Attitudes and Barriers of Physicians toward Palliative Care in Critical Care Setting:Qualitative Content Analysis Using Open-ended Data from Nationwide Self-administrated Questionnaire Survey in Japan

Purpose: Palliative care implementation should take into account the perceptions and acceptability of healthcare providers. This study aimed to identify physicians’ perceptions of palliative care and barriers to palliative care practice in the critical care setting. Methods: A nationwide, self-administered questionnaire was distributed to physicians working in intensive care units, and free-text data were qualitatively analyzed. Results: The questionnaire was sent to 873 respondents, and 436 responded (50% response rate). Of these, 95 (11%) who responded to the open-ended sections were included in the analysis. Conclusion: Japanese physicians working in ICUs recognized that palliative care was their role and practiced it as part of their usual care. They felt, however, that the practice was difficult and not sufficient. Barriers to practice included the lack of human resources and availability of palliative care teams, and the lack of uniformity in the perception of palliative care in the critical care setting.

Serum leptin levels in healthy adolescents: Effects of gender and growth

<p><b>OBJECTIVES</b>The purposes of this paper were to evaluate the serum leptin levels in healthy adolescents and to establish standard age variation curves.</p><p><b>METHODS</b>Nine hundred six (414 boys and 492 girls) healthy adolescents were investigated. The maximum increment age in height (MIA) was identified in 124 boys and 130 girls. The menarcheal age (MA) was obtained for 130 girls. Fasting leptin levels were measured by enzyme immunoassay. The MIA was calculated by proportional allotment of yearly height increments.</p><p><b>RESULTS</b>Serum leptin levels did not change in boys and girls from the ages of 9 to 11. They decreased after the age of 11 in boys, while they increased in girls. Stepwise multiple regression analysis revealed that serum leptin levels were closely related to pubertal stage. The levels decreased remarkably after MIA in boys and increased remarkably after MA in girls. We drew standard age variation curves of serum leptin levels by calculating the 25th, 50th and 75th percentiles for each age in both boys and girls. The percentile curves for boys were divided into pre-MIA and post-MIA curves. Those for girls were divided into pre-MA and post-MA curves.</p><p><b>CONCLUSION</b>We have devised a potentially useful method for evaluating serum leptin levels in adolescents considering the effects of gender and growth.</p>

Serum Leptin Levels in Healthy Adolescents: Effects of Gender and Growth

Objectives: The purposes of this paper were to evaluate the serum leptin levels in healthy adolescents and to establish standard age variation curves. Methods: Nine hundred six (414 boys and 492 girls) healthy adolescents were investigated. The maximum increment age in height (MIA) was identified in 124 boys and 130 girls. The menarcheal age (MA) was obtained for 130 girls. Fasting leptin levels were measured by enzyme immunoassay. The MIA was calculated by proportional allotment of yearly height increments. Results: Serum leptin levels did not change in boys and girls from the ages of 9 to 11. They decreased after the age of 11 in boys, while they increased in girls. Stepwise multiple regression analysis revealed that serum leptin levels were closely related to pubertal stage. The levels decreased remarkably after MIA in boys and increased remarkably after MA in girls. We drew standard age variation curves of serum leptin levels by calculating the 25th, 50th and 75th percentiles for each age in both boys and girls. The percentile curves for boys were divided into pre-MIA and post-MIA curves. Those for girls were divided into pre-MA and post-MA curves. Conclusion: We have devised a potentially useful method for evaluating serum leptin levels in adolescents considering the effects of gender and growth.

Evaluating QOL of Elderly People with Dementia / 薬剤疫学

Quality of Life (QOL) is attracting attention as a concept which pursues the humanity of patients in contrast to conventional treatment which mainly consists of treatment for sustaining life. In particular, as senile dementia is one of the diseases for which a complete cure is not available to date and for which the main goal of medical treatment and care is improvement in QOL, appropriate evaluation of the effectiveness of treatment for elderly people with dementia cannot be employed without evaluating their QOL.<BR>As well, in the field of pharmacoepidemiology, with the development of antidementia drugs for Alzheimer's disease (AD), utilization of a QOL scale in evaluating drug efficacy has become an important subject. Considering the characteristics of dementia, it is not necessarily easy to evaluate how much QOL improvement antidementia drugs bring about, because many patients have difficulty in evaluating themselves. Therefore, in addition to QOL evaluation, utilizing objective evaluation by observing patients'behavior or the scale measuring the patients'preferences should be examined.<BR>Furthermore, maintaining QOL of caregivers is an important issue as this is closely related with QOL of patients themselves. To care for elderly people with dementia, a caregiver such as a patient's family member shoulders significant mental/physical burden, which could lead to “collapse by caring”. Therefore, in evaluating antidementia drugs, it is necessary to take QOL of caregivers as well as the patients themselves into consideration.