Trust in Physicians, Continuity and Coordination of Care, and Quality of Death in Patients with Advanced Cancer

Background: Provider-centered factors contribute to unexplained variation in the quality of death (QOD). The relationship between healthcare providers (HCPs) and patients, bidirectional communication, and consistency of longitudinal care planning are important provider-centered factors.Objective: To explore whether the level of trust in HCPs, the quality of continuity of care, and the level of coordination of care among home HCPs are associated with the QOD for cancer patients dying at home.Design: This study was a part of a nationwide multicenter questionnaire survey of bereaved family members of cancer patients evaluating the quality of end-of-life care in Japan.Setting/Subjects: We investigated 702 family members of cancer patients who died at home.Measurements: The QOD was evaluated from nine core domains of the short version of the Good Death Inventory (GDI). We measured five factors on a Likert scale, including patient and family trust in HCPs, continuity of care by home hospice and hospital physicians, and coordination of care among home hospice staff.Results: A total of 538 responses (77%) were obtained and 486 responses were analyzed. Trust in HCPs was correlated with the GDI score (r = 0.300–0.387, p < 0.001). The quality of care coordination was associated with the GDI score (r = 0.242, p < 0.001).Conclusions: Trust of the patient and family in home hospice staff, as well as coordination of care among hospice staff, are associated with the QOD for cancer patients dying at home

Causal relations of health indices inferred statistically using the DirectLiNGAM

Causal relations among many statistical variables have been assessed using a Linear non-Gaussian Acyclic Model (LiNGAM). Using access to large amounts of health checkup data from Osaka prefecture obtained during the six fiscal years of years 2012–2017, we applied the DirectLiNGAM algorithm as a trial to extract causal relations among health indices for age groups and genders. Results show that LiNGAM yields interesting and reasonable results, suggesting causal relations and correlation among the statistical indices used for these analyses

Gradient boosting decision tree becomes more reliable than logistic regression in predicting probability for diabetes with big data

We sought to verify the reliability of machine learning (ML) in developing diabetes prediction models by utilizing big data. To this end, we compared the reliability of gradient boosting decision tree (GBDT) and logistic regression (LR) models using data obtained from the Kokuho-database of the Osaka prefecture, Japan. To develop the models, we focused on 16 predictors from health checkup data from April 2013 to December 2014. A total of 277,651 eligible participants were studied. The prediction models were developed using a light gradient boosting machine (LightGBM), which is an effective GBDT implementation algorithm, and LR. Their reliabilities were measured based on expected calibration error (ECE), negative log-likelihood (Logloss), and reliability diagrams. Similarly, their classification accuracies were measured in the area under the curve (AUC). We further analyzed their reliabilities while changing the sample size for training. Among the 277,651 participants, 15,900 (7978 males and 7922 females) were newly diagnosed with diabetes within 3 years. LightGBM (LR) achieved an ECE of 0.0018 ± 0.00033 (0.0048 ± 0.00058), a Logloss of 0.167 ± 0.00062 (0.172 ± 0.00090), and an AUC of 0.844 ± 0.0025 (0.826 ± 0.0035). From sample size analysis, the reliability of LightGBM became higher than LR when the sample size increased more than 104. Thus, we confirmed that GBDT provides a more reliable model than that of LR in the development of diabetes prediction models using big data. ML could potentially produce a highly reliable diabetes prediction model, a helpful tool for improving lifestyle and preventing diabetes

ニホン ノ カソチイキ ニ オケル シッペイ リカンジ ノ チイキ イリョウ ニ タイスル コウレイシャ ト ヒコウレイシャ ノ アンシンカン ニ カンスル ヨウイン オウダンテキ ケンキュウ

