Real-World Efficacy and Safety of Everolimus with Low Dose Tacrolimus in Liver Transplantation Recipients

Background@#Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. @*Methods@#Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. @*Results@#Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. @*Conclusions@#In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Real-World Efficacy and Safety of Everolimus with Low Dose Tacrolimus in Liver Transplantation Recipients

Background@#Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. @*Methods@#Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. @*Results@#Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. @*Conclusions@#In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Drug use evaluation of opioid analgesics in pain management among patients with hematopoietic stem cell transplantation

Background@#Hematopoietic stem cell transplantation (HSCT) patients usually experience mucositis, musculoskeletal pain associated with high-dose chemotherapy, radiation, post-HSCT infection, or graft-versus-host disease. Pain management is important for the patients’ quality of life. We evaluated appropriate opioid analgesic use in HSCT patients to propose effective pain management strategies. @*Methods@#A retrospective analysis was conducted using electronic medical records of adult patients with HSCT treated with opioids for moderate to severe pain at Seoul National University Bundang Hospital. The numeric rating scale (NRS) was used in pain management. NRS scores of 4‒10 correspond to moderate to severe pain. Appropriate opioid analgesic use was evaluated following published cancer pain management guidelines. @*Results@#In total, 119 cases were evaluated, including 369 episodes of moderate to severe pain.Mucositis-related, musculoskeletal, and headache pain occurred in 62.6%, 25.8%, and 6.0% of episodes, respectively. Frequently used opioids were intravenous tramadol (84.9%), fentanyl patch (73.9%), and intravenous morphine sulfate (68.9%). Intravenous and topical administrations were used for mucosal pain. In total, 95.0% of patients received appropriate short-acting opioids for initial pain management, 80.5% received appropriate doses of short-acting opioids, appropriate opioids dose adjustment was done after first assessment in 95.5% of patients, and 85.6% were converted to appropriate long-acting opioids. @*Conclusion@#Short-acting opioid analgesic use for initial pain management and dose adjustment after assessment were appropriate. However, initial and conversion dosages recommended by guidelines may be difficult to implement considering the severity of HSCT patients.Pain management guidelines specific for HSCT patients should be developed in the future.

Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit

BACKGROUND: The role of clinical pharmacists in medication therapy to improve clinical and economic outcomes has been reported in the literature. This study was conducted to analyze the changes in details of medication interventions before and after the introduction of clinical pharmacists into the care of neurocritical care unit (NCU) patients, and to evaluate the economic effects of clinical pharmacists by calculating the avoidance cost. METHODS: A retrospective study was conducted reviewing the electronic medical records from June 2013 to May 2014 (before), and from June 2016 to May 2017 (after). We calculated the number and rates of intervention, the acceptance rates of it, and also reviewed the list of interventions. We calculated avoidance cost if there was no intervention. RESULTS: The monthly mean number of interventions increased from 8.0 (±5.7) to 31.7 (±12.8) (P < 0.001) and the frequency of intervention also increased from 0.8% to 1.6% (P=0.003). The most frequently provided pharmacist intervention was nutritional support before introduction of clinical pharmacists and discussions on the medication plan after. The number of classified interventions was 14 before introduction of clinical pharmacist services and 33 after. The calculated cost avoidance associated with a clinical pharmacists' integration was 77,990,615 won per year. CONCLUSION: Introduction of clinicals pharmacist into the NCU was associated with increased intervention rates and expanded types of clinical interventions. The cost avoidance achieved by the pharmacists' interventions can be further explored to evaluate if similar expansions of pharmacists' services achieve similar results in other settings.

Concurrent Use of Nefopam vs. Ketorolac with Opioid Analgesic for Post-operative Pain Management

OBJECTIVE: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. METHODS: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. RESULTS: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. CONCLUSION: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for postoperative pain management in general surgery patients in South Korea.

