In previous studies, work-related stress on in-house, outsourced, registered or non-registered dietitians at a hospital has been investigated. There have, however, been no reports on the work-related stress of registered dietitians in different employment positions.

In this study, we investigated work-related stress of chief dietitians, vice-chief dietitians, senior dietitians and junior dietitians who have been employed less than four years. Irrespective of employment positions, more than 50% of the subjects expressed stress caused by workload and work quality.

Among them, junior dietitians with less than 4 years of service complained of mental and physical stress. Vice-chief dietitians had their work under control with the least stress level. Chief dietitians felt less supported by their supervisors and this seemed to lead them to feel overloaded with work. Moreover, they had higher health risk than the nation's standard level.

It becomes apparent that systematic measures are necessary in accordance with stress causing factors which are diverse in different employment positions.

The purpose of Medical Doctors' Assistant (DA) is to provide qualified medical care by reducing physicians' work load, expecting that they can contribute to enhance the quality of health care. However, little evidence is known if DA can indeed improve the quality of health care. The present study investigated if employing DA improved medical safety at the University Hospital using the incident reports filed by the medical doctors (MDs).

The number of incidents filed by MDs in the departments where DA is yet to be introduced was significantly increased during the study period compared to control term (7.4+/-1.8 vs 4.3+/-1.8, P＜0.02). In contrast, following DA implementation, those from the departments employing DA did not increase, as compared to before DA employment (4.0+/-0.6 vs 5.4+/-1.0, NS). The frequency of the increase or decrease in the incident was significantly different between departments with DA and those without DA；increase in the number of incidents was observed in 89% and 17% in the departments without and with DA, respectively; whereas, reduction in the number of incident was identified in 0% and 55% in those without and with DA, respectively (P＜0.02). Moreover, the incidents associated with doctors' hastiness, panic, and shortage of sleep decreased in the department with DA following introduction of DA, whereas they remained the same in those lacking DA before and after evaluation period. Moreover, the number of serious incident (over 3b) was significantly elevated in the department without DA (P＜0.05), but in contrast, it stayed the same in the department with DA, suggesting that DA prevented the serious incident from occurring. These data indicate that DA contributes to the medical safety by reducing the incidents that are involved in medical doctors.

Of falls that occurred at Kurume University Medical Center from April 2015 to March 2016, 78.7% were due to patient-related factors. We considered developing a shared risk and prevention plan for patients, families and nurses. As part of a patient participatory falls prevention plan, we evaluated the degree of risk based on a fall checklist completed by the patients and their families, and shared the risk and preventive plan in a patient participatory explanatory paper and fall prevention leaflet. Of newly hospitalized patients aged over 15 years, the intervention group consisted of 539 hospitalized in the three months from October 2016 who were introduced to the participatory fall prevention plan, while the control group consisted of 511 in the same period of the previous fiscal year. Analysis showed no significant difference in age, sex, or risk between the groups. A total of 18 (5.7%) patients in the intervention group and 16 (4.9%) in the control group experienced falls, and no significant difference in age, sex or risk was observed. Introduction of the patient participatory fall prevention plan did not lead to a decrease in the incidence of falls. It is necessary to examine intervention methods that take patient characteristics into consideration and to make long-term evaluations.

Absorption accident of an intravenous feeding pole occurred in a magnetic resonance imaging (MRI) room. In a separate case, an oxygen tank was left on the stretcher going into the MRI room. In order to avoid such accidents, we made a checklist and started an education group session including experience of an experimental adsorption under high magnetic field. The results were checked off on the checklist by the participating hospital employees before and after the session. Periodic training sessions was effective for changing hazard consciousness to MRI examination in our in-hospital staff to safely operate MRI examination. In the future it is thought that continuation of regular holding is indispensable.

The aim of this study is to clarify the role of hospital infection control team to encourage physician's behavioral change on blood stream infection control of amino acid infusion. In the light of the occurrence of bacteremia caused by contamination of Bacillus cereus grown in amino acid infusion preparations, our hospital infection control team (ICT) proposed two infection control measures to our physicians：1) mixing of the drug solution into the amino acid preparations should be prohibited, and 2) the drip time of the preparation should be set at 8 hours maximum. As a result, 37 physicians (78%) of them who answered a questionnaire by ICT agreed on the prohibition of mixed injection of drugs into the solutions. Regarding the infusion time, approval approached 68%. Based on the result we started to implement infection control measures in the preparation. One of the ways was conducting a questionnaire survey in advance for faithfully reflecting the physicians' opinions, so that measures could be implemented relatively easily. In the countermeasures against infection mainly involving physicians, it is thought that the top-down measures from hospital management will probably give physicians an impression of “forced duty”, and will hinder acceptance and adoption of the crucial anti-infection measures in physicians in the true sense. In order to encourage physician's behavioral change, we propose the bottom-up approach which grasps the physician's thoughts. It should be noted that this approach may be very effective in hospital infection control.

An anonymous, self-administered questionnaire was distributed to 3,827 students at medical and welfare universities to gain insight into students' awareness of basic life support in hypothetical emergency situations and to develop proposals for basic life support education. Of the academic departments, the nursing department was found to have significantly stronger results for level of knowledge and confidence in basic life support. This difference in awareness is likely attributable to the actual state of lectures and seminars and the professional role. Furthermore, the awareness of a medical professional and continued education in basic life support delivered by respective academic departments are important to foster people capable of taking reliable life-saving actions.

Patient Satisfaction (PS) survey is widely used to measure the quality of health care in Japan. However, scores of PS proved hard to interpret because there were no standard and the ratings depend on patient's feelings and values. Therefore, a shift has been made from measuring the opinion of the patient to measuring facts to assess the quality of care (Patient eXperience：PX) in Europe and America. Here, we reviewed the current status of PX in the world and discussed the problems in Japan. We developed Japanese version of PX survey based on the survey in NHS and validated its reliability in Japan.