Ayumi Takayashiki

Palliative care physicians' practices and attitudes regarding advance care planning in palliative care units in Japan: a nationwide survey.

To clarify physicians’ practices and attitudes regarding advance care planning (ACP) in palliative care units (PCUs) in Japan, we conducted a self-completed questionnaire survey of 203 certificated PCUs in 2010. Ninety-nine physicians participated in the survey. Although most Japanese palliative care physicians recognized the importance of ACP, many failed to implement aspects of patient-directed ACP that they acknowledged to be important, such as recommending completion of advance directives (ADs), designation of health care proxies, and implementing existing ADs. The physicians’ general preference for family-centered decision making and their feelings of difficulty and low confidence regarding ACP most likely underlie these results. The discrepancy between physicians’ practices and their recognition of the importance of ACP suggests an opportunity to improve end-of-life care.

Japanese students' perception of their learning from an interprofessional education program: a qualitative study

Objectives The aim of this study was to explore students’ perception of their learning from the interprofessional program implemented in Japan where the implementation and evaluation of interprofessional education is behind that of western countries. Methods We conducted a qualitative research of opinions of students who participated in the interprofessional program implemented in the University of Tsukuba. The participants were 105 medical, 65 nursing, and 35 medical science students. At the completion of the program, we asked that the participants write their opinion on what they gained by participating in the program. From their responses, significant descriptions were extracted, coded by content, and then grouped into subcategories. These subcategories were then separated into main categories based on their emergent themes. Results The main categories identified were such as “understanding of medical professionals,” “interprofessional work,” “holistic care,” “communication,” “sharing,” and “empowerment.” Conclusions The categories extracted in our study, for the most part, matched previous studies, suggesting that the program helped students enhance their understanding of interprofessional work. Although the Japanese health care system and medical education system are different from those of western countries, this suggests that the benefits of interprofessional education in Japan will be similar to those of western countries.

The impact of an early_exposure program on medical students' interest in and knowledge of rural medical practices: a questionnaire survey

BackgroundMany medical students in Japan were brought up in urban areas, thus rural medical practice is often unfamiliar to them. The University of Tsukuba created a one-day early_exposure program to provide freshman students with experience in rural practices. This study was designed to clarify how this one-day early_exposure program affected medical students’ attitudes toward and knowledge of rural practices.FindingsFirst-year medical students (n = 103) were assigned to one of seven rural clinics in which they experienced rural practice for one day. A pre- and post-program questionnaire, rated on a 5-point Likert scale, was administered to assess students’ interest in and knowledge of rural medical practice, with higher scores indicating greater interest and knowledge. Respondents who gave answers of 4 or 5 were defined as having high interest and knowledge. One hundred and one (98.1%) responses were received from students. After the program, the percentage of students interested in rural medical practices was increased (pre- and post-program: 39.0% and 61.0%, respectively; P < .001), as was the number of students who wanted to become physicians in a rural medical practice (pre- and post-program: 53.0% and 73.0%, respectively; P < .01).ConclusionsOur one-day early_exposure program demonstrated a positive impact on medical students’ interest in and knowledge of rural medical practice. Further follow-up surveys are needed to clarify whether these effects are sustained long-term.

Primary Care Education in Japan: Is it Enough to Increase Student Interest in a Career in Primary Care?

Participation in primary care clerkships is known to be a strong facilitator for choosing primary care specialties. These programmes for undergraduate students in Japan are shorter and less intensive than those currently available in the USA or UK, as primary care is still an evolving discipline in Japan. The primary objectives of this paper are: to introduce the major issues that exist with respect to primary care education for undergraduates in Japan; to investigate the level of career preference for primary care among Japanese medical students; to examine the factors Education for Primary Care (2007) 18: 156–64 # 2007 Radcliffe Publishing Limited

Comparison of blood pressure measurements on the bare arm, over a sleeve and over a rolled-up sleeve in the elderly

