[Objective]The purpose of this study was to clarify the current status of cooperation between acupuncturists and physicians providing palliative care at home care support clinics.
[Methods]We studied 297 home care support clinics that provide cancer palliative care in the home. We mailed a self-administered questionnaire to the physicians belonging to the clinics. The questionnaire was created to clarify the number of clinics that provide home palliative care, current status of cooperation with acupuncturists, and methods of information-sharing.
[Results]We received responses from 98 clinics (33.3%response rate). Of these, 14 clinics (14.3%) currently provide care for terminal cancer patients in cooperation with acupuncturists, 9clinics (9.2%) reported having done so in the past. Patient's conditions treated in cooperation with acupuncturists were things such as pain, hiccups, edema, ascites, and constipation. The benefits attributed to cooperation with acupuncturists included "relief of symptoms,""improved patient satisfaction,"and "improved patient motivation."Regarding the presence or absence of information-sharing with acupuncturists, 7clinics (50%) responded that they "always share," 7clinics (50%) responded that they "share depending on the situation,"and no clinic reported "does not share information."Regarding the prospect for cooperation with acupuncturists in providing home palliative care in the future, 9clinics (9.2%) responded that they "actively want to cooperate,"and 65 clinics (66.3%) stated that they would "think about cooperation in some circumstances."
[Conclusion]From this study, it was concluded that cooperation exists between acupuncturists and physicians in 14.3%of home care support clinics providing palliative care. In addition, the possibility that cooperative patient care provides not only symptom relief but also other benefits has been suggested. On the other hand, it is necessary for acupuncturists, as part of a healthcare team, to have access to patient information and the status of other treatments, so that the acupuncturists can be involved in the field of home palliative care. Furthermore, management should promote an environment for cooperating with professionals in other medical occupations, including physicians.

Purpose：The purpose of this study was to clarify the practice of acupuncture and moxibustion in medical institutions with a palliative care unit. Methods：A selfadministered questionnaire was mailed to the physicians in charge of the ward or the chief nurses of 244 medical institutions with a palliative care unit. Results：Responses were obtained from 98 institutions. Among these, it was obvious that acupuncture and moxibustion therapy were performed in six institutions（6.1％）. The conditions of patients treated with acupuncture and moxibustion were pain, fatigue, constipation, and displeasure. Regarding acupuncturists being concerned with a palliative care field, it was described that acupuncturists could have one of the important role in clinical field in palliative care. On the other hand, it was indicated that there were difficulties associated with the practice of acupuncture and moxibustion therapy in a hospital. Conclusion：Although acupuncture and moxibustion therapy are considered to have usefulness as a variety of care, to practice acupuncture and moxibustion therapy in a medical institution, it is necessary to examine create the practice system.

A case of combined redo off-pump CABG (OPCAB) with right gastroepiploic artery and abdominal aortic aneurysm repair is reported. A 71-year-old man with a previous history of CABG was admitted for the operation of recurrent angina pectoris and known abdominal aortic aneurysm. Preoperative coronary angiograms showed obstruction of LITA graft for LAD. The operative procedure consisted of redo OPCAB using right gastroepiploic artery as a transdiaphragmatic graft under left antero-lateral thoracotomy and graft replacement of abdominal aortic aneurysm under median laparotomy simultaneously. This strategy has the advantage of avoiding the continuity of median sternotomy and laparotomy and contributes to the minimally invasive procedure in the combined operation.

This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAX(MV)). To assess the independent association of MAX(MV) with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAX(MV) on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAX(MV) ≥ 37.5℃ was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAX(MV) of 36.5℃ to 37.4℃. In multivariate linear regression analysis, patients with three categories of fever (MAX(MV) of 37.5℃ to 38.4℃, 38.5℃ to 39.4℃, and ≥ 39.5℃) sustained a significantly longer duration of TVT than those with normal range of MAX(MV) in both categories of ICU admission. A significant association between MAX(MV) and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome.
Asian Continental Ancestry Group ; Body Temperature ; Critical Illness* ; Fever* ; Humans ; Intensive Care Units ; Linear Models ; Observational Study ; Propensity Score ; Prospective Studies ; Reference Values ; Respiration, Artificial*