Rethinking the visiting nurse system at a major regional hospital

The authors' hospital is a National Health Insurance System Hospital near four cities. It serves as the central hospital for a region with a population of about 330,000 people. The hospital has 585 beds and sees an average of 1,500 outpatients each day. The average number of hospitalized patients each day is 500. Its visiting nurse department is located in a regional medical center and functions as a "Visiting Nurse Center". The purpose of the present study was to review the visiting nurse system at our hospital that has been operating for the past 8 years. The motivation for this review was our intention to actively increase the number of people advantage of such services, and attempt to provide continuous care for each individual patient. By looking back on the system as it has been practiced, its procedures, and results during the 8 years from 1990 to 1997, we can consider points for improvement from among the problem points discovered. The problems uncovered in our practice of home nursing care are listed below. 1. It is difficult to present a list with an estimated period for the release from the hospital. 2. Instructions for leaving the hospital are not sufficiently detailed. 3. Arranging the schedule and actual visits for diagnosis and treatment is complex. 4. The system for cooperation with the activities that are done in the hospital is insufficient. 5. The system for cooperation with local public health nurses is insufficient. 6. The system for managing equipment is insufficient. 7. The 24-hour support system for terminal patients is inadequate.     

Consideration of cancer home chemotherapy with cooperation between hospital and clinic

Recently, the progress in chemotherapy has brought an improvement in the survival rate of patients with non-resectable digestive tract cancer. Simultaneously, maintenance of patients' QOL is regarded as important. In our hospital, we use low-dose FP therapy to maintain QOL and a satisfactory survival rate. To date, we have administered low-dose FP to more than 50 patients with non-resectable digestive cancer. We investigated patients who received home chemotherapy after being evaluated NC, and found no remarkable side effects as a result of this therapy during admission.     

The roles of a visiting nurse for a terminal stage patient with chronic renal failure: a case study

A visiting nursing service was provided for an 87-year-old male patient with terminal stage of chronic renal failure. Although his primary doctor told us that the patient's prognosis is no good with general prostration, the patient was cared at home because his family strongly wanted him in a home care environment. The patient, who is having a right nephrostomy catheter and urethrovesical indwelling catheter and is in an unstable condition due to dehydration caused by an aggravation of renal failure, left the hospital in the end of August in 2005. Meanwhile, a family care giver was feeling uneasiness due to a lack of experience in giving medical treatment and to care for the patient. Therefore, a visiting nurse provided support to reduce the caregiver's anxiety and taught how to observe the patient's conditions, to give medical treatment and a method to care the patient at home. As a result, the patient's symptom was little improved to a lesser degree of stable condition. The family caregiver's anxiety was also reduced as well. The roles of a visiting nurse for a terminal stage patient are: (1) to urge the family care giver to obtain basic self reliant home care techniques, (2) to create a division of clear roles among the family members, (3) to execute an individualized life for the patient and family, (4) to try to establish a system to cooperate with a medical support group.     

Death at home and hospital of home terminal cancer patients

We think that death at home has increased among patients from our hospital due to following factors: 1) solid cooperation with visiting nurse stations, 2) progress in judgments of care ability, 3) changes in family consciousness, 4) enrichment of other support systems for home care.     

Roles of the hospital pharmacist and the cooperation between hospital pharmacy and insurance pharmacy in the introduction of home parenteral nutrition

In the introduction of home parenteral nutrition (HPN), roles of the pharmacist are important from the viewpoint of drug therapy. In our hospital, patients are to be shifted to home medical care under the adequate guidance and proper adjustment by the cooperation between the clinical pharmacists and home medical care pharmacists. We are also enhancing the cooperation with the pharmacists in insurance pharmacies. At present, however, there are few insurance pharmacies that can concoct the injection of medicine, resulting in our insufficient responses to the needs of the patients. It is necessary and quite important to increase the number of insurance pharmacies that are allowed to manage the patient's medication as well as the concoction of injecting medicine. The cooperation between hospital pharmacy and insurance pharmacy (Yaku-Yaku Renkei in Japanese) is indispensable in order to promote home medical care; especially "the sharing of information" is most required between the two pharmacy groups.     

