Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan.
Methods: This cross-sectional study enrolled all patients aged 65 years or older who received regular home visiting services.
Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40).
Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.

The mortality rate in Japan due to life-threatening illnesses is predicted to increase rapidly. Delivering appropriate care for people with terminal illness is an important, but largely neglected, role of the health care system in many countries. Recently, the concept of “Primary Palliative Care” has been proposed internationally, and is commonly used as a generic term regarding the activities of primary care physicians and home care nursing services. The tasks of primary palliative care include : 1) caring for people with life-threatening illnesses ; 2) contributing a palliative care approach early in the disease process ; 3) embracing all dimensions of care, including physical, psychological, social, and spiritual ; and 4) providing end-of-life care in the community. By building a system of primary palliative care that is consistent with our nation's medical system and values, care that meets the individual and familys' needs can be provided in the primary care setting which will further enable us to contribute to the community.

This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make endof-life decisions. The clinician’s prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician’s prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.

The purpose of this study was to examine the risk factors of stress fractures in terms of training distance and intensity in young male Japanese high school long-distance runners. Nine hundred and twenty-five runners from high schools, colleges, and work teams responded to our questionnaire. Our analysis of the questionnaire found that the onset rates of stress fractures in males were 25.0%, 40.2%, and 55.3% in high school runners, collegiate runners, and work team runners, respectively, suggesting that young Japanese long-distance runners are more likely to suffer from stress fractures than European and American runners. Stress fractures occurred in male high school and collegiate runners after training that had increased running distance (24.7% and 33.1%, respectively) or running intensity (17.0% and 9.6%), or both increased running distance and increased running intensity (29.8% and 34.6%), suggesting that an increase in running distance at moderate intensity might be a major risk factor in stress fractures in young male long-distance runners. Data from college and work team runners that ran all three years of high school show that stress fractures are most likely to occur in May of the high school freshman year. These results suggested a need to reconsider training programs for freshmen to prevent stress fractures in young runners.

Objectives: Elucidate recognition of end-of-life care by nursing care staff in elderly care facilities, and factors influencing such recognition. Methods: We conducted an internet questionnaire with 500 nursing care staff working at elderly care facilities across Japan, and an interview with 10 nursing care staff out of 500. Results: In the questionnaire, facility policies (41%) and cooperation with medical staff (38%) were selected as facilities and systems that are important for end-of-life care, and as a concern, sudden change in the condition of the patient, leading to death (53%) was selected. The interview showed that nursing care staff had a certain level of anxiety regardless of their experience with end-of-life care, with participants discussing their thoughts on how systematic learning of, and actual experience in, end-of-life care changed end-of-life care. Conclusion: Our study showed that systematic learning and experience of end-of-life care were important factors in recognition of end-of-life care by nursing care staff when providing such care in elderly care facilities.

Objective:We compared changes in BMI as well as nutritional and fluid intake in older adult patients who died and survived while in special nursing care facilities, and examined whether trajectories in the death group were effective in predicting prognosis. Methods:We retrospectively extracted data from BMI, nutritional and fluid intake for all older adults admitted to a special nursing care facility between April 2007 and the end of July 2022, searching for changes in the monthly mean values. Results:Data were obtained for 646 patients in the death group and 498 in the survival group. In the death group, BMI, nutrition and fluid intake decreased significantly from 12 months before death compared with the survival group. In the death group, nutrient intake per kilogram of body weight decreased significantly and irreversibly as of 6 months before death, and fluid intake decreased significantly and irreversibly starting 3 months before death compared with the previous month. Discussion:The trajectories of BMI, nutrition and fluid intake decreased simultaneously from 12 months before death, and the significant irreversible decrease in fluid intake followed by nutritional intake per kilogram body weight was effective in predicting the prognosis of elderly patients dying in special care facilities.

Objective: The learning system "KimBen pharma" was introduced into pharmacy education at Okayama University to improve the quality of pharmacy education in accordance with the revision of the Model Core Curriculum for Pharmacy Education.Methods: In this study, we conducted a questionnaire survey of third- to fifth-year pharmacy students as of 2023 to investigate their satisfaction with the learning system and survey on students' awareness following its introduction.Results: Overall, 79% of the students accorded a score of 4 or higher for the item "satisfaction with using KimBen pharma." In addition, 95.2 and 91.9% of the students scored 4 or higher in the "I could feel the clinical pharmacist's point of view" and "I could imagine that what I learned at the university would be useful in the clinical setting" sections, respectively.Conclusion: Pharmacy education using KimBen pharma is highly satisfactory for students, and the system is considered a desirable educational tool across all grade levels from third to fifth year. Additionally, "KimBen pharma" helps students understand the perspective of pharmacists in clinical settings and assists them in concretely visualizing how the content learned at university can be applied in real-world clinical practice.

In recent years, the system for providing home medical care and palliative care has been improved, and the number of cancer patients who are treated at home until the end is increasing. The aim of this study was to investigate the circumstances of cancer patients who died at home and the presence of doctors and nurses at the moment of death. We conducted a prospective survey of end-oflife cancer patients receiving home visits from home care and palliative care clinics in Japan from 1st July to 31st December 2017. During the study period, we analyzed the mortality status of 676 patients who died in their homes, serviced by 45 clinics. Of these patients, 91% were living with families, 49% died on holidays or at night, and the doctor and nurse was present at the time of death in only 5.6% and 9.9% of cases, respectively. Most of the patients who died at home lived with their families, with few doctors and nurses present at the time of their patients’ death.

Purpose: The purpose of this study was to clarify the current status of Do-Not-Resuscitate discussions (DNRd) with terminally ill cancer patients in Japan and the psychological burden on bereaved families depending on whether or not a DNRd is performed. Method: A multicenter prospective observational study of advanced cancer patients admitted to 23 palliative care units (PCUs) in Japan was conducted, and a questionnaire survey of bereaved families was also conducted after patients died. Result: 1,605 patients were included in the analysis, and 71.4% of patients had a DNRd with doctors before PCU admission, 10.8% at admission, and 11.4% during admission. In contrast, 93.3% of family members had a DNRd with doctors before PCU admission, 48.4% at admission, and 52.1% during admission. Conclusion: Although DNRd was performed between patients and physicians in 72.3% of cases at any point throughout the course of time from before PCU admission to death, there was no evidence of psychological burden such as depression or complicated grief in the bereaved families due to patient participation in DNRd.

Abdominal paracentesis is a standard intervention for symptom relief in patients with ascites; however, there is no established agreement regarding the optimal speed of ascites drainage. This paper presents three cases of rapid manual drainage of ascites (RMDA) conducted during home visits: a 72 year-old male with intractable cirrhosis, a 73 year-old male with malignant ascites secondary to cancer of the pancreatic tail, and a 54 year-old male suffering from malignant ascites due to pancreatic tail cancer with hepatic metastases. Drainage volumes ranged from 1.4 to 3 liters, with procedures taking between 12 to 14 minutes. Post-procedure systolic blood pressures were maintained above 90 mmHg at immediate, 2 (±1) hours, and 24 (±12) hours following the procedure in all cases. No severe adverse events were reported. RMDA may offer a reduced procedural time in the home visit context, lessening patient discomfort and healthcare provider costs. Further studies are needed to evaluate the safety of RMDA in home care settings.