Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The appropriate delivery of death pronouncements potentially affects bereaved families' wellbeing positively. Although younger physicians need to learn the competencies and entrustable professional activities (EPAs) to conduct death pronouncement independently, both of which have not been clarified. Therefore, this study aimed to develop a list of competencies and EPAs necessary for death pronouncement practice, which resident physicians need to acquire by the end of their residency training (postgraduate year 2). METHODS: An anonymous modified Delphi study was conducted with a panel of 31 experts. The experts were invited online from general wards in hospitals with resident physicians across Japan to participate in the study using the purposive and snowball sampling method. A non-anonymous web conference was held with three additional external evaluators to finalize the item list. The consensus criterion was defined as a mean response of at least 4 points on a 5-point Likert scale for each competency and EPA item and a rating of 4 or 5 points by at least 80% of the participants. RESULTS: Consensus was achieved, with consistently high levels of agreement across panel members, on 11 competencies and 9 EPA items. Additionally, a correspondence matrix table between competencies and EPAs was developed. CONCLUSIONS: This study clarified the standardized educational outcomes as competencies in death pronouncement practice and the unit of professional practice of physicians who can perform this independently (EPAs), serving as a blueprint to aid the development of an educational model and evaluation method for clinical educational institutions and developers of medical school curriculums.

DOI： 10.1186/s12909-022-03149-5

PubMed

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Language：Japanese   Publisher：横浜市立大学医学会  

がんなどの重い疾病を抱えた患者の住み慣れた自宅などの望む療養場所でつらい症状なく過ごすことが出来る支援を行うことが在宅緩和ケアの目標のひとつである.在宅緩和ケアに医療用麻薬などの症状緩和目的の薬剤は病院内と同様に必要であり,これらの薬剤を患者の元に届ける在宅訪問薬剤師は在宅緩和ケアの推進に不可欠な存在だと考えられる.しかし,実際には地域において医療用麻薬を扱う薬局は少なく,在宅医療に関わる訪問薬剤師の数は十分ではないと考えられている.そこで在宅医療の現場における,訪問薬剤師の印象と期待を聞き取り,今後の課題を考察した.医療,介護,教育,行政の各職種と地域住民などに対して,調査者と回答者が1対1で対面して聴取を行う個人面接を行って口頭データを収集し,インタヴュー形式による質的研究を行った.その結果,訪問薬剤師とその拠点となる保険薬局が在宅での終末期がん緩和ケアに対する医療資源になりうる事を認識している人が少ないなどの問題が明らかになった.在宅訪問薬剤師が在宅緩和医療に参画していくためには,患者にとっての生活の場である自宅と病院内との環境の違いを理解し,また在宅緩和ケアの一般的な在宅医療との相違点を理解し,それらに即した適切な業務を行っていくことが求められていると考えられた.(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01499&link_issn=&doc_id=20211224360003&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00002196%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00002196%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The effects of acotiamide on gastrointestinal motility have not been sufficiently investigated. The aim of this study was to determine whether single preprandial acotiamide or mosapride intake might affect the gastric emptying rate using the 13C breath test. Here, 11 healthy volunteers participated in a randomized three-way crossover study. The subjects received acotiamide (100 mg) or mosapride (5 mg) or placebo before liquid test meal ingestion. Gastric emptying was estimated by determining following parameters: the time required for 50% emptying of the labeled meal (T1/2), lag time for 10% emptying of the labeled meal (Tlag), gastric emptying coefficient (GEC) and regression-estimated constants (β and κ). These parameters were calculated from a 13CO2 breath excretion curve using conventional formulas. The acotiamide, mosapride and placebo conditions were compared, revealing that for gastric emptying rates (values expressed as median), T1/2 (87.83571 min vs 79.95057 min vs 88.74378 min, p = 0.1496), Tlag (46.36449 min vs 42.2897 min vs 47.08094 min, p = 0.4966), GEC (4.382027 vs 4.211441 vs 4.248495, p = 0.8858), β (1.917728 vs 1.757062 vs 1.869141, p = 0.4066) and κ (0.834051 vs 0.819820 vs 0.789523, p = 0.1225) did not significantly differ. In this study, acotiamide (100 mg) or mosapride (5 mg) had no effect on gastric emptying.

DOI： 10.3164/jcbn.20-162

PubMed

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

【目的】終末期がん患者のセクシュアリティへの支援に対する看護師の現状を明らかにする.【方法】2018年12月に神奈川県内緩和ケア病棟18施設の看護師313名を対象に終末期がん患者の「パートナーとの愛を育む時間」に対する認識,感情,支援への行動意図と実践について質問紙調査を行った.【結果】165名中(回収率52.7%)「パートナーとの愛を育む時間」への支援経験があるのは82名(49.7%)であった.行ったことのある具体的な支援内容は「スキンシップを勧める」,「傾聴」,「ハグを勧める」,「入室の際に,ノックや声掛け後に返事を待つなど十分な時間をとる」が多かった.一方,病棟カンファレンスで「パートナーとの愛を育む時間」について話したことがあるのは11名(6.7%)であった.【結論】現状,「パートナーとの愛を育む時間」への支援は個人に任され,組織的には行われていないことが示唆された.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Society for Free Radical Research Japan  

The effects of acotiamide on gastrointestinal motility have not been sufficiently investigated. The aim of this study was to determine whether single preprandial acotiamide or mosapride intake might affect the gastric emptying rate using the 13C breath test. Here, 11 healthy volunteers participated in a randomized three-way crossover study. The subjects received acotiamide (100 mg) or mosapride (5 mg) or placebo before liquid test meal ingestion. Gastric emptying was estimated by determining following parameters: the time required for 50% emptying of the labeled meal (T1/2), lag time for 10% emptying of the labeled meal (Tlag), gastric emptying coefficient (GEC) and regression-estimated constants (β and κ). These parameters were calculated from a 13CO2 breath excretion curve using conventional formulas. The acotiamide, mosapride and placebo conditions were compared, revealing that for gastric emptying rates (values expressed as median), T1/2 (87.83571 min vs 79.95057 min vs 88.74378 min, p = 0.1496), Tlag (46.36449 min vs 42.2897 min vs 47.08094 min, p = 0.4966), GEC (4.382027 vs 4.211441 vs 4.248495, p = 0.8858), β (1.917728 vs 1.757062 vs 1.869141, p = 0.4066) and κ (0.834051 vs 0.819820 vs 0.789523, p = 0.1225) did not significantly differ. In this study, acotiamide (100 mg) or mosapride (5 mg) had no effect on gastric emptying.

DOI： 10.3164/JCBN.20-162

Scopus

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Language：Japanese   Publisher：(公社)地域医療振興協会  

目的:内科医に短時間の実技を交えた小外科講義を行うことで、プライマリ・ケア医に求められる小外科診療が可能となるか調査した。到達目標は「資料を確認すれば単独診療可能」とした。方法:病院勤務内科医14人を対象とした。平日夕方に1人の外科指導医が指切創、熱傷、四肢打撲の3つのテーマについて実技指導を交えた1時間程度の講義を行った。講義開始前、終了直後、終了3〜6ヵ月後の3回、診断、治療、後対応、総合評価の4項目について4段階の習熟度自己評価を行った。「資料を確認すれば単独診療可能」を3点に設定し、講義の短期・長期効果を評価した。結果:講義への参加者は指切創10人、熱傷11人、四肢打撲10人であった。全テーマ、全項目において、終了直後、終了3〜6ヵ月後の平均点は有意に上昇した。しかし、四肢打撲については全評価項目いずれも平均3点未満であった。結論:内科医に対する実技を交えた小外科講義には一定の効果が示唆されたが、四肢打撲の教育効果は限定的であった。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：日総研出版  

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Language：Japanese   Publisher：(一社)日本在宅医療連合学会  

