Sense of Coherence as a Mediator in the Association Between Empathy and Moods in Healthcare Professionals: The Moderating Effect of Age.

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one's own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence (SOC) plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual moods among 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale (EPS), the 13-item Antonovsky's SOC, and Profile of Mood States (POMS). Findings showed that SOC mediated the relations between empathy (EPS) and both POMS-Vigor (POMS-V: self-vigor mood) and POMS-Depression (POMS-D: self-depression mood). Notably, moderated mediation analysis revealed that there was a significant interaction (age × SOC) on self-vigor mood (POMS-V) in healthcare professionals. The indirect effect of empathy (EPS) on self-vigor mood (POMS-V) through SOC was significant at over mean age "32.83." Although there was no significant interaction with age regarding the indirect effect of empathy (EPS) on self-depression mood (POMS-D), in the sub-category level analysis of empathy (EPS), we found a significant interaction item [age × empathy for other's negative affect (EPS-N)] on SOC. This indirect effect was also significant at over mean age "32.83." Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals.

[Peer review method for quality evaluation--methodology of Emergency Medicine Study Group for Quality about trauma management].

Education, resident training, guidelines, and evaluation are necessary to improve health care quality. Changing the resident system, re-organizing medical associations and Evidenced-Based Medicine (EBM) are becoming popular, and clinical practice using guidelines has been stressed in recent years in Japan. However, clinical evaluation is generally not so popular, except within internal conferences, and during short discussions at medical societies, although evaluation of the hospital services is on going by the Japanese Council for Quality Health Care (JCQHC). In contrast, the Joint Commission on Healthcare Accreditation Organization (JCAHO) is generally used for evaluation of hospitals in the US. The TRISS (Trauma and Injury Severity Score) method has offered a standardized approach to the evaluation of the outcome of trauma care. All trauma cases admitted to emergency centers in Japan were reviewed using the TRISS methodology in 2001 to assess preventable trauma death (PTD). There are big discrepancies regarding PTD among hospitals. The Emergency Medicine Study Group for Quality (EMSQ), organized by 14 emergency centers in the Kanto area, has developed a peer review (PR) system using explicit standards together with the TRISS methodology, in order to promote accuracy in the evaluation of PTD. Definitions of trauma, PTD, and a set of standards consisting of 20 items for determining PTD, were proposed. The optimal quality level of medical care for the patients was the criterion against which decisions regarding PTD were made. All death cases whose probability of survival (Ps) value exceeded 50% were reviewed using a PR method based on explicit standards. The PR process found that only 11.2% of all deaths were preventable, although 25.3% were considered preventable by the TRISS method. The PR process, using explicit standards, provided an excellent method of evaluation of PTD. The PR process also serves an educational purpose in improving the quality of care in emergency trauma cases. PR, by applying uniform standards at the optimal level of quality for the patients, offers not only more precise assessment, but also a means of case identification for quality assurance review on a local basis. Outcome reviews will offer the opportunity to assess comparability with national standards and norms. Trauma registry and evaluation are recommended for all emergency centers in Japan. These evaluation processes may be useful for systematic improvement of the emergency medical field.

Comparison of Verbal and Emotional Responses of Elderly People with Mild/Moderate Dementia and Those with Severe Dementia in Responses to Seal Robot, PARO.

INTRODUCTION: The differences in verbal and emotional responses to a baby seal robot, PARO, of elderly people with dementia residing at an elderly nursing care facility were analyzed. There were two groups of elderly people: one was with mild/moderate dementia (M-group) that consisted with 19 elderly residents in the general ward, and the other was with severe dementia (S-group) that consisted with 11 elderly residents in the dementia ward. METHOD: Each elderly resident in both groups interacted with either PARO or a control (stuffed lion toy: Lion) brought by a staff at each resident's private room. Their responses were recorded on video. Behavioral analysis of the initial 6 min of the interaction was conducted using a time sampling method. RESULTS: In both groups, subjects talked more frequently to PARO than to Lion, showed more positive changes in emotional expression with PARO than with Lion, and laughed more frequently with PARO than with Lion. Subjects in M-group even showed more negative emotional expressions with Lion than with PARO. Furthermore, subjects in S-group showed neutral expression more frequently with Lion than with PARO, suggesting more active interaction with PARO. For subjects in M-group, frequencies of touching and stroking, frequencies of talking to staff member, and frequencies of talking initiated by staff member were significantly higher with Lion than with PARO. CONCLUSION: The elderly people both with mild/moderate dementia and with severe dementia showed greater interest in PARO than in Lion. The results suggest that introducing PARO may increase willingness of the staff members to communicate and work with elderly people with dementia, especially those with mild/moderate dementia who express their demand of communication more than those with severe dementia.

A freshman orientation program to provide an overview of the medical learning roadmap.

International accreditation of medical education was introduced in Japan in 2013 and is planning to be applied in late 2014 or 2015. Students will need to cope with the resulting changes and to recognize by what route they will learn medicine. Therefore, a freshman orientation course, which was based on problem-based learning (PBL) and had been held for first-year students, was modified as an awareness reform program in which students would learn "how to learn medicine." We investigated whether this program has led to useful changes in students' recognition of the way of learning in medical school and their directions as learners. The program was held for 114 first-year medical school students in 2013 and consisted of PBL tutorials, large-classroom lectures, simulation learning using role-play with simulated patients, and team-based learning (TBL), presented in this order. Learning modules that is made with an integration of the clinical sciences with the basic biomedical and the behavioral and social sciences were provided. A nonanonymous questionnaire survey asking" what learning methods are effective for you?" was conducted before and after completion of the course. Furthermore, group answers obtained in TBL were investigated. The score for the question" To what extent can you imagine your route of learning during your 6 years?" significantly increased from 3.1±0.99 (mean±SD) before the course to 3.5±0.88 (p<0.01) after the course. The score for the question" To what extent is the small-group learning, such as PBL, useful for you?" significantly increased from 3.9±0.73 to 4.2±0.71 (p<0.05). Group responses in TBL sessions indicated that students desired classes that presented tasks and regarded" emphasis on reflection" and" observation of senior physicians as role models" as the most important methods for learning interview skills. We believe students should acquire active learning attitudes as adults early in their 6 years of medical school. The level of understanding of" how to learn as adults" was 3.7 and indicated a moderate result. This course employed many educational strategies, and we believe it helped students understand what they learn and how to learn during their 6 years of medical and to get an overview of the learning roadmap.

A trial of improvement of immunity in cancer patients by laughter therapy.

PURPOSE: The study was on the impact of laughter therapy on immunological improvement of patients with gastrointestinal cancer undergoing surgery and chemotherapy. MATERIALS & METHOD: Immunological measurements were performed in 41 cases with patients aged 68.9 years suffering from gastric or colorectal cancer. Intervention using Laughter Therapy was applied to 12 out of the 25 patients subjected to laproscopic surgery and 12 out of 19 patients subjected to chemotherapy. RESULTS: Immunity of patients within the control group who had surgery decreased. Immunity of patients within the control group who had chemotherapy decreased. With intervention of Laughter Therapy, the immunity of patients with surgery had either decreased or was the same. However, with intervention of Laughter Therapy using the Smile-Sun Method, the immunity of chemotherapy patients increased, notably in patients with colorectal cancer. The improvement of immunity within the control group was 0 out of 7. CONCLUSION: Patients with advanced cancer have lower immunity which is further decreased with surgery or chemotherapy. Chemotherapy patients who undertook the Laughter Therapy using the Smile-Sun Methodology during treatment in the hospital showed significantly higher immunity levels. The results of this study indicate that patients with gastrointestinal cancer, who undergo laparoscopic surgery or chemotherapy for stomach or colorectal cancer, benefit from a formal program of psychotherapeutic support during the in-patient hospital stay in terms of immunological improvement.

A case of laughter therapy that helped improve advanced gastric cancer.

We have reported the case of a patient diagnosed as having advanced gastric cancer at the age of 88 years old. An endoscopy revealed a type-2 gastric cancer of 25 x 30 mm in the lesser curvature of the middle stomach body and an IIa gastric cancer with T2 SS and cardiac accessory lesions. Both the type-2 and IIa lesions were defined as tub1 with surrounding atrophic gastritis and entero-epithelium metaplastic carcinoma. Considering the patient's age and her desire not to receive cancer treatment, we prescribed laughter therapy as recommended by the Society for Healing Environment. The program was implemented in a laughter-inducing environment and consisted of five stages: (1) Making the patient feel safe, (2) Relaxing the patient, (3) Increasing the effectiveness, (4) Improving her condition and (5) Increasing her joy of living. One year and seven months later, an endoscopy of the lesser curvature of the middle stomach body indicated that the lesions clearly improved with a morphological reduction into IIa + IIc masses. A tissue biopsy revealed that nucleus abnormality clearly improved from the initial diagnosis, with no irregularity in size. The suspected lesion was localized to a limited area near the stomach wall. Although partial gastric adenocarcinoma was suspected, the cancers turned into gastric adenoma, atrophic gastritis, and enteroepithelium metaplastic carcinoma. Now, five years after the initial diagnosis, she maintains a good condition. Laughter, one of our casual behaviors, has the effect of reducing the stress experienced by the human body. Laughter is expected to become alternative medicine in the future, and we hope to see more reports and evidence on soothing therapies using laughter.

Colored-hearing synesthesia.

According to the experimental study of synesthetic tendencies in a total of 104 subjects, the angry voice of the queen of the night from Mozart is pictured as the colors red and yellow. The voice of lament was pictured as yellow. The colors of 'angelic tones' were perceived as cool colors. Though differences between male and female were not clear, synesthesia toward musical phrases were slightly different between seventeen-year-old boys and adults. It is important to choose proper colors to mediate synesthetic tendencies in hospital settings. Angry voices tended to engender warm colors. 'Angelic tones' were cold colors. Patients in ICU may have two attitudes. One is a panic stage which needs calm surroundings, and the other is a fighting stage trying to escape from their serious condition in ICU settings. Common synesthetic tendencies can be used for choosing the color of ICU settings. Hospices have a different attitude to patient care. Colors should be carefully chosen accordingly.

Laughter education and the psycho-physical effects: introduction of smile-sun method.

UNLABELLED: With the aim of reducing cases of bully and suicide, 34 core laughter producers and 179 laughter producers were educated using Smile-Sun Messages in Aomori Prefecture. The purpose of this paper is to explore the key to spontaneous laughter for further application to healthcare settings. METHOD: Andragogy is the backbone idea. The author modified as seven tools such as sharing the objective, learning by heart, concentration, focusing on points, repetition, humor and evaluation. The contents of Smile-Sun Messages are as follows: 1. I love myself, 2. I love to make you happy, 3. I sympathize, 4. "Let's think of it this way", 5. Talk in P-N-P, 6. "I" message with eye-contact and love and 7. Thanks for all. There is no curriculum on how to laugh. RESULTS: Participants gained self confidence by having their good points praised by others. Their depression decreased. Spontaneous laughter arose from participants. They all improved physically in terms of appearance, posture and attitude. There are some reports of better fingering in piano playing in 2 ladies, pain relief in a patient with cancer and improved walking without using a stick for 2 ladies with rheumatoid arthritis and a limp due to an unknown cause. CONCLUSION: Spontaneous laughter can be drawn when self-confidence is recognized. With Smile-Sun Messages in hospitals and healing environments, spontaneous laughter can be drawn from patients which will decrease their depression and help them recover rapidly from their illness.

Revised sunflower-SHELL model--an analysis tool to ensure adverse-events' factor analysis and followed by patient safety strategy.

BACKGROUND: The original SHELL model is specified for analyzing human errors. In addressing medical errors, medical systems should be targeted for improvement instead of blaming human errors. The Sunflower-SHELL model was made for patient-centered incident analysis. A further change was added to enhance more practical and convenient analysis in the healthcare environment based on users' feedback. METHODS: The revised-Sunflower-SHELL model was proposed. Pre-documented factors were newly added in sub-factor rows for easier analysis. Twenty-two nurses learned this analysis in three five-hour day workshops conducted by one of the authors, and reported the effectiveness of the model six months later. RESULTS: The importance of the systemic change was recognized by the twenty two nurses. They noticed changes in awareness of nurses themselves, their peers, and the hospital managers even six months after the workshop. They understood that patient safety is the key to be a hospital chosen by customers. They also noticed that the hospital itself had changed due to the social pressures caused my media exposure and patients' increasing awareness of patient human rights. CONCLUSIONS: The revised Sunflower-SHELL can be applied to conduct root-cause change and to prevent recurrence of the incidents. Once one case is analyzed, the action plan can be applied to other similar incidents' prevention. The model is practical and convenient, so healthcare providers can complete it easily, which raises cost effectiveness because it reduces their efforts on advance events' management.

Brand strengthening decision making delved from brand-contacts in health services organizations.

Under the Japanese Government's strong enforcement of Japanese national medical cost reduction, only hospitals which emphasize patient values, and creation of brands according to them can survive. This study extracted patients' expectations as brand from Campbell's Brand-Contact lists. The authors also proposed to add Brand-strengthening strategies both for short-term strategies (large improvement is not required) and for long-term strategies (restructuring hardware and systems). This method would enable hospitals to collect customers' underlying expectations, and would create high-value brands. Trustful medical service would provide mutual and synergetic medical care effects. It is already considered out of date to conduct qualitative patient satisfaction interviews on current medical services to current customers. It is the only way to survive that hospitals themselves produce their original brands to increase patient loyalty and customer satisfaction. In the process, customer value should be reconsidered from both aspects of the quality of clinical care and of other medically related services. Then hospitals would be able to satisfy both customers' output and process expectations.