• Journal of Hospice and Palliative Care
• /
• v.4 no.1
• /
• pp.41-46
• /
• 2001

Background : Many analgesics are used to relieve the pain of various causes. Among these, $Myprodol^{(R)}$, a combination analgesic with codeine, ibuprofen and paracetamol, was recently used as a new analgesics. This study was performed to survey the kinds of diseases, side effects and pain relief effect of $Myprodol^{(R)}$ in clincal practice. Methods : This retrograde study surveyed the medical records of 183 patients treated with $Myprodol^{(R)}$ at Pain Clinic, Pusan National University Hospital. From medical records, the disease entities, the pain characteristics, duration of $Myprodol^{(R)}$ medication, the analgesic effect and side effects were evaluated. Results : $Myprodol^{(R)}$ is used in the treatment of cancer pain (64.3%) and non-cancer pain (35.7%). Among side effects of $Myprodol^{(R)}$ medication, nausea with vomiting, constipation and generalized edema were common in cancer pain, but epigatric pain was common in non cancer pain. $Myprodol^{(R)}$ was more effective in non cancer pain than cancer pain. Conclusions: $Myprodol^{(R)}$ was used in cancer and non-cancer pain patients. In cancer pain patients, $Myprodol^{(R)}$ was effective in early cancer pain but, not effective in advanced cancer. $Myprodol^{(R)}$ was also used and effective in non-malignant benign chest pain, lumbago, post-operative pain.

• Journal of Hospice and Palliative Care
• /
• v.18 no.1
• /
• pp.1-8
• /
• 2015

Breakthrough cancer pain is a transient exacerbation of pain that occurs despite relatively well controlled background pain with around-the-clock analgesia. It is highly prevalent in patients with cancer pain, with an overall prevalence of 70~90%. Breakthrough cancer pain has several negative effects on quality of life, including a decrease in functional status and social relationship, and higher incidence of anxiety/depression. It also places a detrimental burden on their families, society, and the healthcare system. According to the pathogenic mechanism, breakthrough cancer pain is classified into two categories: idiopathic (or spontaneous) pain and incident pain. Episodes of breakthrough cancer pain have typical characteristics, including rapid onset (5~10 min), severe intensity, and short duration (30~60 min). However, there are some variations in timing and severity of pain among patients and episodes. Therefore, a thorough assessment of pain episodes is needed and management plan must be individualized to provide optimal treatment. Several immediate-release formulations such as oxycodone, morphine, and hydromorphone are widely used despite relatively slow onset of action. Recent studies have shown that transmucosal fentanyl preparations were effective for faster control of breakthrough pain. We hope to improve management of breakthrough cancer pain with more efficient analgesics in line with currently available evidence.

• Journal of Hospice and Palliative Care
• /
• v.2 no.1
• /
• pp.7-15
• /
• 1999

This survey was designed to evaluate knowledge and attitudes of physicians and nurses toward cancer pain management in South Korea and to compare physicians' knowledge and attitudes with nurses' Ninety-nine physicians and 152 nurses working at four major institutions in South Korea were included for the study. With the 30 items of the knowledge with true and false answers about cancer pain such as pain assessment(6 items), pharmacokinetics of opioids(8 items), analgesics classification(11 items), and drug administration(5 items), total score of knowledge answered by physicians was 21.40, which was not significantly higher than 20.87 answered by nurses. Rates of the correct answer were more than 70% in both physicians and nurses. Physicians were more knowledgeable in pharmacokinetics and analgesics classification than nurses, while nurses higher only in pain assessment than physicians. Since physicians and nurses could not effectively manage the cancer pain because of inappropriate knowledge, it is important to provide intensive education to physicians and nurses about cancer pain management.

