INTRODUCTION: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. METHODS: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. RESULTS: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL ≥5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL ≥10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P = 0.001), cervical cancer (OR: 1.912, P = 0.001), and radiotherapy (OR: 1.664, P = 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. CONCLUSIONS: A substantial number of patients present with LLL ≥5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.

To operate successfully, surgeons must plan surgical operations appropriately. However, it is difficult to plan operations adequately because they are often complicated and involve substantial amounts of medical knowledge and information concerning patients. Therefore, it is necessary to develop a process model for surgical operation planning. <br/>In the present study, we divided surgical operation planning into three processes, "Process for understanding the patient's condition," "Process for designing the surgical operation plan," and "Process for reviewing the plan." We identified that an ideal surgery is one that can lead to a radical cure, and can minimize the adverse effect on the QOL of the patient. Based on this, we designed the basic concept of the best surgical operation plan, and developed a process model to facilitate its use. We first identified the components of surgical operation plan and information necessary to the processes for understanding and designing. We then identified functions of the processes and visualized information and functions with a data flow diagram. Finally, we developed a tool for quality assurance in planning, and tested the model by applying it to 9 cases. Subsequently, we proved that the model marshaled the complex process and facilitated the retrospective detection of problems.

Since invasive techniques affect the patient's body, doctors have to acquire knowledge and skills to implement such invasive techniques safely. In addition, to assure quality in the implementation of invasive techniques, we need to assess doctors' competence in relation to these techniques. The purpose of this study was to develop a model to evaluate competence of medical doctors for invasive techniques at hospitals. It is essential that such a model is equipped with functions, procedures, and tools that are based on the existing literature related to competence evaluation. In this study, we reconstructed competence evaluation items used in a previous study. Competence evaluation items should evaluate concisely, specify the knowledge and skills to be acquired, and be comprehensible for the evaluator. To fulfill these requirements, we introduced the concept of the PDCA-cycle in the evaluation items, and applied it to invasive techniques. Based on these evaluation items, we designed procedures and tools for the implementation and management of competence evaluation. The procedure comprises 11 steps that need to be implemented by doctors and secretaries. Finally, we tested the model by utilizing it for deriving competence evaluation criteria in nine invasive techniques in Hospital A.

In recent years, quality and safety of healthcare has drawn a considerable attention and great efforts have been made for ensuring quality and safety of services in hospitals. In order to ensure quality and safety of products and services, in general, it is needed to carry out a management based on appropriate process management plan. In doing so, it is reasonable to prepare a "process management standard" in advance, which is a standard process management plan, and utilize it with some adjustments. "QC process chart" is one of the typical tools to design and describe a process management plan. However, its composition and preparation method has not been proposed systematically. In this paper, we aim to propose a methodology for designing process management standards for daily work in hospitals. We sort out and arrange the concepts relevant to process management, and propose a method to reasonably design process management standards. In using the proposed method, we first breakdown quality objectives in the work, and design process management standard to achieve the quality objectives in six steps. We apply the proposed methodology to "blood sampling" process in the testing department at Hospital A, and design a process management standard for blood sampling process. Then, we make a verification of the validity of the proposed methodology by comparing the designed process management standard with an existing operation standard in Hospital A.

In order to assure quality with limited available resources, hospitals have to develop healthcare delivery processes. Healthcare operation processes at hospitals are processes for delivering healthcare services to patients through medical practice such as surgery and medication. Since healthcare services have characteristics such as patients' variation, healthcare delivery processes are so complicated that healthcare staff cannot establish operation processes. In order to examine complicated operation process, it is useful to understand operation process as a connection of "standard modules". In terms of operation process, standard modules can be defined as best functions to achieve a purpose of the process. In this research, we develop a methodology to define standard modules for a surgery process. We define surgery process modules by function deployment of surgery process aims to achieve quality assurance with resource consumption efficiently. Finally we demonstrate adequacy and availability of standard modules through comparison with items of the standardized manuals in an actual hospital.

There are many product accidents caused by both poor considerations on product design and inappropriate way of use by users. It is crucial to reduce product accidents to achieve "safe and secure society." It is effective to visualize, structure, and reuse both trouble information and implicit knowledge, which lies scattered among users, providers, accident responders, and so on. However, a well-defined methodology for such activities has not been established.<br>In this study, we propose a comprehensive methodology for socio-technologizing product safety knowledge, through extracting the knowledge from various players and feeding back them to product design and safety education for users. We also show an example of the application of the proposed methodology, by applying it to oil stove.

For hospitals, personnel allocation is a critical issue because the quality of healthcare depends on the competence of the personnel. Personnel allocation at hospitals must take into account the diversity of patients' needs, the complexity of the services delivered, and the variation in specialized skills proficiency among personnel. A methodology taking these factors into account has however not been developed yet. The purpose of this study is to develop a model method for personnel allocation that reflects the specific features of hospital jobs. For this purpose, we identified determining necessary competences, determining possessed competences, and deriving allocation patterns as the three core aspects of personnel allocation; and incorporated hospital-specific considerations to each of these aspects. Determining necessary competences involves identifying items to be evaluated and estimating the number of required personnel, based on a job description including hospital-specific features. Determining possessed competences involves evaluating personnel competences in terms of levels reflecting skill proficiency. Deriving personnel allocation patterns involves ensuring quality in situations where possessed competences do not satisfy the necessary competences. Finally, based on real world application, we conclude that our model allows for more adequate patterns of personnel allocation at hospitals than existing approaches.

Hospitals, even under the pressure of shrinking healthcare budgets, have to provide a safe and quality-assured service. Towards this goal, hospitals have to examine the course of health-care service provision, i.e. work processes, and to do so efficiently appropriate information sharing between relevant parties is imperative. In practice however it is rarely achieved, due to the lack of a set way of expressing the necessary information. To answer this lack, a description method that reflects the complex particularities of hospital works is needed. In this research we develop such a description model, effective for designing and analyzing hospitals' work processes. The developed model is a form that covers the hospital works that have to be examined in designing and analyzing work processes. Its contents are introduced by a concept of process flow and unit process. In order to evaluate the developed model, we test its effectiveness for works process analysis and problem analysis with regards to a common hospital work: a clinical test.

The development of methods to improve the quality of services provided at hospitals has been essential owing to the inadequacy of arrangements for standard procedures and the inadequacy of work instructions based on such procedures. In this paper, we propose a method that involves the following steps: description of the job process, analysis of the causes of incidents, and the planning of improvements for the relevant job process. This method describes a healthcare process using a Set Of unit process flow charts (UPFCs), which are structured and standardized modules represented in the form of flow charts that elucidate the elements of jobs. Describing a job in this manner allows for an appropriate and in-depth analysis of the causes of incidents that occur during a job process, owing to the fact that the structure and description of the characteristics of relevant unit processes are properly designed. In this paper, we provide a detailed explanation of how this method was developed. Lastly, we apply the method to actual cases at a hospital to illustrate its effectiveness in comparison with the systems that arc currently in place.