[The use of high-dose oxycodone with midazolam for dyspnea due to end-stage heart failure in an older patient with renal insufficiency].

INTRODUCTION: We herein report a case of dyspnea in an older patient with end-stage heart failure and renal insufficiency successfully controlled with high-dose oxycodone plus midazolam. CASE: A 91-year-old womam with end-stage heart failure due to severe aortic stenosis and complete atrio-ventricular block developed dyspnea. We used continuous oxycodone subcutaneous injection instead of morphine for dyspnea due to renal insufficiency. Oxycodone relieved her dyspnea in a dose-dependent manner without serious adverse events. We also carefully administered midazolam for the dyspnea as well. CONCLUSION: We used high-dose oxycodone plus midazolam to manage dyspnea in an older patient with end-stage heart failure and renal insufficiency. High-dose oxycodone with midazolam might be useful for treating dyspnea under careful observation.

Development of an Online Communication Skills Training Program for Oncologists Working with Adolescents and Young Adults.

There are two purposes to this study. The first purpose was to develop a communication skills training (CST) program for oncologists working with adolescents and young adults (AYA-CST). The second purpose was to evaluate the program's feasibility. The online AYA-CST program was a half-day workshop including a didactic lecture, role-playing with simulated patients and discussions in a small group. All six oncologists who participated in the program satisfactorily completed it. Our AYA-CST program seems feasible and will be tested further in a randomized control study.

Dexmedetomidine for dyspnoea.

Dexmedetomidine is a selective α2-adrenoreceptor agonist with a broad range of effects, including easily controllable sedation, analgesia and anxiolysis. Because of these favorable features, it has replaced traditional sedatives, such as benzodiazepines, and is becoming the first-line sedative for the patients in intensive care units. Terminally ill patients often need sedatives for symptom management, especially for dyspnoea. However, the use of dexmedetomidine in a palliative care setting has rarely been recognised to date. We experienced a patient nearing the end of life due to uncontrollable pulmonary haemorrhage on ventilator, whose dyspnoea was successfully managed by dexmedetomidine in addition to continuous intravenous infusion of oxycodone.

Feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set for inpatient rehabilitation: Selection and validity of a set of categories for inpatients in a convalescent rehabilitation ward.

Funahashi R, Mukaino M, Otaka Y, Senju Y, Yoneda C, Ozeki Y, Shimizu Y, Koike T, Saito E. Feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set for inpatient rehabilitation: Selection and validity of a set of categories for inpatients in a convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2020; 11: 1-8. Objective: To evaluate the feasibility of the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set for inpatients in a convalescent (Kaifukuki) rehabilitation ward. Methods: Overall, 295 inpatients in convalescent rehabilitation wards were rated using the ICF Rehabilitation Set, and the proportion of missing values was investigated. Categories with missing values <10% were selected, and internal construct validity of the total score of the selected categories was examined using Rasch analysis. Results: Missing values were detected in 25 items, of which seven had missing values of ≥10%. No ceiling or floor effects were noted. Rasch analysis of 23 categories with missing values <10% showed a good fit to the model after applying testlet solution and item splitting, which supported the internal construct validity of the ICF Rehabilitation Set. Conclusion: This identified the set of categories of the ICF Rehabilitation Set that could be used for evaluating rehabilitation inpatients. These categories had good internal construct validity based on Rasch analysis.

Effect of subcutaneous oxycodone for end-stage heart failure due to severe aortic stenosis - A case report.

It is difficult to manage the symptoms of patients who are dying of end-stage heart failure (HF). Opioids are sometimes required to relieve their symptoms in addition to oxygen therapy and medical management. Oxycodone is a µ receptor agonist that is known to be a safer opioid than morphine in patients with chronic kidney disease (CKD) because its metabolites have weak pharmacological activity. We treated a 99-year-old woman who had end-stage HF (secondary to severe aortic stenosis) and CKD. It was also difficult to maintain an intravenous line because of severe edema. We administered oxycodone subcutaneously and successfully alleviated her severe symptoms without severe adverse effects of opioids until a few days before her death. We report this case and discuss the possibility of using subcutaneous oxycodone as a new palliative care strategy in patients with end-stage HF. .

[A case of advanced cancer with liver metastasis and paraaortic lymph node metastasis responding remarkably to combination chemotherapy of low-dose CDDP, 5-FU and CPT-11].

A 57-year-old male patient with upper epigastric discomfort was introduced to our hospital from another clinic because of gastric cancer. Several examinations showed massive liver metastasis and paraaortic lymph node metastasis from Type-3 gastric cancer beneath the posterior wall of the pyloric antrum. First we tried infusion of CDDP (10 mg/day for days 1-5 and 8-12) and continuous infusion of 5-FU (500 mg/day for 14 days). Concurrently, we added infusion of CPT-11 (80 mg/day on days 1,8). After 3 courses of chemotherapy, the tumor had decreased remarkably in size. Moreover, liver metastasis and paraaortic lymph node metastasis had vanished. This regimen thus appears to be effective for advanced gastric carcinoma.