Comparison of Life-Sustaining Treatment in Terminal Cancer Patients between a Cancer and Hospice Unit after Do-Not-Resuscitate Orders

PURPOSE: The purpose of this study was to compare the differences in the performance of life-sustaining treatment after signing a do-not-resuscitate (DNR) order between terminal cancer patients who died in the cancer unit and hospice unit. METHODS: We performed a retrospective analysis of 174 patients who died in the cancer unit (CU) and 68 patients who died in the hospice unit (HU) from January 1, 2016 to December 31, 2016 at a hospital specializing in cancer treatment. RESULTS: The rate of life-sustaining treatment administration was lower for patients who died in the HU than that of those who died in the CU. The period until death after signing a DNR order was 7 days for CU patients and 19.5 days for the HU patients. The period from admission to death was also significantly longer in HU patients (32.5 days) than that in CU patients (21.5 days, p < .001). Of the patients who died in the CU, 54% were referred to the HU but did not use the service. Most of the people who signed DNR informed consents were spouses and offspring; only 4.6% of patients signed DNRs. CONCLUSION: It is hard to say that life-sustaining treatment increases the survival period, but it can improve symptom control and quality of life in hospices. Activation of consultation-based hospice is necessary for patients who cannot use the hospice unit. To increase patient's active participation in the life-sustaining treatment decision of terminal cancer patients, it is necessary that an advanced practice nurse specialized in counseling and education is involved in the decision.

Factors Related with Utilizing Hospice Palliative Care Unit among Terminal Cancer Patients in Korea between 2010 and 2014: a Single Institution Study

BACKGROUND: Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS: We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS: The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was “refusing hospice facility” (34.9%), followed by “near death,”“poor accessibility to an HPCU,” and “caregiving problems.” CONCLUSION: Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.

Effects of HACCP Implementation on an Industry Foodservice Operation in Daegu

The purpose of this study was to evaluate the effects of HACCP implementation. The HACCP education was provided twice within one month to 20 employees of a contracted food service operation in Daegu. Critical control points (CCP) were determined based on food preparation processes: non-heating, preparation after heating, and heating. We evaluated the effects of HACCP implementation by checking microbiological quality, time and temperature at each of the CCPs during the receiving, preparation, cooking, and serving stages. After HACCP implementation, the biggest changes in microbiological qualities were in heated foods. At the cooking and serving stages, the microbiological qualities of heated foods improved to the standard levels. HACCP education helped employees ensure that the internal temperatures of the heated foods were kept higher than the standard (74 degrees C) and the food holding temperature avoided the dangerous zone (5-60 degrees C), thus lowering microbiological levels. At the serving stage, the microbiological levels of utensils also improved after HACCP education. This result strongly suggests that it is essential to educate employees in managing the temperature to treat foods safely. However, HACCP education didn't affect the microbiological levels of non-heated foods and foods prepared after heating, which continued to be higher than the standard. The reason for this was that poor microbiological quality seasonings were added to those types of foods. This indicates that seasoning factories as well as food service operations should implement HACCP to reduce hazards.

Evaluation of Sanitary Management based on HACCP of Business and Industry Foodservice Operations in Taegu and Kyungpook Areas

The purpose of this study was to evaluate the status of sanitary management based on HACCP. The surveys which were on various aspects of general characteristics, food handling practice, personal sanitation, equipment sanitation, and equipment possession were carried out using questionnaires for 146 business and industry foodservice operations in Taegu and Kyungpook areas. The results of this study were summarized as follows. Forty-nine percent of surveyed foodservice operations was in Taegu, 51% in Kyungpook and 69.2% in direct foodservice operations and 28.1% in contracted foodservice operations. Seventy-eight percent of foodservice operations replied that they have done only basic sanitary management, while 13% surveyed stated that they were implementing HACCP. Food handling practice and personal sanitation were significantly better in Kyungpook area than in Taegu. Significantly high levels in food handling practice, personal sanitation, equipment sanitation, and equipment possession were seen in foodservice operations which had more than 1,000 meal served than those which had less than 1,000 meals served. According to the results of food handling practice, in items of food-temperature measurement during receiving, cooking, holding after cooking, and reheating, foodservice operations showed very low scores below the average. All foodservice operations presented good scores in the parts of personal and equipment sanitation. In equipment possession, sterilizing systems were generally not enough, dishwasher and sterilizing facilities of contracted foodservice operation showed significantly high scores. Therefore, the business and industry foodservice operations will have to pay special attention to temperature management in the foodservice production process as the first step to implement of HACCP.