In the process of determining policies for end-of-life medical treatment and care for cases in which residents of designated facilities covered by public aid providing long-term care to the elderly / special elderly nursing homes (hereinafter, “nursing homes”) are given a terminal diagnosis after hospitalization at a medical institution, this study clarified the difficulties and challenges associated with collaborations between long-term care facilities and hospitals, as perceived by nursing managers at nursing homes. In 2014, a questionnaire was mailed to 354 nursing managers at nursing homes across Japan. The percentage of respondents perceiving difficulties and challenges towards non-affiliated hospitals was significantly larger than those towards affiliated hospitals. In terms of difficulties, concerns about medical treatment (45.5%) were most common, followed closely by cooperation with attending physicians (43.8%). In terms of challenges, differences in understanding of nursing homes (79.7%) and the adverse effects of medical dependency (71.8%) each accounted for almost 80% of responses, suggesting the need for initiatives at medical institutions to encourage an understanding of the realities of nursing homes.

Purpose：This study was performed to clarify the implementation status of home care nursing for recovery of eating and swallowing function in elderly patients.

Methods：A questionnaire survey comprised of seven factors broken down into 63 items was distributed to 130 nurses on integrated community care wards. Of these seven factors, four were broken down into 43 items regarding assistance with eating, and three factors were broken down into 20 items regarding home care nursing.

Results：The items with the highest scores for assistance with eating were "observing the patients' waking status" （95.0%）. The item with the highest score for home care nursing was "gathering information regarding cognitive function before hospitalization"（90.0%）. However, there were four items less than 50% among "dietary guidance for patients and their families". The items with the lowest scores were“assistance items for food tools,” “consultation with an occupational therapist”, “salivary gland massage before meals”, and “ice massage in the oral cavity before meals”.

Discussion：Collecting information regarding food tools and increasing collaboration with occupational therapists were considered necessary to restore patients' eating and swallowing functions. There is a need for more opportunities for nurses to give discharge guidance to elderly patients and their families.

Purpose：This study focuses on“ Internists Specialized for Organs/Region”. The purpose of this study was to clarify the relationship between their depth of understanding about the characteristics of “General Practitioners” and their recognition of the need for receiving clinical training for home medical care before changing the direction of their careers.

Methods：A questionnaire involving 2,666 participants was conducted from January to April 2016. It focused on changes in career direction from internal-medicine physicians specialized for Organs/Region to general practitioners. The questionnaire included a scale for the recognition of the role of general practitioner and how much importance participants placed on home medical care training for “General Practitioners”. A logistic regression analysis was conducted on the recognition scale score (“Very important” or “ Otherwise”).

Results：Valid responses were received from 501 physicians (18.7%). A significant association was observed between the recognition score of “General Practitioner” and the need for clinical training for home medical care based on the multiple logistic regression analysis (adjusted odds ratio: 1.06; 95% confidence interval: 1.03-1.08; p<0.0001).

Conclusion：It was suggested that the majority of “ Internists Specialized for Organ/Region” recognize the importance of “General Practitioners”. This perspective had a positive correlation to the need for receiving clinical training for home medical care before changing their career direction to “ General Practitioner”.

Purpose：We analyzed the difference in the hospitalization rate and the process of emergency hospitalization between home care child patients and adult patients.

Method：We tracked the hospitalization rate of 15 children and 77 adults receiving home care from one clinic for one year (January 2018-december 2018) then did a retrospective chart review.

Result：Thirty-two hospitalizations were found in 13 children (2.13times/year), while 14 hospitalizations were found in 12 adults (0.16times/year). Half of the home care child hospitalizations were decided by the families and home care nurses.

Conclusion：In the home care setting, more child patients tended to be admitted to hospitals than adult patients. The families and home care nurses have more influence on emergency hospitalization in child cases than they do in adult cases.

Our home care clinic treated two patients who were administrated ketamine via central veins at a university hospital. Two patients strongly requested to spend their last days at home. Our palliative care clinic continuously administered ketamine to these patients at home.

　As far as we know, there was no apparent side effect. Ketamine has been classified as a narcotic drug in 2007. So, it is difficult for home care clinics to handle ketamine. Home palliative care doctors have to prepare in advance to use ketamine on severe terminal patients who wish to spend last days at home. In order to treat cancer patients with ketamine, we must have a narcotics administrator or practitioner license and prescribe it in clinic. Approval usually takes about two weeks after submission of application. Two patients died within several weeks of discharge.