Recently, the Jepanese government have advanced home medical care services. They former health care system was reformed to place much emphasis on home care. But there are many problems:for instance, the difficulty of coordinating discharges from a hospital and cooperation between hospitals and regional clinics. Especially, the biggest problem was that medical staff in wards do not have knowledge of the realities of home medical care and visiting nursing services. In this session, we invite four persons who are actively involved in the front lines in the field of home medical care. We expect they will speak about realities of home care and make you understand the potential of home medical care.
medical care ; Nursing Services ; Home care aspects ; Home ; Future

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

　This report summarizes the Inohana Interprofessional Education （Inohana IPE） program and describes its current achievements and improvement process. Since 2007, a total of 5,679 students have participated in the program. Students who have graduated include 335 from the Faculty of Nursing, 197 from the Faculty of Medicine, 84 from the Faculty of Pharmaceutical Sciences.
　Through Inohana IPE we have created an environment that encourages students’ self-directed learning and the setting of behavioral objectives and have refined the program contents and evaluation method. As the first phase of the improvement, we developed competencies for interprofessional collaboration with 6 components and then created a matrix of learning-achievement goals and 4 learning steps based on the competencies. Furthermore, the number of faculty members participating in the program has increased.
　The two main tasks for the future are to develop an IPE program for nursing and to integrate IPE for basic education and continuing education.

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.
Abdominal Pain ; Aged ; Bezoars ; Colon ; Colon, Ascending ; Colonoscopy ; Diet ; Endoscopy, Digestive System ; Female ; Gastric Bypass ; Gastrostomy ; Humans ; Ileum ; Intestine, Small ; Pyloric Antrum ; Surgical Instruments ; Ulcer ; Vomiting

Understanding of nonalcoholic fatty liver disease (NAFLD) continues to expand, but the relationship between race and ethnicity and NAFLD outside the use of cross-sectional data is lacking. Using longitudinal data, we investigated the role of race and ethnicity in adverse outcomes in NAFLD patients. Methods: Patients with NAFLD confirmed by imaging via manual chart review from any clinics at Stanford University Medical Center (1995–2021) were included. Primary study outcomes were incidence of liver events and mortality (overall and non-liver related). Results: The study included 9,340 NAFLD patients: White (44.1%), Black (2.29%), Hispanic (27.9%), and Asian (25.7%) patients. For liver events, the cumulative 5-year incidence was highest among White (19.1%) patients, lowest among Black (7.9%) patients, and similar among Asian and Hispanic patients (~15%). The 5-year and 10-year cumulative overall mortality was highest for Black patients (9.2% and 15.0%, respectively, vs. 2.5–3.5% and 4.3–7.3% in other groups) as well as for non-liver mortality. On multivariable regression analysis, compared to White patients, only Asian group was associated with lower liver-related outcomes (aHR: 0.83, P=0.027), while Black patients were at more than two times higher risk of both non-liver related (aHR: 2.35, P=0.010) and overall mortality (aHR: 2.13, P=0.022) as well as Hispanic patients (overall mortality: aHR: 1.44, P=0.022).Conclusions: Compared to White patients, Black patients with NAFLD were at the highest risk for overall and non-liver-related mortality, followed by Hispanic patients with Asian patients at the lowest risk for all adverse outcomes. Culturally sensitive and appropriate programs may be needed for more successful interventions.

  One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN.  The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting.   The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries.   The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.