Development of the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to enhance collaboration among health and long-term care providers.

This study aimed to develop the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to create a simple low-burden rating scale for promoting collaboration between health and long-term care providers. A survey was conducted with 151 care providers, obtaining valid responses from 147 (30 nurses, 67 care managers, and 50 care workers; response rate 97.4 %). Through confirmatory factor analysis, we developed a short-version scale consisting of 7 items by selecting one item with the highest regression coefficient from each of the 7 factors in the original 21-item version. The reliability was verified by confirming internal consistency. Regarding construct validity, the goodness-of-fit indices confirmed acceptable fit, and the correlation between the original and the shortened version was 0.98. Convergent validity was found as significant using the collaborative behavior evaluation scale and job satisfaction measure. FACES is considered a useful scale for easily measuring the level of collaboration among various professions in the community.

[Feelings of difficulty experienced by home healthcare support workers in collaborative practice with medical professionals: Scale development].

Objective　Healthcare support workers play an important role in team healthcare. The objective of this study was to develop scales for measuring feelings of difficulty among home healthcare support workers when in collaborative practice with medical professionals.Methods　Scale drafts consisting of 10 questions were developed by an expert panel, using qualitative data from previous studies. We conducted a questionnaire survey of 220 healthcare workers in a certain city using the developed scales, and reliability and validity of the scale were examined.Results　An exploratory and confirmatory factor analysis was conducted, after which two factor structures and six questions were selected. The factors were "feelings of disrespect from medical professionals" and "communication barriers between home healthcare support workers and medical professionals". Cronbach's coefficient alpha was 0.77-0.81 for the scale and its two subscales, which demonstrated good internal consistency. Correlation coefficients between the scale and the face-to-face cooperative confidence questionnaire (FFCCQ) and interdisciplinary collaborative practice scales (ICPS) were estimated to examine the criterion-related validity. As a consequence, the score of the scale had a significant negative correlation with FFCCQ and ICPS (r=-0.36--0.42). The two subscales also had negative correlations with FFCCQ and ICPS (r=-0.17--0.42).Conclusion　The scales we developed were reliable and valid for measuring home healthcare support workers' feelings of difficulty in collaborative practice with medical professionals.

Evaluation of the elements of interprofessional education for end-of-life care among homecare nurses, care managers, and head care workers: A cluster-randomized controlled trial.

Our group developed an interprofessional education (IPE) program for home-based end-of-life (EOL) care among health and welfare professionals, with the purpose of understanding professional roles in EOL care and promoting mutual respect among team members. This study aimed to verify the understanding and awareness of the elements of IPE. Seven districts in a city in Japan were cluster-randomized into an education group or a control group. A questionnaire survey using original items to evaluate two purposes of the IPE program was conducted before the IPE workshop and seven months later. In total, 291 professionals participated in the study: 64 homecare nurses, 129 care managers, and 98 head care workers. Care managers and care workers in the education group significantly understood their own and other professional roles in EOL care (p= .01, p < .0001, respectively) and gained confidence in collaboration among health and welfare professionals (p = .02, p < .0001, respectively). Care workers in the education group felt respect for team members (p = .02). For homecare nurses, no significant effects were observed. The IPE was more effective for welfare professionals who had difficulty cooperating in end-of-life care.

Role for RalA downstream of Rac1 in skeletal muscle insulin signalling.

Insulin-stimulated glucose uptake in skeletal muscle is mediated by the translocation of the glucose transporter GLUT4 from intracellular storage sites to the plasma membrane. The small GTPase Rac1 has been implicated in this insulin signalling, but the mechanism whereby Rac1 stimulates GLUT4 translocation remains obscure. In the present study, we examined the role of the small GTPase RalA downstream of Rac1 in skeletal muscle fibres isolated from genetically modified mice. A dominant-negative mutant of RalA, when ectopically overexpressed, significantly reduced GLUT4 translocation in response to insulin or either one of constitutively activated mutants of Rac1 and its upstream regulators, including the guanine-nucleotide-exchange factor FLJ00068, the protein kinase Akt2 and phosphoinositide 3-kinase. Constitutively activated Rac1 also failed to induce GLUT4 translocation in mouse skeletal muscle fibres in which the expression of RalA was abrogated by specific siRNA molecules. Furthermore, we applied a novel approach to detect the activated form of RalA in situ by immunofluorescence microscopy of mouse skeletal muscle fibres, demonstrating that constitutively activated mutants of Rac1 and its upstream regulators as well as insulin indeed cause the activation of RalA. Notably, this RalA activation was remarkably impaired in rac1-deficient skeletal muscle fibres. Taken together, these results provide evidence that RalA is indeed activated and involved in the regulation of GLUT4 translocation in response to insulin downstream of Rac1 in mouse skeletal muscle.

