au:"Takada, Yasuko" (11)
Kawaguchi, Juri; Hamatani, Yasuhiro; Hirayama, Atsushi; Nishimura, Kunihiro; Nakai, Eri; Nakamura, Emi; Miyata, Michi; Kawano, Yukie; Takada, Yasuko; Anchi, Yuta; Funabashi, Sayaka; Kuroda, Kensuke; Azechi, Michiyo; Takahama, Hiroyuki; Anzai, Toshihisa; Yasuda, Satoshi; Kitaoka, Hiroaki; Izumi, Chisato.
BACKGROUND: In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancer patients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients. METHODS: We retrospectively reviewed consecutive advanced HF patients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment. RESULTS: Morphine was administered for refractory dyspnea in 43 advanced HF patients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p < 0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment. CONCLUSIONS: This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HF patients.
Analgésicos Opioides/uso terapêutico , Dispneia/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Morfina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Dispneia/sangue , Dispneia/fisiopatologia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/efeitos adversos , Peptídeo Natriurético Encefálico/sangue , Cuidados Paliativos , Estudos Retrospectivos , Função Ventricular Esquerda
Development and Practical Test of Quality Indicators for Palliative Care in Patients With Chronic Heart Failure.
Hamatani, Yasuhiro; Takada, Yasuko; Miyamoto, Yoshihiro; Kawano, Yukie; Anchi, Yuta; Shibata, Tatsuhiro; Suzuki, Atsushi; Nishikawa, Mitsunori; Ito, Hiroto; Kato, Masashi; Shiga, Tsuyoshi; Fukumoto, Yoshihiro; Izumi, Chisato; Yasuda, Satoshi; Ogawa, Hisao; Sugano, Yasuo; Anzai, Toshihisa.
BACKGROUND: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.MethodsâandâResults:We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.
Insuficiência Cardíaca/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Cuidados Paliativos/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Doença Crônica , Consenso , Técnica Delfos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais de Ensino/normas , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/normas , Equipe de Assistência ao Paciente/normas , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
Development and validation of support tools for advance care planning in patients with chronic heart failure.
Takada, Yasuko; Hamatani, Yasuhiro; Kawano, Yukie; Anchi, Yuta; Nakai, Michikazu; Izumi, Chisato; Yasuda, Satoshi; Ogawa, Hisao; Sugano, Yasuo; Anzai, Toshihisa; Shibata, Tatsuhiro; Suzuki, Atsushi; Nishikawa, Mitsunori; Ito, Hiroto; Kato, Masashi; Shiga, Tsuyoshi; Fukumoto, Yoshihiro.
Int J Palliat Nurs ; 25(10): 494-502, 2019 Oct 02.
Planejamento Antecipado de Cuidados/normas , Diretivas Antecipadas/psicologia , Doença Crônica/enfermagem , Técnicas de Apoio para a Decisão , Insuficiência Cardíaca/enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários
CORRIGENDUM: Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patientsã- A Single-Center Experience of 5-Year Follow-up.
Hamatani, Yasuhiro; Nakai, Eri; Nakamura, Emi; Miyata, Michi; Kawano, Yukie; Takada, Yasuko; Anchi, Yuta; Funabashi, Sayaka; Hirayama, Atsushi; Kuroda, Kensuke; Amano, Masashi; Sugano, Yasuo; Anzai, Toshihisa; Izumi, Chisato.
Circ J ; 83(11): 2389, 2019.
Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patientsã- A Single-Center Experience of 5-Year Follow-up.
BACKGROUND: Little is known about palliative sedation in terminally ill heart failure (HF) patients.MethodsâandâResults:We retrospectively reviewed terminally ill HF patients who received palliative sedation from September 2013 to August 2018. Among 95 terminally ill HF patients, 25 were prescribed dexmedetomidine and 12 were prescribed midazolam at the end of life. Richmond Agitation-Sedation Scale was significantly reduced (P<0.01), but blood pressure and heart rate were unaltered after treatment in both the dexmedetomidine and midazolam groups. CONCLUSIONS: Prescription of dexmedetomidine and/or midazolam might be feasible in selected terminally ill HF patients.
