This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.

Introduction: Primary care (PC) physicians often struggle with the local dialects of patients, especially when they work away from their hometowns.Method: We conducted a questionnaire survey of PC physicians in the Hokushinetsu region, the northcentral part of Honshu island of Japan, to understand how doctors recognize and deal with local dialects in their daily clinical practice.We also analyzed their comments qualitatively using the Steps for Coding and Theorization (SCAT) method.Results: Thirty-one physicians (21 men and 10 women) completed the questionnaire. Of the total, 71% of respondents worked away from their hometowns.Moreover, 81.8% of these respondents stated they had difficulties understanding the dialect spoken in the region of their workplaces and 36.3% misunderstood the meanings of the dialect spoken by their local patients as a result. Respondents often heard "ui" or "tekinai" as the chief complaints of local patients, and interpreted these words as physical symptoms such as fatigue, dyspnea, and abdominal distension. SCAT analysis suggested that these words can have different meanings depending on the context. PC physicians translate them into medical terms using paraphrasing techniques based on each patient's medical history. Furthermore, PC physicians use dialects according to their relationship with the patient.Conclusion: Understanding the characteristics of these dialects and using them appropriately may improve the doctor-patient relationship.

We have performed mass surveys for colorectal cancer by using an immunological fecal occult blood test (OC Hemodia) since April, 1987. In this report, we evaluated the mass survey protocol, and investigated the upcoming problems and measures.
The total number of examinees for six years until March, 1993 was 172, 474. The persons needed detailed examination amounted to 6, 952 (4.0%) and the persons received the detailed examination, 4, 706 (67.7%). A total of 144 colorectal cancer cases (detection rate: 0.08%, 153 lesions) were discovered, 93 cases (64.6%) were in their early stage. 101 cases (66.0%) of 153 lesions were early cancer, and 71 cases (70.3%) were cured by endoscopic polypectomy.
The detection rate of colorectal cancer was higher in males than females. In particular, the finding rate for males 50 years old and above was extremely high. We strongly recommend that the elderly people should receive a mass survey. Moreover, it is important to offer the opportunity for detailed examination to the persons who don't receive them. That might raise the detection rate.
It was found that detailed examination has left much room for improvement in terms of methodology. Some medical institutions performed only fecal occult blood testing. They are require d to raise the understanding of mass surveys for colorectal cancer. Collaboration with the medical institutions that are capable of detailed examination and care is indispensable to raise the accuracy of examination.
On the basis of the results in 1992, we calculated the diagnostic accuracy of immunological fecal occult blood test. The sensitivity of the one-day-method was 70.8%, the specificity, 97.0%, and the positive predictive value 2.1. The sensitivity of the two-days-method was 86.7%, the specificity, 95. 3%, and the positive predictive value, 2.7, and was better than the one-day-method.
These findings suggest that the carcinomas, negative to the occult blood test, still exist in a high frequency rate. Therefore, we should perform mass surveys by the two-days-method every year, in order to improve the evaluation of the mass survey method for colorectal cancer.