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Analysis of Hospital Characteristics Affecting the Choice of Management Strategy Types: A Cross-Sectional Survey of Private Hospitals in Japan

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Health 2017年第11期9卷 1494-1508页

作者： Yuji Mitadera Mayumi Watanabe nobuhiro sato Motoi Azumi Kouhei Akazawa Department of Medical Informatics and Statistics Niigata University Graduate School of Medical and Dental Sciences Niiga-ta Japan Department of Medical Informatics Niigata University Medical and Dental Hospital Niigata Japan

The hospital environment in Japan has changed drastically lately. Its unpredictability has increased the need for hospitals to select management strategies to clarify their course. However, research on Japanese hospitals’ management strategies has only recently begun with too few studies in this area. Hence, this study clarifies the management strategies of Japanese private hospitals. It explores the hospital characteristics that affect strategy selection. A questionnaire was mailed to 5682 private medical institutions in 2013, and 459 responses with no missing data were used for analysis. Factor analysis yielded four factors: “bed conversion and downsizing (Factor 1),” “diversification of medical and nursing care (Factor 2),” “expansion in business scale (Factor 3),” and “expansion of income from non-insured medical care (Factor 4)”. Logistic regression analysis revealed that Year Founded (before 1965), Hospital Location (municipalities with populations smaller than 100,000), Hospital Type (psychiatric hospitals and mixed-care hospital), and Hospital Income and Expenditure (deficit) had significant positive impacts on the choice of Factor 1. For Factor 2, Hospital Type (sanatorium ward and mixed-care hospitals) and Hospital Income and Expenditure (constant surplus) had positive impacts. For Factor 3, Hospital Type (general hospital) and Bed Counts (more than 200) had positive impacts. For Factor4, Hospital Type (general hospital) had positive impacts. In other words, older hospitals, hospitals in rural areas, psychiatric hospitals, mixed-care hospitals, and hospitals with deficits tended to choose bed conversion and downsizing. Sanatorium ward hospitals, mixed-care hospitals, and hospitals with a constant surplus tended to choose diversification of medical and nursing care. General hospitals and large hospitals tended to choose expansion in scale, and general hospitals tended to choose expansion into non-insured medical care. The planning of mid- to long-term manag

关键词： Hospital Management Strategies Healthcare Management Planning Hospital Diversification

A Scrotal Arteriovenous Malformation: A Case Report

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Modern Plastic Surgery 2014年第1期4卷 16-19页

作者： nobuhiro sato Tomoaki Kuroki Yasuyoshi Tosa Taro Kusano Shinya Yoshimoto Department of Plastic and Reconstructive Surgery Showa University Hospital Tokyo Japan

Purpose: Haemangiomas and vascular malformations are not easy to differentiate clinically. We describe a patient who was initially thought to have a scrotal venous malformation (VM) but after pathological examination was diagnosed to be afflicted with an arteriovenous malformation (AVM) with a micro-fistula in pathorogical photo. We think that even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated. Material and Method: A 38-year-old man who noticed a mass in his scrotum. The patient was seen at our hospital in May 2009 with concern for progression of the scrotal mass. That mass appeared to indicate a simple case of VM of the scrotum. Result and Conclusion: A biopsy of the mass was performed and was diagnosed to be a micro-fistula AVM, with no tumour growth in the vascular endothelial cells. Resection was performed in September 2009. And there is no recurrence. Even if there are suspicions of VM before the operation, the importance of resection with an ample margin of safety is indicated.

关键词： Arteriovenous Malformation Scrotum Resection

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

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Health 2017年第8期9卷 1159-1175页

作者： nobuhiro sato Kohei Akazawa Yuji Mitadera Tsubasa Suzuki Nahoko Ibe Yasuo Hirose Department of Medical Informatics and Statistics Niigata University Graduate School of Medicine Niigata Japan Department of Emergency and Critical Care Medicine Niigata City General Hospital Niigata Japan Development Center of Medical Professionals for Next-Generation Niigata University Hospital Niigata Japan Patient and Family Support Center Niigata City General Hospital Niigata Japan

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

关键词： Older People Emergency Healthcare System Japan Long-Term Care Staffing Problems

A Case of Orbital Lipoma That Occurred in the Lateral Canthal Region of the Tessier no. 8 Craniofacial Cleft

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Modern Plastic Surgery 2014年第2期4卷 32-34页

作者： nobuhiro sato Tomoaki Kuroki Yasuyoshi Tosa Yuki Shimizu Taro Kusano Shinya Yoshimoto Division of Plastic and Reconstructive Surgery Showa University Hospital Tokyo Japan

We report a case of a 37-year-old Japanese female. She had a Tessier no. 8 craniofacial cleft and an orbital lipoma in the lateral canthal region. Excisional surgery and pathological examination revealed a genuine lipoma. No other case has been reported in the literature. Here, we present our case of a rare genuine lipoma located in lateral canthal region of the Tessier no. 8 cleft.