Cultural characteristics of nursing practice in Japan.

The population of Japan has become multi-cultural, and there is more demand for culturally competent nursing care. The purpose of this study was to explore cultural characteristics of nursing practice in Japan focusing on behaviour. We interviewed 25 professionals with experience in or knowledge of nursing practice both in Japan and either the United States, the United Kingdom, Sweden, Thailand or South Korea. Qualitative content analysis has yielded three themes for cultural characteristics of nursing practice in Japan: practice expectations, communication and relationships with patients. Practice expectations for nurses in Japan involved various aspects; nurses conducted a wide range of basic nursing tasks, including bed baths and toileting. They often relied on non-verbal communication to deliver thoughtfulness and perceptiveness. They typically show deference to doctors and colleagues, emphasizing building and maintaining harmony with them. This emphasis on a multifaceted, non-verbal, and harmonious approach seemed characteristic of practice among Japanese nurses.

Thrombosis from a prothrombin mutation conveying antithrombin resistance.

We identified a novel mechanism of hereditary thrombosis associated with antithrombin resistance, with a substitution of arginine for leucine at position 596 (p.Arg596Leu) in the gene encoding prothrombin (called prothrombin Yukuhashi). The mutant prothrombin had moderately lower activity than wild-type prothrombin in clotting assays, but the formation of thrombin-antithrombin complex was substantially impaired. A thrombin-generation assay revealed that the peak activity of the mutant prothrombin was fairly low, but its inactivation was extremely slow in reconstituted plasma. The Leu596 substitution caused a gain-of-function mutation in the prothrombin gene, resulting in resistance to antithrombin and susceptibility to thrombosis.

Determinants of financial performance of home-visit nursing agencies in Japan.

BACKGROUND: Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. METHODS: We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). RESULTS: Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. CONCLUSIONS: The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Five types of home-visit nursing agencies in Japan based on characteristics of service delivery: cluster analysis of three nationwide surveys.

BACKGROUND: The number of home-visit nursing agencies in Japan has greatly increased over the past 20 years since the Japanese government first introduced it in 1992 to meet the increased needs of home-bound elderly. Since then, home-visit nursing has come to serve for a variety of populations such as those with terminal-stage cancer, neurological diseases, psychiatric conditions, or children with chronic conditions; currently the number of agencies has reached 6,801 (as of April 2013). Yet little has been known about the details of their characteristics in terms of patient types or differences/similarities across regions. In this study, we developed a method to categorize home-visit nursing agencies throughout Japan based on their actual service delivery, in order to help improve healthcare policies allowing better services by those agencies. METHODS: We performed a cluster analysis on data from two national databases (Survey of Institutions and Establishments for Long-term Care which is annually administered by the Ministry of Health, Labour and Welfare [dataset 1; n = 5,161] and Information Publication System for Long-term Care which is annually reported by home-visit nursing agencies to their respective prefectural governments [dataset 2; n = 4,400, matching rate to data set 1: 84.4%]), in addition to the results from our original nationwide Fax survey of the service delivery system of home-visit nursing agencies (dataset 3; n = 2,049 matching rate to data set 1: 39.3%). RESULTS: The cluster analysis suggested five categories for home-visit nursing agencies based on the type of service delivery system. For deciding of these categories, we held 13 panel discussions with specialists to confirm that the categorization of the home-visit nursing agencies appropriately reflected their actual delivery systems. The five categories were: nurse-centered (560, 10.9%), rehabilitation-centered (211, 4.1%), psychiatric-centered (360, 7.0%), urban-centered (1,784, 34.5%), and rural-centered (2246, 43.5%). CONCLUSIONS: This five categorization system of home-visit nursing agencies could ensure appropriate healthcare policies that will allow agencies to provide better home-visit nursing services based on their patient and staff characteristics and regional needs. The findings would be valuable both in Japan as well as in other countries with rapidly growing aging populations.

Associations between Japanese people's concern about family caregiver burden and preference for end-of-life care location.

