1.篇名：The role of chemoradiotherapy in maintaining quality of life for advanced esophageal cancer
期刊名稱：AM J HOSP PALLIAT CARE
頁數/論文頁次：no. 1 29-31
1. Robert Tan, MD /Department of Radiation Oncology, Minsheng General Hospital, Taiwan 2. Andrew Young, MD/Department of Clinical Oncology, Taiwan Provincial Taoyuan Hospital, Taiwan
From May 1996 to July 1996, three male patients with advanced esophageal cancer with complete obstruction were treated with concurrent chemoradiotherapy. The first two courses of chemotherapy using 5-Fluorouracil (500mg/m 2 ) and Leucovorin (200mg/m 2 ) on day one through day five were given concurrently with radiotherapy. After completion of radiotherapy, four more courses of chemotherapy using the same regimen were given every four weeks. The total dose of irradiation using six MV linear accelerator given to the primary tumor was 5,000 cGy in 28 fractions. All three patients had relief of their obstruction with complete regression of the tumor after the completion of their treatment. All patients improved clinically and were able to remain symptom-free until the time of their death. The first patient survived for 12 months and died of respiratory failure because of his chronic obstructive pulmonary disease. The second patient also survived 12 months but died of liver metastasis. The third patient lived for 10 months and died of aspiration pneumonia.
2.篇名：Introducing the Chinese Association for Life Care
China has become an aging society. The number of people aged 60 and older has reached 120 millions. The annual increasing rate for people aged 80 and older is 5%. So the needs for medical care and support for daily living among the elderly have been increasing. More and more elderly people are suffering from chronic illness and their physical functions are getting worse. There are great demands for psychological consultation, health promotion and disease prevention and control in order to improve their quality of life and decrease the family and social burden.
In the last few years, multiform of hospice care organization, nursing home and old age home have been built nationwide. This is the inevitable outcome of society development and the need of material civilization and spiritual civilization. People in their late stage of their life should be surrounded with love and help, have less pain, less suffering, so that they could walk through their last journey with dignity. At the same time family members should also get social and psychological support in order to pass smoothly through bereavement. Thus the need emerged to set up and develop hospice care in China.
In the opening ceremony of the First International Hospice Conference between Eastern and Western Country Professor Chen MinZhang, the former Minister of Health said "Take care of the patients in their late stage of life, not only to maintain the person's dignity, but also to alleviate the burden on their family and institution, it is also a part of developing social productivity, is a philanthropic act without negative result."
The development and practice of the Chinese Association for Life Care is closely related with people's quality of life. In order to develop and optimize the business concerning life care, the urgent demand was to establish an organization that would motivate people involved in life care nationwide to move this business forward, to standardize and systematize the activities. Thus we established the Chinese Association for Life Care.
The task of the Chinese Association for Life Care:
1. Enhance domestic and international academic cooperation; realise domestic and international scientific exchange in the field of hospice care.
2. consistent with the topics of life care, mobilize the members of our association to disseminate and promote the knowledge of life care and health promotion.
3. Spread and disseminate the theory and practice of palliative medicine and hospice care to the medical professionals and the public, mobilize social public to participate in life care services.
4. Formulate the regulation of hospice care, establish evaluation index of patient's condition, mental and psychological status and treatment principle, exchange service-related experiences of caring for the terminally ill, and supervise the community workers who carry out patient treatment and hospice care services.
5. Train professional staff, nurse aids, relatives, volunteers, and social workers in order to develop their techniques for human care, daily living support and improve other skills.
6. Combine the traditional medicine and western medicine to develop and promote a high level of life care.
7. Assist the government to issue the related hospice care legislation (regulation).
8. Raise funds; provide equal access to hospice care for poor patients in the late stage of their illness
9. Acknowledge the outstanding and instrumental persons in the life care.
The association should include doctors, nurses, psychological consultants, social workers, volunteers, law workers, religious workers, public media, the respective government section and all people who support life care affairs.
Introducing the Sponsors:
1.Professor Li JiaXi: the wife of Professor Chen MinZhang, the former Minister of Health. She has strived to carry out the behests of Minister Chen MinZhang related to life care affairs. She set up the Beijing Dong Fang Cancer Center and hospice hospital. She organized and facilitated scientific exchange among national and international experts, and sponsored the establishment of life care institutions. At present she is a research fellow at the National Geology Experiment Center, and Biological Environment and Geochemistry Research Center, Chinese Geology Academy. She is also the honorary member of the Chinese Council for International Scientific Exchange Fund.
2.Professor Wu WeiRan: Professor of Surgery, honorary president of Beijing Hospital, member of the Central Health Care Committee, Standing member of Council, the Chinese Association of Medical Science.
3.Professor Geng DeZhang: Professor of Medicine, the former president of Beijing Hospital, the former directorof the Health Care Office at the Ministry of Health.
4.Professor Cui YiTai: Professor of Psychology, the former President of Tianjin Medical University, Vice-chairman of the Chinese Association of Mental Health, Vice-chairman of the Chinese Association of Sexology. He was the first person to establish the hospice care institution in China. He has organized many national and international hospice conferences.
