• 대한족부족관절학회지
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• 제24권4호
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• pp.142-147
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• 2020

Purpose: Diabetic foot ulcers are closely related to body surface heat, which can be affected easily by temperature differences. This study examined the correlation between the healing process of diabetic wounds and abnormal diurnal temperature through an animal study. Materials and Methods: Rats in the abnormal diurnal temperature group and control group were given a 10 mm sized full-thickness skin ulcer. Wound size progression was observed in both groups. H&E and Masson's trichrome staining was performed at 14 days after wound formation, and the number of vessels per unit area and histology analysis were performed. The changes in the ulcer were measured through three dimensional cross-section area using INSIGHT^® devices. Results: The wound recovery period (granulation ingrowing) was 24 days in the abnormal diurnal temperature model and 20 days in the control group. The thickness of scar tissue was 402±23.19 ㎛ in the control group and 424.5±36.94 ㎛ in the diurnal temperature model. Neovascular formation was counted as 5.1±0.97 for the control group and 4.16±0.94 for the diurnal temperature model group. Conclusion: Delayed and inferior diabetic wound healing was observed in the abnormal diurnal temperature group, which was characterized by greater diurnal variations than the typical growth environment.

• 임상간호연구
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• 제26권3호
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• pp.327-336
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• 2020

Purpose: The purpose of this study was to describe changes in positive psychological capital, organizational commitment and burnout according to work periods for new nurses. Methods: A longitudinal study was done using surveys of 91 nurses from a tertiary hospital located in Seoul, South Korea. Data were collected from these newly graduated nurses during the period from July 2018 to September 2019, three times (2 months, 4 months and 6 months after starting to work). Results: Hope of positive psychological capital decreased after 6 months of work (F=7.11, p=.001) and organizational commitment decreased after 4 months of work (F=15.30, p<.001). Factors influencing participants' burnout included the optimism of positive psychological capital and continuance of organizational commitment. These factors explained 51.3% of the variance in burnout (F=48.47, p<.001). Conclusion: Organizational support for new nurses is urgently needed. It is necessary to develop programs to strengthen the positive psychological capital of newly graduated nurses to reduce their burnout and to help their job adaptation.

• 한국의료질향상학회지
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• 제25권1호
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• pp.2-10
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• 2019

Purpose: The purpose of this study was to share program and/or resource on patient safety education for patients and families conducted overseas agency. This study will help the patient safety officer establish and implement an educational plan for patients and families. Methods: We searched the Internet for patient safety related organizations. We chose an institution that provided education for patients and families. Results: Most of the program and/or resource was about patient and family involvement; Taking Care of Myself, My Questions for This Visit, Patient Prep Card, 20 Tips to Help Prevent Medical Errors, Ask Me 3(R), Health and Safety Passport, My Medication log etc. Conclusions: It is necessary to distribute educational materials for patients and families in the country through the results of this study. For patient safety, education and publicity are needed so that developed educational materials can be actively used.

• 대한임상검사과학회지
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• 제51권2호
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• pp.177-184
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• 2019

Mycobacterium은 느리게 성장한다. 따라서 고체배지는 8주, 액체배지는 6주 동안 사용하여야 한다. 이 연구의 목적은 Mycobacterium을 빠르게 성장시킬 수 있는 성장 인자를 찾고, 신속한 동정을 위한 고체배지를 개발하는 데 도움을 주는 것이다. $Difco^{TM}$ Mycobacteria 7H11 agar (Becton, Dickinson and Company)에 activated charcoal, defibrinated sheep blood, L-ascorbic acid를 첨가하여 10종의 Mycobacteria 가지고 Mycobacterium 성장 인자 3가지를 평가하였다. 집락의 검출 시간 및 판독 용이성을 현재의 방법과 비교하였다. 빠르게 성장하는 Mycobacterium 있어 새로운 배지와 기존의 배지에서 검출 시간의 차이는 새로운 배지가 더 빠르다는 것을 확인시켜 주었다. M. kansasii와 M. intracelluare는 7H11 배지보다 7H11 C 배지에서 더 빠르게 자라는 것으로 확인되었다. MTB는 7H11 C 배지에서 다른 배지보다 빠르게 성장하였다. 이 연구는 2 두 가지 성장 인자가 빠르게 성장하는 Mycobacteria과 느리게 성장하는 Mycobacteria에 영향을 주는 것으로 확인되었다. 7H11 C 배지는 색상 대비로 인하여 10종의 모든 Mycobacterium에서 기존배지보다 더 뛰어난 판독 용이성을 보여 주었다. 특히, MTB가 성장했을 경우 집락의 크기가 다른 배지에서 보다 커서 시각화가 용이하였다.

