National University Bundang Hospital (SNUBH) from August 25th to October 13th, 2011. Muscle mass, mid-arm muscle circumference (MAMC) and mid-arm muscle area (MAMA) as muscle mass were calculated by a math formula that was expressed midarm circumference and skinfold thickness which were prospectively measured on the right arm. As traditional nutrition assessment tools, the percent of ideal body weight (PIBW), serum albumin level, total lymphocyte count (TLC), and SNUBH-nutrition screening index (NSI) were collected. As a result, in the initially measured group (n=57), a significant correlation was observed between PIBW and MAMC, MAMA. However, there were no correlations among other traditional assessment tools. In the re-measured group (n=25), whose nutritional status was reassessed after a week, weak correlation was observed between the change of weight and MAMC, MAMA. We concluded that PIBW is related with the skeletal muscle mass in critically ill patients. However, we did not identify the availability of MAMC, MAMA as a valid nutrition assessment tool. Further studies with larger sample size would be necessary to perform.

2012년 제11회 KSPEN 학술대회 : P-5 ; 중환자에서의 영양상태 평가지표 비교

최나예,최수안,이정화,이은숙,조영재,박도중,한호성 한국정맥경장영양학회 2012 한국정맥경장영양학회 학술대회집 Vol.2012 No.-

중환자는 영양불량이 쉽게 발생하여 치료에 부정적인 영향을 야기하므로 적절한 영양 평가가 필요하나, 급성기반응으로 인하여 기존의 영양상태지표로는 유효한 평가를 내리기 어렵다. 이에 본 연구에서는 중환자에서의 골격근량을 측정하여 기존의 영양상태 평가지표와의 상관성 및 각각의 변화율과의 상관성을 확인하여 골격근량 측정의 임상적 유용성을 규명하고자 하였다. 2011년 8월 25일부터 10월 13일까지 분당서울대학교병원 내과계 중환자실에 48시간 이상 재원한 성인 환자를 대상으로 중상박부둘레와 삼두근박하 피부두겹두께를 전향적으로 측정하였다. 기존의 영양상태 평가지표인 이상 체중비, 혈중 알부민 수치, 총 임파구수 및 SNUBH-NSI (nutritional screening index)와 전향적으로 측정된 중상박부 근육둘레와 중상박부 근육면적을 비교하여 그 상관성을 분석하였다(n=57). 또한 내과계 중환자실 재원기간이 1주 이상인 환자의 경우 1주 간격으로 영양상태 평가지표를 재수집하여 변화 추이를 살펴보았다(n=25). 연구결과 초기 측정 환자군에서 기존의 영양상태 평가지표간에는 상관관계가 없었으나, 이상체중비와 중상박부 근육둘레 및 중상박부 근육면적간에는 상관관계를 보였고, 재 측정 환자군에서는 중상박부 근육둘레 및 중상박부 근육면적의 변화와 체중변화와의 상관관계는 있었으나, 다른 영양상태 평가지표 변화와의 상관관계는 없는 것으로 나타났다. 본 연구를 통해 기존의 영양상태 평가지표 중 이상체중비가실제 중환자의 근육량을 반영한다는 것을 확인할 수 있었으나 추적 연구군 수의 부족으로 체중변화와 근육량 변화간의 상관관계에서는 통계적 유의성을 획득하지 못하였다. 본 연구만으로는 영양상태 평가지표로써 중상박부근육둘레 및 중상박부 근육면적의 유용성을 확인하기에는 부족하였고, 향후 다수의 추적 연구군을 대상으로 영양상태 평가지표 변화에 대한 추가 연구가 필요할 것으로 사료된다.

노인환자의 복약순응도 현황 및 영향인자 분석

김민소,최나예,서예원,박진영,이정화,이은숙,Eunkyung Euni Lee,김선욱,김광일,김철호 한국병원약사회 2018 병원약사회지 Vol.35 No.4

Background : To improve medication adherence in elderly patients, the role of pharmacists in teambased services has been highlighted in the literature. However, not much is known about the role and the service elements involved in comprehensive geriatric programs in South Korea. This study was designed to describe the current status of medication adherence in geriatric patients based on the comprehensive geriatric assessment program and analyze the predictive factors for medication adherence in a tertiary teaching hospital. Methods : A retrospective cohort study was performed using electronic medical records of 247 patients from March 1st, 2015 to August 31st, 2015. Medication adherence and the types of non-adherence were also collected. Predictive factors for adherence were evaluated by including factors related to demographics, medications, illness, and patterns of medical usage. Results : The mean age of the study population was 81.2 years (range 65~98 years) and they were taking 9.7 drugs on an average (SD 5.0 drugs). The overall rate of non-adherence was 34%. About 48% of the patients had any forms of assistance in the medication administration. The most common type of non-adherence was“ self-adjustment”. The multivariate analyses revealed that age (adjusted odds ratio, 0.87 [95% CI, 0.80-0.96]; p 0.05) and the number of inappropriate medications (adjusted odds ratio, 0.59 [95% CI, 0.40-0.89]; p 0.05) were strong predictors for non-adherence. Conclusions : These results indicate that strategic considerations of the predictors of non-adherence should be improved in medication counseling services targeting elderly patients.

