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1.
Artigo em Inglês | MEDLINE | ID: mdl-34656654

RESUMO

CONTEXT: Palliative care is an essential component of comprehensive care for patients with critical illnesses. In Japan, little is known about palliative care in intensive care units (ICUs), and palliative care approaches are not widespread. OBJECTIVE: This study aimed to better understand the attitudes of physicians toward palliative care and the utilization and needs of specialized palliative care consultations in ICUs in Japan. METHODS: A nationwide, self-administered questionnaire was distributed ICU physician directors in all hospitals with ICUs. RESULTS: Questionnaires were distributed to 873 ICU physician directors; valid responses were received from 436 ICU physician director (50% response rate). Among the respondents, 94% (n = 411) felt that primary palliative care should be strengthened in ICUs; 89% (n = 386) wanted ICU physicians to collaborate with specialists, such as palliative care teams (PCTs); and 71% (n = 311) indicated the need for specialized palliative care consultations; however, only 38% (n = 166) actually consulted, and only 6% (n = 28) consulted more than 10 patients in the past year. Physicians most commonly consulted PCT for patients with serious end-of-life illness (24%) (n = 107), intractable pain (21%) (n = 92), and providing psychological support to family members (43%, n = 187). The potential barriers in providing primary and specialized palliative care included being unable to understand the patients' intentions (54%, n = 235), lack of knowledge and skills in palliative care (53%, n = 230), and inability to consult with PCTs in a timely manner (46%, n = 201). CONCLUSIONS: These data suggest a need for primary palliative care education in ICUs and improved access to specialized palliative care consultations.

2.
J Cardiol ; 76(2): 177-183, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199753

RESUMO

BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.


Assuntos
Doenças Cardiovasculares/terapia , Cuidados Paliativos/normas , Indicadores de Qualidade em Assistência à Saúde , Adulto , Consenso , Técnica Delfos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade
3.
Am J Hosp Palliat Care ; 33(5): 425-30, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25852202

RESUMO

The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care.


Assuntos
Luto , Família/psicologia , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Assistência Terminal/psicologia , Adulto , Idoso , Estudos Transversais , Relações Familiares , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Conforto do Paciente , Percepção , Assistência Terminal/organização & administração
4.
Am J Hosp Palliat Care ; 33(5): 431-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25862807

RESUMO

This study aimed to clarify perspectives of bereaved family members regarding opioids and compare perceptions before admission and after bereavement. A cross-sectional questionnaire survey for bereaved family members in 100 inpatient palliative care units was administered. Participants were 297 bereaved family members of patients who used opioids. Many bereaved family members had misconceptions of opioids before admission. There was improvement after bereavement, but understanding remained low. Respondents less than 65 years old showed significantly greater decreases in misconceptions regarding opioids compared to older generations, after bereavement. Bereaved family members who were misinformed about opioids by physicians were significantly more likely to have misconceptions about opioids. Educational interventions for physicians are needed to ensure that they offer correct information to the general population.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor do Câncer/tratamento farmacológico , Família/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos/psicologia , Adulto , Fatores Etários , Idoso , Luto , Comportamento do Consumidor , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Percepção , Assistência Terminal/métodos , Assistência Terminal/psicologia
5.
PLoS One ; 10(7): e0133747, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26207755

RESUMO

BACKGROUND: Care-needing older adults and disabled individuals often require handrails for assistance of movements, such as sit-to-stand movements. Handrails must be set at the appropriate position; however, the effects of handrail height on joint movement and center-of-gravity movements during sit-to-stand movement remain unclear. In the present study, we sought to clarify the effects of handrail height on joint movement, center-of-gravity, and floor reaction force during sit-to-stand movement. METHODS: Subjects included 16 healthy young adults and 25 older adults who require long-term care. Kinetic and kinematic measurements during sit-to-stand movement of young adults were conducted using a 3-D motion analyzer and a force plate. Trunk forward tilt angle during sit-to-stand movement of older adults was measured using a still image from a video recording. RESULTS: Using low handrails, sit-to-stand movement resulted in an increased hip flexion angle, ankle dorsiflexion angle, and trunk forward tilt angle and a greater forward center-of-gravity shift than when not using handrails in young adults during seat-off. In contrast, using high handrails resulted in a smaller hip flexion angle and trunk forward tilt angle in young adults. The backward force on the floor was decreased in the low handrail condition, and was increased in the high handrail condition rather than that of sit-to-stand movement without handrails in young adults. The effect of handrail height on trunk forward tilt angle was the same in both healthy young adults and care-needing older adults during seat-off. CONCLUSION: Because handrail height affects joint movement and shift in the center-of-gravity during sit-to-stand movement, handrail position should be selected to match the status of older adults with functional impairment.


