Introduction: The factors associated with the recovery of activities of daily living (ADL) in elderly inpatients have not been clarified. This study aimed to investigate the factors associated with recovery of ADL in elderly inpatients with acute infectious disease who underwent rehabilitation during their hospitalization.

Methods: The study included patients ≥65 years of age who were hospitalized due to acute infectious disease and had undergone rehabilitation at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL, and the recovery rate of FIM was calculated. Furthermore, the factors associated with the recovery rate of FIM were evaluated by multiple regression analysis. Basic characteristics, length of stay, length from onset to starting rehabilitation, physical status (muscle strength and presence of urinary incontinence), and mental status (cognitive and depression) at the start of rehabilitation were included as the evaluation items.

Results: Among the 124 elderly inpatients with acute infectious disease (mean ± standard deviation age, 82.5±7.7), 56 were male and 68 were female. According to the multiple regression analysis, length from onset to starting rehabilitation (β=-0.03), presence of urinary incontinence (β=-0.29), and cognitive status (β=0.01) were factors associated with the recovery rate of FIM.

Conclusion: The study results suggest that length from onset to starting rehabilitation, presence of urinary incontinence, and cognitive status are important for elderly inpatients with acute infectious disease to return to their ADL.

The realist approach aims to evaluate the process of complex interventions and educational programs that are required in primary care. This is one research method focusing on the clarification of "how and why it works", which has been unclear thus far, and to make it possible to reflect on interventions and processes based on reality. In the realist approach, with realism as a paradigm, researchers collect quantitative and qualitative data, and create an integrated series of context, mechanism and outcome based on the concept of constructive alignment. In this report, the authors introduce an outline of the realist approach using an inter-professional shadowing program evaluation conducted for medical students at a community hospital as an example. It is the authors' goal that scientific evaluation applying realist principles be employed in the field of primary care.

Background: The current study aimed to investigate factors associated with the prognosis of activities of daily living (ADL) in elderly patients with pneumonia who had undergone rehabilitation during their hospitalization.
Methods: The study included patients of age ≥65 years who were hospitalized due to pneumonia and had undergone rehabilitation for disuse syndrome at Tsukuba Memorial Hospital. The main outcome was measured using the functional independence measure (FIM) scores to assess ADL. The participants were divided into a high-recovery group (≥80%) and a low-recovery group (<80%) based on the FIM recovery rate score. Further, factors associated with the prognosis of ADL were evaluated using multivariate logistic regression analysis. Basic characteristics, consciousness, usual mode of transportation, FIM score, grip strength, range of motion, orthostatic hypotension, exercise tolerance (6-minutes walking distance), respiratory disorder (Hugh–Jones classification), constipation, malnutrition (mini-nutritional assessment), cognitive (mini-mental state examination), depression (geriatric depression scale), balance (functional balance scale), urinary incontinence, and pressure ulcers were included as the evaluation items.
Results: Among the 51 elderly patients with pneumonia (average age ± SD; 82.0 ± 11.3), 34 patients were classified in the high-recovery group and 17 in the low-recovery group. In multivariate logistic regression analysis, it was revealed that the number of days from the onset until the initiation of rehabilitation (days of inactivity) and nutritional status were factors associated with a high-recovery FIM score.
Conclusions: The study results suggest that days of inactivity and early management of nutritional status after hospitalization are important for elderly patients with pneumonia to return to their ADL.

Introduction: This study compared perceptions of interprofessional collaboration and recognition of work between clinic/small hospital staff and those at regional core hospitals.Methods: An anonymous, self-administered questionnaire was administered to the staff at 4 clinics/small hospital and those at 3 regional core hospitals responsible for regional medical care. The following items were compared between the 2 groups: Assessment of Interprofessional Team Collaboration (AITCS) Japanese version, Readiness for Interprofessional Learning Scale (RIPLS) Japanese version, workplace satisfaction, and relationship with neighboring facilities.Results: The subjects were 74 staff members at clinics and small hospital and 576 staff members at regional core hospitals; their average ages were 41.9 years and 40.6 years, respectively. Compared to staff at regional core hospitals, those at the clinics and small hospitals had significantly higher AITCS scores, RIPLS scores, and workplace satisfaction, and they also considered their institutions to have better relationship with neighboring facilities.Conclusion: The staff of clinics and small hospital were more aware of interprofessional collaboration than hospital staff, and were more satisfied with their workplaces. Understanding the underlying organizational differences may facilitate vertical integration in community-based integrated care systems.

