ABSTRACT
Recently, the Jepanese government have advanced home medical care services. They former health care system was reformed to place much emphasis on home care. But there are many problems:for instance, the difficulty of coordinating discharges from a hospital and cooperation between hospitals and regional clinics. Especially, the biggest problem was that medical staff in wards do not have knowledge of the realities of home medical care and visiting nursing services. In this session, we invite four persons who are actively involved in the front lines in the field of home medical care. We expect they will speak about realities of home care and make you understand the potential of home medical care.
Subject(s)
Medical Care , Nursing Services , ForecastingABSTRACT
Recently, allogeneic bone marrow transplantation (allo-BMT) has been established for the treatment of hematological disorders. Fifteen patients had recieved allo-BMT at Tsuchiura Kyodo General Hospital as of April 1999. In this paper, we analyzedthe results and the problems of allo-BMT at our institution. The mean age of patients was 29.2years. Seven patients had AML, 5 ALL, 1 CML, 1 non-Hodgkin's lymphoma and one had severe aplastic anemia. Bone marrow donors were all HLA-identical siblings. Most of the patients were conditioned with a combination of busulfan or totalbody irradiation, cyclophosphamide and etoposide. To prevent GVHD, cyclosporine A and methotrexate were mainly used. Patients with acute GVHD were 4 and patients with chronic GVHD were only two. Three grade I patients with acute GVHD and all with chronic GVHD did not require therapy. In spite of small numbers of transfused cells, no cases of transplant rejection were found. All these engrafted patients achieved a WBC≥1×10<SUP>3</SUP>μl after a median of 19.5days and a Plt≥5×10<SUP>4</SUP>/μEl after a median of 38.1days. Five of the 14 engrafted patient relapsed in a median of 6.7months and all died in a median of 9.6months. Eight are alive in complete remission for 0.2 to 39.4 months (median 21.7months). For the improvement of the disease-free survival rate after allo-BMT, the prevention of relapse and prophylaxis of GVHD and infection are important. At our institution, especially the former is important. The conditioning regimens were stronger than usual but acute and chronic GVHD was very mild, therefore GVL would be weak. If prophylaxis of GVHD is weaken and mild GVHD ans GVL occur frequently, relapse will be prevented and better results will be obtained.
ABSTRACT
The main purpose of basic clinical training for housestaff is to acquire the ability to be a primary physician who can properly manage acute medical problems, develop intimate bonds with patients, and provide them with continuous care. We emphasize the importance of training in the office, clinic, or patients' homes. Although residents have so far spent most of their clinical rotations in an inpatient setting, a training program that devotes substantial time to ambulatory care is indispensable to improve basic clinical training in primary care medicine.