BACKGROUND Although guidelines recommend that blood pressure (BP) should be measured on a bare arm, BP is sometimes measured over clothing in clinical settings. OBJECTIVE To assess the accuracy of BP measurements over clothing rolled up to the elbow in clinical settings. METHODS This was a cross-sectional study to a total of 186 individuals recruited from a primary care clinic and two day-care facilities between July and September 2014. Main outcome measures were BP measurements on (i) a bare arm, (ii) over the sleeve of a cardigan and (iii) over the sleeve of a cardigan rolled up to the elbow. BP was compared across measurement conditions using the paired t-test and multiple analysis of variance adjusting for age, sex, measurement order and interaction between clothing condition and measurement order. RESULTS Of 186 subjects, 38.5% were male. Mean age was 74.6 years. Mean BP with a bare arm, over a sleeve and over a rolled-up sleeve was 128.9 (SD 19.1)/67.4 (10.8) mmHg, 132.8 (21.0)/72.6 (11.5) mmHg and 133.4 (21.3)/74.4 (12.1) mmHg, respectively. There were significant differences in BP between the bare arm and over a cardigan sleeve (P < 0.001) and the bare arm and over a rolled-up cardigan sleeve (P < 0.001). BP differences were significant even after adjusting for age group, sex, measurement order and interaction between clothing condition and measurement order. CONCLUSIONS Although previous studies have suggested BP measurements over clothing are acceptable, our results suggest that BP should be measured on bare arms as recommended by guidelines whenever feasible.

Association between Excessive Alcohol Use and Alcohol-Related Injuries in College Students: A Multi-Center Cross-Sectional Study in Japan.

Alcohol-related injuries in college students are a major public health problem worldwide. We clarified the association between excessive drinking and alcohol-related injuries in Japanese college students. This was a cross-sectional study with a self-administered questionnaire. From January to March 2013, we sampled all college students and graduate students aged 20 years or older during annual health examinations at three colleges in Mie Prefecture in Japan. The questionnaire assessed the frequency of alcohol drinking, amount of alcohol consumed per day, binge drinking during the past year, alcohol-related injuries during the past year, and demographic data. Logistic regression analysis was conducted on the association between excessive alcohol use and alcohol-related injuries. A total of 2,842 students underwent health examinations, of whom 2,177 (76.6%) completed the questionnaire. Subjects included 1,219 men (56.0%) and 958 women (44.0%). Eighty-eight men (7.2%) and 93 women (9.7%) were classified as excessive weekly drinkers, while 693 men (56.8%) and 458 women (47.8%) were determined to be binge drinkers. Eighty-one men (6.6%) and 26 women (2.7%) had experienced alcohol-related injuries during the past year. In the logistic regression analysis, binge drinkers (odds ratio 25.6 [8.05-81.4]) and excessive weekly drinkers (odds ratio 3.83 [2.41-6.09]) had a history of significantly more alcohol-related injuries, even after adjusting for age and sex. In conclusion, alcohol-related injuries in college students in Japan were strongly associated with excessive drinking. As a strategy for preventing such injuries in this population, an interventional study is required to identify effective methods for reducing excessive alcohol use.

Aspects of clinical skills test demanded by the public for the national medical licensure examination in Japan

Clinical skills tests have recently been added to the national medical licensure examinations in Canada, the US and Korea, and are currently being considered in Japan. As the addition of these costly tests might become a substantial societal burden, obtaining the general public’s opinion is essential, as previously shown by a US poll (Papadakis 2004). Moreover, the competencies (i.e. skills in communication, medical interview, physical examination, case presentation, chart writing and clinical procedures) demanded by the general public for inclusion in the clinical skills tests for new doctors remain unknown. To ascertain public opinion regarding the clinical skills tests, we conducted an Internet-based survey using a 15-item questionnaire among 7213 Japanese (age, 20–69 years). Our questionnaire was based on our previous study (Fukushi et al. 2006). Respondents preferences were rated on a 5-point Likert-type rating scale. The questionnaire was completed by 3093 people (1531 men, 1562 women; completion rate, 42.9%). Most responders (n1⁄4 2800, 90.5%) favoured adding clinical skills tests, particularly including the main skills such as ‘explaining and discussing medical issues clearly and accurately to patients’ (n1⁄4 2176, 70.4%), ‘accurately diagnosing problems by physical examination’ (n1⁄4 1984, 64.1%) and ‘ability to carefully interview patients to make a diagnosis’ (n1⁄4 1663, 53.8%). No significant difference between this preference and the respondent characteristics was found (p4 0.05; Pearson chi-square analysis). Although the professional licensure examination components should depend on not only public demand but also the decision of medical professionals, the results revealed that the respondents’ priority requirements were basic communication and physical examination skills. Even with the expansion of medical school curricula with advances in medicine, teaching basic interview and physical examination skills is still needed. Medical educators should carefully consider these skills when teaching and assessing medical students.

