Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey.

BACKGROUND: The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS: This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS: Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS: Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

Association of polydoctoring and mortality among very old persons with multimorbidity: a prospective cohort study in Japan.

BACKGROUND: Polydoctoring is a crucial aspect of care fragmentation among patients with multimorbidity, but its impact on health outcomes remains unclear. AIM: To determine the effects of polydoctoring, as measured by the Regularly Visited Facility (RVF) indicator, on patient outcomes among older individuals with multimorbidity. DESIGN & SETTING: Data from the ongoing prospective cohort study, Kawasaki Aging and Wellbeing Project (KAWP), was utilized in this study. Among the 1,026 KAWP participants aged 85-89 years, those with two or more chronic conditions were enrolled in this study. METHOD: Care fragmentation or polydoctoring, was evaluated using the RVF, a new indicator that measures the number of medical facilities consistently involved in a patient's care. Based on RVF, mortality was analysed using the Cox-hazards model, with adjustments for age, sex, frailty, and number of comorbidities. RESULTS: A significant reduction in mortality rates was observed in participants with an RVF of ≥3 and 2-4 comorbidities (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.18-0.99). However, no significant difference in mortality based on RVF was observed for those with ≥5 comorbidities. Notably, individuals with ≥5 comorbidities and an RVF of 0 had a significantly higher HR for death (HR 2.68, 95% CI 1.05-6.84). CONCLUSIONS: In older patients with multimorbidity, polydoctoring reduces mortality in patients with ≤4 coexisting conditions, but it does not significantly impact mortality in those with ≥5 conditions. These findings provide insights for healthcare decision-making in managing older patients with multimorbidity.

Exploring factors associated with healthcare professionals' subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels.

OBJECTIVE: The aim of this study was to explore factors associated with healthcare professionals' subjective perceptions of complex issues in primary care settings in Japan. DESIGN: Cross-sectional survey conducted through a self-administered web-based questionnaire. SETTING: Japan, from June to October 2020. PARTICIPANTS: Healthcare professionals recruited via an email list from the Japan Primary Care Association. MEASURES: The questionnaire assessed subjective perception of satisfaction, confidence and burden regarding complex issues using a 100 mm Visual Analogue Scale (VAS). Explanatory variables included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), basic demographic information, administrative experience and an organisational climate scale. This scale comprised the 'Plan, Do, See' (PDS) factor for management and the 'Do' factor in a leader-centred direction for those working under compulsion. Factors associated with subjective perceptions were analysed using binomial logistic regression analysis and Bonferroni analysis (p<0.017). RESULTS: Data from 593 participants (average age of 41.2 years, including 133 nurses, 128 physicians and 120 social workers) were analysed. Median (quartile) VAS scores for satisfaction, confidence and burden were 50 (36-70), 52 (40-70) and 50 (30-66), respectively. Higher satisfaction group was significantly associated with PDS factor, Do factor and JASSIC Score. Greater confidence group associated with older age, male, Do factor, administrative experience and JASSIC Score. No factors were significantly associated with the higher perceived burden. CONCLUSION: These findings reveal that interprofessional competency self-assessment influence perceptions of complex issues among healthcare professionals. Moreover, satisfaction with complex issues might be enhanced by a manageable organisational climate, while confidence might be influenced by personal attributes.

Copper Deficiency: An Overlooked Diagnosis.

Copper deficiency may often be overlooked due to physicians' poor awareness of the disease. Delayed diagnosis and therapy may lead to poor prognosis of neurological function. Here, we present a 68-year-old male with an approximately one-year history of unsteady feet who had visited several clinical departments and was finally diagnosed with copper deficiency. In the present case, it took approximately one year to diagnose the condition, and the therapy of copper supplementation led to only slight improvement in subjective symptoms. Physicians should be more aware of this condition for a good prognosis of the disease.

Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.

Background: Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods: Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results: The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions: RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.

Association Between Varicella-Zoster Virus Vaccination and Patient Experience in Elderly Japanese Outpatients: A Case-Control Study.

