Outcome Evaluation of a Nationwide Education Program for Primary Palliative Care

Background: In Japan, a nation-wide education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. In 2018, this program was revised from a two-day workshop to a hybrid program combining e-learning with a one-day workshop. This study aimed to assess the changes in participant knowledge and difficulties after having completed the revised education program. Methods: The subjects of this study were all participants who completed the revised program from April 2018 to March 2019. We conducted a pre-post survey via the e-learning system, and measured scores on the palliative care knowledge questionnaire to evaluate PEACE (PEACE-Q) and Palliative Care Difficulties Scale (PCDS). Results: A total of 11,124 participants completed the revised program from June 2018 to March 2019. Participants’ knowledge improved significantly according to the PEACE-Q with a total score of 24.1 and 30.0 (p<0.0001), and difficulties diminished as indicated by the PCDS with a total score of 45.2 and 39.2 (p<0.0001). Participants in different professions obtained similar results. Conclusion: Participants’ knowledge and difficulties improved after the revised nationwide primary palliative care education program. Similar results were obtained by participants in different professions.

Recognition of End-of-life Care by Nursing Care Staff, and Factors Impacting Their Recognition: An Exploratory Research Using Mixed Methods

Objectives: Elucidate recognition of end-of-life care by nursing care staff in elderly care facilities, and factors influencing such recognition. Methods: We conducted an internet questionnaire with 500 nursing care staff working at elderly care facilities across Japan, and an interview with 10 nursing care staff out of 500. Results: In the questionnaire, facility policies (41%) and cooperation with medical staff (38%) were selected as facilities and systems that are important for end-of-life care, and as a concern, sudden change in the condition of the patient, leading to death (53%) was selected. The interview showed that nursing care staff had a certain level of anxiety regardless of their experience with end-of-life care, with participants discussing their thoughts on how systematic learning of, and actual experience in, end-of-life care changed end-of-life care. Conclusion: Our study showed that systematic learning and experience of end-of-life care were important factors in recognition of end-of-life care by nursing care staff when providing such care in elderly care facilities.

The effectiveness of scopolamine ointment for drooling in a patient with tongue cancer

A decrease in swallowing function growth may lead to drooling and a diminished quality of life in patients with tongue cancer. Common ways to counteract drooling include a reduction of fluid intake, and the administration of anticholinergics. These actions, however, may not often suppress drooling sufficiently. Here we report how the application of the formulation of scopolamine ointment near the mastoid process behind the ear resulted in the alleviation of drooling in a tongue cancer patient, after continuous intravenous scopolamine butylbromide infusion was unsuccessful. Dry mouth was noted as an adverse event, which was not problematic. Also, the ointment could be used without local dermatitis. Scopolamine ointment is much more convenient to use than continuous injection, suggesting the improved treatment for drooling in patients with tongue cancer.

Usefulness of a palliative care education program based on the Cancer Control Act of Japan：a qualitative study

<b>Background：</b>A palliative care education program based on the Cancer Control Act, namely the Palliative care Emphasis Program on symptom management and Assessment for Continuous medical Education（PEACE）, has been run in Japan since 2008.<b> Purpose：</b>The aim of this study was to evaluate the usefulness of PEACE for clinicalpractice. <b>Method：</b>Focus group interviews were conducted with 12 physicians who attended the program and were chosen by theoretical sampling. Two investigators independently performed thematic content analysis. <b>Results：</b>Qualitative analysis identified five main categories of usefulness of the program：（1）acquiring knowledge of palliative care；（2）acquiring skills to provide palliative care；（3）mastering an attitude of focusing on suffering；（4）acquiring knowledge about home palliative care；and（5）standardizing knowledge of basic palliative care in the community. Three main categories for program improvement were identified, namely the content and structure of the program, as well as the method of running the program. <b>Conclusion：</b>PEACE may be useful in providing systematic education in basic palliative care through the acquisition of basic knowledge and skills, discussion of cases with colleagues, observing good communication by other physicians, and networking in the community.

Cognitive impairment and neural electrophysiological studies in early stage of transgenic Alzheimer's disease mice / 中华行为医学与脑科学杂志

Objective To investigate the early onset of learning and memory function of 4-month-old APP/PS1/Tau Alzheimer' s disease (3×Tg-AD) model mice and explore the pathogenesis of AD in early stage through evaluating neuron excitability and BKCa channel activity in cingulate cortex pyramidal cells.Methods Ten 4-month-old male 3×Tg-AD mice and matched ten wild type (WT) mice.Behavior was tested with the novel object recognition task to observe the ability of learning and memory.Whole-cell patch-clamp recordings were performed to assess the excitability of cingulate cortex pyramidal cells in terms of resting membrane potential and frequencies of spikes evoked by current injection.A train of five pulses of depolarizing currents were injected at 100 Hz to assess the spike width,which was used as an index for BKCa channel activity.Results Compared with the WT group (0.72±0.03),the novel object recognition index significantly decreased in 3 × Tg-AD group (0.55 ± 0.04) (P =0.004).Compared to the WT group((-66.03±0.43) mV),the resting membrane potential in cingulate cortex neurons of 3×Tg-AD group((-62.31±0.54)mV) was significantly depolarized(P=0.000).In contrast to WT group,the action potential firing frequencies evoked by depolarizing current injections were higher in neurons from 3×Tg-AD group(P=0.000),demonstrating that excitability of cingulate cortex neurons was elevated by intracellular Aβ.Spikes were broader in the 3×Tg-AD group than those in the WT group(P＜0.01).Suppression of BKCa channels in cingulate cortex neurons from the 3×Tg-AD group was confirmed on the basis of the spike half-width,since BKCa channels affect the descending phase of spikes.Conclusion Compared to WT mice,4-month-old 3×Tg-AD mice are impaired in learning and memory.The suppression of BKCa channels by intracellular Aβ leads to increase of excitability in cingulate cortex pyramidal cells.

