Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis.

BACKGROUND: A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. METHODS: We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. RESULTS: We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60-80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5-4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. CONCLUSIONS: Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.

[The research purposes and design of clinical database].

We discussed clarification of research purposes and designing of data collection form in large clinical databases. Research purposes are 1)assessment of healthcare quality, 2)evaluation of diagnosis and treatment, and 3)evaluation of health policy. In designing clinical databases, the researchers should consider the following themes;assurance of clinical utility, international collaboration, alleviation of data entry burden and assurance of scientific accuracy.

[The aim and features of clinical database].

Clinical database is a project aiming at quality improvement in medicine. It combines systematic collection of clinical data, analysis and feedback to medical practitioners. Medical professionals can clarify their challenges and deal with quality improvement based on feedback. Large and comprehensive clinical databases have been founded in many countries recently. The databases can be used for various purposes; quality indicator, support tool for medical decision-making, policy decision-making and evaluation, clinical research and public reporting. Administrators must pay attention to scientific, ethical and political perspectives. In this manuscript, the authors discussed definitions and issues of large clinical databases.

[Utilization of clinical database for quality improvement in health care].

Measurement and feedback of clinical performance is one of the important activities in clinical database. In addition, clinical database is used for developing medical guidelines, research for public policy and clinical research, and also various kinds of information can be provided to the public. On the other hand, risk adjustment for data analysis is a key issue in the clinical database. From these viewpoints, this article described the activities for quality improvement, examples of research, and planning of clinical research using the clinical database.

[Total quality management of clinical database].

Data entry system should be constructed considering utility, accuracy, propriety, and feasibility. The methods for developing useful and accurate clinical databases are 1)system development based on the concept of "error proofing", 2)system test by real users, 3)guidances for participants, and 4)incentive for accurate data entry. In terms of propriety, to gain patient's consent on data collection and to publicly announce objectives and methods of clinical database are necessary. Confidentiality and anonymization of data are also important. Balancing efficacy and propriety for maximization of patients' and societal benefit is one of the important responsibilities of database management organizations. In addition, assessment of data quality such as audit and feedback is useful for enhancing accuracy and reliability of clinical databases.

[Quality management and participation into clinical database].

Quality management is necessary for establishing useful clinical database in cooperation with healthcare professionals and facilities. The ways of management are 1) progress management of data entry, 2) liaison with database participants (healthcare professionals), and 3) modification of data collection form. In addition, healthcare facilities are supposed to consider ethical issues and information security for joining clinical databases. Database participants should check ethical review boards and consultation service for patients.

[Work flow of registry in participating facilities and data audit in clinical database].

Clinical database needs quality control and quality assurance of data. Medical staffs of facilities in clinical database need to confirm definitions of data submitted to clinical database and criteria of registered cases, and decide how to entry data before data entry. Especially good communication between surgeons and data managers becomes an important factor of data quality in facilities. Also, we need quality improvement initiatives based on high quality data. Clinical database has to assurance data quality. The indicators of data quality are, for examples, completeness of registration and accuracy of data entry and data quality is evaluated on data verification between data of clinical database and medical records in facilities. From these viewpoints, this article described about work flow of registry for participating facilities and medical staffs.

Public Awareness of Medical Research Terminology in Japan, and the Accuracy of Physicians' Predictions regarding that Awareness.

One of the ethical principles of medical research involving human subjects is obtaining proper informed consent (IC). However, if the participants' actual awareness of medical research terminology is lower than the researchers' prediction of that awareness, it may cause difficulty obtaining proper IC. Therefore, this study aims to clarify the presence of "perception gaps" and then discuss IC-related issues and measures based on the insights obtained. We conducted two online surveys: a "public survey" to understand the Japanese public's awareness of 11 medical research terms and a "physicians' survey" to investigate physicians' predictions regarding public awareness. In the "public survey," for each term, respondents were instructed to select their situation from "understand," "have heard," or "have never heard." In the "physicians' survey," respondents were asked to estimate the proportions of the general public who would "have understood," "have heard," or "have never heard" by using an 11-step scale. We analyzed separately in two age groups to understand the age-related difference. We received 1002 valid responses for the "public survey" and 275 for the "physicians' survey." Of the public respondents, more than 80% had never heard of terms such as interventional study, prospective clinical study, cohort study, Phase I clinical trial, or double-blind study. Concurrently, physicians overestimated general public awareness of the terms placebo, cohort study, double-blind study, and randomized clinical trial (in the group of people under 60). The results revealed the perception gap between the general public and physicians which raise serious concerns about obtaining proper IC from clinical research participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s41649-023-00247-4.

Citation Network Analysis of Nurse Staffing Research from the Past Two Decades: 2000-2022.

Studies have indicated that higher numbers of nurses regarding staffing ensure patient safety and a better practice environment. Using citation analysis, this study visualizes the landscape of nurse staffing research over the last two decades to show the overall publication trends, major contributors, and main research topics. We extracted bibliometric information from PubMed from January 2000 to September 2022. After clustering the network, we analyzed each cluster's characteristics by keyword. A total of 2167 papers were considered for analysis, and 14 clusters were created. The analysis showed that the number of papers published per year has been increasing. Researchers from the US, the UK, Canada, Australia, and Belgium have led this field. As the main clusters in nurse staffing research during the past two decades, the following five research settings were identified: nurse outcome and patient outcome research in acute care hospitals, nurse staffing mandate evaluation research, nursing home research, and school nurse research. The first three clusters accounted for more than 80% of the total number of published papers, and this ratio has not changed in the past 20 years. To further develop nurse staffing research globally, evidence from other geographic areas, such as African and Asian countries, and from long-term care or community settings is necessary.

Evidence of the Association between Nurse Staffing Levels and Patient and Nurses' Outcomes in Acute Care Hospitals across Japan: A Scoping Review.

