Palliative Care Team: The First Year Audit in Japan

Abstract

In Japan, palliative care team (PCT) services have been covered by National Health Insurance since 2002. The primary aims of this study were to compare the characteristics of patients who received PCT services with those admitted to palliative care units (PCU), and to clarify the medical treatments and symptom improvement during the first week after consultation with the PCT. This was a prospective audit study of 111 consecutive cancer patients referred to the PCT in Seirei Mikatabara Hospital and a comparison group of 100 consecutive patients admitted to PCU. As a part of daily practice, we prospectively recorded patient symptoms on a structured data collection sheet at the initial assessment and one week later. Symptom severity was measured by the Japanese version of the Schedule for Team Assessment Scale. After PCT consultation, 25% were discharged to home, 43% died in hospital, 40% died after admission to PCU, and 14% were alive at the end of the study period. Compared with PCU patients, PCT patients were significantly younger, had better performance status, were more likely to be referred with the described aim of symptom palliation, and suffered from more serious pain, appetite loss, somnolence, insomnia, anxiety, and delirium. There were significant improvements in symptom scores of pain, nausea, vomiting, constipation, abdominal swelling, dyspnea, sputum, insomnia, and anxiety during the first week in the PCT group. However, no significant improvements were observed in symptom scores of fatigue, dry mouth, somnolence, and delirium. A median of 3 interventions was performed for each patient, and the most common interventions were administration of NSAIDs, opioids, centrally-acting antiemetics, and steroids. These data indicate that a PCT was successfully implemented in Seirei Mikatabara Hospital, and may contribute to symptom improvement in cancer patients.

Socio-Demographic Characteristics of Patients with Electrical Burns Admitted to Emergency Department

“…Older children and adolescents are exposed to high-voltage lines-derived electric current outside the home or the industrial high-voltage electric current in business environment. The number of men in this age group is significantly higher than woman (8,12).…”

“…In low-voltage electrical burns that are generally superficial, rhabdomyolysis and complications due to it are also rare (7). Although more common in high-voltage EI, life-threatening cardiac rhythm disorders, hidden trauma due to be launched by the electric current, and respiratory arrest are seen in both types of burns (8,9).…”

One-year Follow-up of an Educational Intervention for Palliative Care Consultation Teams

“…The concept of PCTs has widened further in the 20 years hence, with the aim of maximizing symptom palliation, and these teams are playing important roles in the UK, USA, Canada and Australia (1 -4). The effectiveness of PCTs has been investigated by systematic review (5), randomized controlled trials (6,7), historical control studies (8 -11), audit surveys of symptom severity (12,13), descriptive studies of PCT In Japan, hospital-based PCTs are playing an increasingly important role, with several hospitals routinely reporting PCT activities and effectiveness (21,22). The National Cancer Program strongly supports the dissemination of palliative care (23).…”

Efetividade de duas modalidades de equipe de cuidado no controle de sintomas em pacientes com câncer avançado

“…Foram selecionados para análise 04 artigos da busca principal e 12 de busca manual, totalizando 16 estudos [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Os estudos estão sintetizados na Tabela 1.…”

“…Os demais estudos avaliaram mais de um sintoma, sendo que: 03 foram longitudinais prospectivos 14,21,24 , 05 estudos retrospectivos 16,19,[26][27][28] , 03 estudos quasi experimentais 17,23,25 , 02 estudos transversais 20,22 , e 01 qualitativo 13 .…”