Creative activities in home care for terminally-ill cancer patients at a rural municipal hospital

Karuizawa Hospital is a rural, small town municipal hospital with 60 beds, located in Nagano Prefecture in central Japan. The terminal stages of patients who were treated in our department of surgery but later died of cancer are reviewed. In the five year period extending from April, 1994 through March, 1999 sixty patients died from cancer. Of them, 34 people died in their own home and 26 in our hospital. The annual ratio of patients who died at home to those who died in the hospital are analyzed, as well as whether these ratios differed according to the location of the patient's cancer. The identity of the patients' main home caregiver was sought, as well as how many days the patients resided at home until they passed away, and how frequently doctors or nurses visited their home. Some of the doctors' attempts to gain informed consent are described. Based on the findings, the authors recommend an end to the practice of first revealing the name and details of a patient's disease to his/her family. It was also found that documented information is useful in order to promote smooth relationships among patients, family members, and the doctor.     

Correlations between access to mammography and breast cancer stage at diagnosis

BACKGROUND: There is a lack of data on the access to mammography and its relation to the incidence of early breast cancer. In this study, the authors evaluated access by correlating geographically the number of U.S. Food and Drug Administration (FDA)-certified mammography facilities and the AJCC stage of breast cancer at diagnosis by county. METHODS: Breast cancer incidence rates and stage at diagnosis were compared with the number of FDA-certified mammography facilities by county in the Surveillance, Epidemiology, and End Results reporting areas. The objective was to determine whether the number of certified facilities was associated with the percent of breast cancers diagnosed at the in situ stage. This was a multiple-group ecologic study, and counties were used as the units of analysis. RESULTS: There was a strong correlation between the number of mammography facilities and the population of a county, whereas there was no correlation between the number of mammography facilities and the land area of a county. A correlation existed between the percent of incident breast cancers that were diagnosed as in situ disease and the number of mammography facilities per 10,000 women among both whites and African Americans. CONCLUSIONS: There was an association between the number of mammography facilities and population. In counties with >/= 30,000 black and white females, 1) the percent of in situ breast cancers in black women and white women was correlated with the number of facilities per 10,000 women, indicating that population density is a factor in access for both racial groups; 2) except for 2 counties with >/= 30,000 black women, the percent of incident in situ cases was similar in both black women and white women, indicating equal access in both groups; and 3) there was a correlation between the percent in situ incidence and number of facilities per 1000 square miles in white women, but not in black women. There was a direct correlation of statewide mammography rates with the number of facilities per 1000 square miles, indicating that the rate of screening depends on availability. Maximum rates of statewide screening were achieved when there were > 15 mammography facilities per 1000 square miles.     

How to treat a home cancer patient when the patient encountered with delirium symptom

It has been 5 years since the passage of the Basic Act on Countermeasures against Cancer and the Promotion of Cancer Countermeasures. In 2012, the early stage of cancer treatment was desired based on the revision of these master plans for all cancer patients as well as their families. One third of the 1 million annual deaths were caused by cancer in Japan, and predicted that the cancer mortality ratio has been increasing in trend. Less than 10% of the end-of-life stage cancer patients who prefer to die at home fulfill their desire causing a lot of problems. In order to solve the problems, the importance of medical treatment by a team consisted of multi -disciplinary professionals has been sought out. We have erected palliative care team and cancer consulting support center in our hospital to help the patient and their family since 2009. The contents of the consulting subjects were varied and wide, as we have reported in the 21st Japan Society for Home Therapy Research(2010). In case of the cancer patient who displayed with delirium symptom, for instance, there were many occasions we had to stop the home medical treatment. So we studied how to treat a home cancer patient when the patient encountered with delirium symptom.     

