In creating a favorable and safe working environment for healthcare workers, grasping the existence of workplace violence instigated by patients or their relatives is an important issue which also requires further investigation into preventive and reduction scheme. However, little is known about any detailed modes of workplace violence in hospitals. The aim of this study is to reveal the detailed modes of workplace violence in hospitals, to identify the modes of violence which relate to healthcare worker's stress response, and to examine environmental factors which relate to the experience of that violence.

A questionnaire-based, anonymous, and self-administered survey was conducted at 18 hospitals from February to October 2012. Generalized linear mixed model was used to examine a relationship between workplace violence and stress response, and a relationship between experience of workplace violence and work environment.

Among the modes of violence, six types of violence were related to nurses' stress response：being physically kicked’, ‘having personality or abilities put down’, ‘verbally abused on physical appearances’, ‘given unfounded complaint or unfair demands’, ‘being sexually touched on arms or legs’ and ‘being demanded for sexual acts’. These six types of violence related to the respondents'work place assessment of psychiatric wards, outpatient units, dialysis units, night shift, a feeling of manpower shortage and patient safety evaluation.

A further investigation of the circumstances that trigger patient's violence is required to construct preventive measures against each mode of violent act.

In accordance to the recently established Second Master Plan for Promoting Cancer Measures, the April 2009 resolution of the Subcommittee on Regional Alliances in Shiga Conference for Cooperative Cancer Therapy, were reviewed. The subcommittee completed the prefectural liaison critical paths for the Five Big Cancers after 1 year's discussion and put into practice in April, 2010. The main contributors were the members of the Shiga Liaison Council of Cancer Patients, the Shiga Prefectural Medical Association and the Base Hospitals for Cooperative Cancer Therapy. Then, prefectural workshop has been held twice a year and study meetings regularly in each medical service area, aiming to educate the critical paths. 448 paths have been registered and applied (196 for stomach, 222 for colon, 19 for breast, 4 for liver and 7 for lung cancers) by March, 2013, when the First Master Plan terminated. As of the end of November, 2013, the registered critical paths have amounted to 602 (252 for stomach, 305 for colon, 25 for breast, 4 for liver, 9 for lung and 7 for prostate cancers). While there have been wide differences in registration among the Five Big Cancers, the cause of the difference was supposed to be various and unique to each cancer. Rise of registered number of the critical paths, workshop and study meetings, distribution of the pamphlets and simplification of cooperative process altogether have been assumed to enrich the liaison network of cancer therapy. However, it is now clear that there are unavoidable differences among medical service areas and among individual institutions in terms of regional alliances. Our future issues now are to fortify and reconstruct the existing liaison network of cancer therapy, accepting differences in human and material resources as they are, and managing efficient role-sharing of medical cooperation.

In January, 2009, Kagawa Seamless Care Study Group started the operation of the cerebral apoplexy liaison critical path by digital information using Kagawa Medical Internet eXchange (K-MIX).

This time, 580 persons discharged from the convalescence institution were classified into the home return group (407 persons) and the non-home return group (173 persons). The activities of daily living for returning home based on the “everyday life evaluation of function” in both groups were analyzed, and the following results were obtained.

1. In both groups, the degree of life independence at the time of leaving from a convalescence institution was significantly higher than that at the time of leaving from an acute stage hospital.

2. The degree of life independence of the home return group was significantly higher than that of the non-home return group at the time of leaving from both an acute stage hospital and a convalescence institution.

3. In the home return group, index of “cognitive items”, “changing sides”, “rising”, “seating position retention”, and its “dietary intake” were high at the time of leaving acute stage hospital, and “the change”, “move procedure”, and “cleaning the oral cavity” and “exchange of clothing” had improved further at the time of leaving a convalescence institution.

When the degree of independence of self-care items, such as “cognitive items”, “changing sides”, “rising”, “seating position retention”, and “dietary intake”, was maintained by this examination at the time of leaving acute stage hospital, it became clear that the further improvement in a convalescence institution could be expected. In nursing, care and rehabilitation in an acute stage hospital, it seems that the improvement in the degree of independence of daily life, such as operation on a bed and dietary intake, should be given attention.

