• Title/Summary/Keyword: Terminal Care Performance

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Clinical Prognostic Factors of Terminal Cancer Patients with Palliative Procedures for Malignant Gastrointestinal Obstruction (완화적 시술을 받은 악성 위장관 폐색 말기 암환자의 임상적 예후인자)

  • Moon, Do-Ho;Choe, Wha-Sook
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.200-208
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    • 2005
  • Purpose: Palliative procedures or surgical interventions not only manage various symptoms of malignant gastrointestinal obstruction, but also improve the quality of life. We investigated the clinical characteristics and prognostic factors of terminal cancer patients with palliative procedures for malignant gastrointestinal obstruction. Methods: We retrospectively reviewed the medical records of 48 terminal cancer patients with palliative procedures for malignant gastrointestinal obstruction at Sam Anyang hospital from May in 2002 to May in 2005. We excluded patients with palliative tumor resection. We analyzed prognostic factors in symtom-free survival and overall survival using Kaplan-Meier method, univariate and multivariate analysis. Results: There were 25 males (52%) and 23 females (48%), and median age of 48 patients was 65 years. The most common cause of malignant gastrointestinal obstruction was colorectal (26 patients, 55%), followed by stomach (10, 21%). Twenty patients (42%) received previous treatment (chemotherapy, surgery, and radiotherapy) and 28 (58%) never received any. Eighteen of 20 had received chemotherapy. The most common symptom was pain (15 patients, 31%). Twenty three patients (48%) had Eastern Cooperative Oncology Group(ECOG) performance status of 1 or 2 score and 25 patients (52%) 3 or 4 score. The most common palliative procedure was colostomy and there was no mortality concerning the palliative procedures. By univariate and multivariate analysis, performance status was the only independent prognostic factor in overall survival and symptom-free survival. Overall survival was 150 days and symptom-free survival was 90 days. Conclusion:. We confirmed that perftatdormance status is significant independent prognostic factor in terminal cancer patients with palliative procedures for malignant gastrointestinal obstruction.

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Pain and Factors Influencing Its Management in Patients with Terminal Cancer (말기 암환자의 통증 및 통증관리에 영향을 미치는 요인)

  • Yun, Young-Ho;Heo, Dae-Seog;Kim, Hong-Soo;Ou, Sang-Woo;Yoo, Tai-Woo;Kim, You-Young;Huh, Bong-Yul
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.23-29
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    • 1998
  • Purpose : Validity of WHO guideline of cancer pain management has been proven and many trials were done for resolution of inadequate management of cancer pain. We assessed the severity of pain in terminal cancer patients and patient's characteristics influencing inadequate pain management. Methods : This study was done on 100 patients who was confirmed as terminal in Seoul National University Hospital from lune 1997 to November. For getting the informations about dermographic and medical characteristics such as performance and metastasis, and drug-adjusted pain severity the patients, we reviewed the medical records and interview the patients. we assessed the adequacy of prescribed analgesics with WHO guidelines of pain management, and patient's characteristics influencing on adequacy of pain management. Results : 85.0 percent of cancer patient had pain when diagnosed as terminal cancer and 68% of patient had pain above moderate severity. 38.0 percent of those were given inadequate pain management and the greater pain severity, the less adequate(P<0.001). Sex, age, primary site of cancer, metastasis, symptoms such as depression and anxiety, and performance were not significant. Conclusion : Despite guidelines for pain management, many patients with terminal cancer received inadequate pan management. Their is a need for education about evaluation of pain and guidelines of pain management.

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End-of-Life Assessments and Communication for Dying Patients and Their Families

  • Lee, Eun Kyung;Jeong, Hyae Yeong;Kim, Kyung Won
    • Journal of Hospice and Palliative Care
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    • v.24 no.3
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    • pp.194-197
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    • 2021
  • End-of-life assessments aim to help dying patients and their families plan clinical interventions in advance and prepare them for a peaceful end of life, in which the patient accepts life and death, and the family accepts the patient's departure. It is important to assess whether death is imminent within a few days, because critical hospice care is provided intensively during that period. The following five changes constitute objective evidence of the end of life: diminished daily living performance, decreased food intake, changes in consciousness and increased sleep quantity, worsening of respiratory distress, and end-stage delirium. As subjective evidence, it is suggested that sensitive perceptions of experienced nurses and the feelings of family members caring for patients should also be considered. When notifying a patient or family members that the end of life is approaching, the members of the multidisciplinary hospice team must communicate with each other, share accurate information, and provide consistent explanations. They must also listen to non-verbal communication in an empathic and supportive manner.