노인의료센터 다학제 팀의 약물 조정이 약물사용 및 약제비 절감에 미치는 효과

박세진,최나예,서예원,이정화,이은숙,김은경,김선욱,김광일 한국병원약사회 2019 병원약사회지 Vol.36 No.4

Background : Older adults tend to experience multiple chronic conditions on polypharmacy with consequent increase in adverse drug events and medication costs, requiring more medication reconciliation. To date, the effects of medication reconciliation for the inpatients by geriatric pharmacists in multidisciplinary teams have been rarely known in Korea. The purpose of this study was to assess the effects of medication reconciliation by analyzing the changes in prescription and reductions in medication costs for inpatients who received multidisciplinary team care. Methods : Records of patients age 65 and older, admitted to the geriatric center July 1, 2016-June 30, 2017, were retrospectively analyzed in this study. The list of the medications prior to the admission and upon the hospital discharge was obtained from the comprehensive geriatric assessment and electronic medical records, respectively to assess the reduction of the total number of medications, drug duplication, and potentially inappropriate medications (PIM). The cost of drugs was calculated by multiplying the daily price of medicine by the number of days of medication. Results : The mean age of 300 patients was 83.7 (SD 6.9), and 38.7% were males. The patients taking five or more medications were 87.3% before the admission, and 45.0% were mainly diagnosed with infectious disease at admission. With the medication reconciliation, the mean number of medication per patients decreased 10.5 (SD 5.0)-6.5 (SD 3.4) (p 0.001). The number of patients who received the medications listed under PIMs and duplicated was reduced 227-114, and 59-3, respectively (all p 0.001). A total of 458,573 won was saved per person through medication reconciliation. Conclusions : The multidisciplinary team care with the geriatric pharmacist led to safer and more appropriate medication therapy. As a result, it subsequently improved patient safety and medication cost-saving for geriatric patients

상급종합병원 병동담당약사 업무 현황 및 의료인의 인식과 기대 분석

김정은,백시진,최나예,전수정,남궁형욱,이정화,김은경,이주연,Kim, Jeongun,Baek, Sijin,Choi, Nayae,Jeon, Sujeong,Namgung, Hyung Wook,Lee, Junghwa,Lee, Euni,Lee, Ju-Yeun 한국임상약학회 2022 한국임상약학회지 Vol.32 No.1

Background and objective: The Seoul National University Bundang Hospital (SNUBH) implemented ward-based clinical pharmacy system with designated pharmacists in 10 general wards. Designated pharmacists conduct inpatient medication review, medication intervention, and medication consultation, and provide drug information for health care providers. This study aimed to evaluate the clinical pharmacy services and to examine the perception and expectations of health care providers on the services provided by the designated pharmacists in general wards. Methods: A survey was constructed to include questions on the health care providers' recognition, satisfaction, and perceived needs of designated pharmacists. We determined the frequency and type of interventions of ward pharmacist and their acceptance rate through a retrospective observational study using electronic medical records. Results: A total of 59 health care providers responded the questionnaire and 79.7% of the respondents reported moderate to high levels of satisfaction. Satisfaction with the services was positively associated with clinical interventions and nutrition support team (81.4%). Of 59 respondents, 88.1% agreed that preventing drug-related problems by designated pharmacists' activities were effective. The most common interventions included inadequate dosage (27.4%), omission and additional prescription (14.6%) and inadequate drug form (9.6%). The acceptance rate of intervention was 91.5%, and 151 potentially serious risks and 523 significant risks were prevented by the intervention. Conclusion: Positive results were confirmed in the awareness, satisfaction, and perceived needs of the health care providers for designated pharmacists. Expansion of the ward-based clinical pharmacy system with designated pharmacists to other wards may be considered.

Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study

박민지,백희선,송지연,최나예,안요한,강희경,조민현 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.6

Background: Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT. Methods: A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch. Results: Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray’s subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR. Conclusion: Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.