무균조제 항암제 취급의 안전관리

이수미(Su Mi Lee),정선영(Seon Young Chung),임현정(Hyun Jeong Im),박효정(Hyo Jung Park),이수연(Su Yun Lee),전은용(Eun Yong Jeon),손기호(Kie Ho Sohn) 대한약학회 2011 약학회지 Vol.55 No.2

Most antineoplastic agents are nonselective in their mechanism of action, affecting noncancerous as well as cancerous cells, and resulting in acute effects such as irritation of mucous membranes and chronic effects such as genotoxicity, teratogenicity, and carcinogenicity. Healthcare workers occupationally exposed to antineoplastic agents are at risk. The present study aimed to develop and apply methods to monitor occupational exposure to antineoplastic agents, using cyclophosphamide (CP) as the model compound. To monitor environmental and biological exposure, potentially contaminated surfaces were wiped and 24 hour urine samples were collected from workers. Liquid chromatography combined with tandem mass spectrometry was performed, with a limit of detection of 0.05 ng/ml. Measurable amounts of CP were detected on 92% of the sampled surfaces, with a geometric mean of 175.22 ng/m2. Despite the environmental contamination of the model compound, CP was below the detection limit in all urine samples. If workplace contamination cannot be completely avoided, it is importance to reduce exposure to the lowest possible levels. To this aim, efforts to minimize occupational exposure along with biological and environmental monitoring are required. The standardized sampling techniques, and specific and sensitive analytical methods reported in this study may be helpful in assessing occupational exposure and devising strategies to reduce exposure.

정맥영양요법을 시행한 조혈모세포이식 소아의 재원기간에 영향을 미치는 인자

박효정 ( Hyo Jung Park ),윤정아 ( Jung A Yoon ),김도영 ( Do Young Kim ),허윤정 ( Yoon Jung Huh ),정선영 ( Seon Young Chung ),인용원 ( Yong Won In ),이영미 ( Young Mee Lee ),서정민 ( Jeong Meen Seo ),손기호 ( Kie Ho Sohn ) 한국정맥경장영양학회 2011 한국정맥경장영양학회지 Vol.4 No.1

Purpose: Parenteral nutrition (PN) is a standard supportive care for pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) in Samsung Medical Center. The objective of this study was to identify the factors associated with the length of hospital stay (LOS) in pediatric HSCT patients administrating PN routinely. Methods: This was a retrospective study for 128 pediatric HSCT patients from Aug. 2008 to Dec. 2009. Demographics, nutrition status on the first report in the nutrition support team, calories and nutrients supplied, PN duration, LOS, PN-induced complications, and laboratory data were collected from electronic medical records. Multivariate analyses were conducted to identify factors associated with LOS. Results: The median age of registered patients was 70 months (range 6∼239 months). Twenty-three patients (18.0%) were malnourished moderately to severely when PN was started. Number of autologous HSCT was larger than allogeneic HSCT (87 vs 41). In children undergoing HSCT, LOS was significantly correlated with PN duration (P<0.001) and graft type (P<0.001). Especially, in autologous peripheral blood stem cell transplantation (PBSCT), malnourished patients at the beginning of PN were shown the tendency to increase LOS (P=0.024) and PN duration (P=0.043). Conclusion: In pediatric HSCT patients administrating PN routinely, LOS was associated with a graft type of HSCT and PN duration. Especially for autologous PBSCT patients, the nutrition status at the beginning of PN had the influence on LOS and PN duration. During the peri-HSCT period, careful nutrition monitoring can prevent malnutrition, decrease PN duration, and shorten LOS. (JKSPEN 2011;4(1):1-6)

관상동맥 스텐트 시술 후 제3차 재협착 예측인자

조정선 ( Jung Sun Cho ),정명호 ( Myung Ho Jeong ),정선영 ( Seon Young Jeong ),최명자 ( Myung Ja Choi ),정종원 ( Jong Won Chung ),황승환 ( Hwang Seung Hwan ),이상현 ( Sang Hyun Lee ),김계훈 ( Kye Hun Kim ),윤경호 ( Kyung Ho Yun 대한내과학회 2005 대한내과학회지 Vol.69 No.3

Background: Percutaneous coronary intervention (PCI) has been established as one of the effective therapeutic methods in the treatment of ischemic heart disease. A coronary artery stent is the most promising device in PCI, however in-stent restenosis (ISR) remains a major problem to be overcome. Methods: Follow-up coronary angiograms (CAG) three times after stenting were performed in 107 out of 3,816 stented patients at Chonnam National University Hospital between August 1992 and July 2004. The patients were divided into four groups: forty eight patients (Group I: 58.7±9.5 years, 35 Males) had no incident ISR on three follow-up CAG. Fourteen patients had three times of ISR and underwent four PCIs (Group II : 54.5±9.51 years, 12 Males), 15 had two times of ISR and underwent three PCIs (Group III : 53.9±5.9 years, 11 males), 30 had one time of ISR and underwent two PCIs (Group IV : 59.6±9.5 years, 27 males). Each group was analysed according to clinical characteristics, coronary angiographic findings, and therapeutic modalities for ISR. Results: There was no differences in clinical diagnosis, lesion location, multi-vessel lesion and TIMI flow. Risk factors for atherosclerosis were not different except for diabetes mellitus. The incidence of diabetes mellitus was more common in Group II than in Group I (Group I: 22%, Group II: 57%, Group III: 46%, Group IV: 20%, Group I vs. Group II: p =0.023). Stent length and diameter were not different among four groups. Conclusion: The only predictor of recurrent coronary stent restenosis more than three times is diabetes mellitus. (Korean J Med 69:255-263, 2005)

