• Journal of Hospice and Palliative Care
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• v.10 no.2
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• pp.74-77
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• 2007

Purpose: We evaluated how many patients received radiotherapy and how many those of them could not complete radiation therapy in Hospice Ward. Methods: We retrospectively reviewed the general characteristics in 33 patients who began to receive palliative radiation therapy, and radiation dose and reasons of not-completing radiation therapy in Hospice Ward of St. Vincent's Hospital. Results: Thirty three (8.2%) among 404 patients who had been admitted from November 2003 and October 2005 received palliative radiation therapy. The main indications of radiation therapy included brain metastasis, painful bone metastasis, painful tumor mass, and obstructive shortness of breath. Forty five percent of these patients could not complete. And 20% could receive less than 1/3 of planned radiation dose. They failed to complete the treatment often due to poor general rendition. Conclusion: Although palliative radiation therapy had been used frequently for patients with advanced cancer in Hospice Ward of St. Vincent's Hospital, but it was often not completed. With appropriate selection criteria of patients and shorter modification of radiation treatment period, more patients would be benefited with palliative radiation therapy in Hospice Ward.

• Journal of Hospice and Palliative Care
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• v.18 no.4
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• pp.314-321
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• 2015

Purpose: It is well known that a terminal cancer condition affects not only patient themselves but their family members because the patients experience a variety of symptoms. This study was aimed to investigate modifiable factors that influence family caregivers' quality of life, depression, and anxiety. Methods: From January 2015 through May 2015, a survey was conducted with 61 family caregivers of hospice patients who were hospitalized in two university hospitals and one municipal hospital in Busan. The questionnaire was consisted of characteristics of family caregivers and patients, the Korean version of the Caregiver Quality of Life Index-Cancer (CQOLC-K), Beck's Depression Inventory II (BDI-II), Beck's Anxiety Inventory (BAI), and patient's symptom controlling scores rated by family caregivers. Results: Family caregivers' depression was associated with religion. Quality of life and depression of family caregivers were also influenced by monthly household income. Patient age was inversely related to family caregiver's quality of life ($r_s=-0.259$, P=0.043). Family caregivers' quality of life was associated with patient's anxiety (r=0.443, P=0.001). Family caregivers' depression was affected by patient's constipation (r=0.276, P=0.046), anxiety (r=0.508, P<0.001), and daytime drowsiness (r=0.377, P=0.005). And family caregivers' anxiety was influenced by patients' sleep disturbance (r=0.276, P=0.046), depression (r=0.297, P=0.031), and anxiety (r=0.357, P=0.009). Conclusion: According to our findings, family caregivers had higher quality of life and less depression and anxiety when symptoms in hospice patients were well controlled.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.57-67
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• 1998

Purpose : This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. Method: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and for those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as PPO-$FEV_1$, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-$FEV_1%{\times}ppo$-DLco% and ppo-maximal $O_2$ uptake($VO_2$max) were also considered. Results: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean $FEV_1$ of $2.37\pm0.06L$. Twenty nine patients had a decreased $FEV_1$ less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-$VO_2$max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss(p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). Conclusions: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful Our study suggests that ppo-$VO_2$max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.

• Korea Journal of Hospital Management
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• v.13 no.1
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• pp.24-41
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• 2008

