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Aim This study aimed to identify the current situation of interprofessional collaboration for gestational diabetes mellitus (GDM) management in Japan including the professionals involved, the collaboration methods employed, and the barriers perceived by nurses and midwives. Methods This nationwide cross-sectional survey of 1,046 total hospitals facilitating childbirth in Japan used an original 60-item questionnaire to investigate GDM management practice through interprofessional collaboration. The questionnaire required one responder to be a midwife or nurse who was familiar with the management practices for GDM women in their respective hospitals. Quantitative data were analyzed using descriptive statistics, and framework analysis was conducted for qualitative data collected by open-ended questions. Results All 308 respondents (response rate 29.4%) were included. The professionals included in interprofessional collaboration were limited, and the only strategy used for interprofessional collaboration by a majority (91.5%) of hospitals was medical charts. There were 50.8% of hospitals that provided postpartum GDM follow-ups and 54.5% of hospitals that did not engage in external collaboration for GDM management. The barriers to interprofessional collaboration extracted were seven categories and 23 subcategories, which were aligned within the following units of analysis: individual, team, organization, and community. Conclusions This survey shows that interprofessional collaboration, including support for GDM postpartum follow-up in Japan remains insufficient. Furthermore, nurses and midwives perceive numerous barriers to interprofessional collaboration for continuous GDM management at the individual, team, organizational and community levels.

TGF-β1と活性型ビタミンDは, 細胞の成長や分化に対して影響を及ぼすことが知られている。そこで本研究では, ヒト歯根膜由来細胞に対するTGF-β1と活性型ビタミンDの影響を種々の分化マーカーを用いて検討することを目的とした。ヒト歯根膜由来細胞 (HPdLF, HPDL) に様々な濃度のTGF-β1と活性型ビタミンDを作用させ, アルカリフォスファターゼ (ALP) 活性を測定, 歯髄由来細胞, 骨芽細胞と比較した。さらにTGF-β1と活性型ビタミンD を作用させたHPdLFについて細胞増殖能の検討およびALP染色を行った。さらに, 石灰化誘導条件下でPCRにて分化マーカーを検討した。その結果, ヒト歯根膜由来細胞はTGF-β1と活性型ビタミンDを添加した場合, 細胞増殖能は抑制されるが, ALP活性に対する反応性は上昇し, またALP染色陽性細胞も増加した。石灰化誘導培地でのTGF-β1と活性型ビタミンDに対するHPdLFの反応性は, 歯根膜細胞に特徴的マーカーとされるPLAP-1/asporin遺伝子発現は減弱し, 骨芽細胞に特徴的マーカーとされるオステオカルシン遺伝子発現は上昇した。以上の結果から, TGF-β1と活性型ビタミンDはヒト歯根膜由来細胞の分化に対し促進的に作用してALP活性の上昇を示し, 石灰化誘導培地において, よりosteogenicな細胞へと分化誘導することが示唆された。日本歯周病学会会誌(日歯周誌)52(4) : 391-400, 2010.

Introduction: Appropriate deployment of nursing staff to secure quality nursing care has been a challenge for nurse managers. Japan’s nursing staffing system is not as well developed as that in western countries. Aim: To clarify topics of appropriate nursing staffing and find points of improvement for Japan’s patient classification system. Methodology: This qualitative cross-sectional study was conducted from December 2009 to February 2010. The authors surveyed three medical institutions in Japan which have adopted nursing staff deployment systems. We conducted semi-structured interviews with nurse administrators regarding nursing staff deployment at each medical facility. Content analysis was used to analyze the interview data. Results: We identified 4 topics of nursing staffing: (1) “Improving the accuracy of the patient classification scale”, (2) “Developing the staffing system”, (3) “Circumstances causing staffing difficulties”, and (4) “Staffing system for future needs”. Conclusion: Improvement of the scale of nursing necessity and the audit system is urgent in Japan. Developing the staffing system is also important, and nurse managers need to improve their ability to assimilate data. It is also necessary to visualize business aspects on a computer in real time, and nurse administrators should be willing to anticipate business systems in order to fulfill the needs of appropriate staffing.

A role of incident reporting system has become more important for improving of the patient safety. However, the more various causes managers seek for, the longer time healthcare providers send to report near-miss/ medical errors. The purpose of our work was to try to develop "the incident reporting system" utilized the nursing administrative database. As a result, we found that the system would make us spend less time to report medical errors and easy to analyze of the nursing care structure. The system using the nursing administrative database is effective to improve the patient safety rationally.