Comparing insurance payment systems internationally, the roles of critical path were reviewed. Also we discussed critical path in Japan, correlating to DPC (Diagnosis Procedure Combination), which was payment system introduced into university hospital since April 2003. Corresponding to DPC, the following three points were discussed: Classification of critical path according to DPC, the length of stay and cost management. We should start to prepare for DPC, before it would be expanding to other acute hospital.

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We introduced a unified format called “All in one path” from the start of the critical pathway in our hospital. The whole time pathway from admission to discharge includes the days of various examinations. We extracted and used a single path sheet for the day of an examination. But this sheet was inappropriate for “All in one path”. So we examined the contents of the path sheet, changed the sheet size from A 4 to A 5 and called it “Petit path”. A definition of “Petit path” is A 5 size “All in one path” used for examinations or dispositions to inpatients. We use eight “Petit path” for examinations and three for operations.“Petit path” is bound to the lower half of the right page of a hospital sheet, so a doctor can record his notes on the left page and staff can look at the information on the patient on the upper half of the right page. By making out the “Petit path” we standardize care and establish an outcome, and by analyzing the variances of the “Petit path” we improve care. We want to make out many other “Petit path” for various examinations and operations.

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To clarify the benefit of critical path to diabetic patients, blood glucose control critical path for two weeks was made and length of stay, plan achievement rate, discharge standard achievement rate and glycohemoglobin Alc levels (on admission, on 6 months and 12 months after discharge) were examined by comparison to those in non-path group. There was no significant difference in the number of patients, age. The length of stay in path group (17.1±5.5 days) was significantly shorter than that for non-path group (26.6± 6.4 days) (p<0.001). However, the plan achievement rate in path group (36.5±48.1%) was significantly lower than that in non-path group (56.5±49.7%) (p<0.001). There was no significant difference in a plan achievement rate between both groups. As the length of stay variance, it was 265 patient factors (delays of recovery 174, lack of understanding 91), staff factors 33, hospital factors 8 and social factors 2. As for the discharge standard achievement variance, it was recognized 11 cases in a patient factor entirely. Glycohemoglobin Alclevels in path group and non-path group were 8.97±2.24% and 9.35±1.96% on admission, 6.89±1.00% and 7.07±0.82% on 6 months after discharge, and 6.77±0.98% and 7.00±0.78% on 12 months after discharge, respectively and there was no significant difference between two groups. Glycohemoglobin A1c levels in each group were timedependently decreased until 12 months after discharge.

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The purpose of this study is to evaluate the variances related medication management and instruction task which were collected from 4605 patients.
The total incidence of variances was 15.7% (723/4605). The highest incidence (51.8%) was revealed in the department of psychiatry and the lowest (3.6%) in the department of ophthalmology. The total settled rate of variances was 59.4%, among which department of gastroenterology was the highest (80.4%) and cardiology was the lowest (48.3%). In the department in which more number of drugs were prescribed, there was a tendency of poor compliance for medication. Postoperative sleeplessness, pain and constipation were frequently complained in the patients of departments in which many operations were performed.
Consideration of the duration of hospitalization, types of drugs prescribed, age and comprehensiveness of the patient is important to achieve the higher rate of settlement of variances.

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Family caretakers' satisfaction for taking care of patients may promote care continuation in home care setting. The purpose of this study is to clarify that 1) from whom, 2) how much degree of, and 3) what kind of situation, make family caretakers satisfied when they engage daily patient care in home.
Semi-structured interviews for 28 family caretakers were conducted. 26 of 27 respondents reported that they had experienced being satisfied by professional caregivers, with the degrees of “were big”, and “was very big.” 24 of 28 family caretakers had experienced being satisfied by patients who were being taken care of by them. 21 out of 27 family caretakers experienced that their relatives living with them had made them satisfied. It became clear that home visiting nurses as professional caregivers must play important role for making family caretakers satisfied with their function. Due to lack of family caretakers' self-recognition of being satisfied by taking care of patients in home, promotion for family caretakers getting aware of their value and meaning of “care-taking” must be key issue.

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Due to a close relation to ‘obesity’, ‘eating quickly’ is considered to be one of the appetite custom that shouldbe improved. Even it is used commonly in daily life, there is not the clear definition for ‘eating quickly’.
Hearing investigation to images about ‘eating quickly’ and ‘eating slowly’ revealed that 48% of respondents agreed with “a short meal time of the whole” for ‘eating quickly’ with time range of 2-20 minute for that, 44% of respondents agreed with “a little chewing frequency per a mouthful”; for ‘eating quickly’ with chewing frequency range of 2-30 times for that, 34% of respondents agreed with “a long meal time of the whole” for ‘eating slowly’ with time range of 15 minutes to 1 hour for that, and 64% of respondents agreed with “much chewing frequency per a mouthful” for ‘eating slowly’ with chewing frequency range of 10-100 times for that. On the other hand, there were some respondents who have no idea about certain numbers of chewing frequency nor time range for eating even they were asked on those issues.
As a result it merely became clear not to have possibilities to image only mealtime and chewing frequency per a mouthful. Assessment of each target person's recognition of eating style must be essential for personalized educational session for eating habit.

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In anti-infection measures, disinfectants and antibiotics play important roles, and their appropriate use should be promoted. Pharmacists work is closely associated with anti-infection measures, including appropriate preparation of disinfectants, provision of the latest evidence-based information, practice of evidence-based anti-infection measures, monitoring of the use of antibiotics in each patient, and accumulation of original evidence in the appropriate use of antibiotics. At present, in the age of evidence-based medicine (EBM), to promote anti-infection measures in Japan, pharmacists as drug specialists should use their technical knowledge in anti-infection measures. In the future, it is necessary to produce pharmacists who specialize in anti-infection measures (infection control pharmacists), play a role in the infection control team, and promote evidence-based anti-infection measures.

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This research article is trying to analyze the efficiency of the service marketing theory in the medical services. Service marketing has the different framework compared with the products marketing. After clarifying the specific features of the medical service about patients' participation, we consider the adaptability and development of the service marketing theory for the patients' participation in the medical service as compared with other service goods. Then we tried the experimental investigation and cited the example and the study analysis which can be easily made use of by healthcare provider.

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All players in the medical field agree that healthcare providers should provide more information about them to the steak holders. On the other hand, the asymmetry of information is large between patients and/or consumers and medical doctors and/or healthcare providers. Moreover, the uncertainty of the medical outcomes is existed even in the side of medical doctors as well as patients.
The brand may be more important, sometimes key factors for consumers to choose providers, especially in the medical field where when the asymmetry of information is large

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