[Three Elderly Female Patients Who Experienced Self-Recovery during End-of-Life Care at Home].

Recently, after completing hospital treatment, 3 elderly female patients were introduced to our home care department for end-of-life care at home. However, these patients recovered almost by themselves and now spend quiet days. From now on, women became the era they live alone in the statistics on the elderly. On the basis of these 3 cases, it is suggested that elderly female patients have the capacity to overcome conditions such as infectious diseases and digestive system disorders.

Activities and health status of dispatched public health nurses after the great East Japan earthquake.

OBJECTIVE: This study aimed to elucidate the actual activities conducted by public health nurses during their dispatch and their health status during and after dispatch to the three prefectures most severely affected by the Great East Japan Earthquake. SAMPLE: A survey request was sent to a total of 2,237 facilities. Of these, 778 facilities returned questionnaires from dispatched public health nurses. RESULTS: The participants of this study were 1,570 dispatched health nurses who participated in activities mostly at evacuation centers, followed by evacuees' homes. After dispatch, an earlier postdisaster phase at the start of dispatch was independently associated with poor subjective well-being, low mood, worsened sleep state, and intense fatigue. Work hours per day were associated with poor subjective well-being and intense fatigue after dispatch. CONCLUSION: Results suggest that the factor that most strongly affected the postdispatch health of the nurses was the phase that they began their dispatch.

[A study of the usefulness of shared decision making during medical treatment and care-giving in home care].

Forty patients who made a decision about home-based care among 65 deaths from November 2012 to December 2013(21 men, 19 women, average age: 83 years)were evaluated. The family had already decided upon home caregiving in six of these cases. We conducted a clinical ethics dialogue on performing caregiving at home or introducing home care for 34 cases. However, many differences were found in the description of the contents of the medical side of home care and the concept of patients and families in six cases of those 34 cases. It was difficult to conduct the clinical ethics dialogue in such cases. We also incorporated a shared decision making method in order to overcome differences in the way of thinking of these cases. As a result, patients and their families came to voluntarily receive home care and caregiving at home. Thus, shared decision making was a useful method in home care.

Metabolomic profiling of lung and prostate tumor tissues by capillary electrophoresis time-of-flight mass spectrometry.

Metabolic microenvironment of tumor cells is influenced by oncogenic signaling and tissue-specific metabolic demands, blood supply, and enzyme expression. To elucidate tumor-specific metabolism, we compared the metabolomics of normal and tumor tissues surgically resected pairwise from nine lung and seven prostate cancer patients, using capillary electrophoresis time-of-flight mass spectrometry (CE-TOFMS). Phosphorylation levels of enzymes involved in central carbon metabolism were also quantified. Metabolomic profiles of lung and prostate tissues comprised 114 and 86 metabolites, respectively, and the profiles not only well distinguished tumor from normal tissues, but also squamous cell carcinoma from the other tumor types in lung cancer and poorly differentiated tumors from moderately differentiated tumors in prostate cancer. Concentrations of most amino acids, especially branched-chain amino acids, were significantly higher in tumor tissues, independent of organ type, but of essential amino acids were particularly higher in poorly differentiated than moderately differentiated prostate cancers. Organ-dependent differences were prominent at the levels of glycolytic and tricarboxylic acid cycle intermediates and associated energy status. Significantly high lactate concentrations and elevated activating phosphorylation levels of phosphofructokinase and pyruvate kinase in lung tumors confirmed hyperactive glycolysis. We highlighted the potential of CE-TOFMS-based metabolomics combined with phosphorylated enzyme analysis for understanding tissue-specific tumor microenvironments, which may lead to the development of more effective and specific anticancer therapeutics.

[How to respond to patient families that pursue medical treatment excessively].

It is important to know the mental state of the primary caregiver for patients requiring advanced home care. Herein, we report cases of failed medical treatment due to primary caregivers with psychological problems and a strong desire to have the patient live at home. Of the 486 cases analyzed from August 1, 2004 to October 31, 2012, in 10 cases, the primary caregiver had a strong desire to have the patient live at home. Preventing patients from entering home health care has become more difficult recently. Therefore, establishment of guidelines for interacting with primary caregivers is required. The introduction and application of medical ethical consultation is required for this purpose. The medical ethical consultation is designed to avoid the explanation of medical terminology as much as possible. In order to obtain a detailed understanding of the current state of the patient, it is desirable to pursue a clinical ethical interaction.