Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Med Teach ; : 1-10, 2019 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-31595791

RESUMEN

Introduction: We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community. Methods: Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students' reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Results: Influential contexts were medical students' experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients' and/or their family's life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals. Conclusion: Faculties should develop IPE programs in clinical practice based on the 'mechanism', 'context', 'outcome' pattern and 'context-mechanism-outcome' configuration in primary care settings.

2.
J Gen Fam Med ; 20(3): 82-92, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31065472

RESUMEN

Background: Advance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians. Methods: This cross-sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self-completed questionnaire inquiring about the objective variable "I want to discuss AD with my doctor," as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis. Results: A total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05-4.10), physicians who are very good at taking care of patients' disease (OR, 12.68; 95% CI, 1.12-143.22), and patients' worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30-5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26-0.98) as a barrier. Conclusions: Our study indicates that patients' future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.

3.
PLoS One ; 14(1): e0210912, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30653563

RESUMEN

Interprofessional education (IPE) for medical students is becoming increasingly important, as reflected in the increasing number of medical schools adopting IPE. However, the current status of and barriers to pre-registration IPE implementation in Japanese medical schools remain unknown. The purpose of this study was to clarify the status and barriers of IPE implementation in medical schools in Japan. We conducted a curriculum survey from September to December 2016 of all 81 medical schools in Japan. We mailed the questionnaire and asked the schools' undergraduate education staff to respond. The survey items were the IPE implementation status and barriers to program implementation. Sixty-four of the 81 schools responded (response rate 79.0%), of which 46 (71.9%) had implemented IPE, 42 (89.1%) as compulsory programs. Half of IPE programs were implemented in the first 2 years, while less than 10% were implemented in the latter years of medical programs. As part of the IPE programs, medical students collaborated with a wide range of professional student groups. The most common learning strategy was lectures. However, one-third of IPE programs used didactic lectures without interaction between multi-professional students. The most common perceived major barrier to implementing IPE was adjustment of the academic calendar and schedule (82.8%), followed by insufficient staff numbers (73.4%). Our findings indicate that IPE is being promoted in undergraduate education at medical schools in Japan. IPE programs differed according to the circumstances of each school. Barriers to IPE may be resolved by improving learning methods, introducing group discussions between multi-professional students in lectures or introducing IPE programs using team-based learning. In summary, we demonstrated the current status and barriers of IPE implementation in Japanese medical schools. Our findings will likely lead to the promotion of IPE programs in Japan.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Relaciones Interprofesionales , Facultades de Medicina , Curriculum , Humanos , Japón , Encuestas y Cuestionarios
4.
J Interprof Care ; 32(4): 436-443, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29381091

RESUMEN

Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains,, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1-3. Finally, our competency framework included two core domains of "Patient-/client-/family-/community-centered" and "Interprofessional communication", and four peripheral domains of "Role contribution", "Facilitation of relationships", "Reflection" and "Understanding of others". We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of "high-context" and "relationalism" in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.


Asunto(s)
Conducta Cooperativa , Relaciones Interprofesionales , Competencia Profesional/normas , Comunicación , Competencia Cultural , Humanos , Relaciones Interpersonales , Japón , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración , Solución de Problemas , Rol Profesional
5.
J Interprof Care ; 32(3): 321-328, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29161176

RESUMEN

Effective interaction in interprofessional collaboration requires skills in interprofessional facilitation. The need for interprofessional learning and practice in Japan is highlighted by Japan's status as one of the most rapidly aging societies because good care for elderly people with complex needs requires effective collaboration between different professional groups. The development of interprofessional facilitation skills (including management of the additional complexities) among learners or professionals enhances interprofessional learning and consensus building and empowers them to make appropriate commitments when faced with difficult challenges. The 18-item interprofessional facilitation scale (IPFS) can be used to enhance interprofessional facilitation skills. Here, we aimed to develop a Japanese adapted version of the IPFS and to validate it for use with Japanese healthcare professionals. Consistent with guidelines for cross-cultural adaptation, three translators translated the original IPFS from English into Japanese, and an expert and all authors confirmed its face and content validity. The translated items were amended during backtranslation and expert reviews. Exploratory factor analysis was performed with 167 healthcare professionals to explore the underlying structure of the items. This analysis revealed two factors with good internal consistency (Cronbach's alpha > 0.8), which were labelled as: (1) encouraging interprofessional interaction and (2) respect for each professional. The original factor 'Encouraging interprofessional interaction' was divided into two factors in the study. One reason for this division might be related to the behaviour of Japanese health professionals, that is, most Japanese might understand that 'facilitation' encourages relationships as contextual belonging that are distinct from relationships based on respect for others. This mindset is likely based on the notion of 'relationalism', which is fundamental in Japanese culture. Further investigation of this Japanese version of the IPFS will strengthen factor construction and improve scrutiny of the relationships between factors.


Asunto(s)
Cultura , Empleos en Salud/educación , Relaciones Interprofesionales , Encuestas y Cuestionarios/normas , Traducción , Actitud del Personal de Salud , Conducta Cooperativa , Competencia Cultural , Análisis Factorial , Humanos , Japón , Aprendizaje , Psicometría , Reproducibilidad de los Resultados
6.
Geriatr Gerontol Int ; 18(4): 615-622, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29278290

