[Aiming at the Spread of Palliative Care in Community Health Care-Consideration of Human Resource Development from the Viewpoint of the Home Physician and Support Hospital].

Palliative care for cancer patients requires information sharing, including prognoses, to fulfill the wishes of the patient and patient's family as well as to avoid wasting time. It is necessary to recognize the importance of the pre-discharge conference and home medical care to realize the wishes of the patient and the patient's family.

[Influence of the Timing of Cessation of or Withholding Chemotherapy and End-of-Life Care at Home in Patients with Incurable Solid Cancers-An Interim Report of the Results of the Questionnaire Survey among Home Care Physicians in Japan].

Background: The study analyzed data obtained using a questionnaire on the potential discriminative characteristics of patients with an incurable solidcancer who receivedor didnot receive palliative chemotherapy during end-of-life care at home. From the standpoint of regional palliative care, we aimed to investigate the influence of the timing of cessation of or withholding chemotherapy andend -of-life care at home in patients with incurable solidcancers. We plannedthe project to obtain scientific evidence about the timing of cessation of or withholding chemotherapy.

[Usefulness of Peripherally Inserted Central Venous Catheters for Cancer Patients in Palliative Care Settings].

Peripherally inserted central venous catheters(PICCs)are widely used given they have lower incidence of serious complications than central venous catheters. We evaluated the safety and usefulness of ultrasound-guided PICC placement for cancer patients in palliative care settings. We attempted to insert PICCs in 42 patients, and the insertion was successful in 40 (95.

[Considering the Role of Home Care Support Clinics at a Pre-Discharge Conference].

In this study, we considered the role of home care support clinics for patients who wanted to go back to their homes from a hospice, duringa pre-discharge conference. The subjects of our study were 8 patients, of which 7 of them had cancer. Two patients died after the conference.

[The Influence of the Timing of Ceasing or Withholding Chemotherapy in Home-Based End-of-Life Care in Patients with Incurable Solid Cancer - Release of an Interim Report of the Questionnaire Survey to Home Care Doctors in Japan].

Background: The study analyzes a questionnaire on the potential discriminative characteristics of patients with incurable solidcancer, who either receivedor didnot receive palliative chemotherapy while receiving home-basedend -of-life care. From the standpoint of regional palliative care, we sought to investigate the influence of the timing of when chemotherapy was ceasedor withheldin home-basedend -of-life care in patients with incurable solidcancer. We plannedthe project to obtain scientific evidence about the timing of ceasing or withholding chemotherapy.

[End-of-Life Decision Making Support in Palliative Homecare].

Advance care planning is important in end-of-life decision making in home-based palliative care for both cancer patients and non-cancer patients.

[Clinical Utility of Tapentadol].

Tapentadol(TP)is a new strong opioid analgesicthat has both m-opioid receptor(MOR)effects and norepinephrine reuptake inhibitor(NRI)effects. In comparison with the existing strong opioid analgesics, the mechanism of action suitable for palliation of neuropathic pain is expected to be better for TP. The analgesic effect and side effects of this drug were tested in 10 cases of exacerbation of neuropathic pain at our hospital, and the sedative response rate was 70%.

Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels.

Background: Cardiovascular diseases, osteoporosis, and depression are identified comorbidities of chronic obstructive pulmonary disease (COPD), but there have been few reports of chronic kidney disease (CKD) as a comorbidity of COPD. The objective of this study was to investigate the prevalence of CKD in COPD patients using estimated glomerular filtration rate (eGFR) based on creatinine (Cr) and cystatin C (Cys) levels.

Methods: The prevalence of CKD and the values of various CKD-related parameters were compared between 108 stable COPD outpatients (COPD group) and a non-COPD control group consisting of 73 patients aged 60 years or more without a history of COPD or kidney disease.

[A case of stage IV b pancreatic cancer in which a catheter-related infection caused by epidural/subcutaneous reservoir therapy affected palliative home-based care].

We report the case of a patient with a stage IV b pancreatic cancer in which epidural/subcutaneous reservoir therapy was effective for pain control. However, a catheter-related infection caused by methicillin-resistant Staphylococcus aureus (MRSA)was occurred. In recent years, the number of cancer patients desiring palliative home-based care in Japan has increased.

[Cell-free and concentrated ascites reinfusion therapy(CART)].

The cell-free and concentrated ascites reinfusion therapy(CART)is a useful palliative maneuver in a patient suffering from ascites. I think that home medical care cooperation is essential to diffuse at home CART.

[Is home palliative care for head and neck cancer patients a possibility ?].

It is likely that home palliative care for head and neck cancer patients could be treatable at general hospitals or clinics whereas combined joint efforts by medical cooperation from specialists, who are specialized in understanding of the singularity and how to cope with the symptoms, are existed.

