중등도 이상의 위험 수술을 받은 환자에서 수술 전후 항혈전제 약물 사용 평가

이현아,조윤희,조윤숙,한현주,이주연,정근화,이상건,Lee, Hyeon-Ah,Jo, Yun Hee,Cho, Yoonsook,Hahn, Hyeon Joo,Lee, Ju-Yeun,Jung, Keun-Hwa,Lee, Sang Kun 한국임상약학회 2017 한국임상약학회지 Vol.27 No.1

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.

동종 조혈모세포이식을 받은 환자군에서의 Fish Oil을 함유하는 정맥지방유제 공급의 효과

최지형 ( Ji Hyeong Choe ),이영주 ( Young Joo Lee ),배혜정 ( Hye Jung Bae ),정선회 ( Sun Hoi Jung ),한현주 ( Hyeon Joo Hahn ),고영일 ( Yungil Koh ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.1

Purpose: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients’immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).Methods: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records.Results: The patients’ characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs.-1.08%, P=0.245).Conclusion: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.

약사의 중재활동에 의한 약반납 감소효과에 관한 연구

조윤숙,한현주,손인자,엄고혜,이주연,조윤희 韓國病院藥師會 2006 병원약사회지 Vol.23 No.3

The prescriptions and dispenses for inpatients are conducted on a daily basis at Seoul National University Hospital (SNUH). The prescriptions for inpatients are received according to order sites and types of prescriptions. And in some cases, more prescriptions can be ordered than those needed actually, so returned-medications will be occurred, and also increased. Then the purposes of these studies are to analyze the states of returned medications in inpatients, and to make strategies to reduced those at SNUH Pharmacy. As the methods of the studies, we made the lists of returned-medications during April 11~15. 2005, and analyzed current conditions and reasons of returned medications. The results of the studies are as follows. The total prescriptions of returned-medications were 2,732 cases which were 5.14% of all prescriptions. There were 15 kinds of reasons to returned-medications. Among them, three reasons were in charge of 67% of all returned-medication, such as 765 cases of canceled prescriptions after dispense, 535 cases of overlapped prescriptions before and after operations and 527 cases of excessive PRN orders, respectively. Except those reasons, there were 196 cases of left medications caused by a daily basis prescription, 174 cases caused by discharges or deaths of inpatients, and 82 cases caused by continuous prescriptions of multiple use drugs, etc. The strategies to decrease returned-medications were established as follows. First, The one more - checking system was applied whether prescription was canceled or not before transferring UDS carts to nurse stations. Second, if prescriptions before and after operations were overlapped, those of post-operation were canceled. Third, in cases of multiple use drugs, we confirmed medical histories of inpatients, and canceled the prescriptions in which the multiple use drugs were continuously prescribed. In order to check the effectiveness of three strategies, we made second studies which were same as first studies during september 5~9, 2005 after introductions of these strategies to dispensing services for inpatients. The total prescriptions of returned-medications were 2,314 cases which were 3.97% of all prescriptions. The 22.8% of cases of returned-medications were decreased after interventions. From the results of these studies, it was noted that three strategies established on the steps of dispense for inpatients were effective to decrease returned-medications.

Warfarin 약물요법에 대한 환자의 인식도 조사와 복약지도

이현정,한현주,박경호,이병구,조남춘,신완균 한국병원약사회 1996 병원약사회지 Vol.13 No.4

Warfarin is an anticoagulant used in treating thromboembolic disorder and requires close monitoring due to its bleeding tendencies and various drug interactions. In this report, the degree of patient's understanding and the necessity to teach & counsel warfarin therapy were investigated through survey questions and chart review of 49 outpatients who were treated with warfarin. Forty three and 86% of the patients didn't know the pharmacological effects and the side effects of warfarin respectively. Forty three percents of the patients experienced side effects such as bruise(14%), nose bleed(14%), hypermenorrhea(6%). Twenty two percents of patients were noncompliant with warfarin therapy. The International Normalized Ratios(INR) in 41% of the patients were unsatisfactory and some of the patients whose INRs were uncontrolled went to the hospital due to hematurea, hypermenorrhea and bleeding of eye. The results of this report show the issue of the patients didn't understand warfarin therapy well and noncompliance was ignored. The medical team, especially the pharmacy department is sufficiently concerned about the teaching & counseling for more safe, efficient and economic therapy of warfarin. To ratify the existing problems, it is introduced to our institution

3차 진료기관 마약 사용현황 및 관리업무 분석

박영미,한현주,이병구,조남춘 한국병원약사회 1999 병원약사회지 Vol.16 No.4

For the last 2 years the amount of the narcotics prescriptions issued and narcotics used have been increased by 17.4% and 53.7% each. The subjective range of the patients under PCA and the variety of narcotics are increasing ad well. The importance of narcotics requires more time and energy to manage them. Therefore this study is focused upon the necessity simplify the pharmacist's control steps for narcotics and to establish a standard of the additional cost which occurs from the work.

