Activity Report of the Kyoto Hospice and Palliative Care Unit Liaison Committee: Regional Palliative Care Cooperation Developed from Face-to-Face Relationships

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.

Issues Related to the Establishment of Comprehensive Community Care for Neurology Medical Clinic Nurses: Focusing on Regional Cooperation and Individual Support / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to clarify the issues for nurses in neurology departments of medical clinics in building a comprehensive community care system based on the implementation status of regional cooperation and individual support for hospitalized patients. We selected neurology as the subject of our study because patients who visit the neurology department are in the medical clinic for an extended period, and we believe that regional cooperation and individual support are implemented more than in other departments.Methods: A self-administered questionnaire survey was conducted by mail in February 2020 among nurses at 1,052 clinics, which were randomly selected from 2,104 clinics with neurology departments among medical institutions designated for intractable diseases.Results: We collected 174 responses (16.5% collection rate), 164 of which were valid (15.5% valid response rate). The regional cooperation rate was 71.3% and individual support by nurses was implemented at 29.9% of the clinics in the past year. Clinical physicians often sought "patient support in collaboration with related parties" and "patient guidance". Free descriptions included five categories such as [strengthening the awareness and abilities of nurses who are responsible for community healthcare] and [training nurses who can promote comprehensive community care].Conclusion: Regional cooperation and individual support are necessary as nursing activities linked to the functions of family physicians.

Regional cooperation and health diplomacy in Africa: from intra-colonial exchanges to multilateral health institutions / Cooperação regional e diplomacia sanitária na África: dos intercâmbios intracoloniais às instituições multilaterais de saúde

Abstract Tracing the pathways of cooperation in health in sub-Saharan Africa from hesitant exchanges to institutionalized dimensions from the 1920s to the early 1960s, this article addresses regional dynamics in health diplomacy which have so far been under-researched. The evolution thereof from early beginnings with the League of Nations Health Organization to the Commission for Technical Assistance South of the Sahara and the World Health Organization's Regional Office for Africa, shows how bilateral dimensions were superseded by WHO's multilateral model of regional cooperation in health. Alignments, divergences, and outcomes are explored with respect to the strategies and policies pursued by colonial powers and independent African states regarding inter-regional relations, and their implications for public health and epidemiological interventions.

Resumo Trilhando os caminhos da cooperação sanitária na África subsaariana, de intercâmbios incertos a dimensões institucionalizadas dos anos 1920 até início dos anos 1960, este artigo aborda a dinâmica regional na diplomacia sanitária que, até o momento, carece de pesquisas. A evolução, desde os primórdios da Organização da Saúde da Liga das Nações até a Cooperação Técnica na África Subsaariana e o Escritório Regional da África da OMS, demonstra como dimensões bilaterais foram substituídas pelo modelo multilateral da OMS de cooperação sanitária regional. São analisados alinhamentos, divergências e resultados de estratégias e políticas empregados por potências coloniais e Estados africanos independentes em relações inter-regionais, bem como suas implicações em intervenções epidemiológicas e de saúde pública.

Perfection of Regional Cooperation Supervision Mechanism under Marketing Authorization Holder System / 中国药房

OBJECTIVE：To provide reference for perfecting regional cooperation supervision mechanism under the marketing authorization holder （MAH） system in China. METHODS ：Based on the analysis of legal responsibilities of the MAH and entrusted manufacturing enterprise ，the problems were studied and suggestions for improving the regional cooperative supervision mechanism were put forward. RESULTS & CONCLUSIONS ：Sub-contract production is the main target of cross-regional collaborative supervision of drug regulatory agencies. The MAH is responsible for the entire life cycle of the drug ，and the entrusted manufacturing enterprise assumes supplementary responsibility. At present ， the problems of regional cooperation supervision are lacking of targeted legal enforcement basis ，insufficient supervision power ，difficulty in obtaining evidence ， untimely supervision and inadequate department cooperation supervision mechanism. It is necessary to improve the regional cooperative supervision mechanism continuously in perspectives of perfecting legislation ，establishing professional inspector system，improving departmental linkage mechanism ，and strenghtening the database construction.

35 años de ARCAL y 500 de La Habana / 35 years of ARCAL and 500 of Havan

RESUMEN En 2019 Cuba asumió la presidencia del Acuerdo Regional de Cooperación para la Promoción de la Ciencia y la Tecnología Nucleares en América Latina y el Caribe (ARCAL). Este acontecimiento coincide con el aniversario 35 del Acuerdo y los 500 años de La Habana. El artículo presenta los principales impactos de ARCAL en Cuba y una panorámica de las actividades que se realizan para celebrar el aniversario de ARCAL en el marco de las festividades por el medio milenio de la capital.

ABSTRACT In 2019, Cuba assumed the presidency of the Regional Cooperative Agreement for the Promotion of Nuclear Science and Technology in Latin America and the Caribbean (ARCAL). This event coincides with the 35th anniversary of the Agreement and the 500 years of Havana. The article presents the main impacts of ARCAL in Cuba and an overview of the activities carried out to celebrate the anniversary of ARCAL in the framework of the festivities for the half millennium of the capital.

Trial of Seamless Regional Cooperation in Palliative Care of Cancer Patients Using Communication Tools of Cooperation

Regional cooperation in palliative medicine involves multidisciplinary team care. It is very important for cancer patients to choose an appropriate place of stay during their end-of-life period. As the Nagoya Memorial Hospital does not have a palliative care ward, collaborating with other facilities offering palliative care and home care becomes pivotal. Therefore the Higashi-Nagoya home care social gathering was organized to improve communication and cooperation among regional health care professionals. Through discussions during this social gathering, the communication tools for cooperation in palliative care were outlined in November, 2015. We reviewed the outcome of 35 patients referred from our hospital using the communication tools for cooperation in palliative care: 25 patients were referred to chronic care hospitals including palliative care facilities, and 10 patients received palliative care at home; 23 died in the palliative care ward, 6 died at home, and 4 died at our hospital. A questionnaire survey conducted among the community health care professionals revealed that the introduction of this tool would be useful in providing accurate information on the prognosis of patients, level of understanding between the patients and their family, and patients’ views on life and death. Using the communication tool for communication would contribute to realizing seamless palliative care in the region surrounding our hospital, which would in turn lead to local team work and shared responsibilities to provide optimal palliative care.

Development and introduction of a regional cooperation clinical pathway for home palliative care

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

Establishment of a clinical training system beyond the regions and the teaching hospitals / 医学教育

  Teaching hospitals play an increasingly important role in clinical training, and improvement of the education system is required. To effectively utilize limited human and material resources for clinical education and to enhance clinical education and medicine treatment throughout a region, cooperation between hospitals is essential. However, cooperation for clinical education training beyond prefectures or training hospitals cannot be said to be sufficient. The Kisogawa Medical Conference, a collaborative system of 5 training hospitals located around the Kiso River estuary, held medical lectures, hands–on seminars, and joint–hospital case conferences. Cooperation in medical education training and exchanges beyond prefectures and training hospitals is expected to lead to substantial improvements, not only in medical education training, but also in medical care throughout a region.

Aplicación de mantenimiento centrado en la confiabilidad a la Central Nuclear de Embalse / Application of realibility centered maintenance to embalse NPP

RESUMEN Entre las más recientes aplicaciones del Análisis Probabilista de Seguridad de la Central Nuclear de Embalse está el Programa de Mantenimiento Orientado a la Seguridad, el cual se ha desarrollado a través de la metodología de Mantenimiento Centrado en la Confiabilidad. Esta aplicación se ha realizado de manera cooperada entre el personal del departamento de seguridad nuclear de la central y especialistas cubanos del Instituto Superior de Tecnologías y Ciencias Aplicadas. Hasta la fecha se han analizado seis sistemas tecnológicos, obteniéndose importantes resultados relacionados con la optimización del programa de mantenimiento preventivo y predictivo aplicado actualmente a dichos sistemas. Algunas tareas de la metodología se han automatizado a través del código MOSEG. Los resultados del estudio se enfocan a la redacción o modificación del contenido de las Planillas de Inspección, priorización de repuestos, reorientación de técnicas de diagnóstico y modificación de frecuencias y de duración de la ejecución de las acciones de mantenimiento.

ABSTRACT One of the most recent applications of Probabilistic Safety Analysis to Embalse NPP is the Safety Oriented Maintenance Program developed through the Realibility Centered Maintenence (RCM) methodology. Such an application was carried out by a cooperated effort between the staff of nuclear safety department of NPP and experts from Higher Institute of Technologies and Applied Sciences of Cuba. So far 6 technological systems have been analized with important results regarding the optimization of preventive and predictive maintenance program of those systems. Some RCM tasks were automated using the MOSEG code. The results of this study were focused on the elaboration and modification of the Preventive Program, prioritization of stocks, reorientation of predictive techniques and modification in the time parameters of maintenance.