Improving Perception and Satisfaction on Middle and High School Foodservice: The Role of Student Participation Program in Serving School Meals / 대한지역사회영양학회지

OBJECTIVES: We evaluated the extent to which implementation of student participation programs in serving school meals impacts student perception and satisfaction with school foodservice in middle and high school settings. METHODS: Students' perception of management and satisfaction with quality attributes of school foodservice were assessed by questionnaire methods and compared by the program implementation status of student participation in serving school meals. Correlation and multiple regression analyses were performed to identify factors affecting perception and satisfaction. RESULTS: The overall mean score for perception regarding the management of school foodservice was low (3.53 out of 10 points) and middle school students showed a higher mean score than high school students (4.10 vs. 2.94 points). In both middle and high schools, student perception was significantly higher in schools implementing the program. The average score for student satisfaction with the quality of school foodservice was 3.50 out of 5 points. Similarly, we observed a significantly higher satisfaction among middle versus high school students (3.93 vs. 3.04 points) and in schools implementing the program versus those that were not. Overall, student participation in serving school meals resulted in increases in satisfaction with school foodservice of 0.269 and 0.466 points among middle and high school students, respectively. CONCLUSIONS: Implementation of student participation in serving school meals could be used as a strategy to improve perception and satisfaction of students with their school foodservice. Establishment of guidelines of student serving participation programs encompassing different perspectives from students, dietitians and school faculties are warranted.

Improving Perception and Satisfaction on Middle and High School Foodservice: The Role of Student Participation Program in Serving School Meals / 대한지역사회영양학회지

OBJECTIVES: We evaluated the extent to which implementation of student participation programs in serving school meals impacts student perception and satisfaction with school foodservice in middle and high school settings. METHODS: Students' perception of management and satisfaction with quality attributes of school foodservice were assessed by questionnaire methods and compared by the program implementation status of student participation in serving school meals. Correlation and multiple regression analyses were performed to identify factors affecting perception and satisfaction. RESULTS: The overall mean score for perception regarding the management of school foodservice was low (3.53 out of 10 points) and middle school students showed a higher mean score than high school students (4.10 vs. 2.94 points). In both middle and high schools, student perception was significantly higher in schools implementing the program. The average score for student satisfaction with the quality of school foodservice was 3.50 out of 5 points. Similarly, we observed a significantly higher satisfaction among middle versus high school students (3.93 vs. 3.04 points) and in schools implementing the program versus those that were not. Overall, student participation in serving school meals resulted in increases in satisfaction with school foodservice of 0.269 and 0.466 points among middle and high school students, respectively. CONCLUSIONS: Implementation of student participation in serving school meals could be used as a strategy to improve perception and satisfaction of students with their school foodservice. Establishment of guidelines of student serving participation programs encompassing different perspectives from students, dietitians and school faculties are warranted.

Middle East Respiratory Syndrome Outbreak and Responsiveness of the Pharmacy Programs on the Pharmacy Practice Education

BACKGROUND: Pharmacy curriculum change was made from a 4-year program to a 2+4 year program in year 2009 in Korea. The change has resulted in more educational exposures on patient-centered practice environments for about 1,400 hours in the last year of the professional pharmacy program. When the Middle East Respiratory Syndrome (MERS) outbreak hit Seoul and suburban areas and propagated to other provinces in Korea, emergency response to avoid student infection in the pharmacy practice sites became an urgent issue. While other health professional programs such as medicine and nursing had activated emergency preparedness manuals, timely and clear guidelines were not disseminated to all pharmacy programs and protective measures largely relied on individual pharmacy program. METHODS: A survey was developed by the Committee on Pharmacy Practice Experience Programs in the Korean College of Clinical Pharmacy to document the status of pharmacy programs during the Korea MERS outbreak in 2015. The 10-question survey was distributed to the pharmacy practice experience coordinators to 34 out of 35 pharmacy schools in Korea by emails. RESULTS: Our findings showed that 82.4% of the program coordinators (28/34) responded to the survey, 96.4% of the programs did not have emergency preparedness manuals, administrative meetings were held in 89.3% of the pharmacy programs, the rotation schedules were modified or withheld in 53.6% of schools, and the changes were mostly observed from the programs classified as MERS outbreak regions. CONCLUSION: Further needs in establishing the emergency preparedness manual should be explored for pharmacy education stakeholders.

