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.
To clarify the family-perceived necessity of improvement in death pronouncement and explore the potential association between behaviors of physicians and the family-perceived necessity of ...improvement.
A questionnaire survey was conducted involving 226 bereaved family members of patients who had died at home while receiving hospice service. A total of 91 responses were analyzed (response rate, 47%).
All pronouncements were performed by physicians. A total of 89% (n = 81, 95% confidence interval, 81%-94%) of family members reported that they felt no necessity of improvement at all or that almost no improvement was needed. Behaviors of physicians significantly positively correlated with the family-perceived necessity of improvement were that physicians acted calmly, and were not rushed. Those negatively associated were that physicians did not verify the time of death clearly, left the patient's clothes disheveled, and touched the family members' backs or shoulders as an expression of empathy. More than 90% of family members recommended that physicians act calmly, have a suitable appearance for the situation, introduce themselves to family members, explain the cause of death explicitly, and conduct a check using a light and stethoscope for death pronouncement.
Most of the family members who had experienced a patient's death at home were satisfied with the death pronouncement. Several factors were associated with family satisfaction, and further large studies are needed to confirm the results.
It is thought that physicians' behavior at the scene of death certification has a considerable influence on the grief of the bereaved. We constructed a manual to guide the physician's behavior at ...death certification and educate residents and medical students. We collaborated locally across several occupations(e.g., visiting nurse, visiting pharmacist)for the purpose of upgrading the manual. We conducted interviews with physicians and nurses who perform home medical care in this area regarding the scene at a real death certification in making our manual. It was evaluated well in this trial, and participants were cooperative with the interview. We can conduct many collaborations locally in various forms. The regional alliances become smoother as a function of such collaborations. In addition, it is thought that the manual that was constructed following this process will be easily received in the area.
The experience at the time of a patient’s death can affect the mental health of bereaved families. Performing death pronouncements is an important skill for end-of-life care. However, almost no ...educational content regarding death pronouncements is presently included in medical educational programs. We have created a guidebook for “Physician behavior at the time of death pronouncement” based on the results of a questionnaire given to the families of deceased patients that included several items related to this topic. The purpose of this research was to investigate the educational effect of using this guidebook. The guidebook was given to 4th-year medical students attending the Yokohama City University School of Medicine. A survey was then conducted to assess evaluations of self-practice and feelings of difficulty at the time of making death pronouncements both before and after the class. Among the 39 students who provided valid responses, the majority (89.5%) indicated that they had difficulty with the item regarding “the specific method of death pronouncement.” A significant improvement was observed between the responses obtained before and those obtained after the class. We concluded that our guidebook for physician behavior at the time of death pronouncement might be useful for the education of medical students.
► A large-scale dataset of 101 chemicals was created for h-CLAT, DPRA and DEREK. ► h-CLAT and DPRA complemented the limited sensitivity of either test. ► The tiered system of h-CLAT and DPRA ...displayed high accuracy of 86.1% compared with LLNA. ► h-CLAT can serve as part of the test battery with other methods for prediction of sensitizing potential.
Recent changes in regulatory restrictions and social views against animal testing have accelerated development of reliable alternative tests for predicting skin sensitizing potential and potency of many chemicals. Lately, a test battery integrated with different in vitro tests has been suggested as a better approach than just one in vitro test for replacing animal tests. In this study, we created a dataset of 101 test chemicals with LLNA, human cell line activation test (h-CLAT), direct peptide reactivity assay (DPRA) and in silico prediction system. The results of these tests were converted into scores of 0–2 and the sum of individual scores provided the accuracy of 85% and 71% for the potential and potency prediction, compared with LLNA. Likewise, the straightforward tiered system of h-CLAT and DPRA provided the accuracy of 86% and 73%. Additionally, the tiered system showed a higher sensitivity (96%) compared with h-CLAT alone, indicating that sensitizers would be detected with higher reliability in the tiered system. Our data not only demonstrates that h-CLAT can be part of a test battery with other methods but also supports the practical utility of a tiered system when h-CLAT and DPRA are the first screening methods for skin sensitization.
A Case of Iatrogenic Transverse Mesenteric Artery Aneurysm TANAKA, Natsuko; SASAKI, Hayato; YOKOYAMA, Naohiro ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2016, 2016-00-00, Volume:
77, Issue:
12
Journal Article
Open access
A 72-year-old man who had undergone an operation for cholecystocholedocholithiasis 30 years ago was referred to our hospital because of abnormal findings on chest radiography. His chest computed ...tomography (CT) revealed an abnormal mass with a 45-mm diameter in the hepatic flexure of the colon. A foreign body was suspected and we performed tumorectomy for diagnosis. We found that the mass was present in the transverse mesocolon. Because it adhered to the transverse colon and pancreatic head, we resected the mass with the portion of the transverse colon to which it adhered. Postoperative pancreatic fistula and anastomotic leakage were observed and treated using drainage alone. Histopathologically, the mass was filled with coagula, with many fragmented surgical sutures in the fibroid wall region of the mass. Therefore, we diagnosed an iatrogenic mesenteric artery aneurysm due to the previous operation. Aneurysms of the mesenteric artery are usually diagnosed following intraabdominal hemorrhage or gastrointestinal bleeding due to aneurysmal rupture. This case is rare because it was asymptomatic and was incidentally detected via CT.
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