The primary aims of this study were; 1) to investigate the appropriateness of the analgesic therapy in hospitalized cancer patients, and 2) to explore the effects of the screening system by a pharmacist-palliative care physician screening team on analgesic regimens.
The pharmacist-palliative care physician screeningteam screened consecutive cancer patients about the adequacy of analgesic treatments and provided written recommendations to primary physicians. Inclusion criteria were cancer patients admitted to oncology wards, not having been consulted to palliative care team, and receiving opioid or chemotherapy. Of 62 patients screened, analgesia was inadequate in 44%, and preemptive pharmacological treatments for opioid-induced nausea and constipation was lacking in 42% of 43 patients who had received opioids. The team provided a total of 80 recommendations for 52 patients, and primary physicians followed 94% of the recommendations within one week. The pharmacist-palliative care physician screening team may contribute to better analgesia in patients not having been consulted to the specialized palliative care service.

Background/Purpose: The purpose of this study is to clarify the effectiveness of interventions for breast cancer patients with psychological distress by a clinical psychologist on the basis of the contents of the interventions and counseling. Methods: The participants were 20 inpatient and outpatient women aged from 33 to 73 years who had been diagnosed with breast cancer. The interventions were conducted on the basis of patients' complaints about anxiety and/or depression or by a medical doctor's request. The interventions employed unstructured, one-on-one interviews. Each interview usually lasted no more than 60 minutes. Results: The 20 cases were classified into the following categories: (1) 15 general (nonpsychiatric) cases, consisting of (1-1) 9 cases at the cancer-notification and progressive-therapeutic stages and (1-2) 6 cases at the progressive-relapse stage; and (2) 5 specific (psychiatric) cases, consisting of (2-1) 3 cases at the cancer-notification and progressive-therapeutic stages and (2-2) 2 cases at the progressive-relapsestage. As for the general cases, interventions were found to be effective in all 9 cases at the cancer-notification and progressive-therapeutic stages but in only 2 of 6 cases at the progressive-relapse stage. In specific cases, effective interventions were found at the cancer-notification, the progressive-therapeutic, and the progressive-relapsestages. Conclusion: This study suggested that interventions for breast cancer patients by a clinical psychologist are effective. The psychological interventions had two roles: to assess the patients properly and to interview the patients as purposefully as a medical team member would.

Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

　　Chronic kidney disease (CKD) has recently been reported to be an independent risk factor for stroke. However, a detailed analysis was yet to be conducted according to stroke subtype. We attempted to determine the risk factors for stroke using data from the “specific health checkup” for metabolic syndrome conducted by the 9 hospitals affiliated with the Akita Prefectural Federation of Agricultural Cooperatives, and evaluate and determine the risk factors for stroke. There were 401 patients who had undergone metabolic syndrome checkups from 2007 and 2010 and suffered from stroke afterwards within 3 years after the screening. The controls were all 69,407 subjects who were screened during the same period. The predictors examined were sex, age, blood pressure, BMI, cholesterol values (HDL・LDL), history of diabetes mellitus, presence of atrial fibrillation, CKD, and drinking and smoking habits. Analysis was conducted using logistic regression. The risk factors for stroke as a whole were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking history. For cerebral infarction, the risk factors were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking habit. The risk factors for cerebral hemorrhage were age, blood pressure, and CKD. For subarachnoid hemorrhage, the risk factors were female sex, age, blood pressure, low HDLemia, and CKD. In conclusion, CKD is an independent risk factor for the 3 subtypes of stroke, and in particular plays an important role as a higher risk factor for cerebral hemorrhage. Smoking cessation and controls of blood pressure, diabetes and atrial fibrillation are the important measures for stroke prevention. In addition, the further intervention should also be targeted to those with the result of CKD revealed by specific health checkups.