• 대한영상의학회지
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• 제82권3호
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• pp.562-574
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• 2021

MRI는 방사선 위험이 없으며, 높은 연조직 대조도 및 기능 정보 획득의 장점을 가지고 있다. 과거 기술적 한계로 흉부 분야에서 MRI의 사용이 제한되었으나, 최근 기술 발전 및 흉부 MRI의 보험 적용 확대로 흉부 MRI의 적응증과 수요가 급증할 것으로 예상된다. 이에 대한 영상의학회는 한국의 의료 실정에 맞는 흉부 MRI의 적절한 활용과 관련된 지침의 개발이 필요하다고 보고 개발위원회, 실무위원회 및 자문위원회의 의견을 모아 한국형 흉부 MRI 정당성 가이드라인을 개발하였다. 5가지 문장형 핵심질문을 선정하고, 근거기반 임상영상 가이드라인 수용개작 방법론에 의거하여 권고안을 작성하였다. 권고 내용은 다음과 같다. 우연히 발견된 전종격동 병변 환자에서 비종양성 질환 진단을 위하여 흉부 MRI를 권장한다. 폐 종괴가 발견된 진폐증 환자에서 악성 종양과 진행성거대섬유증의 감별 진단을 위하여 흉부 MRI를 권장한다. 악성 흉막 중피종 또는 비소세포 폐암 환자에서 흉벽, 척추, 횡격막 또는 혈관 침범이 의심되는 경우 흉부 MRI를 권장한다. 임산부에서 임상적으로 폐색전증이 의심되나, 다른 검사가 불충분할 경우 비조영 흉부 MRI 혹은 중등도 또는 저위험군 조영제를 가능한 최소한의 용량으로 사용하여 조영증강 흉부 MRI를 고려할 수 있다. 폐첨부 폐암 환자에서 근치적 절제술을 고려할 경우 혈관 및 경막 외 공간의 종양 침범을 확인하기 위해 흉부 MRI를 권고한다.

• 대한영상의학회지
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• 제83권2호
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• pp.254-264
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• 2022

대한영상의학회 진료지침위원회는 기존의 2016년 진료지침을 개정하여 '주사용 요오드화 조영제 및 MRI용 가돌리늄 조영제 유해 반응에 대한 한국 임상진료지침: 개정된 임상적 합의 및 권고안(2022년 제3판)'을 제작하였다. 대한영상의학회와 대한천식알레르기학회, 대한신장학회에세 추천 및 승인된 전문가 위원들이 함께 참여하였고, 전문가 합의 또는 체계적 문헌 고찰을 기반으로, 조영제를 사용 시 감염관리를 위한 자동주입기 및 연결선에 대한 기술과 요요드화 조영제에 대한 급성 유해반응 및 신장 유해반응에 대한 내용들을 수정 및 추가하였다. 이에 개정된 내용을 소개하고자 한다.

• 병원약사회지
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• 제35권4호
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• pp.453-462
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• 2018

Background : The prevalence of chronic hepatitis C virus (HCV) tends to be higher in the elderly. Pegylated interferon and ribavirin therapy (Peg-IFN/RBV) was recommended as the first-line treatment in the past decades, but this regimen showed unsatisfactory results in terms of safety and efficacy especially in elderly patients. Recently, it was demonstrated that dual therapy with daclatasvir and asunaprevir was well tolerated and led to high sustained virological response (SVR) rates, irrespective of age. We conducted a study to evaluate the efficacy and safety of daclatasvir plus asunaprevir by involving elderly patients aged above 65 years. Methods : We retrospectively analyzed clinical data from chronic hepatitis C virus (HCV) genotype 1b patients treated with daclatasvir plus asunaprevir from September 2015 to December 2016 at Seoul St. Mary's hospital. The patients were divided into two groups as elderly patients (older than 65 years) and non-elderly patients (younger than 65 years) and compared the efficacy and safety. Results : A total of 112 patients were treated with daclatasvir plus asunaprevir for chronic hepatitis C. Among them, 101 patients completed the whole treatment, and in 88 patients the amount of HCV RNA was measured after 12 weeks of treatment. There was no significant difference in SVR at 12 weeks between both the groups (p=0.68). Typically, 91.4%(32/35) of elderly patients and 94.3%(50/53) of non-elderly patients achieved SVR12. Common adverse events included elevation in transaminase level, headache, and gastrointestinal disorders. There was no statistical difference in the symptoms between the two groups. Conclusions : The combination therapy with daclatasvir plus asunaprevir exhibited similar rates of SVR12 in HCV elderly patients without leading to further adverse events compared to non-elderly patients. Therefore, it is proposed that daclatasvir plus asunaprevir therapy could be considered as an effective and safe treatment, even in patients aged over 65 years.

