Validation of the Japanese version of the barriers questionnaire II in cancer pain management: a cross-sectional study.

BACKGROUND: The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. In this study, we aimed to assess the reliability and validity of the newly developed Japanese version of the BQ-II (JBQ-II). METHODS: This study used a cross-sectional design. The study was conducted an ambulatory infusion center for cancer in a general hospital in Tokyo, Japan. Participants were 120 Japanese patients with cancer and 21 Japanese health professionals with experience in pain management. Cronbach's alpha coefficient was used to calculate reliability. Test-retest reliability was assessed with Spearman's intra-class correlation coefficient (ICC). Construct, criterion-related, and discriminant validity were assessed using information about pain management, daily life, mental health, and subjective health. RESULTS: The Cronbach's alpha was 0.90 for the JBQ-II, and all ICCs exceeded 0.70 (P < 0.01). Factor analysis showed the JBQ-II had a virtually identical structure to the BQ-II, and path analysis supported the JBQ-II constructs. The JBQ-II was weakly correlated with poor mental state (r = 0.36, P < 0.01). Patients' JBQ-II scores were significantly higher than health professionals' scores. CONCLUSION: The JBQ-II is a valid and reliable measure of patient-related barriers to pain management among Japanese adult patients with cancer.

[Relation between pain and health-related quality of life in cancer patients].

PURPOSE: This study aimed to investigate the relation between pain and health-related quality of lif e(HRQOL)in cancer patients. METHODS: An internet-based HRQOL survey of 618 patients with different malignancies using the EORTC QLQ-C30 and BPI-SF was performed. Three study groups were formed based on the pain in the previous month: group A comprised patients without pain; group B comprised patients with mild pain; and group C comprised patients with moderate to severe pain. RESULTS: Compared with both groups A and B, group C had significantly low global HRQOL and functioning, which resulted in fatigue, dyspnea, disturbed sleep, and financial difficulties. In addition, the patients in group C were significantly dissatisfied with their cancer medical service compared with the patients in both groups A and B. CONCLUSION: Pain is an important health issue that not only negatively affects the HRQOL but also results in fatigue, dyspnea, disturbed sleep, and financial difficulties in cancer patients. These symptoms may be important key words for HRQOL analysis in clinician-patient interviews.

Switching of alternative electrochemical charging mechanism inside single-walled carbon nanotubes: a quartz crystal microbalance study.

We probed electrochemical ion storage in single-walled carbon nanotubes (SWCNTs) of different diameters in two different organic electrolytes using electrochemical quartz crystal microbalance (EQCM) tracking. The measurements showed that charge storage probed by cyclic voltammetry did not deteriorate when steric effects seemed to hinder the accessibility of counter-ions into SWCNTs, and instead proceeded predominantly by co-ion desorption, as was shown by the decrease in the electrode mass probed by EQCM. The dominant mechanism correlated with the SWCNT diameter/ion size ratio; counter-ion adsorption dominated in the whole potential range when the diameter of SWCNTs was comparable to the size of the largest ion, whereas for larger diameters the charge increase coincided with a decrease in the electrode mass, indicating the dominance of co-ion desorption. The dominance of co-ion desorption was not observed in activated carbon, nor was it previously reported for other carbon materials, and is likely switched on because the carrier density of SWCNT increases with applied potential, and maintains the electrode capacity by co-ion desorption to overcome the steric hindrances to counter-ion adsorption.

Electrochemical Reactions of Iodine Molecules Encapsulated in Single-Walled Carbon Nanotubes.

We prepared iodine molecules encapsulated in single-walled carbon nanotubes (I@SWCNTs) by electro-oxidation of iodide ions with empty SWCNT electrode. Li-ion battery electrode properties of I@SWCNTs were investigated. It was found that the I@SWCNT sample can catch and release Li ions reversibly. We performed Raman measurements to reveal the Li-ion storage mechanism of I@SWCNT. It is plausible that chemical reactions of I2 from/into LiI in SWCNTs occur during Li-ion charging/discharging of I@SWCNT. We also prepared the CsI@SWCNT sample to verify that alkali metal ions can be extracted from alkali metal halide in SWCNTs. The extraction of cesium ions from CsI@SWCNT was confirmed by Raman measurements. It was also found that I@SWCNT can work as a Li-ion battery electrode in solid electrolyte as well.

