ABSTRACT
BACKGROUND: The aims of this study were to clarify end-of-life cancer care preferences and associations with good-death concepts. METHODS: The general population was sampled using a stratified random sampling method (N = 2548; response rate = 51%) and bereaved families from 12 certified palliative care units ('PCU-bereaved families') were surveyed (N = 513; response rate = 70%). The respondents reported their end-of-life care preferences and good-death concepts. RESULTS: Regarding place of end-of-life care, approximately 50% of the general population preferred 'Home', while 73% of PCU-bereaved families preferred 'PCU'. The concepts of 'Maintaining hope and pleasure' and 'Dying in a favorite place' were associated with the preference for 'Home'. Regarding prognostic disclosure, approximately 50% of the participants preferred some level of negotiation with the physician. The concept of 'Control over the future' was associated with this preference. Regarding treatment of severe refractory physical distress, 75% of the general population and 85% of the PCU-bereaved families preferred palliative sedation therapy. The concepts of 'Physical and psychological comfort' and 'Unawareness of death' were associated with this preference. CONCLUSIONS: End-of-life care preferences were associated with good-death concepts. It would be useful for health-care workers to discuss patients' good-death concepts to support subsequent treatment decisions.
Subject(s)
Attitude to Death , Neoplasms/psychology , Palliative Care , Euthanasia , Family , Health Care Surveys , Humans , Japan , Surveys and Questionnaires , Terminal CareABSTRACT
BACKGROUND: The aims of this study were to (i) conceptualize dimensions of a good death in Japanese cancer care, (ii) clarify the relative importance of each component of a good death and (iii) explore factors related to an individual's perception of the domains of a good death. METHODS: The general population was sampled using a stratified random sampling method (n = 2548; response rate, 51%) and bereaved families from 12 certified palliative care units were surveyed as well (n = 513; 70%). We asked the subjects about the relative importance of 57 components of a good death. RESULTS: Explanatory factor analysis demonstrated 18 domains contributing to a good death. Ten domains were classified as 'consistently important domains', including 'physical and psychological comfort', 'dying in a favorite place', 'good relationship with medical staff', 'maintaining hope and pleasure', 'not being a burden to others', 'good relationship with family', 'physical and cognitive control', 'environmental comfort', 'being respected as an individual' and 'life completion'. CONCLUSIONS: We quantitatively identified 18 important domains that contribute to a good death in Japanese cancer care. The next step of our work should be to conduct a national survey to identify what is required to achieve a good death.
Subject(s)
Attitude to Death , Neoplasms/mortality , Adult , Aged , Bereavement , Chronic Disease/mortality , Female , Humans , Interpersonal Relations , Japan , Male , Middle Aged , Neoplasms/psychology , Surveys and QuestionnairesABSTRACT
Germ-free rats, fed a modified cariogenic diet 2000 with a reduced sucrose content of 25%, were inoculated with a strain of Streptococcus mutans, Streptococcus intermedius or Propionibacterium acnes, respectively. After 100 days on the diet, the rats were sacrificed. Microscopic examination of stained decalcified tooth sections revealed marked destruction of the outer zones of the dentin infected with S. mutans. The destruction was closely associated with the formation of glucan-mediated large aggregates of S. mutans. The aggregates, however, were rarely formed in the deep zones of the infected dentin. Inoculation with S. intermedius and P. acnes had little effect on the microscopic outline of the decalcified tooth sections. However, the staining behavior of the sections with Mallory's method, Alcian blue-PAS and silver was like that of the tooth sections infected with S. mutans, even in the central and inner zones of the dentin. The histochemical alterations of the deep zones of the dentin induced by the three infected bacteria appeared to be due to their proteolytic rather than to their acidogenic activities.
Subject(s)
Dental Caries/microbiology , Propionibacterium acnes/physiology , Streptococcus mutans/physiology , Streptococcus/physiology , Tooth/microbiology , Animals , Chymotrypsin/metabolism , Colony Count, Microbial , Dental Caries/pathology , Dental Enamel/microbiology , Dental Enamel/pathology , Dental Plaque/microbiology , Dentin/microbiology , Dentin/pathology , Diet, Cariogenic , Germ-Free Life , Male , Microbial Collagenase/metabolism , Microradiography , Pepsin A/metabolism , Propionibacterium acnes/enzymology , Propionibacterium acnes/isolation & purification , Rats , Rats, Inbred Strains , Streptococcus/enzymology , Streptococcus/isolation & purification , Streptococcus mutans/enzymology , Streptococcus mutans/isolation & purification , Tooth/pathologyABSTRACT
A case of inner ear anomaly (Mondini dysplasia) associated with recurrent meningitis found in a 10 year-old boy is reported. The patient had suffered from bacterial meningitis and CSF rhinorrhea five times in 7 years. The origin of CSF leakage had not been detected by bifrontal craniotomy or trans-sphenoidal operation. In May 1985, the dysplasia of the temporal bone and the inner ear had been pointed out by an otologist. And he underwent operations a few times for closing the CSF fistula at the floor of the internal auditory meatus by translabyrinthine approaches, but in vain. On the 7th of November 1985, under the control of intracranial pressure by continuous ventricular drainage, re-operation was performed. Packing the internal auditory meatus with several pieces of muscle and gelatine sponge stopped the CSF leakage and the recurrence of meningitis.
