Recently, workplace violence at hospitals has become an increasing problem. The purpose of this study is to investigate this phenomenon, and the situation of in-house management systems dealing with workplace violence in hospitals in Japan.

A questionnaire was distributed to all 2248 member hospitals of the All Japan Hospital Association over the period from December 2007 to January 2008.

The response rate was 49.2% (1106/2248). 576 hospitals (52.1%) provided 6882 cases of workplace violence that occurred over the year prior to the survey. Most of the cases (86.9%) were caused by patients. In-house management systems dealing with workplace violence were introduced in 10-30% of the responding hospitals. Hospitals with a history of workplace violence were more likely to have an in-house management system than those without.

The high survey response rate might be a reflection of an increasing attention among healthcare facilities towards workplace violence. The result of this study though suggests that an in-house management system alone is not sufficient to secure the safety of hospital staff. Guidelines, reporting systems of workplace violence, and other countermeasures to prevent workplace violence should be developed and introduced with a priority to provide high quality healthcare services.

In order to efficiently develop a regional medical cooperation, a local communal stroke network is important. Not only does it give more opportunities for communication between various medical staff regarding medical services for cerebral stroke, the introduction of the new system is also much easier. The Saiseikai Kawaguchi General Hospital, located in Kawaguchi-city in Saitama Prefecture near Tokyo, is the hub for the regional medical care zone. In February 2008 the regional liaison critical pathway for cerebral stroke (for medical staff) was introduced at the Saiseikai Kawaguchi General Hospital and since April 2008 in most other areas of Saitama Prefecture. Including the Saiseikai Kawaguchi General Hospital, there are currently four acute phase hospitals in the Kawaguchi area, all of which differ in implementation and operational issues in regard to the critical pathway for cerebral stroke. The Saiseikai Kawaguchi General Hospital was chosen for this study on operational issues and this study conducted over the year from April 2008 to March 2009. The study suggested several challenges to be solved; it was difficult to implement critical pathways in clinics and chronic care hospitals, which provided supportive care under the present system, and it was difficult to get the consensus at the meetings held three times a year since the number of participants increased.

Since April 2008, a discharge planning nurse has been posted at the regional medical liaison center at the Mie Chuo Medical Center. To implement and track patients' discharges, a flow chart to systematize discharge plans and a report indicating the activities of the systematic discharge planning (SDP) were introduced and published monthly for feed-back to each department.

From April 2008 to March 2009, a total of 104 patients were screened by the SDP. The patients' demographic and clinical backgrounds, such as diagnosis, age, gender, destination after discharge, substitute medical care (SMC), caregiver and house mate, were evaluated against their adverse effects focusing on the initiation and intervention periods of SDP, and hospital days.

A significantly longer initiation period of SDP was observed in the group of SMC with urethral catheterization. The intervention period of SDP was significantly longer in the group of SMC, such as assisted ventilation, tracheostomy, gastrostomy and tube feeding. Moreover, more hospital days were observed in the group of SMC with tracheostomy, urethral catheterization, gastrostomy and tube feeding. Using the multiple regression analysis, the initiation period of SDP and the hospital days was longest for patients with urethral catheterization. Furthermore, assisted ventilation and gastrostomy stipulated the intervention period of SDP.

For further control a screening sheet for the early induction of SDP to check on the SMC after discharge was implemented.

The results indicate that an early initiation of SDP and a shortening of the SDP period in cooperating with neighboring clinics and hospitals may reduce patients' hospital days. Further tracking and evaluation of the SDP is necessary to perform continuous medical care with an efficient SDP.

In order to safely administer cancer chemotherapy, it is necessary for community-based health care professionals, including community pharmacists, to manage drug treatments.

For this study a questionnaire survey was conducted among all 202 pharmacists who participated in the“Cancer Chemotherapy Training Session”program for community and hospital pharmacists. 137 community pharmacists, 61 hospital pharmacists and 4 others participated in the survey. The different levels of the awareness regarding problems involving patient support, clinical knowledge and medication counseling to outpatients, were examined.