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Language：Japanese   Publisher：藤沢市内科医会  

死亡診断時の医師の立ち居振る舞いは、その後の遺族の悲嘆に大きく影響を及ぼすと考えられているが、現在の医学教育プログラムのなかには、死亡診断時についての教育内容はほとんど含まれていない。我々は遺族アンケートを基にした『地域の多職種でつくった死亡診断時の医師の立ち居振る舞いについてのガイドブック』を作成した。今後の多死社会において、医師は主治医ではない患者の死亡診断に立ち会う場面が増える可能性が高い。国が推進し、国民の求めが高い緩和ケアには遺族ケアも含まれている。当ガイドブックはそれぞれの医師が遺族ケアを意識した死亡診断時の立ち居振る舞いを考える切っ掛けとなればという願いを込めて多職種で作成したものである。(著者抄録)

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Publishing type：Research paper (scientific journal)  

© The Author(s) 2020. Background: Education regarding death diagnosis is not often included in the medical education. Objective: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. Design: Uncontrolled, open-label, multi-center trial. Subjects: A total of 131 doctors undergoing their initial training were enrolled this study. Measurements: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors’ behaviors at the death diagnosis based on our guidebook at each hospital. Results: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that “I do not know what to say to the family after a death diagnosis”. Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for “Give words of comfort and encouragement to family” increased significantly after the lecture to 0.9. Conclusions: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients’ families. After the lecture using our guidebook, residents’ mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

DOI： 10.1177/0825859720951698

Scopus

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Language：English   Publishing type：Research paper (scientific journal)  

Several risk scoring systems exist for acute upper gastrointestinal bleeding (UGIB). The clinical Rockall score (clinical RS) and the Glasgow-Blatchford score (GBS) are major risk scores that consider only clinical data. Computed tomography (CT) findings are equivocal in non-variceal UGIB. We compared CT findings with clinical data to predict mortality, rebleeding and need for endoscopic therapy in non-variceal UGIB patients. This retrospective, single-center study included 386 patients admitted to our emergency department with diagnosis of non-variceal UGIB by urgent endoscopy between January 2009 and March 2015. Multivariable logistic regression analysis was used to investigate CT findings and risk factors derived from clinical data. CT findings could not significantly predict mortality and rebleeding in non-variceal UGIB patients. However, upper gastrointestinal hemorrhage in CT findings better predicted the need for endoscopic therapy than clinical data. The adjusted odds ratios were 10.10 (95% CI 5.01-20.40) for clinical RS and 10.70 (95% CI 5.08-22.70) for the GBS. UGI hemorrhage in CT findings could predict the need for endoscopic therapy in non-variceal UGIB patients in our emergency department. CT findings as well as risk score systems may be useful for predicting the need for endoscopic therapy.

DOI： 10.3164/jcbn.18-115

PubMed

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本在宅医療連合学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

がん末期において療養先として自宅を希望する患者が多いが、症状が安定せず在宅へ移行できない症例も多く経験する。症状が強い場合には在宅医療導入後も緊急入院を必要とすることが多い。今回在宅療養を希望したにもかかわらず、当院への緊急入院を繰り返し在宅導入が困難であった症例を経験したので報告する。また、症例にかかわったがん治療医と在宅医にインタビューを行い両者の視点を比較した。患者・家族の望む生活を実現するには、互いの視点をバランスよく取り入れながら最期まで揺れる希望にそった形での医療のサポートを行う必要があると考えられる。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

切除不能進行大腸がんに対して高用量の5-FUを含む化学療法を投与した後に、高アンモニア血症を来す症例が知られている。症例は81歳、女性。S状結腸癌穿孔、汎発性腹膜炎の緊急手術後、pT4bcN2M1(多発肝転移)、stage IV、KRAS:mutantの診断で切除不能進行再発大腸がんとして、術後mFOLFOX6+Bmab療法4コース目を開始した48時間後に意識障害JCS III-300となった。高用量5-FUを中止したところ速やかに意識障害は消失した。高アンモニア血症の主因が高用量の5-FU製剤によるものと考えられたため、後治療としてXELOX+Bmab療法を開始したところ、高アンモニア血症の発現なく8コース施行し経過観察中である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Although many patients with terminal cancers desire to be cared for at home, frequently, such patients cannot be shifted to home care due to their unstable symptoms. In severe cases, emergency hospitalizations may be frequently required after introducinghome medical care. We report a case of makinghome medical care difficult due to repeated emergency hospitalizations despite of the patient's deep desire. Interviews were conducted with both the oncologist in charge of the case and a home physician, and their viewpoints were compared. For patients and their families to achieve desired livingconditions, it was considered necessary to give supportive medical care that meet their desires until the end of their lives as mutual viewpoints are taken in a good balance.

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

高カルシウム(Ca)血症は癌患者の約20〜30%に随伴するとされ、癌診療において比較的多く遭遇する合併症である。高Ca血症は意識障害などの原因となり、さらに重症例では腎不全を来し致死的となる。今回われわれは、悪性エナメル上皮腫にコントロール不能な高Ca血症を合併し、致死的転機をたどった症例を経験した。本症例では高Ca血症が在宅期間を短縮しており、医療者側が高Ca血症の早期発見やコントロール改善につながる知識を習得することで在宅期間の延長をもたらすと考えられた。また、悪性腫瘍の治療のみでなく合併症である高Ca血症に対する集学的治療をいつまで行うか検討することで、看取り場所の選択肢が広がる可能性があると考えられた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A case of hyperammonemia induced by chemotherapy, including high-dose fluorouracil(5-FU), for advanced unresectable large intestinal cancer has been reported. This case involved an 81-year-old female who was diagnosed with pT4bcN2M1 (multiple hepatic metastases; stage Ⅳ; KRAS: mutant)after emergency surgery for sigmoid colon cancer and diffuse peritonitis. Post-operation, the 4 courses of mFOLFOX6 plus Bmab therapy was started for advanced unresectable recurrent large intestinal cancer; 48 hours later, she developed consciousness disorder(JCS Ⅲ-300). The disorder promptly disappeared after discontinuation of high-dose 5-FU. Because high-dose 5-FU was inferred to be the main cause of hyperammonemia, XELOX plus Bmab therapy was started as a post-treatment. She did not develop hyperammonemia; therefore, 8 courses were administered. The patient is being followed-up now.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Chemical coping also has an idea that it is an early stage of abuse and dependence of opioids, it is important to grasp the frequency, complaints, and risk factors of chemical coping. In this study, observational research was performed backwardly with 549 people using opioids who were newly requested to the palliative care team. Results revealed that 13 of 549 patients (2.4%)were diagnosed with chemical coping. In terms of a breakdown of the complaint, and it was following rate and reasons, 6 people(46%)felt easy, 2 people(15%)were anxious, 2 people(15%)could sleep, 2 people(15%)had unknown reasons, and 1(8%)was calm. Characteristics of each patient diagnosed with chemical coping included frequent psychiatric symptoms such as life expectancy of 3 months, opioid oral administration period of 1 year or more, disease incidence period of 1 year or more, anxiety, delirium, and depression. One benign disease also confirmed the transition to opioid dependence.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The goal of palliative care is to support the ideal life of cancer patients and their partners, but the medical staff does not listen to all the needs of cancer patients and their partners. Cancer patients choose opponents and situations and express their suffering. Additionally, the typical problem of hidden suffering is not the issues of sexuality ? The suffering from sexuality of cancer patients is not expected to be expressed unless there is a suitable opponent. Are we the medical staff ready to respond to the suffering from sexuality of terminal cancer patients ? In this study, we thought that it was necessary to investigate the preparation of medical staff for the suffering from sexuality of terminal cancer patients, through a relationship with the hospitalized inpatient who reported suffering from sexuality.

