Abstract
Introduction : The aim of this historical cohort study was to report the long-term survival rates of patients who received percutaneous endoscopic gastrostomy (PEG) at an intermediate-sized local hospital in Japan.
Subject/Method : Patients who underwent PEG between January 1, 2004 and September 1, 2006 at Aomori Kyoritsu Hospital were followed up until September 1, 2009 through a review of their medical records and telephone interviews.
 The cumulative survival rate with a 95% confidence interval was estimated by the Kaplan-Meier method.
Results : A total of 332 subjects whose ages were 77.5±9.5 years (mean±SD ; median, 78 years) at the start of observation. The proportion of patients whose follow-up was possible was 92.8% (308/332).
 The cumulative survival rates were as follows : 90.3% for 30 days ; 61.8% for 1 year ; 47.9% for 2 years ; 37.6% for 3 years ; and 21.5% for 5 years.
Conclusion : In Japan, the long-term survival rate of PEG recipients at a local intermediate-size hospital was almost the same as the rates obtained in tertiary-care hospitals ; however, the reasons for performing PEG may have been different from those in the latter hospitals.

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Abstract
Objective : The objective of this research was to clarify the substance and goals of community approaches by Japanese family physicians in the Kansai area.
Methods : The subjects were members of The Kansai Society of Family Practice or The Nara Society of Family Medicine, otherwise known as “Manyo-Shu”. We conducted a focus group discussion, carrying out repeated analyses of the records of the discussion, and the subjects checked the results for maximum trustworthiness.
Results : We found six steps in the community approaches. They were, 1) Daily medical practice, 2) Deciding a physician's franchise area, 3) Physician's entry into a community and critical public appraisal of physicians, 4) Assessment of motivation of co-medical staff, and the key person in the community 5) Logistical support for activities by other healthcare professionals, 6) Assessment of outcomes and achievements. Finally, two hypotheses were formulated. One was'the autonomy of community the other, 'no goal'.
Conclusion : We have identified special community approaches for Japanese family physicians in the Kansai area through this focus group discussion.

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Abstract
Objective : We investigated the conditions of home medical care managed by one hospital.
Method : We examined the status of home care in E hospital. The hospital possesses a home care station, in which interviews were conducted with home care nurses.
Results : The average patient age at the start of home care was 80.6 years. The subjects were divided into two groups : one of patients unwilling to travel to the hospital and one, a terminal care group. The former had lower ADLs than the latter. The death rate in the terminal care group was high. The nurses in the hospital were aware that they could ask the specialist doctors questions about medical technique, and could take care of patients in the hospital on the basis of their symptoms, and they worked with an attitude of responsibility to their community.
Conclusion : Many aged and terminal patients presented at E hospital, and the nurses there accepted this situation. We considered that it was important for hospitals to be given public assistance, and necessary for comparative studies to be performed regarding the home care carried out by clinics.

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[in Japanese]

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[in Japanese]

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