• The Korean Journal of Pain
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• v.1 no.1
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• pp.59-63
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• 1988

Recently, epidural tunnelling was introduced for the convenience of keeping a catheter inserted for a long period of time. We had 15 cases in which used epidural tunnelling for the treatment of intractable pain mainly in terminal cancer patients. Epidural puncture with cannulation was carried out in the same technique as used for epidural anesthesia. After the subcutaneous epidural tunnelling was done from the site of the epidural entry to the anterior chest, just under the slim using a tunnelling device, the catheter was threaded through the tunnelling needle at the site of the outlet, was fixed and the tip of the catheter was connected to a filter. Five ml (2 mg) of saline diluted morphine can be given at home as needed when intractable pawn occurs. This long-term treatment of intractable pain by morphine injections through the epidural cannula place by subcutaneous tunnelling, is very convenient for the patient's daily routine and a better alternative in such a situation. Our technique, its advantages and problems were described in this paper.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.324-335
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• 1979

During the period of 4 years from August 1975 to August 1979 one hundred and forty seven cases of lung cancer were seen at Paik Foundation Hospital in Seoul, Korea. Among these 147 cases, 104 patients had primary carcinoma of the lung and the remainder was metastatic carcinoma to the lung. Among these 104 primary carcinoma patients, 73 cases were proven histologically as primary carcinoma of the lung. There were three cases of alveolar cell carcinoma [Table 1 ]. This clinical observation is based on those 73 cases including three case reports of the alveolar cell carcinoma. 1. Peak incidence was observed in the 5th decade of life. Male to female ratio was 2 to 1 [Fig. 1]. 2. Pathological classifications were as follows: epidermoid carcinoma, 24 cases [32.9%]; undifferentiated carcinoma, 20 cases [27.4%]; adenocarcinoma, 15 cases [20.5%]; bronchioloalveolar carcinoma [5.5%] and positive cytology, 10 cases [13.7%] [Fig. 2]. 3. Evidence of inoperability was observed in 55 patients [75% of the 73 cases] [Table 3]. 4. Among those 73 cases, operability was evaluated in 18 patients or 25%. One patient refused operation and 17 patients [23.6%] were explored. In 11 [15%] out of 17 patients, thoracotomies were performed. Six cases were pneumonectomies and 5 cases were lobectomies or bilobectomies [Fig. 3]. 5. First case of alveolar cell carcinoma was a 46 year-old housewife complaining of cough and hemoptysis for one year. The plain chest X-ray and bronchogram showed characteristic pictures as Figures 4 and 5. A pneumonectomy was carried out. Histologically, a beautiful alveolar carcinoma consisted of the characteristic tall columnar epithelial cells, which were lining the alveolar spaces as seen in Figures 6, 7, 8, and 20. 6. In the second case of 41 year old male, predominant clinical feature was single, well defined mass in the right lower lobe [Fig. 10 and 11] on chest X-ray. Bilobectomized specimen showed fragile, soft and hard tissue containing mucoid secretions and focal yellowish necrosis with pigmentation on cut surface [Fig. 12]. Slides showed tumor cells lined up along the alveolar septa with papillary projections [Fig. 13 and 14]. 7. Third case of alveolar cell carcinoma was a 50-year-old housewife with hemoptysis. An outstanding clinical picture was a round to lobulated mass in the right upper lobe [Fig. 16]. She is living now, 2 years and 1 month post-operatively, but has arrived at terminal stage with military nodular disseminations to the contralateral lung [Fig. 19].

