Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010.

Background: We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010.

Methods: We used data from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month.

Percutaneous endoscopic gastrostomy (PEG) tubes are placed in elderly adults in Japan with advanced dementia regardless of expectation of improvement in quality of life.

Background: The Japan Geriatrics Society published a guideline on the decision-making process for health care for the elderly in June 2012, noting that withholding or withdrawing feeding tubes are treatment options that should be discussed during the decision-making process. Arguments against the guideline posit that the insertion of a percutaneous endoscopic gastrostomy (PEG) tube feeding may improve quality of life (QOL) for elderly adults and their relatives.

Objectives: The aim of the present study was to explore (a) expected outcomes with PEG tube placement and (b) outcomes from PEG tube feeding in long-term care settings among elderly adults with advanced dementia in Japan.

Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis.

Background: Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications.

Systems development and difficulties in implementing procedures for elder abuse prevention among private community general support centers in Japan.

The present study examines differences in systems development and difficulties in implementing procedures for elder abuse prevention in 1,119 private and 606 public community general support centers under the public long-term care insurance program in Japan. The private community general support centers showed more difficulty implementing procedures than the public community general support centers. Controlling for the type of municipality, progress in systems development did not differ between the private and public community general support centers.

Health care and personal care needs among residents in nursing homes, group homes, and congregate housing in Japan: why does transition occur, and where can the frail elderly establish a permanent residence?

Objectives: Japan has had high rates of transition to nursing homes from other long term care facilities. It has been hypothesized that care transitions occur because a resident's condition deteriorates. The aim of the present study was to compare the health care and personal care needs of residents in nursing homes, group homes, and congregate housing in Japan.

Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?

Background: The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies.

Methods: An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy.

Community-based system, reports, and substantiated cases of elder abuse: disparities between municipalities and relating factors in Japan.

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention.

Toward the rational use of standardized infection ratios to benchmark surgical site infections.

Background: The National Healthcare Safety Network transitioned from surgical site infection (SSI) rates to the standardized infection ratio (SIR) calculated by statistical models that included perioperative factors (surgical approach and surgery duration). Rationally, however, only patient-related variables should be included in the SIR model.

Methods: Logistic regression was performed to predict expected SSI rate in 2 models that included or excluded perioperative factors.

Provision of individualized care and built environment of nursing homes in Japan.

The Japanese government introduced the concept of 'unit-care model' (a large-scale facility which consists of small-scale groups) in 2003 into nursing homes. The governmental requirements are mainly about structure and staffing, not about the way of care provision. We aimed to examine if the requirements affect actual care provision.

Priority for elderly persons with behavioral and psychological symptoms of dementia on waiting lists for placement in nursing homes in Japan: do nursing homes change priorities based on their own guidelines?

Objectives: In Japan, individuals seeking to be placed in nursing homes under the public long term care insurance program are subject to long waiting lists. Applicants are evaluated according to their needs for nursing home placement and assigned to homes based on their relative priority. The aim of the present study was to examine differences between the admission guidelines used by nursing homes and their attitudes regarding the priority for admitting elderly persons with behavioral and psychological symptoms of dementia (BPSD) from their waiting lists.

Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption.

Purpose: To estimate the impact of surgical site infection (SSI) on postoperative resource consumption for colon and rectal open and laparoscopic surgeries after accounting for infection depth and patient characteristics, and to compare these estimates among institutions.

Methods: We collected administrative and SSI-related data from eight Japanese hospitals, and used generalized linear models to estimate excess postoperative length of stay (LOS) and charges attributable to SSI. Covariates included wound class, American Society of Anesthesiologists (ASA) score, operation time, emergency, colostomy, trauma, implant, and comorbidities.

Quality of life of residents with dementia in a group-living situation: an approach to creating small, homelike environments in traditional nursing homes in Japan.

Objectives: Group living is an approach that can create small, homelike environments in traditional nursing homes in Japan. The aim of the present study was to examine quality of life (QOL) of residents with dementia in group-living situations.

Methods: The group-living group consisted of facilities that formed residential units.

Lay diagnoses and views on causes, coping strategies, and treatment for schizophrenia.

We aimed to clarify the relationship between lay diagnoses and perspectives on schizophrenia regarding causes, coping strategies, treatments, prognosis with and without the help of specialists. Our study sample was 500 adults in Japan. Participants read a vignette that depicted moderate to severe schizophrenic symptoms and yielded lay diagnoses.