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

ケミカルコーピングは乱用や依存の初期段階との考え方もあり、ケミカルコーピングの頻度や訴え、危険因子を把握することが重要である。本検討では緩和ケアチームに新規依頼となったオピオイドを使用している549名を対象とし、後方視的に観察研究を行った。その結果、549名中13名(2.4%)の患者でケミカルコーピングを認めた。訴えの内訳として、6名(46%)で気分が楽になるから、2名(15%)で不安だから、2名(15%)で眠れるから、2名(15%)で何となく、1名(8%)で落ち着くからというような割合であった。ケミカルコーピングと診断された各々の患者の特徴としては、余命3ヵ月以内、1年以上のオピオイド内服期間、1年以上の疾病罹患期間、不安や譫妄、抑うつなどの精神症状を高頻度に有していた。また良性疾患の1名は、オピオイド依存への移行を認めた。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

緩和ケアの目標はがん患者・家族の理想の生活を支えることであるが、医療者は目の前のがん患者のニーズをすべて聞き取れているとは限らない。入院患者の様々な苦痛は相手や場面を選んで表出される。そして隠された苦悩の代表的なものはセクシュアリティの問題ではないだろうか。がん患者のセクシュアリティの苦悩はふさわしい相手がいなければ表出されることはないと予想される。医療者は患者・家族のセクシュアリティの問題に対して準備をしているだろうか?今回われわれ緩和ケアチームは、入院中に性についての発言があった終末期がん患者とのかかわりから現況調査が必要と考えた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Approximately 20-30% of cancers are associated with hypercalcemia, and this is a complication often encountered in cancer care. Hypercalcemia causes disorders such as disturbance of consciousness and, in severe cases, kidney failure and even death. In this report, we present a case of malignant ameloblastoma associated with uncontrollable hypercalcemia followed by a life-threatening disease course. In this case, hypercalcemia shortened the period of home care, and the medical staff could have extended this period by acquiring knowledge that leads to early detection and better control of hypercalcemia. In addition, the choice of the place for end-of-life care may have been expanded by considering the treatment of not only the malignant tumor but also hypercalcemia as its complication.

PubMed

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01159&link_issn=&doc_id=20190122060002&doc_link_id=10.2169%2Fnaika.108.16&url=https%3A%2F%2Fdoi.org%2F10.2169%2Fnaika.108.16&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

DOI： 10.3164/jcbn.17-128

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Celsius Publishing House  

Background/Aims: We conducted a trial to evaluate the FSSG questionnaire and GerdQ questionnaire for diagnostic accuracy given correlation with clinical findings. Methods: One hundred three consecutive patients who were seen in the Yokohama City University hospital with a gastrointestinal symptom in May 2011 were enrolled as potential subjects. Of these, 94 patients underwent upper gastrointestinal endoscopy, and clinical symptoms were evaluated using both the FSSG and GerdQ questionnaires. Results: There were 94 subjects with GERD and 9 subjects with functional dyspepsia as defined by the Rome III criteria. We investigated the sensitivity and specificity of FSSG and GerdQ for GERD. For FSSG, the sensitivity was 0.564, the specificity was 0.778, and the odds ratio was 4.462. For GerdQ, the sensitivity was 0.298, the specificity was 0.889, and the odds ratio was 3.363. When combining the FSSG and GerdQ, the sensitivity was 0.255, the specificity was 0.888, and the odds ratio was 2.722. When using either the FSSG or GerdQ, the sensitivity was 0.723, the specificity was 0.888, and the odds ratio was 5.307. Conclusions: We conclude that having patients complete both the FSSG and GerdQ may be more useful in routine medical examinations than completing only one questionnaire.

DOI： 10.21614/sgo-23-3-198

Scopus

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Celsius Publishing House  

Background/Aims: The aim of this study was to investigate the efficacy and safetyof the oral fluoropyrimidine derivativeS-1 in elderly patients with unresectable pancreatic cancer. Methods: Patients were eligible if they were at least 70 years old and had unresectable pancreatic carcinoma. S-1 was administered orally twice daily after meals at doses of 80, 100, and 120 mg/day forbody surface areasfor 28 consecutive days, followed by a 14-day rest period. Administration was repeated until the appearance of disease progression or unacceptable toxicity. Results: Twenty-one patients were enrolledin this study. Five patients (23.8%) achieved a partial response (95% CI, 8.2-47.2%),stable disease was observed in 9 patients (42.9%), and progressive disease was observed in 5 patients (23.8%).The disease control rate was 66.7%. The median time to progression and overall survivaltime were 3.7 months (95% CI, 2.3-6.5 months) and 7.3 months (95% confidence interval, 4.9-12.1 months), respectively. Toxicity was generally mild, and the most common grade 3/4 toxicities were neutro-penia (14.3%), anemia (14.3%), leucopenia (9.5%), thrombocytopenia (9.5%), anorexia (9.5%), and diarrhea (9.5%). There were no treatment-related deaths. Conclusions: Monotherapy with S-1 is an effective and well-tolerated regimen for elderly patients with unresectable pancreatic cancer.

DOI： 10.21614/sgo-23-3-191

Scopus

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Although chronic constipation is common, colonic functional evaluating tests are uncommon. This study examines whether chronic constipation and gastrointestinal symptoms are correlated with the lateral diameter of the colon measured from MRI images. We included chronic constipation patients in a prospective, cross-sectional study using MRI at three centers. We divided 3D MRI colorectal images into 6 segments using with specified sequences and selected the maximum luminal diameter from each segment. We used the GSRS questionnaire to evaluate gastrointestinal symptoms. We evaluated the correlation between luminal diameters and GSRS scores. We found the following positive correlations: descending colon and unsatisfactory defecation symptoms; sigmoid colon and diarrhea; and rectum and constipation. The sum and ratio of the ascending and sigmoid colon diameters correlated with nausea and diarrhea. The sum of the transvers to the sigmoid colon diameter also correlated with nausea and diarrhea. The sum of all segment diameters correlated with nausea and constipation. In conclusion, we showed cross-sectional study of colonic MRI correlate with gastrointestinal symptoms. MRI might be useful for colonic motility evaluations to determine appropriate constipation treatments (Clinical trial registry number UMIN 000021274).

DOI： 10.3164/jcbn.17-104

PubMed

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Language：Japanese   Publisher：(株)日本メディカルセンター  

＜文献概要＞便秘は医師として基本的な診療対象の一つであるが,わが国の実地診療のなかでは混沌とした概念である.今回,慢性便秘症ガイドラインが刊行され,そのなかで診断につき概説された.問診,身体診察,検体検査,画像検査,専門的な医療機関で行う検査という流れのなかで,解説が行われている.問診では警告症状,危険因子の概念のほか,ブリストル便形状スケールの紹介が盛り込まれている.検体検査では二次性便秘を念頭においた検体検査についても言及されている.画像検査に関しては除外診断としての腹部単純X線検査と注腸X線検査,内視鏡検査が紹介され,一部,保険適用外であるが専門的施設で行われる検査についても触れられている.本稿ではその一部を紹介する.

