ABSTRACT
To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.
ABSTRACT
There were no reports about long survival predictors in palliative care settings. We divided categories into more than 31 days of hospitalization (short period hospitalization) and more than 61 days of hospitalization) (long hospitalization) and analyzed prognostic factors in multivariate methods. We measured the association between the long hospitalization and short period hospitalization groups with regard to terminal symptoms (cancer pain, delirium, nausea and vomiting, fatigue, and dyspnea) and treatment (hydration, continuous sedation, and opioids). In the more than 31 days of hospitalization group, sex (Odds Ratio 0.502), consciousness (Odds Ratio 0.258), and calcium levels (Odds Ratio 0.559) were statistically significant. In the more than 61 days of hospitalization group, the serum CRP level (Odds Ratio 0.254) was statistically significant and serum calcium level (Odds Ratio 0.376) exhibited a trend. The prevalence of fatigue and amount of hydration were significantly low in the more than 31 days of hospitalization group. There were no differences in terminal symptoms and treatment in the more than 61 days of hospitalization group.
ABSTRACT
<p>Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.</p>
ABSTRACT
The purpose of the present study was to indicate the relationship between health-related quality of life (HRQOL) measures, the daily rhythm of oral temperature (OT), and lifestyle. Five-hundred young men volunteered to participate in this study. Their OT, measured using a digital thermometer, was recorded every 2h from the time they woke up to the time they went to sleep for 1 week. The daily rhythm of OT was calculated as a quadratic function using the 1-week data. The HRQOL was measured using the Short-Form 36-Item Health Survey version 2 (SF-36v2). The participants were divided into 3 groups: a high-value group (HG) with ≥ 55 points of each summary score and each subscale score, a middle-value group (MG) with score > 45 and < 55 points, and a low-value group (LG) with score ≤ 45 points. Lifestyle was assessed in terms of eating habits, sleeping and exercise, and the presence of unidentified complaints. At the mental component summary, the OT at the time of waking up and the peak OT in the HG were significantly higher than those in the LG. At the physical and mental component summary, lifestyle in the HG was more favorable. These data suggest that the daily rhythms of OT may reflect the mental health status of an individual. The entraining factors in circadian variation might play a role in improving mental health and reducing unidentified complaints. In conclusion, there appears to be an association between mental health status, lifestyle, and daily rhythms of OT.
ABSTRACT
We have several choices against bleeding and obstruction in advanced gastric cancer patients such as surgical or endoscopic therapy. But we have few reports about palliative radiation. We conduct this study that we perform palliative radiation for unresectable advanced gastric cancer patients between April 2006 and March 2014 in single center. In the aim of the therapy, to stop gastric bleeding were 8, and to improve obstruction depend on gastric cancer were 4. Response rate of stop bleeding was 63％, and improve obstruction was 50％. Median duration of stop bleeding was 103 day, and improve obstruction was 52 day. Overall survival time was 567 day, survival time after the start of radiotherapy was 105days. Radiotherapy was limited in cases because onset time of response needed in comparison with surgical or endoscopic therapy. However, given minimally invasive therapy and a certain response, we can choice it so much more.
ABSTRACT
The aim of this studv was to clarify the effects of water immersion on the cardiovascular recovery process following submaximal steady state exercise on land. Seven male subjects (23 yrs old) underwent experiments under four separate conditions on separate days (15 minutes of cycling exercise at 50% and 80% maximal oxygen consumption followed by 16 minutes of recovery in a sitting position in water and out of water) . Concerning conditions in water, mean water temperature was 29.4 degrees, and the immersion level was set at xiphoid. Mean room temperature in out of water conditions, and during all conditions of exercise, was 24.4 degrees. Oxygen consumption (VO<SUB>2</SUB>), heart rate (HR) and blood pressure (systolic: SBP, diastolic: DBP) were measured under each condi tion. Mean blood pressure was calculated from SBP and DBP (MBP=1/3× ( SBP-DBP) +DBP) . Stroke volume (SV) was measured by Doppler echocardiography, and then cardiac output (CO=SV×HR), total peripheral resistance (TPR=NIBP/CO) and arteriaVmixed venous oxygen difference (a-v O<SUB>2</SUB>diff=VO<SUB>2</SUB>/CO) were calculated. In comparison with the same exercise intensity condition, there were no significant differences between recovery processes of VO<SUB>2</SUB>, HR, SBP, DBP and MBP in and out of water. SV and CO were significantly higher (p<0.05) during the recovery process in water than out of water (SV: at 50 and 80% maximal oxygen consumption conditions, CO: at 80% condition) . The TPR and a-v O<SUB>2</SUB>diff were significantly lower (p<0.05) during the recovery process in water than out of water at 80% oxygen consumption condition. These results indicate that water immersion facilitates circulating blood volume during the recovery process without increasing blood pressure, especially during recovery after high intensity exercise. Therefore, we suggest that increased left ventricular preload with immersion would be an important factor in cardiovascular regulation not only at rest but also during recovery after exercise.
ABSTRACT
We investigated whether the autonomic nervous system (ANS) modulation contribute to the bradycardia induced by endurance training. First, the meta-analysis approach was used to collect group mean values of maximal oxygen consumption (Vo<SUB>2</SUB>max) and heart rate variability (HRV) from 14 studies involving 30 groups and 485 subjects. Subsequently, we performed a cross-sectional (n=116) and intervention (n=training group : 10 and control group : 6) studies. In both studies, ANS modulation was estimated by spectral analysis of HRV. In the meta-analysis and cross-sectional study, HR and natural logarithmic high frequency power (In HF power) were correlated with Vo<SUB>2</SUB>max or peak oxygen uptake (peak Vo<SUB>2</SUB>) . The significant negative correlations were found between HR and In HF power (meta-analysis and the cross-sectional study ; r<SUP>2</SUP> = 0.42 and 0.44, respectively) . Endurance training in the intervention study increased peak Vo<SUB>2</SUB> and resting In HF power, and decreased resting HR. These results strongly suggest that endurance training induces an increase in resting ANS modulation especially parasympathetic modulation. Furthermore, about half of the variability of resting HR can be accounted for by difference in parasympathetic modulation.