Introduction: The factors associated with the recovery of activities of daily living (ADL) in elderly inpatients have not been clarified. This study aimed to investigate the factors associated with recovery of ADL in elderly inpatients with acute infectious disease who underwent rehabilitation during their hospitalization.

Methods: The study included patients ≥65 years of age who were hospitalized due to acute infectious disease and had undergone rehabilitation at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL, and the recovery rate of FIM was calculated. Furthermore, the factors associated with the recovery rate of FIM were evaluated by multiple regression analysis. Basic characteristics, length of stay, length from onset to starting rehabilitation, physical status (muscle strength and presence of urinary incontinence), and mental status (cognitive and depression) at the start of rehabilitation were included as the evaluation items.

Results: Among the 124 elderly inpatients with acute infectious disease (mean ± standard deviation age, 82.5±7.7), 56 were male and 68 were female. According to the multiple regression analysis, length from onset to starting rehabilitation (β=-0.03), presence of urinary incontinence (β=-0.29), and cognitive status (β=0.01) were factors associated with the recovery rate of FIM.

Conclusion: The study results suggest that length from onset to starting rehabilitation, presence of urinary incontinence, and cognitive status are important for elderly inpatients with acute infectious disease to return to their ADL.

Objective: This study aimed to clarify the circumstances and challenges in home care-oriented hospital nurse training on the basis of results of hospital nurse self-evaluations of nursing activities implemented in preparation for home care.

Methods: Group interviews were conducted with 13 nurses at 9 different hospitals, and the results were qualitatively and inductively analyzed.

Results and Discussion: Six categories for actual nursing activities implemented in preparation for home care were extracted. These categories were "I leave home care to other medical professionals," "No form of inter-hospital cooperation has been established," "There is disparity in cooperation with home-visiting nurses," "Social resources are not being used due to a lack of knowledge," "Able to develop a perspective of home care through workshop participation, years of experience, and interest," and "Competency is lacking despite knowledge of home care." Home care was apparently not being utilized by hospital nurses due to a lack of knowledge of social resources and a lack of interdisciplinary cooperation.

Conclusions: Challenges in nurse training implemented in preparation for home care included compensating for the lack of practical knowledge of social resources and devising a duty system and inter-facility exchanges to allow nurses to build experience in other areas and departments. The results of this study suggested the need for organizational training initiatives and for improvement of the quality of individuals in order to put acquired knowledge into practice.

Purpose: This study was conducted to evaluate our diagnostic and therapeutic system using patient checklists, scoring sheet and standardized treatment regimen for the patients with subacute/chronic cough without abnormal chest X-ray findings.

Methods: Based on our clinical system, we had diagnosed and treated 120 patients with subacute/chronic cough without abnormal chest X-ray findings. We also examined 83 cases that were available for evaluation of therapeutic response at the time of second visit.

Results: The mean patient age was 48.4 years (range 21 to 74 years). Thirty-three of the patients were men, 50 were women. Forty-nine cases (59.0%) were diagnosed as "Allergic cough" (such as bronchial asthma, cough-variant asthma, or atopic cough). At the time of the second visit, 67 (80.7%) patients exhibited significant or moderate improvement of their symptoms (49 cases; significant improvement, 18 cases; moderate improvement).

Conclusion: Our clinical system may be useful for patients with subacute/chronic cough. Further clinical investigation is needed.

Introduction: In patients with sleep disturbance, doctors and pharmacists jointly implemented protocol-based pharmacotherapy management (PBPM), and examined the effects and levels of patient satisfaction achieved with this therapeutic approach.

Methods: The subjects were 21 patients with insomnia. Prior to medical consultations with the doctor, the pharmacist collected the patients' information by interviewing them, and followed the protocol to determine their need for sleep medicine, propose optimal prescriptions, and use a cognitive-behavioral therapy approach. Three months after the intervention, changes in the patients' sleep quality were evaluated using the Pittsburg Sleep Quality Index (PSQI), Insomnia Severity Inventory (ISI), and Epworth Sleepiness Scale (ESS). To evaluate the levels of patient satisfaction, we used the Japanese version of the Client Satisfaction Questionnaire comprising 8 items (CSQ-8J).

Results: The patients' scores pertaining to sleep quality before intervention were PSQI: 10.3±4.1, ISI: 15.0±5.3, and ESS: 8.7±6.6, all of which showed significant improvement 3 months after the intervention to respective values of 7.2±2.7, 8.3±4.3, and 6.2±5.5. The mean score for CSQ-8J was 25.5±3.1, indicating high levels of patient satisfaction. No serious adverse events were observed.

Conclusions: The use of PBPM in patients with sleep disturbance can ameliorate their insomnia symptoms and yield high levels of patient satisfaction. Our findings suggested that PBPM allows pharmacists to play an active role in the treatment of insomnia and contribute to the provision of appropriate drug therapy tailored to the needs of individual patients.

Objective: To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.

Methods: We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.

Results: The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).

Conclusions: The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.

Introduction: The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.

Methods: We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).

Results: Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.

Conclusion: The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.

Introduction: We evaluated the risk of shortness of inhalation when using laninamivir without inhalation practices.

Method: We counted the number of attempts required by each patient to sound the whistle. We classified the patients into the following categories: ①Sound rang in the first attempt; ②Sound rang within 3 attempts; ③Sound rang with in 5 attempts; ④Sound rang within 10 attempts; ⑤The whistle did not sound. We assessed the following: 1. the rate of patients younger than 10 years of age assessed category ② or less,; 2. the rate of patients of teen-age, and 3. the rate of patients of 20 years of age or older, assessed category ③ or less.

Results: We examined 56 patients, and we found that the rate for 1. was 7/11= 63.6%, for 2. was 4/33= 12.1%, and for 3. was 2/12= 16.7%.

Conclusion: We found that more than 60% of patients younger than 10 years of age and more than 10% of patients of 10 years of age or older were at risk of shortness of inhalation when using laninamivir without inhalation practices. And we propose other medication if patients cannot sound the whistle within about 5 attempts.