ABSTRACT
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.
Subject(s)
Ascites/therapy , Ascitic Fluid , Home Infusion Therapy , Palliative Care , Ascitic Fluid/chemistry , Cell-Free System , Female , Humans , Male , Middle AgedABSTRACT
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.
Subject(s)
Home Care Services , Palliative Care , HumansABSTRACT
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.
Subject(s)
Head and Neck Neoplasms/therapy , Home Care Services , Palliative Care , Eating , Humans , Patient Care TeamABSTRACT
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. METHODS: Subjects were 101 (58 male and 43 female) gastro-intestinal cancer patients, aged 30 to 91 years (mean 63.9 +/- 12.4) scheduled for intraperitoneal surgery. All patients' plasma BNP concentrations were measured when the patient agreed to the operation. Forty-five patients were enlisted for remeasurements on 2 or 4 postoperative days. We checked patients' backgrounds, perioperative circulatory characteristics and cardiac events. The relationship of BNP to other characteristics and cardiac events were analyzed. RESULTS: The preoperative mean BNP of patients under 55 years of age (n=20) was 20.4, in patients age 55 to 74 (n=60) it was 30.4, and in patients 75 years and over (n=21) it was 162.1. BNP in elderly patients was higher than in the younger. The mean BNP of the 44 patients with some complications (hypertension, ECG abnormality, cardiac disease etc.) was 97.8, as compared to 23.3 in the 57 patients without complications. The BNP was higher in patients who were elderly, had some cardiac disease, lower exercise capacity, chest X ray abnormality or who needed an echo cardiographic examination. Among the 45 patients who were checked pre and postoperatively, 19 patients' BNP increased postoperatively, while 26 patients showed no change or decrease. Excluding 2 patients, with newly onset congestive heart failure during the postoperative period, the preoperative mean BNP was 63.5, and the postoperative mean BNP was 54.6. During the perioperative period, there was no significant change of BNP. There was no relationship between the BNP and perioperative circulatory characteristics or cardiac events. There were 5 cases with high BNP levels (> 300). None of these patients had cardiac symptoms, and they had normal LV systolic function. It is probable that these patients had chronic heart failure due to LV diastolic dysfunction and risks of perioperative heart failure. CONCLUSIONS: We cannot predict any circulatory characteristics and cardiac events from preoperative BNP measurement; however BNP measurement is useful for screening asymptomatic chronic heart failure due to LV diastolic dysfunction.
Subject(s)
Anesthesia , Digestive System Neoplasms/surgery , Heart Failure/diagnosis , Natriuretic Peptide, Brain/blood , Perioperative Care , Ventricular Dysfunction, Left/diagnosis , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Chronic Disease , Digestive System Neoplasms/complications , Female , Heart Failure/etiology , Humans , Male , Middle Aged , Postoperative Complications , Risk Factors , Ventricular Dysfunction, Left/complicationsABSTRACT
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.
Subject(s)
Community Health Nursing , Home Care Services , Palliative Care , Patient Care Team , Mental HealthABSTRACT
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.
Subject(s)
Community Networks , Home Care Services , Hospital Administration , Palliative CareABSTRACT
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.
Subject(s)
Caregivers , Hospice Care/methods , Pain/drug therapy , Quality of Life , Analgesics, Opioid/administration & dosage , Home Care Services , Home Nursing , Hospitalization , Humans , Morphine/administration & dosageABSTRACT
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.
Subject(s)
Breast Neoplasms , Home Care Services, Hospital-Based , Breast Neoplasms/mortality , Breast Neoplasms/nursing , Breast Neoplasms/therapy , Female , Health Care Costs , Humans , Middle Aged , Palliative Care , Quality of Life , Survival Rate , Terminally IllABSTRACT
Patients under home palliative care may occasionally meet an undesirable end because the family would call an ambulance in the case of a sudden change. It may be caused by lack of family education, a short period under home care, or an administrative proceeding. So, we must be careful in home palliative care.
Subject(s)
Caregivers/psychology , Palliative Care , Family , Female , Humans , MaleABSTRACT
We experienced a case of frostbite due to the accidental fall of a portable liquid oxygen device. We think this accident occurred because medical staff have little understanding of an oxygen device. We must use medical instruments safety.
Subject(s)
Accidental Falls , Frostbite/etiology , Oxygen Inhalation Therapy/instrumentation , Oxygen/adverse effects , Aged , Equipment Safety , Humans , MaleABSTRACT
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, a prepare the rescue drug, and a variety of drug durability.
Subject(s)
Analgesics, Opioid/therapeutic use , Fentanyl/therapeutic use , Neoplasms/physiopathology , Pain/drug therapy , Palliative Care , Administration, Cutaneous , Adult , Aged , Caregivers/psychology , Female , Home Care Services , Humans , Male , Middle AgedABSTRACT
Patients under home palliative care may occasionally meet an undesirable end because the family would call an ambulance in the case of a sudden change. It may be caused by lack of family education, a short period under home care, or an administrative proceeding. So, we must be careful in home palliative care.
Subject(s)
Caregivers/education , Home Care Services , Palliative Care , Female , Humans , Male , Patient Education as Topic , Quality of Health CareABSTRACT
We experienced a case of frostbite due to the accidental fall of a portable liquid oxygen device. We think this accident occurred because medical staff have little understanding of an oxygen device. We must use medical instruments safety.
Subject(s)
Accidents , Frostbite/etiology , Oxygen Inhalation Therapy/instrumentation , Aged , Equipment Design , Equipment Failure Analysis , Humans , MaleABSTRACT
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.
Subject(s)
Analgesics, Opioid/therapeutic use , Fentanyl/therapeutic use , Home Care Services , Pain, Intractable/drug therapy , Palliative Care , Administration, Cutaneous , Adult , Aged , Analgesics, Opioid/administration & dosage , Fentanyl/administration & dosage , Humans , Middle Aged , Neoplasms/physiopathologyABSTRACT
Medical network in home palliative care for terminal cancer patients is more difficult compared to that in home care for patients with other diseases because of the following reasons: 1. only a little time for the rest, 2. difficulty of total pain control including physical pain; and 3. difficulty of family care. We think that in the case of home palliative care it is necessary to establish a closer connection and a relationship of mutual trust among medical coworkers.
Subject(s)
Community Health Nursing , Comprehensive Health Care , Home Care Services, Hospital-Based , Palliative Care , Consumer Behavior , Humans , Patient Care Team , Social SupportABSTRACT
Home oxygen therapy for terminal cancer patients is not suitable for present standard. As the result of the questionnaire answered by home care doctors, many of them agreed to reconsider the present standard. We propose the following revision, 1. Standard that highly regard clinical symptoms, 2. subdivision of the fee, 3. addition of home care fee.
