Since September 2005, we have used a critical path system to manage perioperative medical care for patients undergoing cervical laminoplasty. Variance analysis of the outcomes and duration of postoperative hospitalization identified key points for the smooth management of a critical path dealing with a long period of postoperative hospitalization. Cervical laminoplasty is a form of elective surgery, and as long as complications are well controlled preoperatively, there is little likelihood of variance occurring in the anticipated outcome. When the outcome was defined as the duration of postoperative hospitalization, however, the wishes and schedules of patients and their family members accounted for three-quarters of negative variance, and reducing this factor posed a challenge. We changed our method of management in December 2012, improving patient education by providing clear information on discharge criteria and the expected date of discharge from before surgery, and giving them guidance on post-discharge lifestyle at an early postoperative stage. This greatly reduced the negative variance due to the wishes and schedules of patients and their family members. The important points that we identified for the smooth management of a critical path dealing with a long period of postoperative hospitalization of more than 2 weeks were the prevention of perioperative complications and comorbidities through preoperative physical testing and through improved patient education on pre-existing conditions, dealing with patients on an individual basis in accordance with postoperative course, and taking care to ensure that patients and their family members understand the disease and course of treatment in the preoperative stage. Moreover, with the intent to detect postoperative neurological deficits as early as possible, we equipped the critical path system with the check function.

This study aims to visualize the process and problems in initiating homecare in Tenri area. First, we interviewed homecare providers to learn of the initiation process and trouble they encountered at that time. Additionally, two researchers qualitatively analyzed the results of interviews and made a conceptualization of the process and the problems. Furthermore, we made some questionnaires based on the qualitative analysis. Finally, we performed questionnaire surveys in all healthcare facilities providing homecare in Tenri area. In 12 homecare facilities (10 clinics and 2 hospitals), a total of 16 physicians provided 468 patients with homecare in 2013. Of the 468 patients, 30 % are referrals from hospitals (22% from medical doctors, 8% from care coordinators), 29% are transition from outpatients and 16% are direct contacts from patients or their families. Except for one facility specializing in homecare, the others are transition from their outpatients, referral from hospitals and direct contacts from patients and the families resulting in 36%, 21% and 20% respectively. The most frequent problem of the process is maintaining a system providing 24-hour service in each facility. In addition, shortage of family caregivers, no wish of caregivers to receive homecare, instability of patients' livelihood and busyness of each clinic are reported as issues in initiation of homecare.

It is needed for homecare doctors to understand pain, give 24-hour support and manage unpredictable requests from hospitals or patients' families. Furthermore, we should pay attention to coordination among livelihood support, long term nursing care and public welfare in the area.

The hospital's medical safety board searched for the causes of frequent and important errors in the hospital, and proposed measures for creating an educational video to aid error accident prevention and error-recurrence prevention, and for alerting the staff to the causes of these errors. Theme of “drug administration doublecheck miss” was set to 3 scenarios where doctors, nurses and pharmacists are concerned.

The educational video, which can be self-studied by the staff, was created in approximately 11 months. 98.1% of educational DVD users said it provided understanding in the processes where doublecheck miss occurs and 83.6% said there needs to be a review in steps for doublechecking.

Through the DVD creation process from planning to completion, the hospital staff were able to surmount boundaries between professional positions, strengthen multidisciplinary cooperation, and learn that the key to successful error prevention is planning for all possible situations.

The purpose of this study was to evaluate the information accessibility for the websites of twenty-one designated cancer care hospitals in Hokkaido. The web accessibility on basic policy published on the websites of twenty-one hospitals was investigated. The front pages of the website were analyzed using an evaluation tool, miChecker. The web accessibility was evaluated using four items (perception, operability, intelligibility and robustness) based on JIS X 8341-3：2010. The place and the content judged to have problems in each item was extracted and the proportion for each problem was calculated. Furthermore, the accessibility to two medical information (second opinion, operation and treatment results of cancer) in the websites of twenty-one hospitals was investigated by presence or absence of two information and route until information arrival. The result was that there were no hospitals which published the web accessibility basic policy on the website. For itemized evaluation, the evaluation of the perception and the operability for twenty-one websites was overall low, especially in the category on perception -“the achievement standard for non-text contents”- was approximately 70 percent. The operation and treatment results of cancer on the website had less information than second opinion, and needed extra time to access such information. Only four hospital websites had links to either of the two public medical information. It is suggested that most of the websites of twenty-one designated cancer care hospitals in Hokkaido have problems with information accessibility, and they do not offer web contents catering to the inhabitants' (especially the disabled and the aged) viewpoints.