Through a cross-sectional nationwide survey, this study identified the associations between Japanese people's choice of end-of-life care location and their sense of being a burden or a source of concern to their family members. A total of 1,042 people responded to the survey (a response rate of 55 percent). Of these, 44 percent said they would prefer to receive end-of-life care at home, 15 percent in hospital, 19 percent in a palliative care unit, 10 percent in a public nursing home, and 2 percent in a private nursing home. Multinomial logistic regression analysis revealed that those who thought it most important to relieve caregiver burden on family members tended to prefer a palliative care unit or a public nursing home to their own homes; those who were most concerned about the effect their death would have on their family members tended to prefer a hospital or a palliative care unit to their own homes. These findings may assist in the development of a more effective end-of-life care system in Japan and in other countries.

[The need for health consultation services and related factors among non-users of health consultation services residing in urban public apartment complexes].

OBJECTIVES: The aim of this study was to identify the factors associated with the need for health consultation services among non-users of such services within residents of urban public apartment complexes. METHODS: In December 2011, a cross-sectional mail survey was conducted with the inclusion of 2,000 elderly residents, randomly selected from a total of 6,000 residents. We asked about the need for health consultation services, demographic data, daily living situation, medical and care-giving experiences, and health concerns and desires. Data were analyzed using ordinal logistic regression analyses. RESULTS: A total of 534 questionnaires were analyzed from the 553 respondents (response rate 27.7%). Respondents expressed need for health consultation services: very important 21.5%; important 38.2%; unknown 19.1%; not so much important 14.0%; unimportant 6.9%. The analyses revealed that people with greater need tended to have the following features compared to those with less need: lack of independence in daily activities (P=.03), experiencing stress in family relationships (P=.003), having nurses to consult about health concerns (P=.04), do not necessarily need doctor's consultation regarding their health problems (P<.001), feel it difficult to consult doctors when they have health-related questions (P=.007), know about locally-available health consultation services (P=.02). They also wanted to use services they can visit accompanied by acquaintances (P=.002), with one-on-one health consultation regarding their problems (P=.003), where service is free (P=.008), where they receive advice about their illnesses (P<.001) and about their medical and caregiving cost (P=.008), and maintain contact with others using the services (P<.001). CONCLUSION: Although the response rate was low, most of residents expressed a need for a health consultation service. Based on the results of this study, a health consultation service provided by nurses may be an effective solution. They also desire the services to be accessible in the company of their acquaintances, provided one-on-one, free of charge, and to provide opportunities not only for consultation concerning their illnesses but also for interaction with others.

Factors related to a sense of security with medical and long-term care services among community-dwelling middle-aged and older adults in Japan.

AIM: The aim of this study was to identify factors related to a sense of security with regard to medical and long-term care services among middle-aged and older adults. These are for consideration of strategies for the establishment of a community-based integrated care system. METHODS: A cross-sectional survey was conducted in 2400 men and women aged ≥40 years in two cities. Survey items included a scale for sense of security for medical and long-term care, experience of medical and long-term care services, and social and demographic factors. Data were analyzed using univariate and multiple regression analyses. RESULTS: In total, 945 respondents were included in the analysis. In multiple regression analysis, sense of security was significantly higher with ability to consult with medical professionals on medical and long-term care, availability of emotional and instrumental support, norm of reciprocity in the community, community attachment, economic comfort, higher age and male gender, and significantly lower with experience of bereavement at a hospital and depression. CONCLUSIONS: These findings stress the importance of facilitating consultation with medical professionals, support for caregivers of terminally ill patients, and mutual support in the community in a community-based integrated care system. Geriatr Gerontol Int 2022; 22: 568-574.

Factors Related to End-of-Life Care Discussions Among Community-Dwelling People in Japan.

CONTEXT: End-of-life discussions regarding healthcare preferences are important to ensure a dignified end of life. OBJECTIVES: This study clarifies the factors associated with such discussions among community-dwelling people in Japan. METHODS: We conducted a cross-sectional survey of 2400 randomly selected community-dwelling adults over the age of 40 in one urban and rural area each, in Japan. The survey investigated whether the respondents had engaged in discussions about their end-of-life care preferences. Logistic regression analyses were conducted to examine the physical, psychological, social, and demographic factors influencing end-of-life care discussions. RESULTS: Of the final sample comprising 1172 respondents, 41.0% had engaged in end-of-life discussions. Of these, 95.2% had engaged in these discussions with family members, 11.0% with friends and acquaintances, and 4.4% with medical or long-term care personnel. Factors associated with end-of-life discussion engagement included requiring outpatient visits, long-term care requirements, availability of emotional support services, experience of the death of a relative within the past five years, living with a spouse, and being unemployed. CONCLUSION: The results showed that roughly 41% of the surveyed community-dwelling respondents had engaged in end-of-life discussions. The findings suggest that providing emotional support to relieve anxiety regarding one's health and the awareness of death, and having the opportunity to interact with others to discuss end-of-life issues, promote the engagement in such discussions in Japan. This study suggests that it is necessary to create an environment that provides social support and engenders awareness of the importance of end-of-life discussions while the community-dwelling people are still healthy.