Assuntos
Movimento/fisiologia , Postura/fisiologia , Equipamentos de Autoajuda , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Pesos e Medidas Corporais , Deambulação com Auxílio/fisiologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Adulto Jovem
6.
Am J Hosp Palliat Care ; 30(3): 225-30, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22584151

RESUMO

The purpose of this study was to investigate the evaluation of end-of-life care from bereaved family of cancer patients who had died in intensive care units in Japan. Cross-sectional anonymous questionnaire surveys were conducted on community dwelling individuals aged 40-79 who were randomly sampled from census tracts. End-of-life care was assessed using the Good Death Inventory and Care Evaluation Scale. The respondents were 4011 bereaved family and response rate was 40%. Of 390 respondents had experienced bereavement in intensive care unit. Of 152 respondents had lost a loved one due to cancer. The result showed that bereaved family of cancer patients evaluated lower than the non-cancer patients for "The doctors dealt promptly with discomforting symptoms of the patients' (p=0.009), 'The nurses had adequate knowledge and skills' (p=0.016), 'Admission (use) was possible when necessary without waiting' (p=0.008) , Consideration was given to the health of the family (P=0.039) and Physical and psychological comfort (p=0.03). Overall, it can be presumed that the cancer patients' bereaved family evaluated about symptoms management and doctors and nurses skills was low. There is a need to improve for end-of-life care of cancer patients and to conduct further research to explore quality-improvement interventions to bereaved family of cancer in intensive care unit.


Assuntos
Família/psicologia , Unidades de Terapia Intensiva/normas , Assistência Terminal/normas , Adulto , Idoso , Competência Clínica/normas , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Enfermeiras e Enfermeiros/normas , Médicos/normas , Inquéritos e Questionários
7.
J Back Musculoskelet Rehabil ; 25(1): 33-45, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22398265

RESUMO

BACKGROUND: Sit-to-stand (STS) movement is an important part of the overall pattern of walking and affects social independence. OBJECTIVE: We examined the kinematics of STS movement using two adjustable handrails. METHODS: Seventy-five subjects (25 college students, 25 independent elderly people, and 25 physically challenged elderly people) participated in the study. Five types of handrail positions ('no handrails', 'both high', 'both low', 'high and low' and 'reverse high and low') were evaluated. Kinematic data were collected using a VICON analyzer and a Myosystem was used to collect the electromyographic data. RESULTS: STS movements with high and low handrails in the elderly subjects took the shortest time and showed the largest decrease in torque (15%) compared to no handrails. The 'high and low' position also reduced the loads to the greatest extent. The average time period for STS was reduced by 15 to 30% using the high and low handrails compared to no handrail for all three groups. CONCLUSION: The `high and low' handrail position best facilitates STS movement in the elderly by reducing the time needed to perform STS movements and by reducing the torque and subsequent wear on the joints and muscles.


Assuntos
Força da Mão/fisiologia , Limitação da Mobilidade , Movimento/fisiologia , Modalidades de Fisioterapia/instrumentação , Postura/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Pessoas com Deficiência/reabilitação , Eletromiografia , Desenho de Equipamento , Feminino , Humanos , Masculino , Fatores de Tempo , Torque
8.
Intensive Crit Care Nurs ; 27(4): 202-10, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21641222

RESUMO

OBJECTIVES: To develop a scale for assessing "difficulties felt by intensive care unit (ICU) nurses providing end-of-life care" (DFINE). DESIGN AND SETTING: A questionnaire survey of nurses in ICUs at general hospitals in the Kanto region, Japan. MAIN OUTCOME MEASURES: The scale was evaluated by exploratory factor analysis, calculation of Cronbach's α and test-retest reliability. The Frommelt Attitudes Toward Care of the Dying Scale (FATCOD-B-J) and the Nursing Job Stressor Scale (NJSS) were used to investigate concurrent validity. RESULTS: Respondents were 224 ICU nurses (response rate, 78%) at 18 hospitals. Five factors comprising 28 items were identified, involving difficulties related to: "the purpose of the ICU is recovery and survival"; "nursing system and model nurse for end-of-life care"; "building confidence in end-of-life care"; "caring for patients and families at end-of-life"; and "converting from curative care to end-of-life care". Cronbach's α for each factor ranged from 0.61 to 0.8. In terms of test-retest reliability, intraclass correlations for each factor ranged from 0.62 to 0.72. "Building confidence in end-of-life care" in DFINE showed a negative correlation with "positive attitudes towards caring for dying patient" in the FATCOD-B-J (r=-0.4). "Nursing system and model nurse for end-of-life care" in DFINE showed a positive correlation with "conflict with other nursing staffs" (r=0.32) and "conflict with physicians/autonomy" (r=0.31) in the NJSS. CONCLUSION: DFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale.


Assuntos
Atitude do Pessoal de Saúde , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros/psicologia , Assistência Terminal , Adulto , Coleta de Dados , Feminino , Humanos , Japão , Masculino , Estresse Psicológico
9.
Nurs Ethics ; 14(5): 651-64, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17901175

RESUMO

This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care.


Assuntos
Adesão a Diretivas Antecipadas/psicologia , Atitude do Pessoal de Saúde , Cuidados Críticos/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Defesa do Paciente , Assistência Terminal/psicologia , Adulto , Adesão a Diretivas Antecipadas/ética , Adesão a Diretivas Antecipadas/organização & administração , Diretivas Antecipadas/ética , Diretivas Antecipadas/psicologia , Atitude Frente a Morte , Conflito Psicológico , Cuidados Críticos/ética , Cuidados Críticos/organização & administração , Tomada de Decisões/ética , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Universitários , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Motivação , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem no Hospital/ética , Recursos Humanos de Enfermagem no Hospital/organização & administração , Defesa do Paciente/ética , Defesa do Paciente/psicologia , Direito a Morrer/ética , Inquéritos e Questionários , Assistência Terminal/ética , Assistência Terminal/organização & administração , Suspensão de Tratamento/ética
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