Evaluation of Drug-Induced Liver Injury Developed During Hospitalization Using Electronic Health Record (EHR)-Based Algorithm

Yewon Kang,Sae-Hoon Kim,So-Young Park,Bo Young Park,Ji-Hyang Lee,Jin An,Ha-Kyeong Won,Woo-Jung Song,Hyouk-Soo Kwon,조유숙,Hee Bom Moon,Ju Hyun Shim,양민석,김태범 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.3

Purpose: The incidence of drug-induced liver injury (DILI) has been increasing; however, few algorithms are available to identify DILI in electronic health records (EHRs). We aimed to identify and evaluate DILI with an appropriate screening algorithm. Methods: We collected data from 3 university hospitals between June 2015 and May 2016 using our newly developed algorithm for identifying DILI. Among patients with alanine transferase (ALT) ≤ 120 IU/L and total bilirubin (TB) ≤ 2.4 mg/dL in blood test results within 48 hours of admission, those who either had 1) ALT > 120 IU/L and TB > 2.4 mg/dL or 2) ALT > 200 IU/L at least once during hospitalization were identified. After excluding patients with liver disease-related diagnosis at discharge, medical records were retrospectively reviewed to evaluate epidemiological characteristics of DILI. Results: The total number of inpatients was 256,598, of whom 1,100 (0.43%) were selected by the algorithm as suspected DILI. Subsequently, 365 cases (0.14% of total inpatients, 95% confidence interval, 0.13–0.16) were identified as DILI, yielding a positive predictive value of 33.1%. Antibiotics (n = 214, 47.2%) were the major class of causative drug followed by chemotherapeutic agents (n = 87, 19.2%). The most common causative drug was piperacillin-tazobactam (n = 38, 8.4%); the incidence of DILI by individual agent was highest for methotrexate (19.4 cases/1,000 patients administered the drug). Common reasons for excluding suspected DILI cases were ischemic hepatitis and postoperative liver dysfunction. Conclusions: Using our EHR-based algorithm, we identified that approximately 0.14% of patients developed DILI during hospitalization. Further studies are needed to modify criteria for more accurate identification of DILI.

Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study

( Yewon Kang ),( Wanho Yoo ),( Youngwoong Kim ),( Hyo Yeong Ahn ),( Sang Hee Lee ),( Kwangha Lee ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.2

Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public-Private Mix Periods

( Yewon Kang ),( Eun-jung Jo ),( Jung Seop Eom ),( Mi-hyun Kim ),( Kwangha Lee ),( Ki Uk Kim ),( Hye-kyung Park ),( Min Ki Lee ),( Jeongha Mok ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.1

Background: This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDRTB) before and after the implementation of public-private mix (PPM). Factors affecting treatment success were also investigated. Methods: Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017. Results: A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m², previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success. Conclusion: The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.

Functional Expression and Enzymatic Characterization of Intracellular endo-Arabinanase-B from Bifidobacterium longum subsp. suis

Yewon KANG,Saem lee JEONG,Ji-Eun PARK,So-Yeong KANG,Sung-Hwan JEON,Nam Soo HAN,Tae-Jip KIM 한국생물공학회 2017 한국생물공학회 학술대회 Vol.2017 No.10

Effect of early tracheostomy on clinical outcomes in patients with prolonged acute mechanical ventilation

