Recovery phase rehabilitation nursing units are required to prepare an overall rehabilitation plan for individual patient. Arguments doubting the usefulness of such a plan have recently been put forward. The present study was undertaken to evaluate the influence of this kind of plan on the willingness of a patient's family members to participate in the planned rehabilitation, and to find hints useful for improving the plan. To these ends, we conducted a self-entry questionnaire survey. The 49 valid responses to the survey form (prepared by modification of the original survey form on the basis of preliminary survey results) were analyzed by structural equation modeling. The analysis suggested the following necessities:(1)The family members utilize the rehabilitation plan in the order of plan format assessment, assessment of plan contents and decision of their posture towards the plan;(2)Willingness of family members to participate is stimulated by the ease in understanding the reasons for the relevant action taken by staff members, rather than by the action taken by staff members in its own right;(3)To stimulate family's willingness to participate, the information about the physical and mental status of the patient needs to be given in plain words and concretely;and (4)Adequate evaluation is needed regarding the specific information which will be useful for the patient's family.
[Objectives] This paper was designed to analyze the criticisms of US governmental organs to the Joint Commission and the countermeasures taken by the Joint Commission and to find suggestions useful for hospital accreditation in Japan. [Methods] From written publications and other published information, the author summarized the criticisms from governmental organs and the essential points of reform in hospital accreditation and discussed the intentions of both sides and the correspondence between criticisms and reforms. [Results] In the United States, criticisms of the Joint Commission made by governmental organs triggered exteriorization of discrepancies in view and contradictions between the US government and the Joint Commission about external review of hospitals, leading to modifications of the system and reforms in hospital accreditation programs. [Conclusion] Suggestions for hospital accreditation in Japan should focus on the necessity for increasing the number of hospitals receiving hospital accreditation the importance of focusing on evaluation of healthcare quality level and continuous improvement, and the necessity of competitive environments.
In the United Kingdom, health economic evaluation has been introduced into the assessment of healthcare technologies including pharmaceuticals, and the approach of utilizing the assessment results has been used to provide standardised treatment and prescribing. A public organization named NICE (the National Institute for Health and Clinical Excellence) plays a central role in those evaluations and provides guidance as to whether the healthcare technology can be recommended or not in terms of clinical and cost-effectiveness. However, as a result of NICE's decisions leading to limited access to some technologies through the National Health Service (NHS) and there has been a rise in the level of complaints, and the Department of Health has begun to take sequential supplementary measures so that some of the pharmaceuticals to which NICE has limited the access could be used under the NHS. Which elements caused this situation, in which these political measures had to be introduced to resolve the problems arising from the NICE guidance, despite the methods of economic evaluation being applied faithfully in NICE's decision making? This paper outlines the role of NICE in the UK and its change over time, accompanied by discussion regarding potential problems associated with the utilization of health economic evaluation to set governmental policies in Japan.
The Aichi Medical Association (Aichi prefecture, Japan) surveyed 340 medical facilities in Aichi prefecture between February 25, 2008, and to March 31, 2008, regarding problems with patients including abusive language, violent behavior, and sexual harassment. The questionnaire return rate was 54.1%. The survey indicated that healthcare professionals and clerks encountered such problems in 72.8% of the medical facilities as follows:frequent verbal abuse(nurses, 46.2%;clerks, 31.8% and doctors, 18.3%), occasional violence(nurses, 53.2%;doctors, 38.0%;and clerks, 36.7%), and occasional sexual harassment (nurses, 54.2%;clerks, 28.4%;and doctors, 18.2%). Present countermeasures against these abuses and violent behaviors appear to be insufficient. For example, in response to a question regarding the establishment of a system to care for medical staff members who have suffered from such problems, 32.7% of the medical facilities with 300 or more beds responded yes, while only 6.3% of the medical facilities with less than 300 beds responded yes (p<.01).
Objective:To examine drug information-seeking behavior of Japanese people and their attitudes toward drug information. Methods:A self-administered questionnaire was distributed to approximately 2,000 health examinees at a Japanese health care center. Out of 1,978 respondents, 1,707 nonmedical people were included in this study. Results:Drug information was mainly obtained from physicians, pharmacists, and Internet. Their greatest concern was efficacy, followed by potential adverse effects. About 40% of respondents denied that they can get all the information they need. They expressed strong hopes of communicating the benefits and risks of medicines. Conclusion:The information given to people about medicines does not satisfy their needs. People should be informed about the benefits and risks of medicines by health professionals or on the Internet.
Since August 2005, a full-time medical doctor acting as a professional medical safety manager has been designated in our hospital. This arrangement has drastically changed the medical safety training style of the whole medical staff organization. Accordingly, the rate of attendance to this intensive training was improved. In this study, we verified the effectiveness of the change in the training style on the medical safety awareness and medical safety culture of the staff by statistically analyzing the data collected via a customized tool for assessing the medical safety culture in a hospital. From the results of the Steel-Dwass method for the nonparametric multiple comparison of the changes in medical safety awareness by and among occupations, we found that the total score calculated from the factors of organizational environment, risk management, communication and self-awareness was improved in the three years from the start of the intensive training on medical safety awareness. This suggests that educational intervention via the intensive training improved the medical safety awareness and medical safety culture of the whole medical staff organization. In addition, we found statistically significant differences in the four individual factors which measures medical safety awareness by occupations. This implies that in some cases, educational intervention via intensive training may result in various changes in medical safety awareness of the medical staff.