Journal of rural medicine : JRM最新文献

{"title":"Experiences of developing competency in a network of nurse executives working at rural medical facilities: an ethnographic qualitative study.","authors":"Hiromi Fukuda, Chizuru Harada, Akihiro Araki, Yuta Himeno, Akiko Yano, Sachiyo Murashima","doi":"10.2185/jrm.2024-042","DOIUrl":"10.2185/jrm.2024-042","url":null,"abstract":"<p><strong>Objective: </strong>Nurse executives (NEs) working at rural medical facilities encounter challenges, including nursing quality and management, due to a shortage of nurses; this requires them to develop their competencies. A previous study reported that managers working in rural medical institutions gather nearby to learn about management. However, no research has focused on NEs working in rural areas or clarified their experiences in developing competency through learning networks. This study focused on the learning networks of NEs working in rural medical facilities and aimed to clarify their experiences with competency development.</p><p><strong>Patients/materials and methods: </strong>In this study, we conducted competency development for NEs through the learning networks in Japan. An ethnographic qualitative study design was used. Twenty NEs participated in the study. Data were collected through participant observation and ethnographic interviews, and analyzed using thematic analysis.</p><p><strong>Results: </strong>This study revealed the following three themes: (1) aiming to provide medical care that contributes to the rural community; (2) work efficiency by a small number of staff; and (3) development as NEs. The NEs in this study improved as NEs by promoting efficiency in their work with a small group, while aiming to provide medical care that contributes to the rural community through participation in a learning network.</p><p><strong>Conclusion: </strong>A learning network of NEs develops their competencies by helping them improve their practice through dialogue and reflection on their nursing management. Therefore, even in an environment with limited resources, NEs might be able to improve the services of their organization through the learning network.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"78-87"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan.","authors":"Rina Tanohata, Katsutoshi Saito, Takehiko Nagano, Hidenobu Ochiai","doi":"10.2185/jrm.2024-053","DOIUrl":"10.2185/jrm.2024-053","url":null,"abstract":"<p><strong>Objective: </strong>Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.</p><p><strong>Materials and methods: </strong>This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.</p><p><strong>Results: </strong>The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11-0.51). Patients without systolic hypotension were more frequently missed during diagnosis.</p><p><strong>Conclusions: </strong>Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care managers' experiences of interprofessional collaborative practice with physicians in community-based integrated care: a qualitative study.","authors":"Yoshihisa Hirakawa, Erik Masao Eriksson","doi":"10.2185/jrm.2024-045","DOIUrl":"10.2185/jrm.2024-045","url":null,"abstract":"<p><strong>Objective: </strong>Under Japan's Long-term Care Insurance system, care managers (CMs) are expected to function as coordinators in the community-based integrated care system. However, few studies have focused on inter-professional collaboration between medical and non-medical professionals. The aim of this study was to identify CMs' perspectives on enablers and barriers to successful collaboration between care managers and physicians within the community.</p><p><strong>Patient/materials and methods: </strong>We targeted care managers with ample experience working as CMs in the community and recruited 12 CMs using snowball sampling. Online interviews were conducted from January to May 2023 using an open-ended questionnaire concerning participants' experiences of collaborating with physicians and integrating medical services into care management. Qualitative data were analyzed through inductive manual coding using a qualitative content analysis approach.</p><p><strong>Results: </strong>Four main themes were identified as enablers and barriers to successful CM-physician collaboration in the community: medical knowledge, professional attitudes, communication skills, and the professional culture of medicine. Equipping CMs with practical medical knowledge is essential for effective communication. Professional attitudes among CMs are imperative to fostering collaborative relationships. Effective communication skills are another critical factor, emphasizing the need for clarity, specificity, and utilization of nurses as key mediators in physician-care manager dialogue. Recognizing and navigating the professional culture of medicine is essential to overcome barriers stemming from differences in norms, beliefs, and practices between CMs and medical professionals.