In Japan, there is an increasing trend for husbands to attend their partner’s childbirth in hospital. This may be interpreted as a result of an intense eagerness on the part of husbands. Actually, their attitude to childbirth has become very positive. Many studies have pointed out that husband’s support is one of the factors contributing to easier delivery. Our hospital allows husband’s attendance during childbirth. The purpose of this study was to clarify the actualities of the husband’s involvement in childbirth in our hospital, post-delivery changes in the couples’ feelings and the needs of labor support by midwives. For these ends, a questionnaire survey was conducted on 40 couples who have experienced vaginal deliveries, and at the same time we reviewed their birth record. Those who gave girth with their husband present accounted for 45.7%. Most replies of the husbands who had been present at childbirth reflected their strong wishes to support their spouse and share the momentous event.　　It was also found that there was some differences of opinion between couples about the presence of men during their partner’s labor. Therefore, different midwifery support has to be started in the early months of pregnancy according to their needs.　　We have started working out a plan for each mother-to-be from pregnancy to the expected date of confinement. Midwives in the outpatient ward who have a thorough knowledge of the wishes of pregnant women and their husbands are to let midwives in the maternity ward know the exact needs of the couples, thus assuring the women giving birth safe and sound, and contributing to the strengthening of the couples’ bonds.

1. We participated in the 6th Jakarta Meeting on Medical Education held in Indonesia in 2013.
2. In Indonesia, medical education has been attracting more and more medical faculties. We are supposed to disseminate more academic outputs in the future.

Overweight or obesity becomes a worldwide public health issue; the global obesity pandemic. Strategies to effectively prevent overweight and obesity are needed. Slow eating, which involves chewing food slowly and thoroughly, can be an effective strategy to prevent overweight and obesity. Previous studies reported a relationship between rapid eating and overweight. Candidate factors inducing the relationship have been thought to be related to increases in appetite and energy intake through rapid eating, allowing the ingestion of a greater-than-optimal volume of food. While the counter effect of slow eating has been widely known, effects of eating speed on digestion, absorption, and metabolism has yet to be elucidated. If eating speed affects digestion, absorption, and metabolism, eating speed can be a factor explaining the relationship between eating speed and body composition. The present review is to summarize the effects of eating speed on digestion, absorption, and metabolism, consequently suggesting preferable effects of slowly eating on increasing energy expenditure after eating.

To assess the extent of functional gains measured before and after inpatient rehabilitation in patients who have brain tumors, and to identify whether the tumor type, tumor laterality, side of hemiparesis, postoperative addition therapy, cognitive dysfunction, and impairment of consciousness influences outcome. We reviewed the Barthel index(BI)of patients admitted to our hospital from Feb. 2004 to Jan. 2006. Participants numbered 133 persons, aged 52.2±15.4 years old and comprised 57 males and 76 females. All participants had functional impairments resulting from their brain tumors, and patient data was collected from their medical records retrospectively. The numbers of the patients by tumor pathology were 68 gliomas(16 Grade I·II, 52 Grade III·IV), 19 meningiomas, 15 metastatic brain tumors and 31 others. Significant improvements were found between admission and discharge BI scores for all patients, including the glioma group, meningioma group and metastatic tumor group. A significant change of BI improvement was noted between the glioma group and the meningioma group. Length of rehabilitation stay for the glioma group was significantly longer than for the meningioma and metastatic tumor groups. The highest percentage of patients discharged to home was in the glioma group(77.9%). Tumor laterality, side of hemiparesis and postoperative addition therapy all affected functional improvement. We concluded that acute inpatient rehabilitation is an effective treatment for patients with brain tumors that can help them to regain functional ability and to improve their quality of life.

1)We attended the Association of Standardized Patient Educators (ASPE) Annual Conference in 2008.2) The ASPE international committee has aimed to make the group more international by calling for participants from counties outside North America.3) Evolving programs of communication in teams and combining standardized patients and simulation technology were identified as trends in 2008.

Introduction: The purpose of this study was to clarify the needs in end-of-life care management for elderly persons requiring long-term care at home.Methods: Semi-structured interviews were conducted for 20 people working in the community, and were analyzed qualitatively and descriptively.Results: Support to enable discharge at home, formation of a care team to help achieve a desired life and desired end, family support for the entire end-of-life period, support for making timely and informed decisions, control of symptoms to achieve desired results, and both mental and spiritual support for end-of-life acceptance were provided to realize the individuals' desires.Conclusion: This study suggested that it is possible to provide high-quality care management for the elderly requiring long-term care at home in the end-of-life period.

Introduction: To identify factors related to the quality-of-care management performance of older adults who required home care in the end-of-life period and implications for training.Methods: A total of 2,540 care management offices were randomly selected, and one care manager from each office completed a self-administered questionnaire. The End-of-life Care Management Scale was used to assess care management performance. Multiple regression analysis was performed after bivariate analysis using attributes and other factors.Results: The most important factors were previous training in disease, previous training in multidisciplinary collaboration, sex, previous training in nursing, had a visiting nurse agency, years of experience, and previous training in team building, in descending order.Conclusion: Quality-of-care management execution may be improved by focusing on and prioritizing training content where contributions are indicated and utilizing visiting nurses.

As a result of introducing swallowing rehabilitation at a special nursing home for the elderly, a resident became able to take food orally for the first time in about 4 years since having a PEG tube inserted. Further, the resident's FIM, FG, and DSS values improved to some extent. While nutritional care using the PEG tube is recognized as a long-term enteral nutritional therapy, the tube is mostly used as a “PEG tube for survival” and scarcely used as a “PEG tube for eating”, which indicates a PEG tube for supporting oral ingestion. The result indicates that it is preferable to use the PEG tube “for eating” in addition to its use as an option for long-term enteral nutritional therapy. The result also indicates the need to conduct, with the cooperation of nurses and nursing care workers, the nutritional care and regular follow-ups of all nursing home residents, as well as to maintain and improve the residents' swallowing function and their activities of daily living (ADL) by continuing swallowing rehabilitation, oral care, and measures against gastroesophageal reflux disease.

　　Alarms in ambulatory monitoring of electrocardiography (ECG) sound in our cardiology ward too frequently. To investigate the incidence and causes of inadequate alarms, we examined 3,699 alarms in a total of 100 inpatients during a period of 7 days retrospectively. Of the alarms, 49% was related to extreme bradycardia, 31% to extreme tachycardia and 10% to trained ventricular premature beats. Alarms were set off because of correct detection of cardiac abnormalities (50%), poor electrode-to- patient contact (17%) and wrong diagnosis (12%), and body movement of patients (11%). To reduce false alarms in ambulatory ECG monitoring, we though it would be necessary to (1) change electrodes once a day, (2) wipe the sweat from the patient’s chest surface, (3) stick electrodes away from movement sites, (4) tape down lead wires to prevent them from pulling on the electrodes, (5) select sticking sites to get enough QRS voltage (›1mV), and (6) set adequate threshold of heart rate to make alarms.