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Language：Japanese   Publisher：(株)癌と化学療法社  

口腔癌における超選択的偽注化学放射線療法は、治療により粘膜炎の合併症を引き起こす。その症状緩和にオピオイドを用いた疼痛コントロールを行っているが、臨床現場で患者側からの質問として、(1)超選択的動注化学放射線療法終了後からオピオイド中止までの平均日数、(2)オピオイド中止が可能となった患者側の因子の問い合わせが多い。本検討ではこれらを解明することを目的とする。方法として2016年4月〜2017年3月の間、当院口腔外科で超選択的動注化学放射線療法を施行した患者を対象とし、後方視的に観察研究を行い、オピオイド中止が可能な患者群、不可能であった患者群を2群に分類し臨床的背景や臨床データとの比較検討を行った。その結果、オピオイド中止が可能な群では、治療終了後からオピオイド中止までの期間の平均は51(±34.4)日であった。非糖尿病患者と治療中のせん妄ない群がオピオイド中止に寄与する因子として抽出された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

われわれは、入院中に睡眠障害を有したがん患者に合併したせん妄に対するsuvorexantの有用性について検討した。方法は2016年4月〜2017年3月の1年間、当院緩和ケアチームに依頼となった悪性腫瘍に罹患し、不眠症状を有するせん妄患者に対してsuvorexantを用いた9例を対象とし後方視的に観察研究を行った。せん妄の重症度評価としては、DRS-R98の日本語版を用い、その結果suvorexant投与前後におけるDRS-R98の重症度スコアは投与前に比較し、投与後では有意に総スコアの低下を認めた(投与前:10±3.20 vs 6.66±1.73、p=0.0031)。また、安全性の面においてもsuvorexantの有害事象は認められなかった。睡眠障害を有するがん患者に合併したせん妄症状に対するsuvorexantの有用性が示唆された。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 52-year-old woman had been prescribed oral medication of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and oxycodone for intractable pain associated with thoracic metastasis of breast cancer. However, the pain control was poor. Although pregabalin and gabapentin were used as supplementary analgesics, they could not be continued because of their side effects. Based on the noradrenalin reincorporation-inhibiting action of tapentadol, a combination therapy of tapentadol and oxycodone was introduced and satisfactory pain control was achieved. No side effects from the combined opioids were observed. This finding indicates the potential of administrating a combination therapy of m-opioid receptor agonists(such as morphine, oxycodone, and fentanyl)with tapentadol, which has a noradrenaline reincorporation-inhibiting action, as an effective remedy for alleviating intractable pain complicated with neuropathic pain.

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

局所進行口腔癌に対する超選択的動注化学放射線療法は、粘膜炎などの合併症を引き起こし、経口摂取や内服が不可能となる。そのため当院では治療期間中にほぼ全例に胃瘻造設を施行し、栄養および薬剤投与ルートの確保を行っている。本検討では超選択的動注化学放射線療法終了後から胃瘻抜去までの平均日数の算出と、胃瘻抜去が可能な因子を抽出することを目的とした。方法は2016年4月〜2017年3月までの間、当院口腔外科で超選択的動注化学放射線療法を施行した患者を対象とし、後方視的に観察研究を行った。胃瘻抜去が可能であった患者群、不可能であった患者群の2群に分類し、臨床的背景や臨床データの比較検討を行った。その結果、胃瘻抜去可能群において、治療終了後から胃瘻抜去までの平均期間は132(±51.6)日であった。胃瘻抜去が可能な患者因子として、アルコール摂取量が多い、治療前の接触時痛がない、開口3横指確保可能といった因子が抽出された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

アカシジアとは「足がむずむずしてじっとしていられない」を代表的な訴えとする静座不能症状であり、主に抗ドパミン作用によると考えられている。重度の場合、自殺企図の原因となることが知られている。今回、内服困難症例の薬剤性アカシジアに対してフェンタニルクエン酸塩舌下錠が症状緩和に有効と考えられた1例を経験したので報告する。症例は50歳代、女性。胃癌、腹膜播種による癌性疼痛、嘔気のコントロール目的で緩和ケアチームに依頼となった。嘔気に対してメトクロプラミド、ハロペリドールを用いていたが、足のむずむず感、落ち着きのなさを訴え薬剤性アカシジアと診断した。疼痛コントロールのレスキューでフェンタニルクエン酸舌下錠を内服したところ、一時的なアカシジア症状の改善を認めた。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は52歳、女性。乳がん胸椎転移に伴う難治性疼痛に対してアセトアミノフェン、NSAIDs、オキシコドンを内服していたが疼痛コントロール不良であった。鎮痛補助薬としてプレガバリンやガバペンチンを使用したが副作用のため継続できなかった。タペンタドールのノルアドレナリン再取り込み阻害作用に注目し、タペンタドールとオキシコドンによる併用療法を導入したところ、患者の満足のいく疼痛コントロールを得ることができた。オピオイド併用による副作用の出現はなかった。神経障害性疼痛を合併した難治性疼痛に対して、モルヒネ、オキシコドン、フェンタニルなどのμオピオイド受容体作動薬とノルアドレナリン再取り込み阻害作用をもつタペンタドールを併用することが、疼痛緩和に有効である可能性が示唆された。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We investigated the usefulness of suvorexant for complicated delirium in patients with cancer who experience sleep disturbance during hospitalization. Nine patients with malignant tumors complicated with symptoms of delirium and insomnia were included in this study; their palliative care was managed by the palliative care team of our hospital for a period of one year from April 2016 to March 2017. A retrospective follow-up study was then conducted. The Japanese version of DRS-R98 was used to evaluate the severity of the patient's delirium. The total severity score of DRS-R98 significantly decreased after the administration of suvorexant when compared to the score before its administration(6.66±1.73 vs 10±3.20, p=0.0031). In addition, suvorexant did not exhibit any harmful effects. Our results indicate that suvorexant was useful in alleviating delirium symptoms in cancer patients who experience sleep disturbance.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Akathisia is a condition wherein sitting calmly and quietly is impossible, with a representative complaint of restless legs. It is generally assumed to be caused by anti-dopamine activity. In severe cases, it has been known to result in suicide attempt. We reported a case of drug-induced akathisia with difficulty in oral intake, in which fentanyl citrate sublingual tablets were found to be effective in relieving symptoms. The patient was a female aged 50's who had a gastric cancer with peritoneal dissemination causing pain and vomiting. Palliative care was requested for management of symptoms. Metoclopramide and haloperidol were administered for vomiting. However, because of the complaints of restless legs, the case was diagnosed as drug-induced akathisia. Fentanyl citrate sublingual tablets were then administered for pain management, resulting in temporary improvement of akathisia symptoms.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Superselective intra-arterial chemoradiation therapy for locally advanced oral cancer induces complications such as mucositis, which impedes oral intake. Thus, at our hospital, a gastrostomy is performed in almost all patients during the treatment period to ensure the presence of an alternative administration route for nutrition and drugs. The purpose of this study was to calculate the mean number of days from completion of superselective intra-arterial chemoradiation therapy to the decannulation of gastrostomy, and extract patient factors for the decannulation. A retrospective follow-up study was conducted from April 2016 to March 2017 on patients who underwent superselective intra-arterial chemoradiation therapy at our department of oral surgery. The patients were divided into 2 groups:one who was decannulated and the other who did not. Clinical backgrounds and data were compared between the 2 groups. In the group with the decannulation, the mean period from treatment completion to the decannulation was 132±51.6 days. Heavy alcohol consumption, absence of haphalgesia before treatment, and possible securement of the opening with the breadth of 3 fingers, were determined as factors contributing to the decannulation of gastrostomy tube.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Superselective intra-arterial chemoradiation therapy for oral cancer induces the complication of mucositis. Although the associated pain is controlled using opioids, major questions from patients in clinical practice are as follows:(1)the mean number of days from the completion of superselective intra-arterial chemoradiation therapy to the discontinuation of opioid administration, and(2)patient factors enabling the discontinuation of opioids. The purpose of this study was to clarify these points. A retrospective follow-up study was conducted from April 2016 to March 2017 on patients who underwent superselective intra-arterial chemoradiation therapy at our department of oral surgery. The patients were divided into 2 groups:one who discontinued opioids, and the other who did not. Clinical backgrounds and data were compared between the 2 groups. The mean number of days from the completion of superselective intra-arterial chemoradiation therapy to the discontinuation of opioid administration was 51±34.4 days. The absence of diabetes and deliria during treatment were determined as factors contributing to the discontinuation of opioids.

