Medicine
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By virtue of medical advances and an aging society, people have increased opportunities for healthcare exposure. Little is known about the impact of healthcare exposure on the clinical features and molecular typing of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We classified the onset of MSSA bacteremia into 3 mutually exclusive categories according to the Centers for Disease Control definition, and conducted a retrospective cohort study to investigate the differences among patients with community-associated (CA), healthcare-associated community onset (HACO), and hospital onset (HO) MSSA bacteremia at a medical center from January 1, 2002 through December 31, 2011. ⋯ Infection foci varied with different onset settings. Overall, ST188 was the most predominant sequence type. Onset settings were not independently associated with outcomes.
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To investigate the diurnal variations of the ocular blood flow in healthy eyes using laser speckle flowgraphy (LSFG), and to determine the relationship of the diurnal variations between the ocular blood flow and other ocular parameters. This prospective cross-sectional study was conducted at Nagoya University Hospital. We studied 13 healthy volunteers whose mean age was 33.5 ± 7.6 years. ⋯ Although the diurnal variation of the MBR on the ONH was different from the other parameters, that on the choroid was significantly and positively correlated with the DBP (P = 0.002), mean arterial pressure (P = 0.023), and mean ocular perfusion pressure (P = 0.047). We found significant diurnal variations in the ONH and choroidal blood flow. Although the ONH blood flow had its own diurnal variation because of strong autoregulation, the choroidal blood flow was more likely affected by systemic circulatory factors because of poor autoregulation.
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Observational Study
Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence.
Recurrence of acute diverticulitis is common, and--especially complicated recurrence--causes significant morbidity. To prevent recurrence, selected patients have been offered prophylactic sigmoid resection. However, as there is no tool to predict whose diverticulitis will recur and, in particular, who will have complicated recurrence, the indications for sigmoid resections have been variable. ⋯ Low-risk and high-risk groups had 3% and 43% 5-year complicated recurrence rates, respectively. Risk for complicated recurrence of acute diverticulitis can be assessed using risk scoring. The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.
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Observational Study
Changes in disability levels among older adults experiencing adverse events in postacute rehabilitation care: a prospective observational study.
This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs. A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. ⋯ The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012). Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.
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The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. ⋯ Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P < 0.001), 1.226 (95% CI 1.205-1.248, P < 0.001), and 1.536 (95% CI 1.504-1.567, P < 0.001) in outpatient visits and 1.032 (95% CI 0.992-1.074, P = 0.121), 1.056 (95% CI 1.022-1.092, P = 0.001), and 1.208 (95% CI 1.164-1.254, P < 0.001) in complication-incurred hospitalizations, respectively. The monotonic trend was sustained across different strata of age, gender, and disease complexity. The findings of this study suggest that the incentives of continuity of care and physician-patient relationship management should be reinforced during the early stage of diabetes care in future medical care systems.