Measuring well-being in older adults: Identifying an appropriate single-item questionnaire.

AIM: As the older adult population increases globally, it is important for local governments to measure their health and well-being consistently to effectively support this group. Because definitions of subjective well-being - such as happiness, life satisfaction and subjective health - overlap, it is worth considering which single-item indicator local governments can rely on to measure individual well-being. This study, therefore, explored the correlation between three single-item questionnaires on happiness, life satisfaction and subjective health used in government surveys, and established psychometric scales of happiness, life satisfaction and quality of life, and analyzed which of the three single-item indicators most effectively captured the target well-being. METHODS: Randomly selected people aged ≥65 years in urban and rural areas (n = 1440) answered the questions on the Happiness Scale, the Satisfaction with Life Scale and the Quality of Life scale, and the three single-item questionnaires (happiness, life satisfaction and subjective health). We analyzed the data using correlation and multiple regression analyses. RESULTS: The results showed a high positive correlation between the scales and the single-item questionnaires. The single-item life satisfaction and subjective health questionnaires were significantly correlated with all the three scales. Although there was not much difference in the adjusted R2 values between putting three items jointly and separately, the value of single-item life satisfaction was the best and the subjective health was the second best. CONCLUSION: The results showed that the single-item life satisfaction and subjective health effectively captured the target well-being; these could be the appropriate indicators for a potential optimal index. Geriatr Gerontol Int 2021; 21: 1131-1137.

Factors related to preference for participation and degree of commitment in community activities among older adults in Japanese depopulated areas.

To address the rapid increase in the ageing population, Japan implemented the Long-Term Care Insurance System (LTCS) in 2000. Additionally, a community-based integrated community care system was released in 2012. The purpose of these policies was to help older people who need care or support to continue to live their preferred lifestyles in their own communities. According to this paradigm, older residents are themselves considered members of the community caregiving team and expected to participate in volunteer activities to help the neighbourhood. One such activity is social participation including community activities. Many factors influencing social participation have been found in previous literature. However, knowledge of specific factors about community activities is limited, even though these kinds of activities have attracted policy attention. Our study examined factors related to thoughts about community activities among people aged >40 years. We conducted random sampling in two depopulated areas in Japan and used an anonymous mail survey method. Our survey consisted of three parts: social demographics, health and life, and medical/long-term care. A total of 2,466 individuals participated in the study (response rate 52.2%), whose average age was 64.2 (SD = 10.3) and 46.5% (n = 1,146) were female. Items including talking with neighbours frequently (social demographics), higher self-rated health (health and life), the need for health consultations and the desire to take care of family members when they need help (medical/long-term care) were significantly related to both preference for participation and degree of commitment in community activities. To encourage participation in community activities among older citizens, we recommend interventions related to health literacy and family ties.

Monochloramine produces reactive oxygen species in liver by converting xanthine dehydrogenase into xanthine oxidase.

In the present study, we assessed the influence of monochloramine (NH(2)Cl) on the conversion of xanthine dehydrogenase (XD) into xanthine oxidase (XO) in rat liver in vitro. When incubated with the partially purified cytosolic fraction from rat liver, NH(2)Cl (2.5-20 microM) dose-dependently enhanced XO activity concomitant with a decrease in XD activity, implying that NH(2)Cl can convert XD into the reactive oxygen species (ROS) producing form XO. The NH(2)Cl (5 microM)-induced XD/XO interconversion in the rat liver cytosol was completely inhibited when added in combination with an inhibitor of NH(2)Cl methionine (25 microM). A sulfhydryl reducing agent, dithiothreitol at concentrations of 0.1, 1 and 5 mM also dose-dependently reversed the NH(2)Cl (5 microM)-induced XD/XO interconversion. These imply that NH(2)Cl itself acts on the XD/XO interconversion, and that this conversion occurs at the cysteine residues in XD. Furthermore, using the fluorescent probe 2',7'-dichlorodihydrofluorescein diacetate, it was found that NH(2)Cl could increase ROS generation in the cytoplasm of rat primary hepatocyte cultures, and that this increase might be reversed by an XO inhibitor, allopurinol. These results suggest that NH(2)Cl has the potential to convert XD into XO in the liver, which in turn may induce the ROS generation in this region.