PubMed

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

Background and study aims:  The aim of this pilot randomized controlled trial was to evaluate and compare the satisfaction of the endoscopist along with the effectiveness and safety of sedation between sedation protocol using a combination of propofol (PF) and dexmedetomidine (DEX) (Combination group) and sedation protocol using PF alone (PF group) during gastric endoscopic submucosal dissection (ESD). Patients and methods : Fifty-eight patients with gastric neoplasias scheduled for gastric ESD were enrolled and randomly assigned to the two groups. The satisfaction scores of the endoscopists and the parameters for the effectiveness and safety of sedation were evaluated by comparisons between the two groups. Results : The satisfaction scores of the endoscopists, which were measured using a visual analogue scale, were significantly higher in the Combination group than in the PF group (88 vs. 69, P  = 0.003). The maintenance dose of PF was lower in the Combination group than in the PF group (2 mg/kg/h vs. 5 mg/kg/h, P  < 0.001), and the number of rescue PF injections was fewer in the Combination group than in the PF group (2 times vs. 6 times, P  < 0.001). The incidence of bradycardia (defined as a pulse rate ≤ 45 bpm) in the Combination group was higher than that in the PF group (37.9 % vs. 10.3 %, P  = 0.029). Conclusions : This study suggests that gastroenterologist-directed sedation using a combination of PF and DEX during gastric ESD can enhance the satisfaction levels of endoscopists by providing stable sedation with an acceptable safety profile.

DOI： 10.1055/s-0043-122228

PubMed

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Language：Japanese   Publisher：(株)医学出版  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本サイコオンコロジー学会・日本臨床死生学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND STUDY AIMS:  Lubiprostone has been reported to be an anti-constipation drug. The aim of the study was to investigate the usefulness of lubiprostone both for bowel preparation and as a propulsive agent in small bowel endoscopy. PATIENTS AND METHODS:  This was a double-blind, placebo-controlled, 2-way crossover study of subjects who volunteered to undergo capsule endoscopy (CE). A total of 20 subjects (16 male and 4 female volunteers) were randomly assigned to receive a 24-μg tablet of lubiprostone 120 minutes prior to capsule ingestion for CE (L regimen), or a placebo tablet 120 minutes prior to capsule ingestion for CE (P regimen). Main outcome was gastric transit time (GTT) and small-bowel transit time (SBTT). Secondary outcome was adequacy of small-bowel cleansing and the fluid score in the small bowel. The quality of the capsule endoscopic images and fluid in the small bowel were assessed on 5-point scale. RESULTS:  The capsule passed into the small bowel in all cases. Median GTT was 57.3 (3 - 221) minutes for the P regimen and 61.3 (10 - 218) minutes for the L regimen ( P  = 0.836). Median SBTT was 245.0 (164 - 353) minutes for the P regimen and 228.05 (116 - 502) minutes for the L regimen ( P  = 0.501). The image quality score in the small bowel was 3.05 ± 1.08 for the P regimen and 3.80 ± 0.49 for the L regimen ( P  < 0.001). The fluid score in the small bowel was 2.04 ± 1.58 for the P regimen and 2.72 ± 1.43 for the L regimen ( P  < 0.001). There was a significant difference between the 2 regimens with regard to image quality. The fluid score was more plentiful for the L regimen than for the P regimen. There were no cases of capsule retention or serious adverse events in this study. CONCLUSION:  Our study showed that use of lubiprostone prior to CE significantly improved visualization of the small bowel during CE as a result of inducing fluid secretion into the small bowel.

DOI： 10.1055/s-0043-105487

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JOURNAL CLINICAL BIOCHEMISTRY & NUTRITION  

The gastrointestinal effects of alpha-glucosidase inhibitors have not been sufficiently investigated. The aim of this study was to determine whether a single dose of pre-prandial voglibose might affect the rate of gastric emptying, determined using the C-13 breath test. Ten healthy male volunteers participated in this randomized, twoway crossover study. The subjects fasted overnight and received 0.2 mg voglibose or a placebo 2 h before a test meal. They were then served a liquid test meal consisting of 200 kcal per 200 ml that contained 100 mg C-13-acetate. Breath samples were collected under both conditions until 150 min after the meal. A comparison of the control and voglibose conditions revealed that for gastric emptying rates (with values expressed as median: range), T-1/2 [(87.9: 78.0-104.9 min) vs (88.4: 74.3-106.3 min), p = 1], T-lag [(47.1: 39.6-60.1 min) vs (45.4: 31.2-63.3 min), p = 0.432], 13 [(1.89: 1.68-2.18) vs (1.90: 1.35-2.15), p = 0.846] and kappa [(0.81: 0.71-0.98) vs (0.81: 0.50-0.94), p = 0.922] did not significantly differ between conditions. A significant difference between the control and voglibose conditions was found for the GEC [(4.28: 4.09-4.44) vs (4.06: 3.69-4.50), p = 0.0138]. In conclusion, this study demonstrated that the ingestion of oral voglibose led to delayed gastric emptying of a liquid meal.

DOI： 10.3164/jcbn.16-100

Web of Science

PubMed

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

【目的】従来のベンゾジアゼピン系薬剤を用いた鎮静と比較して、食道ESDにおけるプロポフォール(PF)とデクスメデトミジン(DEX)を併用した鎮静の有効性と安全性について検討する。【方法】当施設で食道ESDが施行された連続40症例の臨床情報を遡及的に解析した。20例はベンゾジアゼピン系薬剤による鎮静(従来群)、20例はPF・DEX併用による鎮静(併用群)が行われた。鎮静の有効性と安全性に関する各パラメータを両群で比較した。【結果】併用群は処置時間が有意に短く(61分vs 89分、P=0.03)、抑制を要する体動が見られた患者の割合も有意に少なかった(25% vs 65%、P=0.025)。一方、併用群は低血圧(60% vs 15%、P=0.008)と徐脈(60% vs 15%、P=0.008)の発生率が有意に高かった。治療中断を要する重篤な有害事象は両群ともになかった。【結論】PFとDEXを併用した鎮静は食道ESDにおいて患者体動を抑えた安定した鎮静となり得る可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00192&link_issn=&doc_id=20170321290011&doc_link_id=10.11280%2Fgee.59.226&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.59.226&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

Objective The risk factors associated with severe erosive esophagitis are not well defined in Japan. We aimed to evaluate the risk factors associated with the endoscopic severity of esophageal mucosal injury.
Methods Eighty consecutive Japanese patients with severe erosive esophagitis [Los Angeles (LA) classification grade C or D] who had undergone upper endoscopies in the Gastroenterology Division of Omori Red Cross Hospital between June 2010 and March 2013 were retrospectively analyzed. For each case, a control with mild erosive esophagitis (LA classification grade A or B) who was matched by sex and age was randomly selected during the same period. Among the endoscopic findings, the condition of the gastroesophageal flap valve (GEFV) was graded according to Hill's classification. We identified the risk factors for severe erosive esophagitis using a multivariable logistic regression model.
Results A poor performance status (PS) (odds ratio [OR]=17.1201, 95% confidence interval [CI]=3.0268-140.3121, p=0.0008) and an abnormal GEFV (OR=3.0176, 95% CI=1.0589-9.4939, p=0.0385) were risk factors for severe erosive esophagitis, while the presence of open-type gastric mucosal atrophy (GMA) was inversely associated with severe erosive esophagitis (OR=0.2772, 95% CI=0.1087-0.6675, p=0.0040).
Conclusion Among patients with erosive esophagitis, a poor PS and an abnormal GEFV were associated while GMA was inversely associated with severe erosive esophagitis. Drug therapy alone or in combination with physical therapy may improve the therapeutic effect on severe erosive esophagitis in patients with a poor PS.

