• Journal of Hospice and Palliative Care
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• 제5권1호
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• pp.31-42
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• 2002

목적 : 연구의 목적은 호스피스 완화의료의 표준화를 위한 기초자료로서 국내 호스피스 완화의료 서비스를 제공하는 의료기관 및 비의료기관의 서비스 대상자, 시설 인력구성, 서비스 내용 및 재정적 문제 등 실태를 파악하는 것이다. 방법 : 설문조사는 2001년 7월부터 10월까지 이루어졌으며, 연구자들이 기존 연구를 참조하여 개발한 총 39항목의 설문지를 반송봉투를 넣어 우편으로 발송하여 조사하였다. 회신이 되었지만 내용을 재확인할 필요가 있는 부분과 회신이 안된 기관은 전화를 통해 설문을 완성하였다. 64개 기관이 설문에 응답하였다. 결과 : 국내에는 호스피스 완화의료 서비스를 제공하는 의료기관이 40개, 비의료기관이 24개 있었다. 의료기관 중 11개 기관은 병원연계 및 독립 또는 별도병동이 었고, 비의료기관 중 6개는 입원이 가능한 독립시설에서 호스피스 완화의료서비스를 제공하고 있었다. 호스피스 완화의료 서비스를 받는 대상자 대부분은 암환자였지만 일부는 말기 질환이 아닌 경우도 포함되어 있었다. 전체 64개 호스피스 완화의료 서비스 기관 중 24개만이 의사, 간호사, 사회복지사 및 성직자가 있었다. 가정호스피스 기관으로서 의뢰체계가 있는 경우는 의료기관 89.7%, 비의료기관 73.7% 였다. 24시간 서비스를 제공하는 기관은 의료기관 65.0%, 비의료기관 37.5%였다. 가족을 위한 휴식공간은 병원중심 호스피스완화의료 프로그램의 50%에서 있었다. 전체 호스피스 완화의료기관의 73.9%는 재정적인 문제가 있었으며, 610%는 정부로부터의 재정적인 지원이 필요하다고 응답하였다. 결론 : 64개 호스피스완화의료 프로그램에서 서비스를 제공하고 있지만 아직도 인력, 서비스의 질 및 시설 측면에서는 문제점이 있었다. 말기환자를 위한 서비스의 질을 향상시키고 의료자원의 효율적인 이용을 촉진하기 위해 호스피스 완화의료 서비스의 표준화와 제도화가 필요하다.

• Journal of Gastric Cancer
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• 제22권1호
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• pp.35-46
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• 2022

Background: The correlation between hospital volume and postoperative outcomes has led to the centralization of complex procedures in several countries. However, the results reported in relation to gastric cancer (GC) are contradictory. This study aimed to analyze GC surgical volumes and 30-day postoperative mortality in Italy and to provide a simulation for modeling centralization of GC resections based on district case volumes. Methods: A national registry was used to identify all GC resections, record mortality rates, and track the national in-border GC resection health travel. Hospitals were grouped according to caseload. Centralization of all GC procedures performed within the same district was modeled. The outcome measures were a minimal volume of 25 GC resections/year and the 30-day postoperative mortality. Results: In 2018, 5,873 GC resections were performed in 498 Italian hospitals (mean resections per hospital per year: 11.8); the postoperative mortality rate (5.51%) was tracked from 2016-2018. GC resection health travel ranged from 2% to 50.5%, with a significant (P<0.001) difference between northern and central/southern Italy. The mean mortality rate was 7.7% in hospitals performing one to 3 GC resections per year, compared with 4.7% in those with >17 GC resections/year (P≤0.01). Most Italian districts achieved 25 procedures/year after centralization; however, 66.3% of GC cases in southern Italy vs. 42.2% in central and 52.7% in the northern regions (P<0.001) required reallocation. Conclusion: Postoperative mortality after GC resection correlated with hospital volume. Despite health travel, most Italian districts can reach a high-volume threshold, but discrepancies in mortality rates are alarming.Trial RegistrationResearch Registry Identifierresearchregistry6869

