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원영웅,김화정,권정혜,이하연,백선경,김유정,김도연,류혜원 대한암학회 2021 Cancer Research and Treatment Vol.53 No.4
Purpose In Korea, the “Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life” was enacted on February 4, 2018. This study was conducted to analyze the current state of life-sustaining treatment decisions based on National Health Insurance Service (NHIS) data after the law came into force. Materials and Methods The data of 173,028 cancer deaths were extracted from NHIS qualification data between November 2015 and January 2019. Results The number of cancer deaths complied with the law process was 14,438 of 54,635 cases (26.4%). The rate of patient self-determination was 49.0%. The patients complying with the law process have used a hospice center more frequently (28% vs. 14%). However, the rate of intensive care unit (ICU) admission was similar between the patients who complied with and without the law process (ICU admission, 23% vs. 21%). There was no difference in the proportion of patients who had undergone mechanical ventilation and hemodialysis in the comparative analysis before and after the enforcement of the law and the analysis according to the compliance with the law. The patients who complied with the law process received cardiopulmonary resuscitation at a lower rate. Conclusion The law has positive effects on the rate of life-sustaining treatment decision by patient’s determination. However, there was no sufficient effect on the withholding or withdrawing of life-sustaining treatment, which could protect the patient from unnecessary or harmful interventions.
원영웅 한양대학교 의과대학 2014 Hanyang Medical Reviews Vol.34 No.1
Lung cancer is the leading cause of cancer-related mortality worldwide, including in Korea. Although various treatment modalities have been developed, the prognosis of patients with lung cancer is still very unfavorable. Most patients with lung cancer are diagnosed at an advanced stage, and palliative care remains the only therapeutic option for these patients. Accordingly, early detection of lung cancer may lead to a decrease in lung cancer-related mortality. Therefore, considerable interest has been generated in the development of screening tools to detect lung cancer at an early stage. Although chest radiography and sputum cytological evaluation have been used to screen patients for lung cancer, the sensitivity and specificity of these procedures are not adequate. Recently, low-dose computed tomography (LDCT) has emerged as a promising screening technique, and several trials have demonstrated its benefit in the high-risk population. One such well-designed and well-conducted trial, the National Lung Screening Trial (NLST), showed a 20% reduction in lung cancer-related mortality. Based on the results of NLST and other trials, screening for lung cancer using LDCT is recommended in asymptomatic patients who are at a high risk for lung cancer, with regard to age and smoking history. The present report is a comprehensive review of available evidence on the benefits and risks of lung cancer screening and summarizes some recommendations.
원영웅,강진형,권정혜,구동회,강정훈,맹치훈,안희경,오성용,이대원,손주혁,오소연,이경희,고수진,이근석,김찬규,김지연,지준호,김성배,하주영,김호영 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4
Purpose Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. Materials and Methods This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. Results Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. Conclusion The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.
고세일,원영웅,강정훈 대한의사협회 2022 대한의사협회지 Vol.65 No.1
Background: Opioids are effective analgesics for cancer pain and refractory non-cancer pain. Although they are essential medication, problematic issues on aberrant behavior and adverse events have rapidly emerged as social problems in Korea. This study aimed to describe the mechanisms, efficacy, and adverse events, especially how to deal with opioid dependency. Current Concepts: Opioid-induced aberrant behavior includes physical and psychological dependences (addiction), abuse, and diversion (giving prescribed opioids to another person). Most physicians are unfamiliar with how to handle patients presenting these problematic issues. Physical and psychological dependences develop through different pathophysiologic mechanisms, i.e., noradrenergic and dopaminergic pathways, respectively. Motivational enhancement therapy, psychosocial support, substitution therapy with buprenorphine, and adjunctive medications, including alpha-2 adrenergic agonist, antidepressants, and non-steroidal antiinflammatory drugs, are the mainstay of treatment for opioid dependency. Constipation, nausea/vomiting, drowsiness/sedation, delirium, itching sensation, voiding difficulty, dry mouth, opioid-induced hyperalgesia, and respiratory depression are well-known physical side effects of opioid consumption. Discussion and Conclusion: Research on the development history, epidemiology of opioid dependency, and its treatment are warranted to avoid an opioid crisis in Korea. Above all, thorough knowledge for physicians and patients is urgently needed.