The purpose of this study is to find out physicians' perspectives on patients' and their family's decision making on continuing care at home. Semi-structured interviews of 14 home-care physicians were analyzed in a qualitative and descriptive method.

The interviews found that physicians acknowledged and respected the independent decisions of patient and family on home care and supported them at all times. It also found that physicians regarded crucial points of support interventions at initiation of home care, when a patient needs long-term care, and when terminal care is necessary. Their support is evident as they continually collaborate with the patient and family members or care-givers throughout the process；respond to any crisis arising from long-term home care, assist patient and family in accepting death or disability, be available round the clock, coordinating work with visiting nurses, information sharing with collaborating health care professionals and hospital, establishment of a family backup system, and immediate response to help patient and family ease anxiety. The physicians perceive home care as the empowerment of the patient and family to be involved in the care, in which acknowledgement is given to their participation and their desire to live as normally as possible and die naturally surrounded by loved ones are honored.

To investigate risk factors relevant to the severity of accidental slip-and-fall injuries, we assessed keywords by comparing the words extracted from nursing reports using a text mining method in groups that were classified according to the level of injury severity. A total of 462 cases that were reported in 2013 in our incident reporting system were classified into four groups: cases without injury, cases with injury requiring no treatment, cases with mild injury requiring minor treatment, and cases with severe injury requiring major treatment. Text mining was carried out using the package “RMeCab” that enables the tool for morphological analysis “MeCab” to be added to the software environment for statistical computing and graphics “R”. The results showed that there were substantial descriptions about excretion and physical activity in the nursing reports for cases with severe injury, and suggested that problems of excretion and poor physical activity were risk factors for these cases. On the other hand, there were fewer descriptions about symptoms such as pain and fever, as well as using a wheelchair, in the nursing reports for cases with severe injury. A defensive approach may enable risky actions to be avoided. These observations suggest that descriptions in nursing reports may provide clues to reduce future severe slip-and-fall injuries.

The objective of this study was to investigate the amount of time that had actually been taken by medical facilities between detection of data breaches of patients' personal information and their public announcement, as well as analyze factors responsible for the delay in public announcement of data breaches, in order to propose basic protocol that should be adopted by medical facilities to ensure appropriate handling and timely public announcement of data breaches.

A total of 249 cases of data breach on patients' personal information which had been reported or made public through newspapers, websites, and similar channels between 2008 and 2012 were included in the analysis. Statistical characteristics of the data pertaining to time taken before public announcement were identified. In addition, factors which had caused delay in public announcement were also explored using statistical and case analysis.

The study revealed that the time taken before public announcement was within two weeks in three-fourths of the cases (half of them were within one week). However, 10% of the cases required 25 days or more before public announcement. The major factors responsible for delayed public announcement fell into three groups：1) rational reasons such as implementation of preventive measures against further expansion of the damage；2) irrational reasons such as delay in reporting by the person responsible to the breach；and 3) neutral reasons such as discussions to determine responses and measures to be taken.

If the cause of delay in public announcement is attributable to rational reasons, it may be deemed as acceptable. However, delay due to irrational reasons should be avoided. When data breaches occur, actions must be taken as quickly as possible by medical facilities, using a combination of emergency response measures against further expansion of the damage and prudent/correct measures.

A means to centralize data is desirable to better manage the information of patients seen by multiple healthcare providers. We investigated the possibility of using medication notebooks as such a medium in a community healthcare setting. To efficiently share the information, we drafted a new collaborative notebook format.

The format was then discussed with medical organizations and feedback from medical professionals was incorporated into the format. To determine whether the format would be functional in the medical setting, we conducted semi-structured interviews with patients and medical professionals, and extracted data pertaining to format usability and problems.

In the discussion with the medical organizations, two notebook formats were presented；a type that allows for a description to be written in and a type with a check-box. After evaluating the results of the interviews, 69 items were extracted from the verbal data, which were classified into four areas：“effective information utilization” (31.9%), “obstructive factors” (8.7%), “problem areas” (23.2%) and “useful information” (36.2%).

We found that our format was useful in patient/medical professional collaboration and health management, and hold promise for wide use going forward. Nevertheless, our study also identified areas for improvement, such as illegible handwriting and familiarization with the recording procedure.

Taking these findings into account, we redesigned the format to separate out the descriptive and the check-box sections, and added an item for unused medication. The final design was incorporated into medication notebooks which became available on the market in June 2012. We hope this medication notebook will be utilized in medical collaboration to improve the quality of community healthcare.

