Purpose: An educational program was developed to facilitate advance directive (AD) completion, using the situation of end-of-life care for people with dementia. The aim of the study was to examine the effects on AD completion rates of an education program conducted for local community residents. Methods: The design was a quasi-experimental study with intervention and control groups, respectively. The study population included local welfare officers from two cities in Osaka Prefecture, Japan, of whom 81 persons were allocated to an intervention group and 60 persons to a control group. A 70-minute intervention program was performed twice for the intervention group. Primary outcomes included AD completion and intention to complete an AD, as indicated by binary “Yes” or “No” responses, and secondary outcomes included knowledge of AD, attitudes towards AD, and knowledge of dementia. Results: The intervention group exhibited a significant increase in the number of people who completed an AD from the baseline assessment compared to the four-month reassessment (odds ratio = 5.0, 95% confidence interval = 1.0–25.0, p = 0.04). The results showed that the interactions between group and time were statistically significant for scores of both the AD Attitude Survey Test (F = 4.1, p = 0.04) and the Dementia Knowledge Scale (F = 4.6, p = 0.04). Conclusions: The results suggest that this education program to facilitate AD completion may promote 1) AD completion, 2) favorable attitudes towards AD, and 3) knowledge of dementia among local residents.
Background: Group practices with multiple physicians are preferred for promoting home medical care, but the explanations to patients and families given by the visiting doctors may differ. That could sometimes lead to confusion in patients and families. Methods: We conducted a cross-sectional mail survey of families of Japanese patients who had previously received home medical care. Multivariable adjusted logistic regression for families’ sense of discrepancy between the explanations by doctors in a group practice was performed using eleven explanatory variables including: (1) number of doctors; (2) interval between the doctors’ visits; (3) duration of the doctor’s stay; (4) doctors’ frequent use of technical terminology; (5) doctors’ interruption of family’s talking, etc. Results: Among 271 families who were mailed surveys, 227 responded (83.8%). The final sample for the analyses was 139. Responses were divided into two groups: families who had experienced a sense of discrepancy about explanations by different doctors (“Experienced”, 30 families, 21.6%) and those who had not (“Non-experienced”, 109 families, 78.4%). Families’ sense of discrepancy between the explanations by doctors in group practice was significantly associated with a longer time interval between doctors’ visits (OR: 1.103, 95% CI: 1.008–1.208, p = 0.03) and doctors interrupting families while they were talking (OR: 2.559, 95% CI: 1.166–5.615, p = 0.02). Conclusions: Visiting doctors need to understand that families may have a sense of discrepancy about explanations given by different doctors. This sense of discrepancy was associated with less frequent doctors’ visits and doctors’ interrupting families while they are talking.
Background: Elderly patients are considered to be at risk of developing adverse drug events (ADEs) because they tend to receive a greater number of medications. The purpose of our study is to determine the prevalence of ADEs related to polypharmacy and causative admissions of patients in Japanese acute care hospitalization. Methods: In retrospective cohort study, we analyzed 700 consecutive elderly patients admitted to the department of medicine of a Japanese community hospital in 2011. ADEs were defined by World Health Organization–Uppsala Monitoring Centre criteria. Polypharmacy was defined as five or more medications. Results: The mean age was 79.5 years (men, 54%). The mean number of medications was 6.36 +/− 4.15 (maximum, 26). Polypharmacy was observed in 63% of cases. ADEs were identified in 4.9% (95% CI, 3.5–6.7%). The mean numbers of medications among patients with ADEs and those without ADEs were 9.3 +/− 3.4 and 6.2 +/− 4.1, respectively. A greater number of medications was significantly associated with ADEs (p < 0.001). Polypharmacy was identified in 91% of patients with ADEs, while it was noted in 62% of patients without ADEs (p = 0.001). Using logistic regression analysis, polypharmacy was significantly associated with ADEs (Odds ratio 5.89, 95% CI 1.74–19.9). The highest number of ADEs were identified among patients on antiplatelets or anticoagulants (n = 8), followed by benzodiazepines and NSAIDs (n = 4 for both). The most common ADEs were gastrointestinal bleeding, nausea and congestive heart failure. Conclusion: ADEs complicated to about 5% of acute care elderly hospitalizations in Japan. Polypharmacy was significantly associated with these ADEs.
Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan. Methods: This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services. Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40). Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.
Objective: We performed a meta-analysis to examine the effectiveness of face masks for preventing influenza infection. Methods: A literature search was conducted to identify clinical trials that compared the incidence of influenza infection among family members with and without the use of antiviral face masks; some trials also contained the use of hand hygiene in the intervention group. Data from each trial were combined using a random effects model with the DerSimonian-Laird method to calculate pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: The meta-analysis included seven randomized controlled trials that met our inclusion criteria. With the use of antiviral face masks, the pooled ORs (95% CIs) of laboratory proven infection were 0.69 (0.22–2.18). The pooled ORs (95% CIs) of influenza-like illness (ILI) were 1.07 (0.65–1.78). With the use of antiviral face masks and concomitant hand hygiene, the pooled ORs (95% CIs) of laboratory proven infection were 0.70 (0.35–1.39) in early intervention cases, and 0.93 (0.66–1.30) in all cases. The pooled ORs (95% CIs) of ILI were 1.01 (0.47–2.19) in early intervention cases, and 1.06 (0.53–2.13) in all cases. Conclusion: No statistically significant differences were detected in the incidence of influenza infection by wearing antiviral face masks, suggesting that distribution of face masks in primary care settings may not be enough to prevent influenza-like illnesses amongst family members.
A 51-year-old man was emergently admitted for acute renal failure. Blood tests showed a high serum creatinine level and metabolic alkalosis. He had a history of recurrent vomiting starting one month prior to admission to our hospital, and had circumferential thickening of the cardia on upper gastrointestinal endoscopy and CT. He underwent total gastrectomy and was given a diagnosis of scirrhous gastric carcinoma at the pylorus. After total gastrectomy, acute renal failure and metabolic alkalosis showed amelioration. We report this very rare case with metabolic alkalosis and acute renal failure resulting from pyloric stenosis caused by scirrhous gastric carcinoma.
Pyomyositis is a purulent skeletal muscle infection that arises from hematogenous spread, and is usually accompanied by abscess formation. This condition is commonly seen in the tropics, but has recently been recognized in temperate regions. We report a case of pectoralis pyomyositis in an elderly Japanese woman without any serious underlying medical conditions. The course of illness in this case differed from that seen in tropical cases. We should consider pyomyositis as an important complication of bacteremia, particularly because this pathology is no longer limited to tropical regions and clinically ill patients.
A 40-year-old woman visited our emergency room (ER) with fever and shaking chills. Blood cultures for suspicion of urinary tract infection revealed bacteremia two days later. Since Streptococcus mitis was detected, infective endocarditis was strongly suspected. In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). PDA was confirmed by echocardiography and 3D-CT angiography. The patient was successfully treated by antibiotics and then received transcatheter PDA closure. Careful auscultation after detection of bacteremia led to a diagnosis of PDA.
Background: Activity in international conferences is essential for the academic progress of primary care in Japan. We aimed to clarify the obstacles Japanese university-based primary care physicians face in attending and presenting at international conferences. Methods: We conducted a questionnaire of 10 residents and 22 physicians in the Department of General Medicine and Primary Care at the University of Tsukuba. Results: The primary obstacle preventing conference attendance was English language skills. A secondary obstacle was insufficient time off work. Conclusions: Additional support in English language skills and time off work is necessary to promote attendance at international conferences.