DOI： 10.2169/internalmedicine.56.8058

Web of Science

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Gastroenterological Endoscopy Society  

Background and Aim: The aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD). Methods: We retrospectively reviewed clinical data for 40 consecutive patients who had undergone esophageal ESD at the Yokohama City University Hospital between July 2012 and August 2014. Of these patients, 20 were sedated with benzodiazepines (conventional group) and another 20 patients were sedated with a combination of PF and DEX (combination group). Parameters for efficacy and safety of sedation were evaluated by comparisons between the two groups. Results: Median procedural times in the combination group were shorter than those in the conventional group (61min vs 89 min, P = 0.03), and the percentage of patients who showed restlessness in the combination group was significantly lower than that in the conventional group (25% vs 65%, P = 0.025). Incidences of hypotension and bradycardia in the combination group were higher than those in the conventional group (60% vs 15%, P=0.008, and 60% vs 15%, P = 0.008, respectively). Conclusion: This retrospective study suggests that a combination of PF and DEX may provide stable deep sedation with less body movement than benzodiazepines during esophageal ESD.

Scopus

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DOI： 10.20524/aog.2017.0161

PubMed

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DOI： 10.1055/s-0042-117632

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AVES  

Background/Aims: This study aimed to determine the useful endoscopic findings in a differential diagnosis between early carcinomas (EC) and low-grade adenomas (LGA) in superficial elevated gastric epithelial neoplasia during conventional endoscopy with white- light imaging (C-WLI).
Materials and Methods: We investigated 270 consecutive cases of superficial elevated gastric epithelial neo-plasias, which were removed by endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification: category 4 (mucosal high-grade neoplasia) or 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, while category 3 (mucosal low-grade neoplasia) lesions were diagnosed as LGA. The association between the postoperative pathological diagnoses (EC or LGA) and the following endoscopic findings: localized site, lesion size, color (reddish or whitish), shape (smooth, petal, or irregular), and presences of depression, erosion, ulceration, or nodularity on the surface, were evaluated.
Results: Of 270 epithelial neoplasias, 222 (58 LGA and 164 EC) were retrospectively evaluated. Multiple logistic regression analysis revealed that the lesion size [odds ratio (OR), 1.216; p&lt;0.001) and reddish color (OR, 5.274; p&lt;0.001) were independent findings for EC.
Conclusion: The lesion size and reddish color were useful optical findings for discriminating between EC and LGA.

DOI： 10.5152/tjg.2015.150359

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Background and AimThe aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD).
MethodsWe retrospectively reviewed clinical data for 40 consecutive patients who had undergone esophageal ESD at the Yokohama City University Hospital between July 2012 and August 2014. Of these patients, 20 were sedated with benzodiazepines (conventional group) and another 20 patients were sedated with a combination of PF and DEX (combination group). Parameters for efficacy and safety of sedation were evaluated by comparisons between the two groups.
ResultsMedian procedural times in the combination group were shorter than those in the conventional group (61min vs 89min, P=0.03), and the percentage of patients who showed restlessness in the combination group was significantly lower than that in the conventional group (25% vs 65%, P=0.025). Incidences of hypotension and bradycardia in the combination group were higher than those in the conventional group (60% vs 15%, P=0.008, and 60% vs 15%, P=0.008, respectively).
ConclusionThis retrospective study suggests that a combination of PF and DEX may provide stable deep sedation with less body movement than benzodiazepines during esophageal ESD.

DOI： 10.1111/den.12559

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Language：Japanese   Publisher：(株)癌と化学療法社  

死亡診断の場面での医師の立ち居振る舞いは、その後の遺族の悲嘆に大きく影響を及ぼすと考えられる。死亡診断時の医師の立ち居振る舞いについてのマニュアルを作成し、研修医や医学部生の教育に利用している。現在、これをアップグレードする目的で地域の多職種(訪問看護師、薬剤師)で共同研究を行っている。当地域の現場で在宅医療を行っている医師・看護師へマニュアル作成について、また実際の看取りの場面についてのインタビューを行った。試みに対してはおおむね高評価であり、インタビューに協力的であった。地域の多職種連携は様々な形で行うことができる。地域の多職種で共同研究を行うことで地域連携はより円滑になると思われ、この過程を経てできあがったマニュアルは同地域で受け入れられやすいと思われる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本老年医学会  

94歳女性。80歳頃から妄想・健忘が出現、近医にてアルツハイマー型認知症と診断された。次いで89歳頃よりは誤嚥性肺炎を繰り返し、90歳時に胃瘻を造成、その後、介護老人保健施設に入居したが92歳時に同施設を退所した。今回、退所後、発熱などで病院への救急搬送、入退院が増えたことからケアマネージャーの勧めもあり、在宅医療目的で著者らの施設へ受診となった。初診時、呼びかけに対して全く反応がなくアルツハイマー型認知症のFAST分類7-fであった。胃瘻からの人工的水分、栄養補給法(AHN)についてはトラブルなく成立していたが、患者の娘からAHN中止の希望が出された。そこで、日本老年医学会の高齢者ケアの意思決定プロセスに関するガイドラインにそって、約2ヵ月の時間をかけて複数医師の診察、家族、訪問看護ステーション責任者、ケアマネージャーほか、訪問介護事業所責任者、訪問入浴事業所責任者、介護用具貸出事業所責任者と話し合いを重ねた末にAHNの中止を決断した。しかし、患者はインフルエンザを罹患、肺炎も併発したためAHNは中止せずに経過したが、肺炎発症から7日目に死亡となった。以上、本症例をとおして胃瘻を中止することが命を断ち切るという家族の悩みや、意思疎通のできない患者を如何にして持つべき本人らしさを引き出すかの難しさを改めて実感することができた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J01214&link_issn=&doc_id=20150116190010&doc_link_id=1390001205025576448&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001205025576448&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist that reportedly has more potent antiemetic effects than other 5-HT3 receptor antagonists. The aim of this study was to determine the effect of ramosetron pretreatment on gastric emptying using the 13c-acetic acid breath test. Methodology: Ten healthy male and female volunteers participated in this randomized, twoway crossover study. After they had fasted overnight, the subjects were randomly assigned to receive 0.1 mg ramosetron 1 hour before ingestion of a test meal (200 kcal per 200 mL, containing 100 mg 13(c) acetate) or to receive the test meal alone. Under both conditions, breath samples were collected for 150 min following ingestion of the meal. Statistical com arison of the parameters tetween e two test conditions was formed. Results: No significant differences in the lated parameters, including T 1/2, T lag, GEC or beta and kappa, were observed between the two test conditions. Conclusions: The present study revealed that 0.1 mg mosetron had no significant effect on the rate of gastric emptying. Thus, our results suggest that ramosetron can be administered safely, without gastrointestinal adverse effects, even to terminal cancer patients with delayed or accelerated gastric emptying abnormality.

DOI： 10.5754/hge13057

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Geriatrics Society  

A 94-year-old woman with Alzheimers disease had been receiving nourishment via gastrostomy for three years and in a state in which communication was not possible. Upon the familyʼs request for consultation and advice, and after a considerable discussion according to the guidelines, the decision was made to stop the gastrostomy feeding. The patient subsequently coincidentally contracted influenza one week later and died due to pneumonia. Based on our experience of making the decision to stop nutritional supplementation via gastrostomy according to the guidelines, there are various issues, such as the psychological distress of the family, which cannot be resolved based on the guidelines.