• Journal of Hospice and Palliative Care
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• 제15권2호
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• pp.77-87
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• 2012

목적: 이 연구는 선호 음악 감상이 말기암환자의 통증 정도에 따른 정서 및 스트레스에 미치는 효과를 파악하고자 함이다. 방법: 이 연구에 참여한 대상자는 경상북도 선린병원의 호스피스 완화의료 병동에 입원한 18세 이상의 말기암환자 20명이었으며, 대상자들에게 자신이 선호하는 음악을 선택하도록 하여 각 회기 당 30분씩 총 6회 제공하였으며, 실험 전후, 사전사후 조사를 하였다. 연구 도구로는 통증 자각 척도 중 숫자 통증 등급(Numerical rating scale, NRS), 정서상태 측정 설문지, 스트레스 설문지를 사용하였다. 통증인식 수준에 따른 집단 간 차이를 비교하기 위해 실험 전 자가 통증 척도에 따라 두 집단(통증 점수가 5점 이하인 집단과 통증 점수가 6점 이상인 집단)으로 나눈 후, 주 2회로 매 1회 당 30분씩 총 6회 실험하였다. 매 회기 사전사후 정서 변화를 측정하였고, 1회기 전과 6회 후 스트레스를 측정하였다. 정서 변화와 스트레스는 대응 2-표본 비모수 통계 처리하였고, 추가 분석으로 정서 변화 검사에서 1회기 전과 매회기 후를 반복 측정 분산 분석으로 처리하였다. 결과: 정서상태 변화를 위한 사전사후 검증에서 유의한 차이가 나타났고(P<0.001), 스트레스도 감소된 것으로 나타났다(P=0.001). 두 집단은 통증 인식 수준이 달랐지만 음악치료중재를 통해 모든 대상자들은 정서상태 변화와 스트레스 감소 효과를 나타냈다. 결론: 본 연구 결과들은 선호 음악 감상이 호스피스 완화의료 병동에 입원한 말기암환자들의 통증인식 정도 차이에도 불구하고 두 집단 모두에게 정서와 스트레스를 긍정적으로 전환하기 위한 효과적이고 적절한 중재임을 보여준다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.6069-6075
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• 2013

Background: At present, the diagnosis of colorectal cancer (CRC) requires a colorectal biopsy which is an invasive procedure. We undertook this pilot study to develop an alternative method and potential new biomarkers for diagnosis, and validated a set of well-integrated tools called ClinProt to investigate the serum peptidome in CRC patients. Methods: Fasting blood samples from 67 patients diagnosed with CRC by histological diagnosis, 55 patients diagnosed with colorectal adenoma by biopsy, and 65 healthy volunteers were collected. Division was into a model construction group and an external validation group randomly. The present work focused on serum proteomic analysis of model construction group by ClinProt Kit combined with mass spectrometry. This approach allowed construction of a peptide pattern able to differentiate the studied populations. An external validation group was used to verify the diagnostic capability of the peptidome pattern blindly. An immunoassay method was used to determine serum CEA of CRC and controls. Results: The results showed 59 differential peptide peaks in CRC, colorectal adenoma and health volunteers. A genetic algorithm was used to set up the classification models. Four of the identified peaks at m/z 797, 810, 4078 and 5343 were used to construct peptidome patterns, achieving an accuracy of 100% (> CEA, P<0.05). Furthermore, the peptidome patterns could differentiate the validation group with high accuracy close to 100%. Conclusions: Our results showed that proteomic analysis of serum with MALDI-TOF MS is a fast and reproducible approach, which may provide a novel approach to screening for CRC.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.1955-1960
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• 2014

Background: This study was performed to determine the experiences of nursing students in caring for paediatric cancer patients and their families. Materials and Methods: This qualitative survey was carried out with 14 students studying in the nursing department of the Faculty of Health Sciences of a university in Edirne, Turkey. Data were obtained through focus group interviews and evaluated based on a qualitative content analysis. Results: It was determined that students, for the most part, experienced problems related to communication, sadness, helplessness, fear, anxiety, resentment and anger. In addition, the students were affected most often by effects of the disease and invasive procedures on paediatric cancer patients and their families during the process of caring for them in the oncology clinic. Conclusions: It would be useful to inform nursing students, prior to clinical practice, about the special needs of paediatric cancer patients and families who stay in oncology clinics, and to follow up with appropriate guidance during the clinical practices.

