동종골수이식 공여자 간호를 위한 표준임상지침서 개발

설미이(Seol Miee) 대한종양간호학회 2004 Asian Oncology Nursing Vol.4 No.2

The purpose of this study was to develop a clinical pathway for the allogeneic bone marrow transplantation donor. For this study, a conceptual framework was developed through a review of the literature including six steps which are using in Jones Hopkins Hospital. USA The researcher reviewed 129 medical re-cords of donor who had bone marrow donation between January 2002 to January 2004 to identify the overall service contents required by these patients and to make a prelmunary clinical pathway. A content validity test was done for the preliminary climcal pathway, a professional group screened 51 medical re-cords and adopted with 3 hospitalization days as the climcal pathway framework In the fifth step, climcal pathway test was also done to 7 donors from April 28th to July, 2004 After these processes the final clinical pathway was developed.<br/> The results of this study are as follows<br/> 1 The vertical axis of the clinical pathway includes the following 9 items' vital signs, nursing assessment, activity, diet, intervention, medlcation, test, consultation and patient teaching The duration of the honzontal axis was 3days from admission to discharge.<br/> 2 Analysis of the 129 medical records indicated that the average length of stay was 3 4 days. The medical performance according to the vertica! axis in the prelimioary clinical pathway consisted of 51 items. After clinical validity test, It steel consisted of 51 items 10 the final form<br/> 3 Clinical Validity test was done to 7 bone marrow donors. During these process, The first patient was deleted because he was out of the criteria the investigate set and 6 patients were used, finally<br/> The result of this study indicated all of 7 donors were discharged on expected day<br/> 4 Clinical pathway enables to improve the quality of care, multidisciplinary team work It also helps nursing bone marrow donor. effective education to donor or medical member.<br/> The results of this study suggest that clinical pathway may be able to improve the quality of nursing care for bone marrow transplantation donors

한국 전문간호사제도의 현황과 활성화 전략

설미이 ( Seol Miee ),신용애 ( Shin Yong Ae ),임경춘 ( Lim Kyung Choon ),임초선 ( Leem Chosun ),최정화 ( Choi Jeong Hwa ),정재심 ( Jeong Jae Sim ) 서울대학교 간호과학연구소 2017 간호학의 지평 Vol.14 No.1

Purpose: This study aimed to provide information on the developmental process and current status of Advanced Practice Nurses (APN) and to suggest ways for activating APN roles in Korea. Methods: We reviewed literatures to explore domestic and international trends related to the roles, practice settings, scope of practice, regulatory policies, and political environment of APN. Results: Interest in the APN role has been gaining ground worldwide. While the roles of APN in the USA, Taiwan and Japan have been changed in terms of legislation and institutional regulations, the role of APN in 12 fields except for APN in home care has not been legislated since qualification was specified in Korean Medical Law. Many problems were found in vitalizing APN roles: absence of legal regulations on the scope of practice or health insurance coverage for APN, increase the number of medical support staffs who are not qualified, and a disagreement regarding the qualification field and practical field. Conclusion: This study presents snapshots and vitalizing strategies of practice, and regulation for APN to develop their unique roles in Korea. The tasks and duties of APN should be identified specifically to fulfill their roles. In terms of national health insurance policy APN`s Nursing care should be reimbursed just as nursing care of APN in home care.

분야별 전문간호사의 전문간호업무에 대한 성과 평가: 일개 병원을 중심으로

설미이,이명선,Seol, Miee,Yi, Myoung Sun 한국중환자간호학회 2012 중환자간호학회지 Vol.5 No.2

Purpose: The purpose of the study was to evaluate how advanced practice nurses (APNs) recognized their work by analyzing nursing outcomes. The ultimate goal was to examine the utility of APNs by connecting their work to the outcomes. Methods: Cross-sectional survey was conducted to collect the data from 59 APNs in a tertiary hospital lovated in Seoul, Korea. The questionnaire with 84 outcome indicators for advanced practice nurses was used. Descriptive statistics were used to analyze the data. Results: Among 84 outcome indicators, 11 indicators were associated with the work of APNs. Majority of these findings were included in the categories of clinical results and satisfaction. Items identified to be associated with the work of APNs were different among oncology nursing area, surgical speciality area, emergency care area, and critical care area. Conclusion: The results of the study indicated that the works of APNs were relevant to education/counseling/training and interpersonal relationship with other health professionals. The results of the study could be helpful to delineate the work characteristics of APNs and increase the utility of APNs in Korea where roles of APNs are not yet clearly delineated in most clinical settings.