作者：陳秋媚(Chiu-Mei Chen);周希諴(Hsi-Hsien Chou);陳素蘭(Su-Lan Chen);鄭向帆(Hsiang-Fan Cheng);賴思岑(Szu-Tsen Lai);胡文杰(Wen-Chieh Hu);洪維廷(Wei-Ting Hung);王素鴻(Su-Hung Wang);黃智棼(Chih-Feng Huang);王淑如(Shu-Ju Wang);楊友華(Andrew Young)
The professional community and society at large in Taiwan are gradually recognizing the benefits that hospice palliative care can deliver in terms of improved quality of terminal care and dignity for terminally ill patients. In order to assess the status of hospice palliative care in the medical curriculum as currently taught in Taiwan, the authors developed a study to determine a respondent’s knowledge of and attitudes toward hospice palliative. This study was then executed on a study population of medical students and practicing physicians located at a university hospital campus in central Taiwan. Medical students in their first through fifth years and physicians practicing at the university hospital were requested to participate. We designed a questionnaire covering three “domains”, which the respondents were requested fill out on their own time. The first domain tested a respondent’s knowledge of hospice palliative care basics. It included four sections covering 1) the definition of hospice palliative care; 2) the types of diseases typically covered by hospice palliative care; 3) items of hospice palliative care; and 4) the component members of a standard hospice palliative team. The second domain assessed respondent attitudes toward hospice palliative care. Issues covered included 1) respondent willingness to disclose a terminal diagnosis to his/her patient; 2) willingness to see National Health Insurance cover hospice palliative care costs; 3) desire to see thanatology incorporated into the compulsory medical curriculum; 4) willingness to become a hospice palliative care volunteer; 5) willingness to serve as a terminal care physician; and 6) interest to see a formal hospice-training curriculum instituted in medical school. The third domain gathered respondent background information. Survey results indicated physicians have a significantly greater understanding of hospice palliative care than do medical students. Physicians were relatively more agreeable (P<0.05) to revealing a terminal diagnosis to their patient, more in favor (P<0.05) of paying for hospice care with National Health Insurance funds, and felt more strongly about including thanatology as part of the compulsory medical education curriculum than their medical student associates. The difference separation the 90.6% of physicians and 86.3% of medical students who agreed with the need to institutionalize a formal hospice palliative care in the medical school curriculum was not significant. These results show that hospice palliative care education should be improved and expanded for medical students and clinical physicians.
Keywords 安寧緩和;醫師;醫學生;知識;態度;hospice palliative;physician;medical student;knowledge;attitude
4.篇名：Current Practice Using Hospice Palliative Care for Neurological Diseases
安寧療護的原始名稱為「驛站」，是指一個為了旅途勞累的朝聖者而設的「休息站」。現在的安寧療護則代表了一個多專長的醫療團隊，對於各種的末期病患提供了一種多專業的緩和性醫療照護，相對於傳統醫療所強調的根治性醫療。許多神經科疾病都是不可治癒且常都是長期的疾病，這種特質讓這些病患比其它疾病的患者嚐受了更多的煎熬與折磨。雖然三十多年前當安寧緩和醫療剛開始的時候，大部分的治療對象都集中在癌症末期的病患上。然而隨著安寧緩和醫療概念的推廣普及，與安寧緩和專科醫學的設立之後，安寧療護的對象也漸漸的擴展到了所有的疾病末期的病患，其中也包括了神經科疾病的末期病患。神經科的專科醫師們大約從十五年前開始，就陸陸續續的將一些特定的神經科情況以及神經科疾病，界定為只有安寧緩和醫療才是適合這些病患的醫療照護方法。這些特殊病況與疾病包括了：1 持續性的植物人狀態。2 愛滋病末期。3意識狀態的病患但具深度的或是無法回復的麻痺狀態。4 嚴重的中風。5 高頸椎脊髓傷害。6閉鎖症候群。7 重度失智症。8 重度多發性硬化症。9進行性無法治癒的神經肌肉性疾病譬如運動神經原疾病。然而在我們神經科的臨床領域裡，仍然有不少的疾病沒有被列入以上的名單當中。例如巴金森氏症，脊髓小腦萎縮症，Duchenne肌肉萎縮症以及神經性梅毒等等疾病，都需要神經科醫師們提供更舒適的臨終照護，來改善這些末期病患的生活品質與維護其最後的尊嚴。
The term “hospice” has historically been used in relation to inns and lodges where weary travelers could find a respite from their journey. Today, “hospice palliative care” refers to a multidisciplinary team providing a special type of care to terminally ill individuals. There are numerous neurological diseases that are incurable and chronic in nature, which cause suffering in patients that is typically more prolonged than in patients with other terminal diseases. The early hospice movement, which began about thirty years ago, targeted terminal cancer patients almost exclusively. However, with the spread of the hospice concept and the formalization of the field of palliative medicine, the definition of hospice palliative care has grown to cover endof- including the life care for all kinds of terminally ill diseases-terminal stages of neurological disorders. Beginning some fifteen years ago, neurologists began defining which urological conditions and disorders for which palliative care represented the preferred treatment option.Today, these include patients with the following conditions: 1. comatose; 2. AIDS; 3. profound and irreversible paralysis with retained consciousness and cognition; 4. severe stroke; 5. high cervical spinal cord lesions; 6. locked-in syndrome; 7. advanced dementia; 8. advanced MS; and 9. progressive and incurable neuromuscular diseases such as certain motor neuron diseases and muscular dystrophies. However, there remain other neurological diseases not yet included on this list which have been shown to benefit greatly from hospice palliative care in our clinical practice. Many patients in the terminal stage of neurological disorders such as Parkinson's disease, spino-cerebellar disorders, Duchenne muscular dystrophy, neurosyphilis, and so on are in urgent need of more suitable end-of-life care from neurologists in order to improve their quality of life and provide necessary dignity.
並列篇名：Palliative Radiotherapy Symptom Control in Hospice Care