BackgroundMany patients wish to stay at home during the terminal stage of cancer. However, there is concern that medical care provided at home may negatively affect survival. This study therefore explored whether the survival duration differed between cancer patients who received inpatient care and those who received home care.MethodsWe retrospectively investigated the place of care/death and survival duration of 190 cancer patients after their referral to a palliative care consultation team in a Japanese general hospital between 2007 and 2012. The patients were classified into a hospital care group consisting of those who received palliative care in the hospital until death, and a home care group including patients who received palliative care at home from doctors in collaboration with the palliative care consultation team. Details of the place of care, survival duration, and patient characteristics (primary site, gender, age, history of chemotherapy, and performance status) were obtained from electronic medical records, and analyzed after propensity score matching in the place of care.ResultsMedian survival adjusted for propensity score was significantly longer in the home care group (67.0 days, n = 69) than in the hospital care group (33.0 days, n = 69; P = 0.0013). Cox’s proportional hazard analysis revealed that the place of care was a significant factor for survival following adjustment for covariates including performance status.ConclusionsThis study suggests that the general concern that home care shortens the survival duration of patients is not based on evidence. A cohort study including more known prognostic factors is necessary to confirm the results.
These results suggest that it may be possible to increase the rate of home care for end-stage cancer patients and meet their desires regarding the place of death through approaches to establish trust-based relationships with them and their families, such as strengthening manpower in home-visit nursing agencies and promoting collaboration between visiting nurses and family physicians in charge during home visits.
Aim:To examine the feasibility and usefulness of a novel region-based pathway: the Regional Referral Clinical Pathway for Home-Based Palliative Care.Method:This was a feasibility study to evaluate the frequency of variances and the perceived usefulness of pathway using in-depth interviews. All patients with cancer referred to the palliative care team between 2011 and 2013 and received home care services were enrolled.Result:A total of 44 patients were analyzed, and pathway was completed in all the patients. The target outcome was achieved in 61.4% while some variances occurred in 54.5%. Nine categories were identified as the usefulness of the pathway, such as reviewing and sharing information and promoting communication, education, motivation, and relationships.Conclusion:This novel pathway is feasible and seems to be useful.
We report a rare case of mycotic abdominal aortic aneurysm associated with Campylobacter fetus. A 72-year-old male admitted to the hospital because of pain in the right lower quadrant with pyrexia. The enhanced abdominal computed tomography (CT) examination showed abdominal aortic aneurysm (AAA) measuring 50 mm in maximum diameter and a high-density area of soft tissue density from the right lateral wall to the anterior wall of the aorta. However, since the patient showed no significant signs of defervescence after antibiotics administration, so we performed emergency surgery on the patient based on the diagnosis of impending rupture of mycotic AAA. The aneurysm was resected in situ reconstruction using a bifurcated albumin-coated knitted Dacron graft was performed. The cultures of blood and aneurysmal wall grew Campylobacter fetus, allowing early diagnosis and appropriate surgical management in this case, and the patient is making satisfactory progress. This is the fifth report of mycotic AAA characterizing culture positive for Campylobacter fetus in blood and tissue culture of the aortic aneurysm wall.
A 50-year-old man was admitted to our hospital with lower abdominal pain and vomitus. He complained of oppressive pain in the lower abdomen. Blood examination showed an elevated inflammation reaction. Abdominal CT showed that the superior mesenteric artery was running along the right dorsal side of the superior mesenteric vein and that most of the small intestine was located at the right side of the vertebra. Accordingly, it was suspected that he was suffering from intestinal malrotation. Furthermore, he was suspected to have colon volvulus, because the ascending colon was dilated with indications of a bird's beak sign and whirl like appearance in the center of the abdomen. We therefore performed an emergency laparotomy, suspecting strangulated intestinal obstruction. Intraoperative findings were in accordance with the preoperative CT findings. We diagnosed the case as a malrotation of the non-rotation type. In addition, a ligament was detected between the cecum and retroperitoneum. We then diagnosed the case as volvulus because a 180-degree counterclockwise torsion could be found in the ileocecal region along the ligament's axis. Ileocecal resection was carried out. The postoperative course was satisfactory without any complications. Although the occurrence of a cecal volvulus along with malrotation of the intestine is rare, an emergency operation may be required in cases where necrosis of the intestine is suspected. Consequently, when intestinal malrotation is found at the time of a medical examination of an acute abdominal malfunction, prompt medical or surgical treatment is essential.
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