BACKGROUND: This study examined the association between patient experience (PX, events experienced by patients during primary care that are an indicator of patient-centered quality) of primary care and varicella-zoster virus (VZV) vaccine uptake in older adults. METHODS: A case-control study of VZV vaccination was conducted at a community hospital in Ibaraki, Japan. Patients aged 65 years or older who had continuously been patients of the hospital between April 2018 and April 2021 were included in the study. The vaccinated group consisted of 166 VZV-vaccinated patients. The controls consisted of 29 age- and sex-matched patients who did not receive VZV vaccination. A self-administered questionnaire was distributed between August and September 2021. It included the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) to evaluate PX and included questions about recommendations for VZV vaccination by a physician and the vaccination history of relatives. Multivariable and intermediate factor analyses were used to assess whether there was an association between VZV vaccination and PX. RESULTS: Questionnaires were sent to 457 subjects. Responses from 228 (116 in the vaccination group and 112 in the non-vaccinated group) were included in the analysis. Multivariable analysis, which excluded physician recommendation for VZV vaccination as a variable because it was an intermediate factor in the analysis, showed an association between PX and VZV vaccination (odds ratio, 1.38; 95% confidence interval, 1.00-1.92; P = .049). CONCLUSIONS: PX was associated with past VZV vaccination. Physician recommendation for VZV vaccination was an intermediate factor between PX and VZV vaccination.

Association between family caregivers' primary care experience when they report as patients and their stress related to caregiving: A pilot cross-sectional study.

Background: Few studies have examined whether family caregivers' own primary care providers can affect caregiving-specific well-being, such as caregiver stress. In this pilot study, we explored whether primary care experiences when family caregivers report as patients were associated with the stress of caregiving. Methods: We used cross-sectional data from a survey conducted in Japan between November and December 2020. We recruited family caregivers aged 40-74 years who were caring for community-dwelling adults with chronic conditions. We assessed primary care experience using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) and caregiver stress using the Japanese short version of the Zarit Caregiver Burden Interview. Results: In total, 406 family caregivers were included in the analysis. The mean JPCAT-SF total score was 42.1 out of 100 points. The proportion of caregivers who had higher caregiver stress was 48.8%. After adjusting for possible confounders, the JPCAT-SF score was found to be significantly associated with caregiver stress (lower stress = 0 vs. higher stress = 1; adjusted prevalence ratio per 1 SD increase in JPCAT-SF score = 0.89; 95% CI 0.80-0.98). Among the subscales of the JPCAT-SF, longitudinality, and comprehensiveness (services available) were associated with caregiver stress. Conclusions: Better primary care experiences when family caregivers reported as patients were associated with lower caregiver stress. Longitudinality, which includes focusing attention on the individual as a whole person, and comprehensiveness in the context of building provider-patient relationships that make consultation easier when needed, were associated with lower stress.

Precision engineered peptide targeting leukocyte extracellular traps mitigate acute kidney injury in Crush syndrome.

Crush syndrome induced by skeletal muscle compression causes fatal rhabdomyolysis-induced acute kidney injury (RIAKI) that requires intensive care, including hemodialysis. However, access to crucial medical supplies is highly limited while treating earthquake victims trapped under fallen buildings, lowering their chances of survival. Developing a compact, portable, and simple treatment method for RIAKI remains an important challenge. Based on our previous finding that RIAKI depends on leukocyte extracellular traps (ETs), we aimed to develop a novel medium-molecular-weight peptide to provide clinical treatment of Crush syndrome. We conducted a structure-activity relationship study to develop a new therapeutic peptide. Using human peripheral polymorphonuclear neutrophils, we identified a 12-amino acid peptide sequence (FK-12) that strongly inhibited neutrophil extracellular trap (NET) release in vitro and further modified it by alanine scanning to construct multiple peptide analogs that were screened for their NET inhibition ability. The clinical applicability and renal-protective effects of these analogs were evaluated in vivo using the rhabdomyolysis-induced AKI mouse model. One candidate drug [M10Hse(Me)], wherein the sulfur of Met10 is substituted by oxygen, exhibited excellent renal-protective effects and completely inhibited fatality in the RIAKI mouse model. Furthermore, we observed that both therapeutic and prophylactic administration of M10Hse(Me) markedly protected the renal function during the acute and chronic phases of RIAKI. In conclusion, we developed a novel medium-molecular-weight peptide that could potentially treat patients with rhabdomyolysis and protect their renal function, thereby increasing the survival rate of victims affected by Crush syndrome.

Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis.

BACKGROUND: Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports. METHODS: Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. STUDY PARTICIPANTS: Students who completed the program during October 2018-June 2021. ANALYSIS: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. RESULTS: We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. CONCLUSIONS: Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross-sectional study.

Background: Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work. Methods: This was a cross-sectional study that used self-administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J-WAMI) were also assessed. Participants were divided into high- and low-scoring groups according to the median J-WAMI score, and logistic regression analysis was performed to identify factors related to the high J-WAMI-scoring group. Results: A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years. The median overall J-WAMI score was 38. Factors associated with the high J-WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95% CI: 1.02-1.06) and engagement in research (OR: 2.74, 95% CI 1.33-5.66). Conclusions: Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among PCPs. Supporting these types of work may enhance PCPs' value of their work.

Current status of interprofessional competency among healthcare professions in Japan: A cross-sectional web-based survey.

Background: Self-assessment of professionals' interprofessional competency is meaningful for benchmarking oneself and helping to identify training needs. We aimed to clarify differences in self-assessment of interprofessional competency in Japan by profession and type of facility. Methods: We conducted a cross-sectional study using a web survey among primary healthcare providers in Japan, especially members of the Japan Primary Care Association, between June and October 2020. After sampling using the e-mail list, we used an exponential nondiscriminative snowball method as purposive sampling through key professional informants between November 2020 and February 2021. The questionnaire covered items including participant demographics (age, gender, years of experience as professionals, years of experience working at the current institution, attendance type (regular or part-time work), administrative experience, profession, and facility type) and included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). Differences between healthcare professions (physician, nurse, pharmacist, rehabilitation therapist, and social worker) and between types of facility (university hospital, medium-sized hospital, small hospital, and clinics) were compared using the Kruskal-Wallis test. Results: A total of 593 people responded to the survey. Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. JASSIC scores of physicians and social workers were significantly higher than those of rehabilitation therapists (p < 0.01). Concerning facilities, professionals working in clinics rated themselves higher than those in medium-sized hospitals (p < 0.01). Conclusions: We revealed that self-assessment of interprofessional competency in Japan varied by profession and type of facility.

Family caregivers' experience with healthcare and social care professionals and their participation in health checkups: A cross sectional study in Japan.

Background: For family caregivers, who are generally regarded as a vulnerable population, having regular checkups is a desirable health behavior. This study examined family caregivers' habit of having regular checkups prior to becoming involved with professionals who care for patients, and whether they had had recent checkups. We then examined the association between family caregivers' experience with professionals and their participation in checkups after adjusting for the past habit. Methods: We conducted a cross sectional survey in Japan between November and December 2020. We recruited family caregivers who were aged 40-74 years and caring for community-dwelling adult patients. The outcome variable was whether family caregivers had undergone any health checkups since April 2019. We assessed family caregivers' experience using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Results: Of the 1091 recruited family caregivers, 629 were included in the analysis. Of these, 358 had previously undergone regular checkups, and 158 had no checkups or selected the option "unknown." Outcome rates in each group were 74.6% and 43.0%, respectively, and 62.0% for all 629 caregivers. Multivariate modified Poisson regression analysis revealed that among the J-IEXPAC CAREGIVERS scores, only the domain score for attention for the caregiver was significantly associated with family caregivers' participation in checkups (adjusted prevalence ratio per 1 SD increase = 1.07; 95% CI 1.01-1.14). Conclusions: Among family caregivers' experience with professionals, the factor that focused on caregivers themselves was significantly associated with their participation in checkups. This finding underscores the significance of caregiver-focused care.

Association between experience of interprofessional care and self-medication among family caregivers: A cross-sectional study.

