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웹사이트 http: //hospicecare. co. kr/ http: //www. nccn. org/ http: //www. nhpco. org/ http:

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 2 nd Edition Author(s): Weissman, D.

Fast Fact and Concept #001; Treating Terminal Delirium 2 nd 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: anticholinergics (anti-secretion drugs, anti-emetics, anti-histamines, tricyclic antidepressants, 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 q 1 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 • Oxford Handbook of Palliative Care by

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

저널 Supportive Care in Cancer Journal of Pain and Symptom and Management Palliative Medicine

저널 Supportive Care in Cancer Journal of Pain and Symptom and Management Palliative Medicine Journal of Palliative Care 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 한국 호스피스. 완화의료 학회 http: //hospicecare. co. kr/ The 18 th

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