1.Akathisia Occurrence Induced by Haloperidol Injection and Effectiveness of Biperiden Injection Against Delirium in Cancer Patients
Jinwoo LEE ; Yoriko KOBAYASHI ; Kazuyuki NAKAMURA ; Hiromi KURODA
Journal of the Japanese Association of Rural Medicine 2016;64(5):808-814
When we use haloperidol (HP) parenterally to treat delirium in cancer patients, sometimes akathisia appears. So, we are pressed to give treat this symptom. The aim of this study was to investigate the occurrence rate of akathisia after HP injection and the effectiveness of biperiden injection in the treatment of akathisia. We retrospectively worked out the rate of the use of Hp injection, the rate of the occurrence of akathisia by using Hp and the effectiveness of biperiden injection in the treatment for delirium in 67 patients out of 100 patients who died in the palliative care unit (PCU) and 10 patients with delirium out of 23 patients who were under care of our palliative care team (PCT) in the sections other than the PCU from August to December of 2012. In the PCU, Hp injections were used in 52 patients (78%) out of 67 with delirium, and akathisia was suspected in 23 patients. Biperiden was injected into all of them and it was effective in 21 patients (91%). Our palliative care team gave Hp injections to seven patients (70%) out of 10 with delirium, and akathisia was suspected in one patient. At that time Hp injection was suspended but biperiden was not used. To sum up, Hp was administered to a total of 59 patients (76%) out of 77 with delirium, and akathisia was suspected in 24 patients (40%). Biperiden was used in 23 patients, all of whom were PCU patients, and effective in 21 (91%). When Hp was used to treat cancer patients with delirium, the onset of akathisia was suspected in 40% of them, but biperiden was considerably beneficial in patients with delirium.
2.Usefulness of“Tablet PC application for Pain Memory”on cancer pain assessment
Hirotaka Hirazawa ; Shoko Ando ; Takako Mitsuyuki ; Yoko Yamamoto ; Hiromi Kuroda ; Kazumasa Yamada ; Goro Obinata
Palliative Care Research 2015;10(1):312-317
Objective:The previous study was to develop the“Itamikei”, a small machine which patients can use to record their subjective level of pain. And new assessment tool“Tablet PC application for Pain Memory”, which enable the user to visualize and record the pain levels both instantly and over time. The purpose of this study was to examine the effectiveness of Pain Memory as a pain assessment tool for patients with cancer pain. Method:12 inpatients prescribed analgesics for cancer pain, were instructed to input their pain level into Pain Memory over a 2-week period, and the resulting graph was reviewed by the patient and staff. They also completed a questionnaire evaluating the design, function and pain assessment of the tool. Result:The patients input their pain level into Pain Memory 5.25 times/day(Md), which provided increased opportunities to ascertain the patient’s pain level compared to that“Itamikei”. The design and function of the Pain Memory were given approximately rate 4 using a 5 point scale by both patients and staff members. Moreover, using Pain Memory, the patients highly rated the parameter“I understood changes in pain”, and the staff members highly rated the parameter“Patients participating in the treatment of pain”. Conclusion:We found Pain Memory could be useful in the assessment of pain. It provided more opportunities to ascertain the pain level of patients, and enabled the visualization of the pain level through a graph.
3.Evaluation of the Results of Mass Colorectal Cancer Screening by Immunological Fecal Occult Blood Test.
Shuichi MIHARA ; Sawako KAWAZU ; Michiyo SAWATARI ; Sachio HAMADA ; Hiroe YAMABE ; Hiroko NISHI ; Hiromi KUMABE ; Kazuko HONDOU ; Eiko MORIMOTO ; Ritsuko YOSHIOKA ; Keiichiro KURODA ; Wasaku KOYAMA
Journal of the Japanese Association of Rural Medicine 1995;44(4):597-602
We have performed mass surveys for colorectal cancer by using an immunological fecal occult blood test (OC Hemodia) since April, 1987. In this report, we evaluated the mass survey protocol, and investigated the upcoming problems and measures.
The total number of examinees for six years until March, 1993 was 172, 474. The persons needed detailed examination amounted to 6, 952 (4.0%) and the persons received the detailed examination, 4, 706 (67.7%). A total of 144 colorectal cancer cases (detection rate: 0.08%, 153 lesions) were discovered, 93 cases (64.6%) were in their early stage. 101 cases (66.0%) of 153 lesions were early cancer, and 71 cases (70.3%) were cured by endoscopic polypectomy.
The detection rate of colorectal cancer was higher in males than females. In particular, the finding rate for males 50 years old and above was extremely high. We strongly recommend that the elderly people should receive a mass survey. Moreover, it is important to offer the opportunity for detailed examination to the persons who don't receive them. That might raise the detection rate.
It was found that detailed examination has left much room for improvement in terms of methodology. Some medical institutions performed only fecal occult blood testing. They are require d to raise the understanding of mass surveys for colorectal cancer. Collaboration with the medical institutions that are capable of detailed examination and care is indispensable to raise the accuracy of examination.
On the basis of the results in 1992, we calculated the diagnostic accuracy of immunological fecal occult blood test. The sensitivity of the one-day-method was 70.8%, the specificity, 97.0%, and the positive predictive value 2.1. The sensitivity of the two-days-method was 86.7%, the specificity, 95. 3%, and the positive predictive value, 2.7, and was better than the one-day-method.
These findings suggest that the carcinomas, negative to the occult blood test, still exist in a high frequency rate. Therefore, we should perform mass surveys by the two-days-method every year, in order to improve the evaluation of the mass survey method for colorectal cancer.
4.Autologous Blood Donation for Patients With Low-Lying Placenta
Heisuke HIROWATARI ; Shigeru TODA ; Mai FUJIKURA ; Keita KURODA ; Mayuko BANDO ; Komei KATAYAMA ; Maya HANATANI ; Takuto NAKAMURA ; Aya SOBAJIMA ; Hiromi FUJIKI ; Akiko FUKATSU ; Takayasu SUGANUMA ; Takahiro SUZUKI
Journal of the Japanese Association of Rural Medicine 2021;70(4):354-359
This study was undertaken to elucidate the usefulness and problems of autologous blooddonation for the patients with low-lying placenta. Seventy-eight women with low-lying placentawho gave birth in our institution were retrospectively analyzed. Autologous blood donation wasperformed in 58 patients (74%). The median volume of donated blood was 300 mL. Patients withor without autologous blood donation showed no significant difference in the distance betweenthe edge of the placenta and the internal os of the uterus. Median blood loss due to intrapartumhemorrhage was 1183 mL. All 7 patients with blood loss of more than 2000 mL had donatedautologous blood. The donated blood was transfused in 9 of the 58 patients (16%) who underwentautologous blood donation. No patients underwent allogenic blood transfusion. Althoughautologous blood donation was expected to be useful for avoiding allogenic blood transfusion inthese patients with low-lying placenta, the high discard rate suggests the need for a strategy toselect those patients at high risk for blood loss requiring transfusion.