중증 재생불량성빈혈에서 타인 혹은 HLA 불일치 혈연간 골수이식을 위한 cyclophosphamide와 antithymocyte globulin전처치 요법

이정희,이제환,김신,설미이,이정신,김우건,김상희,지현숙,박찬정,이규형 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: Cyclophosphamide와 ATG의 전처치 요법은 HLA가 일치하는 형제간 골수이식에서는 매우 효과적인 것으로 알려져 있으나, 타인 혹은 HLA 불일치 혈연간 골수이식에서는 전처치 요법으로서 불충분한 것으로 보고되었는데, 주요 문제는 착상 부전이었다. 우리나라를 포함하는 극동아시아 지역의 국가들에서 발표되는 보고에 의하면 타인이식을 포함하여 골수이식 후 착상 부전과 이식편대숙주질환의 발생이 서구 국가들로부터의 보고에서보다 적은 것으로 알려져 있다. 저자 등은 6예의 중증 재생불량성빈혈 환자들에서 질병 초기에 Cyclophosphamide와 ATG만을 이용하여 전처치를 한 후에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행하였다. 방법: 1999년 5월부터 2000년 4월까지 서울중앙병원에서 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 성인 중증 재생불량성빈혈 환자들을 대상으로 하였다. 골수이식을 위한 전처치 요법으로 cyclophosphamide (50 mg/kg/d x 4)와 ATG (30 mg/kg/d x 3)를 투여하였는데, 골수이식 전에 ATG에 대하여 과민 반응을 보였던 한 예 (UPN 120)에서는 ATG 대신에 fludarabine (30 mg/m2/d x 3)을 투여하였다. 이식편대숙주질환의 예방을 위하여 cyclosporine과 methotrexate를 투여하였다. 결과: 연구 기간 중에 모두 6예가 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받았는데, 5예는 타인으로부터 골수를 공여 받았으며, 1예는 HLA의 표현형이 하나의 유전자좌에서 일치하지 않는 형제로부터 골수를 공여 받았다. 타인 골수이식을 받은 5예 중에서 3예의 공여자는 HLA의 표현형이 일치하였으며, 1예는 하나의 유전자좌가 major mismatch였고, 1예는 하나의 유전자좌가 minor mismatch였다. 추적기간의 중앙값은 406일 (범위, 328-643일)인데, 6예 모두에서 착상된 상태를 유지하면서 생존해있다. 2예에서 3도의 급성 이식편대숙주질환과 전신성 만성 이식편대숙주질환이 발생하였다. 결론: Cyclophosphamide와 ATG의 전처치 요법은 재생불량성빈혈의 초기에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 한국인 환자들에서 충분히 착상을 가져올 수 있는 요법으로 생각된다. 비록 본 연구의 대상 환자 수가 적지만 결과는 매우 고무적이다. HLA가 일치하는 형제가 없는 중증 재생불량성빈혈 환자의 경우에 타인 골수 공여자에 대한 검색을 조기에 시행해야 하며, 타인 혹은 HLA 불일치 혈연간 골수이식을 질병 초기에 적극적으로 고려해야 할 것으로 생각된다. Background: Cyclophosphamide (CY) and ATG regimen was reported to be insufficient for alternative donor BMT in SAA patients due to high incidence of graft rejection. The rates of graft rejection and GVHD after allogeneic BMT including unrelated donor transplants seemed to be lower in reports from Asian countries of Far East. We applied CY/ATG regimen to six patients with early stage of SAA transplanted with marrow from alternative donors other than HLA-identical siblings. Methods: Three patients were transplanted from HLA-phenotypically identical unrelated donors, two from one-locus mismatched unrelated donors, and one from an one-locus mismatched sibling donor. Four patients received no previous therapy for SAA, and two received one course of immunosuppressive therapy with ATG. Preparative regimen was CY (200 mg/kg) plus ATG (90 mg/kg) in all patients except one who had had an anaphylactic reaction to ATG prior to BMT and received fludarabine (90 mg/m2) in place of ATG. Cyclosporine plus methotrexate were given for GVHD prophylaxis. Results: All six patients engrafted and all are alive with durable engraftment at a median follow-up of 406 days (range, 328 to 643). Two patients developed grade III acute GVHD and extensive chronic GVHD. Conclusions: CY/ATG regimen may be sufficient in Korean patients with early stage of SAA transplanted with marrow from alternative donors. Although the number of patients in present study is small, results are encouraging. Stem cell transplantation using alternative donors may be considered at early stage of aplastic anemia.

