Introduction : This study examined the correlation between the death of cancer patients at home and the number of COVID-19 infected persons.

Methods : We defined the proportion of cancer patient deaths at home in 2020 by prefecture as the outcome. We also defined the cumulative number of COVID-19 cases that occurred in 2020 by prefecture (per population) as the main factor. We performed single linear regression analysis and multiple linear regression analysis using the number of deaths at home-by-home care supporting clinics, the number of hospitals per population of elderly, the number of people using home-visit nursing per population of elderly, and the number of home-visit care workers per population of elderly as the confounding factors.

Results : the proportion of deaths at home in cancer patients was associated with the cumulative number of COVID-19 cases by both single linear regression analysis and multiple linear regression analysis.

Conclusion : Prefectures with a higher number of COVID-19 infections also has a higher number of at home deaths among cancer patients, who may have a greater need for end-of-life care at home.

Since very few registered dieticians are involved in home medical care in Toyota City Japan, the role of registered dieticians is not understood by healthcare workers providing home medical care. A workshop to teach care workers (n=15), nurses (n=8), and rehabilitation workers (n=13) the importance of nutritional management and increase their awareness of the roles of registered dieticians was held. Whether people who completed the workshop hadincreased expectations of registered dieticians was then investigated. The results showed that, though all healthcare workers thought nutritional management was necessary, they perceived their own knowledge of nutritional management as inadequate. It was also shown that the demand for registered dieticians and the level of interest in nutritional management differed depending on job category. In the future, it will be necessary to investigate workshop programs aligned with the needs of each profession.

【Object】This survey has clarified the possibilities and problems brought by home-based enzyme replacement therapy for patients with mucopolysaccharidosis and their families.

【Methods】Questionnaire survey. Interview survey.

【Results】The survey results showed that 66% of the respondents who wanted to receive home-based enzyme replacement therapy also hoped for home-visit medical care. The home-based enzyme replacement therapy showed the possibilities of reducing the load of a regular hospital visit by lowering the risk of infection and balancing the patient’s social life and medical treatment. One of the reasons the home-based enzyme replacement therapy was not realized, although the patients and their families had the desire to do it, was the poor system of regional health care service. Those who did not hope for home-based enzyme replacement therapy answered that it was hard to imagine receiving the therapy at home, and they were worried about how to cope with the side effects. They also wanted to draw a line between home and the place where they receive medical care. Home-based enzyme replacement therapy should be more understood and promoted by providing patients and their families with more information, including the advantages and disadvantages of the therapy.

【Conclusions】At the same time, the regional healthcare system should be improved so as to respond to patients' requests for home-based enzyme replacement therapy.

【Purpose】The purpose of this study was to clarify the collaborative activities and mutual recognition between community comprehensive care unit's nurses (Ns) and care managers (CM) in supporting discharge of elderly from hospital.

【Method】300 nurses working in community comprehensive care wards and 360 care managers working in B City in A Prefecture were surveyed using an anonymous self-administered questionnaire.

【RESULTS】The highest percentage of responses regarding necessary collaborative activities with multiple professions in supporting hospital discharge were the same for Ns and CMs. The items regarding practice with the highest percentages were “relationship as a team” for Ns, and “user-centered awareness” for CM. While these professionals were willing to share information about their patients' lives after discharge, the percentage of those explaining their expertise was low. It is thought that collaborative activities focusing on these aspects would lead to more appropriate discharge support.

We analyzed 495 home care patients. The mean age of all patients (195 males and 300 females) was 83.4±10.1 years. The mean age of male patients (81.0±11.7years) was significantly younger than the mean age of female patients (84.9±8.6 years) The mean age of patients with malignant disease was 77.1±9.9 years for men and 77.2±12.9 years for women, which was significantly lower than the mean age for benign disease, 82.0±12.0 years for men and 86.0±7.2 years for women. The survival rates for all patients were 75.5% at 1 year, 65.3% at 2 years, and 54.2% at 3 years. By gender (195 males and 298 females) , the rates were significantly higher for females：82.2% for females and 64.8% for males at 1 year, 71.9% for females and 54.5% for males at 2 years, and 65.4% for females and 37.4% for males at 3 years. Age at first diagnosis (HR 1.056 95%CI 1.0300 － 1.086) , gender (HR 2.744 95%CI 1.849 － 4.073) and PS (HR 1.627 95%CI 1.332 － 1.988) were significantly correlated with prognosis for survival in patients with benign disease. Forty nine (31.6%) patients died at home, 32 (20.6%) in a nursing home, 73 (47.1%) in a hospital, and 1 (0.6%) unknown.

A qualitative inductive study using individual interviews was conducted to clarify the perspectives from which home physicians evaluate prescriptions for home care patients and how they decide prescription. A semi-structured individual interview was conducted with 17 physicians engaged in home medical care. We found that home physicians made prescribing decisions based on a variety of factors ; the physical effects of drugs, the patient's prognosis and quality of life, their relationship with the patient and family, and their interactions with various professions. Visualization of the prescription changing process and a common understanding of prescribing behavior among healthcare professionals are expected to improve the quality of prescribing in-home medical care.

Introduction : We describe a case in which a patient presented with aggravated disuse syndrome during hospital admission into an acute-care hospital. Home-visiting medicine was introduced for the patient upon discharge.

Case : An 81-year-old woman was transferred from an acute-care hospital to our hospital. The patient was almost bedridden due to disuse syndrome. Her family was perplexed by the patient’s declining condition but wished to take care of the patient at home. The patient was emergently discharged from our hospital. On the day of discharge, nasal cannula oxygen was initiated and the patient was started on home-visiting medicine. 10 days after discharge, the patient died. The family was grateful they could stay with the patient during that period.

Discussion : Before initiating home visiting medicine, care service using medical and nursing care insurance are usually planned. However, depending on the patient's condition, home visiting medicine should be initiated soon after emergent discharge. To smoothly achieve this goal, daily interdisciplinary collaboration is essential.

The purpose of this study was to prepare a dysphagia diet using limited ingredients and cooking utensils to simulate disaster conditions. A total of 7 ingredients were selected from a government reference list of relief supplies. Cooking was done using a cassette stove and plastic bags. We made adjustments in accordance with guidelines for dysphagia diet 3 as set forth in Japanese Dysphagia Diet 2021. A creep meter was used to examine the validity of the swallowing-adjusted foods. The measurements showed that most of the adjusted foodstuffs conformed to the standard. Some foods were non-compliant due to changes in physical properties caused by changes in temperature. Care must be taken when serving such items. To provide appropriate food support in the event of a disaster, it is necessary to establish a food support system for people with feeding and swallowing difficulties through repeated studies such as this one.