</p><p><strong>Conclusion: </strong>This study underscores the significance of interprofessional education focusing on cultural differences and the development of systematic learning approaches to enhance CMs' medical knowledge of CMs. Furthermore, the findings highlight the need for clarity in defining CMs' roles within healthcare teams and addressing physicians' misperceptions regarding their contributions and responsibilities.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"132-137"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early insulin averts hyperglycemic crisis in slow-onset durvalumab-induced checkpoint inhibitor-associated autoimmune diabetes mellitus.","authors":"Takaaki Matsuda, Yoshinori Osaki, Motohiro Sekiya, Hitoshi Shimano","doi":"10.2185/jrm.2024-030","DOIUrl":"10.2185/jrm.2024-030","url":null,"abstract":"<p><strong>Objective: </strong>Checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM), a variant of type 1 diabetes, is a rare immune-related adverse events (irAEs) caused by antibody-based immune checkpoint inhibitors. CIADM typically manifests as fulminant or acute-onset type 1 diabetes in the insulin-depleted state. However, we encountered a patient with slow-onset CIADM who initially presented with hyperglycemia without decreased insulin secretion after treatment with durvalumab (an anti-PD-L1 antibody).</p><p><strong>Patient: </strong>A 60-year-old man diagnosed with small-cell lung cancer on durvalumab combined with dexamethasone treatment experienced an increase in glycated hemoglobin (HbA1c) from 6.4% to 7.8% after three cycles.</p><p><strong>Results: </strong>Despite preserved endogenous insulin secretion (C-peptide, 2.47 ng/mL with a casual plasma glucose level of 287 mg/dL), basal insulin therapy was initiated considering CIADM. HbA1c levels remained stable (8.5-9.2%) for 3 months but increased to 13.4% at 18 weeks, indicative of CIADM. Declining endogenous insulin secretion resulted in ketosis; however, hyperglycemic crisis was prevented through basal insulin therapy.</p><p><strong>Conclusion: </strong>We emphasize that CIADM develops gradually and does not always occur in the course of fulminant or acute-onset type 1 diabetes; therefore, early initiation of insulin in the presence of hyperglycemia is crucial to prevent hyperglycemic crises.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 2","pages":"150-155"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of physical activity with the International Physical Activity Questionnaire among outpatients with type 2 diabetes mellitus in Japan.","authors":"Miki Yokoyama, Yoko Kusuba, Kaori Hashizume, Emi Matsuura","doi":"10.2185/jrm.2024-002","DOIUrl":"https://doi.org/10.2185/jrm.2024-002","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the amount of physical activity, including daily movement, and the factors related to the amount of physical activity undertaken by patients with type 2 diabetes mellitus at an outpatient clinic.</p><p><strong>Patients and methods: </strong>A self-administered questionnaire was distributed to 111 patients, aged 20 years or older, with type 2 diabetes mellitus, who visited a diabetes outpatient clinic. The amount of physical activity was investigated using the International Physical Activity Questionnaire-Long Version. Influencing factors were divided into individual attributes (age, sex, and employment status), disease-related factors (body mass index, treatment period, medication usage, insulin usage, symptoms of fatigue, and lethargy), and emotion-related factors (depression and optimism). These were tested using stepwise regression analysis.</p><p><strong>Results: </strong>Daily physical activity was 288 metabolic equivalents of task/minute. The sub-scores by the time of day showed \"physical activity within the household\" and \"physical activity during leisure time\" as the highest, with 51 metabolic equivalent of tasks/minute. Employment status, medication usage, and depression status were found to have a significant influence and explained 17.9% of the distribution of the entire model.</p><p><strong>Conclusion: </strong>The results suggest that the amount of daily physical activity among non-working patients should increase. Moreover, we highlight the need to provide diabetes education from the early treatment stages and the importance of early detection and care of patients' psychological needs.