DOI： 10.3143/geriatrics.51.560

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Language：Japanese   Publisher：(株)癌と化学療法社  

死亡診断の場面での医師の立ち振る舞いは、その後の遺族の悲嘆に大きく影響を及ぼすと考えられる。医師教育のなかには死後の内容はほとんど含まれず、グリーフケアを意識して死亡確認を行う医師は少ないことが予想される。緩和ケア病棟の看護師へのアンケート調査を行った結果、主治医と主治医以外の医師では死亡診断の際の立ち振る舞いに違いがあることが示された。主治医以外の医師であってもグリーフケアを意識した死亡確認ができるように、立ち会う看護師の声に基づき、死亡診断時の医師の立ち振る舞いについてのマニュアルを作成した。(著者抄録)

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We investigated the trend in admission to new a palliative care unit (PCU) over 9 months. We observed a significant difference in the length of PCU stay depending on whether patients had access to a house call doctor. These findings suggest that house call doctors play an important role in ensuring a smooth admission to the PCU. In addition, our study suggests that review of the operational management in the PCU is required.

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Language：Japanese   Publisher：(株)癌と化学療法社  

緩和ケア病棟開設後の9ヵ月間の入院患者について、その入院動向を調べたところ、自宅からの入院患者は往診医がいる場合といない場合で、入院までの日数や在院日数に差がみられた。在宅療養患者がスムーズに緩和ケア病棟に入院できるようにするための、往診医の役割や緩和ケア病棟運営システムの見直しの必要性などが示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

多くの終末期がん患者がホスピス・緩和ケア病棟での療養を希望するが、実際に利用できる患者は非常に少ない。当院は、「なるべく多くの方に緩和ケアを提供する」ことを目標とし、「一般病棟も含め緩和ケアの場とする」、「ホスピスへの入院はホスピスを希望する方のなかで最も予後予測の悪い方を優先する」を実践してきた。2007年4月～2011年3月の集計で87%の患者が希望するタイミングで当院に入院できた。地域の医療資源を考慮してホスピス病棟の運用を工夫することで、終末期がん患者はより多くの時間を自宅で過ごせる可能性があると考える。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J00296&link_issn=&doc_id=20121228360014&doc_link_id=issn%3D0385-0684%26volume%3D39%26issue%3D12%26spage%3D39&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0385-0684%26volume%3D39%26issue%3D12%26spage%3D39&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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Introduction: Recently, attention is being paid to gastrointestinal symptoms for Rome III criteria. The aim of this study was to determine whether Japanese volunteers could discriminate between manpuku (satiety) and bouman (epigastric bloating) in Japanese volunteers. Methods: Seventeen healthy subjects were recruited for a modified Boeckxstaens' water drink test. Data from the drink test and a questionnaire were analyzed. Results: The median value of maximum ingested volume was 1350mL. Maximum ingested volume and body mass index were correlated (P=0.0445). All subjects felt manpuku (satiety), bouman (epigastric bloating) and nausea. The time courses of manpuku (satiety) and bouman (epigastric bloating) in the questionnaires were classified into 5 groups: manpuku (satiety) dominant type (29.4%), bouman (epigastric bloating) dominant type (23.5%), manpuku (satiety) preceding type (11.7%), bouman (epigastric bloating) preceding type (29.4 %) and equal type (5.8%). Conclusion: Some Japanese discriminate between manpuku and bouman, but others feel them as identical symptoms.

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Language：Japanese   Publisher：(株)癌と化学療法社  

緩和医療における胃瘻の適応は十分に論議されていないのが現状である。内視鏡やデバイスの進化により従来は不可能だった症例も安全に胃瘻造設が行えるようになった。胃瘻はがん患者の在宅療養に非常に有用なツールの一つである。緩和医療における胃瘻の適応は引き続き論議されるべきテーマと考えられる。当院においての適応は、(1)必要な栄養・水分を自発的に摂取できない(通過障害に加え口腔内疼痛も含む)、(2)消化管吸収機能正常、(3)生命予後予測4週以上(+悪液質ではない)、(4)本人の意思としている。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20111222400029&doc_link_id=issn%3D0385-0684%26volume%3D38%26issue%3D12%26spage%3D85&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0385-0684%26volume%3D38%26issue%3D12%26spage%3D85&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPANDIDOS PUBL LTD  

The goal of this study was to investigate Cystatin SN, a cysteine protease inhibitor, as a novel tumor marker for colorectal cancer (CRC). Gene expression profiles of mRNA from normal tissues and cancer cell lines were performed. Twenty-eight monoclonal antibodies for Cystatin SN were generated and serum Cystatin SN was quantified using ELISA in sera from 159 patients with CRC and 40 healthy controls. Cystatin SN was highly expressed in colon cancer cells. Employing a receiver-operating characteristic curve, we obtained an area under the curve of 0.708 for Cystatin SN, 0.819 for carcinoembryonic antigen (CEA) and 0.703 for carbohydrate antigen 19-9 (CA19-9). The combination assay of Cystatin SN, CEA and CA19-9 showed 62.9% sensitivity and 90.0% specificity. Especially, the sensitivity of the combination assay in stages I and IT detection, in which stages curative operation would be possible, was improved over that of the assay testing only for CEA and CA 19-9 (from 37.5 to 42.5% in stage I, from 49.0 to 60.8% in stage II). Furthermore, Western blot analysis revealed that Cystatin SN was increased in the urine from patients with CRC. Our results suggest the possibility of utilizing this novel tumor marker that can be tested in urine samples. These observations suggest that Cystatin SN in combination with CEA and CA19-9 is a useful tumor marker for detecting early stage CRC and that it is a unique urinary excretory protein, suggesting that Cystatin SN might be a novel candidate for use in mass screening for CRC.

DOI： 10.3892/ijo_00000310

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/MCG.0b013e31805d7ef1

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Language：English   Publisher：KARGER  

DOI： 10.1159/000106975

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J-GLOBAL

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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J-GLOBAL

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J-GLOBAL

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DOI： 10.11477/mf.1430200227

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J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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DOI： 10.24508/mms.2017.06.002

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DOI： 10.2512/jspm.12.906

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Language：Japanese  

CiNii Books

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：AVES  

DOI： 10.5152/tjg.2014.5262

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Language：English   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to deter,. mine the possible existence of a correlation between the gastric transit time (GTT) measured by video capsule endoscopy (VCE) and the parameters of gastric empty! ing determined using 13C breath test (BreathID system). Methods: Eight healthy male volunteers participated in this randomized; two-way crossover study. The subjects were randomly assigned to undergo VCE using the pillCam SB capsule endoscopy system or the 13C breath test for 4 hours after a test meal (400 kcal per 400 mL) containing 100 mg of 13C acetic acid administered after overnight fasting. The VCE images were analyzed and the GTT was determined using the proprietary RAPID software. The parameters, namely T lag, T1/2 and GEC were calculated using the Oridion Research Software (beta version). The GTT measured by VCE and the parameters of gastric emptying were compared statistically. Results: No significant correlation was observed between the GTT and T lag (p = 0.5263), T 1/2 (p = 0.4100) or GEC (p = 0.2410), as determined by calculation of the Spearman's rank correlation coefficient. Conclusions: GTT measured by VCE cannot serve as a substitute for the gastric emptying time measured by the 13C breath test.

DOI： 10.5754/hge13358

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Language：English   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The aim of this study was to comparatively examine the convenience of use of the QUEST and GerdQ questionnaires as self- administered diagnostic instruments. Methodology: This was a two-way crossover study conducted from December 2011 to April 2012. The subjects were 70 third-year nursing students of Yokohama Soei University in Yokohama, Japan. They were randomly assigned to fill in either of the study questionnaires first, and then the other on a later. Results: A significant difference was observed in the questionnaire completion time between the QUEST and GerdQ questionnaires (125.5 vs. 44 seconds, P &lt; 0.0001) and also in the number of subjects asking questions while completing the questionnaires (26 vs. 1 subject, respectively: P &lt; 0.0001). To detect GERD based on a QUEST score &gt;= 4 of ROC analysis revealed an area under the curve for the GerdQ score of 0.616. The sensitivity and specificity calculated using this cutoff value were 0.842 and 0.312, respectively. Conclusion: This study revealed that Japanese subjects may find it easier to complete the GerdQ than the QUEST questionnaire.