• Journal of Hospice and Palliative Care
• /
• v.19 no.3
• /
• pp.201-210
• /
• 2016

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

• Journal of Hospice and Palliative Care
• /
• v.18 no.2
• /
• pp.120-127
• /
• 2015

Purpose: We aimed to investigate how serum vitamin D levels are related to survival of terminally ill cancer patients. Methods: From May 2012 through June 2013, a retrospective chart review was performed on 96 hospice patients. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with severe vitamin D deficiency and Coxcy and Coxional hazard analyses were used to evaluate effects on survival. Results: The mean vitamin D level in patients was $8.60{\pm}7.16ng/ml$. Vitamin D was severely deficient (<10 ng/ml) in 75 patients (78.2%), deficient (10~20 ng/ml) in 13 patients (13.5%), relatively insufficient (21~29 ng/ml) in five patients (8.3%) and sufficient ((t ng/ml) in three patients (3.1%). Hyperbilirubinemia (${\geq}1.2g/dl$) was the only factor associated with severe vitamin D deficiency according to the multiple logistic regression analysis (Odds ratio, OR=18.48, P<0.05). Although hyperbilirubinemia showed a strong association with survival (Hazard ratio, HR=2.25, P<0.01), no association was found between severe vitamin D deficiency and survival (HR=1.15, P>0.05) in Cox's proportional hazard analysis. Conclusion: Although serum vitamin D levels were severely low in terminally ill cancer patients, we found no association between severe vitamin D deficiency and patient survival.

• Journal of Hospice and Palliative Care
• /
• v.21 no.1
• /
• pp.9-13
• /
• 2018

Purpose: The purpose of this study was to assess the factors influencing the rescue medication decisions for breakthrough cancer patients and evaluate treatments using the factors. Methods: Based on the results of an online survey conducted by the Korean Society of Hospice and Palliative Care from September 2014 through December 2014, we assessed the level of agreement on nine factors influencing rescue medication preference. The same factors were used to evaluate oral transmucosal fentanyl lozenge, oral oxycodone and intravenous morphine. Results: Agreed by 77 physicians, a rapid onset of action was the most important factor for their decision of rescue medication. Other important factors were easy administration, strong efficacy, predictable efficacy and less adverse effects. Participants agreed that intravenous morphine produced a rapid onset of action and strong and predictable efficacy and cited difficulty of administration and adverse effects as negative factors. Oral oxycodone was desirable in terms of easy administration and less adverse effects. However, its onset of action was slower than intravenous morphine. While many agreed to easy administration of oral transmucosal fentanyl lozenge, the level of agreement was low for strength and predictability of its efficacy, long-term durability and sleep improvement. Conclusion: Rapid onset of action is one of the important factors that influence physicians' selection of rescue medication. Physicians' assessment of rescue medication differed by medication.

• Journal of agricultural medicine and community health
• /
• v.27 no.1
• /
• pp.51-64
• /
• 2002

This study was aimed to provide the basic data for the development of effective educational program by reflecting the opinions of the visiting health service workers. The subjects were 144 visiting health service workers in Gwangju and Jeollanam-do area who responded the mail questionnaire. The data were collected from June to July, 2001 using questionnaire composed of the education need, knowledge by subjective appraisal, and experience of education. The major findings of this study were as follows: 1. The number of respondents who received at least one education within recent three years were 43(29.9%) at the central level, 57(39.6%) at the provincial level and 53(36.8%) at the district level. The satisfaction with education was higher at the central level than at the provincial and district level. 2. Knowledges by subjective appraisal on the 'chronic degenerative diseases management' and 'health promotion' was relatively high. while that of 'rehabilitation' was low. 3. The knowledge by subjective appraisal of visiting health service was related with experience of education and license status. The knowledge was higher in registered nurses than in nurse aids. The curricula related to increased level of knowledge of visting health service workers were 'elderly health care', 'rehabilitation' and 'psychiatric-mental health nursing' educations at the central level 'continuing education for the community health practioners' and 'psychiatric-mental health education' at the provincial level and 'elderly health care', 'rehabilitation' 'psychiatric-mental health' and 'acute diseases control' educations at the district level. 4. The respondents preferred elderly health management as the contents of education, officer group education as the method of education, province(30.4%) as the main body of education, exercise and practice as the form of education, 2-3 times per year as the frequency of education, and 3-5days as the period of education. The findings of this study could suggest that future education program should be planned to increae the knowledge level of visiting health service workers by reflecting their educational need.