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"20-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between repeated specific health guidance during specific health checkups and mental health: a cross-sectional survey study in Japan.","authors":"Daisaku Nishimoto, Shimpei Kodama, Chiemi Nishimoto, Keiko Kubota, Asutsugu Kurono, Ikuko Nishio","doi":"10.2185/jrm.2024-027","DOIUrl":"https://doi.org/10.2185/jrm.2024-027","url":null,"abstract":"<p><strong>Objective: </strong>Repeated guidance through specific health guidance (SHG), a service that provides health advice to high-risk individuals for specific health examinations, may be affected by examinees' mental health status. However, the association between repeated SHG sessions and mental health remains unclear.</p><p><strong>Materials and methods: </strong>Data were collected from 123 men and women who underwent specific health checkups at Jiaikai Izuro Imamura Hospital between April 13, 2021 and April 13, 2022 after receiving SHG in the previous year. A questionnaire survey was conducted to assess burnout, resilience, and lifestyle-related factors such as weight change and the amount of alcohol consumed. Odds ratios (OR) and 95% confidence intervals (CI) for repeated SHG were estimated using stepwise multiple logistic and mediation analyses.</p><p><strong>Results: </strong>The results showed that repeated SHG was significantly associated with weight gain ≥10 kg from the age of 20 years (OR=4.41, 95% CI 1.74-11.20) and burnout subscale of cynicism (OR=4.18, 95% CI 1.31-13.33).</p><p><strong>Conclusion: </strong>Weight loss guidance could be an effective component of SHG. Additionally, individuals who are repeatedly provided with SHG experience a mental health burden. Furthermore, interventions to reduce cynicism may be necessary to prevent the need for repeated SHG.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"39-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between daily eating habits and occurrence of stroke in the O City Cohort I survey: a 26-year follow-up of residents in rural Japan.","authors":"Mako Toda, Koutatsu Maruyama, Isao Saito, Shinji Tanaka, Yutaka Takeuchi, Hirotada Okubo, Tadahiro Kato","doi":"10.2185/jrm.2024-026","DOIUrl":"https://doi.org/10.2185/jrm.2024-026","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to elucidate the relationship between daily eating habits and stroke risk factors in O City, Ehime Prefecture, Japan, using stroke registry data collected over a 26-year follow-up period based on standardized national criteria.</p><p><strong>Materials and methods: </strong>Overall, 1,793 middle-aged Japanese participants (446 men and 1,347 women) who completed a 33-item Food Frequency Questionnaire (FFQ) and had no history of stroke were matched to those from O City in a stroke registry from 1996 to 2022. Stroke diagnosis for each person was used to determine whether this was their first documented stroke, and we classified strokes as either a cerebral infarction (CI) or a hemorrhagic stroke (HS), the latter which included an intracerebral hemorrhage (ICH) or a subarachnoid hemorrhage (SAH). A Cox proportional hazard regression model was used to examine the association between habitual dietary intake and the occurrence of stroke, using the following covariates: age, body mass index, elevated blood pressure/hypertension, dyslipidemia, prediabetes/diabetes, alcohol consumption, and smoking.</p><p><strong>Results: </strong>During the 26 years of follow-up, 45 men (10.1%) and 76 women (5.6%) had stroke. The CI rate was 70.2% (n=85; 38 men, 47 women). The HS rate was 29.8% (n=36; 7 men and 29 women); of these patients, 26 and 10 had ICH and SAH, respectively. In men, orange intake showed a significant inverse correlation with CI. In women, fresh fish intake showed a significant inverse correlation with CI, while yogurt intake showed a significant inverse correlation with HS.</p><p><strong>Conclusion: </strong>Our results indicated that fresh fish intake was significantly associated with the prevention of CI among women in a Japanese cohort survey.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"28-38"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonal and sex differences in instrumental activities of daily living and objective physical activity among older adults residing in rural areas with snow and cold regions.","authors":"Tomohito Tadaishi, Junko Hasegawa, Hideki Suzuki","doi":"10.2185/jrm.2024-025","DOIUrl":"https://doi.org/10.2185/jrm.2024-025","url":null,"abstract":"<p><strong>Objective: </strong>To determine the seasonal differences in instrumental activities of daily living (IADL) and objective physical activity among older adults residing in non-urban areas in snowy and cold regions according to sex.</p><p><strong>Patients and methods: </strong>Fifty older adults aged ≥65 years were included in the present study. IADL was assessed using the revised Frenchay Activities Index (FAI), and physical activity was measured using a triaxial accelerometer. Comparisons were made between the snowy and non-snowy seasons based on sex.