• Journal of Hospice and Palliative Care
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• v.25 no.3
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• pp.110-120
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• 2022

Purpose: The purpose of this study was to confirm the factor structure of the McGill Quality of Life Questionnaire-Revised (MQOL-R) in the context of Korean culture and to verify its reliability and validity. Methods: The participants comprised terminal cancer patients aged 25 or older, and data from 164 participants were analyzed. The study was conducted in the following order: translation, expert review, reverse translation, preliminary investigation and interviews, and completion of the final version. Confirmatory factor analysis was applied to evaluate the validity of the instrument, and the Beck Depression Inventory, Korean version (K-BDI) was applied to confirm the criterion validity of the MQOL-R Korean version. The Cronbach's alpha coefficient, representing internal consistency, was measured to evaluate reliability. Results: Cronbach's alpha for all 14 questions was 0.862. The model fit indices for confirmatory factor analysis were within the acceptance criteria. The factor loadings of all four factors were over 0.50, and convergent validity and discriminant validity were confirmed. Regarding criterion validity, a negative correlation was found between the four factors of MQOL-R Korean version and the K-BDI. Conclusion: The MQOL-R Korean version, the reliability and validity of which were verified in this study, is a 15-item tool consisting of 14 items dealing with four physical, psychological, existential, and social factors and a single item evaluating the overall quality of life. The MQOL-R Korean version is an instrument that can more concisely and effectively measure the quality of life of patients with life-threatening diseases.

• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.119-126
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• 2016

Purpose: This study analyzed the difference in survival time of patients with delirium according to sedative medication. Methods: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. Results: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=-3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). Conclusion: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.

• Journal of Hospice and Palliative Care
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• v.15 no.4
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• pp.205-211
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• 2012

Purpose: This study was performed to identify the level of stress perceived by nurses who attend dying patients in the cancer care unit; their understanding regarding end-of-life care and related training needs. Methods: A cross-sectional descriptive study was conducted with 151 nurses stationed at the cancer care units of four general hospitals located in Seoul and Gyeonggi province in Korea. Data were collected using self-reported questionnaires and the response rate was 96%. The data were analyzed using t-test, ANOVA and Pearson's correlation analysis. SPSS 12.0 was used for data analysis. Results: Nurses experienced a high level of stress in the end-of-life care settings. Their understanding of end-of-life care was above the mid-point of the scale while their training needs for end-of-life care was relatively high. The more experienced the nurses were, the more stressed they were, particularly due to excessive workload. Nurses who served longer in the cancer unit tended to show greater needs for end-of-life care training. Conclusion: This study found nurses perform end-of-life care with a high level of stress but with insufficient understanding, and thus, showed great needs for related training. Such findings can be useful to develop an end-of-life care training program for nurses.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.30-34
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• 2006

Purpose: This study is to report the operating result of the Hospice Cyber Counselling Program for improving quality of lift for terminal patients and their families. Methods: This study was performed followed by counsellor training, building strategy of public relations, management, and evaluation of the effect in order. Results: 72 subjects visited our cyber homepage and became members for approximately 9 months from Oct. 2004 to July 2005; 17 subjects in their 20s (23.6%), 12 subjects in their 30s (16.7%), 17 subjects in their 40s (23.6%), and 13 subjects above 50s (18%). Classified by diagnose related group, cancer related disease consist of 90%. As for the relationship between contents of counselling and counselling applicants, families consist of 90% and self-applicants only 10%. Only 30 members used on-line counselling and their counselling frequency was just 35 times. Although counselling frequency and the number of members who used the counselling site were not high, they tend to contact with a counsellor continuously and use the site actively after the first counselling. Conclusion: Cyber counselling program for hospice was practically managed to improve quality of life for terminal patients and their families as a basic activity for hospice business activation. Basic public relations with regard to hospice business by mass media and the press should be performed continuously and the hospice training program is required for medical personnel to be continue.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.114-121
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• 2007