Adherence to blood pressure measurement guidelines in long-term care facilities: A cross sectional study

To assess the extent to which long‐term care facilities in Japan adhere to blood pressure (BP) measurement guidelines.

Internet Survey Regarding Knowledge About the Common Cold in Japan

Background: Our aim was to assess people’s knowledge about the common cold and to identify factors leading to medical consultation for intravenous infusion or injection. We expect that this knowledge will be used to develop educational interventions that facilitate appropriate self-care and decision-making regarding whether or not to seek medical consultation. Methods: This study was conducted among people aged 20 to 79, excluding healthcare professionals. A national Internet survey administered in 2012 asked 17 questions about the prevention of, general knowledge about, and behaviors for coping with the common cold. Factors associated with the belief that early symptom relief could be achieved by infusion or injection were evaluated by multivariate analysis. Results: Three hundred and forty-eight (348) people (mean age: 48.6 ± 16.9 years) were included in the analysis. Nearly 80% of participants endorsed questionnaire items stating that “taking cold medicines earlier” and “receiving an infusion or injection” were appropriate actions for recovering from a cold, and more than 60% reported that “you should see a doctor when you catch a cold”. Factors affecting the expectation that infusion or injection would provide early symptom relief included younger age and inaccurate knowledge about treatment of the common cold, for instance the idea that “you can recover from a cold earlier if you take cold medicines”. Conclusions: We found that people’s knowledge about prevention of the common cold was relatively sufficient, but their understanding of the clinical issues and treatment related to the common cold was not. Since the expectation that infusion or injection would provide early symptom relief was associated with inaccurate knowledge about treatment of the common cold, it is considered that people require further health literacy education.

Blood pressure measurements over thin and thick sleeves in the frail elderly

Objective Blood pressure (BP) measurement is recommended on bare arms, but undressing the arms for BP measurements is often difficult for frail elderly individuals. We aimed to assess the accuracy of BP measurements over arms with thin and thick clothing among the frail elderly. Participants and methods This is a cross-sectional study. Individuals aged 65 years or older were recruited from three long-term care facilities in Japan between April and May 2016. The main outcome measures were BP measurements (a) on a bare arm, (b) over a thin shirt, (c) over a thin shirt and a cardigan, and (d) over the sleeve of a thin shirt and a cardigan rolled up to the elbow. BP was compared across measurements using the paired t-test and multiple analysis of variance adjusting for sex and treatments for hypertension. Results Of 147 participants, 23.8% were men. The mean age of the participants was 87.2 years (SD: 7.8). The mean (SD) BP on a bare arm, over a shirt, over a shirt and a cardigan, and over a rolled-up sleeve were 128.8 (20.0)/69.3 (13.2), 131.0 (22.2)/73.9 (15.2), 136.9 (22.2)/78.9 (15.8), and 136.4 (26.0)/80.7 (15.9) mmHg, respectively. BP measurements over clothed arms were significantly higher than bare arm measurements. BP differences were significant when measured over a cardigan after adjusting for sex and treatments for hypertension. Conclusion In the elderly, clothing has a significant effect on BP measurements. The arms should be undressed as much as possible for BP measurements in the elderly.