Although it has been emphasized in the medical field that inter-professional collaborations are useful and important, there are only a few meetings that participants can discuss actively and debate frankly with each other. We started workshop meetings with hospital inter-professionals to resolve a lot of issues in hospital management within a short period of time.

Members of the meeting are staffs who are recommended from different working fields in our hospital. Before the meetings, we requested them to make some opinions on issues that we should solve and put into effects. Then we used the mind-map technique to obtain the product by aggregating opinions in the meeting. It was decided that this meeting would be held once a month, and time managed to be completed within one hour.

Initial meeting produced a key word of this year；Hospitality. In subsequent meetings, we conducted workshops and discussed action plans to realize Hospitality. The standard operations adopted through the meetings were greeting activities, cleanup activities, mediation workshops, and poster contest for cleanup activity. All of committee members had disseminated individual objects to the hospital. Workshop-style meetings can promote proactive involvement and result in better implementation of new programs.

To integrate and make full use of medical data effectively, we constructed the computerized discharge planning management system which was retrieved from the data warehouse. The computerized management system consisted of four stages--clinical assessments, planning, scheduling, and tracking. The risk evaluation for discharge planning was standardized and enrolled in the basic patient profiles in the electrical medical records. Responsible nurses for discharge planning were selected the intervention cases from the clinical assessments, which composed of the stability of the diseases, physical conditions, and activities of daily life. The discharge planning was normalized to clarify the problems and the current challenges for hospital discharge by inter professional works. We clarified the effect of the computerized discharge planning management on the length of stay. The number of patients more than 50 days in hospital stays was significantly reduced after introducing the system. The utilization ratio of the normalized planning had improved significantly among each half-yearly (respectively, 8.7%, 59.2%, 76.8%, p<0.0001). As the standard planning ratio was increasing, conferences and medical social worker consulting were held more early, and the length of stay was also significantly shortened (67.0±51.2, 45.4±32.7, 39.5±28.2, respectively, p<0.05).

The discharge planning management system could lead to early implementation of discharge planning conferences and be resulted to decrease long-term inpatients.

To develop a conceptual model for nursing staff resource management, we connected Diagnosis Procedure Combination (DPC) codes with the level of need for nursing care in acute-care hospitals, and thereby ascertained changes in the level of need for nursing care for a particular disease treated by particular interventions. Data on DPC codes and the levels of need for nursing in patients hospitalized in a surgical ward of an acute-care hospital (≥500 beds), and those on the clinical ladder levels of nurses working in the same ward were collected in October 2010. The mean scores of the level of need for nursing care by ICD disease (A score) and by the presence/absence of surgical intervention (B score) were calculated in order to examine their time-course changes. The first day of hospitalization was designated as day 0. Data for one common disease (malignant gastric tumor) were extracted into graphs showing changes in the A and B scores over time period. In addition, changes in the level of need for nursing care and changes in the nursing power score (ladder level × number of nurses) in the surgical department were examined. Our results suggest that examining changes in the level of need for nursing care after removing the influence of variance enables the need for nursing care to be more accurately predicted. Furthermore, nursing power declined on Saturdays and Sundays over the 1-month period, suggesting the need for a flexible staffing system that can respond to sudden increases in the admittance of patients in serious condition.

The purpose of this study was to evaluate the web accessibility for the website of the advanced treatment hospital. The front pages of the website as of December 1, 2013 for three advanced treatment hospitals in Hokkaido were analyzed using an evaluation tool, miChecker. The comprehensive evaluation and four items evaluation (perception, operability, intelligibility and robustness) were carried out, and areas where problems were likely to occur in each item were extracted. Furthermore, the accessibility to two medical information (second opinion, operation and treatment results of cancer) in the website of three hospitals was compared with the website of the Osaka University Hospital based on JIS X 8341-3：2010 (web accessibility). As a result, the web accessibility of three hospitals had problems for the comprehensive evaluation. For itemized evaluation, the evaluation of the intelligibility and the robustness was high for three websites, but the evaluation of the perception and the operability for two websites was significantly low. Most of the problems were caused by the situation that there was not the alternate text for the image in the website. The front page of one hospital had the menu on the second opinion, but the front page of three hospitals did not have the menu on it. All four hospitals did not have information on the operation and treatment results of cancer in the website. It is concluded that the website of the advanced treatment hospitals in Hokkaido has problems with not only the compliance with JIS X 8341-3：2010 (web accessibility) but also accessibility to medical information.