Journal of General and Family Medicine最新文献

{"title":"Brown nails as clues for shock diagnosis","authors":"Satoshi Inaba M.D.,&nbsp;Hisatoshi Okumura M.D.,&nbsp;Yuichiro Nakanishi M.D.,&nbsp;Atsushi Kawashima M.D.","doi":"10.1002/jgf2.753","DOIUrl":"https://doi.org/10.1002/jgf2.753","url":null,"abstract":"<p>A previously healthy 60-year-old Japanese male farmer presented with shock, initially unresponsive to fluid resuscitation. Upon incidental observation of brown nail discoloration, adrenal insufficiency was suspected, confirmed by elevated ACTH levels. The timely recognition of nail hyperpigmentation led to the diagnosis of tuberculous Addison's disease, allowing for appropriate treatment and resolution of the condition.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"169-170"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581408","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":"Hospitalization of patients with Down syndrome in acute care hospitals in Japan","authors":"Keisuke Yasunami MD,&nbsp;Ryutaro Matsugaki PhD,&nbsp;Keiji Muramatsu MD, PhD,&nbsp;Shinya Matsuda MD, PhD","doi":"10.1002/jgf2.746","DOIUrl":"https://doi.org/10.1002/jgf2.746","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Down syndrome is the most common genetic disorder, and the life expectancy of patients with Down syndrome has increased over the decades. However, the diseases and social problems experienced by patients with Down syndrome remain unknown in Japan. Therefore, we aimed to investigate the disease status of such patients admitted to acute care hospitals in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study was conducted using the Diagnosis Procedure Combination data from 2016 to 2021 to evaluate routes of admission, principal diagnoses, comorbidity of dementia, orthopedic surgeries for limb fractures, and discharge destinations of patients with Down syndrome (International Classification of Diseases, Tenth Revision code: Q90).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 26,195 individuals with Down syndrome were included, of whom 5195 were ≥20 years of age. As the age increased, the number of admissions from home decreased and that from nursing homes increased. Pneumonia was the most common principal diagnosis, with the incidence of aspiration pneumonia increasing in patients &gt;40 years of age. We observed an increase in the incidence of dementia and surgery for limb fractures after 40 years of age. The number of discharges to home decreased with increasing age, whereas that to nursing homes increased with increasing age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results suggest that patients with Down syndrome are often hospitalized because of pneumonia and that the incidence of aspiration pneumonia, dementia, and limb fractures increases after 40 years of age. Therefore, a system to prevent pneumonia, especially aspiration pneumonia, and limb fractures in patients with Down syndrome is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"135-142"},"PeriodicalIF":1.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.746","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581983","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":"Integrating psychiatry and family medicine in the management of somatic symptom disorders: Diagnosis, collaboration, and communication strategies","authors":"Victor Ajluni MD","doi":"10.1002/jgf2.725","DOIUrl":"10.1002/jgf2.725","url":null,"abstract":"<p>Somatic symptom disorders (SSDs) present a complex interplay of physical and psychological factors, necessitating an integrative approach to diagnosis and management. This article explores the collaborative efforts between family medicine and psychiatry in addressing SSDs, emphasizing the importance of a multidisciplinary strategy for comprehensive patient care. Effective diagnosis involves recognizing the significance of both somatic symptoms and the patient's psychological response, with tools like structured clinical interviews and self-report questionnaires playing crucial roles. Management strategies include psychotherapeutic interventions such as cognitive behavioral therapy (CBT), pharmacological treatments, and lifestyle modifications, all tailored to the patient's needs. Communication strategies are vital in validating patients' experiences while addressing underlying psychiatric issues. Techniques such as active listening, biopsychosocial framing, and the teach-back method foster trust and improve treatment adherence. Cultural considerations and the use of interpreters enhance communication with diverse patient populations. Training programs for healthcare providers further improve competency in managing SSDs. This integrative approach aims to enhance patient outcomes by addressing the multifaceted nature of SSDs through collaborative care, effective communication, and comprehensive treatment planning.