• Journal of Hospice and Palliative Care
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• 제24권2호
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• pp.116-129
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• 2021

Purpose: The purpose of this study was to examine the knowledge, caregiving performance, stress levels, and mental health of family caregivers of terminal cancer patients with delirium, insofar as these characteristics are relevant for delirium. Methods: Between May 1, 2019, and June 1, 2020, 96 family caregivers of terminal cancer patients with delirium completed a structured survey, the results of which were analyzed. Results: The average correct answer rate for delirium-related knowledge was 53.2% across all subcategories, which included knowledge of causes (41.5%), symptoms (65.4%), and caregiving (51.7%). The average score for family caregivers' performance of caregiving for delirium was 2.60±0.5, with subcategories including caregiving for patients without delirium (2.16±0.95), caregiving for patients with delirium (2.84±1.01), and stress related to caregiving for delirium (39.88±16.55), as well as categories such as patient-related caregiving (44.32±28.98), duty-related caregiving (44.21±30.15), and interpersonal relationship-related caregiving (22.35±25.03). For mental health, the average score among family caregivers was 1.96±0.70, with the highest score being for the category of additional items (2.28±0.84). Family caregivers of patients with hyperactive delirium as the delirium subtype had higher scores for caregiving performance than caregivers of patients with mixed delirium. Conclusion: Scores for the delirium-related knowledge and caregiving performance of family caregivers were low, while their caregiving stress levels were high due to their lack of knowledge and experience. This indicates the importance of delirium-related education for family members of patients with delirium and the necessity of developing nursing intervention programs to help manage stress and promote mental health among family caregivers.

• Journal of Hospice and Palliative Care
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• 제10권2호
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• pp.78-84
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• 2007

목적: 본 연구는 오늘날 증가추세에 있는 폐암 환자에게 보다 체계적이고 효율적인 호스피스 완화의료를 위한 기초자료를 제공하고자 호스피스 병동에서 임종한 말기 폐암 환자의 임상적 특성을 조사하였다. 방법: 2003년 3월 1일부터 2006년 12월 31일까지 샘 안양병원 호스피스 병동에서 말기 폐암으로 임종한 129명의 환자를 대상으로 하여 이들의 의무기록을 후향적으로 조사하였다. 수집된 자료는 실수와 백분율, 빈도와 중간 값으로 제시하였으며 호스피스 완화의료 동안의 생존기간은 SPSS 13.0의 Kaplan-Meier방법으로 분석하였다. 결과: 129명의 말기 암 환자 중 남자 93명(72%), 여자 36명(28%), 연령의 중간 값은 68세(범위 $37{\sim}93$세)이었다. 진통제를 복용하고 있었던 환자는 82명(64%)이었으며 그렇지 않은 환자는 47명(36%)이었다. 입원 이유는 호흡곤란이 47명(36%)으로 가장 많았고 이는 일반적으로 말기 암환자의 입원이유가 통증인 것과 다르게 나타났다. 호스피스 병동 입원 후 120명(93%)의 환자에게 마약성 진통제를 사용하였고 주사용 모르핀(103명, 80%)이 가장 많이 처방되었다. 진정제를 사용한 환자는 87명(67%)이었으며 미다졸람을 가장 많이 사용하였다(68명, 53%). 호스피스 완화의료 동안의 생존기간의 중간 값은 35일, 입원 일수의 중간 값은 24일이었다. 결론: 말기 폐암환자에서 호흡곤란의 조절은 매우 중요하며 말기 폐암 환자에 대한 호스피스 완화의료의 기간이 짧아서 효과적인 호스피스 완화의료를 위해서는 가족과 환자에게 지속적인 교육과 홍보가 필요하다고 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8359-8364
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• 2016