Physician and nurse attitudes toward artificial hydration for terminally ill cancer patients in Japan: results of 2 nationwide surveys.

This study investigated physician and nurse attitudes toward artificial hydration in terminally ill cancer patients and compared differences in attitudes between these 2 professions and among clinical settings in Japan. The response rate was 53% (584/1,123) for physicians and 79% for nurses (3,328/4,210). More physicians answered that artificial hydration alleviates the sensation of thirst. More palliative care unit physicians and nurses answered that withholding artificial hydration alleviated several physical symptoms. Oncologists answered that artificial hydration alleviated the sensation of thirst and fatigue. Discussion among patient-centered teams and individualized decision making are important. Because the differences identified here are attributable to differences in knowledge of artificial hydration for terminal cancer patients, oncologists should place greater emphasis on the opinion of palliative care specialists. Medical practitioners caring for terminal cancer patients should consider a broader range of views on hydration therapy, with a focus on effective hydration techniques and alternative interventions.

Nurse views of the adequacy of decision making and nurse distress regarding artificial hydration for terminally ill cancer patients: a nationwide survey.

We evaluated nurse views on the adequacy of decision-making discussion among nurses and physicians regarding artificial hydration for terminally ill cancer patients and nurse distress arising from artificial hydration issues, as well as factors related to this distress. A self-administered questionnaire consisting of 4 questions about nurse views of discussions regarding artificial hydration and 6 questions about nurse distress arising from artificial hydration issues was distributed in participating institutions in October 2002 and returned by mail. A total of 3328 responses (79%) were analyzed. Almost half of the nurses felt that discussion of terminal hydration issues was insufficient. Among responses, 39% of oncology nurses and 78% of palliative care unit (PCU) nurses agreed that patients and medical practitioners discuss the issue of artificial hydration adequately, and 49% and 79%, respectively, agreed that medical practitioners discuss the issue of artificial hydration with other physicians adequately. As for distress on behalf of patients and families who refuse artificial hydration, 44% of oncology nurses and 57% of PCU nurses experienced such distress for patients, and 19% and 28% did so for families, respectively. Furthermore, 48% of oncology nurses and 47% of PCU nurses experienced distress arising from disagreements among medical practitioners about withholding artificial hydration, whereas 44% and 43% experienced distress about medical practitioners refusing artificial hydration, respectively. Discussion among care providers regarding artificial hydration is insufficient, particularly in general wards. Medical practitioners caring for terminally ill cancer patients should engage in greater discussion among patient-centered teams and facilitate individualized decision making.

Structural visualization of expert nursing: Cancer pain management.

Nurses' knowledge and making decisions in Cancer Pain Management contribute much to the improvement of cancer patients' QOL. Based on the practice of a expert nurse involved in Cancer Pain Management, we have developed the algorithm, which clarified that nurses implement much of observations or complicated decision-makings in Cancer Pain Manage Hereafter it is a significant challenge to examine its consistency and validity to develop its system.

[Preparation of pamphlets to teach the technique of home parenteral nutrition aiming at timely back home].

The home drip infusion is a stressful procedure for both patients and families under HPN at home. Effective and reliable guidance for drip infusion management should be provided while patients are still at the hospital to realize reliable home care. We revised the HPN Guidance Manual and report the process in this article. We revised the manual according to the principles that "the guidance is subdivided into 3 steps so that the contents of the guidance can be adjusted for individual patients", that "a lot of photos and illustrations for frequently used 2 models are placed" and that "a video is prepared to make the most of the impact motion pictures can give". We want to use the manual in future clinical practices.

[Preparation of pamphlets to teach the technique of home parenteral nutrition aiming at timely back home].

The home drip infusion is a stressful procedure for both patients and families under HPN at home. Effective and reliable guidance for drip infusion management should be provided while patients are still at the hospital to realize reliable home care. We revised the HPN Guidance Manual and report the process in this article. We revised the manual according to the principles that "the guidance is subdivided into 3 steps so that the contents of the guidance can be adjusted for individual patients", that "a lot of photos and illustrations for frequently used 2 models are placed" and that "a video is prepared to make the most of the impact motion pictures can give". We want to use the manual in future clinical practices.