• 대한영상의학회지
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• 제83권1호
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• pp.138-148
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• 2022

목적 본 연구는 전국 인구 기반 데이터베이스를 이용하여 국내 소아 전산화단층촬영의 비율과 연간 추세를 평가하였다. 대상과 방법 2012년부터 2017년까지 국내에서 촬영된 소아 전산화단층촬영에 대한 건강보험심사평가원의 데이터를 사용하였다. 연령, 성별, 진단명 및 해부학적 위치에 대한 데이터를 같이 추출하여 분석하였다. 결과 18세 미만 어린이 58527528명을 대상으로 총 576376건의 전산화단층촬영이 시행되었다(1000명당 9.8회). 어린이 1000명당 전산화단층촬영 횟수는 9.0회에서 11.0회로 23.2% 증가했다. 전산화단층촬영 건수는 6-12세 그룹에서 32.9%(1000명당 7.4회에서 9.8회로 증가), 13-18세 그룹에서 34.0% 증가했다(1000명당 11.4회에서 15.3회로 증가). 부위별 전산화단층촬영의 비율은 두부(39.1%), 사지(32.5%), 복부(13.7%) 순서로 확인되었다. 사지 전산화단층촬영 횟수는 83.6% 증가했으며(1000명당 2.3회에서 4.2회로 증가) 사지 전산화단층촬영의 비율은 25.3%에서 37.7%로 증가했다. 결론 소아 환자의 전산화단층촬영은 2012년부터 2017년까지 매년 4.4%의 속도로 지속적으로 증가했다. 따라서 의사는 소아 환자에서 전산화단층촬영으로 인한 이득과 방사선 노출로 인한 잠재적인 피해를 적절히 고려하여 신중하게 촬영을 결정해야 한다.

• 한국임상약학회지
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• 제32권3호
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• pp.185-190
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• 2022

Background: Denosumab (Prolia®) is administered every 6 months for osteoporosis treatment. Co-administration of calcium and vitamin D is required to minimize hypocalcemia risk. We evaluated clinical outcomes based on the administration interval of denosumab and co-prescription with calcium-vitamin D combination products. Methods: A retrospective study was conducted using electronic medical records from 668 patients who started denosumab therapy between January 1 and December 31, 2018, at Seoul National University Bundang Hospital. Clinical outcomes, as measured by changes in T-score, were evaluated by the intervals and concurrent prescriptions with calcium-vitamin D combination products. Results: Of the 668 patients, 333 patients met the eligibility criteria. These patients were divided into two groups based on appropriateness of the administration interval: "Appropriate" (304 patients, 91.3%) and "Inappropriate" (29 patients, 8.3%). T-score changes were significantly higher in the "Appropriate" than in the "Inappropriate" group (0.30±0.44 vs. 0.13±0.37, p=0.048). At the beginning of the treatment, 221 patients (66.4%) were prescribed calcium-vitamin D combination products, but the changes in T-scores were not significantly different by the prescription status of the product (0.29±0.46 vs. 0.28±0.38, p=0.919). Conclusion: T-scores were significantly improved in patients with appropriate administration intervals. No significant changes in T-scores were observed by the prescription status with calcium-vitamin D combination products. For optimal treatment outcomes, prescribers should encourage adherence to the approved prescription information on dosage and administration, and pharmacists should provide medication counseling for patients.

• 한국임상약학회지
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• 제32권3호
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• pp.215-225
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• 2022

Background: Patients with hematologic cancers have a risk of drug-related problems (DRPs) from medications associated with chemotherapy and supportive care. Although the role of oncology pharmacists has been widely documented in the literature, few studies have reported its impact on cost reduction. This study aimed to describe the activities of oncology pharmacists with respect to hematologic diseases and evaluate the associated cost avoidance. Methods: From January to July 2021, patients admitted to the department of hemato-oncology at Seoul National University, Bundang Hospital were studied. The activities of oncology pharmacists were reported by DRP type following the Pharmaceutical Care Network version 9.1 guidelines, and the acceptance rate was calculated. The avoided cost was estimated based on the cost of the pharmacy intervention, pharmacist manpower, and prescriptions associated with the intervention. Results: Pharmacists intervened in 584 prescriptions from 208 patients during the study period. The most prevalent DRP was "adverse drug event (possibly) occurring" (32.4%), followed by "effect of drug treatment not optimal" (28.6%). "Drug selection" (42.5%) and "dose selection" (30.3%) were the most common causes of DRPs. The acceptance rate of the interventions was 97.1%. The total avoidance cost was KRW 149,468,321; the net profit of the avoidance cost, excluding labor costs, was KRW 121,051,690; and the estimated cost saving was KRW 37,223,748. Conclusion: Oncology pharmacists identified and resolved various types of DRPs from prescriptions for patients with hematologic disease, by reviewing the prescriptions. Their clinical service contributed to enhanced patient safety and the avoidance of associated costs.