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Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.
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Objectives: This study aimed to clarify the present system of palliative care at general hospitals, and to examine the factors contributing to the opioid consumption. Methods: We surveyed the palliative care system using a self-administered questionnaire, which was mailed to 37 general hospitals in Southern and Southwestern wards, Tokyo. Multiple regression analyses were used to identify the associations between explanatory variables and the opioid consumption. Results: Valid responses were obtained from 18 hospitals (response rate: 48.6%). 35% of the general hospitals didn’t have a palliative care team and most hospitals had no specialists. In multivariate analyses, factors associated with the opioid consumption were pharmacists with speciality of pharmaceutical palliative care, physicians joined the palliative care education program based on the Cancer Control Act of Japan, and the number of physicians’ correct answers of questions regarding palliative care. Conclusion: The survey showed that the higher consumption of opioids is significantly associated with the number of health care workers who have knowledge of palliative care. Our study suggested that the arrangement of palliative care experts might decrease the differences in the opioid consumption between general hospitals.
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<b>Introduction</b>: The importance of estimating the prognosis of advanced cancer patients is well known, but clinicians do not estimate survival time accurately. Since there is a need for an objective index to estimate survival time, the utility of the Prognostic Nutritional Index (PNI), which depends only on objective factors, was evaluated. <b>Methods</b>: The PNI was calculated using the following formula, PNI=10×serum albumin value (g/dL)+0.005×lymphocyte count in peripheral blood, at 3 months, 2 months, 1 month, 3 weeks, 2 weeks, 1 week, and within 3 days before death in 278 cancer patients (166 men, 112 women; age range, 33-99 years; mean age, 69.8 years) who died in a hospital surgical unit. <b>Results</b>: Sites of primary diseases included lung, breast, esophagus, stomach, colorectum, liver, biliary tract, and pancreas. The PNI values showed a gradual decrease over time. Changes in the PNI values were lower in non-gastrointestinal cancer patients than in gastrointestinal cancer patients. The mean PNI value was significantly higher in patients who lived >3 weeks (38.8) than in those who died within 3 weeks (32.4). When the PNI cut-off point was set at 35, and it was assumed that the life expectancy was within 3 weeks in cases with PNI <35, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 74.8%, 62.2%, 68.1%, and 69.6%, respectively. <b>Discussion</b>: The PNI appears to be a useful and simple parameter to predict clinical outcomes of patients with terminal stage cancer. Particularly, the PNI is considered feasible for gastrointestinal cancer patients.
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<p><b>AIM</b>To report two cases of the left testicular artery arching over the left renal vein (LRV) before running downward to the testis.</p><p><b>METHODS</b>The subjects were obtained from two Japanese cadavers. During the student course of gross-anatomical dissection, the anatomical relationship between the testicular vessels and the renal vein was specifically observed.</p><p><b>RESULTS</b>The arching left testicular artery arose from the aorta below the LRV and made a loop around the LRV, which appeared to be mildly compressed between the arching artery and the psoas major muscle.</p><p><b>CONCLUSION</b>Clinically, compression of the LRV between the abdominal aorta and the superior mesenteric artery occasionally induces LRV hypertension, resulting in varicocele, orthostatic proteinuria and hematuria. Considering that the incidence of a left arching testicular artery is higher than that of a right one, an arching left artery could be an additional cause of LRV hypertension.</p>
Subject(s)
Aged, 80 and over , Humans , Male , Arteries , Congenital Abnormalities , Constriction, Pathologic , Hypertension , Renal Veins , Pathology , TestisABSTRACT
The Ibaraki Prefectural University of Health Sciences has introduced an integrated education management system to improve the quality of education. The management system was implemented by the Academic Affairs Committee and is run by the newly-created Kyouiku Suishin Shitsu (Educational Development Services). The management system evaluated past curricula and coordinated the introduction of new courses and integrated curricula designed to stimulate selflearning by students. The management system also integrated the student evaluation system and simultaneously coordinated faculty development workshops for all university staff to improve teaching skills. Several questionnaires showed that the new curricula met students' learning needs and provided a more objective evaluation system. The integrated education management system functions as a positive component in the improvement of the education system for students of allied health professions.
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Pulmonary rehabilitation is a common therapy for improving both exercise tolerance and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) . Although exercise is an important rehabilitation strategy, walking, treadmill use, bicycling and respiratory muscle training can be monotonous. A comprehensive exercise program that includes recreational activities may be a more effective means to decrease the occurrence of dyspnea during daily activities and improve QoL in patients with COPD. The purpose of this study was to investigate the effects of our exercise therapy, including recreational activities and respiratory muscle training, on dyspnea and health related QoL (HRQL) in COPD patients. Thirty-eight male patients with COPD were randomly assigned to a control (C) (70.1±6.4yr) (n=12) . pulmonary rehabilitation (PR) (70.3±8.3yr) (n= 16), or exercise (EX) (68.7±4.6yr) (n=10) group. The following evaluations were performed at baseline and at 8 weeks: (1) cycle ergometer test ; (2) 6-min walking distance : (3) physical fitness (4) pulmonary function ; (5) dyspnea : and (6) HRQoL (SF-36) . The C group showed no significant changes in physical fitness, pulmonary function, dyspnea, and HRQoL scores throughout the observation period. There was a significant (<I>P</I><0.05) improvement in 6-min walking distance. physical fit-ness, maximum rnspiratory pressure (MIP), and HRQoL for the PR group. The EX group demons-trated a significant (<I>P</I><0.05) improvement in physical fitness, maximum expiratory pressure (MEP), dyspnea, and HRQoL. Moreover, the degree of improvement in each variable was greater for EX than for PR. There were significant (<I>P</I><0.05) correlations between MIP and FEV<SUB>1.0</SUB> (r=0.65), and between MEP and FEV<SUB>1.0</SUB> (r=0.43) . Based on these results, it appears that our comprehensive exercise program, including recreational activities and respiratory muscle training, improves physical fitness, pulmonary function, dyspnea, and quality of life in COPD patients.
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The purpose of this study was to examine the validity of physical performance tests (test battery) for assessing functional fitness required for activities of daily life in older persons with chronic disease. This test battery consisted of 4 items: arm curl, walking around two cones, moving beans with chopsticks, and functional reach. Seventy-one persons (aged 66.7±7.8 yr) with either hemiplegia, Parkinson's disease (PD), or chronic obstructive pulmonary disease (COPD) served as subjects. There were significant differences among standard test scores in each rate of progression of the disease in all hemiplegia groups (Stages III, IV, V), and COPD groups (Stages 1, 2, 3) (Kruskal-Wallis'<I>H</I>=22.3 and 7.3, respectively) . In PD groups, there was no significant difference between standard scores in Stages II and III (Mann-Whitney's <I>U</I>=4.0) . However, the rank order correlation coefficient between the ranking in standard test score and the ranking in physical independence assessed by a medical doctor and a public health nurse was significant (ρ=0.57, <I>P</I><0.05) . All tests were safely applied for all subjects. These results suggest that our test battery may be applicable to a majority of older persons with various chronic diseases. Furthermore, the variability of standard test scores was greater than the clinical subjective ratings by Stage, which suggests that such a classification may provide a better description of disease progress/functional fitness.