Background: Thailand has come to an epidemiologic transition with decreasing infectious diseases and increasing burden of chronic conditions, including cancer. Breast cancer has the highest incidence rates among females throughout Thailand. This study aimed to identify the current burden and the future trends of breast cancer of Lopburi, a province in the Central Thailand. Materials and Methods: We used cancer incidence data from the Lopburi Cancer Registry to characterize and analyze the incidence of breast cancer in Central Thailand. With joinpoint and age-period-cohort analyses, the incidence of breast cancer in the province from 2001 to 2010 and project future trends from 2011 to 2030 was investigated. Results: Age-adjusted incidence rates of breast cancer in Lopburi increased from 23.4 to 34.3 cases per 100,000 female population during the period, equivalent to an annual percentage change of 4.3% per year. Both period and cohort effects played a role in shaping the increase in incidence. Joinpoint projection suggested that incidence rates would continue to increase in the future with incidence for women ages 50 years and above increasing at a higher rate than for women below the age of 50. Conclusions: The current situation where early detection measures are being promoted could increase detection rates of the disease. Preparation of sufficient budget for treatment facilities and human resources, both in surgical and medical oncology, is essential for future medical care.

• 근관절건강학회지
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• 제19권2호
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• pp.173-183
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• 2012

Purpose: The purpose of this study was to analyze nursing records for pain management in intensive care unit (ICU) patients. Methods: Nursing process for pain management were analyzed retrospectively by 180 ICU patients' nursing records. Instruments consisted of 3 questionnaires (pain assessment, intervention, and evaluation). Results: For assessment, there was different pain intensity between cancer patients (7.95) and non-cancer patients (7.20). Also pain intensity was lower in PCA group (5.08) than in PCA with PRN group (8.27). Common pain site was surgical areas, along with 17 kinds of words expressed for pain, and mean of pain intensity was 7.47 by numeric rating scales (NRS). For intervention, the patients received pharmacologic interventions (99.4%) such as narcotic analgesics (38.3%) intermittently (70.5%) without side effects (94.4%). For evaluation, mean of pain intensity was decreased to 3.14, but a few patients (12.8%) experienced pain over 5 points despite the intervention. Nurses evaluated the degree of pain relief after the intervention in 87.2% of patients. Conclusion: Nurses do assess patients' pain by using objective tool, intervene, and evaluate for effective pain management. Nurses should make an individual approach and record all nursing activities for pain management.

• 임상간호연구
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• 제21권2호
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• pp.154-168
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• 2015

Purpose: This study aimed to adapt the previously developed, high-quality oral care guideline for the usage in clinical settings in Korea. Methods: Guideline adaptation process was undertaken according to the guideline adaptation manual version 2.0 developed by National Evidence-based Healthcare Collaborating Agency (Kim, et al., 2011) and the standardized methodology for nursing practice guideline adaptation (Gu, et al. 2012). Results: The adapted oral care guideline was consisted of 10 domains and 85 recommendations. The number of recommendations in each domain were: 4 general issues, 2 oral care indications, 10 oral assessment 16 general oral care, 15 oral care for critically ill, 15 oral care for cancer patients, 14 oral care for cancer patients withoral complications, 5 oral careeducation, 2 oral care referral, and 2 documentation and report. Ten point six percent of the recommendations were rated as grade A, 20.0% as grade B grade, and more than half (69.4%) were rated as grade C. Conclusion: The adapted oral care practice guideline is expected to included the evidence-based practice guidelines as fundamentalss of nursing practice. Dissemination of the developed guideline nationwide would contribute improving the efficiency of oral care practice.