Introduction: The purpose of this study was to identify factors that affect the expression of opinions regarding choices in end-of-life medical services by community-dwelling elderly people.
Methods: We mailed a self-administered questionnaire to 780 elderly people who participated in preventive care projects in two municipalities in the Kanto region.
Results: Of the 368 respondents (response rate, 47.2%), we included 348 who provided valid responses (valid response rate, 94.6%) in the analysis. We performed logistic regression analysis to identify factors influencing the expression of opinions regarding choices in end-of-life medical services. As a result, the experience of being at someone's deathbed was an influencing factor (p=0.046, OR=1.576).
Conclusion: The factor affecting the expression of opinions regarding choice in end-of-life medical services was the experience of being at someone's deathbed.
Introduction: We investigated the end-of-life care preferences of patients with mild dementia and compared them with the hopes of caregivers regarding end-of-life care for patients.
Methods: A questionnaire survey was conducted among outpatients with mild dementia or mild cognitive impairment and their family caregivers who visited the Medical Center for Dementia.
Results: We analyzed 50 pairs of dementia patients and their family caregivers. Of people with dementia, 24 respondents (48.0%) preferred "antibiotics and infusions for pneumonia" at the end of life. Eleven respondents (22.0%) preferred "central parenteral nutrition". Eight respondents (16.0%) preferred "resuscitation". For each end-of-life care item, the concordance rate between patients and caregivers on "prefer" / "do not prefer" was 0%-76%. Patients and their families who discussed end-of-life care had a significantly higher concordance rate for "resuscitation" preference than those who did not.
Conclusion: For patients and their families to be able to make decisions they do not regret, it is important to promote discussions about end-of-life medical care before the patient's condition becomes severe.
Introduction: Tetanus is a highly fatal infection that causes tonic convulsions. Although magnesium sulfate may be effective as a treatment option for myopathic symptoms, there is little knowledge regarding its use. Therefore, this study assessed the use of magnesium sulfate for patients with tetanus requiring critical care management.
Methods: Using multiple mailing lists of registered physicians in Japan, a questionnaire survey was conducted on the conditions during which magnesium sulfate was used for patients with tetanus requiring critical care management. An internet questionnaire form service was utilized.
Results: The number of targets in this study was 24,266 and responses were received from 604 physicians, 252 of whom treated patients with tetanus requiring critical care management. In total, 126 of the above physicians used magnesium sulfate for tetanus.
Conclusion: Magnesium sulfate was used for a substantial number of patients with tetanus requiring critical care management. To establish the utility of magnesium sulfate as a tetanus treatment option, further evidence is required.
Introduction: The aim of this study was to clarify the process by which family physicians succeed their parents in their family's clinic and issues that successors experience during this process.
Methods: Subjects were certified family physicians in Japan who either succeeded their parents in their clinics or were working regularly at their family's clinic and were planning to succeed their parents. Participants were recruited through a certified family physician mailing list or privately contacted, and participated in a semi-structured individual interview. The text of the interviews was thematically analyzed.
Results: Twelve participants were interviewed. All were male. Seven participants succeeded their parents. Family physicians succeeding their parents in their clinics felt implicit expectations towards succession from their family members and communities, which made them think that succession was the goal. They realized that they had no ability to decide on the timing of succession, clinics have customs and continuity, predecessors have different ideas about professionalism, and family businesses are complex. They felt conflict, especially about predecessors, in their emotions towards family members and ideas based on professionalism.
Conclusion: We clarified the process of succession by family physicians in their family's clinic, and the issues and conflicts they face during this process.
Introduction: Our aim was to examine the changes in the self-rated frequency of activities among elderly residents living in communities during the self-restraint period associated with the Coronavirus Disease 2019 (COVID-19) pandemic.
Methods: Regular outpatients aged 75 years or older who visited the hospital or clinic at the Center for Community Medicine in north-western Gifu prefecture between May 11 and May 22, 2020 were selected as participants. The frequency of outings, walks, outdoor exercise, indoor exercise, farm work, communication and interaction, such as at community salons, direct communication with friends and estranged family members, and remote communication by telephone and video calls was surveyed using a questionnaire method at four levels: "0 days", "1-2 days", "3-4 days", and "5 days to every day" per week in the two weeks prior to the visit and in the same period in the previous year.
