Differences in code status practice patterns among emergency clinicians working in Japan and the United States.

OBJECTIVE: This study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S. METHODS: A cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals. RESULTS: A total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants' backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions. CONCLUSION: Significant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions. PRACTICE IMPLICATIONS: Serious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians.

Basic life support by citizens in Kawasaki City, Japan - a descriptive epidemiological study of out-of-hospital cardiac arrest patients.

AIM: To better understand the current status and barriers to making basic life support a common practice among the citizens of Kawasaki City, Japan. METHOD: We extracted data according to the Utstein-style guidelines specifically regarding out-of-hospital cardiac arrests (OHCAs) of cardiac etiology. The items were as follows: (i) OHCA witnessed by a citizen, (ii) the victim received bystander cardiopulmonary resuscitation (CPR), (iii) an automatic external defibrillator was used by the witness. We compared the rate of each item and the 1-month survival rates with the national average in Japan. We further divided Kawasaki City into three areas and compared each item. We also examined the rate of bystander CPR in each time period and location. Statistical analysis was carried out using the χ2-test and Fisher's test. RESULTS: The 1-month survival rates did not differ significantly from the national average for cases meeting conditions (i)-(iii): (i) 14.0% versus 13.3%, (ii) 19.1% versus 16.4%, (iii) 71.4% versus 53.3%, respectively. However, the rate of condition (i) was significantly lower (47.5% versus 55. 8%, P = 0.01). The rate of condition (ii) was higher in the northern area of Kawasaki City, as well as in a location other than the home in the daytime. The rate of condition (ii) was low in the home. CONCLUSIONS: Although the 1-month survival rates of OHCAs witnessed by citizens in Kawasaki City did not differ significantly from the national average, the low rate of bystander CPR was notable, especially in the southern and middle areas of the city and when the location was in the home, which implies that basic life support knowledge should be spread to these areas.