Journal of General and Family Medicine最新文献

{"title":"Addressing social determinants of health as effective readmission prevention and discharge support","authors":"Kakeru Iwase MD, MFA, Yuya Yokota MD, PhD, Shintaro Kosaka MD, Kazushige Fujiwara MD, Junki Mizumoto MD, PhD","doi":"10.1002/jgf2.70059","DOIUrl":"https://doi.org/10.1002/jgf2.70059","url":null,"abstract":"<p>Effective collaboration both within and beyond hospital settings, grounded in an understanding of the social determinants of health (SDH), can improve the quality of care, especially in discharge planning and readmission prevention.<span><sup>1</sup></span> In acute care hospital wards, where medical services are often fragmented, general practitioners are expected to deliver care informed by SDH-related evidence, adopting a holistic and patient-centered approach.</p><p>At the 30th Annual Meeting of the Japanese Society of Hospital General Medicine, we convened a symposium to explore the necessity of evidence-based interventions targeting SDH to reduce readmissions and support effective discharge planning in hospital settings.</p><p>First, we presented recent evidence on the prevention of readmissions through interventions addressing the social determinants affecting patients with chronic heart failure—an ambulatory care-sensitive condition of great relevance. While the evidence on the effectiveness of social interventions for reducing readmissions remains inconsistent, current data suggest that individualized, context-sensitive support may provide benefit. For instance, younger male patients have been identified as being at higher risk of readmission, and targeted lifestyle modifications, including dietary changes and medication adherence, have demonstrated efficacy.<span><sup>2</sup></span> Additionally, a retrospective observational study of heart failure patients in Japan shows that structured once-weekly monitoring for patients with dementia is independently associated with readmission, demonstrating the importance of social support.<span><sup>3</sup></span></p><p>Second, we introduced a case study from a large acute care hospital that has implemented a continuum of care framework focused on the “Patient Journey.” This initiative seeks to identify patients' SDH and deliver context-sensitive support aligned with their personal values. We demonstrated that screening for SDH during hospitalization, alongside integrated admission and discharge planning, can improve post-discharge outcomes for both older adults and pediatric patients.<span><sup>4</sup></span> Among older patients, a narrative review and thematic analysis highlight the complexity of frail syndrome and the need for contextualized interventions.<span><sup>5</sup></span> By embedding SDH screening into the clinical pathways for geriatric syndromes, socioeconomic status, educational attainment, social support, and housing conditions were systematically addressed by the interdisciplinary admission and discharge support team. This approach has the potential to improve healthcare quality, including reduced hospital length of stay and lower readmission rates.</p><p>Finally, we discussed an original case that one of the authors experienced involving a heart failure patient who experienced fragmented care delivery, and we examined strategies for the patient journey. The case is an 80-yea","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"497-498"},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease in the primary care setting: A narrative review","authors":"Faryal Safdar MD,&nbsp;Ahsan Aslam MD, MS, FACP","doi":"10.1002/jgf2.70054","DOIUrl":"https://doi.org/10.1002/jgf2.70054","url":null,"abstract":"<p>Chronic kidney disease (CKD) is a growing public health concern globally, with primary care physicians (PCPs) playing a pivotal role in its early detection and management. This review explores the epidemiology, risk factors, screening strategies, and clinical manifestations of CKD within primary care settings. PCPs are integral in recognizing at-risk populations, initiating timely screening through eGFR and albuminuria tests, and managing modifiable risk factors like hypertension and diabetes. The article discusses current guideline-recommended pharmacologic therapies—including RAAS inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal MRAs—that slow disease progression. Lifestyle modifications and dietary interventions are emphasized as essential components of care. Additionally, the review outlines key indications for nephrology referral and the management of common CKD complications, such as anemia and mineral-bone disorder. By embracing a proactive and multidisciplinary approach, PCPs can significantly influence CKD outcomes, reduce progression to end-stage renal disease, and improve overall patient prognosis.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"385-393"},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current state of heart failure management by home health-care professionals","authors":"Rie Shimomoto RN, PhD,&nbsp;Toru Kubo MD, PhD,&nbsp;Marina Minami MA, PhD,&nbsp;Miyuki Tsuchihashi-Makaya RN, PhD,&nbsp;Narufumi Suganuma MD, PhD,&nbsp;Hiroaki Kitaoka MD, PhD","doi":"10.1002/jgf2.70051","DOIUrl":"https://doi.org/10.1002/jgf2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to clarify the status of disease management during home visits for patients with heart failure (HF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, questionnaire surveys were conducted with health-care professionals employed by home-visit nursing stations in Kochi Prefecture. Data were collected by postal mail between May and June 2019. A 13-item questionnaire was created based on the disease management items in the “2017 Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure.” The Chi-square test and logistic regression analysis were used for the statistical analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis set comprised data collected from 144 nurses and therapists. Regarding disease management for patients with HF, 99.1% of the nurses examined the “status of blood pressure measurement” during home visits. Regarding therapists, 100% confirmed the “status of blood pressure measurement” as well as “signs and symptoms of heart failure.” The items “status of medication use,” “body weight measurement and changes,” “infection prevention and vaccination,” “psychiatric symptoms (anxiety and depression),” and “cognitive function” were confirmed significantly more frequently by nurses than by therapists. After adjusting for confounders, compared with therapists, “body weight measurement and changes” (adjusted odds ratio [aOR]: 4.58; 95% confidence interval [CI]: 1.11–18.87) and “psychiatric symptoms (depression and anxiety)” (aOR: 7.25; 95% CI: 1.39–37.70) were confirmed significantly more frequently by nurses than by therapists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present findings suggest that, compared with therapists, nurses attempt to gain a greater overall understanding of the status of patients with HF in disease management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"435-441"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes associated with use of makyokansekito, a Japanese herbal kampo medicine, in outpatients with community-acquired pneumonia: A retrospective cohort study","authors":"Yuichiro Matsuo MD, MPH,&nbsp;Takuma Shibahara MD,&nbsp;Hideo Yasunaga MD, PhD","doi":"10.1002/jgf2.70052","DOIUrl":"https://doi.org/10.1002/jgf2.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although selected patients with community-acquired pneumonia (CAP) can be treated in outpatient settings, some exhibit an insufficient response to initial outpatient treatment resulting in subsequent hospitalizations. Laboratory and animal studies have demonstrated that makyokansekito, a Japanese herbal kampo medicine, can alleviate lung damage and inflammation. However, its clinical effectiveness in adult patients with CAP has not been evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the commercially available JMDC health insurance claims database (Tokyo, Japan), we identified outpatients with CAP between April 2012 and April 2022. Patients were classified into those who received or did not receive makyokansekito on the day of diagnosis. The primary outcome was hospitalization within 30 days. The secondary outcomes included antibiotic treatment duration and total medical costs. Multivariate regression analyses were used to compare the outcomes between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 76,177 eligible patients, 273 and 75,904 were classified into the makyokansekito and non-makyokansekito groups, respectively. After adjustment, the proportions of hospitalized patients in the makyokansekito and non-makyokansekito groups were 3.0 and 3.4%, respectively, with a difference of −0.4% (95% confidence interval [CI], −2.5% to 1.8%; <i>p</i> = 0.705). The adjusted mean antibiotic treatment durations were 6.3 and 6.5 days, respectively, with a difference of −0.2 days (95% CI, −0.6% to 0.1%; <i>p</i> = 0.155). Adjusted total medical costs were 53,455 and 52,000 Japanese yen (JPY), respectively, with a difference of 1452 JPY (95% CI, −10,988 to 18,525 JPY; <i>p</i> = 0.852).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of makyokansekito in outpatients with CAP was not associated with a reduction in hospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"427-434"},"PeriodicalIF":2.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A relapse of acute group B streptococcus meningitis in a healthy adult: Case report and review of the literatures","authors":"Wannisa Wongpipathpong MD,&nbsp;Pornrujee Hirunpat MD,&nbsp;Suppachok Kirdlarp MD,&nbsp;Somnuek Sungkanuparph MD","doi":"10.1002/jgf2.70039","DOIUrl":"https://doi.org/10.1002/jgf2.70039","url":null,"abstract":"<p><i>Streptococcus agalactiae</i> (GBS) is a rare cause of meningitis in healthy adults. We report the case of a healthy 33-year-old man with acute GBS meningitis who experienced relapsed high-grade fever and increased intracranial pressure following completing intravenous antibiotics. A short course of corticosteroids, along with additional antibiotics, improved the cerebrospinal fluid (CSF) profile, and no further complications occurred after the recurrent episodes. The study highlights the need to consider significant CSF inflammation and potential neurological complications in acute GBS meningitis patients, even in the absence of immunodeficiency or previous surgeries. One of the possible routes of infection in our case was suspected from a history of nasal mucosal damage. The importance of careful monitoring and treatment adjustments should be performed and correlated with clinical signs and symptoms.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"485-489"},"PeriodicalIF":2.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5G approach: Enhancing collaboration between primary care and specialist physicians","authors":"Kosuke Ishizuka MD, PhD,&nbsp;Taiju Miyagami MD, PhD,&nbsp;Yohei Kanzawa MD,&nbsp;Aiko Harada MD,&nbsp;Dai Aoki MD,&nbsp;Yoshiki Umezawa MD,&nbsp;Masataka Ono MD,&nbsp;So Sakamoto MD, PhD","doi":"10.1002/jgf2.70049","DOIUrl":"https://doi.org/10.1002/jgf2.70049","url":null,"abstract":"&lt;p&gt;Effective collaboration between specialist and primary care physicians is essential for improving patient outcomes and ensuring appropriate medical resource use.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; However, their different perspectives can create barriers to care.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Referral of patients from primary care to specialist physicians can result in gaps in diagnostic workup and treatment, leading to unnecessary tests or delays.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Moreover, the lack of standards for consultation timing and information sharing contributes to misunderstandings. To address these issues, we—members of the Junior Doctors Association of the Japanese Society of Hospital General Medicine (JSHGM)—propose the “5G Approach,” (1. Gray Tolerance, 2. Guiding Criteria, 3. Gradual Transition, 4. Ground-Level Coordination, and 5. Growth Through Follow-up) five principles to promote effective collaboration between primary care and specialist physicians (Table 1). These principles were developed through a narrative literature review and discussions among eight primary care physicians with a median of 10 years' experience. The framework reflects clinical realities based on challenges from acute care settings and aligns with established concepts in the literature on collaborative care.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; It has been informally applied in case discussions to improve communication between primary care and specialist physicians.&lt;/p&gt;&lt;p&gt;In primary care, treatment plans are often made before confirming the diagnosis.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Primary care physicians must make decisions to mitigate risk while navigating uncertainty.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Specialist physicians, in turn, are expected to understand and respond appropriately to this uncertainty.&lt;span&gt;&lt;sup&gt;1, 6&lt;/sup&gt;&lt;/span&gt; However, discrepancies in perception may arise between the two regarding the degree of diagnostic certainty.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; To prevent this, primary care physicians must acknowledge and share diagnostic uncertainty with specialist physicians,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; clearly communicating which aspects of the diagnosis are certain and which are uncertain, and specialist physicians should use this information to respond flexibly and manage time effectively.&lt;/p&gt;&lt;p&gt;To facilitate the transition from primary care to specialist care, the appropriate timing of consultations and the criteria for transfer need to be clarified.&lt;span&gt;&lt;sup&gt;1, 2, 7&lt;/sup&gt;&lt;/span&gt; In practice, lack of clarity can result in missed opportunities for timely interventions.&lt;span&gt;&lt;sup&gt;1, 2, 7&lt;/sup&gt;&lt;/span&gt; Thus, setting clear criteria for specialist consultation and patient transfer from primary to specialist care is necessary.&lt;span&gt;&lt;sup&gt;1, 2, 7&lt;/sup&gt;&lt;/span&gt; Moreover, even when the diagnosis is uncertain, sharing transfer criteria can streamline care, promote appropriate medical resource use, and optimize patient outcomes.&lt;span&gt;&lt;sup&gt;1, 2, 7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Depending on the patient's","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"495-496"},"PeriodicalIF":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core competencies of rural practice for medical students of government-sponsored medical education programs in Taiwan: The students' perspective","authors":"Shih-Ming Li PhD,&nbsp;Hang-Rui Zhang MS,&nbsp;Hsin-Yun Chang MD,&nbsp;Cheng-Loong Liang MD, PhD,&nbsp;Wang-Huei Sheng MD, PhD,&nbsp;Tsung-Ying Chen MD,&nbsp;Wen-Yuan Lin MD, PhD,&nbsp;Zih-Jie Sun MD, MS,&nbsp;Jin-Shang Wu MD, MS","doi":"10.1002/jgf2.70045","DOIUrl":"https://doi.org/10.1002/jgf2.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The shortage of rural physicians remains a public health concern. Placing medical students in rural areas and exposing them to rural physicians as models may enhance physician retention in rural areas. The purpose of this study was to explore the core competencies of medical students for rural practice and develop a framework of such competencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A three-stage mixed method was used to develop the core competencies of medical students who will engage in rural practice. In the exploring stage, four physicians completed in-depth interviews; eight students participated in the focus group to identify the core competencies. In the construct stage, two students were interviewed individually and four students as a group to construct the framework. Finally, the competencies were validated by experts in the verification stage. In addition, the analytic hierarchy process was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After thematic analysis, three themes—<i>adaptation</i>, <i>befriending</i>, <i>and career</i>—emerged as the ABC model for rural practice. The framework of competencies for rural practice was established with the ABC model and validated by the analytic hierarchy process (AHP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although some competencies vary across professional stages, the ABC model—adaptation, befriending, and career—is the competencies essential for medical students preparing to practice in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"416-426"},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between polypharmacy and the risk of requiring long-term care among community-dwelling older residents: A retrospective cohort study","authors":"Kengo Maeda MD,&nbsp;Shin-Ya Kawashiri MD, PhD,&nbsp;Kazuhiko Arima MD, PhD,&nbsp;Tetsuro Niri MD, PhD,&nbsp;Yukiko Honda MPH, DrPH,&nbsp;Jun Miyata MD, PhD,&nbsp;Fumiaki Nonaka MD, PhD,&nbsp;Hirokazu Kumazaki MD, PhD,&nbsp;Takahiro Maeda MD, PhD,&nbsp;Yasuhiro Nagata MD, PhD","doi":"10.1002/jgf2.70041","DOIUrl":"https://doi.org/10.1002/jgf2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Polypharmacy has been increasing attention as it is associated with a number of health problems, especially adverse outcomes in older adults. However, there is insufficient evidence regarding the risk of polypharmacy and long-term care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed a community-based retrospective cohort of residents of Goto City by combining data from health checkups, prescription information, and long-term care needs certification database. The study sample included residents aged 65–79 years in 2015 who were followed up for 4 years. The number of medications used was categorized as 0, 1–5, 6–9, and ≥10. The outcome was initiation of long-term care. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1083 participants, 58 used long-term care for 4 years. Compared with participants taking no medication, the incidence of long-term care initiation was approximately double in those taking 1–5 medications, four times higher in people taking 6–9 medications, and 13 times higher in people taking ≥10 medications. After adjusting for potential baseline confounders, the number of medications was significantly associated with the initiation of long-term care services (1–5 drugs: adjusted HR 2.38, 95% CI 1.06–5.34; 6–9 drugs: adjusted HR 2.97, 95% CI 1.23–7.15; and ≥10 drugs: adjusted HR 5.54, 95% CI 1.89–16.23).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among community-dwelling residents aged 65–79 years, the risk of requiring long-term care had a dose–response relationship with the number of prescribed medications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"402-407"},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral primary adrenal lymphoma","authors":"Rio Shimizu MD,&nbsp;Shogo Shirota MD","doi":"10.1002/jgf2.70042","DOIUrl":"https://doi.org/10.1002/jgf2.70042","url":null,"abstract":"&lt;p&gt;A previously healthy 83-year-old woman was admitted to our hospital with a three-week history of fever and a one-day history of lower back pain. On physical examination, her body temperature was 38.9°C, blood pressure was 100/61 mmHg, and pulse rate was 112 beats/min. Palpable masses in the bilateral costal areas and bilateral costovertebral angle tenderness to percussion were noted. Laboratory tests revealed an elevated white blood cell count of 10,470/μL, lactate dehydrogenase level of 603 U/L, C-reactive protein of 15.64 mg/dL, and soluble interleukin-2 receptor of 2403 U/mL. Cortisol level was 4.57 μg/dL, and adrenocorticotropic hormone was 549.0 pg/mL. Adrenocorticotropic hormone stimulation test revealed a peak cortisol level of 4.99 μg/dL. Abdominal contrast-enhanced computed tomography (CT) demonstrated bilateral adrenal enlargement with heterogeneous enhancement (Figure 1). The right and left adrenal glands were 7 and 6 cm long, respectively. CT-guided biopsy of the right adrenal mass revealed proliferation of atypical cells with a high nuclear-to-cytoplasmic ratio on hematoxylin and eosin staining. Immunohistochemical staining revealed CD20 and Bcl-6 positivity, consistent with diffuse large B-cell lymphoma (Figure 2A,B). Based on these findings, the patient was diagnosed with bilateral primary adrenal lymphoma and primary adrenal insufficiency. She was treated with hydrocortisone at a dose of 20–30 mg per day, adjusted according to her clinical condition, and subsequently started on chemotherapy with rituximab, cyclophosphamide, doxorubicin, etoposide, and prednisone, but died on the 117th hospital day.&lt;/p&gt;&lt;p&gt;Primary adrenal lymphoma (PAL) is a rare lymphoma that accounts for approximately 1% of all malignant lymphomas, of which 80% are bilateral.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; PAL is characterized by its large size (&gt;5 cm) but lacks specific imaging features distinguishing it from other adrenal malignancies.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Other differential diagnoses of bilateral adrenal masses include pheochromocytoma, tuberculosis, or metastases. The average size of PAL masses has been reported to be 5.5 cm, while other bilateral adrenal masses are generally smaller, often less than 5 cm.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In addition, in cases of bilateral adrenal masses, adrenal insufficiency has been reported in 57% of PAL and 94% of tuberculosis and is less common in pheochromocytoma and metastasis.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; If bilateral adrenal masses &gt;5 cm are found in a patient with fever and back pain, it is important to consider PAL, evaluate adrenal function, and perform biopsy promptly.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Rio Shimizu:&lt;/b&gt; Writing – original draft; data curation; investigation. &lt;b&gt;Shogo Shirota:&lt;/b&gt; Writing – review and editing; conceptualization; supervision; project administration.&lt;/p&gt;&lt;p&gt;This study did not receive any specific grants from agencies in the public, commercial, or non-profit sectors.&lt;/p&gt;&lt;p&gt;The authors declare that they have n","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"493-494"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking community-based clinical training in Japan: Toward a more effective model for increasing the number of general practice physicians","authors":"Masanobu Okayama MD, PhD","doi":"10.1002/jgf2.70038","DOIUrl":"https://doi.org/10.1002/jgf2.70038","url":null,"abstract":"&lt;p&gt;The effectiveness of Community-Based Clinical Training (CBCT) in increasing the number of general practice physicians remains uncertain. In Japan, where the population is rapidly aging and shrinking, the demand for general practice physicians has significantly escalated to ensure adequate health care for the public, particularly in rural and underserved areas. General practice physicians are expected to play a vital role in providing comprehensive and continuous care to the aging population. Therefore, finding an effective strategy to secure an adequate number of general practice physicians is a crucial social issue.&lt;/p&gt;&lt;p&gt;CBCT is considered a promising approach to addressing this issue. It provides students and residents opportunities to engage with various aspects of community healthcare, including outpatient care, home visiting care, nurse home care, preventive care, health education, and more, particularly in rural and underserved areas. First introduced in the United States, CBCT has been implemented in numerous countries. It has spread rapidly worldwide since the 1990s, and nearly all medical schools and teaching hospitals in Japan offer this clinical training program.&lt;/p&gt;&lt;p&gt;Several studies have examined the effects of CBCT. Trainees report that their experiences during CBCT profoundly influence their understanding of general practice. They acknowledge the importance of acquiring diverse perspectives, understanding the physician's role, recognizing the significance of community care, respecting individual lifestyles, addressing multimorbidity, navigating various healthcare settings, and collaborating with different professionals.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This training has a positive short-term impact on attitudes and awareness related to general practice and community healthcare. Participants' ratings of their attitudes and awareness significantly improved after the training, not only in rural areas,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; but also in urban settings.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;However, the effect of CBCT is insufficient regarding career preferences for general practice physicians. The research conducted with graduates from a single medical university suggests that conventional CBCT might not be sufficient in Japan for effectively developing general practice physicians.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Additionally, a study at one teaching hospital indicated no positive relationship between the amount of compulsory undergraduate education in community-based medicine and the subsequent rise in the number of residents choosing general practice majors in Japan.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A Longitudinal Integrated Clerkship (LIC) is a novel model of CBCT where students participate in the comprehensive care of patients over time and maintain ongoing learning relationships with both patients and supervising clinicians across multiple disciplines. Although there is no definitive minimum duration for student placements in an LIC program, severa","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"383-384"},"PeriodicalIF":2.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}