Results: In total, 292 people aged 75-95 years participated in the study. There was an increase in the number of respondents who reported a lower frequency of going out, walking, farming, outdoor exercise, home exercise, visiting community salons, and direct conversation than in the previous year. There was a significant difference between the two groups (P<0.05).
Conclusion: In this study, the self-rated frequency of physical activity and social activity decreased among community-dwelling elderly due to the COVID-19 epidemic, suggesting a reduction in these activities.
Introduction: The purpose of this study was to clarify the needs in end-of-life care management for elderly persons requiring long-term care at home.
Methods: Semi-structured interviews were conducted for 20 people working in the community, and were analyzed qualitatively and descriptively.
Results: Support to enable discharge at home, formation of a care team to help achieve a desired life and desired end, family support for the entire end-of-life period, support for making timely and informed decisions, control of symptoms to achieve desired results, and both mental and spiritual support for end-of-life acceptance were provided to realize the individuals' desires.
Conclusion: This study suggested that it is possible to provide high-quality care management for the elderly requiring long-term care at home in the end-of-life period.
We report the case of a 1-year-old female with invasive pneumococcal disease (IPD) after three administrations of the 13-valent pneumococcal conjugate vaccine (PCV13) according to the immunization schedule for children in Japan. Blood culture detected Streptococcus pneumoniae 24B, which is a non-vaccine serotype. In Japan, PCV7 introduced in 2010 reduced the number of IPD patients under 5 years of age. However, the number of children under 5 years of age with IPD due to non-vaccine serotypes gradually increased after 2014 even though PCV13 was introduced in 2013. Pneumococcal vaccination cannot completely prevent IPD. Therefore, medical practitioners should pay attention to IPD due to non-vaccine serotypes.
Objective: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by optic neuritis and myelitis. NMOSD is more prevalent in the elderly than multiple sclerosis. In particular, optic neuritis of NMOSD is common in the elderly.
Methods and Results: We report an 82-year-old female patient with no medical history who presented with optic neuritis as the first attack of NMOSD. On day X−15, she developed horizontal hemianopia and was referred to our department. On admission, her visual acuity was hand motion. Cerebrospinal fluid suggested pleocytosis. Magnetic resonance imaging revealed a hyper-intense lesion on the optic chiasm and optic tract. Steroid pulse therapy was performed, but from the night, delirium with visual hallucinations developed. She refused drug administration, removed the intravenous administration route, and was unable to continue in-hospital treatment.
Conclusion: NMOSD often develops in the elderly with optic neuritis, and in addition to steroid therapy, plasma exchange or immunoglobulin therapy is expected to improve the prognosis. However, in our case, treatment was discontinued due to marked delirium accompanied by visual hallucinations. Visual hallucinations are more likely to occur in elderly patients with visual impairment, and clinicians should be careful and manage hallucination-associated delirium.
Introduction: The aims of this study were to clarify the characteristics and examine measures for improving the nursing practice competencies of home health nurses.
Methods: A narrative review was conducted to analyze the definitions of key elements that constitute the competencies in nursing practice of home health nurses in Japan.
Results: The competencies of home healthcare nurses were based on professional attitudes, knowledge, and skills. The characteristics of these competencies were demonstrated in daily life in the practice of home health care. The following common elements were extracted from more than half of the seven articles reviewed: "support for users and their families with independence and individuality," "utilization of the health care system, social resources, and inter-professional collaboration," "basic professional attitude and demeanor as a home health nurse," and "risk management for disaster and infection."
Conclusion: The development of these four elements of nursing practice in the training of home healthcare nurses should be prioritized. To improve the competencies of home healthcare nurses, on-the-job training that focuses on the individuality of users and opportunities for team management should be provided. In the training of newcomers, competencies should be achieved based on their attitude as professionals and risk management skills.
This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.