완화 의학 관련 학술대회 및 홈페이지, 저널 소개 서울특별시립동부병원 가정의학과 김대영 한겨레21 창간 10돌 기념으로 2004년 10월 휴먼다큐멘터리 사진공모전 입상작이 발표되었다. 장호열씨의 금상작을 포함하여 총 네 작품을 선정하였다. 금상작 ‘생의 마지막 걸음-호스피스’는 “삶과 죽음이란 어려운 주제를 매우 안정적이고 호소력 짙게 표현”한 수작이다 서울특별시립동부병원 가정의학과 김대영

소득계층에 따른 암환자의 암 종별 의료이용에 관한 연구결과 소득계층에 따른 암환자의 암 종별 의료이용에 관한 연구결과 (1999년 신규 발생한 암환자를 대상으로 5년간 추적 연구한 결과) 2006.8.24. 보건복지부

소득5계층>소득1계층(남자 1.4배, 여자 1.2배) 5년간 상대생존율 소득1계층>소득5계층 지역별 의료이용율 소득계층에 따른 암발생률 소득5계층>소득1계층(남자 1.4배, 여자 1.2배) 5년간 상대생존율 소득1계층>소득5계층 (남자 42.4%대 26.9%,여자 59.7%대 50.0%) 지역별 의료이용율 사망장소별 사망전 1년간 진료 교육수준에 따라 소득계층간 유의한 차이가 발생

2005년 사망원인통계결과 2006년 9월 통계청 발표

사망원인별 사망률 비교

각종 암의 성별 사망률(2005) 남자 : 폐암, 간암, 위암 여자 : 위암, 폐암, 간암

완화의료의 방향은?

말기암 환자 진료의 정상화방안 3차 의료기관 (가정) 환자/가족 병원중심기관 병동형 산재형 2차 의료기관 1차 의료기관 지역중심기관 시설형 가정형 (가정) 환자/가족

호스피스-완화의료 제도화 (병상) 3차 의료기관에 거주지의 장기입원중인 1, 2차 의료기관 말기 암 환자 가정에서 제대로 진료도 받지 못한 채 임종하고 있는 소외된 환자 지원 (재원) 3차 의료기관 ‘무의미한 의료행위‘의 중단  절약된 재원

소개

웹사이트 http://hospicecare.co.kr/ http://www.nccn.org/ http://www.nhpco.org/ http://www.plwc.org/ http://www.capc.org/ http://www.epec.net/ http://www.pain.com/ http://palliativedrugs.com http://www.ampainsoc.org/ http://www.eperc.mcw.edu/ http://www.eapcnet.org/ http://www.hms.harvard.edu/cdi/pallcare/ http://www.hospicecare.com/

Fast Fact and Concept #001; Treating Terminal Delirium 2nd Edition Author(s): Weissman, D. Some degree of cognitive function loss occurs in most patients in the week or two before death. The typical scenario presented to housestaff is a late-night call from a ward nurse saying, “Mr. Jones is confused, what should we do”. This Fast Fact reviews assessment and management issues in terminal delirium. Key teaching points: The term “confusion” is not an accurate descriptive term—it can mean anything from delirium, dementia, psychosis, obtunded, etc. Patients need a focused assessment, including a brief mini-mental examination. Clinicians should use one of several validated delirium assessment tools to help quantify and document cognitive function. Delirium can be either a hyperactive /agitated delirium or a hypoactive delirium; the hallmark of delirium is an acute change in the level of arousal; supporting features include altered sleep/wake cycle, mumbling speech, disturbance of memory and attention and perceptual disturbances with delusions and hallucinations. The most common identifiable cause of delirium in the hospital setting is drugs: anti-cholinergics (anti-secretion drugs, anti-emetics, anti-histamines, tricyclic anti-depressants, etc.), sedative-hypnotics (e.g. benzodiazepines) and opioids. Other common causes include metabolic derangements (elevated sodium or calcium, low glucose or oxygen); infections; CNS pathology; or drug/alcohol withdrawal. The degree of work-up to seek the cause of delirium is determined by understanding the disease trajectory and overall Goals of Care, see Fast Fact #65. The drug of choice for most patients is a major tranquilizer. There is one controlled clinical trial of haloperidol versus lorazepam in HIV patients; haloperidol was the superior agent. Haloperidol is administered in a dose escalation process similar to treating pain. Start haloperidol 0.5-2 mg po or IV q1 prn. Benzodiazepines can be used, but may cause paradoxical worsening of symptoms. Non-pharmacological treatments should always be used in delirium management: reduce or increase the sensory stimulation in the environment as needed; ask relatives/friends to stay by the patient; frequent reminders of time/place. See Fast Fact # 60 for a discussion of newer pharmacological treatments

책 Oxford Textbook of Palliative Medicine by Derek Doyle , Geoffrey Hanks , Nathan I. Cherny , Kenneth Calman Oxford Handbook of Palliative Care by Max Watson, Caroline Lucas, Andrew Hoy, Ian Back Palliative Medicine: A Case-based Manual by Neil MacDonald, Doreen Oneschuk , Neil Hagen , Derek Doyle Introducing Palliative Care by Robert G. Twycross Outpatient Management of Advanced Cancer: Symptom Control, Support, and Hospice-In-The-Home by J. Andrew Billings Palliative Care Formulary by Robert Twycross, Andrew Wilcock, Sarah Charlesworth, Andrew Dickman Palliative Care in the Home by Derek Doyle, David Jeffrey, Kenneth Calman

저널 Supportive Care in Cancer Journal of Pain and Symptom and Management Palliative Medicine Journal of Palliative Medicine Journal of Palliative Care European Journal of Cancer European Journal of Cancer Care Palliative and Supportive Cre Journal of Cancer Education Quality of Life Research American Journal Hospice and Palliative Care European Journal of Palliative Care Pain Progress in Palliative Care

단체 및 학술대회 캐나다 유럽 미국 한국 호스피스.완화의료 학회 http://hospicecare.co.kr/ The 18th World Congress of the Children’s Hospice International : Sep 7 - 9, 2007, Singapore 아시아 7th Asia Pacific Hospice Conference : Sep 27 – 29, 2007 Manila www.aphc2007.com 캐나다 16th International Congress on Care of the Terminally Ill : Sep 26-29, 2006, Montreal, Canada http://pal2006.com/index-e.html 유럽 10th congress of the European association for palliative care : June 7-9,2007, Budapest, Hungary http://www.eapcnet.org/budapest2007/ 미국 Annual Assembly of AAHPM and HPNA : February 14-17,2007 http://www.aahpm.org/

감사합니다.