We aimed to summarize the evidence of an association between nurse staffing and nursing sensitivity outcomes in Japanese hospitals. A scoping review was conducted and reported following the PRISMA-SR 2020 statement. The ICHUSHI and CiNii databases were searched for published articles written in Japanese and PubMed and CINAHL for those written in English. Out of the 15 included studies, all observational studies, 3 were written in Japanese and the others in English. The nurse staffing level measures were grouped into three categories: patient-to-nurse ratio, nursing hours per patient day, and nurse-to-bed ratio. The outcome measures were grouped into three categories: patient outcome, nursing care quality reported by nurses, and nurse outcome/nursing care quality. Some studies reported that the nursing staff increasingly favored positive patient outcome. Conversely, the findings regarding failure to rescue, in-hospital fracture, and post-operative complications were inconsistent. Although some studies indicated that more nurse staffing was favored toward better patient and nurse outcomes, due to the sparse accumulation of studies and heterogeneity among the findings, it is difficult to draw robust conclusions between nurse staffing level and outcomes in Japanese acute care hospitals.

How Japanese parents of deaf children arrive at decisions regarding pediatric cochlear implantation surgery: a qualitative study.

In recent years, many children with severe or profound congenital hearing loss have undergone treatment to receive cochlear implants; however, the efficacy and risks associated with pediatric cochlear implants are still unknown. Some deaf adults are opposed to parents making the decision regarding cochlear implants for their children. To elucidate the benefits and risks perceived by parents and to investigate parents' decision-making processes, we interviewed 26 parents of deaf children (aged 12 years or younger) who live in the wider Tokyo area, Japan. The results showed that the participants perceived auditory and speech improvements as benefits. On the other hand, participants pointed out various risks associated with cochlear implantation such as medical complications, restrictions on daily activities, cost of cochlear implant upgrades, low effectiveness, and the negative psychosocial impact associated with the implants. Participants who emphasized the benefits of the surgery tended to approve of cochlear implants. Participants who emphasized the risks of the surgery tended to disapprove. All participants, however, were reluctant to make the decision to undergo cochlear implants on behalf of their children due to the uncertain benefits and risks. Participants who believed that early implantation during infancy would be associated with better outcomes regarded their surrogate decision-making as necessary and approved the treatment. This decision, however, was made with certain stipulations; for example, these parents resolved to discuss the decision with their children as they got older, and would give their children the option of having the implant removed. Those who did not believe claims about the effectiveness of early implantation postponed decision-making. These results suggest that guardians face difficulty in decision-making and need information and support from various professionals, deaf adults, parents of children with implants, and children with implants themselves.

Evaluation of universal newborn hearing screening in Japan: an analysis of the literature.

INTRODUCTION: To address delayed language development associated with severe-to-profound congenital hearing loss (CHL), universal newborn hearing screening (UNHS) has been implemented in many countries. In Japan, approximately 27,000 neonates (2.5% of newborn) are screened annually through public-funded programs. While foreign literature highlights the need for assessment, in Japan this has hitherto not been evaluated in detail. OBJECTIVE: To investigate the efficacy of UNHS in Japan. METHODS: We used two criteria to evaluate UNHS; accuracy of screening and the effectiveness of early detection, and searched the major medical and social research journal data bases for related research papers. Eleven articles were identified providing information on accuracy of screening tests and two on effectiveness of early detection. RESULTS: 1) In two prefecture-based studies, 900 and 1,272 newborns were screened to find one case of bilateral CHL. In nine hospital-based programs, the number tested ranged from 313 to 1,910. None of the studies measured the sensitivity and specificity against a best practice standard. 2) The two studies suggested that early intervention might be beneficial, but neither provided conclusive evidence. CONCLUSION: The effectiveness of UNHS in Japan is still equivocal because of the difficulties associated with differential diagnosis of hearing loss and normal hearing at the early stage of life and the lack of evidence on effectiveness of early intervention. Before nationwide implementation of UNHS, these issues should be fully investigated and evaluated.

Difficulties in receiving a medical consultation among Japanese workers with mental health problems.

OBJECTIVES: The aim of this study was to elucidate the factors affecting the difficulties in receiving a medical consultation among workers with mental health problems. METHODS: The present study was performed using a cross-sectional survey. We requested occupational physicians and nurses who were members of the Japan Society for Occupational Health to distribute self-administered questionnaires to their clients. RESULTS: Ninety-nine workers (68 males and 30 females), aged 40.6 ± 9.1 yr, returned completed questionnaires; 65% of the respondents had been diagnosed with depression. The most common difficulty perceived by them was that there were no intra-office counselors. Multiple regression analysis revealed that the number of months between the onset of mental health problems and the first medical consultation was significantly associated with age and having no sick leave allowance. CONCLUSIONS: The implementation and enhancement of sick leave allowance may promote early intervention in regard to workplace mental health problems. Mental health education and regular checkups for older workers is also critical for early detection and intervention of mental health problems.

[Reconstituting evaluation methods based on both qualitative and quantitative paradigms].

Debate about the relationship between quantitative and qualitative paradigms is often muddled and confusing and the clutter of terms and arguments has resulted in the concepts becoming obscure and unrecognizable. In this study we conducted content analysis regarding evaluation methods of qualitative healthcare research. We extracted descriptions on four types of evaluation paradigm (validity/credibility, reliability/credibility, objectivity/confirmability, and generalizability/transferability), and classified them into subcategories. In quantitative research, there has been many evaluation methods based on qualitative paradigms, and vice versa. Thus, it might not be useful to consider evaluation methods of qualitative paradigm are isolated from those of quantitative methods. Choosing practical evaluation methods based on the situation and prior conditions of each study is an important approach for researchers.