الملخص
Objective: Community-based integrated care wards (CICW) play a role in supporting the return of patients to their homes. However, studies investigating the readmission risk associated with CICW are lacking. To investigate the influence of CICW on readmission, we conducted a retrospective cohort study among Japanese elderly people.Materials and Methods: This study used data from the Diagnosis Procedure Combination (DPC) and medical records of the Hamada Medical Center, Shimane Prefecture in 2014–2019. The number of subjects and readmission in each hospitalization case (general ward only [GW] and CICW) were 1,521 and 416 subjects and 152 and 49 cases, respectively. We selected the hospitalization cases for heart failure (I30–I52), ischemic heart disease (I20–I25), pneumonia (J09–J18), chronic lower respiratory tract diseases (J40–J47), intestinal diseases (K55–K64), cerebrovascular disease (I60–I69), gallbladder, bile duct, and pancreatic diseases (K80–K87) from the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The hazard ratios (HRs) and 95% confidence intervals (CIs) for readmission via a CICW were estimated using a multivariate Cox proportional hazards model.Results: The HRs for readmission associated with CICW were not different between the shorter and longer durations, considering the percentage of CICW stay. Compared with GW cases, the HR of CICW cases was 0.40 (95% CI, 0.17–0.92) in coordination with outside agencies of hospital discharge support. While the HR of GW cases was 2.35 (95% CI 1.01–5.47), a significantly increased risk was observed in people living alone. A similar risk was not observed in CICW cases with the HR of 0.56 (95% CI 0.15–2.07).Conclusion: The present study observed decreased risk of readmission among the patients discharged from CICW, compared to GW. Further research is required to clarify the causal factors for this decreased risk.
الملخص
We have several choices against bleeding and obstruction in advanced gastric cancer patients such as surgical or endoscopic therapy. But we have few reports about palliative radiation. We conduct this study that we perform palliative radiation for unresectable advanced gastric cancer patients between April 2006 and March 2014 in single center. In the aim of the therapy, to stop gastric bleeding were 8, and to improve obstruction depend on gastric cancer were 4. Response rate of stop bleeding was 63％, and improve obstruction was 50％. Median duration of stop bleeding was 103 day, and improve obstruction was 52 day. Overall survival time was 567 day, survival time after the start of radiotherapy was 105days. Radiotherapy was limited in cases because onset time of response needed in comparison with surgical or endoscopic therapy. However, given minimally invasive therapy and a certain response, we can choice it so much more.