Experience of End-of-Life Home Care in an Acute General Community Hospital in Japan
Bibliographic record
Abstract
We sometimes encounter situations in which it is impossible to find appropriate home care clinics despite patients’ wish of spending end of life (EOL) at home. We herein report our experience in cases of EOL home-based care managed by medical staff in an acute general community hospital. We retrospectively reviewed the clinical data of five cancer patients who received EOL home care managed by our institution between May 2016 and October 2018. We assessed the background characteristics and clinical course, how medical staff managed the patients and degree of satisfaction in the EOL care we provided, based on impressions interviews with the patients and their families. The median duration between the final examination by doctors in the hospital and death was 5 days (range: 7 h - 5 days). Regarding the visits to the four patients other than the one who died during her outing, home-visit nurses visited the patients’ homes every day in three of four patients, and both a care manager and a medical social worker (MSW) tried to evaluate the condition of the remaining patient by visits and phone calls. Information on the patients’ condition at home was given to the medical staff in order to discuss optimal home care. When they died, a doctor, a home-visit nurse, a nurse belonging to the palliative care team and a MSW visited in all cases. All patients spent their EOL calmly at home, and their families were pleased with their EOL and grateful to the medical staff who supported the patients. We supported patients’ EOL by managing home-based medical care in cooperation with multi-occupational staff. We should organize a system for meeting patients’ changing wishes flexibly. J Med Cases. 2019;10(3):75-77 doi: https://doi.org/10.14740/jmc3263
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".