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Volume 43 (2013)
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Volume 43, Issue 1
Displaying 1-13 of 13 articles from this issue
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Features
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Susumu KAWAMURA, Tetsu SHINKAIArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 7-11
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSThe important rule of the administrator of local cancer center must raise the quality of regional cancer medical service. For promoting standard cancer care and developing of reliable and safe cancer treatment in each institutes, securement and proper arrange of the excellent special staff for cancer medical care based on reconstruction of organization and system should be considered. In addition, participation of cancer patients and their family leads to the guarantee of quality of medical care, so it would be important to support the system construction to practice it.View full abstractDownload PDF (747K) -
Kenjiro AOGIArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 12-18
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSA new clinical pathway system, Patient Condition Adaptive Path System (PCAPS) for breast cancer treatment, was evaluated to elucidate its utility in Japanese clinics, concerning its efficacy in quality and safety assurance in breast cancer treatment. PCAPS mainly consists of two parts, the "Process chart", which shows the clinical flow connecting individual unit sheets according to medical decisions by logics, and the "Unit sheet", which shows the medical procedures and decisions being performed as the medical treatment in clinics. Surveillances to confirm the adherence of the "Process chart" in PCAPS to the medical processes in breast cancer clinics was shown that there were some "Guideline-practice gap" in clinics in Japan, and also the possibility of the evaluation of "Process chart" to be the resources for "Quality Indicator" in breast cancer treatment, especially showing real medical performances in Japan. PCAPS showed its utilities as a good clinical guide in breast cancer treatment.View full abstractDownload PDF (1332K) -
Makio GAMOHArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 19-22
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSCancer has been the first cause of death in Japan since 1981. As for solid cancers, local therapies as surgical operation have been and still are the main means to cure them. However, for half of the cancer patients who will develop or already have metastatic diseases, systemic therapy is needed to control the disease and to maintain good quality of their life. Recently, standard regimens, i. e. evidence based scheduled anti-cancer drug administration, are used in most facilities, assuring the quality of the treatment. On the other hand, recent development of anti-cancer agents including molecular target drugs increases complexities of the treatments. To manage anti-cancer drug therapies, we described a generic clinical process chart. It involves an adaptation of the regimen, monitoring of adverse effects, evaluation of clinical benefits, and logic that switch the process. By using it, we can not only ensure the safety of the therapies, but analyze the quality of them. Additionally, multidisciplinary cancer treatment board to discuss about difficult cases is to be organized in facilities that provide cancer care.View full abstractDownload PDF (557K) -
Kunio MORISHIGEArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 23-26
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSAccording to the recent health statistics in Japan, atherosclerotic cardiovascular disease has been a one of the leading causes of death in this country. As this trend is expected to continue over the next several decades in the rapidly aging society, management of the disease is an urgent social issue to be solved. In a current medical practice, physicians should take multi-disciplinary approach to treat risk factors of atherosclerosis in each patient, considering evidence-based clinical guidelines. Management of clinical information is mandatory throughout the process including primary assessment, outpatient treatment, and hospitalization. However, treatment of a patient with multiple risk factors and complications is often challenging, even for experienced physicians. To improve the quality of clinical management for atherosclerotic diseases, we are now developing a PCAPS-based clinical pathway system with reference to a wide range of clinical guidelines. The system may facilitate continuous cooperation between general practitioners and specialists. Furthermore, development of hospital-customized guidelines or community-customized guidelines, effectively utilizing clinical resources available in each hospital or community, will open a new avenue for implementing the best clinical practice.View full abstractDownload PDF (606K) -
Toshiro KATSUTA, Yoshihiro NATORIArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 27-29
