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N Shirotani

Publications and source records attributed to N Shirotani.

At least 19 recordsLinked to original sources
PubMed1999

Clinical study on the ratio of glucose/fat in peripheral parenteral nutrition and the usage of a midline catheter.

Two important unsolved questions related to peripheral parenteral nutrition are the ratio of components in the intravenous (IV) solution and catheter-related complications. The present study was undertaken to evaluate the nutritional profiles of three kinds of IV solutions with different ratios of components, while maintaining the total energy at about 1 200 kcal/day and the amino acid level at 60 g. The IV solution formulas used were as follows : glucose/fat = 2:1, osmolarity ratio = 3.3 for group A, glucose/fat = 1:1, osmolarity ratio = 3.1 for group B, and glucose/fat = 1:2, osmolarity ratio = 2.6 for group C. The incidence and severity of complications were then analyzed in relation to the type of IV solution used, the indwelling time, and the type of catheter (midline catheter or short peripheral catheter). The results of peripheral parenteral nutrition were favorable when the glucose/fat ratio of the IV solution was either 1:1 or 1:2. The midline catheter was inserted for an average of 11.9 +/- 4.0 days, and the incidence of catheter-related complications following parenteral nutrition with a midline catheter was low when the osmolarity ratio of the IV solution was 3.1 or less. These results indicate that a midline catheter is useful when administering peripheral parenteral nutrition.

Catheterization↗
PubMed1998

[Medical cooperation between the in-home medical care and family physician].

It is important to exchange information about the patient between the family physician and medical staffs in the university hospital in home care, in order to create the good relationships among the patient, caregiver and the family physician. The main points are as follows: 1. Collaboration advice with the family physician before discharge. 2. Sharing medical treatment among medical staffs. 3. Sharing patient information with medical staffs. 4. Team approach.

Aged↗
PubMed1998

[Life supports for terminal cancer patients].

An In-home medical care center was established at Tokyo Women's Medical University in 1997, and supported 14 cases that were treated at home. According to these cases, we understood that the terminal cancer patients and their family had various ways of thinking, especially misgivings about their surroundings. Causes of the misgivings were divided into 6 elements, such as experience, environment, situations, patients themselves, information and time management. To remove these uneasy feelings, we thought that our medical care center should play an important role in providing early consultation for cancer patients and their families. We concluded that the most important thing was collaboration with regional medical staff.

Aged↗
PubMed1998

[Application of percutaneous trans esophageal gastro-tubing (PTEG) in to home care for a patient with terminal stage of gastric cancer].

PURPOSE: Since 1994, we devised and have continued to develop a percutaneous trans esophageal gastro-tubing (PTEG) as an effective technique to drain gastrointestinal contents of critical patients suffering from gastric carcinoma. Here we report our satisfactory experience with a critical gastric cancer patient for whom we improved QOL by the application of the PTEG technique. The patient suffered from severe stenosis or obstruction of the digestive tract. This method was found to be effective enough to enable the patient to receive further medical care at home. CASE: The patient was a 36-year-old female who had far-advanced, inoperable gastric carcinoma. It was therefore decided to use the PTEG method. METHOD: The PTEG method was performed using a rupture-free balloon (RFB) catheter to drain the gastrointestinal contents. A reservoir-port for IVH use was embedded to control the patient's nutrition. A morphine hydrochloride suppository was then given for the pain. REMARK: PTEG was found to be effective, safe and simple; moreover, it is a less-invasive, intestine-maintaining method, which enabled the patient to continue receiving further medical treatment at home.

Adult↗
PubMed1997

[Home parenteral nutrition (HPN) for cancer patients].

We have treated thirty-five cancer patients with HPN since 1987. This paper describes its efficacy and problems. Their average age was 62 years old. The duration of HPN varied from 31 to 573 days (mean: 167 days). The catheter was removed in three cases because of catheter fever or obstruction. Metabolic complications arose in three cases, but they were easily treated. Twenty-three cases underwent pain control. Twelve cases were given cancer chemotherapy. We concluded that HPN for recurrent cancer patients is a relatively safe and effective means to improve the quality of life. We consider the following important in order to carry out HPN more smoothly. 1) Improvement of drug delivery system. 2) Establishment of home care system with other hospitals, clinics, and home care companies. 3) The easing of health-insurance restrictions on making out prescriptions to outpatients.

Adult↗
PubMed1996

[Attempt to create a HPN database].

