Objective : It is not known whether residents in geriatric facilities are satisfied with the rehabilitation they receive. The purpose of this study was to investigate the relationship between their satisfaction with facility services and their satisfaction with the rehabilitation they receive in geriatric facilities. An additional aim was to identify the factors related to customer satisfaction with rehabilitation.
Methods : One hundred residents in 19 geriatric facilities participated in this study. After obtaining informed consent from the residents, we conducted semi-structured interviews which included scales for facility services satisfaction, customer satisfaction with rehabilitation, and the Geriatric Depression Scale (GDS). The characteristics and conditions of the residents were investigated by interviewing the facilities' staff. For statistical analysis, we used Spearman's, rank correlation test, and multiple regression analysis.
Results : Sixty-seven percent of the subjects were women, and the mean age (±SD) was 78.2±10.4 years. Multiple regression analysis revealed that the total customer satisfaction with rehabilitation score was associated with facility service satisfaction (β=0.232, p<0.05). Significant associations were also observed with “female”(β=0.198, p<0.05), “support counselors” (β=0.269, p<0.01), and “GDS” score (β=-0.291, P< 0.01). Customer satisfaction with rehabilitation was associated with “age” (β=-0.296, p<0.01), “BI” (β=0.261, p<0.01), “satisfaction with rehabilitation time” (β=0.254, p<0.01), “satisfaction with the training environment” (β=0.206, p<0.05), “toilet training” (β=0.210, p<0.05), “bathing training” (β=-0.252, p<0.01), and “GDS” score (β=-0.258, p<0.01).
Conclusion : Customer satisfaction with rehabilitation was significantly associated with facility service satisfaction in geriatric facilities.
These data suggest that rehabilitation is an important service in geriatric facilities, and supplying a sufficient number of hours of rehabilitation and having adequate facilities for rehabilitation were important for improving satisfaction with rehabilitation services in geriatric facilities.

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Introduction : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.
Methods : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.
Results : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.
Conclusion : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.

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[in Japanese]

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Introduction : We report the effect of adaptive servo ventilation (ASV) treatment on heart failure in a home care setting.
Methods : For eight home care patients aged ≥75 with heart failure, we diagnosed sleep-disordered breathing (SDB) by using a simplified monitor and implemented ASV treatment. We assessed its effect on heart failure by using NT-proBNP. We also assessed its effects on SDB by using apnea hypopnea index (AHI).
Results : Three patients dropped out because they felt fear of putting on the mask. Among the other five patients, we observed a significant decrease rate of NT-proBNP (mean : -0.43, 95% confidence interval (CI) : -0.64, -0.22) after the ASV treatment. With regard to AHI, we observed a decreasing tendency (mean : -20.4 /hour, 95% CI : -41.2/hour, 0.4/hour).
Conclusion : This study suggests that ASV treatment is effective for a treatment of heart failure in a home care setting.

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[in Japanese]

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Objective : To understand the issues, future goals and support for the lives of the residents who were victims of the Great East Japan Earthquake.
Methods : We conducted interviews with two men and six women among the affected residents who were living in temporary housing in the City of Tagajo in July 2013.
Results : Most residents had many acquaintances, so there were minimal interpersonal troubles. However, many of them are elderly and there was concern regarding those that do not attend community meetings. This temporary housing was assisted by volunteers from the whole country who came at the early stages to support them. Upon moving into the temporary housing, there were some initial problems such as no reheating of the bath water and dark surroundings due to the lack of street lamps. However, following requests to the City of Tagajo, most of these issues were resolved. Many of the residents need to use a wheelchair compared to normal situation and concern was expressed regarding who will support them if another big earthquake occurs.
Conclusion : New permanent housing is being constructed and gradually being occupied, and no major problems were seen among the residents interviewed. However, the existence of the group of people who cannot come to the community meetings and the issues that elderly residents have were clarified. Support for these residents, including health maintenance, is felt to be necessary.

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[in Japanese]

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[in Japanese]

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The role of primary care in palliative care provision has been recognised as significant, nevertheless we, Japanese primary care providers, do not have many chances to share and discuss what barriers we perceive in practice. We held a workshop in the form of World Cafe at the 4th annual conference of Japan Primary Care Association to share the perceived barriers in providing palliative care. 17 participants (12 doctors and 5 pharmacists) have suggested various obstacles including difficult applying acquired knowledge to clinical practice. It was also speculated that the participants were struggling with diverse complex issues emerged from patients' care which are not to be solved by already existing knowledge. The discussions suggested the importance of interdisciplinary work to deal with high complexities inherent to palliative care. It is also crucial to collaborate and communicate not only at the individual professionals level but also at the organizational level to tackle the obstacles to provision of best palliative care in primary care setting.

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The purpose of this study is to clarify the role of the home care death conference which visiting nurse stations and home care clinics provide.
Methods : Interviews of clinic physicians, clinic nurses and nurses of the visiting nurse stations were performed. Data were analyzed by a modified grounded theory approach.
Results : Interviews were performed on eleven eligible individuals. Fourteen concepts were elucidated. These were categorized into five core categories : “the home care death conference as a place of learning”, “the home care death conference as a place of healing”, “reconfirmation of the role of a condolence visit”, “building relationships face-to-face”, “limitations of the home care death conference”.
Conclusion : Participants reflected on home care death conferences in manner of two ways ; “the home care death conference as a place of learning” and “the home care death conference as a place of healing”. Participants were able to discuss condolence visits in the home death conferences. Building relationships face-to-face is potentially effective in making community care networks operate effectively.

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[in Japanese]

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