당뇨병

김희세 약업신문사 1998 의약정보 Vol.1998 No.8

High degree of supervision improves adherence to inhaled corticosteroids in children with asthma

박근미,한혜원,김희세,김재윤,이은미,조현주,양송이,정영호,홍수종,김형영,서주희,유진호 대한소아청소년과학회 2015 Clinical and Experimental Pediatrics (CEP) Vol.58 No.12

Purpose: Adherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma. Methods: Fifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30. Results: Adherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter (74.4%±17.4% at day 30, 66.5%±18.4% at day 60, and 67.4%±22.2% at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly dif- ferent when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P=0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group (82.0±16.0 vs. 66.1±14.5, 75.4±14.4 vs. 56.2±18.4, 75.0±18.3 vs. 55.0±19.7 [P=0.027]; 77.9±12.2 vs. 59.1± 11.4 [P=0.021]) after adjustment for sex and age. Conclusion: The level of caregiver supervision is an important factor affecting adherence to ICS the- rapy in children with asthma. Therefore, a high degree of supervision may be required to increase adhe- rence to ICS therapy in children with asthma.

항암제 주사 조제 오류의 발생률, 유형 및 원인분석

허영설,강민경,김희세,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.1

The objective of this study is to investigate the incidence, types, stages and causes of preparation errors in intravenous chemotherapeutic agents in order to prevent medication error and improve patient safety. The study was performed in the Outpatient Department of Pharmacy in ASAN Medical Center during a nine month period from January to September 2011. Preparation errors were both selfreported and non-self-reported. Analysis included 99,085 preparations, and preparation errors were detected in 155 preparations (0.16%, 95% CI=0.10%-0.21%). Common types of errors were incorrect dosage of drugs (18%), incorrect volumes of diluents (14%), and spills in the process of preparation (13%). The most common stages of error occurrence were the preparing stage (51%) and checking stage before preparation (17%). Causes included mistakes in device operation (16%), process violation (16%), and incorrect identification of drugs or diluents (13%). Other causes included poor quality of medication (26%), unusual processes of preparation (15%), and insufficient support of computerized systems (27%). To prevent error, working routines should be established for the through verification of the systems, and to analyze, change, and monitor the processes and environments.

항응고약물상담 서비스( AC S )가 신경과 환자의 warfarin 치료효과에 미치는 영향

예경남,김재연,김희세,나양숙,신혜영,오정미 韓國病院藥師會 2005 병원약사회지 Vol.22 No.1

Pharmacist-managed anticoagulation service (ACS) are responsible for providing the patient education, adjustment of warfarin dosage, monitoring of side effect to maintain prothrombin time within the therapeutic range. Many studies have proven the therapeutics efficiency of ACS by showing the improvements in warfarin therapy while reducing warfarin related adverse effects. There are several hospitals in Korea that are operating the ACS. The ACS in Seoul Asan Medical Center (AMC) began to provide the ACS for the neurology patients treated with warfarin from April 2003 and its effectiveness remains to be evaluated. The purpose of this study was to evaluate the therapeutic effect of ACS by comparing the achievement rate of INR within the therapeutic range before and after ACS operation and by surveying the patient satisfaction of ACS. We compared the achievement rate of INR values within the therapeutic range during the six-month before the ACS (Pre-ACS) and after the referral to the ACS (Post-ACS). The study included 58 patients who had been previously managed by physician but now was managed by ACS. We have also surveyed the patient satisfaction of ACS A total 679 INR values were analyzed pre-ACS group consisted of 285(41%) cases while post-ACS group consisted of 411(59%) cases. The analysis showed that the achievement rate of INR values within the therapeutics range in post-group was significantly superior to the Pre-ACS(65.45% vs. 47.9%, p.0.0001). Furthermore post-group spent more time within the therapeutic range than the pre-ACS group (68.08% vs. 50.10%, p.0.0001). Seventy-nine patients completed the survey on the patient satisfaction. Most patients responded positively with ACS in 18 questions, which correspond with overall satisfaction on ACS, understanding of explanation, knowledge of their medication and non-medication (Cronbach α0.66, 0.77, 0.84, 0.68 respectively). In conclusion, ACS improved the anticoagulation control in neurology patients treated with warfarin by effectively maintaining the INR level within the therapeutics range. The levels of patient satisfaction on ACS and knowledge of the disease and medication were superior.

약사의 항암제 처방감사를 통한 약물오류 예방

강민경,윤선혜,허영설,김희세,송영천 한국병원약사회 2011 병원약사회지 Vol.28 No.3

The purpose of this study was to analyze chemotherapy-related medication errors detected by pharmacist in outpatient department and to evaluate efficacy of new alert system in chemotherapy monitoring program to prevent them. Finally, we evaluated the efficacy of pharmacists’prescription review. The study was performed at Asan Medical Cancer Center pharmacy from October 2008 to September 2010. We reviewed medication orders by using chemotherapy monitoring program and Electronic medical record (EMR), and compared the quantity and quality of reviewing medication orders and intervention after applying new alert system. During the study period, the number of medication monitoring increased from 47,928 to. 59,618. And, the frequency of pharmacists’interventions increased, especially anticancer-drug dosage related interventions increased from 31% to 46%. When we analyzed the reason of dosage errors,laboratory data related errors increased from 9% to 16%. We confirmed that pharmacists’chemotherapy monitoring and intervention improved qualitively and quatitatively after applying new alert system. And, it prevented potential harm due to medication errors.