Immunosuppressive therapy using antithymocyte globulin (ATG) and cyclosporine (CSA) for the patients with bone marrow failure syndrome

( Jung Hee Lee ),( Je Hwan Lee ),( Seong Jun Choi ),( Miee Seol ),( Jung Shin Lee ),( Woo Kun Kim ),( Kyoo Hyung Lee ),( Young Joo Min ) 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

Immunophenotypic markers in adult acute lymphoblastic leukemia: the prognostic significance of CD20 and TdT expression

Dae-Young Kim,박한승,최은지,이정희,이제환,Mijin Jeon,Young-Ah Kang,Young-Shin Lee,Miee Seol,조영욱,장성수,Hyun-Sook Chi,이규형,박찬정 대한혈액학회 2015 Blood Research Vol.50 No.4

BackgroundEfforts to overcome poor outcomes in patients with adult acute lymphoblastic leukemia (ALL) have focused on combining new therapeutic agents targeting immunophenotypic markers (IPMs) with classical cytotoxic agents; therefore, it is important to evaluate the clinical significance of IPMs.MethodsBaseline characteristics and clinical outcomes of patients with adult ALL were retro-spectively analyzed. The percentage of blasts expressing IPMs at diagnosis was measured by multicolor flow cytometry analysis. Samples in which ≥20% of blasts expressed an IPM were considered positive.ResultsAmong the total patient population (N=230), almost all (92%) were in first or second hem-atological complete remission (HCR) and 54% received allogeneic hematopoietic cell transplant (allo-HCT). Five-year hematologic relapse-free survival (HRFS) and overall sur-vival (OS) rates were 36% and 39%, respectively, and 45.6% and 80.5% of patients were positive for the IPMs CD20 and terminal deoxynucleotidyl transferase (TdT), respectively. Expression of CD20, CD13, CD34, and TdT was associated with HRFS rate, and ex-pression of CD20 and CD13 was associated with OS rate, as was the performance of al-lo-HCT. In multivariate analysis, positivity for CD20 (HRFS: hazard ratio [HR], 2.21, P<0.001; OS: HR, 1.63, P=0.015) and negativity for TdT (HRFS: HR, 2.30, P=0.001) were both significantly associated with outcomes. When patients were categorized into three subgroups according to positivity for CD20 and TdT, there were significant differences in HRFS and OS among the subgroups.ConclusionPositivity for CD20 and TdT expression and clinical risk group were prognostic factors in adult ALL.

Immunophenotypic markers in adult acute lymphoblastic leukemia: the prognostic significance of CD20 and TdT expression

Dae-Young Kim,박한승,최은지,이정희,이제환,Mijin Jeon,Young-Ah Kang,Young-Shin Lee,Miee Seol,조영욱,장성수,Hyun-Sook Chi,이규형,박찬정 대한혈액학회 2015 Blood Research Vol.50 No.4

BackgroundEfforts to overcome poor outcomes in patients with adult acute lymphoblastic leukemia (ALL) have focused on combining new therapeutic agents targeting immunophenotypic markers (IPMs) with classical cytotoxic agents; therefore, it is important to evaluate the clinical significance of IPMs.MethodsBaseline characteristics and clinical outcomes of patients with adult ALL were retro-spectively analyzed. The percentage of blasts expressing IPMs at diagnosis was measured by multicolor flow cytometry analysis. Samples in which ≥20% of blasts expressed an IPM were considered positive.ResultsAmong the total patient population (N=230), almost all (92%) were in first or second hem-atological complete remission (HCR) and 54% received allogeneic hematopoietic cell transplant (allo-HCT). Five-year hematologic relapse-free survival (HRFS) and overall sur-vival (OS) rates were 36% and 39%, respectively, and 45.6% and 80.5% of patients were positive for the IPMs CD20 and terminal deoxynucleotidyl transferase (TdT), respectively. Expression of CD20, CD13, CD34, and TdT was associated with HRFS rate, and ex-pression of CD20 and CD13 was associated with OS rate, as was the performance of al-lo-HCT. In multivariate analysis, positivity for CD20 (HRFS: hazard ratio [HR], 2.21, P<0.001; OS: HR, 1.63, P=0.015) and negativity for TdT (HRFS: HR, 2.30, P=0.001) were both significantly associated with outcomes. When patients were categorized into three subgroups according to positivity for CD20 and TdT, there were significant differences in HRFS and OS among the subgroups.ConclusionPositivity for CD20 and TdT expression and clinical risk group were prognostic factors in adult ALL.

Prognostic implications of CD14 positivity in acute myeloid leukemia arising from myelodysplastic syndrome.

