Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 44, Issue 3
Displaying 1-20 of 20 articles from this issue
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Contents
  • Planning for home care hospice system in medical care
    -The role and definition of the home care agency-
    MASAKO SUGIMOTO
    1998 Volume 44 Issue 3 Pages 271-285
    Published: December 21, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.44.271
    JOURNAL FREE ACCESS
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    Objective : This study was performed to increase understanding regarding the growth of home hospice care within home care agencies in Japan, and to discuss the role and definition of the home care agency as part of the medical care to improve home hospice care with particular attention to terminally ill cancer patients. Material and methods : We sent a questionnaire to the presidents of 1485 home care agencies throughout Japan, and interviewed 5 medical doctors. Results : A total of 73.4% of home care agencies provide home hospice care, and treat an average of 13.7 patients each year. Patients who died in the home per year averaged 3.2. The home care agencies with nurses experienced in home hospice care exhibited high performance ratios. Furthermore, home care agencies which do not provide home hospice care, are highly interested in the home hospice care program. There are some differences between the home hospice care which home care agencies perform, and that provided by doctors. The necessity of a 24-hour response system has been suggested. To improve home hospice care, close cooperation between doctors (who practice home hospice care, and those in hospitals) is important. Therefore, government and hospital support are necessary to develop programs and to provide factual education regarding home hospice care for doctors and nurses. In addition, for the general public to accept home hospice care, extensive publicity and health education is essential. Conclusion : This study suggests that home care agencies can play a key role in the home hospice care system, if these agencies provide a 24-hour answering and response system for terminal cancer patients, and if doctors are involved with the care program. Home hospice care in the Japanese medical care will greatly improve if government support is received to increase understanding, and to provide education for doctors, nurses and the general public.
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  • Effects of personal attributes and working environment on subjective symptoms of fatigue experienced by the staff of institutions for the mentally retarded
    HIDEKI SATOH, KAZUO NAKAJIMA
    1998 Volume 44 Issue 3 Pages 286-293
    Published: December 21, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.44.286
    JOURNAL FREE ACCESS
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    Objective : The state of fatigue before commencing work and after finishing work was assessed among the staff of institutions for the mentally retarded, and the effects of personal attributes and the working environment on subjective symptoms of fatigue were investigated. Materials and methods : The subjects were selected from the staff of 32 institutions in Hokkaido for the mentally retarded that had been in operation for more than 3 years. Only staff directly involved with the mentally retarded were selected for the survey. Personal attributes, working environment and subjective symptoms of fatigue were assessed. Results : The results of the analysis demonstrated that the frequency of fatigue experienced after finishing work was higher than that before starting work, and the type of fatigue was mental. Among the subjective symptoms, “drowsiness and listlessness” was correlated with the following 5 items : age, marital status, experience at institutions for the mentally retarded, working hours per week, and number of night duties per month. The “number of night duties per month” was also correlated with difficulty in concentration. Both sex of the subject and number of night duties per month were correlated with “localized malaise”. Conclusion : The fact that number of night duties per month was correlated to 3 subjective symptoms of fatigue indicates the necessity for improvement in the working environment and rationalization of duties and the working system to maintain the health of staff in institutions for the mentally retarded.
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  • Improvements in the system of prescribing and dispensing medicine
    NORIKO FUKUSHIMA
    1998 Volume 44 Issue 3 Pages 294-304
    Published: December 21, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.44.294
    JOURNAL FREE ACCESS
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    Objectives : The purpose of our research was to clarify concrete problems and to offer suggestions for pharmacists to improve medical effects. Subjects and methods : Subjects were selected from community pharmacy members of the A. Municipal Pharmacists Association. Of 238 pharmacies contacted, 191 responded, and of 441 pharmacists working for the responding pharmacies, 391 responded (recovery rate : 88.7%). The survey was conducted between October and November 1996. A questionnaire was distributed to each pharmacist and completed questionnaires were collected. Results : Some differences in managing patients' medication histories and instructing drug use were noted between individual pharmacies. The pharmacists who mainly engaged in filling prescriptions at dispensing pharmacies filled out many items in a patients' medication log although the items did not necessarily ensure improved medical outcomes. When instructing drug use, the patients' medication records were utilized, but the pharmacist sometimes failed to understand information such as the patients' symptoms due to lack of medical expertise. Pharmacists who mainly engaged in selling medicine at pharmacies and who engaged in both filling prescriptions and selling medicine managed patients' medication records poorly. More effective methods of using patients' medication histories should be developed in the future. Conclusions : Pharmacists must avoid differentials in pharmaceutical practices in different pharmacies to ensure better outcomes with separate systems of prescribing and dispensing. Our study showed that key areas must be improved, such as thorough implementation of keeping medication records, establishing ways to effectively assess the medication history, securing a system of obtaining up-to-date information and coordinating better relationships with other medical professionals. We suggest that appropriate training and education programs for pharmacists be reinforced and propose that a committee for interdisciplinary practices be used to achieve the desired goals.
