ABSTRACT
This study investigated the characteristics of emergency patients, including walk-in patients and those brought in by ambulance, who visited Akita Kousei Medical Center in the 6 months from April 2019, and the clinical features of elderly patients with heart failure. Elderly patients above 70 years of age accounted for 38.7% of emergency cases and up to 61.7% of ambulance cases. The most common diseases and disorders were orthopedic, digestive, otorhinolaryngeal, respiratory, neurological, dermatological, and cardiovascular disease, in that order. In total, 56 patients with heart failure were admitted during this period (age 83.5±8.3 years, male: female ratio, 1:1.67). Hospitalization from homes accounted for 66.1% of admissions, with the remainder from nursing homes. After treatment, 35.7% of patients moved to nursing homes and 19.6% died despite in-hospital care. Because heart failure is one of the most common conditions in elderly patients, it is pertinent to recognize the importance of quality of outpatient care to prevent hospitalization and also to preserve quality of life by focusing on alleviating overall pain and discomfort.
ABSTRACT
Akita has the fastest aging community in Japan. Increasing demand for emergency care and subsequent hospital care for elderly patients is placing excessive pressure on community hospitals because of the chronic shortage of doctors and other medical staff. The characteristic features of these patients are comorbidities, high incidence of cognitive disorders of varying degrees, and physical frailty. To address these urgent problems in a comprehensive manner, the creation of a special department, the ER and GP (general practitioners) department, might be an effective solution. The absence of a GP section in the hospital and lack of family physicians is a major problem in the Japanese medical system. In this context, Akita prefectural government established a training institute for general practitioners and family physicians in Akita Kousei Medical Center in 2012. Only 6 trainees have joined the program in 4 years, so major problems remain. One is the limited human resources available: young doctors and students are still not familiar with the specific area of GP. This is because of the long history of Japanese postgraduate training that is focused on cultivating specialist physicians. The second major problem is the differences that often exist between these doctors─generalists include both hospitalists and family physicians─and these two groups sometimes have completely different mentalities. More time is needed to establish a new style of hospital medicine.
ABSTRACT
<b>Purpose:</b> Patients with end－stage cancer are prone to various problems in their oral mouth. Survey of nurses’ attitudes regarding oral care in our cancer base hospital was conducted and discussed. <b>Method:</b> 197 nurses working with terminally ill cancer patients in the hospital were involved in the questionnaire survey. <b>Results:</b> 159 nurses completed the questionnaire (81%). 153 nurses responded that oral care was necessary for end－of－life stage (96%) but only 29 nurses responded that adequate oral care was provided (18%). <b>Conclusion:</b> The results showed that the nurses acknowledged of importance of oral care at end－of－life stage but didn’t provide the adequate oral care. The survey found that requesting oral care and relief of symptoms as supportive care are lacking of cooperation with the Dentists. How to share information and work with out－of－hospital dentists will be a challenge in the future.