BACKGROUND: Although healthcare professionals pay attention to the drugs prescribed by physicians, few studies have assessed self-medication by family caregivers. Family caregivers' experience of interprofessional care in the care of patients can influence caregivers' health behaviors. OBJECTIVES: This study aimed to describe self-medication among family caregivers of community-dwelling adult patients, and to assess association between family caregivers' experience of interprofessional care and their self-medication, adjusting for possible confounding factors. METHODS: We conducted a cross-sectional survey from November to December 2020 in Ibaraki Prefecture, Japan. Family caregivers between 40 and 74 years old and caring for community-dwelling adult patients with chronic conditions were recruited. The use of any self-medication in the last 2 weeks by family caregivers was the outcome variable. The explanatory variable was family caregivers' experience of interprofessional care in the care of patients, using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Adjusted covariates were age, gender, educational attainment, annual household income, self-rated health, and caregiving time of family caregivers. RESULTS: Of 1091 recruited family caregivers, 750 were included in the analysis. A total of 258 (34.4%) family caregivers reported having used self-medication in the past 2 weeks. Logistic regression analysis showed that having a higher score on the J-IEXPAC CAREGIVERS (odds ratio 0.80 per 1 standard deviation increase) was associated with less use of self-medication by caregivers. CONCLUSIONS: This study revealed that about one-third of family caregivers self-medicate, and this practice is associated with a less positive experience of interprofessional care. These results suggest that it is important for healthcare professionals to be aware of the health condition of family caregivers and to provide appropriate advice regarding self-medication.

How do medical students learn in an online community diagnostics program?

BACKGROUND: The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns. METHODS: A 2-week general medicine clinical practice program was conducted for 4th- and 5th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results. RESULTS: First, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local community, and their reflection on themselves was encouraged. CONCLUSION: In this online community diagnosis program, medical students learned about the community through four types of learning patterns. Medical students may develop an understanding of community with interest using variation theory as a program development perspective and cognitive flexibility theory surrounding the essential ambiguity and abstraction of community.

Factors associated with interprofessional competencies among healthcare professionals in Japan.

We aimed to explore factors associated with interprofessional competencies among healthcare professionals in Japan. From June to October 2020, we conducted a cross-sectional survey via a validated self-administered web-based questionnaire using the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). We recruited participants from an e-mail list. The questionnaire asked about JASSIC, basic demographic information, whether they had undertaken pre- and post-licensure interprofessional education (IPE), and administrative experience; as well as an organizational climate scale, including "Plan, Do, See" factor for management (PDS factor), and the "Do" factor in a leader-centered direction for people who work unwillingly. Factors associated with the total JASSIC score as interprofessional competencies were determined using multiple regression analysis. We analyzed data from 560 participants with an average age of 41.0 years, comprising 132 nurses, 127 doctors, and 120 social workers. The median of the total JASSIC score was 72/90 (range: 66-78). On multiple regression analysis, total JASSIC score was significantly associated with age, PDS factor, administrative experience, pre-licensure IPE, and pos-licensure IPE. These findings emphasize the importance of pre- and post-licensure IPE, and administrative experience for improving interprofessional competencies in Japan.

What Role Expectations Do Primary Care Physicians in Japan Hold for Physical Therapists Regarding Primary Care?

INTRODUCTION/OBJECTIVES: This study aimed to clarify what primary care physicians (PCPs) in Japan understand of the role of physical therapists (PTs) through the experience of working with PTs in hospitals, and what roles PCPs expect for PTs in future primary care. METHODS: Semi-structured interviews were conducted individually with 9 purposively sampled PCPs with sufficient experience of collaboration with PTs. Interview data were analyzed by theme analysis focusing on "What does the PCP understand about the role of PTs through the experience of working with PTs in hospitals?" and "What roles and purposes does the PCP wish for PTs in primary care settings?" RESULTS: PCPs viewed PTs as providers of rehabilitation in the traditional medical model, and understood their role as an occupation having a mono-causal viewpoint, namely a specific and well-defined outcome for individual patients, and intervening with patients within a short clinical course with the aim of improvement or maintenance of the patient's condition. With regard to future primary care, PCPs expected that PTs would interpret various factors related to patient lives from the viewpoint of causal interactions; become important stakeholders in the community; and respond flexibly to patients and the environmental factors around them with continued support to the individual. CONCLUSIONS: PCPs understood the role of PTs in hospitals as "Rehabilitation in the traditional medical model," and expected the future role of PTs in primary care as "Rehabilitation in integrated community care."