급성 심근경색의 Practice Guideline 이행에 대한 평가

정선영,이숙향,민일기 이화여자대학교 약학연구소 2004 藥學硏究論文集 Vol.- No.13

The management of Acute Myocardial Infarction (AMI) has been updated with evidence based medicine. The purpose of this study is to evaluate adherence to ACC/AHA Guidelines for the Management of Patients with AMI from emergency arrival to discharge and compared quality indicators with clinical targets of each indicator. Medical records and complete prescription records for AMI patients (n=82) between Jan and Oct. 2002 were retrospectively reviewed. Aspirin, nitrates, β-blockers, thrombolytic agents, ACE inhibitors (ACE) and cholesterol lowering agents were prescribed to 100%, 93.9%, 46.3%, 19.5%, 89.0% and 61.0% of patients during hospitalization, respectively. The median time taken to perform reperfusion therapy was 62 minutes for thrombolytic therapy, and 185 minutes for percutaneous transluminal coronary angioplasty. Adherence to quality indicators such as aspirin within 24 hours, 13-blockers within 24 hours, aspirin at discharge, li blockers at discharge, ACE at discharge and smoking cessation counseling, was 97.6%, 41.5%, 91.5%, 58.5%, 82.9% and 89.0%, respectively. In hospital mortality rate was 11% (n=9). During a 6-month follow-up, when left ventricular ejection fraction was less than 40%, there was a correlation with recurrent MI and rehospitalization (p=0.029), and for patients with anterior wall MI, there was a high frequency in rehospitalization (p=.020). Except for the use of β-blockers, our results were very dosed to the clinical target. In conclusion, this study implied that compliance to the guidelines would improve clinical outcomes and become a tool for the evaluation and management of the quality of the AM treatment course.

약물부작용 감시정보시스템의 도입과 평가 : pilot study

황수희,김은영,이용석,정선영,이영미,손기호,최경업,이숙향,김윤 韓國病院藥師會 2005 병원약사회지 Vol.22 No.2

A computerized surveillance system is the most recent tool to monitor, identify and prevent ADEs, based on alerts generated by matching signals such as abnormal lab data with electronic medical records (EMRs). Since this system has been proven to be simple and cost-effective in detecting ADEs, there is a growing trend towards routine application. The objectives of this study were to implement the system in Samsung Medical Center (SMC), a 1300-bed tertiary hospital, and evaluate its applicability and validity in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The retrospective analysis was performed using 1-month EMRs in 598 discharged patients from 2 ICUs and 5 general wards. Alerts as potential indicators of ADEs were generated by this system using our modified signals. Patient charts were carefully reviewed by clinical pharmacists to detect ADEs and to verify whether these ADEs were also recognized by the signals. A total of 718 alerts were generated by the system and 187 ADEs were detected by chart review. One hundred forty eight alerts were found to be associated with ADEs. The sensitivity of the modified signals for identifying ADEs was estimated to be 79.1 (95% confidence interval [CI], 73.3~85.0) percent, and the estimated specificity was 29.2 (95% CI, 26.1~32.3) percent. The PPV and the NPV were 20.6 (95% CI, 17.7~23.6) percent and 85.8 (95% CI, 81.6~89.9) percent, respectively. Our computerized surveillance system showed that the sensitivity value was higher (79.1% vs. ca 50%) and the specificity was lower (29.2% vs. ca 70~80%) than those reported in the literature. It would be necessary to further modify the signals to improve the specificity and rate of ADE detection. More studies will be needed to confirm the usefulness and cost-effectiveness of this system.

의약품 사용 오류 예방을 위한 generic 의약품 명명제도 개선 제언

이지현,조정아,이영주,김은영,정선영,김정미,손기호 韓國病院藥師會 2008 병원약사회지 Vol.25 No.2

With tens of thousands of brand name and generic drugs currently on the market, the potential for medication error due to confusing drug name is significant. In Korea, every generic drug can have own brand name. This could lead medication errors due to similarities between generic names and brand names or between brand names and brand names. In this study, we searched examples of drug name pairs presumed to have potential for medication errors related with confusing drug name and tried to suggest the strategies for the prevention of medication errors. We surveyed the Samsung Medical Center Drug Formulary(SMC Formulary) and National Registered Drug Formulary to find out the examples of drug name pairs that have phonetic similarities. And we compared current drug name nomenclature process of Korea with other countries, mainly focusing on performing the risk assessment as a part of drug naming. Among 818 oral drugs in SMC Formulary, there were 12 pairs of sound-alike drug between generic names and brand names and 20 pairs between brand names and brand names. 23 pairs(71.9%) of them were identified as pair of different therapeutic category. For National Registered Drug Formulary, We also surveyed similarity of selected 4400 subject(42.7% of oral drugs registered) and found that 14 similar pairs of generic name and brand name and 57 pairs of brand names. Of this, 66 pairs(93.0%) were pair of different therapeutic category. On the contrary to our situation, generic drug cannot have own brand name in USA and Japan. It must be made up of generic name and company name. Around the drug name selection process, those countries have intervention process by regulatory authorities with regards to prevent potential medication errors from confusing drug name and safety concern. To reduce medication errors stemming from sound-alike drug name, healthcare providers need to share the information about the drug names which have medication error potential and past cases of those errors. And to make safe drug use environment, it is highly recommended for regulatory authorities to develop intervention process in drug naming practices and simplify the brand name system of generic drugs instead of allowing own brand name to them.