Clinical Change of Terminally Ill Cancer Patients at the End-of-life Time (임종 전 말기 암 환자의 임상 증상 및 징후의 변화)

  • Koh, Su-Jin;Lee, Kyung-Shik;Hong, Yeong-Seon;Yoo, Yang-Sook;Park, Hyea-Ja
    • Journal of Hospice and Palliative Care
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    • v.11 no.2
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    • pp.99-105
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    • 2008
  • Purpose: In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of dying patients. Methods: We enrolled the terminal cancer patients from Kangnam St. Mary's Hospital from 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. Results: Average period from hospitalization to death was 11.7 days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 48% and at last 48 hours is 25%. Physical symptoms that have significant prognostic importance are poor oral intake, weakness, constipation, decreased Karnofsky performance status, bed sore, edema, jaundice, dry mouth, dyspnea. Dying patients showed markedly decreased systolic blood pressure, cyanosis, drowsiness, abnormal respiration, death rattle frequently at 48 hours before death. Conclusion: If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning.

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The Relationship of Plasma Visfatin Level and Anorexia in Terminal Cancer Patients (말기암환자의 혈중 Visfatin 농도와 식욕부진의 관계)

  • Lee, So Jin;Lee, Joon Yong;Choi, Youn Seon;Lee, June Young
    • Journal of Hospice and Palliative Care
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    • v.17 no.1
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    • pp.18-26
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    • 2014
  • Purpose: Anorexia is a common symptom in terminal cancer patients. Some data have suggested a role of visfatin in regulating feeding behavior. We studied the relationship of a serum visfatin level and anorexia in cancer patients provided with hospice care. Methods: After informed consent was obtained, 69 cancer patients over 20 years old at a hospice center were enrolled in the study from July 2009 to July 2010. We characterized patients by age, sex, body mass index, primary cancer site, and Eastern Cooperative Oncology Group (ECOG) performance status, etc. Also, blood tests were performed to measure the level of hemoglobin, white blood cell (WBC), C-reactive protein (CRP), total cholesterol, albumin, lymphocyte count, glucose, blood urea nitrogen (BUN), creatinine, tumor necrosis factor-alpha (TNF-${\alpha}$), interukin-6, leptin and visfatin. Results: The mean age of subjects was 65.5 years old, According to univariate analysis, pulse, ECOG performance scale, opioid use and visfatin level were different between the anorexia and non-anorexic group (P<0.05). The median visfatin level was higher in the anorexia group than the good appetite group (P=0.0323). Serum visfatin concentrations were not related with either body mass index or serum leptin or total cholesterol levels, but it was negatively correlated with serum albumin levels (P=0.0198) and lymphocyte counts (P=0.0013). Conclusion: This study did not identify a novel link between visfatin levels and anorexia in cancer patients at a hospice.

The Effects of Plasma Endotoxin Level on Survival Time of Terminally Ill Cancer Patients (말기암환자에서 혈장 내독소 농도가 생존기간에 미치는 영향)

  • Lee, Jin-Ah;Yoon, Ho Min;Choi, Youn Seon;Yeon, Jong Eun;Lee, June Young
    • Journal of Hospice and Palliative Care
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    • v.17 no.2
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    • pp.57-65
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    • 2014
  • Purpose: Since most terminally ill cancer patients die of multiple organ failure, plasma endotoxin concentration levels may be used to predict the life expectancy. This study was performed to evaluate the clinical significance of endotoxin level in plasma as a prognostic factor for survival in patients with terminal cancer. Methods: This study was conducted with 56 terminally ill cancer patients, above 20 years old, from April 2009 through October 2009. Demographic characteristics, Karnofsky performance status, and survival time were evaluated. We analyzed blood levels of white blood cell hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, c-reactive protein, total bilirubin and endotoxin in each patient. Results: We considered following variable for univariate analysis: plasma endotoxin level, sex, age, WBC, hemoglobin, hematocrit, AST, ALT, total bilirubin, CRP and severity of pain. Univariate analysis did not show a significant association between plasma endotoxin level and survival time. However, in a multivariate analysis with factors that were found to be significantly associated with survival sex, WBC count and total bilirubin level in univariate analysis, high levels of plasma endotoxin and short survival time were significantly related. Conclusion: Plasma endotoxin level could be used as a prognostic factor to predict the life expectancy of terminally ill cancer patients.

