Search

We provided home care and home palliative care services to 129 patients from December 1996 to March 2009. One hundred thirteen of 129 patients (87.6%) suffered a malignant disease. 113 patients of the 129 had died, and 57 of the 113 patients (50.4%) died at home. We tried a continuous/seamless practice of palliative care up to acute phase. We could make a smooth transition of a terminal cancer patient from hospital to home medical care and to a discharge planning. Since 1992, Iwaki palliative therapy research has started and been contributed largely in enlighten, development and local communication between hospitals and clinics in Iwaki city. However, the present status of the palliative research has not been working well in support of home palliative care under the hospital-clinic cooperation. So, we took three important actions: (1) construction of medical network, (2) educational medical training course for skill-improvement and (3) critical path for local alliance of palliative care in order to push forward with home palliative care, and we are now carrying forward these three projects under the cooperation of Iwaki city medical associate.

Home care for patients with gastrointestinal malignancies includes nutritional support, chemotherapy and hospice care. Every step should be started after acquiring sufficient information on the disease. Home infusion therapy (HIT) is most important for nutritional care because the patient usually cannot eat or eats very little. It should be started fast within another symptoms controllable. With some problems in access procedure, total calories, formula, catheter infection, it is important to treat individually not to over dose. As for home chemotherapy, new molecular target-based therapies that prolong tumor dormancy are expected to be developed. Regarding home hospice, the control of pain, nausea, general fatigue, and other symptoms is the key to continuous home hospice care. The medical linkage between hospital and clinic, clinic and clinic and skillful visiting nurses is indispensable and the establishment and quality of medical systems, networks play an important role in the home care of patients of gastrointestinal malignancies.

About 40 years ago, we had a huge number of tuberculosis patients which were about three to five millions. And a great deal of effort has been given in order to conquer tuberculosis. The philosophy and the technology used in there efforts are thought to have made considerable contributions to the development of modern medicine in other fields in Japan. The controlled clinical trial used to test new antituberculous agents has been a basis for a modern judgment on the effectiveness of any new drugs and it has brought good clinical practices. Scientific procedures for diagnosis, bronchoscopy and pulmonary function tests started in the field of tuberculosis to have more detailed diagnosis included differential one, preoperative evaluation, and evaluation for respiratory failure. Philosophy and methods of modern rehabilitation for the patients started from the care for the patient with pulmonary tuberculosis. Occupational therapy has been used for confirmation of curability of tuberculosis and restoration of the physical strength. Physiotherapy also started from exercises preventing deformities of the thorax after thoracoplasty. Terminal care for patients with cancer and other incurable diseases is now most new medical way, but in the field of tuberculosis before chemotherapeutic era, these were good experiences for this kind of care. A pain control using morphine or cocaine for spinal caries and laryngeal tuberculosis, and also telling the truth to the patients were the good examples. Holistic medicine, which is also a modern topic, has been considered in tuberculosis medical care, because the disease has so much psycho-social problems.(ABSTRACT TRUNCATED AT 250 WORDS)