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  • Study on the transition of autopsy rate in University Hospitals in Japan
    by questionnaire survey to the councilors of the Japanese Society on Hospital Administration
    XUEKUN YANG, HISAMASA IMAI
    1998 Volume 44 Issue 3 Pages 305-312
    Published: December 21, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.44.305
    JOURNAL FREE ACCESS
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    In the first paper of this study series, by analysis from annual medical records we had shown in detail the tendency of linear decrease in autopsy rate in all the University Hospitals in Japan since early 1980s till now. In the second paper, as a next step, we performed a questionnaire survey on the downward trend of autopsy rate to leading staff in the Clinical and Pathological Departments of Juntendo University Hospital, in order to search significant candidates for cause for the downward trend of autopsy rate and to take measures to stop this trend. In this paper, we performed the same questionnaire survey as in the second paper to all the councilors of the Japanese Society on Hospital Administration and analysed the data and compared with those in the second paper. The first and the greatest candidate to be pointed out by both the medical staff in Juntendo University Hospital and the councilors of the Japanese Society on Hospital Administration was, as expected, recent remarkable advances in diagnostic techniques, e. g. diagnostic imaging and biopsy. The second candidate by the councilors was troubles with the system for autopsy in the Pathology Department, and the evaluation was diverse between the clinicians and the councilors (negative) and the pathologist (affirmative). The third candidate by the councilors was troubles with clinical system in University Hospitals itself, of which the medical staff in Juntendo University did not think important. The councilors considered that advances in the diagnostic techniques caused the value of autopsy decreased for the doctors in charge, all the Clinical Departments and also the Pathologists, i. e. the whole clinical system. And they also pointed out negligence of the whole medical side for appeal to the general public on what medical care is. As a coutermeasure in University Hospitals, system-organization of selection of the cases necessary to be autopsied in advance and also of medical quality assurance with biopsy and autopsy was proposed.
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  • The activity of the medical care center for the demented elderly in Juntendo University Urayasu Hospital
    YOSUKE ICHIMIYA, MASAHIRO TSUJI, ICHIROU TAKAGI, YUSUKE NOZAKI, TAKUYA ...
    1998 Volume 44 Issue 3 Pages 313-319
    Published: December 21, 1998
    Released on J-STAGE: November 18, 2014
    DOIhttps://doi.org/10.14789/pjmj.44.313
    JOURNAL FREE ACCESS
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    Objective: In order to establish function and roles of the medical care center for demented elderly, the activities of that center in Juntendo University Urayasu Hospital, which has been located in the city area, were investigated. Materials: All cases, who consulted the center for dementia from June 1994 to March 1998, were investigated for this study. Methods: Clinical data (type of consultation; by telephone or personal, sex, age, adress, problem, diagnosis and out-come after the consultation) were collected from the consulting and medical records of them retrospectivelly. Results: Total number of the consultations were 223 cases (72 males, 150 females and 1 unknown). 29% of the cases lived in Urayasu city, however 21% of the cases lived in Tokyo area beside to Urayasu city. 170 cases were recommended to recieve medical check at the consultation. So, 131 cases visited to Juntendo Urayasu Hospital in order to recieve medical check after the consultation. Clinical diagnosis of them were 53 cases of cerebro-vascular dementia, 47 cases of Alzheimer-type dementia, 12 cases of depression, 2 cases of neurosis and 17 cases of other diagnosis. Conclusions: Not so little problems in concernning with demented elderly has been appeared in this area. It is important to study for the out-come after the consultation.
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