Takayoshi Terashita

Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

BackgroundPost-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access.MethodsWe conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively.ResultsSurvivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking.ConclusionsPost-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

Problem-based learning for radiological technologists: a comparison of student attitudes toward plain radiography

BackgroundKnowledge and skill expected of healthcare providers continues to increase alongside developments in medicine and healthcare. Problem-based learning (PBL) is therefore increasingly necessary in training courses for radiological technologists. However, it is necessary to evaluate the effects of PBL to completely introduce it in our education programs. As a Hypothesis, it seems that a change occurs in the student’s attitudes by participating in PBL practical training. There is the Semantic Differential (SeD) technique as a method to identify student’s attitudes. We conceived that PBL could be appropriately evaluated by using SeD technique. In this paper, we evaluated PBL for plain radiography practical training using the SeD technique.MethodsThirty-eight third-year students studying radiological technology participated. PBL was introduced to practical training in plain radiography positioning techniques. Five sessions lasting 5 h each were delivered over a 5-week period during November to December 2012. The clinical scenario was an emergency case with multiple trauma requiring plain radiography. Groups comprising approximately eight students created workflows for trauma radiography with consideration of diagnostic accuracy and patient safety. Furthermore, students groups conducted plain radiography on a patient phantom according to created workflows and were then guided by feedback from professional radiologists. All students answered SeD questionnaires to assess views on plain radiography before instruction to provide preliminary practical training reports and after completing practical training.ResultsThe factors were identified using factor analysis of the questionnaires, which were answered before and after each practical training session. On evaluation of the relationships between factors and question items according to factor loading, we identified “reluctance”, “confidence”, and “exhaustion” as the predominant attitudes before practical training. Similarly, we identified “expectation”, “self-efficacy”, and “realness” as the predominant attitudes after practical training. The attitudes toward plain radiography changed before and after PBL practical training.ConclusionsThe attitude of self-efficacy was noted after practical training, which incorporated PBL. Student self-efficacy was thought to increase through self-directed learning, which is one of the aims of PBL. Although the influences of other lectures and training, which were performed in parallel with the PBL practice training, were not completely excluded, and although the number of study participants was small, we were able to confirm the effects of PBL.

Establishing community-based integrated care for elderly patients through interprofessional teamwork: a qualitative analysis

Background Working in multidisciplinary teams is indispensable for ensuring high-quality care for elderly people in Japan’s rapidly aging society. However, health professionals often experience difficulty collaborating in practice because of their different educational backgrounds, ideas, and the roles of each profession. In this qualitative descriptive study, we reveal how to build interdisciplinary collaboration in multidisciplinary teams. Methods Semi-structured interviews were conducted with a total of 26 medical professionals, including physicians, nurses, public health nurses, medical social workers, and clerical personnel. Each participant worked as a team member of community-based integrated care. The central topic of the interviews was what the participants needed to establish collaboration during the care of elderly residents. Each interview lasted for about 60 minutes. All the interviews were recorded, transcribed verbatim, and subjected to content analysis. Results The analysis yielded the following three categories concerning the necessary elements of building collaboration: 1) two types of meeting configuration; 2) building good communication; and 3) effective leadership. The two meetings described in the first category – “community care meetings” and “individual care meetings” – were aimed at bringing together the disciplines and discussing individual cases, respectively. Building good communication referred to the activities that help professionals understand each other’s ideas and roles within community-based integrated care. Effective leadership referred to the presence of two distinctive human resources that could coordinate disciplines and move the team forward to achieve goals. Conclusion Taken together, our results indicate that these three factors are important for establishing collaborative medical teams according to health professionals. Regular meetings and good communication facilitated by effective leadership can promote collaborative practice and mutual understanding between various professions.

[An introduction and implementation of problem-based learning for radiography positioning training].

The knowledge of radiological technologists is expected to increase with medical development. However, it is impossible to impart all knowledge in a limited time frame. Problem-based learning (PBL) is a learning methodology to solve it. In the PBL, students can gain problem-solving abilities by acquiring necessary knowledge from clinical cases and applying them during practice. We here report to implement the PBL in radiography practice. This practice opened a course at 2nd semester of third-grade students in our school. The practice flow includes presentation of clinical case and a survey of necessary knowledge, group work, radiography, reflection through practice, and deliberation of different cases. The clinical case was the radiography of an emergency patient. The evaluation items were about knowledge, skill, and attitude. By the PBL practice, students could realize a clinical scene, and discover considerable points unwritten in textbooks.

低管電圧撮影，および逐次近似応用画像再構成法を利用した造影剤減量の試み：頭部CTA を対象として

This study aimed to reduce contrast medium dose without reducing the diagnostic capability of computed tomography (CT) angiography of the head. We evaluated the advanced statistical iterative reconstruction (ASiR) settings to adjust to low tube voltage CT. A syringe phantom was constructed using dilute contrast medium and was imaged at tube voltages of 80-120 kV. The iodine volumes, CT values, and image noise were measured in these images. The noise-power spectrum and modulation transfer function were measured from quality assurance phantom images that had been obtained using the tube voltage selected after considering the image noise results as described above and reconstructed using different ASiR rate settings and convolution kernels. Our results suggested that imaging at 100 kV could reduce the contrast medium dose by 14%, compared with imaging at 120 kV, and that the resulting image quality could equal that of conventional imaging by performing reconstruction at a 40% ASiR rate and detail kernel.

Quantification of the subjective labour load of a filmless radiology system by the contingent valuation method: a pilot study

Background: A filmless radiology system, which implements a radiology information system and picture archiving and communication system, brings major changes in the work patterns of radiologists and radiological technologists. The purpose of this study was to prospectively quantify the subjective labour load of a filmless radiology system for radiologists and radiological technologists by the contingent valuation method (CVM) and to evaluate the economic labour value. Methods: The questionnaire survey included 14 radiologists and 46 radiological technologists. There was a 75% effective response rate with a total of 45 respondents. The subjective labour load of a filmless radiology system was quantified by the CVM as willingness to accept (WTA). The double-bound dichotomous choice approach was employed for the questionnaire format for WTA. Logistic regression analysis was used to identify the factors affecting WTA. Results: The median and mean WTA per month for radiologists were estimated to be 82,902 yen (

[Development of a radioactive pharmaceuticals management system using a Web-based system].

829) and 46,808 yen (

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

468), respectively. The median and mean WTA for radiological technologists were estimated to be 15,622 yen (

A Qualitative Study of Japanese Patients' Perspectives on Post-treatment Care for Gynecological Cancer

156) and 16,784 yen (

Medical Reimbursement Receipt Analysis to Determine the Relationship between Disease Type and Patients' Healthcare-seeking Behavior

168), respectively. Logistic regression analysis showed promotional view (i.e., willingness to introduce computerization of medical information) as the only significant factor affecting WTA for radiological technologists ( p < 0.05). Conclusions: The change from film-based- to filmless- radiology system would be acceptable providing that medical staff in the department of radiology think their labour changes would yield an increase of satisfaction equivalent to 1,430,000 (