This research is aimed at analyzing and understanding the perception and attitudes of inpatients in a general hospital in Seoul towards the activation of private health insurance. Survey was conducted against 231 inpatients, results of which were analyzed in the methods of frequency analysis, chi square test, and logistic regression. The results are summarized as follows; First, better-educated population who finished college education at least, higher-income population, and people who had more knowledge about private health insurance showed more perception about activation of private health insurance. Second, better-educated population who finished college education at least, higher-income population, those who are insured in existing private insurance, oncological patients, and people who had more knowledge about private health insurance showed more positive attitude towards private health insurance paying for actual damages, long-term care insurance, and income security insurance. Third, age and education were the factors affecting perception about activation of private health insurance. The older the age is, perception was 1.035 times positive towards activation of private health insurance, and those who finished college education or above showed 3.148 times positive perception towards the same. Forth, surgical patients showed 1.087 times more positive attitude towards private health insurance paying for actual damages than internal medicine patients, while oncological patients showed 2.314 times more positive attitude than internal medicine patients. Further, understanding on the activation of private health insurance was 6.014 times higher in the higher understanding group than in the lower understanding group. Intention to use long-term care insurance was 2.692 times stronger in the male group than in the female group, and 3.616 times stronger in the oncological patients group than in internal medicine patients group. Further, understanding on the activation of private health insurance was 3.881 times deeper in the higher understanding group than in the lower understanding group. Intention to use income security insurance was 3.185 times stronger in those who have academic background of under the high school than those over the college, and 4.175 times higher in the group those whose monthly average income is over 4 million won than those under 4 million won. Also, intention to use income security insurance was 4.323 times higher in the group those who are insured by existing private insurances than those who are not insured by those insurances and it was 5.234 times higher in the group of oncological patients than in the group of internal medicine patients. Further, intention to use income security insurance was 3.559 times higher in the group those who thought that out-of-pocket money of the National Health Insurance is too much to bear than those it is quite endurable. Understanding on the activation of private health insurance was 4.875 times deeper in the higher understanding group than in the lower understanding group. There were some suggestions could be made based on the results of this research. First, reinforced publicity and education is needed for the low-educated or low-income group, as there are gaps in the understanding on the activation of private health insurance depending on the degree of education and income. Second, government should prepare administrative complementary measures to solve the problem of adverse selection by the consumer which is foreseen when private health insurances are activated. Third, government should suggest the desirable course of development of private health insurance items to ensure efficient use of enormous fund of private insurance market for health security of the people. Further, institutional complementary measures are needed to convert existing cancer insurances or specific disease insurances to private health insurances paying for actual damages guaranteeing against every kind of disease. Forth, it judged that, not only private health insurances paying for actual damages, but also long-term care insurances and income security insurances are prospective as fields to create fresh demand for insurance industry.

• Journal of Hospice and Palliative Care
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• v.14 no.1
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• pp.28-33
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• 2011

Purpose: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. Methods: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. Results: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. Conclusion: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.

• Journal of Hospice and Palliative Care
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• v.3 no.1
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• pp.39-48
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• 2000

Purpose : The purpose of the study is to disclose the spiritual needs of hospice patients. Method : The questionaire survey was carried out on 49 hospice patients and 40 caregivers who were in the 9 hospice institutions from lune to August in 1999. Results : In the patients, mean scores of the spiritual needs were significantly higher in the group with stomach cancer, college education, christians, $8{\sim}14$ days of hospice care and the group thinking that religion was important, and in the caregivers in the group of religions besides christianity and lives under $3{\sim}5$ years of medical treatment. In the total average of the spiritual needs, the patients's average was significantly lower than the caregiver's. Among the different categories, the patient's needs were highest in the area of meaning of life and the hope, the caregiver's needs in the love and the concern. However, both groups were low in the religion area. In the items of the love and the concern, the patient was highly responding to the 'wanting someone to give warm concern in conversation' and the caregiver was highly responding to the 'giving a warm response to questions on the sad and hard time'. And also, the patient was lowly responding to the 'wanting more concerns to him than other patients', and the caregiver was low responding to the 'patients wanting warm response in conversation'. In the categories of religious area both group were highly responding to the 'wanting to be helped to relax out of all'. And they gave lowest response to the 'wanting to introduce a book to know God'. In the area of meaning of life and hope, the both groups gave highest response to the 'wanting to be guided to have the hope' and lowest to the 'wanting to have opportunity to reconcile the person with bad relationship'. Conclusion : Summing up the above results, personal in-depth conversation is necessary to understand more deeply the spiritual needs of hospice patient. Moreover the hospice team needs to have more systematic approach to find out the spiritual needs of hospice patients.