关键词： Lipoma Tessier no. 8 Craniofacial Cleft

Coexistence of esophageal superficial carcinoma and multiple leiomyomas:A case report

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World Journal of Gastroenterology 2006年第28期12卷 4588-4592页

作者： Takeshi Iwaya Chihaya Maesawa Noriyuki Uesugi Toshimoto Kimura Kenichiro Ikeda Yusuke Kimura Shingo Mitomo Kaoru Ishida nobuhiro sato Go Wakabayashi Departments of Surgery Ⅰ Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Departments of Pathology Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Division of Pathology Central Clinical LaboratoryIwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan Critical Care Medicine Iwate Medical University School of MedicineUchimaru 19-1Morioka 020-8505Japan

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-yearold man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient＇s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas （20 lesions, up to 3 cm in diameter）, and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be rnisdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

关键词： Multiple leiomyomas Squamous cell carcinoma Esophagus Coexistence

Location of Early Colorectal Cancers at Fold-top May Reduce the Risk of Lymph Node Metastasis

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Location of Early Colorectal Cancers at Fold-top May Reduce ...

Multiple primary malignant neoplasms of three early cancer lesions： a case report

第八届国际治疗内镜和消化疾病学术会议

作者： Takeshi Terai satoshi Abe Naoto Sakamoto Akihito Nagabara Toshifumi Ohkusa Tatsuo Ogihara nobuhiro sato Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan

＜正＞Purpose: The aim of this study was to look for significant correlations between location of early colorectal cancer, distance from muscularis mucosae to muscularis propria and the frequency of lymph node metastasis. Methods: A total of 166 early colorectal cancers, including 67 surgically resected lesions, were evaluated. The cancers were divided into two groups: metastatic and nonmetastatic. Cancer lesions were further subtyped at the fold-top or the fold-bottom. Macroscopic classifications and histology were

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Chinese Medical Journal 2011年第8期000卷 1278-1280页

作者： ZHANG Wan-jun QIAN Xiao-ping SHI Yu PAN Wen-sheng XU Xiang YE Zai-yuan WU Liang-qin Takeshi Terai nobuhiro sato Sumio Watanabe Department of Gastroenterology the Second Affiliate-d Hospital Zhejiang University School ofMedicine Hangzhou Zhejiang 310009 China Department of Radiology the Second Affiliated Hospital Zhejiang University School ofMedicine Hangzhou Zhejiang 310009 China Department of Infectious Disease the First Affiliated Hospital ofZhejiang University School of Medicine Hangzhou Zhejiang310009 China Department of Pharmacy the Second Affiliated Hospital Zhejiang University School ofMedicine Hangzhou Zheiiang 310009 China Department of General Surgery Zhejiang Provincial People'sHospital Hangzhou Zhejiang 310014 China Terai Clinic Tokyo 101-0021 Japan Department of Gastroenterology Juntendo University School ofMedicine Tokyo 113-8431 Japan

Multiple primary malignant neoplasms （MPMNs） are rarely reported and it is important to give early diagnosis and proper therapy for these patients. Here reported a case of 62-year-old man with concomitant three early stage cancer lesions in upper gastrointestinal tract, all of which were detected by endoscopy. The first one was an llc-type lesion at angular part of stomach under endoscopy, which was histologically confirmed to be a mucosal well-differentiated *** patient underwent a standard radical gastrectomy for the lesion after the failure of endoscopic treatment. The other two neoplasms were observed during follow-up and were indicated as early stage lesions by synthesizing information from endoscopy, endoscopic ultrasonography, computed tomography and biopsy. One displayed as a hyperemic patch （3cm×4 cm in size） located at the part of esophagus 27 cm away from the incisor teeth and was proved to be moderately differentiated squamous cancer by histopathological examination. The other was an llc-type lesion （3.0 cm×3.5 cm in size） located at the part of esophagus 36 cm away from the incisor teeth, and the biopsy result showed a poorly differentiated squamous carcinoma. Both the two lesions were treated with radical radiation because the patient refused surgery management. No recurrence of former lesions or occurrence of novel lesions were observed during post-treatment follow-up, suggesting radical radiation might be effective for this patient.

关键词： multiple primary malignant neoplasms early cancer upper gastrointestinal tract

Malignant lymphoma in the ileum diagnosed by double-balloon enteroscopy

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World Journal of Gastroenterology 2007年第24期13卷 3388-3391页

作者： Kazuko Beppu Taro Osada Akihito Nagahara Naoto Sakamoto Tomoyoshi Shibuya Masato Kawabe Takeshi Terai Toshifumi Ohkusa Tatsuo Ogihara nobuhiro sato Toshiki Kamano Yasuo Hayashida Sumio Watanabe Department of Gastroenterology Juntendo University School of Medicine 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 Japan Department of Coloproctological Surgery Juntendo University School of Medicine dicine 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 Japan Department of General Medicine Juntendo University School of Medicine 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 Japan

A 73-year old man presented with abdominal pain. A tumor with central ulceration was observed in the ileum using double-balloon enteroscopy. Histological findings of the biopsy specimens were consistent with malignant lymphoma. Double-balloon enteroscopy confirmed the diagnosis of a malignant lymphoma tumor which was surgically resected. The patient is still in complete remission now.

关键词： Malignant lymphoma Double-balloon enteroscopy

Location of Early Colorectal Cancers at Fold-top May Reduce the Risk of Lymph Node Metastasis

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Location of Early Colorectal Cancers at Fold-top May Reduce ...