ABSTRACT
In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia（PCA）pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku（Easy）Pack”that are characterized by the following：（1）opioids are prescribed by a home care physician；（2）a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution；（3）the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital；and（4）the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.
ABSTRACT
<b>Purpose & Methods</b>: With the aim of investigating how early palliative care intervention should be provided, we conducted questionnaire-based screening and QOL evaluations of patients undergoing first-line chemotherapy before and at 3 to 4 weeks after the initiation of treatment, using "a questionnaire on the ease of daily living" and the EuroQol (EQ5D), respectively. <b>Results</b>: Of the 66 patients who participated in this investigation, 56 completed the second survey. With respect to "Concerns and Worries", more than half of the respondents complained concernes/worries about "Conditions and/or Treatments" both before and after chemotherapy, but there were changes in content between the first and second surveys. "Physical Symptoms" were experienced by more than 80 percent of patients before treatment. After treatment, 13 patients saw improvement or disappearance of their symptoms and 22 patients experienced new symptoms. "Emotional Distress" decreased after treatment. This decrease was more pronounced among patients who expressed concerns about their conditions and/or treatments in the first survey. EQ5D health utility scores tended to decrease in patients who had presented with adverse reactions, but improved in those free of adverse reactions. <b>Conclution</b>: Changes were observed in patients' palliative care needs before and after the initiation of first-line chemotherapy, which indicates a need for sequential screening over the course of treatment.
ABSTRACT
The self-monitoring of blood glucose is a recommendable method for control of diabetes mellitus. But few reports of the prospective insulin sliding scale for outpatients were available in Japan. To elucidate the efficacy of the prospective insulin sliding scale for outpatients with diabetes mellitus, 14 insulin-treated patients who usedwith the prospective insulin sliding scale (scale group) and 14 insulin-treated patients who did not use with the prospective insulin sliding scale (control group) were studied over a period of 6 months.<BR>The control group showed no significant change of Hb Aic level. But the scale group showed a significant reduction in Hb Aic level at 5 months (8.37 ± 1.14% to 7.50 ±1.42%, p<0.008). The scale group had an almost two fold increase in the frequency in hypoglycemia. However, there was no severe hypoglycamia. There were weight gains in the control group and scale group, but there was no difference between control group and scale group.<BR>These data suggest that the prospective insulin sliding scale is useful for the better control of diabetes mellitus.
ABSTRACT
A 62-year-old woman was adimitted to our hospital because of thirst and a body weight loss of 9kg. She had a history of vasospastic breast pang 5months before. The level of fasting plasma glucose was 320 mg/dl and the level of HbA<SUB>1c</SUB> was 13.0%. The autoantibody to glutamic acid decarboxylase was positive. The level of urine C-peptide was 28.6μg/day. She rejected insulin injections and was treated with glibenclamide. The level of urine C-peptide increased to 70.0μg/day. The disease was controlled with the levels of 6.0% of HbA<SUB>1c</SUB>. But her condition became uncontrollable gradually after 6 months and she was treated by insulin therapy.<BR>Insulin secretion in type 1 diabetes mellitus was transiently improved by sulfony 1 urea. This suggests that not only the insulin secretion but also glucotoxicity plays an important role in early stage of type 1 diabetes mellitus.
ABSTRACT
To determine risk factors for progression of diabetic retinopathy, a study was conducted in 92 patients with diabetes whose HbA1c levels were more than 9.5% when they were admitted to our hospital.<BR>The progression of retinopathy was observed in 50% of the patients during 12 months after admission. Their cases were diagnosed as preproliferative retinopathy. The duration of no-treatment, serum cholesterol level, blood pressure and proteinuria were significantly greater in the deterioration group of retinopathy than in the no-deterioration group. Nerve conduction velocity was significantly lower in the deterioration group of retinopathy than in the no-deterioration group. The reduction of HbA1c level during the period of 3 months after admission was significantly higher in the deterioration group than in the improved group. In the patients whose initial levels of HbA1c were less than 10%, the deterioration of retinopathy was not observed. In conclusion, these findings suggest that the duration of no-treatment, serum cholesterol level, blood pressure, proteinuria, nerve conduction velocity, retinopathy severity, the HbA1c level at admission and the reduction of HbA1c level during the 3-month period are risk factors for the progression of retinopathy.