Both, community pharmacists and hospital pharmacists were aware of the importance of the pharmacist's support for cancer patients. Concerning the problems of medication counseling for cancer patient, 71.1% of the community pharmacists and 51.1% of the hospital pharmacists were aware of their lack of knowledge. The awareness of a lack of patient's information in medication counseling was significantly higher for community pharmacists. In addition, self-evaluation of knowledge concerning outpatient cancer chemotherapy was high for pharmacists with more than 10 years' experience and those with the experience of counseling cancer patients. However, a significant difference was seen here between the community pharmacists and the hospital pharmacists. To effectively give community-based support to cancer patients under home care, all community pharmacists need to cooperate with physicians and other co-medicals. A different work environment should not make a difference. It is therefore important for both, hospital pharmacists and community pharmacists to share the problems of cancer patient's medication management, and continue standardized practices by participating in training sessions to improve their awareness of the role of pharmacists in the regional alliances critical path.

While chemotherapy with anticancer drugs is effective, the adverse effects may prevent a continuous therapy. Because myelo-suppression induced by anticancer drugs is a dose-limiting factor. Chemotherapy should therefore be given with consideration to prevent adverse effects and prophylaxis due to decreased blood cell counts.

This study examines the usage of G-CSF in cancer chemotherapy at the University of Tokyo Hospital, and also its adherence to the ASCO Practice Guideline Recommendations for the Use of G-CSF (2006). 125 inpatients, who underwent chemotherapy between April 1 and 14, 2006, participated.

Of these patients, 27 (22%) were given G-CSF, while 98 (78%) were not given G-CSF. Of the 27 patients given G-CSF, 11 (40.7%) had been recommended the use of G-CSF in accordance with the ASCO Practice Guideline Recommendations due to the severity of their conditions , while 16 (59.7%) had not been recommended for G-CSF medication. Of the 98 patients not given G-CSF, 4 patients (4.1%) were not recommended to use G-CSF due to their deteriorating conditions, and the other 94 patients (95.9%) were not administrated G-CSF as their conditions did not warrant it under the ASCO Practice Guideline Recommendations. This study suggests that the G-CSF is more likely to be used for prevention than recommended by the ASCO Practice Guideline Recommendations.

Patients, who are taking ACD (anti-coagulation drugs), need appropriate drug holidays to undergo safe examinations and surgery. Excessive drug holidays can increase the risk of cardiovascular events, and in contrast, lack of drug holidays can lead to the postponement or cancellation of examinations and surgery. Recently many kinds of generic drugs are available. A pharmacists' intervention is indispensable to check on prescriptions as well as on proper drug holidays.

At the Department of Spine and Spinal Cord Center of the International University of Health and Welfare Mita Hospital outpatients, who are scheduled to be hospitalized for an examination and surgery, receive a differentiation of ACD and consultation on drug holidays by a pharmacist after their consultation with a physician.

For this study a survey on the achievement of pharmaceutical instructions by pharmacists was conducted over a 3 month time period from January to March 2009 among patients, who had an examination and surgery at the Spine and Spinal Cord Center.

283 patients (average age: 60.7) were reviewed and 121 of them (average age: 69.2) were taking ACD with a usage rate of 42.8%. No case of postponement or cancellation resulted from any usage of ACD during this survey period. The significance of the pharmaceutical instruction of ACD by pharmacists could therefore be reaffirmed.

This study researches the use and practical application of the “My Diagnosis & Treatment Record” currently implemented at the Kagawa Rosai Hospital. The “My Diagnosis & Treatment Record” is a file for gathering a patient's own drug and care information. The contents of the information are various data, such as a hospitalization, treatment planning document, a disease and a treatment description, various consent documents, an overview critical path of inter-regional association, a critical path for patients, a nursing care plan, an inspection result, medication counseling, the care plan of the elderly care insurance, records of being home, and the drugs information from a dispensing pharmacy, etc. It is currently used for diagnosis of cerebral apoplexy and femoral neck fracture, and is mostly useful now as an “information shared file” between the medical staff of an acute stage, convalescence and maintenance term and being home. Further use also in cancer community-health-care cooperation is desirable.