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSTreatment for an unruptured cerebral aneurysm, together with its outcome, does not differ much from case to case, and thus it is a good candidate for making a patient condition adaptive path system (PCAPS). The content of PCAPS for this disease at present is shown. It may be completed in a final form within a couple of years. However, medical treatments for most diseases related to brain are not as simple as that of an unruptured aneurysm. Furthermore, the outcome of a complicated disease will differ diversely. Making PCAPS for such disease will meet lots of difficulties. What PCAPS is aiming at is not a mere analysis for a better time-efficacy or cost-performance, but to secure the quality of management of the patients. Any function to check the quality and to secure it should be woven in the program, and to make such PCAPS is our mission.View full abstractDownload PDF (352K) -
Takashi MOTEGIArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 30-33
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSClinical guidelines have been updated to standardize the management of exacerbation of COPD. But there is wide gap between guideline and clinical practice. Therefore we need clinical pathway to fill in the gaps.View full abstractDownload PDF (458K) -
Masako FUJIWARAArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 34-37
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSPediatricians know "children are not small adult". Children are on stage of development, and their condition may deteriorate easily. Pediatrician need to enlighten family members for them to give informed consent. Children often visit pediatricians for preventive medical care and examinations, including vaccinations and health checkups. The bulk of pediatric care is emergency medicine. Pediatricians are themselves limited resource, and the improvement of emergency pediatric service system is required, too. Young doctors and residents provide medical care in university hospitals and children's hospitals, and there is the problem of education for maintenance of the quality. To ensure quality and security in pediatric care, we should 1) provide for comprehensive informed consent by the families, 2) construct a system of good preventive medicine and good HIS system for pediatrician, 3) educate young doctors to a higher standard of quality, 4) make efforts to decrease the number of "therapeutic orphan drugs". Pediatricians should understand these problems while providing medical care.View full abstractDownload PDF (594K) -
Hidenori OGUCHI, Nodoka MIYAZAKI, Mayu UKAI, Natsuki KOIDE, Shinya KON ...Article type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 38-43
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSThe annual number of births in our region is about 5,000, and most of the deliveries occur in three hospitals and six clinics. As the numbers of childbirth facilities in our region has declined, since 2006 we have attempted to achieve a division of roles according to the functions of childbirth facilities in order to prevent the collapse of regional perinatal care services. A multicenter study has been conducted to evaluate the Japanese pregnancy risk score as a means of objectively evaluating how far centralization of high-risk pregnancies to regional perinatal centers and decentralization of low-risk pregnancies to regional medical institutions have progressed. Although the number of low-risk pregnancies in a regional prenatal center decreased from 305 cases per year in 2006 to 164 cases per year in 2010, the number of high-risk pregnancies in a regional perinatal center increased from 255 cases per year in 2006 to 372 cases per year in 2010. The data showed that centralization of high-risk pregnancies to a regional perinatal center and decentralization of low-risk pregnancies to regional medical institutions had been achieved in our region.View full abstractDownload PDF (755K) -
Makoto IDEArticle type: Features 〔Clinicians' Aspects for Quality Assurance in Healthcare〕
2013 Volume 43 Issue 1 Pages 44-48
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSThe situation of rehabilitative procedure in medical settings is still uncertain. The phase classified by time-course (acute/sub-acute/chronic) and the category of the facility (general/rehabilitative/community-based) should be counted first in discussing this theme. Some clients receive rehabilitative therapeutic service for quite long time from acute hospital to community based settings. It is not easy to observe and maintain the quality of this medical resource crossing over the facilities variation. The professional therapists (Physical therapist・Occupational therapist・Speech pathologist) work together as a team according to the instruction of a Physician in charge or Physiatrist. The things should be mentioned specially is that each therapists works with their own opinion as certified professionals. Their therapeutic theories varies widely, because of not so many of them are on academic backgrounds with clarified evidence. Quality assurance of rehabilitation in medical circumstances would be established through the process of, 1) visualizing the theory of therapeutic measure and 2) standardization covering facilities with different characteristics.View full abstractDownload PDF (592K)
Serial
