Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Dec 2006
["My tiny windows"--a nurse's point of view--case study from a home palliative care meeting].
In visiting nursing care for home palliative care, nurses should take medical care with a holistic viewpoint. Nurses are not only a daily care provider to clients, but nurses are also necessary to think of themselves as being a person because they are in contact with clients' lives every day. In this home palliative care case, nurses had a chance to intervene with a woman with end-stage-cancer. ⋯ So it was necessary to have meetings frequently to discuss the problem. One of the things we thought was that we had to listen to the client and to watch her expression and behavior very carefully. This case study suggested that nurses should reconsider their practices to improve and to establish their original methods of nursing along with their clients.
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Gan To Kagaku Ryoho · Dec 2006
[Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints].
In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice. (5) To deliberate the difference between ethical and legal judgment, an interdisciplinary approach should be carried out. (6) To achieve consensus among the people, the importance of an Advanced-Directive should prevail widely.
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Gan To Kagaku Ryoho · Dec 2006
[Palliative care team support services by the hospital for home palliation].
At Osaka National Hospital, we opened a palliative care team (PCT) since July 2004. The PCT advises the symptom management of cancer patients and supports patients' decision making. By March 2006, 355 consecutive cancer patients referred to the PCT, including 221 patients with psychiatric symptoms. ⋯ The reasons for this prolongation are that psychiatric symptoms (especially delirium) are often overlooked, and that home doctors and visiting nurses often hesitate to take on the home medical care because of unfamiliarity with them. The management of psychiatric symptoms at home is important for appropriate end-of-life care. The PCT and regional doctors have to work closely in cooperating with the successive palliation when the patient is transformed to home medical care.
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Gan To Kagaku Ryoho · Dec 2006
[Home mechanical ventilation-tracheostomy ventilation, for the long-term and variation].
We experienced long-term ventilation for 30 patients mostly with amyotrophic lateral sclerosis (ALS). For long-term ventilation by tracheostomy positive pressure ventilation (TPPV), we must set tidal volume (TV) over 600 ml, because setting 400 ml as TV usually applied in Japan, often develops atelectasis which causes frequent or serious pneumonia. To avoid both the elevation of airway pressure and hyper ventilation, the following intervals are needed: 10 times/min for breathing frequency and 2 seconds for exhaling time. ⋯ This method can provide certain ventilation also during sleep. When the respiratory failure proceeds further, we manage the ventilation with a bi-level ventilator on TPPV, because a bi-level ventilator is also good adapting to assist spontaneous breathing in that stage. And if the patient does not have bulbar paralysis, the patient can utter by air leakage with using bi-level ventilator and flattening the cuff of the tracheal canule.