ABSTRACT
Objective：The number of heart failure （HF） patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.
ABSTRACT
Objective：The number of heart failure（HF）patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.
ABSTRACT
The aims of the present study were: [1] to evaluate whether Erbium-Doped: Yttrium, Aluminum and Garnet [Er: YAG] laser could be a prophylactic methods against transient bacteremia during scaling and root planing [SRP] [2] to confirm the efficacies of SRP with Er: YAG laser by clinical and microbiologic evaluations. Twenty chronic periodontitis subjects were randomly treated for quadrant SRP with either conventional hand instrument [n=10] or Er: YAG laser [n=10] monotherapy. Peripheral blood samples were drawn at baseline and 6 minutes after initiation of SRP, and were cultured for the analysis of bacteremia. Clinical measurements of full mouth plaque control record [PCR], probing pocket depth [PPD], clinical attachment level [CAL] and bleeding on probing [BOP] were made at baseline and 1 month after SRP. In addition, microbiologic analyses of subgingival samples were also performed at baseline and 1 month after SRP using the polymerase chain reaction Invader method. The incidence of bacteremia during SRP was 0% [0/10] in the Er: YAG laser group and 80% [8/10] in the hand instrument group, which was significantly different [P = 0.0003]. All isolates from blood were facultative or obligate anaerobes and more than half of the microorganisms were species of streptococci. Intragroup comparison revealed that the mean PPD and CAL significantly decreased compared to baseline in both groups [P < 0.05]. However, the percentage of BOP positive significantly decreased only in Er: YAG laser group [P = 0.005]. In addition, the reductions of the subgingival bacterial counts between baseline and 1 month after SRP were also comparable between the two groups. The present study demonstrated that SRP with Er: YAG laser could not only be an alternative treatment for improvement of clinical and microorganisms situations but also a novel prophylactic method against transient bacteremia