At the hospital where dialysis patients are cared for, there is a need for information sharing between dialysis nurses and ward nurses with respect to expertise of dialysis. Using a mobile terminal, we devised a program for hospital workshops and self-learning modules. We compared this program with the conventional Off-the-Job Training (Off-JT). The subjects were 21 ward nurses and a survey by questionnaire was used to evaluate the program. According to the post-implementation survey, the ward nurses reported that they had more exposure to dialysis information and were able to deepen their knowledge. In addition, an improvement of learning motivation was also observed. Off-JT with mobile terminals has many advantages such as it being browser-free, providing on-going access any time a question arises, and having a chat function which provides precise answers and easy exchange of opinions. Based on this study, it has been shown that Off-JT using mobile terminals is useful not only for knowledge acquisition on dialysis but also as an educational tool for other inpatient care.

Many of cancer chemotherapy are performed in an outpatient department today. In order to observe the state of the patients and symptoms while chemotherapy is conducted, we post pharmacists in the outpatient chemotherapy room, providing education to patients, as well as giving suggestions to doctors regarding prescription. In this study, we reviewed pharmacists' suggestions to doctors and investigated the change of side effects of the patients. We studied 84 patients who received cancer chemotherapy as outpatients from July 2011 to June 2013 with side-effect Grade I and over at the point we provided the suggestion. Then, we compared the side-effect Grade before and after the suggestion. As the symptoms to evaluate we chose nausea, vomiting, anorexia, stomatitis, diarrhea, condition of skin and nails, constipation, peripheral neuropathy, which were reported in the form of self-check list by the patients each time they received chemotherapy. During the term of investigation, we interviewed 335 patients, resulting in 3,902 times in total. In the same period, we gave 342 suggestions to the doctors, and 88.0% of the suggestions were accepted. Among the suggestions, 52.0% were related to side effect, 17.0% treatment contents, 13.5% complication, 8.8% pain, 5.3% examination, 2.0% administration day changes, and 1.5% drug interaction, respectively. Out of 84 patients, 51% made improvement in terms of Grade, and symptoms elimination was observed in 38%. These results suggest that placement of pharmacists in an outpatient chemotherapy room is helpful to observe directly the change of the patients' condition. Furthermore, it enables for the pharmacists to make appropriate and urgent suggestions from the pharmaceutical point of view.

Type 2 diabetes impairs the quality of life of patients because of the micro-and macro-angiopathic complications. Furthermore, the augmentation of medical costs due to the recent increase of the disease poses a serious problem of national importance. Therefore, we have analyzed the relationship between several clinical indicators and medical costs.

A total of 798 patients with type 2 diabetes who had more than 1 year of outpatient history at Aso Iizuka Hospital from January 2006 to March 2013 were enrolled. The relationship between the clinical indicators and the monthly average medical costs (MAMC) was analyzed using the database developed from electronic medical records and detailed statements of remuneration for treatment. Patients included 420 men and 378 women whose ages ranged from 17 to 93 years (63.1±12.9 years). As a result, the blood levels of glucose and glycoalbumin positively correlated to MAMC. On the other hand, the estimated glomerular filtration rate (eGFR) negatively correlated to MAMC. MAMC revealed gradual increase in accordance with the elevation of GFR stages. Noteworthy, there were no significant differences of MAMC between G1, G2, G3a and G3b, but MAMC showed significant differences between G3b, G4 and G5.

The diabetic nephropathy should be strictly controlled at G3a stage in order to optimize MAMC in the treatment of type 2 diabetes.