Dexmedetomidina/administração & dosagem , Insuficiência Cardíaca/terapia , Midazolam/administração & dosagem , Cuidados Paliativos , Assistência Terminal , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
Possible associations between palliative care conferences and positive outcomes when performing palliative care for patients with end-stage heart failure: a nationwide cross-sectional questionnaire survey.
Kurozumi, Yuma; Oishi, Shogo; Sugano, Yasuo; Sakashita, Akihiro; Kotooka, Norihiko; Suzuki, Makoto; Higo, Taiki; Yumino, Dai; Takada, Yasuko; Maeda, Seiko; Yamabe, Saori; Washida, Koichi; Takahashi, Tomonori; Ohtani, Tomohito; Sakata, Yasushi; Sato, Yukihito.
Heart Vessels ; 34(3): 452-461, 2019 Mar.
Congressos como Assunto , Insuficiência Cardíaca/terapia , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Inquéritos e Questionários , Estudos Transversais , Feminino , Humanos , Masculino
Nationwide Survey of Palliative Care for Patients With Heart Failure in Japan.
Kuragaichi, Takashi; Kurozumi, Yuma; Ohishi, Shogo; Sugano, Yasuo; Sakashita, Akihiro; Kotooka, Norihiko; Suzuki, Makoto; Higo, Taiki; Yumino, Dai; Takada, Yasuko; Maeda, Seiko; Yamabe, Saori; Washida, Koichi; Takahashi, Tomonori; Ohtani, Tomohito; Sakata, Yasushi; Sato, Yukihito.
BACKGROUND: Palliative care for heart failure (HF) patients is recommended in Western guidelines, so this study aimed to clarify the current status of palliative care for HF patients in Japan.MethodsâandâResults:A survey was sent to all Japanese Circulation Society-authorized cardiology training hospitals (n=1,004) in August 2016. A total of 544 institutions (54%) returned the questionnaire. Of them, 527 (98%) answered that palliative care is necessary for patients with HF. A total of 227 (42%) institutions held a palliative care conference for patients with HF, and 79% of the institutions had <10 cases per year. Drug therapy as palliative care was administered at 403 (76%) institutions; morphine (87%) was most frequently used. Among sedatives, dexmedetomidine (33%) was administered more often than midazolam (29%) or propofol (20%). Regarding the timing of end-of-life care, most institutions (84%) reported having considered palliative care when a patient reached the terminal stage of HF. Most frequently, the reason for the decision at the terminal stage was "difficulty in discontinuing cardiotonics." A major impediment to the delivery of palliative care was "difficulty predicting an accurate prognosis." CONCLUSIONS: This large-scale survey showed the characteristics of palliative care for HF in Japan. The present findings may aid in the development of effective end-of-life care systems.
Atenção à Saúde , Insuficiência Cardíaca , Cuidados Paliativos , Inquéritos e Questionários , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade
Design of a nationwide survey on palliative care for end-stage heart failure in Japan.
J Cardiol ; 71(2): 202-211, 2018 Feb.
BACKGROUND: The term palliative care has historically been associated with support for individuals with advanced incurable cancer, so cardiologists and cardiac nurses may be unfamiliar with its principles and practice. However, palliative care is now a part of end-stage heart failure management. We conducted the first nationwide survey to investigate the status of palliative care for heart failure in Japan. METHODS AND RESULTS: A self-reported questionnaire was mailed to all Japanese Circulation Society - authorized cardiology training hospitals (n=1004) in August 2016. The response deadline was December 2016. The survey focused on the following topics: basic information about the facility and multidisciplinary team, patient symptoms for palliative care, positive outcomes after providing palliative care, drug therapy as palliative care for patients with heart failure, advance care planning with patients and their families, and impediments to providing palliative care to patients with heart failure. The results of the survey will be reported in detail elsewhere. CONCLUSIONS: Current guidelines on palliative care do not specifically address what team members should be involved, what drugs should be used, or when palliative care should be started. This survey collected information to improve the quality of palliative care and provide more specialized palliative care within the limits of resources.
Insuficiência Cardíaca/terapia , Cuidados Paliativos , Inquéritos e Questionários , Hospitais de Ensino , Humanos , Japão
au:"Takada, Yasuko"