Development of dietary pattern evaluation tool for adults and correlation with Dietary Quality Index

BACKGROUND/OBJECTIVES: As the prevalence of chronic diseases has risen, the need for straightforward diagnostic tools for monitoring nutrition status to improve nutrition counseling and disease prevention has likewise increased. This study developed an easily usable dietary behavior pattern diagnosis checklist and investigated its correlation with dietary quality index. SUBJECTS/METHODS: A draft dietary pattern evaluation tool was generated by analyzing previous studies. The draft questionnaire comprised 61 questions for assessing dietary habits. A survey was administered to 320 adults (19 to 64 years old) using the dietary pattern evaluation tool and 24-hour-recall method between March and May of 2014 in Jeonbuk province and the metropolitan area. Principal component analysis with varimax rotation was performed to identify dietary behavior patterns. Nutritional analysis was conducted using CAN-Pro 4.0, and the Diet Quality Index-International (DQI-I) was calculated to assess dietary quality. The correlation between dietary pattern scores and DQI-I scores was also analyzed. RESULTS: The factor analysis resulted in a total of 34 questions mapped to four main dietary behavior patterns: "high fat and calorie" pattern (12 questions), "overeating/binge" pattern (nine questions), "dietary impulse" pattern (eight questions), and "unbalanced food intake" pattern (five questions). The four dietary behavior patterns were negatively correlated with DQI-I adequacy and total scores (P < 0.01). CONCLUSIONS: The dietary pattern evaluation tool developed in this study can be used to diagnose a client's dietary behavior problems and is available as a nutrition counseling tool in the field.

Development of dietary pattern evaluation tool for adults and correlation with Dietary Quality Index

BACKGROUND/OBJECTIVES: As the prevalence of chronic diseases has risen, the need for straightforward diagnostic tools for monitoring nutrition status to improve nutrition counseling and disease prevention has likewise increased. This study developed an easily usable dietary behavior pattern diagnosis checklist and investigated its correlation with dietary quality index. SUBJECTS/METHODS: A draft dietary pattern evaluation tool was generated by analyzing previous studies. The draft questionnaire comprised 61 questions for assessing dietary habits. A survey was administered to 320 adults (19 to 64 years old) using the dietary pattern evaluation tool and 24-hour-recall method between March and May of 2014 in Jeonbuk province and the metropolitan area. Principal component analysis with varimax rotation was performed to identify dietary behavior patterns. Nutritional analysis was conducted using CAN-Pro 4.0, and the Diet Quality Index-International (DQI-I) was calculated to assess dietary quality. The correlation between dietary pattern scores and DQI-I scores was also analyzed. RESULTS: The factor analysis resulted in a total of 34 questions mapped to four main dietary behavior patterns: "high fat and calorie" pattern (12 questions), "overeating/binge" pattern (nine questions), "dietary impulse" pattern (eight questions), and "unbalanced food intake" pattern (five questions). The four dietary behavior patterns were negatively correlated with DQI-I adequacy and total scores (P < 0.01). CONCLUSIONS: The dietary pattern evaluation tool developed in this study can be used to diagnose a client's dietary behavior problems and is available as a nutrition counseling tool in the field.

Current View of Orphan Drug Usage in Tertiary Hospital and Rare Incurable Disease Hospital

OBJECTIVE: Until now, there is minimal number of research for overall domestic status of orphan drug use in Korea. The purpose of this study is to identify the list of orphan drugs available in Korea and to understand the status of orphan drug usage in tertiary Hospitals and rare incurable disease Hospital. METHODS: We made domestic orphan drug lists based on available orphan drugs in Korea. Based on this lists, we conducted e-mail survey from August, 2014 to September, 2014 to identify domestic status of orphan drug usage including the availability and management of orphan drugs. RESULTS: There are three hundred and eighteen orphan drugs (184 ingredients) registered in Ministry of Food and Drug Safety. Among the three hundred and eighteen orphan drugs, Two hundred and twenty-eight drugs (102 ingredients) were selected. Information on each item was collected and documented with generic and brand names, manufacturers, wholesalers, indications, FDA approval status and insurance coverage. Forty-three tertiary hospitals and thirty-two rare incurable hospitals responded to the survey questionnaire (57.3%). According to the survey result, the antineoplastics and immunomodulating agents group has the highest percentage (40%) usage in the hospital. Of fortythree tertiary hospitals, thirteen hospitals manage orphan drugs separately (30.2%). Based on the reply, most of the healthcare professionals commented the drug information related to efficacy and safety including medication counseling of orphan drugs is insufficient. CONCLUSION: Through this study we anticipate providing an understanding of orphan drug usage status in Korea. We found the limited resources to the information on orphan drugs and this information requires updating on a regular basis. This can be the basis for further studies about preparing drug information, educational resources for rare disease patients.