The increasing cesarean rate globally and what we can do about it.

Cesarean sections sometimes save the lives of mothers and babies; however, they are excessively used compared to medical necessity, which is influenced by various factors that are explored in this article. Since, in most cases the risks of cesarean sections are greater than the benefits, particularly in cesareans that are not medically indicated, it is astonishing that cesarean surgery is the most common surgical procedure, taking away resources from medically necessary care. While economic incentive is counted among the reasons for the increasing cesarean trend, the situation is not so simple since many factors interact to cause the trend.

Costs of hospital-acquired infection and transferability of the estimates: a systematic review.

Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAI (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced.

Systemic Therapy for Metastatic Colorectal Cancer: Patterns of Chemotherapy and Biologic Therapy Use in US Medical Oncology Practice.

Purpose: With the emergence of new chemotherapies and biologic agents in the treatment of metastatic colorectal cancer (mCRC), the optimal combination and sequencing of these therapies are yet to be determined. This study examined the extent and pattern of chemotherapy and biologic therapy use by line of treatment. Biologic continuation and dose escalation were also examined.

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.

The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses.

Variations in analytical methodology for estimating costs of hospital-acquired infections: a systematic review.

Quantifying the additional costs of hospital-acquired infections (COHAI) is essential for developing cost-effective infection control measures. The methodological approaches to estimate these costs include case reviews, matched comparisons and regression analyses. The choice of cost estimation methodologies can affect the accuracy of the resulting estimates, however, with regression analyses generally able to avoid the bias pitfalls of the other methods.

Disparities in systems development for elder abuse prevention among municipalities in Japan: implications for strategies to help municipalities develop community systems.

In April 2006, a national elder abuse prevention and caregiver support law was enacted in Japan, where elder abuse prevention is carried out by municipalities, and caregiver support and intervention are provided by a public long-term care insurance program. The aims of this study were (1) to examine factors at baseline affecting disparities in the progress of systems development for elder abuse prevention among municipalities, and (2) to determine what kind of support municipalities request from prefectural or national governments to help municipalities develop systems for elder abuse prevention. Written questionnaires were administered to the most knowledgeable person in the department responsible for reporting elder abuse in each municipal government between December 2006 and October 2008.

Development of a clinical pathway for long-term inpatients with schizophrenia.

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long-term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge.

The effect of an educational leaflet on depressive patients' attitudes toward treatment.

Improving patient adherence to antidepressant treatment is an important issue. Patients' attitudes toward symptoms, results, causes, disease course, and effective treatment of depression can influence their adherence to therapy. We aimed to assess the efficacy of an educational leaflet designed to improve patients' attitudes toward depression and antidepressant treatment.

Change in clinical practice after publication of guidelines on breast cancer treatment.

Objective: Several studies raise questions about whether clinical practice guidelines actually guide practice. We evaluated patterns of use of breast-conserving surgery (BCS) over time to examine the effect of guideline publication.

Design: Retrospective analysis of time-series data on breast cancer treatment.

Impact of the elder abuse prevention and caregiver support law on system development among municipal governments in Japan.

Objectives: Japan enacted the elder abuse law in April 2006. The present study was aimed to examine the progress of systems development and difficulties with implementing activities in municipal governments for dealing with elder abuse after the law.

Methods: Between 11 and 22 December 2006 a paper questionnaire was sent to all 1840 Japanese municipalities and received 917 responses (49.

[Implementation of discharge planning in the care of hospitalized older adults. Focus on involvement of home care providers at hospitals].

Objectives: The present study was conducted to assess current implementation of discharge planning in the care of hospitalized older adults, and to examine the association between implementation and involvement of home care providers at hospitals.

Methods: The subjects were 434 hospitals with 100 beds or more for general patients, nationwide. We conducted a questionnaire survey by mail of hospital staff responsible for the discharge planning, and assessed to what extent home care providers were associated with the implementation of discharge planning in the hospitals.

Processes of decision making and end-of-life care for patients with dementia in group homes in Japan.

The aim of the present study was to clarify the processes of decision making and end-of-life care for patients with dementia in the group homes in Japan. We investigated 45 group homes for patients with dementia regarding cases of end-of-life care during a 3-year period between March 2004 and February 2007. Thirty-three cases from respondent group homes were collected.