Evaluating a conceptual framework for quality assessment of medical interpretation.

OBJECTIVE: We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. METHODS: A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. RESULTS: Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. CONCLUSION: A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. PRACTICE IMPLICATIONS: Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.

[Possible relationship between prescription medications and urinary dysfunction in elderly home health care patients].

AIM: Although urinary incontinence (UI) in the elderly appears to be related to polypharmacy, it is unclear whether multiple medications elevate UI quantitatively or qualitatively. There have been few studies on the association of polypharmacy with each type of UI. The present survey aimed to clarify these issues. METHOD: The subjects were elderly home health care patients ≥65 years of age taking ≥5 prescription medications and not being treated with anti-cancer agent. The visiting nurses filled out a questionnaire based on their nursing and medication records. Types of UI were evaluated according to a UI checklist. RESULTS: A total of 167 subjects (97 women, 70 men, mean age of 83.8 years) were eligible for the data analysis. Subjects talking 5-9 prescription medications accounted for 59.3%, while those talking≥10 counted for 40.7%. Men talking ≥10 medications showed a slight but non-significant increased risk of UI. In women, α-adrenergic antagonists and benzodiazepines significantly increased the risk of stress UI and urge UI, respectively. Furthermore, α-adrenergic antagonists reduced the risk of functional UI, whereas acetylcholinesterase inhibitors elevated it. α-adrenergic antagonists in combination with benzodiazepines also significantly increased the risk of stress UI and urge UI, while α-adrenergic antagonists with acetylcholinesterase inhibitors increased the risk of stress UI. In men, there were no prescription medications that were particularly related to UI. CONCLUSIONS: The present results suggest that there are gender differences in prescription medications-induced UI. It is likely that the causing medications are different depending on the type of UI, and the combination of them significantly increase the risk of UI.

Changes in perceived filial obligation norms among coresident family caregivers in Japan.

PURPOSE OF THE STUDY: Japan introduced a nationwide long-term care insurance (LTCI) system in 2000, making long-term care (LTC) a right for older adults regardless of income and family availability. To shed light on its implications for family caregiving, we investigated perceived filial obligation norms among coresident primary family caregivers before and after the policy change. DESIGN AND METHODS: Descriptive and multiple regression analyses were conducted to examine changes in perceived filial obligation norms and its subdimensions (financial, physical, and emotional support), using 2-wave panel survey data of coresident primary family caregivers (N = 611) in 1 city. The baseline survey was conducted in 1999, and a follow-up survey 2 years later. RESULTS: On average, perceived filial obligation norms declined (p < .05). Daughters-in-law had the most significant declines (global and physical: p < .01, emotional: p < .05) among family caregivers. In particular, physical support, which Japan's LTC reform targeted, declined significantly among daughters and daughters-in-law (p < .01). Multiple regression analysis indicated that daughters-in-law had significantly lower perceived filial obligation norms after the policy introduction than sons and daughters (p < .01 and p < .05, respectively), controlling for the baseline filial obligation and situational factors. IMPLICATIONS: Our research indicates declining roles of daughters-in-law in elder care during Japan's LTCI system implementation period. Further international efforts are needed to design and implement longitudinal studies that help promote understanding of the interplay among national LTC policies, social changes, and caregiving norms and behaviors.

Evaluation of weight loss in the community-dwelling elderly with dementia as assessed by eating behavior and mental status.

Involuntary weight loss is a symptom of protein energy malnutrition often reported among elderly people, especially those with dementia. In this study, we examined whether dementia-related eating difficulties increase the probability of weight loss in the elderly. This cross-sectional observation study was conducted in 60 community-dwelling elderly people with dementia (84.1±6.7 yr of age). Over 6 months, 26.7% of the subjects lost at least 5% of body weight. Impaired mental status and eating difficulties were closely associated with weight loss as determined by Spearman's rank correlation coefficient. Assessment of eating difficulties combined with mental states in the subjects by discriminant analysis enabled us to differentiate subjects with >=5% weight loss from those with less than 5% weight loss at a probability of 76.4%. This result suggests that eating difficulties and impaired mental status among elderly people with dementia are closely associated with weight loss.

Sleep-related problems and use of hypnotics in inpatients of acute hospital wards.