DOI： 10.5754/hge14396

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Language：English   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background /Aims: The natural immunomodulator actoferrin is known to possess anti-inflammatory effects. However, there have been no studies examininig the mode of action of lactoferrin in protecting the esophageal mucosa against damage. We investigated the effect of lactoferrin on gastric acid secretion and in protecting against acute acid reflux-induced esophagitis in rats. Methodology: Male Wistar rats aged 8 weeks, weighing 210-240 g, were used for all the experiments. A gastric perfusion system was installed using the method of Ghosh et al. Lactoferrin was administered once via he caudate vein, starting 24 hours before an acute acid reflux (treatment mode), or saline (control). Statistical comparison of the parameters between the two test conditions was performed. Results: No significant differences in basal or stimulated gastric acid secretion, or in the serum gastrin level were observed between the two test conditions. Esophageal damage was attenuated by the improvement in the esophageal tissue weight and macroscopic scores. Significant reductions in the histological scores, myeloperoxidase activity and the levels of proinflammatory cytokines, tumor necrosis factor-a and interleukin-1 beta were also observed following lactoferrin administration. Conclusions: We concluded that lactoferrin exerts a protective effect against acute acid reflux-induced esophageal damage in rats.

DOI： 10.5754/hge13380

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Language：English   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Ramosetron is a new selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist that reportedly has more potent antiemetic effects than other 5-HT3 receptor antagonists. The aim of this study was to determine the effect of ramosetron pretreatment on gastric emptying using the 13c-acetic acid breath test. Methodology: Ten healthy male and female volunteers participated in this randomized, twoway crossover study. After they had fasted overnight, the subjects were randomly assigned to receive 0.1 mg ramosetron 1 hour before ingestion of a test meal (200 kcal per 200 mL, containing 100 mg 13(c) acetate) or to receive the test meal alone. Under both conditions, breath samples were collected for 150 min following ingestion of the meal. Statistical com arison of the parameters tetween e two test conditions was formed. Results: No significant differences in the lated parameters, including T 1/2, T lag, GEC or beta and kappa, were observed between the two test conditions. Conclusions: The present study revealed that 0.1 mg mosetron had no significant effect on the rate of gastric emptying. Thus, our results suggest that ramosetron can be administered safely, without gastrointestinal adverse effects, even to terminal cancer patients with delayed or accelerated gastric emptying abnormality.

DOI： 10.5754/hge13057

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Language：English   Publisher：HINDAWI PUBLISHING CORPORATION  

The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 mu g tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE) and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen), a placebo tablet 60 minutes prior to CE and a 24 mu g tablet of lubiprostone 30 minutes prior to CE (P-L regimen), or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen). The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117-407) minutes in the P-P regimen, 122.5 (27-282) minutes in the L-P regimen, and 110.5 (11-331) minutes in the P-L regimen (P = 0.042). This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

DOI： 10.1155/2014/879595

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Language：English   Publisher：GEORG THIEME VERLAG KG  

DOI： 10.1055/s-0034-1377634

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(株)ヴァンメディカル  

既存のプロトンポンプ阻害薬(PPI)を投与されているにもかかわらず、胸やけあるいは酸逆流症状のいずれかが残存する患者30例を対象にエソメプラゾールに切り替え、患者満足度を検討した。切り替え前後の症状について比較した結果、症状の強さおよび症状の頻度、双方の質問項目すべてにおいて有意な改善が認められた。また、エソメプラゾールに対する満足度は「満足している」と「やや満足している」を合わせると73.3%であった。既存のPPIで症状が残存している患者においてはエソメプラゾールに変更する治療法も一選択肢と考えられた。(著者抄録)

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Background/Aims: The gastrointestinal motility effects of endogenous incretin hormones enhanced by dipeptidyl peptidase-IV (DPP-IV) inhibitors have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial sitagliptin, the DPP-IV inhibitor, administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test. Methods Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted for overnight and were randomly assigned to receive 50 mg sitagliptin 2 hours before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C-acetate) or the test meal alone. Under both conditions, breath samples were collected for 150 minutes following the meal. Liquid gastric emptying was estimated by the values of the following parameters: the time required for 50% emptying of the labeled meal (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (Tlag), the gastric emptying coefficient and the regression-estimated constants (β and κ), calculated by using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 2 test conditions were compared statistically. Results No significant differences in the calculated parameters, including T1/2, Tlag, gastric emptying coefficient or ß and κ, were observed between the 2 test conditions. Conclusions The present study revealed that single-dose sitagliptin intake had no significant influence on the rate of liquid gastric emptying in asymptomatic volunteers. © 2013 The Korean Society of Neurogastroenterology and Motility.

DOI： 10.5056/jnm.2013.19.2.227

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Language：Japanese   Publisher：(一社)日本内科学会  

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The behavior of a physician when confirming the death of a patient is thought to greatly affect the bereaved family. The required aspects of a physician&#039;s behavior after a patient&#039;s death are rarely included in physician education. Therefore, the few physicians who confirm the death of a patient should be conscious of the grief of the family members. A questionnaire survey was administered to nurses of a palliative care unit, and the findings showed that the behavior of an attending physician was different from that of other physicians when confirming death. We have prepared a manual that specifies the expected behavior of physicians confirming the death of patients to ensure that physicians other than the attending physician are also conscious of subsequent grief care for the bereaved family.

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PubMed

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Language：English  

Background: Malignant bowel obstruction affect a patient's quality of life, but, management of MBO is controversial. Case presentation. A 51-year-old woman who had been diagnosed as uterine cervix cancer 2 years ago and had undergone surgery, chemotherapy and radiotherapy, was admitted to our hospital. She was diagnosed as having a recurrence of peritoneal metastasis and bowel obstruction. For her nasal pain, we considered insertion of a postpyloric decompression tube through the gastrostomy instead of via the nasal cavity. After insertion of a percutaneous gastrostomy tube was performed endoscopically, we introduced a postpyloric decompression tube through her gastrostomy. She could be discharged home, and 91 days later, she died in her home under hospice care, as she had wished. Conclusions: Insertion of a postpyloric decompression tube through a gastrostomy might be useful in the management of advanced cancer patients with bowel obstruction. © 2013 Kurita et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1756-0500-6-217

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PubMed

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：Japanese   Publisher：横浜市立大学医学会  

【目的】近年、機能性消化管障害の診療等で症状の評価が見直されている。同じように&quot;腹がふくれる&quot;症状を表す言葉に満腹と膨満があるが、その区別の詳細は不明である。本研究の目的は、日本人が満腹と膨満をどのように区別しているかを調べることである。【方法】健常男性17名を対象とし、腹部症状の定量的評価の方法として、Boeckxstaensの飲水試験を行った。飲水試験で得られる問診表をはじめとする情報を解析し、満腹感と膨満感の関連につき考察した。【結果】最大飲水量の中央値は1350mLであった。満腹感と膨満感について問診表における推移を解析すると、満腹感優位型(29.4%)、膨満感優位型(23.5%)、満腹感先行型(11.7%)、膨満感先行型(29.4%)、同等型(5.8%)に分類された。最大飲水量とBMIのみ正の相関が認められた(P=0.0445)。満腹、膨満、嘔気は全員に出現し、その閾値容量は各々相関していた。【結論】満腹感と膨満感は個々により捉え方が異なる可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：胃病態機能研究会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：診断と治療社  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2011088782

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.1055/s-2007-966598

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2006211115

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2006123556

Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2006059573

Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2006021543

Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2005269765

Language：Japanese   Publisher：南山堂  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2005230574