Family Physicians' Perspectives and Practices on Advance Care Planning in Regional Cities in Japan and the United States: A Convergent Parallel Mixed-Methods Study.

BACKGROUND: Advance care planning (ACP) has been widely recognized and practiced worldwide since the 1990s. However, only a few studies have compared clinicians' international perceptions of and experiences with ACP. Therefore, this study explored the perceptions and practices of family physicians (FPs) regarding ACP in Japan and the United States. METHODS: We conducted a convergent parallel mixed-methods study using a cross-sectional web-based anonymous questionnaire survey to examine how the perceptions and practices of ACP differ between Japanese and American FPs working in regional cities. RESULTS: Responses from 20 and 19 FPs in Japan and the United States were obtained, respectively. Both FP groups received ACP training during their residency and practiced ACP with the highest regard for the patient's wishes and values. Quantitative analysis revealed that American FPs placed more emphasis on documentation and patient language skills. Qualitative analysis revealed that Japanese FPs equally emphasized communication with patients' families and with patients. We merged the results of both analyses and hypothesized that the variations in the FPs' approaches to ACP might reflect variations in their backgrounds, such as health insurance systems, cultures, and values in the two countries, rather than differences between individual physicians. CONCLUSION: Our study showed that both Japanese and American FPs respect patients' wishes in ACP, with some differences in their perceptions and practices. Therefore, FPs should understand and be flexible with their patients' values and cultural backgrounds as intercultural translators while following appropriate management procedures for successful ACP.

Home and social role as factors leading to health maintenance among the elderly living in rural Japan: A longitudinal study.

Purpose: Our study aimed to clarify home and social factors by gender that lead to maintenance of health in the elderly, such as taking care of others and having social activities. Methods: A total of 14,712 and 14,799 respondents to the "Survey of Needs in the Spheres of Daily Life" conducted in Nanto City, Toyama Prefecture in 2017 and 2020, respectively, who were aged 65 years or older (recovery rate was 78.5 %) were enrolled. Of these, 4,322 people who answered that they did not receive long-term care in 2017 survey and who also responded to the 2020 survey or were confirmed dead by the time of the survey were included in the analysis. The status of health maintenance was the outcome and those who answered the 2020 survey saying they did not receive long-term care were defined as health maintained. Those who answered that they did receive long-term and those who died were defined as health lost. Results: After adjusting for variables such as basic attributes, health status, and functional capacity, the elderly who had persons whom to they provided care (excluding long-term care) had health maintenance rate higher at 3 years than those who did not provide care or long-term care. In addition, the results showed that men who had job with income and women who participated in neighborhood associations had higher rates of health maintenance. Conclusion: This study showed that older adults who take on roles at home and in society are more likely to maintain their health.

What was happening in the collaboration between general practitioners and public health nurses in the community: A qualitative study.

Background: Interprofessional collaboration in the community is becoming essential in primary care, particularly collaboration between public health nurses and general practitioners. However, the precise value of such collaboration has not been sufficiently studied. The purpose of this study was to conduct a qualitative analysis of collaboration between general practitioners and public health nurses in the community to explore the details of the phenomenon and its possible impact on the community. Methods: Since 2015, The University of Toyama has been implementing the Collaborative Health Activities Project, in which general practitioners and public health nurses work together to promote community health. Focus group and individual interviews were conducted with participating staff, and the data were analyzed qualitatively. Results: Fifteen themes were generated, in six categories. The categories were as follows: enhanced roles of public health nurses and physicians in the community, new perspectives on the community, public health nurses' sense of trust and empathy toward physicians, bonds of solidarity between public health nurses and physicians, proactive change in residents, and supporting "hangout places". Conclusion: The collaboration between general practitioners and public health nurses familiar with the same community fostered a sense of trust and empathy and created the bonds of solidarity between staff and residents. The results also suggest the collaboration may have a positive impact on the local community by inspiring residents to change proactively and supporting "hangouts" where residents and professionals can informally connect.

Clinical Presentations of Teenage Outpatients Encountered by General Internists in Japanese Hospitals: A Cross-Sectional Study.

Introduction General internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. Methods This study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data. Results The number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms. Conclusions The potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments ("Sogo-Shinryo") in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.

Realist approach to community-based participatory research on a community health break-down in Japan: mechanism reasoning, knowledge and a trust partnership.

BACKGROUND: Our 10-year programme of community health regeneration and community-based participatory research (CBPR) was initially unknown. However, we succeeded in creating a collaboration between residents, medical staff, and administrative staff. We adopted a realist approach as an evaluation method. METHODS: The realist approach evaluates a programme using a Context-Mechanism-Outcome configuration (CMOc), which is a relatively new methodology. First, the programme manager summarised the entire programme, conducted questionnaires and interviews with seven core members, and summarised each into a CMOc. The programme was evaluated with particular focus on mechanistic reasoning. RESULTS: The number of doctors and nurses increased and residents became more active. The success factors were the acquisition of participants' knowledge and trust partnerships. In addition, it was important that the timing of the activity was good and that the participants were highly conscious. CONCLUSIONS: The 10-year CBPR was examined using a realist evaluation method. Knowledge acquisition and trust partnerships are important for reasoning mechanism.

The Seamless Communication on a Rural Island in Japan: A Qualitative Study from the Perspective of Healthcare Professionals.

On remote islands, interprofessional collaboration is essential to support older adults who live at home, despite the limited number of healthcare professionals (HCPs). Therefore, it is important for HCPs to collect and share information about older adults with health problems. This study aimed to clarify how rural HCPs collaborate using limited resources to support older adults in remote islands. We conducted semi-structured interviews with 10 healthcare providers for older adults on Zamami Island of Okinawa, Japan. We performed a qualitative analysis using the steps for coding and theorization method. Four themes were extracted: "Collection and communication of information between residents", "Communication of information from non-HCPs to HCPs", "Sharing of information between HCPs", and "HCPs taking action to initiate their approach". Islanders take care of each other and know each other's health status, while HCPs gather their health information. When necessary, HCPs on the island gain essential information regarding older adult patients from islanders not only through work, but also through personal interactions. Afterward, HCPs approach older adults who need health care. The human connections on this remote island serve as social capital and enable flexibility in both gathering information and seamless communication among islanders who also serve as informal resources that contribute support for older adults.

[Do elderly people providing nursing or caring for others help the providers maintain their health?]

AIM: The present study clarified the relationship between elderly individuals providing nursing or caring for others, including their spouses, and their own health maintenance over three years. METHODS: Study participants were those who had completed the "Survey of Needs in the Spheres of Daily Life" distributed to all elderly individuals ≥65 years old in Nanto, Toyama Prefecture, Japan, in both 2014 and 2017. We evaluated data from 6,088 individuals after excluding those with insufficient data. Detailed responses were analyzed in order to understand the situation of the people to whom the respondents were providing nursing or care (e.g. spouses or others), the presence or absence of providing this nursing or care, and the relationship between these factors and the providers' health maintenance over a period of three years using multiple logistic regression analyses. RESULTS: Even after adjusting for critical variables, including basic attributes, overall health, and functional capacity in elderly men, among the subjects who had partners to whom they provided nursing or care, including a spouse, the number of individuals whose own health was maintained 3 years later was higher than among those who did not provide such nursing or care (odds ratio [OR], 1.67; P = 0.004). Furthermore, compared to women who did not provide nursing or care, the OR for women who did provide care for people others than their spouses was 1.44 (P = 0.045). CONCLUSIONS: Our results suggest that providing nursing or caring for others (including a spouse for elderly men; excluding a spouse for elderly women) has a positive impact on health maintenance among the elderly.

What are the factors that cause emergency home visit in home medical care in Japan?

