In Sasebo and north medical area in Nagasaki prefecture, the proportion of people 65 years and older will continue to increase, while the number of younger people will decrease. The rates of mortality from malignancy, stroke and acute myocardial infarction are very high in this area. In view of the above situation, we have been taking actions to improve several practices of health care management at Sasebo City General Hospital.

First of all, special medical networks in this district have been constructed among our hospital and many other medical institutions. In particular, the Ajisai internet network, which was developed by Nagasaki prefectural government and put into practice in July 2012, is a very useful tool in regional medical services. Furthermore, in order to establish the emergency medical care system, we opened the emergency medical care center in April 2012.

Secondly, the regional medical center like our hospital has to be transformed into the magnet hospital that can attract and educate medical staff. We organized the study and training center for regional medical services. In this center, medical staff who are interns, residents, nurses, radiologists and so on are able to study various kinds of general medicine. We will build the housing for the medical staff as well.

Thirdly, we should provide our patients with safe, reliable and high quality medical care. The quality of the regional medical care has to be elevated and standardized in the community. Various staff in the medical institutions would work together as a team, and then the medical team could provide good medical care seamlessly from hospital to home.

While many clinical guidelines have been widely published, secondary prevention therapies for coronary artery disease (CAD) were sometimes underused in daily clinical practice. The liaison critical pathway (LCP) for CAD was based mainly on the guidelines in CAD secondary prevention. We investigated the effect of the LCP for primary physicians on lifestyle modification for patients with CAD. The total subjects of LCP for CAD were 280 patients and 80 primary physicians. We conducted a survey to 235 community physician members, and obtained 79 responses (33.2%).

The physicians with more than 5 cases of the LCP for CAD were higher in the guidance ratio of the treatment goals of hyperglycemia and dyslipidemia, the restriction of saturated fatty acid, the high intake of ω3 fatty acid, work life balance guidance. This high-LCP-experience group scored high in delivering adequate target values of glucose and lipid metabolism, and LCP was evaluated to be very effective for the management of CAD.

The LCP for CAD was guide for the primary physicians to improve the patient's lifestyle modification.

The analysis of incident reports of each hospital is the most suitable way to prevent medical errors. As a results of the incident reports analysis at our hospital in 2008, missed medicine was the most frequent error, in which pre-breakfast α-glucosidase inhibitor (α-GI) being the most commonly missed drug. One of the reasons considered was nurses' lack of knowledge concerning α-GI medication. Occurrence of missed α-GI just before breakfast was independent of the years of experience of nurses.

From April 2009, we took preventive measures against missed α-GI by giving information about α-GI to all nurses in our hospital.

As a result, numbers of the incident reports about α-GI were decrease by 90.7% in 2009, by 94.4% in 2010 compared with that of 2008.

It suggested that to prevent medical errors, analysis of incident reports at each hospital and to obtain appropriate cooperation from nurses are effective.

Pre-AVOID (be prepared to avoid the adverse drug reaction) refers to pharmaceutical care meant for preventing adverse effects or disadvantages for patients on medication. Pre-AVOID case reports should be shared among pharmacists and other clinical staff members to ensure proper use of medicines and patient safety.

Thus, we developed a system for storing conventional pre-AVOID case reports and ensured that these reports were securely shared in the pharmaceutical department of Kyusyu Kosei-Nenkin Hospital. Since the system had a summary template, the pharmacists' burden of making reports reduced. In addition, we created a database for accumulating case reports, and this database was used to share the case reports with pharmacists on a regular basis or to extract important case reports for presentation to the other clinical staff members.

Between June and December 2010, 129 pre-AVOID cases were reported. 92 cases were reported by pharmacists in wards, 33 from dispensary, and 4 from the medical rounds made by the team. As a result of pre-AVOID, 30 patients with chronic kidney disease received proper dose according to their renal function, 16 drug interactions were prevented, 12 prescriptions were corrected because they were different from patient-brought-drug, and adverse drug effects were detected at an early stage in 7 patients. All the pharmacists reported their pre-AVOID cases in this system.

We constructed an efficient pre-AVOID case report system and used the information for qualitative pharmaceutical care.

In April 2006, Nanpuh Hospital began to be reimbursed using DPC/PDPS (diagnosis procedure combination/per diem payment system). Various kinds of data stored every day are precious resources to the hospital. We have examined the method of providing information which utilized these resources.

The objective of this research is to evaluate the effectiveness of providing data to clinical staff. We first visualized the data for treatment process, and as a result, in cases of an operation of a stomach malignant tumor without other illness (DPC code：060020xx01x0xx), average lengths of pre-operation hospital stay was shortened. Moreover, as a result of data visualization of operation room availability, the working ratio of operation rooms during the morning became higher. Notably, operation room availability in the 10：00 time frame was maintained at a satisfactory rate in all the days of the week. In all categories of evaluation check points, namely objective evaluation, specific discussion, patient satisfaction, personnel satisfaction and management, the results were satisfactory.

The improvement of implementation rate is an important issue when conducting clinical trials. We, therefore, have investigated the factors which influenced the implementation rate using the protocol data of the clinical trials in the past. Multi-regression analyses were performed using 38 clinical trials of the outpatient subjects which were conducted during 5 years from 2003 until 2007. As a result, 3 parameters (number of inclusion criteria, study duration (day), number of laboratory tests) influenced the implementation rate, but contents of laboratory tests did not. By substituting the data of these 3 factors for the regression equation, the implementation rate of the concerned clinical trial would be estimated at the time of the contract, resulting in the qualitative improvement of the clinical trial management.

A medical information system comprising all departmental systems including electronic medical recording (EMR) system was implemented at Yokohama Medical Center in April 2010 following relocation to a new ward. Along with the complete computerization of healthcare operations, a clinical trial management system interlinked with the EMR system was also implemented for clinical trial operations. Through this system, the advantages of the medical information system are used to conduct clinical trial medicine equivalent to daily medical practice.

Issues for clinical trials involving hospitalized patients (inpatient clinical trials) include the difficulties of constant involvement of the clinical research coordinator (CRC), as is found in standard outpatient clinical trials, and ensuring that the staff members of each related department understand the trial content. In the present study, we constructed an inpatient clinical trial critical path that integrated the advantages of the critical trial management system utilized for outpatient clinical trials with the treatment critical path, which was a function of the EMR system “for implementing inpatient clinical trials”. As a result, information is smoothly disseminated and shared among the staff members of wards and departments related to the clinical trial, and high quality clinical trials can proceed even when a CRC is absent.

Methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection has become a serious problem in Japan. There are many intractable cases in MRSA infection. Rifampicin and trimethoprim/sulfamethoxazole are used to treat patients as an adjunct to MRSA infection antibiotics. Therefore, we reviewed the published literature using the PubMed and Ichushi in order to examine the effects of rifampicin or trimethoprim/sulfamethoxazole combination therapy in the treatment of MRSA pneumonia and sepsis. One randomized controlled trial and 1 case-control study have examined the effectiveness of rifampicin in the treatment of sepsis. Neither of the studies showed statistically significant differences in efficacy between RFP combination drug therapy group and monotherapy group. However, several case reports have identified the efficacy. One randomized controlled trial has examined the effectiveness of rifampicin in the treatment of MRSA pneumonia, in which statistically significant differences was shown in efficacy between RFP combination drug therapy group and monotherapy group. There were only a few data regarding the use of trimethoprim/sulfamethoxazole combination for treatment of MRSA sepsis and pneumonia. Our literature survey suggests that rifampicin or trimethoprim/sulfamethoxazole combination therapy can be a therapeutic option for MRSA sepsis and pneumonia.