• Journal of Hospice and Palliative Care
• /
• v.11 no.1
• /
• pp.42-50
• /
• 2008

Purpose: Undertreatment of canter pain, especially due to the differences in the perception of pain between the patients and caregivers, is a well recognized problem. The purpose of this study were to determine if there exist differences in communication about pain intensity scores between patients and their family caregivers in Korea. Methods: A total of 127 patient-family caregiver dyads who have experienced canter pain participated in this study at a hospital in Seoul for six months. The data were obtained by fare to face interview with a structured questionnaire based on Brief Pain Inventory-Korean version and other previous researches. The clinical information for all patients was compiled by reviewing their medical records. Results: Patients' 'worst-pain for 24-hour' and 'right-now-pain' scores estimated by family caregivers were significantly higher than those by patient themselves. The degree of agreement between patients and family caregivers in the estimate of patients' 'worst-pain for 24-hour' intensity categories was 78.7% for 'severe pain', 40% for 'no pain', 27.5% for 'mild pain' and 22.9% for 'moderate pain'. In case of 'right-now-pain' intensity categories, the agreement was 50% for 'severe pain', 47.2% for mild pain, 46.3% for 'no pain', and 26.3% for 'moderate pain'. Conclusion: This study demonstrates that the degree of agreement between patients and family caregivers in the estimate of patients 'pain intensity categories was less than 50% except for 'severe pain'. The results indicate that Korean family caregivers tend to overestimate the canter pain intensity of their caring patients, especially, when a lancer patient has 'moderate' or 'mild pain'. Health Providers are advised to educate patient-family caregiver dyads to use a pain measurement scale to promote their agreement in pain Intensity stores. Further analyses and studies are needed to identify the factors and differences that influence their communication about pain intensity scores between patients and their family caregivers.

• Journal of Hospice and Palliative Care
• /
• v.13 no.1
• /
• pp.41-49
• /
• 2010

Purpose: This study was performed to explore the preference for care near the end-of-life of nurses who had been working in an acute hospital. Methods: Data were collected by using PCEOL-K which was originally developed in U.S. and standardized into Korean version. Two hundred nurses from one acute hospital who agreed to participate in the study filled out questionnaires and 177 questionnaires were analyzed for the study results. Results: Relatively positive preference toward spirituality and pain control and negative preference toward decision making by health care professional were uncovered. Conclusion: Nurses consider patient's autonomy, pain control and spirituality as important factors at the end-of-life care. Further studies regarding the preference for the care near the end-of-life of diverse groups such as patients, doctors, and family members are called for.

• Journal of Hospice and Palliative Care
• /
• v.2 no.1
• /
• pp.1-6
• /
• 1999

Background : Euthanasia is defined as "a deliberate intervention undertaken with express intention of ending a life so as to relieve intractable suffering". There have been keen debates in the medical literatures on the questions relating to the legalisation and the provision of euthanasia and physician-assisted suicide. Methods : Literatures on the debate of euthanasia published during the last several years were reviewed, and the indications used in performing euthanasia were listed. And the results of a more liberal policy on euthanasia in Netherland were introduced. Results : Other clinical practices are sometimes described as euthanasia but can be distinguished by examination of ethical principles involved. The guidelines for the practice of euthanasia and physician-assisted suicide in the Netherlands were inadquate and were abused, while the Remmelink Committee Report said that euthanasia in the Netherland had been adequate. Conclusions : There are no clinical situations necessitating the legalisation of euthanasia or physician assisted suicide. Comprehensive and mutidisciplinary palliative care can effectively relieve much of the suffering of the terminally ill that is presently cited as justification for euthanasia or physician-assisted suicide.