To evaluate whether or not cancer care utilizing community coalition-based critical pathways is patient-centered, we elucidated factors that affect the level of satisfaction in breast cancer patients.

A self-reporting questionnaire survey was conducted, with 385 female primary breast cancer patients who received surgeries, asking level of satisfaction with hospital visit, quality of medical care, physicians and breast cancer care as a whole. Depending on whether or not the patients were under the care of a community coalition utilizing critical pathways, the patients were divided into two groups, community coalition group and designated hospital group, and results between the two groups were compared. We examined how each of the survey items affected the level of satisfaction with breast cancer care as a whole.

The number of respondents in the community coalition group and in the designated hospital group was 86 and 151, respectively. Compared to the designated hospital group, more patients in the community coalition group received medical treatment other than for breast cancer, and the level of satisfaction with hospital visits and with physicians was higher, but the degree of recognition to implement examinations as scheduled was lower. There was not a significant difference between the two groups about the level of satisfaction with breast cancer care as a whole. We found a strong correlation between the level of satisfaction with breast cancer care as a whole and the level of satisfaction with physicians. The degree of recognition to discover a recurrence promptly was found to have the strongest influence on the level of satisfaction with breast cancer care as a whole.

Cancer care utilizing community coalition-based critical pathways was found to increase the level of satisfaction with hospital visits and with physicians, and were therefore likely contributing to the level of satisfaction with breast cancer care.

This study aims to demonstrate the responses of private hospitals to functional differentiation policies, which the government had been implementing since the late 1990s. A repeated survey questionnaire was conducted in 1998 and 2012, among hospitals owned by medical corporations and privately owned hospitals in Fukuoka prefecture, of which 90 responded. A quarter of the hospitals had changed their hospital type between 1998 and 2012. However, no significant changes were seen in the share of the hospital types as a whole, but a small increase in long term care hospitals. Arguably, private hospitals were found to be insensitive to regulations or government policies. However, hospitals that underwent changes had more positive opinions about the policy. The majority of the unchanged hospitals were Care-Mix type, and some changed hospitals took two different courses, either acute care, or long term care. We can assume the bilayer of hospitals, one that are sensitive to the policies and changing their type accordingly, and another, unchanged Care-Mix type, that preserve the status quo and also the majority.

Basic employment data was collected from a mail-in survey of 916 hospital pharmacists in Japan, and common trends were explored for respondents who had experienced employment changes. Survey items included respondents' individual attributes and information related to work facilities and employment changes. Multiple logistic regression analysis was performed to explore factors concerning the existence of employment change. The response rate was 52.5%. The respondents' average duration of employment at their current employment location was 10.2 ± 9.1 years. A total of 35.3% of respondents reported having experienced an employment change. Among them, 38.8% had previously been employed in pharmacies and 35.3% in hospitals. Results of the analysis revealed that most respondents who changed employment were old, worked in facilities with small number of beds, had few years of employment at the current facility, and held qualifications such as certified and/or professional pharmacist. Those who changed employment were more likely to be employed by facilities with small number of beds because small-and medium-sized facilities have a common employment practice of mid-career recruitment. Furthermore, these people were more likely to hold professional certificates because of their independence and awareness of improved career prospects.

Although multiple recommended therapies for the patients with coronary artery disease (CAD) were published in the past 15 years, many patients in whom therapies are indicated are not receiving them in actual clinical practice. We have surveyed the contribution level of liaison critical pathway (LCP) for CAD on patient education for 4 years. The total number of subjects of LCP for CAD was 603 patients between the years 2007 to 2011. We conducted the effects of LCP for the cardiovascular nurses at the starting time of the LCP, after half a year, two years later and four years later. At the time of the introduction of the LCP, LCP was effective in the information sharing, guidance, and the treatment of specific goals. The leadership and attitudes, however, of medical staffs for the patient education were low. As the LCP practicing years advanced, improvement were seen on the opportunities to meet patients (p=0.0006), the activity of patient guidance (p<0.0001) and the knowledge of heart disease (p=0.0004) of medical staffs. The LCP had improved the knowledge of cardiac rehabilitation in nurses (p<0.0001) and decreased the delay of starting LCP for CAD by doctors (p<0.0001).