OBJECTIVE: Although sleep disorders are highly prevalent among patients with physical disorders, only limited information is available about the actual status of sleep-related problems in inpatients of acute hospital wards. We conducted a multicenter cross-sectional observational survey investigating the prevalence of sleep disorders and use of hypnotic-sedative drugs among inpatients of acute wards in 44 general hospitals in Japan. METHOD: Questionnaire-, actigraph- and observation-based sleep evaluations were simultaneously performed in 557 adult inpatients [mean age 72.8 + or - 12.8 (S.D.) years] of acute wards during a one-month period in July 2007. RESULTS: Of the 421 patients with data available, 22.3% had at least one of the following sleep disorders: sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder and nocturnal behavior disorder. Similarly, 62.7% had insomnia, 6.9% had severe daytime sleepiness and 12.8% had other sleep-related symptoms. Only 13.8% were free of any sleep-related problem. Although 33.7% of insomnia patients were taking hypnotic-sedative drugs, 65.2% of them complained of residual insomnia symptoms. CONCLUSION: The findings obtained in this study have revealed the remarkably high prevalence of sleep-related problems experienced by inpatients of acute hospital wards in Japan. Proper diagnosis of sleep disorders should be made among patients with physical disorders.

[Research related to the status of "collaboration" among municipal public health nurses in Japan].

PURPOSE: The two main goals of this research were: (1) To clarify the current state of collaboration among municipal public health nurses throughout Japan (referred to collectively as "Public Health Nurses"); and (2) To identify personal factors that separate Public Health Nurses who collaborate frequently from those who do not, and to clarify the characteristics of relevant interventions. The author believes that the results of this study should be valuable in demonstrating specific methodologies related to the ability of Public Health Nurses the ability to execute collaborative activities. OBJECTIVE: Before conducting the main survey, a preliminary survey was performed to determine the affiliate divisions for Public Health Nurses employed by all of the 3,190 municipalities in Japan. Based on this survey, we gained an understanding of factors such as the number of Public Health Nurses and their places of employment. Next, during December 2003 to August 2004, we carried out a questionnaire survey by post to the 21,631 Public Health Nurses in Japan who had been identified through the preliminary survey. METHODS: Survey items included: the Public Health Nurse's gender, age, position, most recent academic history, total years of work, number of years working with the current employer, affiliated division, types of tasks undertaken, status of execution of those tasks, and collaborative activities, as well as specialists institutions and organizations involved in such collaboration. RESULTS: Data were gathered from 13,024 Public Health Nurses, which represents roughly 80% of the Public Health Nurses in Japan. First, regarding collaboration, links with health and medical institutions, health centers, and other government institutions appeared active, but this was not the case for social welfare facilities for the physically or mentally disabled. Furthermore, although the subjects collaborated with Public Health Nurses from other institutions, as well as with government administrators and doctors, there was little collaboration with pharmacists or with mental health and welfare workers. When we analyzed data for individual specialists and specialized institutions, we found that the "collaborating" group had significantly higher scores for collaborative activities than the "not collaborating" group. These scores are believed to reflect actual conditions. When we analyzed the relationships between personal factors for Public Health Nurses and collaborative activity scores, we found that scores tended to be higher for older nurses and for those with more years of experience. Looking at the relationship between details of tasks undertaken and collaborative activity scores we found that the group developing new business or securing budgets to develop new business had significantly higher scores, and that in terms of the execution of day-to-day operations, the Public Health Nurses with higher scores were those undertaking tasks that required new knowledge, or tasks that demanded high-level skills. CONCLUSIONS: Municipal Public Health Nurses often collaborate with specialists or health-related divisions, but they do not collaborate closely with divisions related to welfare services for the physically or mentally disabled. The Public Health Nurses with the highest collaborative activity scores were those scores clearly indicated active collaboration, and whose personal factors included extensive experience in the field. These Public Health Nurses were also involved in tasks that demanded a high level of skill.

Prediction of care class by local additive reference to prototypical examples.

The public long-term care insurance program for the elderly in Japan set out in 2000 toward establishing a new system whereby citizens can be assured that they will receive care and be supported by the society as a whole. The insurance program includes computer-aided certification processes to estimate the needs for nursing care for clients. In this work, we show the applicability of an adaptive local nonlinear approximation method associated with the Japanese national database for automatic inference of the care class.