The usefulness and necessity of postgraduate community-based training program in Saku Central Hospital : Impact of implementation of the New Postgraduate Training System for Physicians / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : The objective of this research was to evaluate and to seek out factors that affect the usefulness and necessity of postgraduate community-based training programs in Saku Central Hospital (SCH) after the implementation of the New Postgraduate Training System for Physicians (NPTSP) <br><b>Methods</b> : A questionnaire survey of physicians who entered the residency program of SCH between 1996 and 2007 was conducted.<br><b>Results</b> : The questionnaire was sent to 111 physicians, and responses were received from 73 (65.8%). Of the reasons for selecting SCH for residency training, three showed significant increases after the implementation of NPTSP : the training system, the general medicine department/general outpatient clinic, and the overall ambience of the SCH staff. The usefulness of the community-based training program showed a 3.77 times higher odds ratio (OR) in male residents (95% CI, 1.31-10.9). Necessity was decreased after the implementation of NPTSP, showing an OR (95% CI) of 2.99 (1.05-8.55).<br><b>Conclusion</b> : Of the reasons why residents selected SCH, the management system for the residency program and the environment for general practice in the hospital became more important after the implementation of NPTSP. The need for a community-based training program in SGH was decreased after NPTSP emphasized primary care.

Changes attained through the Palliative Care Education Program based on Cancer Control Act of Japan from the trainers' perspective

<b>Purpose</b>: The Palliative Care Education Program based on the Cancer Control Act has been held throughout Japan since 2008. The aim of this study is to identify changes attained through the program from the trainers' perspective. <b>Method</b>: The contents of the brain-storming sessions with the twelve trainers were qualitatively analyzed. <b>Results</b>: Six main categories of improvement were identified. These include: Reinforced cooperation; improved palliative care skills and knowledge; improved awareness of palliative care; improved understanding of the local palliative care resources; behavior modification of the participants; and development of in-hospital palliative care systems. <b>Conclusion</b>: Trainers recognized that holding the Palliative Care Education Program provides not only direct results such as greater knowledge and improved delivery of palliative care by physicians, but also indirect results such as enhanced cooperation and improved awareness of local palliative care resources.

Successful management of intractable malodor of a malignant fungating wound with the clindamycin-cadexomer iodine ointment

<b>Purpose</b>: Since malodor of a malignant fungating wound decreases quality of life of patients, its management is important. Metronidazol ointment, clindamycin ointment, and cadexomer iodine ointment have been used for treatment of malodor of a malignant fungating wound because they have antibacterial activity for anaerobic bacteria. Nevertheless, management of malodor of a malignant fungating wound has been unsatisfactory and it needs improvement. <b>Methods</b>: A mixture ointment of clindamycin and cadexomer iodine was employed in a case with malodor of a malignant fungating wound that had not been successfully controlled by cadexomer iodine ointment. <b>Results</b>: Malodor and exudate of a malignant fungating wound reduced. In addition, no adverse event such as skin troubles was observed and it was used safely. <b>Conclusions</b>: It was suggested that the clindamycin-cadexomer iodine ointment was more effective for treatment of refractory malodor of a malignant fungating wound than cadexomer iodine ointment.

Family-perceived usefulness of a pamphlet for families of imminently dying patients: a multicenter study

<b>Purpose:</b> To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. <b>Methods:</b> Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. <b>Results:</b> We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). <b>Conclusion:</b> “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

Current problems with project management and learning materials of a palliative care education program for physicians based on the Cancer Control Act

<b>Background</b>: In order to improve physicians' competence of palliative care, the PEACE project, a palliative care education program for physicians based on the Cancer Control Act, has been conducted throughout the country since 2008. The effectiveness and limitations of the current project management techniques and learning materials have not been determined. This study aimed to explore current problems with the PEACE project and to seek corrective strategies. <b>Method</b>: A workshop was held with 36 participants who had finished PEACE faculty-development programs, and involved brain-storming with physicians. The results of brain-storming sessions were qualitatively analyzed. <b>Results</b>: Most problems identified related to the burden, to the host, of holding the faculty-development program workshop. In addition, some problems related specifically to the individual host site or community involved. <b>Conclusion</b>: One strategy to improve these problems is to incorporate e-Learning to both expand the program and reduce the burden on the host site. In addition, workshop materials could be improved to include additional modules and revised guidelines. Palliat Care Res 2011; 6(2): 143-149