Medication Utilization during Pregnancy and Development of Educational Materials for Safe Use of Medication

PURPOSE: This study aimed to investigate the safe medication utilization and the education demands during pregnancy and it further reported the development of educational materials for pregnant women. METHODS: A survey was conducted in two tertiary care university hospitals and one community hospital specialized in obstetrics and gynecology from July 2 to 29 2014. The survey questionnaires included the usage of medications and the unmet needs on medication use during pregnancy. Ad ditionally, pregnant women's requests regarding to medication use were collected through group interviewing of community pharmacists. Based on these results, educational materials were de veloped and implemented. After implementing the education sessions, the satisfaction was evaluated. RESULTS: A total of 152 pregnant women answered completely the questionnaire. Among them, 130 participants (42.8%) were given the medication information from their physicians. Exposure to a teratogenic drug during pregnancy was a major concern for most pregnant women (79.6%). The majority (90.1%) of subjects reported a necessity of medication-related education during their pregnancy. The interview with 48 pharmacists indicated that the most commonly used OTC drugs in pregnancy were vitamins (25.2%), iron supplements (23.7%), and the most frequently used prescription drugs were antiinflammatory-analgesics (25.3%), followed by antibiotics (20.9 %). Based on the results, booklets of drug therapy during pregnancy, leaflet of pregnancy category index were made. Also, on-line flash and presentation materials for instructors were prepared. Through the trial education with the developed materials, it was confirmed that the contents of education materials were well understood and satisfied by the pregnant women. CONCLUSIONS: This study showed the need of the medication-related education for the pregnant women. The developed education materials would be helpful sources to provide accurate and reliable medication-related information to health professionals and pregnant women.

Erratum: Current View of Orphan Drug Usage in Tertiary Hospital and Rare Incurable Disease Hospital

Erratum agreed to by all authors, editor in chief, publisher, and scientific society.

Korean Food Exchange Lists for Diabetes: Revised 2010 / 임상당뇨병

A food exchange system for diabetes is a useful tool for meal planning and nutritional education. The first edition of the Korean food exchange lists was developed in 1988 and the second edition was revised in 1995. With recent changes in the food marketplace and eating patterns of Koreans, the third edition of food exchange lists was revised in 2010 by the Korean Diabetes Association, the Korean Nutrition Society, the Korean Society of Community Nutrition, the Korean Dietetic Association and the Korean Association of Diabetes Dietetic Educators through a joint research effort. The third edition is based on nutritional recommendations for people with diabetes and focuses in adding foods to implement personalized nutrition therapy considering individual preferences in diverse dietary environment. Foods were selected based on scientific evidence including the 2007 Korea National Health and Nutrition Examination Survey data analysis and survey responses from 53 diabetes dietetic educators. While a few foods were deleted, a number of foods were added, with 313 food items in food group lists and 339 food items in the appendix. Consistent with previous editions, the third edition of the food exchange lists included six food categories (grains, meat, vegetables, fats and oils, milk, and fruits). The milk group was subdivided into whole milk group and low fat milk. The standard nutrient content in one exchange from each food group was almost the same as the previous edition. Korea Food & Drug Administration's FANTASY(Food And Nutrient daTA SYstem) database was used to obtain nutrient values for each individual food and to determine the serving size most appropriate for matching reference nutrients values by each food group. The revised food exchange lists were subjected to a public hearing by experts. The third edition of the food exchange lists will be a helpful tool for educating people with diabetes to select the kinds and amounts of foods for glycemic control, which will eventually lead to preventing complications while maintaining the pleasure of eating.

