As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.

PURPOSE: In Japan, about 80% of deaths occur in hospitals, especially long-term care beds. The purpose of this study was to clarify the nursing practices used for such older patients at the end-of-life stage in long-termcare wards via the modified grounded theory approach (M-GTA). METHODS: Data were obtained through semi-structured interviews of nineteen nurses working in cooperating long-term care wards, acute care wards, or hospice services (to allow for constant comparison between these types of wards) in western Japan in 2014. We analyzed the transcribed data using M-GTA. RESULTS: The core category that emerged from the analysis was “Balancing enhancement of patients' daily life quality and life-sustaining care in the face of uncertainty about the patients' character.” Eleven categories emerged, such as Seeking older patients' character with their family, Supporting families' decision making, Rebuilding patients' daily life in the ward, and Sustaining patients' life span through medical care. CONCLUSIONS: Nurses experienced uncertainty about the care needs of older patients, the ethical problems of Enhancing the patients' QOL by using risky care, and the evaluation criteria used to judge their own nursing care after the patients' death. All nurses had the goal of ensuring a natural death for all patients. Nurses' acceptance and evaluation of their own care was critically influenced by the patient's family's responses to their care after patients' death. Further research is necessary to develop evaluation criteria and educational programs for end-of-life nursing care of older adults.
Adult ; Decision Making ; Grounded Theory ; Hospices ; Humans ; Japan* ; Long-Term Care* ; Nursing ; Nursing Care ; Qualitative Research ; Quality of Life* ; Terminal Care ; Uncertainty

As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.

BACKGROUND: The association between meat, fish, or fatty acid intake and acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) has been investigated in a few studies, and the results were inconsistent. In addition, most studies are mainly based on the United States and European countries, in which the dietary patterns differ from that in Asia. Therefore, the risk of AML/MDS from meat, fish, or fatty acid intake in Asia requires further exploration. The aim of this study was to investigate the association between AML/MDS incidence and meat, fish, or fatty acid intake using the Japan Public Health Center-based prospective study. METHODS: The present study included 93,366 participants who were eligible for analysis and followed up from the 5-year survey date until December 2012. We estimated the impact of their intake on AML/MDS incidence using a Cox proportional hazards model. RESULTS: The study participants were followed up for 1,345,002 person-years. During the follow-up period, we identified 67 AML and 49 MDS cases. An increased intake of processed red meat was significantly associated with the incidence of AML/MDS, with a hazard ratio of 1.63 (95% confidence interval, 1.03-2.57) for the highest versus lowest tertile and a P_trend of 0.04. Meanwhile, the intake of other foods and fatty acids was not associated with AML/MDS. CONCLUSION In this Japanese population, processed red meat was associated with an increased incidence of AML/MDS.
Animals ; Japan/epidemiology* ; Prospective Studies ; Incidence ; Public Health ; Meat/adverse effects* ; Fatty Acids/adverse effects* ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes/epidemiology*

BACKGROUND: Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals. METHODS: We investigated 913 non-diabetic males and females, aged 40-69 years, during 2018-2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately. RESULTS: All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were -5.8 for moderate drinkers, and -6.1 mg/dL for heavy drinkers in males and -2.7 mg/dL for female current drinkers. CONCLUSIONS Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.
Humans ; Male ; Female ; Diabetes Mellitus, Type 2 ; Blood Glucose Self-Monitoring ; Blood Glucose ; Alcohol Drinking/epidemiology* ; Risk Factors ; Alcoholic Intoxication