Objective: The purpose of this study is to identify the problems in the adverse drug report (ADR) system in early post-marketing vigilance phase (EPM phase) in Japan.
Methods: The incidence of all ADRs and the ratio of serious ADRs were compared between the new drug application phase (ND phase) and the EPM phase.  The target medicines were Moxifloxacin (Avelox®tablets, 400mg), Gatifloxacin (Gatiflo®tablets, 100mg) and Prulifloxacin (Sword®tablets, 100mg).
Results: The average incidence of all ADRs in the ND phase was 100-fold greater than that in the EPM phase.  There were also 2-fold differences in the ratio of serious ADRs of individual medicines.
Conclusion: There are several problems with the ADR system in the EPM phase in Japan.  It is currently possible that the implementation of EPM will vary between in individual medicines and companies.  This suggests that the present data cannot be applied universally.  Thus, there is an urgent need to standardize the implementation of EPM.

Introduction: We investigated the relationship between knowledge of the common cold and desire for medical treatment.Methods: We administered an anonymous self-questionnaire about the common cold to citizens receiving health checkups in City X, Ibaraki Prefecture, between August and September 2012. We assessed citizens' knowledge about the common cold and whether they sought medical treatment for it, in addition to their demographic attributes.Results: We included 1079 citizens (response rate, 74.5%) in the analysis. The majority of participants believed that receiving intravenous (IV) infusions or injections for the common cold led to faster recovery times (75.9%). Roughly half of the participants (42.0%) did not believe that antibiotics are not effective against virus-based colds, while 28.6% were unsure. Finally, endorsement of the questionnaire items "taking cold medications early leads to faster recovery" (OR: 1.61) and "IV infusions or injections lead to faster recovery times" (OR: 1.86) were associated with a desire for medical treatment.Conclusion: Our results indicate that patients' knowledge about the common cold and their understanding of treatment options available at medical institutions were inadequate. Furthermore, we found that an awareness of how cold medicines, IV infusions, or injections may shorten treatment duration was associated with a desire for treatment.

It is difficult to implement interprofessional education (IPE) in the classroom due to COVID-19. To share our knowledge of online IPE, we report on how we provided IPE for first-year students at two universities. At Mie University, a class was implemented to use Zoom. Quizzes and chats promoted interactions between instructors and students. At Hokkaido University of Science, an online team medical experience game was conducted via Zoom and a Learning Management System (LMS). The activity promoted interaction between students through gameplay and clear instructions. In both cases, students could successfully develop online IPE based on existing learning methods. Through their experience, it was clear that students are able to understand other professionals’ roles. They were also to commit to membership and/or teamship. On the other hand, students faced challenges with faculty familiarity and time allocation.

For this second report, we divided the efforts of the University of Tsukuba into two parts. In the first part, we introduced the Interprofessional program, an inter-university collaborative educational program between the University of Tsukuba and Ibaraki Prefectural University of Health Sciences. Before the COVID-19 pandemic, this program was conducted using TBL (Team-based learning) in a large conference room. After the pandemic, this was conducted online (using Zoom). The main changes due to the online implementation were the following five points; (1) online faculty meetings, (2) advance distribution of materials, (3) testing using Google Forms, (4) group work using the breakout function, and (5) simultaneous editing using Google Docs. In the future, we would like to examine the possibility of new educational methods while creating innovations that are possible only through online interprofessional educational programs.

In the second part of the second report, we introduce the Care Colloquium, an inter-university collaborative educational program between the University of Tsukuba and the Tokyo University of Science. The Care Colloquium is an interprofessional education program that uses PBL (Problem-based learning). In response to the COVID-19 pandemic, this program was implemented online using Microsoft Teams, with advance preparation including manual maintenance and communication testing. The same learning outcomes were achieved as the face-to-face implementation. Undergraduate interprofessional education tends to be a large-scale program, and the shortage of faculty and classrooms is challenging, but online education could overcome these obstacles. The development of hybrid programs that use the merits of both face-to-face and online education may lead to the promotion of interprofessional education in the future.