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"12-18"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958589","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":"Effectiveness of the educational training program for Japanese chief residents: A one-year pilot study","authors":"Toshinori Nishizawa MD,&nbsp;Kazuya Nagasaki MD, PhD,&nbsp;Kazuki Tokumasu MD, PhD,&nbsp;Shunsuke Kosugi MD,&nbsp;Tadayuki Hashimoto MD, MPH,&nbsp;Kosuke Tanaka MD,&nbsp;Koma Hotta MD,&nbsp;Sho Isoda MD,&nbsp;Aiko Harada MD,&nbsp;Shinya Ishigame MD,&nbsp;Takuma Hata MD,&nbsp;Masayuki Nogi MD, MHPE, FACP","doi":"10.1002/jgf2.744","DOIUrl":"10.1002/jgf2.744","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multi-institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Six participants completed self-assessment questionnaires at three points: before, immediately after, and 6 months post-program. Knowledge and behavior changes were compared using the Mann–Whitney <i>U</i> test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant improvements in knowledge were observed and maintained at 6 months. However, behavioral changes were limited, with significant improvements only in counseling skills.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The program effectively increased knowledge but faced challenges in translating it into sustained behavioral change.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"100-105"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958564","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":"Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study","authors":"Hirohisa Fujikawa MD, PhD,&nbsp;Takuya Aoki MD, PhD, MMA,&nbsp;Takayuki Ando MD, MPH,&nbsp;Junji Haruta MD, PhD","doi":"10.1002/jgf2.747","DOIUrl":"https://doi.org/10.1002/jgf2.747","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ambiguity tolerance in the clinical context is increasingly recognized as essential for physicians to work as professionals. However, the relationship between specialty and ambiguity tolerance in the clinical context has been understudied. Here, we investigated the association between specialty and ambiguity tolerance in the clinical context, focusing on differences between family physicians (FPs) and non-FPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a nationwide cross-sectional study in Japan. We asked FPs from 14 family medicine residency programs across Japan and non-FPs from monitors of an internet survey company in Japan to participate in the study. We assessed their tolerance for ambiguity using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors (J-TAMSAD) scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 388 physicians (178 FPs and 210 non-FPs) completed our anonymous online survey and were included in the analysis. After adjustment for possible confounders (gender and postgraduate years), FPs had higher J-TAMSAD scale scores than internists/pediatricians, surgeons, and physicians with other specialties, meaning that FPs had greater ambiguity tolerance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study reveals that FPs had greater tolerance for ambiguity in the clinical context than non-FPs. Our findings suggest that there may be a need to increase non-FP's tolerance for ambiguity specific to the clinical context through educational interventions, since ambiguity is inherent and growing in medicine today. FPs and non-FPs should work together to complement each other's strengths, rather than simply improving the training of non-FPs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"128-134"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.747","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582020","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 nasogastric tube feeding and discharge outcomes in patients aged 80 and older with aspiration pneumonia: A propensity score-matched retrospective cohort study","authors":"Misa Kitamura MD,&nbsp;Toshinori Nishizawa MD,&nbsp;Atsushi Yanai MD, PhD,&nbsp;Masako Taguchi RN,&nbsp;Noriko Matsumoto RD MSc,&nbsp;Kuniyoshi Hayashi PhD,&nbsp;Hiroko Arioka MD","doi":"10.1002/jgf2.745","DOIUrl":"https://doi.org/10.1002/jgf2.745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study investigated the association between nasogastric tube feeding (NGF) and discharge rate to previous residences with oral intake in patients aged 80+ with aspiration pneumonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study included 256 hospitalized patients with aspiration pneumonia from 2012 to 2022, which could not start oral intake within 48 h due to dysphagia. Using 1:2 matched-pair analysis, the association of interest was examined using logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NGF was associated with a lower discharge rate (odds ratio: 0.15; 95% CI: 0.05–0.46).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with NGF had a lower discharge rate to previous residences with oral intake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"177-181"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582058","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":"Esophageal perforation and epidural emphysema as complications of nasogastric tube placement","authors":"Yusuke Ito MD,&nbsp;Junki Mizumoto MD, PhD","doi":"10.1002/jgf2.743","DOIUrl":"10.1002/jgf2.743","url":null,"abstract":"<p>We present a 72-year-old man with end-stage renal disease and Hashimoto encephalopathy in whom a diagnosis of epidural emphysema because of esophageal perforation by a nasogastric tube placement. Although its imaging findings may be alarming to clinicians, close monitoring and conservative treatment are advisable.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"98-99"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958570","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":"Refeeding syndrome and vitamin B1 deficiency in a young man with normal body mass index following starvation in the COVID-19 era","authors":"Naoaki Tsuji MD,&nbsp;Hisatoshi Okumura MD,&nbsp;Satoshi Inaba MD,&nbsp;Akihito Kaneko MD,&nbsp;Atsushi Kawashima MD","doi":"10.1002/jgf2.729","DOIUrl":"10.1002/jgf2.729","url":null,"abstract":"<p>COVID-19 has spread worldwide and significantly influenced economies. Refeeding syndrome (RFS) is a potentially fatal abnormalities of electrolytes and fluid that can occur in malnourished patients undergoing mechanical refeeding. Herein, we report the case of a man in his 20s with a normal body mass index who presented with RFS and vitamin B1 deficiency. Although it was uncommon under normal circumstances, it occurred because of the severe social situations that were prevalent in the COVID-19 era. In this era, physicians should carefully evaluate their patients' nutritional status to identify those at risk for RFS, even in young individuals.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"92-94"},"PeriodicalIF":1.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958596","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":"Characteristics of patients with somatoform pain disorder","authors":"Lena Barth,&nbsp;Linda Baumbach PT, PhD,&nbsp;André Hajek,&nbsp;Lutz Götzmann MD,&nbsp;Katrin Feiks MD,&nbsp;Michael Rufer MD,&nbsp;Kyrill Schwegler MD,&nbsp;Bianca Schwennen MD,&nbsp;Kirstin Bernhardt MD,&nbsp;Uwe Wutzler MD,&nbsp;Paul Kaiser,&nbsp;Lutz Wittmann,&nbsp;Adrian Siegel MD","doi":"10.1002/jgf2.735","DOIUrl":"10.1002/jgf2.735","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with somatoform pain experience physical pain that cannot be attributed to any underlying medical or physiological cause, and it is often thought to be related to psychological factors. Health professionals encounter difficulties identifying this specific type of chronic pain, leading to suboptimal treatment strategies. Therefore, we aimed to describe the characteristics of patients with somatoform pain, to support the identification of affected patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected and analyzed a cross-sectional survey data from 200 patients with somatoform pain admitted to one of three psychosomatic centers in Germany between August 2013 and July 2014. The survey contains 10 different categories, all of them referring to pain-related topics. Within the survey, we analyzed validated as well as non-validated questionnaires. Here, we present the following five: Personal data, Body: Pain perception, Cognition: Pain processing, Pain behavior, and Physical complaints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our results highlight that most patients with somatoform pain experience it in several body parts and as persisting, lasting &gt;12 h/day (50%), and constantly changing (71%). Furthermore, patients indicate feelings of helplessness, by agreeing to the expressions the pain controls me (70%). Finally, we found that pain is predominantly seen as suffering, failing to convey emotional pain, despite cognitively acknowledging the dependency of emotional and physical pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study identified specific and distinctive characteristics in the emotional and behavioral responses of patients with somatoform pain, potentially distinguishing them from other patients with chronic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"65-72"},"PeriodicalIF":1.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958651","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":"Role-play-based coaching program for empowering clinical educators","authors":"Hajime Kasai MD, PhD,&nbsp;Kiyoshi Shikino MD, PhD, MHPE, FACP,&nbsp;Shogo Mohri MD,&nbsp;Asuka Sato MD, PhD,&nbsp;Hidetaka Yokoh MD, PhD, MHPE","doi":"10.1002/jgf2.739","DOIUrl":"10.1002/jgf2.739","url":null,"abstract":"<p>Coaching in medical education is a valuable method for enhancing the well-being and job satisfaction of medical professionals, particularly through interactive conversations that foster self-awareness and independent action. A 90-min coaching training program, incorporating lectures and role-plays, was conducted to equip medical professionals with essential coaching skills. The program was well received, and there are plans to expand and tailor future programs to further develop these skills among various healthcare educators.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 1","pages":"108-109"},"PeriodicalIF":1.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958602","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}