ABSTRACT
This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.
ABSTRACT
<b>Introduction</b> : This study aimed to clarify the relationship between the presence of someone to care for and the subjective QOL (quality of life) of local elderly people.<br><b>Methods</b> : Data for 7,728 residents aged 65 and above was obtained from the everyday life sphere needs survey implemented by the government of Nanto City, Toyama Prefecture, between May to July, 2014. Multiple logistic regression analysis was conducted to evaluate the relationship between two sets of variables : first, the presence (or absence) of “something to live for”, “sense of fulfillment”, and “self-esteem” as indicators of the respondents'subjective QOL ; and second, a set of explanatory variables (common to all models) including the presence of someone to care for, indicators of the personal attributes, health, and life style of the respondents.<br><b>Results</b> : The presence of someone to care for was positively related to the presence of “something to live for,” “sense of fulfillment,” and “self-esteem,” which were indicators of subjective QOL, even after several indicators of personal attributes, health, and life style were accounted for.<br><b>Conclusion</b> : Promoting mutual help in local areas has a positive significance for those elderly who take care of others, as well as for those who accept care. The results also suggest the social importance of being the recipient of care in the elderly.
ABSTRACT
<b>Background:</b> Urosepsis is a potentially fatal syndrome that is sometimes difficult to diagnose. Thus, the aim of the present study was to clarify the clinical and laboratory characteristics and pitfalls in the diagnosis of urosepsis.<br><b>Methods:</b> We enrolled the study participants based on clinical records of patients with urosepsis treated between January 2009 and April 2012 inclusive, in the Department of General Internal Medicine, Toyama University Hospital and retrospectively surveyed underlying diseases, clinical symptoms, physical findings, and laboratory data, respectively.<br><b>Results:</b> Ten definitive patients were selected (nine females and one male; age, 55–86 years). Fever was the most frequent symptom followed by nausea. Lower back pain was the chief complaint in only two patients. One patient complained of dysuria, and on examination half of the patients lacked costovertebral angle (CVA) tenderness. Five patients showed elevated liver enzymes without evidence of hyperbilirubinemia.<br><b>Conclusions:</b> There were no specific clinical characteristics of urosepsis, and symptoms in some patients resembled digestive diseases such as cholangitis. Our results demonstrate that use of dipstick urinalysis and microscopic urinalysis are essential for the diagnosis in patients with sepsis. Abdominal ultrasonography and/or computed tomography should also be considered to rule out false negative results of urinalysis related to urinary tract obstruction, and to detect other focal infections when appropriate.