• Journal of Hospice and Palliative Care
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• v.12 no.4
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• pp.194-198
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• 2009

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea Purpose: Malignant bowel obstruction causes gastrointestinal symptoms and leads to diminished quality of life in patients with advanced cancer. Several studies have shown the efficacy of octreotide for the relief of malignant bowel obstruction-related symptoms. The aim of this study is to assess the efficacy and safety of octreotide in patients with malignant bowel obstruction. Methods: We retrospectively reviewed medical records of twenty nine patients who had suffered from malignant bowel obstruction without clinical improvement of conservative care and subsequently, received octreotide treatment. Initial dosage of octreotide was 0.1 mg/day, and dose was escalated depending on the clinical effect. For each patient, we assessed visual analogue scale (VAS) of pain, number of vomiting episode, and amount of nasogastric tube drainage. Results: Median dosage of octreotide was 0.2 mg/day (range 0.1~0.6), and median duration from initial medication to death was 20 days (range 2~103). VAS before and after octreotide treatment were 5.6$\pm$1.24, and 2.7$\pm$0.96, respectively. The numbers of vomiting episode before and after octreotide treatment were 3.6/day$\pm$2.5, and 0.4/day$\pm$0.8, respectively. The mean amounts of nasogastric tube drainage before and after octreotide treatment were 975$\pm$1,083 cc/day and 115$\pm$196 cc/day, respectively. Statistically significant reduction in VAS, the number of vomiting episode and the amount of nasogastric tube drainage were observed after octreotide treatment (P<0.05). Conclusion: Administration of octreotide in patients with malignant bowel obstruction, which is uncontrolled by other medication, was effective and safe. In such clinical situations, physicians should consider to add of octreotide for symptomatic control.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.67-77
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• 2003

Objectives: This study is designed to suggest the health service goals necessary for providing the more efficient services relevant to the requests of the community, through the evaluation on the operating status of the unified health subcenters. Methods: We visited total 5 unified health subcenters comprising 3 ones located in Gyeongsangbuk-do and 2 ones located in Gyeongsangnam-do from December 2000 to January 2001, and interviewed about the pre- and post-unified status related to manpower, facilities, equipment, medical service and health service quality, and the problems and improvement plans of the unified management. Results: According to the evaluation on the manpower before and after the unification of the health subcenters, the total employees increased by 2.8 persons on average from 6.8 to 9.6 persons in the investigated subjects. The numbers of doctors, dentists and nurses were almost the same as before. There were no clinical pathologic technician and radiological technician before but they were appointed to duty in 3 unified health subcenters later. The unification of the health subcenters has produced slight increases in the frequency of the medical service and dental treatment and considerable increases in that of the physical therapy and laboratory tests. In relating to the changes of the health service, the cases of visiting health care and ambulatory medical service, and the total number of health education participants were greatly increased after the unification. The number of cases undergoing the vaccination and cervical cancer screening was similar to that of the pre-unification while the patient number of the registration to hypertension or diabetes showed a tendency to increase a little. Since the unification of the health subcenters, the frequency of laboratory tests has been increased, but the quality of health service has not been improved yet. Nevertheless, the unification seems to be positive according to the result of the great improvement in visiting health care, ambulatory medical service and health education service. The problems of the unification of the health subcenters were indicated in indefiniteness of the service details between the workers; excessively large building hard to be effectively managed; insufficient medical instruments, inappropriation of working expenses, lack of professional training for the health education, etc. Conclusions: For further active functions of the unified health subcenters, the minimal allocation basis to appoint doctors, nurses and administrative workers to do the duty should be differentiated from the basis for a health subcenter, and the fundamental instruments needs to be expanded to improve the quality of the medical service and visiting health care service. Moreover, the unified health subcenter needs to have definite service details between the workers, and should improve the working efficiency through the development of service-related guidelines.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.159-193
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• 2015

Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient's side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Burgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that 'legal presumption of negligence' relating to 'negligence in the occurrence of hospital infections,' which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.

• The Korean Journal of Nuclear Medicine
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• v.35 no.6
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• pp.371-377
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• 2001

Purpose: One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients. as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. Materials and Methods: We reviewed spine SPECT studios obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2. Posterior element: posterior to body (pedicle), posterior to Intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Results: Sixty-nine bone lesions were detected on SFECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis; linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Conclusion: Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients.