Building Medical Rehabilitation System with Safety and Without Interruption for the Patients with Coronavirus Disease 2019 Using the Functional Resonance Analysis Method (FRAM)

IntroductionCoronavirus disease 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no systematic development of a safe and uninterrupted provision system of medical rehabilitation for patients and medical staff with COVID-19. The Functional Resonance Analysis method (FRAM) is used to analyze performance in a socio-technical system. In FRAM, each "Function" is viewed from six aspects : Input, Output, Preconditions, Resources, Control, and Time. These aspects define each Function and reveal connections between Functions. In this study, we analyzed a safe and uninterrupted provision system for medical rehabilitation--for severely ill COVID-19 patients using FRAM to prepare for possible problems in the future. MethodsThe subject of analysis was the provision system for medical rehabilitation for patients with COVID-19 at the Rehabilitation Center of Hyogo College of Medicine College Hospital. The analysis was conducted by dividing a 21-month rehabilitation period beginning April 2020 into 5 phases, and analyzing each phase using FRAM. The first four phases were retrospective analyses, and the fifth phase was a prospective analysis. ResultsOur results showed that the number of rehabilitation physicians, consultation systems, and full-time therapists was adjusted and the system providing rehabilitation was modified during each phase. DiscussionElements of Function, such as preconditions, control, and resources, require modification in each phase. In the process of adding and deleting these elements, it became clear that it was necessary to deal with new characteristics of SARS-CoV-2 infection. Retrospective system analysis using FRAM may contribute to the planning of measures necessary for the implementation of rehabilitation medicine prospectively.

Aspects of the process of acquiring nursing competence in junior students - analysis of reflections on exercises using role-playing / 医学教育

Objectives: To reveal nursing competence acquired by nursing students via role-playing (RP) exercises and define the learning points necessary for acquiring practical nursing skills.Methods: Qualitative content analysis was performed using debriefing sheets (DSs) for adult nursing RP. There were 109 participants.Results: The DSs of 69 individuals who met the selection criteria were used as base data, and 1179 data items were extracted. The results showed that the structure included 3 main themes, 8 subthemes, 31 categories, and 121 subcategories.Conclusion: The results indicated that participants noticed the underlying elements that make up practical nursing skills, analyzed them using advance organizers based on previously learned knowledge, and applied the acquired practical nursing skills to newly proposed strategies for continuous self-management for adult patients with chronic disease and their families. One aspect of nursing competence, "ability to improve nursing quality," could not be extracted; the elucidation of this acquisition process is a task for future research.

The Experience of Introduction Team-Based Learning（TBL） / 医学教育

Introduction: Our school adopted team-based learning （TBL） in symptomatology classes for fourth-year students in 2010.<br>Method: This study examined the effects and problems of using a questionnaire survey involving students.<br>Results: The final scores of the students were distributed widely between approximately 65 to 90 points, indicating that TBL increased the spread of scores. The results of the survey showed that many students considered TBL to be a more effective approach than class-based learning, but most students showed an unfavorable attitude toward peer assessment. However, the results of multiple linear regression analysis showed no correlation between the survey results and final scores. The students who did not work together had better scores than students who did （p＝0.048）.<br>Discussion: The findings suggest that students’ scores after TBL are correlated with those after class-based teaching and that TBL helps improve students’ scores, especially those for case-study questions.

End of life care of persons with amyotrophic lateral sclerosis in hospice

This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

Individual testimonies to nursing care after the atomic bombing of Hiroshima in 1945.

AIM: The aim of the present research is to clarify the nursing care conducted just before and after the atomic bombing of Hiroshima in 1945. METHODS: Five surviving nurses, who were registered nursing staff at that time in Hiroshima, offered to participate in this research. Individual interviews were conducted in order to obtain the information concerning the nursing activities in the disaster-stricken areas. The collected information was collated with the documents with regard to the atomic bombing in Hiroshima, and compared with the current studies concerning nursing in disaster. FINDINGS: The five nurses who participated in the study made it clear that, from the day of the bombing, nursing care activities changed moment by moment according to the condition of the radiation victims, the stricken areas and the relief systems. Under these circumstances, the nurses tried to help the victims of the bombing by devising anything useful for nursing care. CONCLUSION: The research participants left their messages, pointing out that nurses' mental attitude to those in front of them as patients is one of the most important things to keep in mind following any major disaster.

Clinical and Epidemiological Studies of Lifestyle-induced Health Problems in Rural Area. Relationships between Dietary Habits and Results of Health Checkups / 日本農村医学会雑誌

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.<BR>To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.<BR>When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.<BR>A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.