BACKGROUND: In the home medical care setting, the factors causing emergency home visits (EHV) remain unclear. This study aimed to determine those factors and examine their relationship with EHV requests. METHODS: This is a single-center retrospective observational study from data obtained from a home medical care clinic. We assessed the association between frequency of EHV and age, gender, level of care-needed, cancer, and medical device in use with using Poisson regression analysis. RESULTS: A total of 608 EHV in 214 patients were analyzed. Common chief complaints were fever, death, and dyspnea. As factors that affect frequency of EHV because of fever, higher care-needed level (RR: 3.35; 95% CI: 1.95-5.74, P < .001), urinary catheter use (RR: 1.94; 95% CI: 1.22-3.08, P = .005), and central venous port use (RR: 2.39; 95% CI: 1.44-3.96, P = .001) showed significant correlation. Regarding EHV because of dyspnea, lung tumor (RR: 2.71; 95% CI: 1.26-5.84, P = .011) and home oxygen use (RR: 3.96; 95% CI: 2.05-7.68, P < .001) showed significant correlation. Regarding EHV because of all chief complaints, higher care-needed level (RR: 1.59; 95% CI: 1.12-2.26, P = .009), urinary catheter use (RR: 1.78; 95% CI: 1.13-2.93, P = .014), and central venous port use (RR: 1.75; 95% CI: 1.04-2.93, P = .034) showed positive correlation. CONCLUSION: The factors associated with frequency of EHV because of fever or all chief complaints were urinary catheter use, central venous port use, and higher care-needed level. As for dyspnea, they were lung cancer and home oxygen use. Our study suggests that the burdens on medical staffs, patients, and their families can be reduced through recognizing these risk factors.

Recurrent Drug-induced Liver Injury Caused by the Incidental Readministration of a Kampo Formula Containing Scutellariae Radix.

A 67-year-old woman experiencing coughing visited a clinic and was prescribed drugs, including shosaikoto extract, for 4 days. She subsequently suffered from liver injury, but her condition improved after the discontinuation of all medications. Approximately 1 year later, she experienced fatigue, consulted another clinic, and received saikokeishikankyoto extract for 21 days. She subsequently suffered liver injury again. Both shosaikoto and saikokeishikankyoto contain Scutellariae Radix. This case is thought to be one of recurrent drug-induced liver injury caused by the incidental readministration of a Kampo formula containing Scutellariae Radix. An awareness of adverse drug events caused by Kampo formulas, especially those containing Scutellariae Radix, is essential.

A 56-year-old female with celiac artery compression syndrome recovering through dietary changes and weight gain.

Celiac artery compression syndrome is a rare condition characterized by extrinsic compression of the celiac artery by the median arcuate ligament, which leads to chronic, recurrent postprandial epigastric pain. Although traditional treatment of this syndrome involves laparotomy to release the median arcuate ligament, here we report on the rare case of a middle-aged woman recovering with no specific treatment through her use of a food diary to change her diet which resulted in gradual weight gain. This suggests that in some cases, a conservative therapy for celiac artery compression syndrome should be tried before choosing surgical intervention.

Spontaneous pneumomediastinum in young women: Comparison between anorexia nervosa and nonanorexic patients.

Spontaneous pneumomediastinum is a benign, self-limited condition that mainly affects young people. In this report, we present four cases of this uncommon condition and a review of the current literature. Two cases had no prior significant medical history: one had a history of asthma and the other underwent regular outpatient treatment for anorexia nervosa. The three patients who were not anorexic spontaneously improved within a few days. However, the patient with anorexia nervosa took 2 months to recover. It appears that spontaneous pneumomediastinum is an intractable complication of anorexia nervosa, and the improvement of nutritional status in the patient is essential to manage this condition.

A case of suspected MPO-ANCA-related hypertrophic pachymeningitis with atypical presentation.

A 66-year-old man presented to our emergency department with acute consciousness disorder, headache, and fever. Initial laboratory data indicated a high level of inflammatory reaction. Enhanced magnetic resonance imaging revealed a thickening of the right cranial dura mater on T1-weighted images. We presumed the patient was diagnosed as having myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-related hypertrophic pachymeningitis (HP). Acute impaired consciousness without focal signs is an unusual presentation of HP. This treatable disease should be considered as a differential diagnosis when a patient presents with drowsiness and headache.