The inter-professional work by using the LCP for CAD had been changed to be active in educating patients and improve medical knowledge of medical staffs.

We analyzed the incident reports filed by nurses at Hokkaido University Hospital over the 7-year period from 2002 to 2009. During this period, a total of 12,798 incident reports were filed. A dramatic increase of 33% was observed in 2007 compared to data from 2006. In 2007, to achieve a target of 7 patients per nurse, the number of nurses increased by 22% compared to the total in 2006 following the hiring of 140 nurses (most of whom were recent graduates of nursing school). The number of incident reports filed by recent graduates was high in 2007. Although recent graduates filed 2 to 3 times more reports than nurses with 2 or more years of experience, the average number of incident reports per nurse did not increase significantly. The increase in the number of nurses did not lead to the decrease in the number of incident reports. Medicine administration was the most frequent incident category among recent graduates of all incident reports they filed. Among medicine administration-related incident reports, errors in the speed of drip infusion via peripheral veins were the most common among recent graduates and 2 or 3 years-careers. Clarification of recent graduates' incident reports provides important and useful data for educating nurses about patient safety.

As fall-prevention in hospitals is extremely important, assessment of the risk of falls using a fall assessment score on admission is commonly performed in hospitals. Although it is essential to validate a fall assessment system, no validation has been done in our hospital. Therefore, in the present study, we evaluated the use of a fall assessment score in our hospital. We enrolled all patients (15 years of age and over) who were admitted to the neurosurgery and neurology ward between April 2009 and March 2010. Among these 532 patients, 40 (7.5%) experienced a fall. Based on the fall assessment score, 2.7% of patients with a category 1 had falls while those with category 2 and category 3 had significantly more falls (5.3% and 15.3%, respectively). Univariate Cox proportional hazard modeling that considered the duration of hospitalization showed that there were no significant differences between patients who had experienced a fall and those who had not experienced a fall in terms of age, hearing and visual deficits, cognitive dysfunction, and patient's character. Multivariate Cox proportional hazard modeling that considered the duration of hospitalization revealed that inpatient falls were significantly associated with experience of a fall and use of medication related to falls. When dividing patients into 3 groups (patients with both experience of a fall and taking medication related to falls, patients with either experience of a fall or taking medication related to falls, and patients without either risk factor), the rate of falls in each group was found to be similar to the rates in the three classes defined based on 8 commonly used parameters. The current fall assessment score used in our hospital is considered to have good predictive validity. However, the score could potentially be simplified without losing predictive efficacy.

We investigated 5,145 consultation records from nationwide intractable disease support centers, and examined the contents of 2,033 consultation records for the ten intractable diseases about which advice is most frequently requested. Diseases with the largest numbers of consultations were Parkinson-related diseases (PD) and amyotrophic lateral sclerosis (ALS), followed by ulcerative colitis (UC). Although the numbers of patients with PD and UC (number of claimant certification issues for medical care) were about 100,000, respectively, that of patients with ALS was about 8,300, being the smallest among the ten intractable diseases, showing no significant correlation between the number of patients and that of consultations. However, focusing attention on consultations from the patients themselves, a significant positive correlation was observed between the number of patients and that of direct consultations from the patients themselves (p<0.05).

For nine intractable diseases other than ALS, the percentages of consultations from the patients themselves were 49.3% to 81.4%, but the percentages of those requesting a consultation for ALS were 48.4% for support personnel (health and medical welfare professionals), 26.7% for family members, and 8.4% for patients themselves. Based on the consultation item tendencies, consultations for the ten diseases were classified roughly into three types：(1) working consultation (five diseases including UC)；(2) patient association activities (four diseases including PD)；and (3) recuperation environment adjustment (ALS), suggesting a relationship with disease types.