Aim: Many methods aiming to achieve face-to-face, multi-discipline healthcare cooperation have been attempted in Japan in order to optimize the community care system. There are however, many obstacles to the commencement or successful coordination of meetings, seminars, and workshops for health care professionals, particularly longterm cooperation and financial constraints. We have developed methods to solve these problems. Methods: We invented a new method, called Care Café based on the philosophical and sociological ideals utilized by the World Café. Care Café is held on a regular basis to facilitate communication and cooperation between healthcare professionals with the aim of finding solutions to mutual problems. Results: Care Café has been held on a monthly basis in Asahikawa, where it started. There have been 9 Care Café events in Asahikawa so far, with the number of healthcare professionals in attendance totaling approximately 700. The concept of Care Café is earning greater recognition in Japan, and Care Café events have now been held in 16 different Japanese cities, for an aggregate total of 29 events nationwide. We have received Care Café reports from participating cities detailing successful multi-discipline healthcare cooperation in solving medical issues. Conclusions: Care Café started in Asahikawa. It has been spreading among healthcare professionals nationwide. We expect Care Café to establish and develop new face-toface, multi-discipline healthcare cooperation.

Purpose: This study was conducted to verify the reliability and validity of a scale evaluating the quality of communication and cooperation among medical, nursing, and welfare services in a region. Methods: To apply "a measure to quantify the quality of communication and cooperation among health care providers in a region" (Morita et al, 2013) developed for health care professionals engaged in the care of homebound patients to broader profession and disease categories, the measure was modified to newly establish the 26-item "measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region." In total, 362 health care professionals were enrolled in this study. Results: The internal consistency was excellent. Exploratory factor analyses identified the factor structure as being identical to that of the original scale. The total score had negative but significant correlations with subscales for difficulties in regional cooperation on the Palliative Care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, and the number of persons to whom the respondent could inquire about support. Conclusion: This scale may be useful for describing the extent of global communication and cooperation among medical, nursing, and welfare services in a region.

Background: In order to improve physicians' competence of palliative care, the PEACE project, a palliative care education program for physicians based on the Cancer Control Act, has been conducted throughout the country since 2008. The effectiveness and limitations of the current project management techniques and learning materials have not been determined. This study aimed to explore current problems with the PEACE project and to seek corrective strategies. Method: A workshop was held with 36 participants who had finished PEACE faculty-development programs, and involved brain-storming with physicians. The results of brain-storming sessions were qualitatively analyzed. Results: Most problems identified related to the burden, to the host, of holding the faculty-development program workshop. In addition, some problems related specifically to the individual host site or community involved. Conclusion: One strategy to improve these problems is to incorporate e-Learning to both expand the program and reduce the burden on the host site. In addition, workshop materials could be improved to include additional modules and revised guidelines. Palliat Care Res 2011; 6(2): 143-149

Purpose: The Palliative Care Education Program based on the Cancer Control Act has been held throughout Japan since 2008. The aim of this study is to identify changes attained through the program from the trainers' perspective. Method: The contents of the brain-storming sessions with the twelve trainers were qualitatively analyzed. Results: Six main categories of improvement were identified. These include: Reinforced cooperation; improved palliative care skills and knowledge; improved awareness of palliative care; improved understanding of the local palliative care resources; behavior modification of the participants; and development of in-hospital palliative care systems. Conclusion: Trainers recognized that holding the Palliative Care Education Program provides not only direct results such as greater knowledge and improved delivery of palliative care by physicians, but also indirect results such as enhanced cooperation and improved awareness of local palliative care resources.

Objective：Care Cafe® aims to remove the barriers between medical treatment, nursing, and welfare, particularly with regard to actual practice. This study was conducted to investigate the changes in local integration using the Care Cafe®. Method：Participants in Care Cafe® filled out the questionnaire before and after attending. We used the Mixed Method to compare the results. This method provides analysis on changes in“quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region”scale points, as well as content analysis on the free-opinion space. Results：The“quantify the quality of communication and cooperation”scale points increased significantly overall, as well as on the subscale. The effect size ranged form 0.32 to 0.36. We also had various successes in the content analysis of the free-opinion space, such as building face-to-face relationships in multiple occupations, that being one of the main purposes of Care Cafe®, as well as providing support, learning through discussion, and generating social capital. Conclusion：Care Cafe® may be a useful tool for improving local, multi-discipline cooperation involving medical treatment, nursing, and welfare.

　In the coming ″Super-aging society″ , collaboration between medical professionals and health workers in home-care will be critical. Thus, undergraduate interprofessional education is important for the improvement of a collaborative attitude. We ran a 2-day IPE program for a medical and a rehabilitation student focused on collaboration for patients who have chronic diseases and problems in Activities of Daily Life (ADL) . As a result, one showed marked improvement in ADL while the other did not. Students learned not only roles and perceptions of other professionals but also a sense of worth and an appreciation of the difficulty of patient-centered home-care.

We performed surgical treatment for 21 patients of airway obstructions associated with congenital heart disease from December 1986 to March 1993. In all patients perioperative bronchoscopy demonstrated the cause and site of airway obstructions. Seven patients with corrective cardiac surgery (7/7), 7 with palliative cardiac surgery (7/10) and 2 with surgery for airway diseases (2/4) could be weaned from respirators following surgical treatment. Five patients died postoperatively. A respirator was required in 16 patients (76%) preoperatively. The suspension of pulmonary artery with intraoperative bronchoscopy was carried out in 6 patients. Five (5/6) were successfully extubated earlier postoperative day (mean 8.4 days), whereas only five in 10 patients without that procedure could be weaned from the respirator at a mean of 2 months. Identification of potential airway obstruction and early extubation is needed to reduce the mortality and morbidity caused by airway obstruction associated with congenital heart disease. Preoperative bronchoscopy is useful for diagnosis of airway obstructions and essential for decision making concerning surgical treatment. To early extubation in patients with marked airway obstructions, we recommend appropriate choice of the surgical procedure combined the suspension of pulmonary artery.

Seven patients with congenital heart defects suffered from multiple major hemorrhages from the lung after surgery and 5 of them died at 8 to 54 postoperative days because of respiratory insufficiency. In a patient with tetralogy of Fallot associated with pulmonary atresia, bleeding occured after the second shunt operation, presumably from rupture of bronchial collateral vessels. The clinical diagnoses of the other 6 patients were coarctation of the aorta (CoA) with common atrioventricular canal (CAVC) in 1, triple shunt in 1, persistent truncus arteriosus in 2, total anomalous pulmonary venous connection in 1 and CAVC in 1. Subclavian flap aortoplasty was performed without pulmonary artery banding in the patient with CoA and CAVC, whereas complete repair was performed in the other 5 patients. As these patients were associated with severe pulmonary hypertension preoperatively and 4 of them encountered pulmonary hypertensive crisis, the hemorrhage from the lung may be related to pre and postoperative high pressure of the pulmonary artery. Dilatation and rupture of the pulmonary capillary net was demonstrated in the patient with CoA and CAVC. These findings suggest the hypothesis that bleeding occurred due to rupture of the capillary net as a result of transmission of high pressure. Major bleeding from the lung is a rare but catastrophic complication after repair of congenital heart defects. As the treatment is difficult, early surgical intervention and treatment of postoperative pulmonary hypertension are important in complex lesions with severe pulmonary hypertension.