Objective: This study aimed to clarify outpatient nurses' awareness of their support for the decision-making of newly diagnosed cancer patients undergoing surgical therapy.

Methods: Semi-structured interviews were conducted with eight outpatient nurses from two hospitals, and transcribed data were analyzed qualitatively.

Results: The following four categories of outpatient nurses' awareness were extracted: "Difficult environment for supporting decision-making", "Identifying a patient in need of support", "Collaborating at the organizational level", and "Supporting the patient until a satisfying decision is made". Although the nurses recognized the need to support cancer patients' decision-making when undergoing surgical therapy, they were obliged to prioritize other duties and found it difficult to adequately provide the support needed. Although it was difficult, nurses tried to identify patients requiring support during their routine work, and to assist them until a satisfying decision was made by collaborating with colleagues at the organizational level.

Conclusion: In order for outpatient nurses to more effectively support cancer patients' decision-making, it is necessary to allocate an adequate number of personnel, secure interview spaces, and provide training for nurses to improve their skills in decision-making support, in addition to implementing the necessary organizational changes.

Objectives: To clarify the current status of education and training at home-visit nursing service agencies, and to compare them by size.

Methods: A convergent mixed method design was employed to analyze national administrative data of home-visit nursing service agencies in Tokyo in 2015. The categories regarding the training institution and its themes were created based on the detailed description of the training. For qualitative analysis, the corresponding analysis was conducted for the size of the agencies, and the utilization rate and scale of training for each theme were analyzed quantitatively. The qualitative and quantitative results were then integrated.

Results: A total of 311 agencies were included in the analysis. Eight categories for training institutions, such as "medical institutions", were identified among the medium-sized agencies, with the smaller agencies having higher utilization rates. Among the 38 categories for training themes, "psychiatric nursing" and "child health nursing" were found among medium-sized or larger agencies. Moreover, larger agencies had higher utilization rates of training for these themes.

Conclusions: We identified the training institutions and the themes of the home-visit nursing service agencies in Tokyo. Home-visit nursing service agencies used many training institutions, regardless of size, whereas the themes were related to agency size.

Background: Few studies have focused on the current state of referral and consultation practice between generalists and specialists at Japanese university hospitals.

Methods: We retrospectively analyzed the electronic medical records of 513 outpatients (a cumulative total of 608 patients) who visited the Department of General Medicine of Toyama University Hospital between January and December 2016. All patients used our in-hospital consultation and referral service.

Results: We referred 492 new patients to different specialists, with 40% referred to psychiatry, orthopedics, otolaryngology, and dermatology specialists. Our suspected diagnoses were correct for 285 of 395 patients (72%) who were referred to specialists to confirm the diagnosis. No abnormalities were observed in 86 patients (21%), and inappropriate referrals were made for 5 patients (1.2%). We also received 116 consultations from specialists, 66% of which were from orthopedics, psychiatry, gynecology, oral dental surgery, and neurosurgery specialists. Many of the referred patients had vague symptoms such as fever and general fatigue.

Conclusion: Improving the practical skills of generalists regarding orthopedic and otolaryngologic problems may result in more appropriate referrals. Our department also served as a consultant for medical problems for specialists, especially orthopedic surgeons and psychiatrists.

Objective: We investigated cases of visit encouragement by pharmacists and drugstore salespersons, and confirmed the significance of self-medication support.

Methods: We conducted a web survey for pharmacists working at community pharmacies and drugstores, and registered salespersons working at drugstores. The main survey items were the attributes of the respondents, whether they had experience in encouraging visits to the doctor during consultations for cold-like symptoms, and the type of encouragement (patient background, main complaints, and prognosis).

Results: We obtained responses from 300 pharmacists working at community pharmacies, 57 pharmacists working at drugstores, and 56 registered salespersons. Of the respondents, 88% of the pharmacists at community pharmacies, and 100% of the pharmacists and registered salespersons at drugstores had experience in encouraging doctor visits. Of the 84 visit encouragement cases reviewed, the diseases that were often suspected were influenza, sinusitis, and gastroesophageal reflux disease. Cases of early symptoms of tuberculosis, mycoplasma pneumonia, and cerebral infarction, which were identified as a result of the doctor visits, were also included.

Conclusion: Our study suggested that when customers with cold-like symptoms received accurate support from pharmacists and registered salespersons, they not only selected the correct OTC drugs for their symptoms, but they also received support that led to the early detection of serious diseases.

Introduction: The Japanese government implemented a community-based integrated care system that provides community healthcare resources for elderly people focusing on home health care in particular. To achieve this, interprofessional teams in the community need to function seamlessly. Thus, we explored the process by which healthcare professionals change their recognition of the relationships and problems among them through the dialogue of home health care promotion.

Methods: We held the World Cafe to discuss with healthcare professionals about home health care in a city in Ibaraki Prefecture. All dialogues were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

Results: Although healthcare professionals had strongly recognized the hierarchical relationship, they deepened their mutual understanding by sharing their background and values. While sharing the hope to make equitable relationships, they changed their recognition as follows: home health care was not "someone else's problem" but "their own problem" and "their own community's problem".

Conclusion: It is necessary for healthcare professionals to share issues and explore methods to solve them in the community, and to change the relationships among stakeholders because problems related to home health care promotion are complex. This study clarified that healthcare professionals are motivated to seek solutions to problems proactively via their relationships in interprofessional teams in the community.

Introduction: This study examined the significance of support groups from the perspective of families for members who were parents of mentally disabled children in their 20s.

Methods: We conducted semi-structured interviews with parents who joined support groups for families of mentally disabled young adults. A qualitative and inductive classification method was used to extract categories from the data obtained.

Results: Five parents agreed to participate in an interview survey. Ten categories were identified: "talking to others in the same situation", "pleasant places where they feel at ease", "connecting with other families", "sharing the same issues with others", "talking about things other than their children", "learning from each other", "promoting empowerment as a parent", "dealing with their children more easily", "improving family relationships", and "preparation for raising issues within the community".

Conclusion: Parents who joined support groups for families of mentally disabled young adults felt that it was important to share problems regarding their children's siblings, the types of housing their children are faced with living in when they become independent, and the types of insurance plans their children can purchase. They also found it important for family support groups to be able to help prepare them to raise issues within the community.

Unconscious bias refers to implicit associations or attitudes we hold that operate beyond our conscious awareness. It can significantly influence our behavior and decision-making. Studies suggest that the lack of advancement into prestigious and leadership positions by women and gender pay gaps are due to the unconscious gender bias against women. In traditionally male-dominant fields, such as medicine, women are evaluated less favorably than their male colleagues. Women physicians are exposed to negative unconscious bias in numerous settings from daily interactions with patients, physician colleagues and co-medical workers to evaluations, access to educational opportunities and promotions. The unconscious bias against women negatively affects not only social interactions and external evaluations of women, but also their performance. To reduce the unconscious bias against women, training for staff and stakeholders, including women themselves, and the construction multi-faceted systematic interventions are needed.

In February 2017, general practitioners (GPs) from the Department of Community and Family Medicine of Fukushima Medical University in Japan visited Australia for a study tour where the tour participants met with local GPs, GP registrars and researchers. During this tour, we visited public hospitals and observed multiple GPs providing community-based health care. We also attended a new GP registrars' orientation where the two authors gave a presentation about the current status of primary care in Japan. We then visited an Aboriginal health research center, and learned about the cultural values of the Aboriginal people and the challenges of implementing large-scale cohort studies.