RESUMEN

AIM: We investigated factors that predict the prognosis of activities of daily living (ADL) in elderly patients who had undergone rehabilitation during hospitalization for acute infectious disease. METHODS: The present prospective cohort study included 131 patients who were hospitalized due to acute infectious disease and who had undergone rehabilitation during hospitalization. Patient characteristics collected from medical records included age, sex and comorbidity score. The level of ADL 2 weeks before admission was assessed by interview at the start of rehabilitation. Grip strength testing, Short Physical Performance Battery as an assessment of lower limb function and the Mini-Mental State Examination as an assessment of cognitive status were carried out at the time of hospital discharge. The level of ADL at 6 months after discharge was assessed by telephone interview. Multivariate logistic regression analysis was used to identify factors that independently predict ADL dependence (defined as being dependent in one or more ADL items at 6 months after discharge). RESULTS: The average age of participants was 81.5 years, and 52.7% were women. A total of 22.1% of patients showed dependence in an ADL at 6-month follow-up. Factors that predicted an ADL dependence were comorbidity score (OR 4.19, 95% CI 1.19-14.69) and lower limb function (OR 0.51, 95% CI 0.36-0.72) at discharge. CONCLUSIONS: The present findings have implications for the healthcare planning and well-being of elderly patients during hospitalization and after discharge. Geriatr Gerontol Int 2018; 18: 615-622.


Asunto(s)
Actividades Cotidianas , Enfermedades Transmisibles/terapia , Hospitalización , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Japón , Masculino , Pronóstico , Estudios Prospectivos
7.
J Gen Fam Med ; 18(6): 403-408, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29264072

RESUMEN

Background: The progress in aging and the shortage of physicians is a significant problem in Japan. Hence, healthcare professionals including pharmacists should cooperate to provide medical services with limited resources. However, pharmacists might have inadequate skills in taking medical histories. Therefore, we developed an interview tool to collect accurate medical history. In this study, we aimed to validate the contents of medical histories taken by a pharmacist using the interview tool and investigate physician consultation length. Methods: Setting intervention days alternately, adult outpatients of the Kitaibaraki Center for Family Medicine who had new symptoms had their medical histories taken by one of two pharmacists before their physician visit during the study period. The contents of the medical history taken by a pharmacist using text analysis were validated on other four days. All sentences collected by a pharmacist or five physicians were divided into segments, and six other physicians assessed each segment. Differences in length of the physician consultation between those with and without (intervention and control groups, respectively) medical history taken by a pharmacist were investigated. Results: Of 23 patients' medical histories taken by a pharmacist using the interview tool, 84.4% of segments were related to the clinical diagnosis. The mean consultation length was 10.1±8.4 minutes in the intervention group (n=104) and 13.0±10.4 minutes in the control group (n=96) (p=0.048). Conclusions: Medical histories taken by a pharmacist using the interview tool had high content validity and might reduce physician consultation length.

8.
BMJ Open Qual ; 6(2): e000106, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29435505

RESUMEN

Transferring non-specialised tasks from registered nurses to nursing assistants may help registered nurses focus on specialised tasks. Optimising the workflow of nursing assistants by making their tasks more efficient may improve problems associated with the shortage of registered nurses. The nursing assistants at our hospital were stressed about referring inpatients to outpatient specialty clinics. Therefore, we initiated a project to optimise the referral process and reduce the time spent by nursing assistants on this task, with the collaboration of physicians, registered nurses and administrative assistants. The Training for Effective & Efficient Action in Medical Service-Better Process (TEAMS-BP) method, which was developed by modifying the Japanese Training Within Industry-Job Method, was used for the optimisation process. TEAMS-BP teaches users how to break each task down into its individual components, to scrutinise the details, and then to develop new processes by eliminating, combining, rearranging and simplifying tasks. At baseline, each referral took 10 min and was performed 39 times over 10 days in six wards. The first TEAMS-BP cycle did not yield satisfactory results for the nursing assistants. In the second TEAMS-BP cycle, participants included inpatient and outpatient physicians, registered nurses and administrative assistants. As a result, we changed the referral process from paper to electronic records and streamlined referrals that were ordered by inpatient physicians to outpatient physicians. The use of this method saved the equivalent of 175 hours of nursing assistants' time per year at no additional cost. If we had been able to define the referral process as an interdisciplinary task and show the merits to each department from the beginning, we may have been able to form the interprofessional team in the first TEAMS-BP. Improving the efficiency of nursing assistants can allow other professionals to focus on their specialised tasks more effectively.

9.
J Interprof Care ; 31(1): 85-90, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27996353

RESUMEN

Interprofessional education (IPE) for healthcare professionals is important in Japan because of its rapidly aging population and increasingly complex healthcare needs. However, no tools have been validated in the Japanese context to evaluate healthcare professionals' attitudes towards, or readiness for, IPE. The professional version of the Readiness for Interprofessional Learning Scale (RIPLS) with 23 items was selected for cross-cultural adaptation because it has been widely used internationally and a Japanese edition of the student version has already been developed. We followed a guideline for cross-cultural adaptation and subsequently conducted factor analysis with 368 responses from over 16 professions. Face and content validity was confirmed through the translation process. We obtained four factors with good internal consistency (Cronbach's alpha > 0.7). These results were similar to those of the original UK study, apart from one factor being divided into two different factors in this study. Studies are required to further confirm the rigor and generalisability of the results; however, the Japanese RIPLS can be used to evaluate healthcare professionals' attitudes towards IPE, which can eventually lead to a better IPE development for healthcare professionals in Japan.


Asunto(s)
Actitud del Personal de Salud , Competencia Cultural , Relaciones Interprofesionales , Estudiantes del Área de la Salud/psicología , Encuestas y Cuestionarios/normas , Humanos , Japón , Psicometría , Reproducibilidad de los Resultados
10.
J Interprof Care ; 30(5): 675-7, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27351518

RESUMEN

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.


Asunto(s)
Conducta Cooperativa , Comunicación Interdisciplinaria , Competencia Profesional , Desarrollo de Programa , Prestación de Atención de Salud , Humanos , Japón , Ciencias Sociales
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA