Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independentl...Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independently. A previous study had established a Fitness Age Score (FAS) based on a theory for biomarker of aging. This study clarified whether the FAS could be used to predict the need for certification of long-term care (CLTC) in independent elderly people. We included 939 independent, community-dwelling-elderly (average age, 74.4 years) whose physical function was measured and for whom the CLTC was tracked for 24 months. The FAS comprised five physical fitness items: Walking time, grip strength, one-leg standing, vertical jump, and functional reach test. Based on the FAS, we calculated the odds ratio (OR) for the CLTC. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) was used for further analysis. We also used the Youden Index (YI), minimum distance method (MD), and two-graph ROC method (TG) to calculate cutoff values (CVs) for screening. We divided subjects into the low and high physical fitness group with CVs. We developed cumulative CLTC curves using the Kaplan-Meier method. Sixteen people could not be tracked for the full 24 months. The measurement of FAS was completed for 798 people, of whom 28 became CLTC. The measurement of FAS was not completed for 125 people, of whom 21 became CLTC. The CLTC OR for people with incomplete FAS was 5.553. The AUC was 0.72 (p < 0.001). The CVs for the FAS were -0.29 for YI (sensitivity, 92.9% and specificity, 40.4%), -1.23 for MD (57.1% and 73.4%), and -0.81 for TG (60.7% and 60.9%). The cumulative CLTC curves according to CVs all showed significant differences (p = 0.000 - 0.020). In conclusion, the FAS can be used to predict CLTC.展开更多
Stercoral colitis is the inflammation of the colonic wall caused by fecal impaction. When a patient with a history of chronic constipation visits the Emergency Center with diffuse abdominal pain, sepsis and or rectal ...Stercoral colitis is the inflammation of the colonic wall caused by fecal impaction. When a patient with a history of chronic constipation visits the Emergency Center with diffuse abdominal pain, sepsis and or rectal bleeding, clinicians should consider the possibility of stercoral colorectal perforation. An accurate diagnosis on a computed tomography (CT) scan (for fecal impaction, intra-abdominal feces, intraperitoneal free air, stranding of the peri-colonic fat in the segment, presence of extraluminal bubbles of gas) may facilitate early surgical intervention and improve the patient’s prognosis based on our clinical experience dealing with three patients who had stercoral colitis.展开更多
A low body mass index (BMI) is often associated with low nutritional status and adverse health outcomes. While the BMI is used in describing “thinness” meaning cachexia, serum albumin levels were also used in assess...A low body mass index (BMI) is often associated with low nutritional status and adverse health outcomes. While the BMI is used in describing “thinness” meaning cachexia, serum albumin levels were also used in assessing patient’s nutritional conditions. Object: A retrospective study was conducted to determine whether the extremes of BMI and/or cachexia increased the morbidity and mortality in our critical emergency department. Methods: A hundred and five cases with low BMI (≤18.5 kg/m2) were chosen from the patients who were admitted to our critical emergency department from Sept 2013 to Aug 2016. The relationship between serum albumin levels on admission and prognosis were analyzed. Results: No significant correlations were observed between body mass index and albumin levels in thin patients. Lower levels of serum albumin (p Conclusions: Even with low BMI, if the albumin value was 3.3 g/dL or more, the prognosis was good in our emergency department. Estimation of albumin level on admission is not only a simple and objective way to assess the nutritional status but also a useful outcome predictor of critically ill patients coming to emergency centers.展开更多
文摘Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independently. A previous study had established a Fitness Age Score (FAS) based on a theory for biomarker of aging. This study clarified whether the FAS could be used to predict the need for certification of long-term care (CLTC) in independent elderly people. We included 939 independent, community-dwelling-elderly (average age, 74.4 years) whose physical function was measured and for whom the CLTC was tracked for 24 months. The FAS comprised five physical fitness items: Walking time, grip strength, one-leg standing, vertical jump, and functional reach test. Based on the FAS, we calculated the odds ratio (OR) for the CLTC. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) was used for further analysis. We also used the Youden Index (YI), minimum distance method (MD), and two-graph ROC method (TG) to calculate cutoff values (CVs) for screening. We divided subjects into the low and high physical fitness group with CVs. We developed cumulative CLTC curves using the Kaplan-Meier method. Sixteen people could not be tracked for the full 24 months. The measurement of FAS was completed for 798 people, of whom 28 became CLTC. The measurement of FAS was not completed for 125 people, of whom 21 became CLTC. The CLTC OR for people with incomplete FAS was 5.553. The AUC was 0.72 (p < 0.001). The CVs for the FAS were -0.29 for YI (sensitivity, 92.9% and specificity, 40.4%), -1.23 for MD (57.1% and 73.4%), and -0.81 for TG (60.7% and 60.9%). The cumulative CLTC curves according to CVs all showed significant differences (p = 0.000 - 0.020). In conclusion, the FAS can be used to predict CLTC.
文摘Stercoral colitis is the inflammation of the colonic wall caused by fecal impaction. When a patient with a history of chronic constipation visits the Emergency Center with diffuse abdominal pain, sepsis and or rectal bleeding, clinicians should consider the possibility of stercoral colorectal perforation. An accurate diagnosis on a computed tomography (CT) scan (for fecal impaction, intra-abdominal feces, intraperitoneal free air, stranding of the peri-colonic fat in the segment, presence of extraluminal bubbles of gas) may facilitate early surgical intervention and improve the patient’s prognosis based on our clinical experience dealing with three patients who had stercoral colitis.
文摘A low body mass index (BMI) is often associated with low nutritional status and adverse health outcomes. While the BMI is used in describing “thinness” meaning cachexia, serum albumin levels were also used in assessing patient’s nutritional conditions. Object: A retrospective study was conducted to determine whether the extremes of BMI and/or cachexia increased the morbidity and mortality in our critical emergency department. Methods: A hundred and five cases with low BMI (≤18.5 kg/m2) were chosen from the patients who were admitted to our critical emergency department from Sept 2013 to Aug 2016. The relationship between serum albumin levels on admission and prognosis were analyzed. Results: No significant correlations were observed between body mass index and albumin levels in thin patients. Lower levels of serum albumin (p Conclusions: Even with low BMI, if the albumin value was 3.3 g/dL or more, the prognosis was good in our emergency department. Estimation of albumin level on admission is not only a simple and objective way to assess the nutritional status but also a useful outcome predictor of critically ill patients coming to emergency centers.