서울대학교병원 원외처방의 대체조제 현황조사

안현주,허란희,김민정,조은정,한현주,손인자 韓國病院藥師會 2004 병원약사회지 Vol.21 No.3

This study is an attempt to investigate on the substitution of outpatients prescriptions dispensed in SNUH(Seoul National University Hospital) after launching the prescription-drug dispensing separation system in Korea. Out of the outpatient prescriptions issued in SNUH from July 2000 to September 2003, those substituted were chosen for the study. The percentage of prescriptions which were substituted and the rate for drug substitution which were not allowed has been on the decrease as the prescription-drug dispensing separation steadily gained its ground. Medicine most substituted at the pharmacies are diazepam, atenolol, furosemide, amitriptyline in order of frequency. The rate of substitution of prescriptions was highest in the department of plastic surgery, with the departments of neuropsychology, emergency, diagnostic radiology following. When substituting prescriptions, pharmacists sometimes failed to report the amount of the dispensed medicine(37%), the date of the prescriptions(14%), the name of the pharmacy(8%) and the pharmacist(7%). 29% of the substitution appeared to be done at the pharmacies located around SNUH, and 69% at the other pharmacies. We found examples of the reports not being made properly when substitutions were done to some degree. Also it was difficult to control the malpractice. And to improve this situation, some measures and efforts should be taken by pharmacies, pharmaceutical companies, and the government authorities.

외래환자 처방전상에 나타난 약물 상호작용 실태 및 병원 조제담당 약사의 인지도 조사

김민선,최윤아,류윤미,한현주,이병구,박경호,조남춘 한국병원약사회 1999 병원약사회지 Vol.16 No.2

The importance of pharmacotherapies, as a medical treatment on diseases, is on the increase. By using various medicines at one time, it may give a rise to higher beneficial effects than using one medicine and adverse effects may be protected. Accordingly, many patients use more than two medicines or several ones against a complication. Because the likelihood of drug-drug interactions increase with the number of drugs prescribed for a patient, rigorous(or careful) attention and follow up are needed. As well as, the role of a special inspection for pharmacists becomes more important. The existence of drug interactions, the type of drug interactions, the possibility of administration, the extent and the range of effects, and the necessity of some managements must be checked. According as the above check points, the prescription must be certified. If it happens any problem, the most safe and effective pharmacotherapy must be adopted through the discussion with doctors. In this research, through the investigation of prescription for out patients and the evaluation of a possibility of drug interactions, the paper for questionnaire was made. A degree of recognition of pharmacists in hospitals about drug interaction was checked by the paper for questionnaire.

소아에게 처방되는 정제의 투여 용이성 조사

문정연,김귀숙,문순란,한현주,손인자 한국병원약사회 2003 병원약사회지 Vol.20 No.4

In the Children's Hospital of Seoul National University Hospital it is general practice to prepare and administer powder or liquid formulations to children under 6 and tablet formulations to those older. However, pulverizing tablets to administer powder formulations causes loss of content, change in bioavailability, and difficulty in identification. Consequently, a new principle of dividing highly water-soluble tablets down to quarter segments without having to change formulation type and administrating them even to children under 6 has been established and practiced for instances that allow despite the fact that they may be easily pulverized. This study was performed to classify and investigate the feasibility of original tablet form administration by investigating the solubility of commonly prescribed pediatric medicines. The study has been executed using 51 medicines(sugar, film coated tablets, capsules, coated tablets, powder formulations) out of 116 possible pediatric medicines commonly pulverized for children under 6. Primary research was done with surveys completed by 50 guardians of children who have visited the pediatric clinic. This study has utilized tablet medicines that dissolve under 1 minute on the basis of 42 of these guardians(84%) reporting their preference of waiting no more than 1 minute for a tablet to dissolve before administering to their child. First, tablets were placed in ambient sterilized distilled water and observed in 20-second intervals for solubility. Tablets that took longer than 1 minute to dissolve were stirred 2 times per second as a secondary measure to observe those that took less than a minute to dissolve. In order to establish an objective standard, a shaker was utilized at 950rpm in the verification process. 8(16%) of the test tablets dissolved within the first interval, 11(22%) dissolved within the second interval, none dissolved within the last interval, and 2(4%) dissolved after 60 seconds or within 60 seconds with the aid of the stirrer. Therefore, 21(41%) out of 51 test tablets were determined as capable of being administered in tablet form because of its superior water-solubility. It can be expected that problems from pulverization can be improved with administration of any of these 21 test tablets in its original formulation even to children under 6 while also promoting convenience in the preparation and dispensing of pediatric prescriptions.

원외처방전 검토시 발생한 문의처방 분석

허란희,이주연,임영근,조윤숙,이지영,이영희,정성훈,박종윤,소원희,진보영,한현주,이병구,손인자 한국병원약사회 2002 병원약사회지 Vol.19 No.1

The purpose of this study is to evaluate hospital pharmacist's double-check task of outpatient prescription since separation of dispensary from medical practice carried out, which is being shifted to pharmacists out of hospital gradually. We analyzed 2,613 conference call on prescription out of one-year 488,481 outpatient prescription made in SNUH(Seoul National University Hospital). And it is classified and analyzed by month, by department and by conference call item. This study can provide useful information for doctors and pharmacists. Consequently, the doctors can avoid prescription errors. And the pharmacists can promote the capacity of double-checking prescriptions.