Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30 days of discharge

Abstract Background Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Methods Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis. Results Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates. Conclusions From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients

The Inheritance of Jumping Activity in Reciprocal Cross of Two Subspecies of Mice

The objective of this study was to describe the nature of the inheritance of jumping as a behavioral trait and to analyze quantitatively the jumping height as a measure of vigor in two subspecies of mice. Two subspecies of mice, Yonakuni wild mouse (Y) and CF#1 laboratory mouse (C), were used as the parental types. Reciprocal mating between these two subspecies was made to produce subsequently the first and second generations. The first generation was F1 (YC) resulting from Y male x C female, and F1’ (CY) from C male x Y female. The second generation F2 (YCYC) was from mating F1 x F1 and F2’ (CYCY) from F1’ x F1’. Individuals were treated with a set of direct current shock apparatus at six weeks of age to evoke jumping. The results showed that the ratio between jumping and non jumping mice (J: NJ) for C was 0%:100% (0:1), which means that all C did not jump throughout the experiment, whereas Y was 68%:32% (2:1); and the F1 and F2 showed 65%:35% (2:1) and 51%:49% (1:1), respectively. All F1’ and F2’ individuals jumped as indicated by the ratio 100%:0% (1:0) for both these two genetic groups. Of the jumped mice, average height of the first three jumping observed for pooled sexes in Y, F1, F2, F1’, and F2'' were 19.3 cm, 19.3 cm, 18.0 cm, 19.9 cm and 16.4 cm, respectively. The distribution of jumping height showed a tendency to be a normal distribution. The jumping activity and jumping height may be affected by some major genes and polygenes, respectively. Keywords : Jumping Inheritance, Reciprocal Cross, Subspecies of Mic

Heterosis Effects on Jumping Height and Body Weight in Three-Way Rotational Crossing in Mice

The three-way rotational crossing experiment has been conducted to evaluate heterosis effects on jumping height and body weight. Yonakuni wild mice (Y) and two genetic groups of CF#1 (C) and C3H/HeNCrj (H) laboratory mice were used as materials. Reciprocal rotational crossing was made by crossing C male Y female and Y male X C female to produce basic group designated G0 and G0’, respectively. The females of the G0 and G0’ were mated to the H sire to produce second generation (G1 and G1’), and at the following generation the replacement females were mated to Y or C sire according to the basic group to produce G2 to G3 and G2’ to G3’. Individual jumping height data at Wk6 and body weight data at 1 (Wk1), 3 (Wk3), 6 (Wk6) and 10 (Wk10) weeks of age were analyzed. The results showed that effects of genetic group, sex and interaction of genetic group by sex were significant (p<0.01) for jumping height. For males, 55.34%~79.17% and 54.46%~78.29% of heterosis were reached at G1 to G3 and G1'''' to G3’, respectively. While for females at G1 to G3 and at G’ to G3’, heterosis effects were 61.53%~80.42% and 47.79%~85.86%, respectively. For body weight, genetic group was a significant source of variation at all ages studied. Sex effect was significant at Wk3, Wk6 and Wk10, and interaction between genetic group and sex was significant at Wk6 and Wk10 (p<0.01). C sires resulted in the highest body weight of offspring, while H sires were the intermediate and Y sires were the lightest. The significant positive and negative heterosis effects for body weight were exhibited. Crossing involved the Y sires in addition to smaller maternal effects of Y dams tended to result in small heterosis. Keywords : Jumping Height, Body Weight, Heterosis, Rotational Crossing, Mic

Average Direct and Maternal Genetic Effects and Heterosis Effects on Body Weight in Two Subspecies of Mice

Data on body weights were analyzed in the four genetic groups from all possible crosses of two subspecies of mice to estimate average direct genetic effects (ADGE), average maternal genetic effects (AMGE) and heterotic effect (HE). The genetic groups used were CF#1 laboratory mouse (Mus musculus domesticus), Yonakuni wild mouse (Yk, Musvusculus molossinus yonakuni) and two reciprocal F1 crosses of them, CY and YC. First symbol in the reciprocal F1 represent subspecies of dam. Body weight at 1 (Wk 1), 3 (Wk 3), 6 (Wk 6) and 10 weeks of age (Wk 10) were analyzed from 258 mice of the four genetic groups. The model used to evaluate body weights included main effects of genetic group and sex, and interaction effect between genetic group and sex. The ADGE and the AMGE were estimated as deviations of Yk from CF#1. The HE was estimated from the differences between the reciprocal F1 and the midparent mean, Results of this study showed that all effects, except sex and interaction between genetic group and sex at Wk1 and Wk3, were highly significant source variation (p<0.01). The ADGE were positive and highly significant (p < 0.01) at all ages studied for both sexes, while the AMGE were highly significant at Wk3, Wk6 and Wk10. The ADGE were larger in contributing effect on body weight differences than the AMGE. The positive value of the HE were observed at all ages for males, while for females the positive effects occurred from birth through weaning. Keywords : Direct and Maternal Effects, Heterosis Effects, Body Weight, Subspecies of Mic

Multiphasic Analysis of Growth Curve of Body Weight in Mice

The present study describes the analysis of the multiphasic growth function (MGF) to body weight in laboratory and wild mice. Three genetic groups of laboratory mice (Mus musculus domesticus) designated CF#1, C3H/HeNCrj and C57BL/6NCrj, and a genetic group of Yonakuni wild mice (Mus musculus molassinus yonakuni, Yk) were used. Mean body weight of each genetic group-sex subclass from birth to 69 days of age taken at 3-day intervals were analyzed by a monophasic, diphasic and triphasic functions for describing growth patterns. A comparison among the three functjions of the MGF was based on the goodness-of-fit criteria : residual standard deviation (RSD), adjusted R-squrare (Adj R2) and Akaike`s information criterion (AIC). Result of this study indicated that body weight averaged heavier for males than for females. Among the four genetic groups within both sexes, CF#1 showed the highest, subsequent followed by C3H/HeNCrj, C57BL/6NCrj and Yk. Comparison among the three functions revealed that the triphasic function was the best fit to growth data, with the lowest RSD, the highest Adj R2 and the lowest AIC, for the four genetic groups. For the triphasic function, RSD within each genetic group-sex subclass was similar for males and females. ADJ R짼 was 0.999 for all genetic group-sex subclasses. AIC for laboratory mice males and females ranged from -70.48 to 66.50 and from -92.81 to -68.64, respectively ; whereas for Yk wild mice males was-78.42 and females -78.42. Keywords : Multiphasic Growth Function, Goodness-of-fit Criteria, Body Weight, Mic

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

Abstract Background Colorectal cancer screening (CRCS) needs to be pandemic‐resilient to avoid long‐lasting shutdowns; however, realistic participation target remains unelucidated. This study aimed to identify the lowest acceptable participation rate in CRCS during a pandemic, focusing on vulnerable older populations who require urgent intervention. Methods This nationwide cross‐sectional study included 80,946 inpatients aged 70–85 years who were first diagnosed with colorectal cancer (CRC) after 70 years of age, between April 1, 2014 and March 31, 2019, in Japan. To evaluate the association between area‐level CRCS participation rate and individual early CRC detection, a multilevel logistic regression model was constructed. The mandatorily implemented screening rates were converted to the total screening rate equivalents (TSREs), which reflect the remaining contributions of voluntarily provided screenings. Results Early detections during stages 0–I were significantly observed when primary screening rate was ≥38% (TSRE) and combined follow‐up rate was ≥85%. For early detection during Tis–T1, primary screening rate ≥ 38% (TSRE) and combined follow‐up rate ≥ 90% were necessary. For follow‐up rates ≥70% or ≥75%, there were cases where missed detection of Tis–T1 were observed. Conclusion The results indicate that, even during pandemic, CRCS should achieve a primary screening rate of 38% and follow‐up rate of 85% for vulnerable older populations. These values, lower than the current desirable rates, suggest the maximum possible compromise in balancing the resources between cancer screening and pandemic measures. Moreover, they also indicate the minimum target for shifting to fecal immunochemical test‐focused program. Further explorations with varied CRCS settings are necessary for verification

Flowchart showing initial patient eligibility and exclusion because of early discharge.

Flowchart showing initial patient eligibility and exclusion because of early discharge.</p