( Yewon Kang ),( Kwangha Lee ),( Eun-jung Jo ),( Jung Seop Eom ),( Jeongha Mok ),( Mi-hyun Kim ),( Ki Uk Kim ),( Hye- Kyung Park ),( Min Ki Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: There are few data regarding effect of early tracheostomy on clinical outcomes in our country. Our study aimed to investigate effect of early tracheostomy on clinical outcomes (including long-term mortality) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ≥ 96 hrs). Methods: Data were obtained retrospectively from 575 patients, (69.4% male; median age 68 years) who hospitalized at a medical intensive care unit (ICU) of a single university-affiliated tertiary care hospital over 9 years (between March 2008 and February 2017). Early tracheostomy was defined as ≤ 10 days after translaryngeal intubation. Results: Their hospital and one-year cumulative mortality rate after ICU admission were 38.6 % (n=222) and 61.2 % (n=352), respectively. Also, one hundred forty-three patients (24.9%) underwent early tracheostomy, while others classified with late (n=115, 20.0 %) or no tracheostomy group (n=317, 55.1%). When total patients were divided two groups (early versus late or no tracheostomy), there were no significant differences of Acute Physiology and Chronic Health Evaluation II [median 22 interquartile range (16-25) vs 19 (15-25), p=0.172] and Sequential Organ Failure Assessment scores [7 (5-10) vs 6 (4-9), p=0.737] on ICU admission between both groups. However, early tracheostomy group showed higher medical costs during hospital stay [26,609 (17,634-44,066) vs 21,536 (13,974- 36,509) USD, p=0.013], ICU rehabilitation (46.2 vs 20.1%, p<0.001) and lower hospital mortality (21.7 vs 44.2% p<0.001). In stepwise multivariable Cox-proportional hazard model, early tracheostomy [Hazard ratio 1.550 (95% Confidence interval 1.197-2.006), p=0.011] was associated with one-year survival improvement. Conclusions: In our study, early tracheostomy group showed higher total hospital cost during hospital stay. Also, early tracheostomy was associated with higher hospital and one-year survival improvement.

Gene Cluster Analysis for Enzymatic Utilization of Arabinan in Bifidobacterium longum subsp. suis DSM 20211

Yewon Kang,Ji-Eun Park,Heeji Shin,So-Young Kang,Nam Soo Han,Tae-Jip Kim 한국당과학회 2018 한국당과학회 학술대회 Vol.2018 No.01

Arabinans can be synergistically degraded into L-arabinose and arabinooligosaccharides (AOS) by the actions of exo-arabinofuranosidase (AF) and endo-arabinanase (ABN). Bifidobacterium spp., the well-known probiotic bacteria, were reported to utilize linear AOS as the prebiotic carbohydrates. Two different endo-arabinanase genes were previously found and cloned from the genome of Bifidobacterium longum subsp. suis DSM 20211. In this study, the modes of action for both endo-arabinanases, BflsABN-B1 and B2, were comparatively characterized, and their gene cluster was analyzed in detail. The gene cluster analysis revealed that the corresponding contig 11 of Bf. longum subsp. suis includes several putative exo-acting AF genes, the ABC transporter-related genes, ATP-binding protein genes, as well as both ABNs-B. According to the gene cluster analysis, the extracellular BflsABN-B1 hydrolyzes arabinan polymers to the short chain AOS, which are imported into the cell membrane through the ABC transporters. Within a cell, AOS can be hydrolyzed into L-arabinose by an intracellular BflsABN-B2 and various exo-AFs. These results proposed the hypothetical enzymatic system for the arabinan utilization in Bf. longum subsp. suis.

인터랙티브 제품의 온보딩 경험 만족도 향상을 위한 매뉴얼 디자인 연구

강예원(Yewon Kang),유승헌(Seunghun Yoo) 한국HCI학회 2022 한국HCI학회 학술대회 Vol.2022 No.2

제품의 기능이 고도화되면서 매뉴얼은 사용자가 제품을 사용하는 초기 온보딩 단계에서 중요한 역할을 한다. 여러 제품 브랜드는 제공 기능 설명을 위해 기존 종이 매뉴얼 뿐 아니라 다양한 방식의 인터랙티브 매뉴얼을 제공하고 있으나 사용자 만족도는 성공적이지 못한 경우가 많다. 본 연구는 제품 매뉴얼의 사례 분석과 설문 조사를 기반으로 사용자의 만족도 향상을 위한 인터랙티브 매뉴얼 디자인 가이드를 영상, 웹, 앱 총 3 가지 플랫폼별로 나누어 도출하고 기대 효과를 제시하였다.

