We reviewed the cases of breast cancer that had not been detected by physical examination (PE), ultrasound (US) and mammography (MMG). Of 90 cases that were diagnosed as breast cancer definitely on pathological assay, 13 cases had gone unnoticed by PE, seven by US, and 15 by MMG. Thus, the detection rate worked out at 85.6%, 92.2% and 83.3%, respectively. When the diagnoses wee made by any combination of one with another, the detection rate for joint PE/US, PE/MMG and US/MMG came to95.6%, 97.8% and 98.9%, indicating that the combined use of US and MMG was most efficient.
  Tumors that had been undetected by PE and MMG were significantly smaller in size than those that had been detected, but this was not the case for tumors that had gone unnoticed by US. Therefore, we considered that oversight during US examination is more likely due to difficulty making diagnostic differentiation between cancer and fatty tissue or cyst, etc. than tumor size. We found that those cases which had gotten pass PE had a significantly lower histological grade malignancy and a lower grade of invasiveness than the other cases of breast cancer, even though the former tended to show lymphatic metastasis frequently. Furthermore, all of these metastatic breast cancers had a smaller diameter ranging from 0.8cm to 0.9cm. This suggested hat we cannot afford to let them pass because they are non-palpable. At present, the Japanese Ministry of Health, Labor and Welfare are recommending the breast cancer mass-screening by use of PE in combinationwith MMG. However, because MMG is not always omnipotent and lets many breast cancer cases pass, we should conduct the mass screening with US and MMG but without PE.

View full abstract

  At medical fields, how should procurement processes of medical material be? We tried to research that onto Hospitals affiliated with the National Federation of Agricultural Cooperatives for health and welfare using questionnaire researchmethod to grasp the actual conditions of medical material procurement processes. The research was proceeded taking the hospitals which have more than a hundred beds as the object. The research requested 97 hospitals and fifty-three hospitals responded. From the research, we could get the following results. The enough results to judge as results; implementation of plan of buying budgets 79%, affirmance of clearance asset 89%, clarification of necessity 96%, trial calculation of profitability and productivity 98%, research for the use utility after adoption 76%, supplement of a job lot 91%, consideration of safety 96%, prime cost dropby joint purchase 61%. On the other hand, it is considered that following things are not enough results;document audit with suppliers' business outline and supplier record 34%, purchasing administrator's lack of acknowledgements of medical material 55%, dealing with immovable stock in subsequent occasion after changes of doctors 41%, efficient ability as in analysis of time by purchase products 59%, transaction expenditure of wastes 46%, reduction of labour by joint purchasing 59%. On the whole, it may be said that hospitals, which have purchase board , are trying to select products from various sides. However, it cannot be said that Secretariat's knowledge a bout medical product are not good enough to selectit. Therefore, deliberating with participants to the committee is important andclue. In this case, substance should be described visually and objectively as in a chart graph. It may bring us excellent purchasing on medical products by consideration of selecting standard.

View full abstract

  A reduction in electricity and heating expenses is a major consideration with every hospital in Japan. In our hospital, all the personnel including the members of the facilities division have joined forces to mount the “1,300kW campaign” aimed at cutting down on the amount of maximum instantaneous electric power consumption (demand) from 1,500kW to 1,300kW in one year, and succeeded in curtailing heating and lighting expenses by well over 4 million yen. The key to success was how to control the amount of demand. The cooperation of all the personnel of the hospital was vital. Therefore, it was important to raise the awareness of all the personnel concerning energy conservation. We thought that setting the concrete numerical target “from 1,500kW to 1,300kW” was effective. It is no exaggeration that such a cutback in energy consumption contributes not only to the management of a medical institution but also to the environmental preservation on a global scale. Finally, the medical institutions should put contribution to the community into the basic principles at the time when environmental preservation (ecology), energy consumption reduction, risk management and catastrophic disaster etc. have become topics of conversation.

View full abstract

  Local residents were screened for colorectal cancer, and the results during six year period are reported. The two-day immunological fecal occult blood test was used as the first screening method. The barium enema radiography was used as the secondary screening method even if only one of the occult blood reactions was positive. Images were acquired in varius directions from rectum to the sigmoid colon (the most common site of colorectal cancer) and at least anterior-posterior images in two directions were obtained another sites as well. Barium enema radiography is less distressing to patients than the endoscopy of entire large intestine and can be carried out quickly. In addition, its accuracy is considered comparable to that of endoscopy, and the results of our study were no poorer than that obtained in institutions where only endoscopy was carried out.

View full abstract

  Hand-washing before operations is an important and fundamental precaution against infection. However, it should be noted that washing hands many times and brushing excessively damage the skin and cause wound infection during operations. Inthis paper, we examined the disinfection effect of the scrub method using Chlorohexidine gluconate and an ultrasonic cleaner. The scrub method was very effective, whereas the rate of disinfection tended to fall when the utltrasonic method was used.

View full abstract

  Our hospital began to deliver treatment of the sort which could well fall into line with the newly classified set of good clinical practices in June 1998, and our department began to provide in Norvember 1999. This report provides the results of a survey on the clinical drug trials we have since done. The number of clinical drug trials which had been done at our department before September 2005 and for which the period of registrationhad come to an end was 13. One hundred and sixty-one patients were contracted for clinical drug trials. Of them, consent was secured from 138 patients. The number of registered patients came to 125, and the rate of performance stood at 77.6%. A phase-specific comparison of this rate reveals that Phase II trials in the former period accounted for 25%, Phase II trials in the latter period 90.0%, Phase II/III trials 86.7% and trials for long-term asministration 81.3%. When the performance of clinical drug trials was compared in terms of rate on the basis of whether placebos were involved, the rate was 75.9% for six trials not including placebos and 78.5% for seven trials including placebos. For one trial for an acute disease, the rate was as low as 37.5%. The rate of performance was relatively high at our department, but when it comes to Phase II trials in the former period and trials for acute diseases, the rate of performance was low. The existenceor nonexistence of placebos did not affect the rates of performance.

View full abstract

  On October 1, 2004, we began postoperative home visits to patients who had been put under general anesthesia.
  In the initial period, there were not a few patients who went unnoticed as only their names were put in their papers for postoperative home visits. In light of this situation, we performed a questionnaire survey on the necessity of postoperative home visits with 23 nurses picked up as respondents.
  Of them, 15 nurses (65%) said they thought it necessary to put the paper in the due form. For improvements in the form, we decided to add another item - that is, information on the checkup of the skin. Twenty-one nurses (92%) said they thought postoperative home visits necessary, as they were much interested in the postoperative conditions of patients.
  As we had designated nurses in charge of postoperative home visits, the number of patients to whom postoperative home visits were not made was on the decrease. The designation of nurses in charge of postoperative home visits and the changes made in the form proved useful in our endeavor to firmly establish the system of posterative home visits.

View full abstract