Effective Rehabilitation Intervention which Using Activities of Daily Living Observation and Non-verbal Communication for Terminal Lung Cancer Patient with Difficulty to Express Hope Clearly to Improve His Quality of Life: Case Report

Purpose: The goal of rehabilitation for advanced cancer patients is to improve their quality of life (QOL). The meaning of QOL can only be determined by an individual patient. Rehabilitation begins with exploring the patient's hope. Here, we report a case suffering to express hope with difficulties by terminal stage lung cancer with brain metastases. Case: An 83-year-old male who was diagnosed with lung cancer (adenocarcinoma) and brain metastases admitted to palliative care unit because of progressive disease against chemo-radiotherapy. On admission, he could eat independently and walk to bathroom with slight assistance. A few weeks later, he had an epileptic seizure, right-hemiplegia and disturbance of consciousness. This episode made it drastically difficult for us to communicate orally with him. And, we tried hard to know the patient's hope by assessment using activities of daily living (ADL) observation and non-verbal communications. He revealed to be eager to eat even in a PS grade 4. He sometimes could talk a few words and, by rehabilitation techniques, he started to enjoy eating independently. For about three weeks, he could eat until the day before he died. Discussion: Eating behavior could be influenced by proper way of rehabilitation. Conclusion: ADL observation and non-verbal communication could be an effective rehabilitation approach to stimulate feeding behavior resulting in the improvement of patient's QOL.

Two advanced cancer patients in whom escitalopram was useful for depression

<b>Purpose</b>: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. <b>Case 1</b>: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. <b>Case 2</b>: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. <b>Conclusion</b>: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

Factor Structure of the Targeted Inventory on Problems in Schizophrenia

OBJECTIVE: The aim of this study was to explore the factor structure of a novel, 10-item rating scale, the Targeted Inventory on Problems in Schizophrenia (TIP-Sz). Determining the factor structure will be useful in the brief evaluation of medication and non-medication treatment of the disease. METHODS: An exploratory factor analysis was performed on TIP-Sz scores obtained from 100 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. RESULTS: The factor analysis extracted four factors that were deemed clinically pertinent, which we labeled: disorganization, social cooperativeness, functional capacity, and emotional state. The items exhibited cross-loadings on the first three factors (i.e., some items loaded on more than one factor). In particular, the 'behavioral dyscontrol and disorganization,' 'insight and reality testing,' and 'overall prognostic impression' items had comparable cross-loadings on all of the first three factors. The emotional state factor was distinct from the other factors in that the items loading on it did not cross-load on other factors. CONCLUSION: The TIP-Sz scale comprises factors that are associated with the psychosocial functioning and emotional state of patients, which are important outcome parameters for successful treatment of the disease.

A study of the significance of death conferences in the palliative care unit : through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.

Survey of Information about the Flavor of the Original Drugs and Generics / 医薬品情報学

<b>Objective: </b>There are some cases in which the original drug and generic, or various generic drugs have different flavors.  In prescription substitution, there is concern that difference in the flavor of the drug will influence on medication adherence.  Therefore pharmacists should sufficiently understand information regarding the flavors of drugs.  We investigated the source of information on flavor and an actual flavor.<br><b>Methods: </b>The study was limited to antibiotic powders for pediatric patients, 43 original drugs and 68 generic drugs were examined.  We collected information on the flavor by the paper document, such as pharmaceutical reference issued by the pharmaceutical companies, and by telephone.  We investigated the inclusion of the paper document, presence of descriptive information on the flavor listed in the paper document and the concordance between the flavor of the original drug and that of the generic drug.<br><b>Results: </b>For both the original drugs and generics, a flavor was added to many drugs (86.0 and 91.2%, respectively).  There were many cases in which the original drug and generic drug had different flavors.  However, information on the flavor was only described on the paper document of 28.6% of original drugs and 45.3% of the generic drugs.  Inquiry to the pharmaceutical companies by telephone was needed to know the flavor of drugs not described.  The inclusion of the paper document varied greatly with each pharmaceutical company.<br><b>Conclusion: </b>In the promotion of prescription substitution, it is necessary to promote proper administration of generic drugs by maintaining and collecting information on the flavor, and providing sufficient information to patients.