Palliative Care in Japan for Individuals with Amyotrophic Lateral Sclerosis

Palliative care has not been focused on noncancer yet. Amyotrophic lateral sclerosis (ALS) is a fatal, rapid progressive, and intractable neurodegenerative disease. Individuals with advanced ALS cannot perform activities of daily living by themselves, but their mental awareness remains clear. Individuals with ALS experience various pain soon after diagnosis, and a multidisciplinary team approach is needed because their pain can become complicated Caring for individuals with ALS needs to both start and end with palliative care in the physical, psychological, social, and spiritual aspects. The Japanese Ministry of Health, Labour and Welfare enacted the Principles of Policy for Rare and Intractable Diseases (nanbyo), which were the first set of such principles to be established in the world. This chapter describes the palliative care in Japan, from the perspectives of nursing and nanbyo measures. Also, three unique characteristics of ALS care in Japan are mentioned: the high level of disagreement between patients and family; the high rate of ventilator use compared with Western countries; and the low consumption of morphine. Healthcare practitioners need to apply the notion of the total pain to provide palliative care to individuals with ALS and acknowledge the challenges of providing timely symptomatic management

Nurses’ Awareness of Cognitive Impairment in Individuals with Amyotrophic Lateral Sclerosis

Journal Articl

回復期病院における急性期病院からの転入患者の特性と退院先 ―自宅退院と施設退院の患者特性の比較―

【目的】標準的な二次医療圏の回復期病院における急性期病院からの転入患者の特性と退院先を明確にし,地域完結型医療を推進するための示唆を得る.【対象と方法】 2007年度の転入患者 265人の診療記録の遡及調査を行い,記述統計および退院先により比較検討した.【結果】対象者は平均 76.5歳,脳血管疾患 47.1％で, 41.6％が入院後に介護保険を申請, 91.3％に退院調整がされた.退院先は 40.0％が施設,うち 18. 9％は介護老人保健施設であった.退院先施設が居住地の二次医療圏内である者は 77.4％で,介護老人福祉施設では 50.0％であった.退院先が自宅か否かの比較では,回復期病棟への入院,紹介元病院での入院期間,入院期間,医療処置の有無,ADL,認知機能,家族員数に有意差が見られた.【結語】加療に加え,ADL改善,認知症進行防止,介護保険の申請支援,退院調整の情報共有等とともに在宅・生活重視型施設の医療体制整備の必要性が示唆された

Benefits of off-campus education for students in the health sciences: a text-mining analysis

<p>Abstract</p> <p>Background</p> <p>In Japan, few community-based approaches have been adopted in health-care professional education, and the appropriate content for such approaches has not been clarified. In establishing community-based education for health-care professionals, clarification of its learning effects is required. A community-based educational program was started in 2009 in the health sciences course at Gunma University, and one of the main elements in this program is conducting classes outside school. The purpose of this study was to investigate using text-analysis methods how the off-campus program affects students.</p> <p>Methods</p> <p>In all, 116 self-assessment worksheets submitted by students after participating in the off-campus classes were decomposed into words. The extracted words were carefully selected from the perspective of contained meaning or content. With the selected terms, the relations to each word were analyzed by means of cluster analysis.</p> <p>Results</p> <p>Cluster analysis was used to select and divide 32 extracted words into four clusters: cluster 1—“actually/direct,” “learn/watch/hear,” “how,” “experience/participation,” “local residents,” “atmosphere in community-based clinical care settings,” “favorable,” “communication/conversation,” and “study”; cluster 2—“work of staff member” and “role”; cluster 3—“interaction/communication,” “understanding,” “feel,” “significant/important/necessity,” and “think”; and cluster 4—“community,” “confusing,” “enjoyable,” “proactive,” “knowledge,” “academic knowledge,” and “class.”</p> <p>Conclusions</p> <p>The students who participated in the program achieved different types of learning through the off-campus classes. They also had a positive impression of the community-based experience and interaction with the local residents, which is considered a favorable outcome. Off-campus programs could be a useful educational approach for students in health sciences.</p