Comparison in the views of life and death between nurses and docters of a University Hospital

医師と看護師の死生観とその影響要因の相違をふまえ，質の高い緩和ケアチームについて検討することを目的とした．A 大学病院に勤務する医師と看護師に死生観について質問紙調査を行った．平井らが開発した死生観尺度（▯＝０．８８，７因子２７項目）を用いた．有効回答は医師１２０名（医師群）と看護師３４７名（看護師群）であった。統計処理については危険率５％未満を有意差とした．分析にはSPSS１１．０J for Windows（SPSS社製）を用いた．倫理的配慮は倫理審査会の承認を得た後，対象者へは参加の自由とプライバシーの保護を保証した．①「死への恐怖・不安」と「人生の目的意識」の因子には群間で有意差は認められなかった．②「死後の世界観」，「解放としての死」，「死からの回避」，「死への関心」や「寿命観」の５因子において両群間で有意に看護師群の方が高かった．③年齢などの各要因と死生観尺度との関係は両群者ともに年齢と「寿命観」で有意差が認められた．④死を迎える時に，希望する場所と死生観尺度得点に有意差が認められた．医師と看護師の死生観は「死後の世界観」などの因子得点で有意差が認められ，緩和ケアチームを効果的に展開していくためには双方の死生観の理解と，ケアへの活用の必要性が示唆された．A high quality palliative care team has been examined considering the differences between doctors and nurses in their views of life and death and its influential factors. A survey has been conducted on doctors and nurses employed at A University Hospital in their views of life and death. “Rinroshiki Syakudo”, a scale developed by Hirai et al（▯＝０．８８，７ factors，２７ items）, has been used as a scale of their views. The results of １２０ doctors and ３４７ nurses were analyzed by t-test, and significant difference was defined as a risk below ５％. SPSS １１．０J for Windows（by SPSS）was used for the analysis. After an approval of an audit for an ethical consideration, participants were ensured their freedom to participate and privacy protection. １） No significant differences have been found in factors “death anxiety” and “life purpose” in scales of views of life and death ２） However ５ factors， “after life belief”， “death relief”，“death avoidance”， “death concern” and “supernatural belief” were significantly high in nurses. ３） There was also a significant difference between the age and their “supernatural belief” in both doctors and nurses. ４） There were also significant differences in “where they want to die” and the total score of the scale, when facing own death. There being differences in factors such as “afterlife belief” between doctors’ views and those of nurses, the result suggested the need to understand both of the views and reflect them to palliative care

Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI

BACKGROUND: High bleeding risk (HBR) and complex percutaneous coronary intervention (PCI) are major determinants for dual antiplatelet therapy (DAPT) duration. OBJECTIVES: The aim of this study was to evaluate the effects of HBR and complex PCI on short vs standard DAPT. METHODS: Subgroup analyses were conducted on the basis of Academic Research Consortium-defined HBR and complex PCI in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Verulam's-Eluting Cobalt-Chromium Stent-2) Total Cohort, which randomly compared clopidogrel monotherapy after 1-month DAPT with 12-month DAPT with aspirin and clopidogrel after PCI. The primary endpoint was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) endpoints at 1 year. RESULTS: Regardless of HBR (n = 1, 893 [31.6%]) and complex PCI (n = 999 [16.7%]), the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (HBR, 5.01% vs 5.14%; non-HBR, 1.90% vs 2.02%; P interaction = 0.95) (complex PCI, 3.15% vs 4.07%; noncomplex PCI, 2.78% vs 2.82%; P interaction = 0.48) and for the cardiovascular endpoint (HBR, 4.35% vs 3.52%; and non-HBR, 1.56% vs 1.22%; P interaction = 0.90) (complex PCI, 2.53% vs 2.52%; noncomplex PCI, 2.38% vs 1.86%; P interaction = 0.53), while it was lower for the bleeding endpoint (HBR, 0.66% vs 2.27%; non-HBR, 0.43% vs 0.85%; P interaction = 0.36) (complex PCI, 0.63% vs 1.75%; noncomplex PCI, 0.48% vs 1.22%; P interaction = 0.90). The absolute difference in the bleeding between 1- and 12-month DAPT was numerically greater in patients with HBR than in those without HBR (-1.61% vs -0.42%). CONCLUSIONS: The effects of 1-month DAPT relative to 12-month DAPT were consistent regardless of HBR and complex PCI. The absolute benefit of 1-month DAPT over 12-month DAPT in reducing major bleeding was numerically greater in patients with HBR than in those without HBR. Complex PCI might not be an appropriate determinant for DAPT durations after PCI. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498)

Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Percutaneous Coronary Intervention: From the STOPDAPT-2 Total Cohort

[Background:] The benefit of clopidogrel monotherapy after 1-month dual antiplatelet therapy (DAPT) compared with 12-month DAPT with aspirin and clopidogrel was demonstrated in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2), but not in the STOPDAPT-2 acute coronary syndrome (ACS); however, both trials were underpowered based on the actual event rates. [Methods:] We obtained the prespecified pooled population of 5997 patients as the STOPDAPT-2 total cohort (STOPDAPT-2: N=3009/STOPDAPT-2 ACS: N=2988; ACS: N=4136/chronic coronary syndrome [CCS]: N=1861), comprising 2993 patients assigned to 1-month DAPT followed by clopidogrel monotherapy, and 3004 patients assigned to 12-month DAPT with aspirin and clopidogrel after percutaneous coronary intervention. The primary end point was the composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or any stroke) or bleeding (Thrombolysis in Myocardial Infarction major/minor) end points at 1 year. [Results:] One-month DAPT was noninferior to 12-month DAPT for the primary end point (2.84% versus 3.04%; hazard ratio [HR], 0.94 [95% CI, 0.70–1.27]; Pnoninferiority=0.001; Psuperiority=0.68). There was no significant risk-difference for the cardiovascular end point between the 1- and 12-month DAPT groups (2.40% versus 1.97%; HR, 1.24 [95% CI, 0.88–1.75]; Pnoninferiority=0.14; Psuperiority=0.23). There was a lower risk of the bleeding end point with 1-month DAPT relative to 12-month DAPT (0.50% versus 1.31%; HR, 0.38 [95% CI, 0.21–0.70]; Psuperiority=0.002). One-month DAPT relative to 12-month DAPT was associated with a lower risk for major bleeding regardless of ACS or CCS (ACS: HR, 0.46 [95% CI, 0.23–0.94]; P=0.03, and CCS: HR, 0.26 [95% CI, 0.09–0.79]; P=0.02; Pinteraction=0.40), while it was associated with a numerical increase in cardiovascular events in ACS patients, but not in CCS patients, although not statistically significant and without interaction (ACS: HR, 1.50 [95% CI, 0.99–2.27]; P=0.053, and CCS: HR, 0.74 [95% CI, 0.38–1.45]; P=0.39; Pinteraction=0.08). [Conclusions:] Clopidogrel monotherapy after 1-month DAPT compared with 12-month DAPT with aspirin and clopidogrel had a benefit in reducing major bleeding events without being associated with increase in cardiovascular events

Impact of the clinical frailty scale on mid-term mortality in patients with ST-elevated myocardial infarction

Background: “Frailty” is associated with poor prognosis in ST-elevated myocardial infarction (STEMI). However, there is little data regarding the impact of the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), a simple and semiquantitative tool for assessing frailty, on mid-term mortality in STEMI patients. Methods: A total of 354 consecutive STEMI patients (mean age 69.8 ± 12.4 years; male 76.6%) who underwent percutaneous intervention between July 2014 and March 2017 were retrospectively reviewed. The study endpoint was mid-term mortality according to the CFS classification. Furthermore, in order to clarify the impact of CFS upon admission on mid-term mortality, the independent predictors of all-cause death were evaluated. Results: Patients were categorized into three groups (CFS 1–3, n = 281; CFS 4–5, n = 62; and CFS 6–7, n = 11). During the study period (median 474 days), all-cause death was observed in 39 patients. After multivariate Cox regression analysis, higher CFS (adjusted hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.43–3.85, p < 0.001), higher Killip score (adjusted HR 2.46, 95%CI 1.30–5.78, p = 0.002), and lower serum albumin level (adjusted HR 4.29, 95%CI 2.16–8.51, p < 0.001) were significantly associated with an increased risk of all-cause death. Conclusion: In conclusion, severe frailty was associated with mid-term mortality in STEMI patients who underwent PCI. Keywords: Coronary heart disease, ST-elevated myocardial infarction, Frail, Prognosi