</p><p><strong>Results: </strong>Compared to the non-snowy season, the female participants exhibited significantly lower scores for outdoor housework, outdoor activity, and overall scores on the FAI during the snowy season. In terms of physical activity, a decrease in the number of steps and light-intensity physical activity, accompanied by an increase in sedentary behavior, was observed in both sexes. High light-intensity physical activity decreased in the snowy season, especially in the female participants. In addition, the total moderate-to-vigorous physical activity (MVPA) and short-bout MVPA (intermittent and lasting <10 minutes) also decreased.</p><p><strong>Conclusion: </strong>Considering the significant changes in lifestyle and physical activity during the cold snowy season, women should consider performing alternative physical activities other than indoor household chores. Furthermore, men should be encouraged to participate in indoor household chores they typically do not engage in, irrespective of the season.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training of medical coordinators for noncommunicable diseases based on Japanese experience.","authors":"Megumi Ogawa, Yurie Kobashi","doi":"10.2185/jrm.2024-033","DOIUrl":"https://doi.org/10.2185/jrm.2024-033","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of noncommunicable diseases (NCDs) is increasing in low- and middle-income countries and represents a major public health challenge. Herein, we present Japan's experience in training medical coordinators to combat NCDs, with a focus on hepatitis, early-onset dementia, and children with medical complexity. Coordinators play an important role in bridging the gap between patients and healthcare services.</p><p><strong>Materials and methods: </strong>We examined the training and roles of the coordinators. In the Japanese model, medical coordinators, including both medical and non-medical personnel, have successfully strengthened the delivery of healthcare services for specific diseases. However, challenges persist, including the uneven distribution of coordinators, inconsistencies in training programs, the program's relatively recent establishment, and limited awareness of coordinators' roles and activities.</p><p><strong>Results and conclusion: </strong>Training medical coordinators can strengthen comprehensive patient support in managing NCDs. Despite its limitations, this model provides valuable insights for developing interventional strategies in other Asian countries facing similar medical human resource shortages. Collaboration among governments, hospitals, and related organisations in training coordinators holds promise in addressing the growing prevalence of NCDs in these regions.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"46-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factor for difficult cases at the comprehensive consultation services about medical, welfare and legal problems.","authors":"Michiki Narushima, Chiaki Ando, Makoto Mochizuki, Osamu Terada, Hiroki Suzuki, Nozomi Kani, Motoyoshi Matsunaga","doi":"10.2185/jrm.2024-036","DOIUrl":"https://doi.org/10.2185/jrm.2024-036","url":null,"abstract":"<p><p>It is very important to cooperate with interprofessional personnel is in order to establish the community-based integrated care system, but this is very difficult. We have held comprehensive consultation services regarding medical, welfare, and legal problems to support the community.</p><p><strong>Objectives: </strong>This study aimed to identify the associations between background factors (such as medical conditions, intractable diseases, welfare problems, disabilities, economic difficulties, legal problems, elderly adults, children, and foreign persons) and difficult cases to provide more thorough consultation services.</p><p><strong>Patients and methods: </strong>A survey was conducted on people who participated in comprehensive consultation services on medical, welfare, and legal issues related to medical care, welfare, and legal matters held from April 2021 to March 2024. We analyzed risk factors that may be difficult to resolve using multivariate logistic regression.</p><p><strong>Results: </strong>Multivariate analysis showed that the factor of \"economic difficulty\" was significantly more difficult to solve.</p><p><strong>Conclusion: </strong>When treating patients, doctors must consider the possibility of multiple underlying issues. It is advisable for doctors to be aware of the need to consult with social workers and legal professionals when necessary.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"20 1","pages":"53-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}