This study analyzed the influence of the 2011 Fukushima Nuclear Power Plant accident on work and family of the nurses who were evacuated due to this event. The subjects of the survey are 7 nurses who worked for the closedown hospital by the accident. The data collection was performed by a semi-structural interview. And the text data were analyzed qualitatively by M-GTA. Results of the analysis for immediately after an accident was categorized into 6 parts：“Work commitment to a nursing job”, “Human relations in the organization”, “Action as the managerial class”, “Psychological reward”, “Conflict of work and the family”, and “Experience of the radiation exposure”. The result of analysis for 2 years after earthquake disaster was categorized into 2 parts：“a PTSD state”, and “unrestored living environment”. The results showed that the nuclear event affected the nurses in the group dynamics, work and family conflict, also their mental health.

Cancer regional alliances critical path is designed by national cancer practice cooperation hub hospitals and prefectures. However it is not widely introduced and the situation is the same in Ehime prefecture. In order to effectively utilize the alliances path, we developed procedure and management (design, adaptation, explanation, role allotment, management tool, etc.) of it in Shikoku Cancer Center. The developed system was fully operational from April 2012 and it was adapted to 261 patients, which were less than 30% of possible cases. However, this meant that it was possible to increase the number of cases, if regional alliances critical path was consistently used in accordance to alliance path procedure and management, which helps medical staffs share roles and encourage local medical institutions.

We evaluated the clinical collaborative path for diabetes mellitus used in Okayama Prefecture. Total of 324 patients (mean age：60±9 yrs, duration of diabetes：8.5±8.9 yrs, HbA1c：9.4±2.2 %), using the diabetic critical path in Okayama Medical Center, were tested. They were followed up in Okayama Medical Center every six months for re-evaluation of diabetic complications and therapeutic strategies. The HbA1c levels were 7.0-7.2% in 6 to 60 months from induction of the critical path. In 81 cases, the critical path was finished because of good clinical course. The mean HbA1c levels was 6.3±0.6% at finish time in them.

According to the latest data, the frequency of multiple daily injections (MDI) was decreased (26% to 18%) and the frequency of oral antidiabetic agents (OAD), diet therapy and GLP-1 receptor analogs were increased (46% to 50%, 5% to 7%, 1% to 5%, respectively) compared to those at the induction of the critical path. Especially in 81 patients in whom the critical path was finished because of good clinical course, the frequency of MDI was significantly decreased (16% to 5%) and the frequency of OAD and diet therapy were increased (67% to 72%, 4% to 8%, respectively), suggesting that the diabetic treatment was stepped down while the inter-regional cooperative therapy is maintained.

The clinical collaborative path is useful as a tool to initiate collaborative management for diabetes mellitus between hospitals and clinics. Development of inter-regional cooperation results in promoting role-sharing and function differentiation in hospitals and clinics.

Bone-Modifying Agents (BMA), such as bisphosphonates and denosumab are useful medicine that suppresses Skeletal-Related Event (SRE), and improves patient's prognosis and quality of life. However, the possible adverse event of osteonecrosis of the jaw (ONJ) is a severe problem. Risk factors of ONJ are dental infection and extraction. Those dental problems should be treated before administering BMA. And, when ONJ develops, dentist's participation is necessary. Therefore, the cooperation of doctors using BMA and a dentist is important. In order to promote the medical treatment cooperation in administering BMA safely, we organized “Liaison meeting for BMA”. Members consisted of physicians, dentists, and pharmacists. Our purposes are follows：

1. Mutual understanding of multi occupational category concerning ONJ by BMA

2. Construction of system for BMA treatment

13 meetings were held by June, 2014, including study meetings and lecture meetings where the system for the BMA treatment was prepared. As a result, 12 patients used the system by present, and all patients outcome are good. We will support the safe use of BMA by introducing the system to various medical institutions.

There is concern that reducing length of hospital stay may result in low-quality transitional care for the patients and their families. In order to secure adequate quality for patients and families, hospital workers should effectively acquire a management skill for discharge planning. A case method is a teaching method that is widely used in business schools. Students can enhance their leadership and management skills through discussions on a case example. Prior to this research, we hypothesized that this case method could be adjusted into education of discharge planning. Therefore, we developed a novel educational program of the discharge planning using a case method education.