Fibroblast growth factor-1-induced ERK1/2 signaling reciprocally regulates proliferation and smooth muscle cell differentiation of ligament-derived endothelial progenitor cell-like cells.

The periodontal ligament (PDL) is a fibrous connective tissue located between the tooth root and the alveolar bone. We previously demonstrated that a single cell-derived culture of primarily cultured PDL fibroblasts has the potential to construct an endothelial cell (EC) marker-positive blood vessel-like structure, suggesting that the fibroblastic lineage cells in ligament tissue could act as the endothelial progenitor cells (EPCs), which regenerate to construct a vascular system around the damaged ligament tissue. Moreover, we showed that EPC-like fibroblasts expressed not only EC markers but also smooth muscle cell (SMC) markers. Generally, an interaction between ECs and SMCs regulates blood vessel development and remodeling, and is required for the formation of a mature and functional vascular network. However, the mechanism underlying the SMC differentiation of the ligament-derived EPC-like fibroblasts remains to be clarified. In this study, we showed that suppression of fibroblast growth factor 1 (FGF-1)-induced extracellular signal-regulated kinase 1/2 (ERK1/2) signaling with the MAPK/ERK kinase (MEK) inhibitor U0126 completely abolished the FGF-1-induced proliferation of the ligament-derived EPC-like fibroblasts. In addition, U0126 treatment of FGF-1-stimulated ligament-derived EPC-like fibroblasts significantly induced the SMC differentiation of the cells. Thus, FGF-1-induced ERK1/2 signaling not only promoted the proliferation of the ligament-derived EPC-like fibroblasts, but also suppressed the SMC differentiation of the cells, suggesting that FGF-1 controls the construction of a vascular network around the ligament tissue by regulating the proliferation and SMC differentiation of the EPC-like cells through ERK-mediated signaling.

The Effects of Percutaneous Endoscopic Gastrostomy on Quality of Life in Patients With Dementia.

BACKGROUND: To examine the effects of percutaneous endoscopic gastrostomy (PEG) on quality of life (QOL) in patients with dementia. METHODS: We retrospectively included 53 Japanese community and tertiary hospitals to investigate the relationship between the newly developed PEG and consecutive dementia patients with swallowing difficulty between Jan 1st 2006 and Dec 31st 2008. We set improvements in 1) the level of independent living, 2) pneumonia, 3) peroral intake as outcome measures of QOL and explored the factors associated with these improvements. RESULTS: Till October 31st 2010, 1,353 patients with Alzheimer's dementia (33.1%), vascular dementia (61.7%), dementia with Lewy body disease (2.0%), Pick disease (0.6%) and others were followed-up for a median of 847 days (mean 805 ± 542 days). A total of 509 deaths were observed (mortality 59%) in full-followed patients. After multivariate adjustments, improvement in the level of independent living was observed in milder dementia, or those who can live independently with someone, compared with advanced dementia, characterized by those who need care by someone: Odds Ratio (OR), 3.90, 95% confidence interval (95%CI), 1.59 - 9.39, P = 0.003. Similarly, improvement of peroral intake was noticed in milder dementia: OR, 2.69, 95%CI, 1.17 - 6.17, P = 0.02. Such significant associations were not observed in improvement of pneumonia. CONCLUSIONS: These results suggest that improvement of QOL after PEG insertion may be expected more in milder dementia than in advanced dementia.

Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan.

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient's characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

Does Helicobacter pylori eradication therapy for peptic ulcer prevent gastric cancer?