소비자의 옴니채널 경험 개선을 위한 리뷰 데이터 기반 요인 분석 프레임워크

강예원(Yewon Kang),최예림(Yerim Choi),정민교(Min Gyo Chung) 한국정보기술학회 2022 Proceedings of KIIT Conference Vol.2022 No.12

최근 ICT의 발달로 인해 모바일 기기가 보편화됨에 따라 온라인과 오프라인 채널 간의 구분이 무너지고 있다. 또한, 기업들은 비즈니스 기회 창출을 위한 디지털 트랜스포메이션 과정에서 옴니채널 서비스를 제공하는 추세에 따라 옴니채널 전략 도출의 필요성이 증가하고 있다. 기존 연구들에서는 사례 분석 방법이나 선행 문헌을 통한 요인 도출 방법으로 이루어져 소비자 경험에 대한 연구는 단편적인 실정이다. 옴니채널의 경험을 개선하기 위해 다양하고 방대한 소비자 경험을 활용할 필요가 있으며, 리뷰 데이터는 소비자의 다양한 감성을 포함하고 있어 소비자의 경험을 파악 및 개선할 수 있는 자원이다. 따라서, 본 연구는 국내 대표 헬스&뷰티 옴니채널 브랜드인 올리브영의 리뷰 데이터를 활용하여 소비자의 옴니채널 경험을 개선할 수 있는 요인 분석 프레임워크를 제안한다. 제안한 프레임워크는 국내 옴니채널 브랜드인 올리브영 데이터를 이용해 검증하였으며, 채널과 관계없이 언급 빈도가 높은 동일한 요인이 소비자 만족도에 미치는 영향력도 높았다. 카테고리별 채널에 따라 소비자의 감성 차이가 있는 요인들은 건강/위생용품, 바디 케어, 푸드 카테고리의 ‘용량’이 공통적으로 도출되었으며, 네일 카테고리의 ‘지속력’, 헤어 케어 카테고리의 ‘가격’ 이 도출되었다. 연구에서 제안한 프레임워크는 옴니채널 개선 전략 수립 시 효율적인 전략 도출 과정의 기초자료로써 사용될 것으로 기대한다. Recently, online and offline channels distinction has been eliminated due to the development of ICT and mobile devices becoming common. Also, companies are increasingly in the necessity of omni-channel strategies according to the trend of providing omni-channel services, which is in the digital transformation process to create business opportunities. Prior studies on customer experience, which only exist for case analysis method or a factor extraction method through prior studies, are fragmentary. In order to improve the customer’s omni-channel experience, it is necessary to utilize a various and wide range of customer experiences and review data including customers’ sentiments can be used to understand the experience. Therefore, we propose a factor analysis framework that improves customers’ omni-channel experience by utilizing the review data of Olive Young, a representative health & beauty omni-channel brand in Korea. The proposed framework was verified by dataset a collected from domestic omni-channel brand Olive Young and the same factors with high frequency of mention regardless of the channel also had a high impact on consumer satisfaction. In addition, factors that differ in consumers sentiment according to channels by category include capacity in common in health/sanitary products, body care, and food categories, durability in nail categories, and price in hair care categories. The framework proposed in the study is expected to be used as basic data for the efficient strategy derivation process when establishing an omni-channel improvement strategy.

다기능 가전제품 UX의 사용성 영향 요소와 제품 구매 의사 관계성 분석 -소형 복합 정수기 인터페이스 비교를 중심으로

강예원(Yewon Kang),유승헌(Seunghun Yoo) 한국디자인학회 2021 한국디자인학회 학술발표대회 논문집 Vol.2021 No.11

경구 유발시험으로 진단한 Pyrazinamide 유발 두드러기와 혈관부종: 증례 보고

강예원 ( Yewon Kang ),강지은 ( Jieun Kang ),이경민 ( Kyoungmin Lee ),정대현 ( Dae Hyun Jeong ),노수민 ( Soomin Noh ),서보미 ( Bomi Seo ),김태범 ( Tae-bum Kim ) 대한내과학회 2018 대한내과학회지 Vol.93 No.3

항결핵제에 의한 즉시형 과민반응은 드물게 발생하지만, 국내의 결핵 유병률이 높고 항결핵제가 자주 처방되는 약물임을 고려할 때, 치료시 주의를 기울이는 것이 필요하겠다. Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs. (Korean J Med 2018;93:306-310)