Cetuximab 주입관련반응의 발생 빈도 및 관련 인자 분석

장호석,강민경,허영설,김희세,곽혜선,송영천 한국병원약사회 2013 병원약사회지 Vol.30 No.1

Monoclonal antibody treatments can result in severe infusion reactions. Among these, cetuximab, mouse-human chimeric monoclonal antibody reported 15~20% infusion reactions (severe infusion reactions 3~5%). However, there are no actual reported incidences in Korea, and little information regarding the prevention, management or outcomes of infusion reactions. This study represents one of the first attempts to describe the clinical consequences regarding the incidence rates of infusion reactions, effect of premedication and test dose. A retrospective chart review was conducted in Asan Medical Center. Eligible patients were treated with cetuximab as either single agents or in combination with additional chemotherapy. Case searches were conducted by electronic medical records from June 2006 to October 2010. Source documents were evaluated for infusion reactions based on the Common Terminology Criteria for Adverse Events version3.0 (CTCAE v3.0). A total of 336 patients (215 men and 121 women) with the mean age of 56 years (27-76 years) were enrolled in this study. 11 patients were identified with infusion reactions. Mild and moderate infusion reactions are 9 (≤grade2, 3.3%) and severe infusion reactions are 2 (grade4, 0.6%). In premedication, 7 of 285 patients (2.5%) who received antihistamine were identified with a infusion reaction, while 4 of 51 patients (15.2%) who received antihistamine and corticosteroid (p=0.63). 4 of 84 patients (4.8%) treated with monotherapy and 7 of 252 patients (2.8%) treated with combination therapy suffered from infusion reaction (p=0.712). Patients with the administration of test dose (n = 49) experienced infusion reactions were 5 people. Further, 3 of these 5 patients (60%) were identified with infusion reactions at the main dose, not test dose. In addition, 6 patients of the past 2 mg/ml formulation with the unfiltered group (n = 288) (2.1%) and 5 patients of the present 5 mg/ml of the formulation was filtered (n = 48) (10%) were identified with a infusion reactions (p=0.915). It was difficult to find significant factors relating to the infusion reactions because incidences of cetuximab infusion reactions were lower than the previously reported. However, we found that antihistamine with corticosteroids as a premedication tended to reduce infusion reactions and the test dose is not valid.

외래 항암주사병동 복약상담 현황 및 만족도 조사를 통한 복약상담 개선 방안

차현경,류수경,허영설,김희세,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.2

In this study, we measured the satisfaction and demand of counseling by a survey to cancer center, which counseled patient and family members, and it aimed to study the way to in which improvements of the medication counseling could be made, based on an analysis of pharmacist’s intervention. Satisfaction of counseling, contents, when patient want to be counseled, counseling time, and number of counseling were surveyed by 148 patients, who were counseled for 3 weeks, from May 12 to June 1 in 2011, and pharmacist’s interventions were analyzed. Providing information (25 cases) is mostly rated in the content of pharmacist interventions of surveyed patients. In this satisfaction of the survey results, the most patients answered that pharmacists’medication counseling is helpful for getting the information of the medicine’s name, the effects, and usage. The side effects are mostly indicated with what they want to be counseled, by 74 patients (51%), patients’requirement was diversely shown in the question about asking what the proper number for counseling is. Most patients were satisfied with the questions,which were asked of counseling, kindness and satisfaction level. On this basis, improving medicine explanation, adjusting the number of counseling times, according to patients need, developing standardized patients counseling software and managing it, we are expecting that the effective and high quality pharmacist medical counseling will be achieved.

Voriconazole의 용량 변경 현황 분석 및 제안

이재은,김승란,김예지,김희세,김재연 한국병원약사회 2018 病院藥師會誌 Vol.35 No.3

Background : Voriconazole is a first-line agent for treatment of invasive aspergillosis. However, the relationship between dose and serum concentration of voriconazole is non-linear, making it very difficult to predict changes in serum level of voriconazole upon dosage change. Here, we reviewed and analyzed cases of changing dose of voriconazole when its serum concentration was not within therapeutic range. Methods : We retrospectively analyzed medical records of adult patients who were hospitalized in Asan Medical Center from January 2010 to December 2015. We excluded cases whose voriconazole level was not in a steady state, those who were administered incompatible drugs, and those who were diagnosed with liver cirrhosis. The number of hospitalization was the unit of analysis. Patients were classified by their initial serum concentration of voriconazole as follows: Group 1 (G1) (TDM1; 1st level 0.5 ㎍/ml), G2 (0.5≤TDM1 1 ㎍/ml), G3 (1≤TDM1 5.5 ㎍/ml (therapeutic range)), G4 (5.5 ≤ TDM1 10 ㎍/ml) and G5 (TDM1≥10 ㎍/ml). Chi-square test and Fisher’s exact test were used to test if there were statistical differences between groups. This study was approved by our Institutional Review Board (No. S2016-1134-0001). Results : A total of 574 cases were analyzed and classified into five groups. We found that 93%, 82%, 87% and 76% of G1, G2, G4 and G5, respectively, reached therapeutic range of voriconazole when their dosages were changed as follows: increased by 2 mg/kg/day, increased by 0.5 mg/kg/day, decreased by ≥1 mg/kg/day and decreased by ≥2 mg/kg/day, respectively. Conclusions : The following dose changing regimen would be more reasonable when serum level of voriconazole is not within therapeutic range: G1, increase by 2-5 mg/kg/day; G2, increase by 0.5-2.5 mg/kg/day; G4, decrease by 1.5-4 mg/kg/day; G5, skip one dose and decrease by 2.5-4 mg/kg/day.