Background: Apoptosis plays a crucial role in carcinogenesis, as well as in development and tissue homeostasis. Terminal deoxyribonucleotidyl transferase mediated neck end labelling (TUNEL) and in situ nick end labelling (ISEL) have been used to investigate the apoptosis in tissues. Since the introduction of the M30 monoclonal antibody to overcome drawbacks of TUNEL and ISEL, the apoptosis in various tumors, with the exception of pulmonary carcinomas, has been studied. In this study, attempts were made to examine the correlation of apoptosis in non-small cell carcinomas, using both M30 and the expression of p53 protein, with the clinicopathological factors. Material and Method: Forty five patients with surgically resected non-small cell carcinomas were included. Immunohistochemical staining with M30 and p53 monoclonal antibody were peformed, and their expressions compared with the clinicopathological features. The overall survival time and recurrence-free survival time were calculated, and the factors influencing the survival time analyzed using a univariate analysis. The effects of the expression stati of M30 and p53 on the risks of cancer related to both death and recurrence were evaluated using a multivariate analysis. Result: The p53 positive group had many more M30 positive cells than the p53 negative group (p53 positive group; $61.7{\pm}26.8$ cells vs. p53 negative group; $45.6{\pm}29.6$ cells, p=0.005) and significantly more p53 positive patients showing at least 10 positive cells (apoptotic index, $Al{\ge}1$) on M30 staining (p53 positive group; 52.4% (11/21) vs. p53 negative group 16,7% (4/24), p=0.025). In the univariate analysis, the survival times in relation to smoking (pack-year), performance status (PS) and Al showed significant differences. The multivariate analysis demonstrated the relative risk (R.R) of cancer death increased almost 7.5-fold (R.R 7.482; 95% Cl $1.886{\sim}29.678$; p=0.004) and the risk of recurrence almost 3,8-fold (R.R 3.795; 95% Cl: $1.184{\sim}12.158$; p=0.025) in the high Al (${\ge}1$) compared to the low Al (<1) group. There was no prognostic effect of p53 expression on the survival time or risk of cancer death and recurrence. Conclusion: In non-small cell lung carcinomas, M30 immunohistochemistry was an excellent method for analyzing apoptosis; the high apoptotic index could be an adverse prognostic predictive factor.

• Journal of Hospice and Palliative Care
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• v.24 no.4
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• pp.204-213
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• 2021

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

• Asian Oncology Nursing
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• v.2 no.1
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• pp.5-16
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• 2002

Purpose: This study was to develop a stress-adaptation model for family caregivers of cancer patients that could provide the basis of planning nursing intervention. Method: A hypothetical model was developed using the family adaptation model proposed by Haley et al. (1987). In the literature, the stressor was identified as patient's characteristics, caregiver's characteristics, duration of illness, and family life events. It affected stress appraisal, family resources, family coping and finally caregiver's adaptation. In this model, 18 paths were constructed. Data were collected from 241 caregivers, whose family members were in treatment between June and August 2000, at 3 university hospitals and were analyzed by SPSS and LISREL programs. Results: 1) The overall fitness indices of the hypothetical model were x 2=267.78 (P= .0), GFI= .92, AGFI= .87, NFI= .93, NNFI= .93, PNFI= .64, PGFI= .55, and RMR= .43. Ten of the eighteen paths proved to be significant. 2) To improve the model fitness, the hypothetical model was modified considering modification indices and the paths proved not significant. Final model excluded 3 paths demonstrated to be improved by x2=161.96 (P= .00), GFI= .95, AGFI= .91, NFI= .96, NNFI= .96, and RMR= .23. Twelve of fifteen paths proved to be significant. 3) Stress appraisal was influenced by disease related characteristics and duration of illness and was explained 22% of the variance. Family resources were influenced by stress appraisal and was explained 57% of variance. Family coping was influenced by disease related characteristics, caregiver's characteristics, duration of illness, family life event, and stress appraisal and was explained 57% of variance. Family caregiver adaptation was influenced by disease related characteristics, caregiver's characteristics, stress appraisal, and family coping and was explained 31% of variance. Twelve of fifteen paths were significant. Conclusion: Based on this study, to help family caregivers to adapt, individual intervention is necessary with consideration of disease related and caregiver's characteristics and duration of illness. The intervention should include efforts to raise the family resources and to identify positively the stress they encounter, and there is a need to establish an adaptation model that considers emotional aspects of family caregivers. Since there is a difference in emotional status depending on the disease stage, a study needs to be done to analyze the differences among the disease stages (diagnosis, treatment, recurrence, and terminal stages).

• 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.