RESUMEN
For increasing medical care demand by aging population, the Japanese government is shifting to home medical care for treatments that do not necessarily require hospitalization. It is therefore essential to identify factors involved in improving the quality and outcomes of home medical care. This study examined the effect of hospital discharge support in long-term care wards on readmission rates. We used medical insurance and the Long-Term Care Insurance data of patients aged ≥ 65. Participants were patients who discharged between April 2012 and March 2016 from long-term care wards that did not require 24-hour monitoring and had no specific incurable diseases. Participants were divided into two groups according to hospital discharge support, defined by medical fee incentives for discharge planning and coordination of medical and nursing services after discharge. We explored the association between hospital discharge support and risk-adjusted readmission based on patient characteristics for one year beginning the month after patient discharge. This study involved a total of 10,998 patients: 2,563 patients with hospital discharge support and 8,435 patients without relevant support. In the group with hospital discharge support, there was a significant reduction in readmission rates. When examined by patients' characteristics, this association was significant in groups with age ≥ 85, care needs levels 1 to 2 (conditions requiring partial care for daily living), dementia or fracture. Our results suggest that hospital discharge support by medical and nursing care workers is effective in reducing readmission rates. Moreover, patients' age, care needs, and underlying disease should be considered.
Asunto(s)
Cuidados a Largo Plazo/estadística & datos numéricos , Atención de Enfermería , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Seguro de Cuidados a Largo Plazo/estadística & datos numéricos , Japón , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Enfermeras y Enfermeros , Médicos , Resultado del TratamientoRESUMEN
Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) are immune-mediated peripheral neuropathies, and most of these cases were known to be associated with a preceding infection. Recent reports evidenced an increase in the number of infectious disease cases after the earthquake. The aim of this report is to investigate the incidence and clinical features of GBS and FS after the Great East Japan Earthquake. We found GBS and FS patients had markedly increased in 2011, the year of the earthquake. In regard to an antecedent illness, gastrointestinal infection was significantly increased in GBS patients after the earthquake. These results suggest environmental factors including infectious agents and stress caused by the earthquake might have been involved in the outbreak of the diseases.
Asunto(s)
Infecciones por Campylobacter/epidemiología , Gastroenteritis/epidemiología , Síndrome de Guillain-Barré/epidemiología , Síndrome de Miller Fisher/epidemiología , Terremotos , Humanos , Incidencia , Japón/epidemiología , Estudios RetrospectivosRESUMEN
A 28-year-old man noticed weakness in his left arm when he woke up. He was diagnosed as left radial nerve palsy and managed conservatively at a local hospital. A few days later, severe pain of the brachium appeared. Although severe pain improved in a year, dysesthesia and muscle atrophy remained. On admission, muscle weakness and atrophy were found in muscles innervated predominantly by the left radial nerve. In addition, needle-electromyography and computed tomography revealed the involvement of muscles innervated by the left suprascapular, long thoracic and axillary nerves, and we diagnosed the patient as neuralgic amyotrophy. Neuralgic amyotrophy should be kept in mind in diagnosing acute onset, painful radial palsy.