The Development of a Korean Drug Dosing Database / 대한의료정보학회지

OBJECTIVES: This report describes the development process of a drug dosing database for ethical drugs approved by the Korea Food & Drug Administration (KFDA). The goal of this study was to develop a computerized system that supports physicians' prescribing decisions, particularly in regards to medication dosing. METHODS: The advisory committee, comprised of doctors, pharmacists, and nurses from the Seoul National University Bundang Hospital, pharmacists familiar with drug databases, KFDA officials, and software developers from the BIT Computer Co. Ltd. analyzed approved KFDA drug dosing information, defined the fields and properties of the information structure, and designed a management program used to enter dosing information. The management program was developed using a web based system that allows multiple researchers to input drug dosing information in an organized manner. The whole process was improved by adding additional input fields and eliminating the unnecessary existing fields used when the dosing information was entered, resulting in an improved field structure. RESULTS: A total of 16,994 drugs sold in the Korean market in July 2009, excluding the exclusion criteria (e.g., radioactivity drugs, X-ray contrast medium), usage and dosing information were made into a database. CONCLUSIONS: The drug dosing database was successfully developed and the dosing information for new drugs can be continually maintained through the management mode. This database will be used to develop the drug utilization review standards and to provide appropriate dosing information.

Korean Food Exchange Lists for Diabetes: Revised 2010

A food exchange system for diabetes is a useful tool for meal planning and nutritional education. The first edition of the Korean food exchange lists was developed in 1988 and the second edition was revised in 1995. With recent changes in the food marketplace and eating patterns of Koreans, the third edition of food exchange lists was revised in 2010 by the Korean Diabetes Association, the Korean Nutrition Society, the Korean Society of Community Nutrition, the Korean Dietetic Association and the Korean Association of Diabetes Dietetic Educators through a joint research effort. The third edition is based on nutritional recommendations for people with diabetes and focuses on adding foods to implement personalized nutrition therapy considering individual preferences in diverse dietary environment. Foods were selected based on scientific evidence including the 2007 Korea National Health and Nutrition Examination Survey data analysis and survey responses from 53 diabetes dietetic educators. While a few foods were deleted, a number of foods were added, with 313 food items in food group lists and 339 food items in the appendix. Consistent with previous editions, the third edition of the food exchange lists included six food categories (grains, meat, vegetables, fats and oils, milk, and fruits). The milk group was subdivided into whole milk group and low fat milk. The standard nutrient content in one exchange from each food group was almost the same as the previous edition. Korea Food & Drug Administration's FANTASY (Food And Nutrient daTA SYstem) database was used to obtain nutrient values for each individual food and to determine the serving size most appropriate for matching reference nutrients values by each food group. The revised food exchange lists were subjected to a public hearing by experts. The third edition of the food exchange lists will be a helpful tool for educating people with diabetes to select the kinds and amounts of foods for glycemic control, which will eventually lead to preventing complications while maintaining the pleasure of eating.

A Study on Nutrition Knowledge, Dietary Attitudes and Nutrition Education Needs among Child-Care Teachers / 대한지역사회영양학회지

This study was conducted on 175 child-care teachers, who participated in in-service education, to research the methods to improve child-care teacher's nutrition management capability for infants and children. Investigated results of child-care teachers' nutrition knowledge, dietary attitude status, and needs on nutrition education in child-care centers are as follows: The score of child-care teachers' nutrition knowledge was 10.83 points out of 15, which is about 72%. Total score increased as teachers' age but not significantly different from their career duration, since teachers who have a child-care career less than 5 years acquired 10.91 points, which is higher than 10.64 points of teachers having more than 5 years of child-care career. Teachers' average recognition to the nutrition knowledge was 90.6%, increased significantly by the older they are, and decreased according to the accumulation of their career. The average accuracy of the nutrition knowledge was 79.7%, increased in proportion to the teachers' age. The marks of child-care teachers' dietary attitude were 41.3 points (possible score range 5-50) and 83%, older teachers tended to have more desirable dietary attitude. As indicated by the increment of child-care career, the score of emotional attitude tended to be increased but which of cognitive and behavioral attitude showed a declining tendency. Nutrition information which child-care teachers were mainly interested in were correct selection of food (58.1%), obesity and weight management (52.7%), and nutrient content of food (44.9%). Nutrition education contents which child-care teachers needed were 'nutritious food and menu for child' (72.2%), 'health management of child' (69.2%) and meal management of child (40.2%). Nutrition education methods, which child-care teachers considered as of desirable ones, were cooking class of small scale (31.8%), visiting class at child-care center (26.5%). In consequence, the nutrition knowledge and dietary attitude of child-care teachers were not good and showed different issues by age and career duration. Therefore, it is requisite to intensify nutrition management courses in child-care teachers' qualification and in-service education courses which has actual necessity and suitability based on teachers' age, career, and the type of child-care center, and to disseminate these through public health centers and child-care & education information centers to pursue the efficient balance of nutrition education programs.

Feasibility of Using Digital Pictures to Examine Individuals' Nutrient Intakes from School Lunch: A Pilot Study

The purpose of this pilot study was to examine the feasibility of using digital pictures to assess individuals' nutrient intakes from school lunch. The subjects for the study were 29 male students and 40 female students from two classes in a middle school located in Daejeon Metropolitan City, Korea. The school lunch service was self-operated and the students were allowed to portion the foods by themselves. The teacher in charge of each class took digital pictures of every student's lunch plate that was tagged with an i.d. number, before and after eating for two consecutive days. The researchers estimated the amount of food, which an individual actually consumed by comparing pre- and post-pictures of their plate with reference food pictures for better visual estimation of the food amounts. Individual energy and nutrient intakes were calculated using CAN-Pro (ver 3.0) using the food intake data visually estimated from the digital pictures and school lunch recipes. The teachers in charge reported that about 10~15 additional minutes were needed to take the pictures used for the study and this additional time did not place much burden on the service process during the lunch period. The results showed that the students' actual energy and nutrient intakes from the same school lunch menus were quite varied as the serving portions were not regulated and left-overs were not prohibited. This pilot study suggests that examination of individual nutrient intake using digital picture is a feasible method in the context of school lunch service.

Development of Renal Dosing System at a University Hospital / 대한의료정보학회지

OBJECTIVE: This report is describing the development and implementation process of the knowledge-based renal dose adjustment system at a university hospital. METHOD: From the hospital drug formulary which included about 1500 medications, clinical pharmacists selected 243 nephrotoxic medications which require dose adjustment in patients with renal impairment. Through literature review and consultation of clinical pharmacists, nephrologist, and infectious disease specialist, we developed an accordant renal dosing knowledge-base and used them to build the rules for dosage adjustment alerts and to provide information related to alerts such as patients' age, gender, most recent weight, latest serum creatinine, calculated creatinine clearance, and recommended dosage for renal insufficiency. STATUS REPORT: As of August 2006, the renal dosing system which monitored drug prescription and generated real-time alerting window to help physician to adjust drug doses in patients with renal impairment was implemented and has been operated well since initial implementation. CONCLUSION: Renal dosing system based upon knowledge-based renal dosing guideline was successfully developed and implemented into a local clinical practicesetting.

A Study on Knowledges and Attitudes about Breast Milk Feeding and Needs for Breast Milk Feeding Education among High School Students / 대한지역사회영양학회지

This study was carried out to investigate the experiences of breast milk feeding information and education, breast milk feeding knowledge and attitude and needs for breast milk feeding nutrition education of high school students to encourage breast milk feeding. The subjects were 565 (male: 250, female: 315) high school students from first to third grade. The results obtained were as follows: In this survey, only 30.0% of subjects experienced breast milk feeding information and only 6.1% of subjects had breast milk feeding education. And the subjects showed the average scores of knowledge of breast milk feeding were 0.29 points of 1 point. Subjects knew well about ingredients of breast milk but they didn't know well about the physiology and method of breast milk feeding and benefits of breast milk feeding for mothers. The average scores of attitude of breast milk feeding were 3.03 points of 4 points, showed slight positive attitudes of breast milk feeding, but they had negative attitudes of emotional and practical aspects. The future plan of feeding practices was breast milk feeding 35.9% and 60.0% of formula milk feeding. A concern was that the students showed high ratio of formula milk feeding plan and they decided by incorrect knowledge of breast milk feeding. The 33.5% of students answered high school students will need breast milk feeding nutrition education, and they thought hospital faculties were the proper educators of breast milk feeding education, but dietitians were recomended as educators because of easy access at school and good knowledge of life-cycle nutrition. Therefore, to encourage breast milk feeding by mothers and supporters of breast milk feeding, breast milk feeding nutrition education is needed urgently among high school male and female students. And nutrition education programs will have to contain benefits of breast milk for babies and mothers and physiology and practical methods of breast milk feeding to improve emotional and practical attitudes for breast milk feeding. Nationwide campaign to promote breast milk feeding at public areas will be needed.