Choi, Yunsuk,Lee, Je-Hwan,Kim, Sung-Doo,Kim, Dae-Young,Lee, Jung-Hee,Seol, Miee,Kang, Young-Ah,Jeon, Mijin,Jung, Ah Rang,Lee, Kyoo-Hyung Elsevier Science Publishers 2013 International journal of hematology Vol.97 No.2

<P>Secondary acute myeloid leukemia (s-AML) arising from myelodysplastic syndrome (MDS) shows different clinical features from de novo AML. We assessed the prognostic significance of immunophenotypic markers in patients with s-AML arising from MDS. Sixty-five adults diagnosed with AML arising from MDS between 1996 and 2010 were retrospectively analyzed. Immunophenotyping was performed for markers including CD3, CD7, CD10, CD13, CD14, CD19, CD33, CD34, CD41, CD45, CD56, CD65, CD117, HLA-DR, and TdT. Of these immunophenotypic markers, only CD14 positivity was significantly associated with lower complete remission rate (P = 0.034) and significantly shorter overall survival (OS, P < 0.001) and event-free survival (EFS, P < 0.001) on univariate analysis. On multivariate analysis, these differences remained significant in terms of OS [hazard ratio (HR) 4.49; P < 0.001] and EFS (HR 4.06; P < 0.001). Other significant prognostic variables included age 60 years [shorter OS (P = 0.003) and EFS (P = 0.020)], higher WBC count (>60,000/μL) [shorter OS (P < 0.001) and EFS (P = 0.001)], and poor cytogenetic risk group [shorter OS (P = 0.005)]. CD14 expression on leukemic blasts is an independent prognostic factor for survival outcomes in patients with AML arising from MDS.</P>

Comparison of anthracyclines used for induction chemotherapy in patients with <i>FLT3</i>-ITD-mutated acute myeloid leukemia

Choi, Eun-Ji,Lee, Je-Hwan,Lee, Jung-Hee,Park, Han-Seung,Ko, Sun-Hye,Hur, Eun-Hye,Moon, Juhyun,Goo, Bon-Kwan,Kim, Yeonhee,Seol, Miee,Lee, Young-Shin,Kang, Young-Ah,Jeon, Mijin,Woo, Ji Min,Lee, Kyoo-Hyu Elsevier 2018 Leukemia research Vol.68 No.-

<P><B>Abstract</B></P> <P>This retrospective analysis compared anthracyclines (as part of an induction regimen) in 128 newly diagnosed <I>FLT3</I>-ITD-mutated AML patients. Induction regimens comprised high-dose daunorubicin (HD-DN; 90 mg/m<SUP>2</SUP>/d × 3d; n = 44), standard-dose daunorubicin (SD-DN; 45 mg/m<SUP>2</SUP>/d × 3d; n = 51), or idarubicin (IDA; 12 mg/m<SUP>2</SUP>/d × 3d; n = 33) in combination with cytarabine (100–200 mg/m<SUP>2</SUP>/d × 7d). Fifty-three patients showing persistent leukemia on interim bone marrow examination received a second course of induction chemotherapy comprising 2 days of daunorubicin (45 mg/m<SUP>2</SUP>/d) or IDA (8 or 12 mg/m<SUP>2</SUP>/d) in addition to 5 days of cytarabine. Complete remission (CR) rates were 77.3%, 56.9%, and 69.7% for HD-DN, SD-DN, and IDA, respectively (<I>P</I> = 0.101; HD-DN <I>vs.</I> SD-DN, <I>P</I> = 0.036; HD-DN <I>vs.</I> IDA, <I>P</I> = 0.453; IDA <I>vs.</I> SD-DN, <I>P</I> = 0.237). The HD-DN showed higher overall survival (OS) and event-free survival (EFS) than SD-DN and IDA: the differences between HD-DN and SD-DN (<I>P</I> = 0.009 for OS and <I>P</I> = 0.010 for EFS) were statistically significant.</P> <P>Results of <I>in vitro</I> studies using <I>FLT3</I>-ITD-mutated cell lines supported these findings. In conclusion, HD-DN improved the CR rate, OS, and EFS of <I>FLT3</I>-ITD-mutated AML patients. HD-DN also tended to yield better outcomes than IDA, though the difference was not significant. The superiority of HD-DN over IDA should be confirmed in future studies.</P> <P><B>Highlights</B></P> <P> <UL> <LI> <I>FLT3</I>-ITD-mutated AML patients benefited from high-dose daunorubicin. </LI> <LI> High-dose daunorubicin seems to yield better results than idarubicin. </LI> <LI> The results of <I>in vitro</I> studies support these findings. </LI> </UL> </P>