AIM: To investigate the effects of Helicobacter pylori (H pylori) eradication therapy for treatment of peptic ulcer on the incidence of gastric cancer. METHODS: A multicenter prospective cohort study was conducted between November 2000 and December 2007 in Yamagata Prefecture, Japan. The study included patients with H pylori-positive peptic ulcer who decided themselves whether to receive H pylori eradication (eradication group) or conventional antacid therapy (non-eradication group). Incidence of gastric cancer in the two groups was determined based on the results of annual endoscopy and questionnaire surveys, as well as Yamagata Prefectural Cancer Registry data, and was compared between the two groups and by results of H pylori therapy. RESULTS: A total of 4133 patients aged between 13 and 91 years (mean 52.9 years) were registered, and 56 cases of gastric cancer were identified over a mean follow-up of 5.6 years. The sex- and age-adjusted incidence ratio of gastric cancer in the eradication group, as compared with the non-eradication group, was 0.58 (95% CI: 0.28-1.19) and ratios by follow-up period (< 1 year, 1-3 years, > 3 years) were 1.16 (0.27-5.00), 0.50 (0.17-1.49), and 0.34 (0.09-1.28), respectively. Longer follow-up tended to be associated with better prevention of gastric cancer, although not to a significant extent. No significant difference in incidence of gastric cancer was observed between patients with successful eradication therapy (32/2451 patients, 1.31%) and those with treatment failure (11/639 patients, 1.72%). Among patients with duodenal ulcer, which is known to be more prevalent in younger individuals, the incidence of gastric cancer was significantly less in those with successful eradication therapy (2/845 patients, 0.24%) than in those with treatment failure (3/216 patients, 1.39%). CONCLUSION: H pylori eradication therapy for peptic ulcer patients with a mean age of 52.9 years at registration did not significantly decrease the incidence of gastric cancer.

Development of a standard for hospital-based palliative care consultation teams using a modified Delphi method.

Although palliative care consultation teams are rapidly being disseminated throughout Japan as a result of government policy, the role of these teams has not been standardized. The aim of this study was to develop a hospital-based palliative care consultation team standard. We adopted a modified Delphi method to develop a standard. Twenty-seven multiprofessional panelists were selected according to two criteria: adequate experience as part of a palliative care consultation team and representative of 16 palliative care-related organizations. Panelists rated the appropriateness of 33 statements in a provisional standard, which was generated by the authors, using a nine-point Likert-type scale in a first-round survey. We set two criteria for agreement: the median value was 8 or more, and the difference between the minimum and maximum was 4 or less. There were 15 disagreements in the first-round survey. Based on discussions through e-mails and a panel meeting, these 15 statements were dealt with as follows: one was rejected, one was combined with another statement, three were unmodified, and 10 underwent minor revisions. Moreover, two statements that generated agreement were divided into two statements each. Consequently, the number of statements was 37. In a second-round survey, three statements engendered disagreement and were modified. At the end of the process, there were 37 statements in four areas: "philosophy and policy," "structure for care provision," "contents of activities," and "quality assurance and care improvements." This standard may be useful as a clinical activity guide as well as a method to evaluate palliative care consultation teams.

The sky blue method as a screening test to detect misplacement of percutaneous endoscopic gastrostomy tube at exchange.

BACKGROUND: During tube exchange for percutaneous endoscopic gastrostomy (PEG), a misplaced tube can cause peritonitis and death. Thus, endoscopic or radiologic observation is required at tube exchange to make sure the tube is placed correctly. However, these procedures cost extensive time and money to perform in all patients at the time of tube exchange. Therefore, we developed the "sky blue method" as a screening test to detect misplacement of the PEG tube during tube exchange. METHODS: First, sky blue solution consisting of indigocarmine diluted with saline was injected into the gastric space via the old PEG tube just before the tube exchange. Next, the tube was exchanged using a standard method. Then, we checked whether the sky blue solution could be collected through the new tube or not. Finally, we confirmed correct placement of the tube by endoscopic or radiologic observation for all patients. RESULTS: A total of 961 patients were enrolled. Each tube exchange took 1 to 3 minutes, and there were no adverse effects. Four patients experienced a misplaced tube, all of which were detectable with the sky blue method. Diagnostic parameters of the sky blue method were as follows: sensitivity, 94% (95%CI: 92-95%); specificity, 100% (95%CI: 40-100%); positive predictive value, 100% (95%CI: 100-100%); negative predictive value, 6% (95%CI: 2-16%). CONCLUSION: These results suggest that the number of endoscopic or radiologic observations to confirm correct replacement of the PEG tube may be reduced to one fifteenth using the sky blue method.