[Usefulness of epidural catheter with the subcutaneous reservoir for cancer pain control in homecare service].

The epidural block therapy is offered to reduce one of the side effects of systemic administration of opioids such as drowsiness. Hence, it is necessary to set a subcutaneous reservoir to prevent a catheter-related infection for a long period of time. One hundred twenty five patients with this manipulation during the year 2004 to 2010 showed a significant improvement in their pain level calculated by Numerical Rating Scale(NRS).

[The change in home palliative care].

A promotion of home palliative care at our clinic has been built with many factors including a home medical care desired by patient's family, governance of the law, progress of medical measures and an improvement of medical cooperation.

[A case with an ovarian cancer patient who could receive anti-cancer therapy and palliative care simultaneously at home through seamless collaboration in healthcare linkage].

A palliative care team provides palliative care in the hospital setting.However, palliative care might be discontinued when a patient was switched to an outpatient from an inpatient or when a patient was being transferred to another hospital.In the present work, we report a case who could receive anti-cancer therapy and palliative care simultaneously at home.

Novel cell-free and concentrated ascites reinfusion therapy (KM-CART) for refractory ascites associated with cancerous peritonitis: its effect and future perspectives.

Background: We have actively carried out cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites. However, with conventional CART, the membrane becomes clogged after processing about 2 L of cancerous ascites fluid due to the fact that it is rich in cellular and mucous components; it is therefore difficult to process the entire volume of collected ascites.

Methods: We developed KM-CART which includes a membrane cleaning function, and applied it in 73 cases of cancerous ascites, after its basic functions had been evaluated in 11 cases of refractory cancerous ascites.

[Experimental inhalation therapy with nebulized tiotropium in COPD patients unable to use the Handihaler].

Background: We report the efficacy and safety of experimentally nebulized tiotropium use. We identified 19 elderly very severe COPD (GOLD stage IV) inpatients unable to use tiotropium in the Handihaler by themselves from January 2008 through May 2009. The contents of an 18 microg capsule of tiotropium were dissolved in 5 ml saline and nebulized via a nebulizer.

Development of a predicting tool for survival of terminally ill cancer patients.

Objective: To develop a predicting tool for survival of terminally ill cancer patients.

Methods: This prospective, multicenter study was composed of two cohorts of samples: development and test. In the development sample of terminally ill cancer patients, 32 candidate predictors were studied to develop a new tool, Japan Palliative Oncology Study-Prognostic Index using the Cox proportional hazard model.

[BNP measurement for perioperative management].

Background: It is difficult to evaluate the tolerance to anesthesia of patients undergoing operations, who have risk factors of congestive heart failure, such as hypertension, old age or various cardiac diseases. BNP (B type natriuretic peptide) is a useful biomarker as a screening tool for LV dysfunction. Therefore we hypothesized that the measurement of BNP may be useful for perioperative management of these patients.

[The medical cooperation in home palliative care with regard to "hospital-medical office and hospital-hospital disease cooperation"].

In the medical cooperation of home palliative care, it often happens to be one-way cooperation. Therefore, it is necessary to have a capability of "home medical support hospital" with functions like helping the patient and his family to prepare for a home care transition and a way to cope with emergency situations.

[The medical cooperation in home palliative care--a design of cooperation with the visiting nursing station].

In home palliative care on site, the trinity of cooperation in "medical-nursing-patient" care is essential. It is necessary to cooperate with the visiting nursing station and to give special considerations in the areas of sharing information, understanding of the difference between in-patient and out-patient and the management of mental health of the caregivers.

Artificial hydration therapy, laboratory findings, and fluid balance in terminally ill patients with abdominal malignancies.

To explore the association between hydration volume and laboratory findings, and between calculated fluid balance and changes in clinical signs of dehydration and fluid retention in terminally ill cancer patients, a secondary analysis of a large multicenter, prospective, observational study was performed. The study enrolled 125 abdominal cancer patients who received laboratory examinations in the last week before death. Patients were classified into two groups: the hydration group (n = 44), who received 1L or more of artificial hydration per day both 1 and 3 weeks before death, and the nonhydration group (n = 81).

[Breast cancer and home care].

In the case of home care treatment of breast cancer patient, it is necessary to consider both social and medical problems based on the characteristics of breast cancer and associated its problems.

[How to use rescue-dose in home hospice care].

In home hospice care, we must try to control steady pain, to give guidance about medication, and to calm anxiety once out of the hospital. We think that it may be important to consult on the issues related to rescue-dose drugs, selection of the drug from the stand point of QOL, and to counsel on behalf of the patient and family.

[Usefulness of fentanyl patch in home palliative care].

Fentanyl patch (Durotep patch) is useful analgesic for terminal patients under home care, but the patients family may feel uneasy because they have to determine the induction dose, prepare the rescue drug, and a variety of drug durability.