This program was conducted from April 2012 to July 2012 at Tenri hospital. The participants were provided with a case method education consisting of the following three steps：1) Preparing their opinions about teaching cases prior to the classes. 2) Small group discussions between participants followed by full classroom discussion with the lecturer, 3) A short lecture by the lecturer summarizing key points in the cases. Two healthcare professionals specialized in care transition prepared four cases based on actual care transition in Tenri Hospital.

This program enrolled 57 healthcare staffs working in Tenri Hospital and affiliated care institutions. Over 90% of the participants were satisfied with the program. The participants' self-awareness survey was based on the following four categories：acquiring core competencies for discharge planning, problem extraction through active interaction among the participants, precious opportunities for inter-professional communications, and growing awareness of the problems related to the current discharge planning.

In conclusion, this case method, using a discussion-based education based on actual cases, successfully contributed to enhancing the participants' awareness for management of discharge planning in addition to obtaining the core competency. Furthermore, the program itself could promote inter-professional communications among the hospital workers.

Patient supporting center opened in our hospital in August 2013. It focused on eliminating patient anxieties during waiting term before their admission. Various kinds of healthcare workers such as doctors, nurses, nutrition advisers, pharmacists, and rehabilitation staffs try together to provide necessary information before admission. Nutrition advisers in the department of nutrient management provide special nutrition guidance to the patients either with malnutrition or the diabetics and overweighed.

The purpose of this study is to evaluate the effectiveness of this program in the management of the patient care afterwards.

From August 2013 to January 2014, 952 patients visited to patient supporting center. Of those, 287 patients (30%) received special nutritional approach by the dietary managing staffs. 160 patients (17%) were diabetic and/or hypertensive. 39 obese patients (BMI≥25) in prehospital period revealed apparent weight loss by the time of their admission into hospital. Food allergy protective meal could be prepared in 52 patients (5.5%). Nutrition dietary advices were prepared for 1.5 times the number of patients compared with those last year. The number of special meal menu provided for the patients increased 3.2% compared with that of last year.

It is suggested that diet intervention in prehospital stage in patient support center is useful in patient nutrition management in hospital life as well as to patient profits.

This study evaluated the effects of social rehabilitation through community participation of elderly and disabled individuals who use a rehabilitation facility. We followed 40 individuals from rehabilitation facility users for one year. Intervention group consisted of 20 individuals who requested community participation activities. Control group consisted of 20 individuals with no significant difference in variables of：age-, need of care-, gender-, living with family member-, and degrees of the facility use. Both groups were provided individual rehabilitation and group rehabilitation, but the intervention group was also given community participation activities. We then examined LSA score and need of care degree at the baseline and at the end of the intervention in both groups. We performed within- and between-group comparisons in LSA score and need of care degree.

For intervention group, the average LSA score was 36.2±21.5 points at the baseline, 49.7±20.8 points at the end of the intervention and ratio of improving LSA score was 1.70±0.98. For control group, the average LSA score was 36.9±26.4 points at the baseline, 38.6±25.8 points at the end of the intervention and ratio of improving LSA score was 1.15±0.44. Within-group comparisons for intervention group, the LSA score at the end of the intervention was significantly greater than that of at the baseline. However, no significant difference was found in control group. Moreover, for between-group comparisons, the ratio of improving LSA score of intervention group was significantly greater than control group, whereas need of care degree was not significantly different between both groups.

Social rehabilitation to enhance community participation is a valid approach for housebound elderly persons. To improve QOL issues in elderly persons, prevalence of social rehabilitation is required in community-based rehabilitation.

We conducted SWOT analysis using the strengths and the weaknesses extracted with the KJ method, and elucidated the vision and strategic theme of the Mie-chuo Medical Center, National Hospital Organization based on these results. Then we applied the balanced score card (BSC) which was constituted of the strategic map and target and the outcome measure with its value from the four points of view of financial affairs, customer, internal process, and learning and growth. A part of the outcome measures and target values were referred from the result obtained from the statistical analysis of clinical and financial data.

Because BSC in 2013 was a short-term trial, several target values could not attain the expected value in financial affairs, customer, and internal process. It was also suggested that new benchmarks were needed to be established from the viewpoint of learning and growth. New outcome measures and target values in 2014 were set up considering these results.

As a result of applying BSC, the management goals were able to be shared among the medical staffs in our hospital. Furthermore, the evolution of the executive BSC to each department's BSC has taken on a new significance in the sense of reconfirmation of hospital management and strategic goal in each department.