Analyzing annual changes in network structures of a social media application-based information-sharing system in a Japanese community.

BACKGROUND: Understanding the evolution of social network services (SNSs) can provide insights into the functions of interprofessional information-sharing systems. Using social network analysis, we aimed to analyze annual changes in the network structure of SNS-based information sharing among healthcare professionals over a 3-year period in Japan. METHODS: We analyzed data on SNS-based information sharing networks with online message boards for healthcare professionals for 2018, 2019, and 2020 in a Japanese community. These networks were created for each patient so that healthcare professionals could post and view messages on the web platform. In the social network analysis (SNA), healthcare professionals registered with a patient group were represented as nodes, and message posting and viewing relationships were represented as links. We investigated the structural characteristics of the networks using several measures for SNA, including reciprocity, assortativity and betweenness centrality, which reflect interrelational links, the prevalence of similar nodes with neighbors, and the mediating roles of other nodes, respectively. Next, to compare year-to-year trends in networks of patients overall, and between receiving nursing care levels 1-3 (lighter care requirement) and levels 4-5 (heavier care requirement), we described the annual structural differences and analyzed each measure for SNA using the Steel-Dwass test. RESULTS: Among 844, 940, and 1063 groups in each year, groups for analysis in care levels 1-3/4-5 were identified as 106/135, 79/89, and 57/57, respectively. The overall annual assessment showed a trend toward increased diameter and decreased density, but the differences were not significant. For those requiring care levels 1-3, assortativity decreased significantly, while for those requiring care levels 4-5, reciprocity decreased and betweenness centrality increased significantly. No significant differences were found in the other items. DISCUSSION: This study revealed that the network of patients with a lighter care requirement had more connections consisting of nodes with different links, whereas the network of patients with a heavier care requirement had more fixed intermediary roles and weaker interrelationships among healthcare professionals. Clarifying interprofessional collaborative mechanisms underlying development patterns among healthcare professionals can contribute to future clinical quality improvement.

[Relationship between the use of home-visit nursing services and family caregivers' experience of interprofessional care].

AIM: To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers' experience of interprofessional care, which is an indicator of the care process. METHODS: We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers' experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses. RESULTS: A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant. CONCLUSIONS: We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings suggest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.

Verification of a Sense of Community Scale for Hospitals in Japan.

INTRODUCTION/OBJECTIVES: We aimed to verify whether a sense of community scale developed for hospital wards can be applied to hospitals. METHODS: A cross-sectional study was conducted using a self-administered questionnaire between July and October 2018 in 3 hospitals in Japan. The subjects were staff members working in these hospitals who provide direct medical or administrative services to patients and their families. The questionnaire inquired about the participants' basic attributes and workplace satisfaction, and included the sense of community scale and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II. We evaluated the scale's structural validity, internal consistency, and hypothesis testing for construct validity. RESULTS: Of 826 eligible staff members, 539 were included in the analysis. Mean age was 40.4 years and 77.4% were female. Exploratory factor analysis showed that 24 of the 28 items in the sense of community scale could be categorized under 3 factors. Confirmatory factor analysis demonstrated a goodness of fit index of 0.794, adjusted goodness of fit index of 0.752, comparative fit index of 0.885 and root mean square error of approximation of 0.092. Cronbach's α for score in the sense of community scale was high (.96). Participants who reported high workplace satisfaction had significantly higher scores in the sense of community scale than those who indicated low workplace satisfaction (P < .001). CONCLUSIONS: We verified the reliability and validity of the Japanese version of the sense of community scale, which was originally developed for hospital wards, for the community in hospitals. With further verification, we hope the scale will be useful for evaluating the sense of community in hospitals.