Introduction: The effectiveness of first-aid measures (binding, incision and aspiration) for patients with habu bites and the indications of dry habu equine antitoxin for patients with habu bites are unclear. We investigated the relationships between first-aid measures and prognosis, and between symptoms (pain, swelling and bleeding) and antitoxin administration. Methods: We evaluated responses to a questionnaire submitted by 65 patients with habu bites. Patients who fully recovered were defined as "good", and those who had functional disorders, with or without rehabilitation, were defined as "bad." Fisher's exact test was used for analysis. Results: Pain was significantly related to antitoxin administration; however, swelling and bleeding were not related to antitoxin administration. First-aid measures and local symptoms were not related to prognosis. Conclusion: Our results revealed that many doctors determine the need for antitoxin administration according to pain. Moreover, our results suggested that the need for first-aid measures for patients is minimal. However, to clarify the indications for antitoxin administration and the effectiveness of first-aid measures for patients, further studies are warranted.

Introduction: We conducted 3 surveys to elucidate the current status of Women's Health (WH) training in Japanese General Practice Residency Programs, and the opinions that the residency program directors and learners have about the training.

Methods: Three questionnaire surveys were conducted during Aug-Nov, 2015. Subjects of the surveys were residency program directors (Survey 1), resident physicians (Survey 2) and medical students (Survey 3).

Results: Survey 1 (response rate 42.7%): Regarding the programs, 6.8% and 38.9% provided compulsory WH rotations and selective rotations, respectively. Of the respondents, 71.4% wished to improve WH training, whereas 68.0% noted barriers, including the shortage of teaching physicians, and lack of understanding by teaching physicians regarding the needs and objectives of WH training. Survey 2 (response rate 45.8%): Of the residents, 14.5% and 27.9% had compulsory and selective WH rotations, respectively. The WH training was reported to be insufficient by 57.8% of the respondents. Survey 3 (response rate 85.4%): Of the medical students, 97% desired WH training and 97.7% wished to practice WH in the future.

Conclusion: Our surveys revealed WH training in current Japanese General Practice Residency Programs to be inadequate, and both trainers and trainees desired further improvement of their training programs.

Purpose: In this study, we performed a longitudinal examination of the occurrence of homeboundness among community-dwelling elderly individuals and changes in associated factors, including the sense of coherence (SOC).

Methods: A questionnaire survey was conducted targeting community-dwelling elderly individuals to evaluate homebound status, a basic checklist (CL), and SOC. Among these individuals, frail elderly people who maintained a non-homebound state were extracted and a follow-up survey was carried out one year later. Those who maintained the non-homebound state one year later were classified into the maintenance group and those who became socially withdrawn were classified into the transition group. Factors predicting the homebound state one year later were examined using multiple logistic regression analysis. Furthermore, the changes in CL and SOC between the transition and maintenance groups were compared.

Results: In the transition group, motor function, cognitive function, and sense of manageability on the initial survey were significantly lower than those in the maintenance group. Significant correlations were noted in the homebound transition group with lack of money management (OR: 3.04, 95% CI: 1.19-7.82) and a declined sense of manageability (OR: 0.82, 95% CI: 0.69-0.99). Depression and the sense of manageability had also significantly deteriorated one year later compared with those in the maintenance group.

Conclusion: This study suggests that individuals who transition to a state of homeboundness have a slightly lower SOC than those who maintain their non-homebound status.

Objectives: The purpose of this study was to examine the occurrence of accrued receivables by types of medical insurance to clarify those responsible for the accrued receivables related to medical expenses.

Methods: Using accrued receivable data for FY2016 (for practices from April 2016 to March 2017) obtained from Matsue Seikyo General Hospital, quantitative analysis was carried out for the occurrence of accrued receivables by hospital visiting patterns and insurance types.

Results: The incidence rate of accrued receivables among all consultations at the hospital was 1.06%. The incidence rate was the lowest for patients with Union Health Insurance. On the other hand, the incidence rate of accrued receivables among patients with health insurance administered by the Japan Health Insurance Association, which is another employment-based health insurance, was three-times higher than that of those with Union Health Insurance, and higher than those with National Health Insurance or Advanced Elderly Medical Service. The incidence rate of public assistance was the highest at Seikyo General Hospital, including hospital admission; it was characterized by a high incidence of accrued receivables for expenses for diapers and hospital gowns during hospitalization.

Conclusion: To mitigate this issue, cooperation of hospital staff was suggested to be important.

Introduction: Although the number of deaths following a diagnosis of senility is increasing in Japan, the criteria of senility are unclear. Therefore, the purpose of this study was to investigate methods to diagnose senility in home medical care.

Methods: We mailed questionnaires to 908 members of the Japan Network of Home Care-Supporting Clinics.

Results: In total, 535 members (58.9%) responded. Responses of 501 members who selected senility as the cause of death were analyzed. Most doctors considered "continuous care of the patient", "the patient's ADL and gradual decline in oral intake", and "the absence of other critical diseases" to be important when diagnosing senility. The items affecting a diagnosis of senility were "the family's understanding and opinions", "other diseases being medically excluded", and "contribution to the patient's QOL".

Conclusion: In home medical care, many doctors consider continuity of care, gradual decline, and the absence of other critical diseases to be important when diagnosing senility. Non-medical aspects, such as the family's opinions and patient's QOL, affected the diagnosis.

In Japan, improving the quality of primary care is an urgent issue; however, there is currently no specialized third-party evaluation program for primary care facilities. In this article, prior to the development of Japan's third-party evaluation program for primary care, we examined the systems and standards for the evaluation of primary care facilities in other countries. Based on the comparison of standards for the evaluation of primary care facilities by third-party evaluation agencies in four countries with Japanese hospital evaluation standards, the standards for collecting and utilizing quality data need to be strengthened from the viewpoint of patients, and areas, such as preventive medicine and home care, need to be covered when developing evaluation standards for primary care facilities in Japan. Moreover, building the structure of the standards with primary care as the main framework will strengthen the function of primary care facilities through continuous quality improvement.

Point-of-care ultrasound (POCUS) has become increasingly employed in recent years. POCUS is the concept of quickly assessing for conditions using ultrasound based on the patient history and physical examinations to make a clinical decision in a timely manner. This concept has been developed and widely used in emergency medicine and other specialties, and has spread to primary care over the past several years. In Japan, POCUS is not well-known in primary care, but the importance of primary care physicians using ultrasound has been reported since the 1990s. However, many physicians depend on higher imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), instead of ultrasound. Although the benefits of integrating POCUS into primary care have been documented, the barriers of POCUS being employed by primary care physicians include a shortage of educational resources and time during busy practice. As primary care settings in Japan vary, such as clinics, hospitals and patient homes, the indications and required skills for POCUS differ. A standardized training curriculum for POCUS needs to be developed according to the primary care setting.