Takami Maeno

Multicenter Prospective Study on Efficacy and Safety of Octreotide for Inoperable Malignant Bowel Obstruction

OBJECTIVE The aim of this study was to evaluate the efficacy and safety of octreotide for malignant bowel obstruction in a multicenter study. METHODS Terminally ill patients diagnosed with inoperable malignant bowel obstruction were treated with octreotide 300 microg/day. The primary endpoint was the overall improvement rate of subjective abdominal symptoms. The degrees of nausea, vomiting, abdominal pain, distension, anorexia, fatigue, thirst and overall quality of life were evaluated by the self-rating scores selected from the MD Anderson Symptoms Inventory and Kuriharas Face Scale. RESULTS Forty-nine patients were enrolled in the study, and 46 patients received study treatment, including 17 gastric, 13 colorectal, 7 ovarian and other cancers. The median survival time was 25 days. The number of vomiting episodes significantly correlated with the MD Anderson Symptoms Inventory nausea and vomiting scores (P< 0.001) before octreotide treatment. Of 43 patients evaluable for efficacy, the scores of all the MD Anderson Symptoms Inventory items except abdominal pain and the number of vomiting episodes improved during the first 4 days of octreotide treatment (P< 0.0062). The MD Anderson Symptoms Inventory scores were decreased in 59-72% of patients, and overall quality-of-life scores improved in 56% of patients. No serious adverse events were observed. CONCLUSIONS The high improvement rate in abdominal symptoms suggested the efficacy of octreotide in terminally ill patients with malignant bowel obstruction.

Palliative care physicians' practices and attitudes regarding advance care planning in palliative care units in Japan: a nationwide survey.

To clarify physicians’ practices and attitudes regarding advance care planning (ACP) in palliative care units (PCUs) in Japan, we conducted a self-completed questionnaire survey of 203 certificated PCUs in 2010. Ninety-nine physicians participated in the survey. Although most Japanese palliative care physicians recognized the importance of ACP, many failed to implement aspects of patient-directed ACP that they acknowledged to be important, such as recommending completion of advance directives (ADs), designation of health care proxies, and implementing existing ADs. The physicians’ general preference for family-centered decision making and their feelings of difficulty and low confidence regarding ACP most likely underlie these results. The discrepancy between physicians’ practices and their recognition of the importance of ACP suggests an opportunity to improve end-of-life care.

Japanese students' perception of their learning from an interprofessional education program: a qualitative study

Objectives The aim of this study was to explore students’ perception of their learning from the interprofessional program implemented in Japan where the implementation and evaluation of interprofessional education is behind that of western countries. Methods We conducted a qualitative research of opinions of students who participated in the interprofessional program implemented in the University of Tsukuba. The participants were 105 medical, 65 nursing, and 35 medical science students. At the completion of the program, we asked that the participants write their opinion on what they gained by participating in the program. From their responses, significant descriptions were extracted, coded by content, and then grouped into subcategories. These subcategories were then separated into main categories based on their emergent themes. Results The main categories identified were such as “understanding of medical professionals,” “interprofessional work,” “holistic care,” “communication,” “sharing,” and “empowerment.” Conclusions The categories extracted in our study, for the most part, matched previous studies, suggesting that the program helped students enhance their understanding of interprofessional work. Although the Japanese health care system and medical education system are different from those of western countries, this suggests that the benefits of interprofessional education in Japan will be similar to those of western countries.

Can we predict future depression in residents before the start of clinical training

Depression among medical residents is a very serious problem. It is, however, very difficult to detect signs of depression early, despite the severity and frequency of depression. We designed a nationwide longitudinal study to investigate whether the Sense of Coherence (SOC) Scale, an indicator of ability to cope with stress, could predict future depressive symptoms among medical residents.

Advance directives and do-not-resuscitate orders among patients with terminal cancer in palliative care units in Japan: a nationwide survey.

Objective: To examine the current status of advance directives (ADs) and do-not-resuscitate (DNR) orders among patients with terminal cancer in palliative care units (PCUs) in Japan. Methods: We conducted a retrospective chart review of the last 3 consecutive patients who died in 203 PCUs before November 30, 2010. Results: The percentages of patients who had ADs during the final hospitalization for cardiopulmonary resuscitation, mechanical ventilation, intravenous fluid administration, tube feeding, antibiotic administration, and who had appointed a health care proxy were 47%, 46%, 42%, 19%, 18%, and 48%, respectively. Seventy-six percent of the patients had a DNR order. Of the patients with decision-making capacity, 68% were involved in the DNR decision. Conclusions: These findings may reflect positive changes in patients’ attitudes toward ADs, in Japan.

Indicators of a Major Depressive Episode in Primary Care Patients With a Chief Complaint of Headache

Objective.—To identify the indicators of major depressive episode (MDE) in primary care patients with a chief complaint of headache.

Prospective Clarification of the Utility of the Palliative Prognostic Index for Patients With Advanced Cancer in the Home Care Setting

Aims: This study aimed to prospectively clarify the accuracy of the Palliative Prognostic Index (PPI) for advanced cancer patients in home care settings. Method: The study included 66 advanced cancer patients who received home visiting services between April 2010 and June 2012, and who died at home or in the hospital. Using medical records from initial home visits, we prospectively calculated PPI scores along with sensitivity and specificity. Results: For 3- and 6-week survival, prognostic prediction showed respective sensitivities of 60% and 70.6%, and specificities of 87.0% and 71.9%. Conclusion: The sensitivity of the PPI for advanced cancer patients in home care settings was lower than that reported for patients in palliative care units. Development of prognostic tools suitable for home care settings is needed.

Rapid effects of Kikyo-to on sore throat pain associated with acute upper respiratory tract infection.

Abstract Background: Kikyo-to is used empirically for relieving sore throat pain associated with acute upper respiratory tract infection (URTI) in Japan. However, few studies have demonstrated its clinical effect. This study was conducted to investigate the efficacy of Kikyo-to on sore throat pain associated with acute URTI. Methods: Patients with sore throat pain who were diagnosed with URTI in General Medicine Department Office, Tsukuba Medical Center Hospital from January to March 2012 were enrolled. Patients received 2.5 g of Kikyo-to diluted in a cup of hot water. The primary outcome was the change in sore throat score on the visual analog scale (VAS) 10 min after Kikyo-to administration. Secondary outcomes were change in sore throat score on VAS after 30 min and impact of sore throat pain on daily life (none, mild, moderate, and severe) after 10 and 30min. Results: Forty patients were eligible. Mean VAS score was 48.2±18.2 before treatment and reduced significantly to 35.4±18.1 after 10 min and 30.7±19.3 after 30 min (p<0.001 in both periods). The proportion of patients with moderate or more impact of sore throat pain on daily life was 67.5% and was reduced significantly to 37.5% after 10 min and 30% after 30 min (p<0.001 in both periods). The patients reported no side effects. Conclusions: Kikyo-to relieves sore throat pain associated with acute URTI.

Self-reported fast eating is a potent predictor of development of impaired glucose tolerance in Japanese men and women: Tsukuba Medical Center Study

We recorded self-reported eating patterns in 172 Japanese men and women who were subsequently followed for 3 years for the occurrence of impaired glucose tolerance (IGT). Incidence of IGT was significantly higher in those who reported eating fast. Self-reported eating fast is a potent risk factor for development of IGT.

Association between potentially inappropriate medications and anxiety in Japanese older patients

The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety.