BACKGROUND

Whether the improvement in activities of daily living (ADL) after cataract surgery in patients from nursing care facilities is comparable with that in patients from home remains unclear.

METHODS

Data of patients who underwent cataract surgery from April 2014 to March 2015 were extracted from a national inpatient database in Japan. We identified 222,883 patients hospitalized from home and 1,228 patients hospitalized from nursing care facilities who underwent cataract surgery during hospitalization. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. The primary outcome was the proportion of patients with improved ADL after cataract surgery. ADL assessment was performed by calculating the Barthel index. We also compared the length of hospital stay between the groups.

RESULTS

Patients from nursing care facilities were more likely to be older and female and to have a higher comorbidity index and lower ADL score at admission. In the matched-pair analysis of 1,228 vs. 24,560 pairs, a lower proportion of patients hospitalized from nursing care facilities had an improved ADL score (odds ratio, 0.64; 95% confidence interval, 0.53–0.78; p < 0.001). There was no significant difference in the length of hospital stay between the groups.

CONCLUSIONS

In this large nationwide cohort of patients with cataracts, hospitalization from nursing homes was significantly correlated with poor improvement in ADL compared with hospitalization from home. These results suggest that early cataract surgery prior to admission to nursing care facilities should be recommended for patients with cataracts.

BACKGROUND

The association between physician specialty and stroke mortality remains controversial. The present study evaluated the effectiveness of admission to a hospital with neurologic specialist staffing on 30 day in-hospital mortality after cerebral infarction, controlling for measured and unmeasured hospital and patient characteristics.

METHODS

The study involved 56,866 patients with cerebral infarction who were hospitalized within 1 day after onset between July 1, 2010 and March 31, 2012. Participants were identified using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institution and Hospital Report data and Survey of Physicians data. Well-staffed hospitals were defined as those with ≥3 board-certified neurologic specialists. Poorly-staffed hospitals were those with <3 board-certified neurologic specialists. The association between neurologic specialist staffing and 30-day in-hospital mortality was examined using a generalized estimation equations logistic regression model. Ordinary least square model and two-stage least square model using differential distance to hospitals as an instrumental variable were used for sensitivity analyses.

RESULTS

After adjusting for patient severity and hospital characteristics, 30-day in-hospital mortality at well-staffed hospitals was significantly lower than that at poorly-staffed hospitals (odds ratio, 0.89; 95% confidence interval, 0.79–0.99; P = 0.040). Hausman specification test suggested that admission to well-staffed hospital was exogenous. Ordinary least square model showed 30-day in-hospital mortality at well-staffed hospitals was significantly lower than that at poorly-staffed hospitals (risk difference, −0.6%; 95% confidence interval, −1.2% to −0.0%; P = 0. 044).

CONCLUSIONS

Hospitals with ≥3 neurologic specialists were associated with reduced 30-day in-hospital mortality for cerebral infarction.

BACKGROUND

Preparations of 2.5% lidocaine plus 2.5% prilocaine cream (trade name EMLA® cream) or 5% lidocaine cream (trade name LMX5® cream) are used for local anesthesia. To our knowledge, no study has directly compared the analgesic effects for venipuncture between EMLA® cream and LMX5® cream. We conducted a double-blinded randomized crossover trial to evaluate the analgesic effects of these two creams in healthy adults using a visual analogue scale (VAS).

METHODS

This crossover trial enrolled 24 healthy adult participants randomly assigned to 4 groups by combining 2 formulations of anesthetics and different left-right arm-treatment protocols. The primary outcome was each subject’s VAS score (range 0 to 100) for pain during blood sampling. The secondary outcomes were blood sampling site, blood sampling volume, blood sampling frequency, and occurrence of side effects. We conducted a multivariate regression analysis for the VAS score after adjusting for participants’ background characteristics while also adjusting for clustering of arm-treatment protocols within individuals using a generalized estimating equation.

RESULTS

There were no significant differences between EMLA® and LMX5® cream after adjusting for participants’ background characteristics, including age and sex (difference: 2.83; 95% confidence interval: −11.25 to 16.92; P value: 0.693). There were also no marked differences in secondary outcomes between EMLA® cream and LMX5® cream. No adverse reactions that could be clinically problematic were observed with either cream.

CONCLUSION

This randomized crossover trial showed that there was no significant analgesic difference between EMLA® cream and LMX5® cream. Both creams were effective without clinically serious side effects.

The registration number is UMIN000011463.

The registry website is UMIN (http://www.umin.ac.jp/ctr/index.htm).

BACKGROUND

Commonly used scales that measure hope in general may not capture how people experience their health and how healthcare affects hope as a patient-reported outcome. Therefore we tested question-items for measuring health-related hope (HR-Hope), and developed a scale for measuring HR-Hope in adults with chronic illnesses.

METHODS

Using results from a qualitative study, we wrote 45 question-items to measure 3 domains of HR-Hope: health & illness, role & social connectedness, and “something to live for.” We tested those items among 454 patients with chronic kidney disease (stage 3 to stage 5 requiring dialysis) in a cross-sectional survey. Using the results of factor analysis and of analyses based on item-response theory, we chose 18 of the 45 items, and proceeded to the next steps: reliability testing and criterion-based validation testing.

RESULTS

Exploratory factor analysis indicated unidimensionality. Confirmatory factor analysis showed that the data were consistent with a single second-order factor (health-related hope) and 3 first-order factors (the 3 domains). Coefficient α for total HR-Hope scores was 0.93. The HR-Hope scale was moderately correlated with both domains of Snyder’s hope scale. Compared with Snyder’s hope scale, the HR-Hope scale was more strongly correlated with the Center for Epidemiologic Studies Depression Scale and with the 8 domains of the Short Form-36-v2. Compared with Snyder’s hope scale, the HR-Hope scale was more sensitive to impaired performance status, depression, acceptance of illness, and the presence of family.

CONCLUSIONS

The 18-item HR-Hope scale can be used to measure health-related hope in people with chronic illness.