本研究では、静岡県の過疎地域において、地域住民を対象とした大規模なアンケート調査を行い、地域医療に対する疾病罹患時の高齢者、非高齢者の安心感に関連する要因の抽出を目的とした。1701 名の住民が統計分析解析対象となり、多変量線形回帰分析の結果、行政への信頼、地域社会の愛着、住民間の温かい関係と医療への親和性が、高齢者の安心感と正の相関を示した。高齢者の安心感は、地域住民との温かい関係や、医療への親和性などが関連しており、老年看護学・地域包括ケア学の立場からは、高齢者を孤立・孤独にさせないような地域での取り組みを推し進めることで、過疎地域であっても高齢者が不安の少ない生活を送ることに寄与できるかもしれない。非高齢者に関しては、職業や人生に満足し、ストレスがなく、最期を迎えたい場所は慣れた病院であることが安心感に関連していた。安心感の関連要因は、年齢層により異なることを考慮し、支援する必要があることが明らかになった。In depopulated areas, residents experience anxiety, and community maintenance is difficult owing to the deterioration of local medical and welfare systems. Providing adequate support and security until the end of people’s lives is necessary. This study aimed to identify the factors associated with sense of security of health care in two depopulated areas of Japan. We also examined the factors differ by age, and administered a cross-sectional survey; demographics; physical, mental, and social factors. We received 2462 responses（response rate 53.0%）. Study variables were compared by age group（˂ 65 and ≥ 65） using the Wilcoxon rank-sum test for continuous variables and the chi-square test. A multivariate linear regression analysis revealed different correlations differ by age. Occupation and life satisfaction were essential for the younger group, while warm relationships between residents and accessibility of medical care were important for the older group. Strengthening confidence in the administration and community attachment can contribute to increased such feelings for residents in depopulated areas. These agebased differences in depopulated areas of Japan, relating to such feelings should be considered when developing interventions to promote health care by community health nurses.原著論文Original Article

Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: a three-year prospective study

<p>Abstract</p> <p>Background</p> <p>Although osteoarthritis (OA) of the knee joints is the most common and debilitating joint disease in developed countries, the factors that determine the severity of symptoms are not yet understood well. Subjects with symptomatic medial knee OA were followed up prospectively to explore the relationship between radiographic changes and symptoms or physical examination findings.</p> <p>Methods</p> <p>One-hundred six OA knees in 68 subjects (mean age 71.1 years; 85% women) were followed up at 6-month intervals over 36 months. At each visit, knee radiographs were obtained, symptoms were assessed by a validated questionnaire, and the result of physical examination was recorded systematically using a specific chart. Correlations between the change of radiographs and clinical data were investigated in a longitudinal manner.</p> <p>Results</p> <p>During the study period, the narrowing of joint space width (JSW) was observed in 34 joints (32%). Although those knees were clinically or radiographically indistinguishable at baseline from those without JSW narrowing, differences became apparent at later visits during the follow-up. The subjects with knees that underwent JSW narrowing had severer symptoms, and the symptoms tended to be worse for those with higher rates of narrowing. A significant correlation was not found between the severity of symptoms and the growth of osteophytes. For the knees that did not undergo radiographic progression, the range of motion improved during the follow-up period, possibly due to the reduction of knee pain. Such improvement was not observed with the knees that underwent JSW narrowing or osteophyte growth.</p> <p>Conclusion</p> <p>The result of this study indicates that the symptoms of knee OA patients tend to be worse when JSW narrowing is underway. This finding may explain, at least partly, a known dissociation between the radiographic stage of OA and the severity of symptoms.</p

シュウショウジ フウフ ドウシツ ノ ザイタク コウキ コウレイシャ ニ タイスル センシング ギジュツ ヲ モチイタ スイミン ジッタイ チョウサ ヤカン ミマモリ ノ ヒツヨウセイ ノ ケントウ

【目的】就床時夫婦同室の在宅後期高齢者の夜間見守りの検討に、睡眠状況についてセンシング技術を用いて調査する。【方法】高齢夫妻2 組に対し、センシング機器を用いて測定、自記式記録、家族介護者の観察等を実施した。【結果】1 組目の夫はCPAP を装着していても睡眠時無呼吸が観察され、妻は喘息だが、睡眠効率は高かった。妻は難聴もあり、夫の睡眠状況の影響を受けなかった。2 組目の夫は夜間頻尿による排泄のための離床があったが、妻は片側難聴と背を向けて側臥位で寝ており覚醒しなかった。両夫婦とも就床と起床時刻については、同室者の干渉を認めたが、夫婦の長年の工夫などで中途覚醒については、干渉を認めず、同室とする目的である、お互いの見守りは完全ではなかった。【結論】同室者の干渉は、中途覚醒については認められず、お互いの睡眠を妨害することは少ない一方で、夫婦同士による見守りでは、不十分であった。センシングデータ、観察等の統合により、在宅環境における現状把握のためのさらなる調査が必要である。研究報告Report