Prediction of Patient Discharge Status Based on Indicators on Admission (입원 초기 지표를 통한 호스피스 환자의 퇴원 형태 예측)

  • Chung, Sung-In;Lee, Seung Hun;Kim, Yun-Jin;Lee, Sang-Yeoup;Lee, Jeong-Gyu;Yi, Yu-Hyeon;Cho, Young-Hye;Tak, Young-Jin;Hwang, Hye-Rim;Park, Eun-Ju;Kim, Kyung-Mi
    • Journal of Hospice and Palliative Care
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    • v.21 no.3
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    • pp.75-83
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    • 2018
  • Purpose: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. Methods: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. Results: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). Conclusion: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

암환자 인식에 관한 연구 - 간호사ㆍ의사를 중심으로

  • Jo, In-Hyang
    • Korean Journal of Hospice Care
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    • v.2 no.1
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    • pp.58-74
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    • 2002
  • This paper constitutes a descriptive investigation and used a structured questionnaire to investigate nurses' and doctors' recognition of cancer patients. The subjects were extracted from the medical personnel working at the internal medicine, the surgery ward, the obstetrics and gynecology department, the pediatrics department, the cancer ward, and the emergency room of five general hospitals located in Seoul and Gyeonggi Province. The research lasted from August, 2001 to September 2001. Total 137 nurses and 65 doctors were included and made out the questionnaires directly distributed by the investigator. The study tool was also developed by the investigator and consisted of such items as the demographic and social characteristics, the medical personnel's recognition degree of cancer and cancer patients, their recognition of the management of cancer patients, and their participation in a hospice. The results were analyzed using the SPSS Window program in terms of technological statistics, ranks, t-test, and ANOVA. The reliability was represented in Cronbach' α=.75. The nurses' and doctors' recognition degree of cancer and cancer patients had an overall average of 3.86 at the 5 point-scale. The items that received an average of 4.0 or more included 'Medical personnel should explain about the cancer cure plans to the cancer patient and his or her family', 'A patient whose case has been diagnosed as a terminal cancer should be notified of it, 'If I were a cancer patient, I would want to get informed of it,' and 'Cancer shall be conquered whenever it is'. In the meantime, the items that received an average of 3.0 or less was 'My relationship with the cancer patient's family has gotten worse since I announced his or her impending death.' And according to the general characteristics and the difference test, the recognition degree of cancer and cancer patient was high among the subgroups of nurses, females, married persons, who were in their 30s, who had a family member that was a cancer patient, and who received a hospice education. The biggest number of the nurses and doctors saw 'a gradual approach over several days'(68.8%) as a method to tell a cancer patient about his or her cancer diagnosis or impending death. Those who usually tell tragic news were the physician in charge(62.8%), the family members or relatives(32.1%) and the clergymen(3.8%) in the order. The greatest number of them recommended a cancer patient's home as the place where he or she should face death because they thought 'it would stabilize his or her mentality'(91.9%) while a number of them recommended the hospital because they 'should give the psychological satisfaction to the patient'(40%) or 'should try their best until the last moment of the patient's death'(30%). A majority of the medical personnel regarded 'smoking or drinking' and 'diet' as the causes of cancer. The biggest symptom of a cancer patient was 'pain' and the pain management of a cancer patient was mostly impeded by the 'excessive fear of drug addiction, tolerance to drugs and side effects of drugs' by medical personnel, the patient, and his or her family. The most frequently adopted treatment plan of a terminal cancer patient was 'to do whatever the patient or his or her family wants' to resort to a hospice' and 'to continue active treatment efforts' in the order. The biggest reasons why a terminal cancer patient went to see a doctor were 'pain alleviation' 'control of symptoms other than pain(intravenous supply)' and 'incapability of the patient's family' in the order. Terminal cancer patients placed their major concern in 'spiritual(religious) matter' 'emotional matters' their family' 'existence' and 'physical matters' in the order. 113(58.5%) of the whole medical personnel answered they 'would recommend' an alternative treatment to a terminal cancer patient mostly because they assumed it would 'stabilize the patient's mentality.' Meanwhile, 80(41.5%) of them chose 'not to recommend it mostly due to the unverified effects and high cost of it(78.7%). A majority of them, I. e. 190(94.1%) subjects said they 'would recommend' a hospice to a terminal cancer patient mostly because they thought it would help the patient to 'mentally prepare'(66.6%) Only 17.3% of them, however, had received a hospice education, most of which was done through the hospital duty education(41.4%) and volunteer training(34.5%). The follows are results of this study: 1. The nurses and the doctors turned out to be still passive and experience confusion in dealing with a cancer patient despite their great sense of responsibility for him or her. 2.Nurses and Doctors realize the need of a hospice, but an extremely small number of them participate in a hospice education or performance. Thus, a whole recognition of a hospice should be changed, for which purpose a hospice education for nurses and doctors should be provided. 3.Terminal cancer patients preferred their home to a hospital as the place to face their impending death because they felt it would bring 'mental stability.' And most of nurses and doctors think it would be unnecessary for them to be hospitalized just for control of their symptoms. Accordingly a terminal cancer patient can be cared at home, and a home hospice care needs to be activated.

