Palliative care outreach in communities without specialists is important, but its effectiveness has not yet been clarified in Japan. The current study aimed to identify interventional targets of palliative care outreach in home care in a community without specialists. We conducted a questionnaire survey (five-point scale) of home care nurses’ attitudes, difficulties, and practices for palliative care among 39 nurses working at five visiting nurse stations in Tome city. Difficulties in “symptom palliation” and “communication with medical practitioners” were high. Nurses tended to have low confidence and high motivation. Items with particularly low confidence were “communication with home care physicians” and “staff support”. Practices in “communication with physicians” and “coordination with care person” were low. Our survey identified enhancement of face to face relationships and support for home care nurses to improve their skills and confidence as interventional targets for palliative care outreach.

This study aims to clarify the impact of continuous outreach activities on home care nurses in a community where palliative care professionals are absent. We have continued this outreach activities in Tome-City, Miyagi Prefecture, Japan since July 2018 and conducted the questionnaire surveys (five-point scale and text open-ended questions) at the beginning of the activities, and two years later, using a Likert method and free writing about their difficulties, confidence and motivation regarding palliative care. As a result, home care nurses in Tome City (39 respondents at the start of palliative outreach, and 24 at 2 years) completed the survey. There was no significant difference between at the start and after 2 years, but 66.7% of participants reported outreach activities as effective after 2 years. In our analysis of free-form text responses, that nurses’ perspectives of end-life care had expanded and their confidence improved over time. There is possibility that outreach activities are useful in reducing their difficulties and improving their confidence. However, it will take time over the medium to long term to spread the influence to the entire region.

Objective: The effectiveness of palliative care for patients with amyotrophic lateral sclerosis (ALS) has not been fully validated. This study aimed to evaluate the impact of palliative care interventions on ALS patients using the Integrated Palliative care Outcome Scale (IPOS). Methods: A retrospective study was conducted on ALS patients at National Hospital Organization Yamagata National Hospital who received interventions from the palliative care team between November 2020 and December 2022 and were proxy-evaluated using IPOS. Results: Eleven patients were included in the analysis. Before and after the palliative care team intervention, the total IPOS score improved significantly from 24 to 18.9 (p=0.032), and the score for “Have you felt at peace” improved from 2 to 1 (p=0.031). Conclusion: Palliative care interventions may help alleviate suffering in ALS patients. However, further studies with larger sample sizes and long-term observational research are required to confirm these findings.

BACKGROUND: Hepatocyte growth factor (HGF) may act as a possible biochemical index for vascular damage, although evidence for the association between HGF and carotid intima-media thickness (CIMT) is limited. Since both HGF and circulating CD34-positive cells play an important role in endothelial repair, circulating CD34-positive cell levels may influence the association between HGF and CIMT. METHODS: We conducted a cross-sectional study of 269 elderly Japanese men aged 60-69 years who had undertaken an annual medical checkup from 2014 to 2015. RESULTS: The median value for circulating CD34-positive cells was 0.93 cells/μL. Among the study population, 135 men showed low circulating CD34-positive cell levels (≤ 0.93 cells/μL). By multivariable linear regression analysis, HGF was found to be significantly positively associated with CIMT only to participants with low circulating CD34-positive cell levels, with a multi-adjusted β of 0.26 (p = 0.005) and 0.002 (0.986) for low and high circulating CD34-positive cell levels, respectively. In addition, a significant interaction was observed between HGF and circulating CD34-positive cell levels (low and high) on CIMT (multivariable p value of 0.049). A positive association exists between HGF and CIMT in elderly Japanese men, limited to participants with low circulating CD34-positive cell levels. CONCLUSION A positive association exists between HGF and CIMT in community-dwelling elderly Japanese men, which is limited to participants with low numbers of circulating CD34-positive cells. Our findings indicate that circulating CD34-positive cell levels could determine the influence of HGF on CIMT in elderly Japanese men.
Aged ; Antigens, CD34 ; blood ; Biomarkers ; blood ; Carotid Intima-Media Thickness ; Cross-Sectional Studies ; Hepatocyte Growth Factor ; metabolism ; Humans ; Japan ; Male ; Middle Aged