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• Challenges of Dental Hygienists in a Multidisciplinary Team Approach During Palliative Care for Patients With Advanced Cancer: A Nationwide Study.

  Nakajima N

  The American journal of hospice & palliative care ( American Journal of Hospice and Palliative Medicine )    1049909120960708 - 1049909120960708   2020年09月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  PURPOSE: Palliative care is constructed by various kinds of professionals. This study aimed to identify the challenges that dental hygienists (DHs) encountered when working with other professionals in a multidisciplinary team approach in palliative care for advanced cancer patients. METHODS: We conducted the following two studies: (1) a questionnaire-based survey for DHs who belong to Japanese Society for Oral Care (JSOC) on oral care in palliative care settings (n = 1,290), and (2) surveys on education for DHs in universities. Items in this study included the following: 1) a cross-sectional analysis of the curriculum on palliative care at 10 universities and 2) a questionnaire-based survey on palliative care education at 1 of the 10 universities (n = 75). RESULTS: (1) Seventy-three percent had experience in oral care in palliative care settings. The number of DHs with ≥20 years' experience was significantly higher than those with <10 years' experience (76% vs 66%, p = 0.042). Further, 92% received no formal palliative care education, and 94% perceived a lack of knowledge on palliative care. These data did not differ based on the years of experience. (2) (a) There was no specific curriculum on the subject of palliative care in 10 universities. Lectures on palliative care were provided at 3 universities. (b) Fifty-five percent of students attended lectures on palliative care. However, 88% of them experienced anxiety, and 78% perceived few classes on palliative care. CONCLUSIONS: For DHs, to positively contribute to multidisciplinary palliative care team approach, it is important to establish pregraduate and postgraduate education systems.

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• The Effectiveness of Artificial Hydration Therapy for Patients With Terminal Cancer Having Overhydration Symptoms Based on the Japanese Clinical Guidelines A Pilot Study.

  Nakajima N

  The American journal of hospice & palliative care ( American Journal of Hospice and Palliative Medicine )  37 ( 7 ) 521 - 526   2020年07月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  BACKGROUND: Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for patients with terminal cancer. The Japanese Society for Palliative Medicine published the guideline for AHT in 2007, and it was revised in 2013 based on the concept of cancer cachexia. OBJECTIVES: The purpose of this study was to evaluate the effects of AHT for patients with terminal cancer having overhydration symptoms based on this revised guideline. METHODS: This is a before-and-after study. We retrospectively analyzed 121 patients, of the 523 patients with terminal cancer who were admitted during the last 4 years, who were receiving "inappropriate hydration therapy." We performed guideline-based AHT and examined the effects on the alleviation of hydration-related symptoms, quality of life (QOL), patient satisfaction, and the feeling of benefit from AHT using a numeric rating scale, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30, satisfaction scale, and benefit scale on day 7 ± 1 compared to those at baseline. RESULTS: Hydration-related symptoms (nausea: 32, abdominal pain/distention: 35, peripheral edema: 42, and dyspnea: 28 cases) were significantly improved after performing guideline-based AHT (5.35 ± 1.26→4.00 ± 1.51, P = .002; 5.41 ± 1.44→4.12 ± 1.52; P = .005; 5.16 ± 1.38→3.29 ± 1.66; P < .0001; and 5.24 ± 1.22→4.21 ± 1.53, P = .002, respectively). The general QOL scores, overall satisfaction, and feeling of benefit were also significantly improved (2.67 ± 1.21→3.98 ± 1.55, P < .0001; 2.25 ± 1.35→3.48 ± 1.44, P < .0001; and 3.12 ± 1.24→4.31 ± 1.38, P = .0001, respectively). CONCLUSIONS: An appropriate AHT could alleviate overhydration-related symptoms and improve the QOL, patient satisfaction, and feeling of benefit.

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• Reversibility delirium in ill-hospitalized cancer patients: Does underlying etiology matter?

  Matsuda Y, Maeda I, Morita T, Phase-R group (Nakajima N, et al)

  Cancer Med   9 ( 1 ) 19 - 26   2020年01月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

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• 尊厳と安心のある社会に向けた緩和ケアと地域づくり:医療者間コミュニケーションの視点から

  中島 信久

  医療と社会 ( 公益財団法人 医療科学研究所 )  30 ( 1 ) 43 - 51   2020年

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  <p>「尊厳と安心のある社会に向けた緩和ケアと地域づくり」を目指すとき，コミュニケーションの視点から取り組むことは大切である。緩和ケアにおけるコミュニケーションは，患者－家族間，医療者間，患者・家族－医療者間の３つに大別される。このうちの２つ目，すなわち医療者間コミュニケーションに焦点を当てて論じる。医療者間のコミュニケーションを考える場合，「連携」がキーワードになる。この「連携」には「他の職種との連携（多職種連携）」，「診療科間の連携」，「専門家とジェネラリスト（一般臨床家）との連携」「病診連携・病病連携」などといった様々なかたちがある。</p><p>がん対策基本法の制定，PEACE研修会の開催，緩和ケア病棟や在宅緩和ケアの充実などにより，近年，わが国の緩和ケアの質は向上した。その一方で，地域間で提供される緩和ケアやがん医療の質に差異があることも事実である。われわれが沖縄で行っている４つの柱からなる包括的なプラン（「緩和ケアを『広める』『高める』『深める』『繋げる』ための取り組み）が，こうした問題を改善し「地域づくり」に役立つと思われるので紹介する。具体的には，①県全体への基本的緩和ケアの普及（＝広める）とともに②地域緩和ケアの中核を担う医療者のレベルアップ（＝高める）を図り，さらには③がん治療と緩和ケアの統合の実践（＝深める）を専門レベルで行う。①，②，③に取り組みながら④多職種連携・地域連携を進める（＝繋げる）ことが，質・量両面で充実したコミュニケーションに基づいた「尊厳と安心のある社会に向けた緩和ケアと地域づくり」の発展につながると期待される。</p>

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• Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain.

  Nakajima N

  Japanese journal of clinical oncology ( Japanese Journal of Clinical Oncology )  49 ( 11 ) 1061 - 1064   2019年12月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

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• 緩和医療・終末期ケア

  長尾 和宏, 新城 拓也, 小澤 竹俊 ( 担当: 単著 )

  中山書店  2017年