We experienced fifty cases of HPN (home parenteral nutrition) from January 1987 to May 1994. Using effectively these important data, we attempted to make a database for these fifty cases of HPN. We constructed a database based on Windows 3.1-J and Access 2.0-J produced by Microsoft company. At this time, we introduce a part of the database, which must be completed in terms of input items and simplicity.

Humans↗
PubMed1995

Report on the first annual survey of home parenteral nutrition in Japan.

An annual survey of the current national status of home parenteral nutrition (HPN) in Japan was begun in 1991, with a total of 231 registered patients from 142 institutions providing adequate data for evaluation and analysis. HPN was given for an average of 683 +/- 764 days to 93 patients with malignant diseases and 138 with benign disease, including 53 with inflammatory bowel disease and 79 with short bowel syndrome, 107 (46.3%) of whom were successfully rehabilitated. By the end of 1990, 61% of the patients investigated were still on HPN, 7% had already completed HPN, and 26% had died, the deceased accounting for 54% of the patients with malignant diseases and 7% of those with benign diseases. A total of 321 catheters had been used by all 231 patients, the most common being the subcutaneously implanted type, accounting for 33% of all catheters. By the end of 1990, 32% of these 321 catheters were still in place, 18% had been removed on the termination of HPN and 44% had been removed due to complications of total parenteral nutrition, including 20% for catheter fever. Rehospitalization was required in 62% of the patients, the cause being HPN-related in 21% of the total patients. Metabolic complications were experienced by 60% of the patients, but none of these were severe although 6% required hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Study of medical economy in home parenteral nutrition].

UNLABELLED: The authors studied the relation between home parenteral nutrition (HPN) and medical economy. The items of study are 1) cost benefit of HPN compared with TPN, 2) hospital intention to promote HPN, 3) economical demerits for outpatients receiving HPN. RESULTS: 1) HPN had the advantage of cost benefit compared with TPN in reimbursement; however, hospitals did not have such an intention. 2) It is necessary for advanced home care to improve reimbursement in the health insurance system; and in the existing situation, hospitals do not profit from HPN. 3) Home care companies are unprofitable because of nursing visits and reimbursement issues which do not ease legal restrictions. 4) HPN in the present situation depends on the ability of patients to pay and the ability of care givers to provide care.

Cost-Benefit Analysis↗
PubMed1994

[Home therapy approach in cancer patients-nutrition therapy (case 1-1)--a case of recurrent gastric cancer with home parenteral nutrition].

This paper describes a case of recurrent gastric cancer with home parenteral nutrition (HPN). A 48-year-old man underwent nutrition support with HPN for the last 6 months. We treated the patient with adjuvant chemotherapy and provided pain management along with HPN treatment. The patient was able to achieve a meaningful and satisfactory quality of life. We concluded that HPN for recurrent cancer patients is a relatively safe and effective means of improving and maintaining the nutritional status. We think the following is important in order to establish home infusion therapy. 1) Organization of a home care team (physician, nurse, pharmacist, dietitian, and caseworker) and a practice-team approach. 2) Establishment of a home infusion system in home care. 3) Preparation of patient manuals by the medical staff. 4) Establishment of sterility preparation and delivery system in home infusion therapy. 5) Establishment of a patient-information-communication system by connection with other hospitals, clinics, and home care companies.

Fluorouracil↗
PubMed1991

[Total parenteral nutrition for home therapy in cancer patients].

Home parenteral nutrition (HPN) was used in 14 cancer patients within a 4-yr and 4-month period. Indications included severe malabsorption, short bowel syndrome, radiation enteritis, and malignancies. The mean duration of HPN was 184 days (range: 21-706 days). HPN duration for patients with benign causes (BP) was longer [427 days (range: 176-706 days)] than for cancer-related patients (CP) [49 days (range: 21-121 days)]. The mean catheter life spans to date for BP and CP have been 596 days (range: 187-1173 days) and 127 days (range: 73-278 days), respectively. Serious catheter problems occurred 4 times in BP with the external catheter. Metabolic complications with clinical symptoms occurred in one BP who had short bowel syndrome. We followed with an evaluation of the quality of life of HPN patients. Three in 14 cases returned to work, two of them part time, and two others did most of the housekeeping, but 9 remained at home receiving only outpatient treatment. Some physical distress was recorded in all but one case. We concluded that HPN for cancer patients is a relatively safe, effective means of improving and maintaining the nutritional status, and it can reduce the length of hospitalization. We attempted to evaluate whether these patients were able to achieve a meaningful and satisfactory social and familial life. Our study was not sufficient to assess the psychological and social problems. We should establish criteria for quality of life to evaluate overall satisfaction with conditions of life under HPN.

Adult↗