Association between the number of board-certified physiatrists and volume of rehabilitation provided in Japan: an ecological study / Journal of Rural Medicine

Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered.Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists.Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P<0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services.Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

Beta-Tricalcium Phosphate Block for Donor Site Morbidity of the Patella in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.

Decision-making support for cancer patients and their families at a palliative care clinic in a designated regional cancer care hospital

<b>Objective：</b>There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services.<b> Method：</b>We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. <b>Results：</b>The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. <b>Conclusion：</b>The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.