Factors in Avoidable Emergency Visits for Ambulatory Care-sensitive Conditions among Older Patients Receiving Home Care in Japan: A Retrospective Study.

Objective Older adults have many health conditions that do not require hospitalization, such as cognitive decline and progression of frailty, so it is necessary to prevent avoidable emergency visits for ambulatory care-sensitive conditions (ACSCs) in this population. We therefore examine Freund's classification of reasons for hospitalization owing to ACSCs to identify factors involved in elderly patients visiting emergency departments in Japan. Methods This retrospective case-control study included patients who received emergency transport for medical treatment at Yushoukai Home Care Clinic Shinagawa in Japan between January 1, 2016, and April 30, 2019. We examined patients' medical records and categorized the reasons for emergency visit by ambulance in accordance with Freund's categories (physician related level, medical causes, patient level, and social level). In addition, we classified and compared patients who lived at home (Group A) with those living in a care facility for older adults (Group B). Results A total of 365 patients visited the emergency department (298 in Group A and 67 in Group B). Among these, we determined that emergency visits were potentially avoidable in 135 patients from Group A and 28 from Group B. The patient and social level categories accounted for 81% of potentially avoidable emergency visits. Confirmed advanced care planning (ACP) was significantly associated with avoidable emergency visit by ambulance in multivariate analyses. Conclusion To prevent emergency visits for ACSCs among older people, ACP should be encouraged.

Utilization of central disk of blastoderm and germinal crescent region for production of interspecific germline chimera between chicken and quail.

AIM: The production of interspecific germline chimeras between chicken and quail were attempted employing the dissociated cells derived from the blastodermal central disk (stage X) and the germinal crescent region of embryo (stage 7-8). METHODS: The central disk (CD) of the area pellucida in chicken blastoderm (stage X) and the germinal crescent region (GCR) of embryo (stage 7-8) were dispersed and injected into the subgerminal cavity of quail blastoderm (stage X). Injected eggs were incubated for 7 days or to hatching. The donor chicken DNA was detected by the polymerase chain reaction. RESULTS: In day-7 embryos, chicken DNA was detected in 5 gonads and 9 brains from 53 survived embryos received chicken CD cells, and 1 gonads and 6 brains from 27 survived embryos received chicken GCR. Chicken DNA was also detected from the semen of one adult male hatched from eggs received chicken GCR cells. CONCLUSION: CD and GCR cells as the donors showed the possibility to produce the interspecific germline chimera, but further studies are needed to make necessary improvement.