Effect of a multidisciplinary end-of-life educational intervention on health and social care professionals: A cluster randomized controlled trial.

BACKGROUND: The aging of populations is rapidly accelerating worldwide. Especially, Japan has maintained the highest rate of population aging worldwide. As countermeasures, the Japanese government prioritized the promotion of local comprehensive care systems and collaboration in medical care and social (long-term) care. Development of a system to connect medical and social services in the community is necessary for the increasing older people, especially for the people in the stage of end of life. OBJECTIVE: This study aimed to assess the effect of a multidisciplinary end-of-life educational intervention program on confidence in inter-professional collaboration and job satisfaction among health and social care professionals. DESIGN: a cluster-randomized controlled trial. SETTING/PARTICIPANTS: Three professional groups (home care nurses, care managers, and heads of care workers) in an urban area participated in this trial. INTERVENTION: We implemented a multidisciplinary end-of-life educational intervention program comprising two educational workshops and an educational booklet to support multidisciplinary care for end-of-life patients during the 7-month study period. MAIN OUTCOME MEASURE: Confidence in improved interactions among professionals and job satisfaction were assessed with the Face-to-Face Cooperative Confidence Questionnaire and the Minnesota Satisfaction Questionnaire at T1 (before intervention) and T2 (7 months after the intervention). RESULTS: In total, 291 professionals participated in this study (experimental group n = 156; control group n = 135). Multivariate regression analyses showed significant between-group increases on all of seven subscales in participants' face-to-face cooperative confidence over the study period; no effect was evident regarding job satisfaction. CONCLUSIONS: A multidisciplinary end-of-life educational intervention program increased confidence in multidisciplinary collaboration among health and social care professionals. TRIAL NUMBER: UMIN Clinical Trial Registry, Japan UMIN000022772.

S-1 plus cisplatin combination therapy for the patients with primary liver carcinomas.

BACKGROUND/AIMS: 5-FU plus Cisplatin combination therapy had been employed against primary liver carcinomas for years. S-1 is a fourth-generation oral fluoropyrimidine and attracts considerable interest for the activity against gastric cancer. We herein examined the effect and adverse effects of S-1 plus Cisplatin combination therapy for primary liver carcinomas. METHODOLOGY: 4 patients with hepatocellular carcinoma (HCC) and 3 with cholangiocellular carcinoma (CCC) were employed for this study. They all had far-advanced diseases in and/or out of the liver at the time of the therapy initiation. They were 4 men and 3 women. Their ages were in the range of 42-73 (58 +/- 9.73, mean +/- SD) years old. The protocol of the therapy is a 3-week period of S-1 (70-80 mg/m2/day) oral administration combined with 2 intravenous administration of CDDP (20-35 mg/m2) during the period. With two weeks of intermission, the therapy was repeatedly performed 2-11 times for each patient. RESULTS: Three patients had PR and 2 had NC response with the therapy. Two patients with HCC and pre-treatment with 5-FU had PD response. Although the patients developed leukopenia and thrombocytopenia, the therapy was well tolerable also in the outpatient basis. CONCLUSIONS: S-1 plus Cisplatin combination therapy is a potential therapy for advanced primary liver carcinomas.

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

AIM: To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. METHODS: A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. RESULTS: Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. CONCLUSIONS: It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950.

Transarterial chemoembolization with degradable starch microspheres, irinotecan, and mitomycin-C in patients with liver metastases.

Degradable starch microspheres (DSMs) provide transient occlusion of small arteries and are thought to improve the therapeutic effect of anticancer drugs. Irinotecan (CPT-11) is one of the most effective anticancer agents. We herein report cases with liver metastases treated with transarterial chemoembolization with DSM, CPT-11, and mitomycin-C (DSM-CPT therapy). Five patients underwent DSM-CPT therapy for liver metastases that originated from colorectal cancer for four and gastric cancer for one. They all lack indication for surgery. They were all male with an age range of 42-78 years (mean, 55.2 years). Three of them had pretreatment histories with 5-fluorouracil or related agents, and four of them had combined systemic or local chemotherapy at the period. Required doses for stasis of whole blood flow of hepatic artery of DSMs were used with CPT-11 and mitomycin-C. After one to six injections, four patients had a partial response and the disease progressed in one patient with gastric cancer origin. Two of the partial response patients underwent surgery after 2 months of the partial response period. Carcinoembryonic antigen and CA19-9 levels in partial response patients decreased to 16.1% and 19.3% of the level before treatment, respectively. DSM-CPT therapy can be a potential therapy for liver metastases.