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Takeo HIRAIArticle type: Serial [ISO 26262 –Approaches to Functional Safety in Automotive Industry-]
2013 Volume 43 Issue 1 Pages 49-52
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSISO 26262 is officially published in Nov.2011. This is a simple ISO standard, but it's treated like quasi-mandatory one for component suppliers because of the request from vehicle manufacturers. This situation is also influenced by the important fact that any small failure or defect in electrical/ electronic control in vehicle basic functions may lead fatal damage. So, many automotive manufacturers in the world are trying to follow the requirements of this standard. In the first part, the background of ISO 26262, and necessity of automotive focused standard apart from basic standard IEC 61508 is mentioned. And in the main part, how the Japanese automotive industry is coping with this standard is mentioned in relation to the development procedure particular in Japanese market. Then trends of each industry in Japan, Europe, US and Asia are explained. Finally the situation in semi-conductor field, as an example of typical products which is influenced by functional safety, is explained. At last influence of legislation especially related with electronic controlled system is briefly investigated.View full abstractDownload PDF (915K) -
Satoko TSURU, Shogo KATOArticle type: Serial [Activity for Quality and Safety Assurance in Healthcare and Social Service]
2013 Volume 43 Issue 1 Pages 53-56
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSIn this issue, activities for quality and safety management in Sugi Medical are presented through an interview by the members of editorial board. We interviewed Mr. Keiji Arai (President, Sugi Medical) and Mrs. Kesami Sano (General Manager, Quality Management Department). Sugi Medical is one of the Sugi Holdings Group companies, which started at 2008. Their services are covering home medical care, and they are operating home-visit nursing stations and In-home long-term care support stations. There are three processes: "(1) order", "(2) prepare materials", "(3) provide medical services", in home medical care. In these processes, drugstores carry out "(2) prepare materials" after doctor's order. Sugi medical is aiming to provide total service in home medical care, because they consider that there are some problems in coordination between "(2) prepare materials" and "(3) provide medical services". Interview contents are (1) History of Sugi Medical, (2) Services and its Characteristics of Sugi Medical, (3) History and organizational efforts for quality assurance and management, (4) Difficulty and special efforts, and (5) Future aspect.View full abstractDownload PDF (1614K)
Research Papers
Contributed Paper
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Haizhe JIN, Masahiko MUNECHIKA, Masataka SANO, Masaaki KANEKOArticle type: Contributed Paper
2013 Volume 43 Issue 1 Pages 133-142
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSIt is necessary to tackle medical errors in order to provide safe healthcare. Medical errors are defined as departures from standards and can be divided into 2 categories : the first occurs even though workers follow standards, and the second occurs because they act contrary to standards and is called non-observance. Although some studies, as typified by error proofs, have been performed on the former, there are few studies on the latter. Therefore, errors due to non-observance chronically occur in hospitals. In this paper, we define non-observance as intentional departure from standards and discuss a mechanism generating non-observance. Furthermore, we propose a method to analyse non-observance and to prevent it by improving work methods and education.View full abstractDownload PDF (1375K)
Applied Research
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Akira NAGAMATSU, Takeshi NAKAJO, Yoshio TANIGUCHIArticle type: Applied Research
2013 Volume 43 Issue 1 Pages 143-151
Published: January 15, 2013
Released on J-STAGE: August 30, 2017
JOURNAL RESTRICTED ACCESSAs systems and products are advanced, it becomes essential for the manufactures of these products to ensure the quality of the business processes. Although Hitachi has developed and used a method of evaluating business processes of each business unit and their execution status based on ISO 9001 etc, it was not able to attain trouble free of the developed products. This paper proposed a procedure of producing questionnaires through analysis of troubles information, which can be used in the evaluation of business processes. This procedure considers the facts that effective countermeasures depend on types of inappropriate human behaviors and technical contents of troubles vary with business units. The proposed procedure was applied to a development project of the business unit related to social infrastructure. As the results, it was found that the questionnaires produced by the proposed procedure can greatly increase the number of findings as well as the number of the risks identified in FMEA/design documents.View full abstractDownload PDF (1325K)
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