The current status of palliative care teams in Japanese university hospitals: a nationwide questionnaire survey.

GOAL: Although the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals. MATERIALS AND METHODS: In 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals. RESULTS: Of 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 +/- 64, mean/median +/- SD), daily number of patients treated by PCTs (12/11 +/- 14), and days of PCT care per patient (30/30 +/- 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p < 0.001) compared to noncertified PCTs. Over the 3-year period, the number of hospitals utilizing PCTs only slightly increased (2003: 27%, 2004: 29%, 2005: 33%), as did those using certified PCTs (2003: 3%, 2004: 9%, 2005: 11%). In 2005, the reasons for noncertification of PCTs included "lack of physicians who specialize in palliative care (82%)" and "lack of nurses who specialize in palliative care (56%)." CONCLUSIONS: The entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue.

Effect of Hochu-ekki-to on asymptomatic MRSA bacteriuria.

Hochu-ekki-to, a multiple herbal drug which consists of 10 medicinal plants (Astragali radix, Atractylodis lanceae rhizoma, Ginseng radix, Angelicae radix, Bupleuri radix, Zizyphi fructus, Aurantii nobilis pericarpium, Glycyrrhizae radix, Cimicifugae rhizoma, and Zingiberis rhizoma), was administered to 38 patients with asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria, and the effect was evaluated. The patients received Hochu-ekki-to at a daily dose of 7.5 g for at least 24 weeks. As a prognostic nutritional index (PNI), albumin and lymphocytes in the peripheral blood were measured, in addition to urine culture. The results were compared with those in 12 untreated control patients with asymptomatic MRSA bacteriuria. Four of the 38 patients treated with Hochu-ekki-to received antibacterial drugs during the treatment period, and were excluded from the study. Among the 34 eligible patients treated with Hochu-ekki-to, urinary MRSA was eradicated in 12 patients, and the bacterial counts in urine culture decreased to 10(2) CFU/ml or less in 10 patients. In patients treated with Hochu-ekki-to, urinary bacteria were decreased from 10 weeks after treatment compared with the findings in control patients (P < 0.05). PNI improved in all patients compared with the baseline before treatment. It was considered that the biodefense function was recovered via nutritional improvement by the administration of Hochu-ekki-to, and, as a result, MRSA bacteriuria improved. Further investigation would be needed in future.