Statistical estimation of the number of breast cancer patients with disabilities resulting from surgery.

BACKGROUND: The prolongation of the post-operative life of cancer patients brings new medical demands. The purpose of this paper is to estimate the total number of women patients with breast cancer who will have disability resulting from surgical treatment from 2000 to 2020 in Japan. METHODS: The estimation was carried out using four indices: the number of cases of women diagnosed with breast cancer, the proportion of surgical operations, the frequency of disability from surgical treatment, and the crude survival rate of the patient group. The crude survival rates of surgically-treated breast cancer patients were estimated by the Weibull model. The frequencies of iatrogenic disabilities were calculated from several reports of complaints of pain in the chest wall or axilla and lymphedema of the arm, and 95% confidence intervals were calculated by the Monte Carlo simulation. RESULTS AND DISCUSSION: The number of women patients with disability from breast cancer treatment from 2000 to 2020 was estimated to be 42,016 (95% CI: 41,236, 42,796) people in 2000 and 72,514 (95% CI: 71,196, 73,832) people in 2020 for pain in the chest wall or axilla, and 22,486 (95% CI: 22,148, 22,823) people in 2000 and 38,692 (95% CI: 38,094, 39,290) people in 2020 for lymphedema of the arm. Treatment supports required for the disability are medication and social support. Cancer patients with disability after treatment need long-term support in their daily life.

[A report on medication adherence among outpatients].

BACKGROUND: Increase in chronic disease and hospital stays of minimal length have caused a rise in the number of outpatients receiving long-term medication. The authors conducted the present study to examine their adherence to medication. METHODS: Self-administered questionnaires covering 20 items related to adherence were collected from outpatients who received medication from O university hospital on a day in October 1998. The authors examined the relationship between adherence to medication and lifestyle and then analyzed predictors of adherence using discriminant analysis. RESULTS: The rare of adherence to medication for 943 outpatients in O university hospital was 87.9%. The major reasons for non adherence were "forgetting medication", "leaving home without [one's] medication," "suspecting side effects" and "having no symptoms". The patients who made a detailed explanation displayed better understanding and adherence to medication. Although 94.8% of the patients received an explanation about their medications at least once, 76.9% expressed some anxiety about their use. Predictors of poor adherence to medication were "no support to remind the patient to take medicines correctly," "anxiety about medication," "not receiving a detailed explanation about medications," "poor knowledge of medication," and "youth (20-29 years of age)." CONCLUSION: Among outpatients in O university hospital, the medication adherence rate is 87.9%, but most patients had anxieties. The results clarified the need to consider lifestyle in medication management in the outpatient setting, since this was the main predictor of adherence to medication.

Evaluating the benefit of introducing medical clerks as transcriptionists to assist physicians in outpatient clinics: a quantitative analysis of medical records by counting characters.

This study evaluates the effects of the medical clerks introduced to reduce physicians' workloads in outpatient clinics by assisting with their documentation processes (e.g., the production of electronic medical records (EMRs)). The volume of information written in narrative text in EMRs from 2007 (pre-introduction of medical clerks) to 2012 (post-introduction) was measured by counting Japanese characters. The total number of medical records for analysis was 1,577. The average number of characters in EMRs increased from before the introduction of medical clerks to afterwards regardless of the types of documents (subjective or objective data) or visits (first or second visits). We conclude that introducing medical clerks improves the quantity of outpatients' medical records and that such a character-counting method is useful for evaluating the benefit of the introduction of medical clerks to assist physicians.

Workflow analysis of medical staff in surgical wards based on time-motion study data.

The aim of this study is to clarify the change over time in the elements of work (job elements) and their features, as well as the relationship between job elements and the type of job, job class, and the role of the hospital they are performed in. A time-motion study was conducted on the medical staff in the surgical wards of two hospitals. An analysis of roles bys by (a) type or class of job type, and (b) hospital function was conducted. The number of working hours was analyzed, as well as the ratio of working hours with respect to direct and indirect job elements. The job elements required for each medical staff member were proven to differ by type of job (doctors and nurses) and also by job class (nurse leaders and staff). When comparing between hospital the differences in job elements were proven not to be a result of differences in hospital function, but to result from the ward system (ward design and nursing system).