Factors affecting the decision of cancer patients to be cared for at home or in hospital

Community health care and, more specifically, home health care are major developments over recent years. In many European countries there has been serious debate on the necessity of home care, the importance of this type of health care for the patient and family, and those factors influencing patient choice with regard to health care at home or in hospital.
This question of choice between home and hospital care forms the basis of this piece of research, the aim of which is to examine the biosocial factors that influence the decision of cancer patients in Greece to choose health care at home or in hospital.     

Inpatient hospital admission through an emergency department in relation to stage at diagnosis of colorectal cancer

The purpose of this study was to use population-based sources to estimate the frequency and characteristics of first inpatient hospital admission through an emergency department (ED) among 11,023 patients with diagnosed colorectal cancer between 1992 and 1996. Patients were identified from the population-based Connecticut Tumor Registry. Linkage with a statewide hospital discharge database (inpatient only) disclosed that 20% had a first hospital inpatient admission through an ED. Inpatient admission through an ED was statistically significantly associated with older age and race and was a statistically significant risk factor for distant stage at diagnosis. Studies are needed of the roles of patient delay and lack of screening in influencing ED presentation, especially in the elderly.     

Home visiting nursing care for a terminal stage cancer patient with bed sore--coordination through exchanging of advice request memo as a useful tool

Visiting nursing care service was provided to a 40s female patient, who had a terminal cancer with bed sore around the sacred bones. We started the nursing service when the patient was still cared at hospital. The nursing service we provided was coordinated by the certified nurse specialized in skin and excrement care and home visiting nurse. A smooth home care transition was resulted because of the coordination provided by the two nurses. We started coaching the family while the patient was still at the hospital with a home care instruction manual until the patient was discharged. All in all, the patient and her family were at ease with two nurses' coordinated efforts. Since the patient was cared at home, her bed sore problem got worse due to an absence of caregiver. In order to solve the bed sore problem, the visiting nurse took pictures of peeled adhesive patch and the bed sore around the sacred bones to show and consult with the certified nurse. With the advice from the certified nurse, the home visiting nurse was able to care the bed sore problem manageable in size. From this experience, we learned that a proper communication channel, in this case an advice request memo exchange, between the certified nurse and visiting nurse was a useful tool for both sides in order to properly assess the patient's medical care needs.     

Present and future home therapy in advanced stage of pancreatic cancer

We describe the present and future directions of home therapy in pancreatic cancer patients according to the chemotherapy and best supportive care. Chemotherapy in an outpatient clinic is widely supported by the use of gemcitabine, and useful because of mild adverse effect, good clinical benefit response and survival benefit. Since there is no secondary chemotherapy agent after gemcitabine treatment failure, best supportive care is essential. Control of blood glucose level, ascites and pain are also important. Now pain control and home therapy are easy to perform because of the development of various useful opioid agents.     

A case report of a terminally ill patient who died of cancer at home under pain control

Ninety percent of patients we handle at our visiting nurse group are last stage cancer patients. We report a terminally ill cancer patient who died at home under a high dose of powerful opioids to control pain. The patient was a 69-year-old woman with colorectal cancer. She lived together with her husband and their elder son's family. Even though the patient's condition dramatically shifted time to time, we could maintain a good QOL of the patient till her death at home. After the outpatient chemotherapy treatment began, we confirmed the patient's colorectal cancer had spread to her bones. We started using powerful opioids for pain control and the patient was eventually transferred to home hospice care. Then, the patient suffered a self destruction of the cutis metastasis layer and the disease caused broken bones on her left thigh. We however continued on providing home care service because of the patient's strong desire to stay home even if the family's concern as a care giver had multiplied. We increased the frequency of home visits and telephone calls in order to give medical and spiritual support for both the patient and her family. As a result, we could keep the patient's good QOL up to the time of her death. Based on the experiences through taking care of the patient, we strongly felt that the timing of proper guidance for the peaceful death to the family, a communication method or a communication system and telephone call visits were very important, in addition to controlling the condition of illness in order to keep up a good QOL for both the patient and her family.