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Comparison of Quality of Life due to Performance Status in Terminal Cancer Patients (말기 암 환자에서 수행능력에 따른 삶의 질 비교)

  • Chae, Jin-Sung;Jung, Gyou-Chul;Kim, Sun-Hyun;Yeom, Chang-Hwan
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.183-189
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    • 2005
  • Purpose: Despite the advance of medical science, the number of cancer patient have increased and the mortality rate is also on the rise. Therefore, a perfect cure for cancer is crucial, but the value and meaning of the remaining life for the patient are also becoming more and more important. The principal aim of this study is to examine the differences in the quality of life, physical and psychosocial symptoms according to the performance status of terminal cancer patients. Methods: We evaluated the performance status, demographical data, blood analysis and quality of life of cancer patients who visited the Department of family Medicine at Myoung-ji Hospital in Korea between September 1, 2003 and August 31, 2005. Their performance status (ECOG) was divided into two groups ($ECOG\;0{\sim}1/ECOG\;2{\sim}4$) and analyzed by ANOVA to see if there was a difference in their blood analysis and quality of life. A P value of less than 0.05 was considered to be significant. Results: A total of 104 patients were evaluated, among which 71 patients (23 male and 48 female) scored $0{\sim}1$, and 33 patients (8 males and 25 females) scored $2{\sim}4$ in the ECOG. The blood analysis showed that patients whose performance status was $2{\sim}4$ had lower levels of lymphocytes, hemoglobin, protein, albumin and sodium. The evaluation on their quality of life showed that the overall health status of patients with $2{\sim}3$ functional ability were poor (P=0.02). Also, from a functional perspective, these patients had poor physical (P=0.05) and role (P=0.01) scores, and in terms of symptoms, they showed a significant loss of appetite. Conclusion: If a patient's performance status was poor, levels related to certain nutritions were also found to fall in blood tests, thereby leading to an overall weakened state of health. However, there was no difference in symptoms except for a loss of appetite. In conclusion, it is most important to increase the appetite in patients with poor performance status.

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A High-Performance Sensorless Control System of Reluctance Synchronous Motor with Direct Torque Control

  • Kim Min-Huei;Kim Nam-Hun;Choi Kyeong-Ho;Kim Dong-Hee;Hwang Dong-Ha
    • Proceedings of the KIPE Conference
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    • 2001.10a
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    • pp.355-359
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    • 2001
  • This paper presents an implementation of digital control system of speed sensorless for Reluctance Synchronous Motor (RSM) drives with DTC. The control system consists of stator flux observer, rotor position/speed/torque estimator, two hysteresis band controllers, an optimal switching look-up table, IGBT voltage source inverter, and TMS320C31 DSP controller by using fully integrated control software. The stator flux observer is based on the combined voltage and current model with stator flux feedback adaptive control that inputs are current and voltage sensing of motor terminal with estimated rotor angle for wide speed range. The rotor position is estimated by observed stator flux-linkage space vector. The estimated rotor speed is determined by differentiation of the rotor position used only in the current model part of the flux observer for a low speed operating area. It does not require the knowledge of any motor parameters, nor particular care for motor starting, In order to prove the suggested control algorithm, we have a simulation and testing at actual experimental system. The developed sensorless control system is shown a good speed control response characteristic results and high performance features in 50/1000 rpm with 1.0Kw RSM having 2.57 ratio of d/q reluctance.

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