Objectives(1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data.DesignMulticenter retrospective cohort study.SettingTo derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three “derivation” hospitals.ParticipantsAdults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients).AnalysisWe analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the “ID-BactER” score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed.ResultsThere were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.ConclusionsThe ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation.

Background There is a growing need to realize high-quality end-of-life care at home that respects the patient’s wishes. Objective To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care. Methods In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians. Results Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51–2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation. Conclusions Patient-centredness in home medical care facilitates the initiation of ACP participation.

Aim This study aimed to examine the validity of the care‐needs levels classified in Japan's long‐term care insurance system (LTCI‐CNLs) when compared with patients’ self‐perceived functioning, disability and physical performance among patients receiving home medical care. Methods This was a multicenter cross‐sectional study in Japan. Patients who were receiving continuous home medical care and who could respond to the questionnaire were enrolled in this study. In addition to the LTCI‐CNLs, the 12‐item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the SARC‐F were used to measure functioning, disability and physical performance (sarcopenia). In addition, correlations and associations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were analyzed using Spearman correlations and linear mixed models. Results Data from 181 patients were included in the analyses. The LTCI‐CNLs varied, ranging from support level 1 (5.5%) to care‐needs level 5 (10.5%), with care‐needs level 2 being the most prevalent (24.9%). Moderate correlations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were found (ρ = 0.58 and 0.44, respectively). Although WHODAS 2.0 and SARC‐F scores varied within each LTCI‐CNL, predicted WHODAS 2.0 and SARC‐F scores increased as LTCI‐CNL increased. Dementia was not associated with WHODAS 2.0 or SARC‐F. Conclusions The LTCI‐CNLs was associated with self‐reported functioning, disability and physical performance among home medical care patients. Future studies can use the LTCI‐CNLs as an outcome variable for specific care approaches or as a proxy covariate for casemix status. Geriatr Gerontol Int 2021; 21: 229–237.