Of cancer patients in the hospital-based cancer registry at the Miyagi Cancer Center, 3,499 patients diagnosed, operated on or initially admitted between 2000 and 2008 without information about their vital status in 2012 were followed up by accessing resident registration cards and permanent domicile data. In addition, information on death certificates was requested from the Ministry of Justice for cause of death. After referring to resident registration cards, the vital status for 99.3% of patients was ascertained, and the vital status for another 0.5% of patients was identified through permanent domicile data. That is, the proportion of patients with known vital status was 99.8% at the end of the investigation. Charges for investigating via resident registration cards and permanent domicile data totaled 963,150 yen and 221,000 yen, respectively. Information on resident registration cards was available for a fee in almost all municipalities, but 4 cities and 1 district refused to provide information because they were not permitted to do so to the local incorporated administrative agency. Furthermore, even in those municipalities permitted to provide information from resident registration cards, detailed explanations and responses to the request for related materials were needed. Therefore, it took three months to complete the investigation using resident registration cards due to the time and effort needed for information requests from the municipalities. In contrast, investigations through permanent domicile data required no additional time or effort and took only a month to finish because certification from the national government for this investigation was part of the application process. If certification from the national or local government is available or if a clear legal basis exists for providing requested information, investigations using resident registration cards proceed smoothly and reduce the length of these investigations.

The educational issue of newly hired nurses includes deviations from an intended course after graduation, a decline in nurse ability and skills, an increase in the number of inexperienced mentors and burden of extra workload, and variation in education contents among mentors. To solve these problems, it is deemed necessary that we promote educational linkage with standardized teaching/evaluation methods. We conducted “Objective Structured Clinical Examination (OSCE)” from our own perspective regarding three techniques；the standard drawing blood method, drug preparation and intravenous drip infusion. Also, we evaluated the nursing department OSCE based on the results of a questionnaire survey carried out before and after conducting OSCE.

Among 57 newly hired nurses, when compared the self-evaluation of the proficiency level between after practical skill seminar and one month after conducting OSCE, the latter showed significantly higher points in the drug preparation.

At the same time, we assessed the self-evaluation of procedure adherence rate on eight items in the standard drawing blood method six months and ten months after OSCE. Comparing operating group (n=52) with a non-operating group (n=22-25) regarding the self-evaluation of procedure adherence rate six months after OSCE, the former reported significantly higher adherence rates in “checkup patients with test tubes (p=0.003)” and “blood drawing after confirming avascularization and the puncture site (p=0.024)”. Meanwhile, there was no significant difference between the two groups ten months after OSCE.

From these results we conclude that the nursing department OSCE would standardize teaching/evaluation methods in education for newly hired nurses and that it would be useful for early learning and to maintain its effects.

Aging of the population, which will progress rapidly into 2025, is one of social problems in Japan. Specifically, medical care cost is expected to further escalate. In order to maintain universal health care system, it is important to streamline medical resources while securing necessary medical services. In Saga University Hospital, the number of the elderly is also increasing, and ischemic heart disease is one of the most frequently occurring diseases. In this study, based on the difference in surgery of ischemic heart disease in our hospital, the authors investigated the current situation of mortality rate, the number of hospitalizations, total length of stay and total medical bills, and discussed measures to make medical bills more reasonable.

Patients with ischemic heart disease in our hospital between July 2008 and August 2013 were extracted and classified into two groups：patients who underwent percutaneous coronary intervention (PCI group) and patients who underwent coronary artery bypass grafting (CABG group). In addition, PCI group was divided into three subgroups based on the frequency of PCI：once (PCI-1), twice (PCI-2), and three times or more (PCI-3+).

Compared with PCI group, CABG group had longer length of stay and higher medical bills. Between PCI-3+ group and CABG group, there was no significant difference in mortality rate, length of stay or medical bills.

The results suggest that if mortality rate is used as an index of securing necessary medical services, PCI is better than CABG in terms of length of stay and medical bills. However, in the cases where PCI was performed three times or more, there was no difference in efficiency. Therefore, not to investigate difference in operative procedure but to cooperate with backup hospitals and to improve home medical care will be a more effective measures to streamline medical resources.

To identify factors relevant to the revenue and expense of medical association hospital, multiple regression analysis was conducted by setting the revenue-and-expense ratio as the dependent variable and hospital business management indices as the independent variables. The result made clear that the revenue and expense of medical association hospital had a close relation with the inpatient per-person-per-day hospitalization profit, the number of inpatients per doctor, the cost-of-materials ratio and the number of outpatients per doctor. Also, medical association hospital which was relatively high in the revenue-and-expense ratio had a strong relation with the personnel expenditure ratio in addition to the cost-of-materials ratio and the inpatient per-person-per-day hospitalization profit. It was suggested that the control of the cost-of-materials ratio and the personnel expenditure ratio, and the improvement of the inpatient per-person-per-day hospitalization profit contributed to the improvement of the revenue and expense. It further became apparent that factors relevant to the revenue and expense of medical association hospital varied according to the nurse to bed ratio and the number of hospital beds.