This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.

BACKGROUND: Atopic dermatitis (AD) in infants is often related to food allergies (FA). The beneficial effects of lactic acid bacteria towards allergic diseases have been reported, but there are few reports on their effect and preferable dosages on AD in young children with concomitant FA. OBJECTIVE: To examine additional effects of two different dose of paraprobiotic Lactobacillus acidophilus L-92 (L-92) on the clinical treatment in young children afflicted by AD with diagnosed or suspected FA. METHODS: Fifty-nine AD young children from 10 months to 3 years old, with FA or who had not started to ingest specific food(s) because of high specific IgE levels, were recruited and randomly allocated into L-92 group (daily intake of 20 mg L-92/day) and placebo group. Participants were given test sample with conventional treatment for AD over a 24-week period. The severity of eczema was evaluated using SCORing Atopic Dermatitis (SCORAD) index before intervention, and at 4, 12, and 24 weeks after intervention. RESULTS: After 24 weeks of intervention, a significant decrease in SCORAD was observed only in the L-92 group when compared with the baseline values. Significant decreases in thymus and activation-regulated chemokine (TARC) and total IgE were also detected 24 weeks after intake in the L-92 group compared with the placebo group. CONCLUSION: It was suggested that intake of sufficient amounts of L-92 works as an adjunctive treatment of young children afflicted by AD with diagnosed or suspected FA.
Bacteria ; Chemokine CCL17 ; Child ; Dermatitis, Atopic ; Eczema ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Infant ; Lactic Acid ; Lactobacillus acidophilus ; Lactobacillus