Purpose: The aim of this qualitative research was to identify the components of the changes in perception experienced by the physicians and nurses concerning the medical care they provide for Hematology Ward patients in the terminal phase. Methods: We performed semi-structured interviews with three physicians and five nurses concerning case conferences about patients in the terminal phase and both qualitatively and descriptively analyzed the data from those interviews. Results: We extracted the category of ‘consciousness of terminal phase’ from subcategories “consciousness about the period of terminal phase” and “change in care where patients’ remaining time is considered.” We also extracted the category ‘team approach’ from subcategories “know the importance of information sharing within the medical care team,” “nurses can play a coordinating role” and “opportunity to know the will of patientsand families.” Conclusion: The study showed that the case conferences made physicians and nurses conscious of the terminal phase on the medical ward where patients with various symptoms are mixed. We found that case conferences provided an opportunity for physicians and nurses to become conscious of the needs of the terminally ill, become aware of the importance of information sharing, and perceive the importance of the team approach. Furthermore the case conferences caused the nurses to become more aware of their role in the care of patients in the terminal phase. Palliat Care Res 2011; 6(2): 227-232

Purpose: The aim of this study was to characterize the process of adaptation experienced by the spouses of allotransplanted male patients following discharge. Methods: We conducted semi-structured interviews with six spouses and questioned them about the difficulties experienced in daily life following the discharge of their husband, and their coping strategies. We descriptively analyzed the interview data using the modified grounded theory approach. Results: We extracted ‘habituation of combating communicable diseases' from “responsibility for making effort,” “management of everyday life, ”confidence derived from experience “ and “habituation in the family.” We also extracted ‘change in anxiety and concern' from “perception of differences in attitude in daily life between husband and wife,” “change in the sense of values,” “finding a point of compromise in each family,” “benefit from allotransplant,” and “persistent anxiety.” Conclusion: The females habituated themselves to combating communicable diseases by gaining self-efficacy so that they reconciled a new, fixed lifestyle with their husbands following allotransplantation. Although their anxiety and concerns changed over time, they had persistent anxiety about both their husbands' health, including the risk of relapse or graft-versus-host disease, and financial hardships.

　　In Japan, few reports have discussed adverse events and safety after simultaneous vaccination during infancy. The purpose of this study was to elucidate adverse events after simultaneous vaccination of inactivated vaccines in infants in comparison with those after single vaccination. Selected for this study were infants aged ≥2 months who received subcutaneous injections of inactivated vaccines between July 2012 and June 2013. These subjects were divided into two groups: a single-vaccination group (46 subjects) and simultaneous-vaccination group (42 subjects). The presence or absence of severe adverse events that required hospitalization was investigated. We also checked up on subject background and systemic [fever (transitional and highest body temperature)] and local (dermatological, respiratory, gastrointestinal, neurological, and other organs’ symptoms) adverse events. Questionnaires to investigate if adverse events occurred during one week after simultaneous vaccination, questionnaires were distributed to the parents of all the subjects. “We performed vaccination in 162 subjects, and the collect rate of questionnaires was 57% (97/162).” The percentage of effective answers to the questionnaire survey was 91% (88/97). Among simultaneous-vaccination group subjects, 14 (32%) received Haemophilus influenzae type b (Hib) + 7-valent pneumococcal vaccine (PCV7) and 12 (27%) received Hib + PCV7 + Diphtheria-Pertussis-Tetanus vaccine. No subject developed severe adverse events that required hospitalization. The body temperatures taken on the day following the injection in the simultaneous-vaccination group were significantly higher than those in the single-vaccination group (p=0.049). However, the incidence of other systemic and local adverse events in the simultaneous-vaccination group was not significantly different from that in the single-vaccination group. Compared with single vaccination, simultaneous vaccination of inactivated vaccines in infants resulted in a significant rise in body temperature on the day following vaccination; however, no severe adverse events occurred.

Objective: This study aimed to reveal the relationship between anxiety and depression and personal attributes or difficulties in daily life in patients after total laryngectomy. Methods: An anonymous questionnaire was mailed to 135 members of a self-help patient group. The questionnaire included the following items: personal attributes, difficulties in daily life, and anxiety and depression (according to the Nottingham Adjustment Scale-Japanese Laryngectomy Version). Multiple regression analysis was conducted with anxiety-depression score as the dependent variable and personal attributes and difficulties in daily life as independent variables. Results: Among the 57 patient respondents, 43 provided valid answers and were selected for analysis (valid response rate: 36.8%, 41 men and 2 women, mean age: 67.5±10.6 years). Results revealed that presence of anxiety and depression were significantly associated with patient age (β=−0.369, p=0.004) and difficulties pertaining to speech/performance during outings and engaging in hobbies (β=0.419, p=0.002). Conclusions: Our findings indicate that there is an increased risk of anxiety and depression in patients are young or middle aged and have difficulties in outings and engaging hobbies. Therefore, in clinical practice, nurses should carefully assess the mental state and difficulties in daily life in these patients after total laryngectomy. Moreover, nurses should continuously provide psychosocial support to patients and their families in order to help patients prevent psychological problems even after they are discharged from hospital.