Journal of General and Family Medicine最新文献

{"title":"Availability of primary care physicians and hepatocellular carcinoma-related mortality in the United States","authors":"Daniyal Raza MD,&nbsp;Udhayvir Singh Grewal MD","doi":"10.1002/jgf2.679","DOIUrl":"https://doi.org/10.1002/jgf2.679","url":null,"abstract":"<p>Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer worldwide and majority cases are diagnosed at an intermediate or advanced stage. Per our analysis, greater availability of primary care physicians correlates with lower HCC-related mortality. Our results underscore the need for efforts to expand access to primary care among all populations, especially African Americans, to improve overall HCC-related outcomes.\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":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140104431","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":"Treatment interruption in hypertensive patients during the COVID-19 pandemic: An interrupted time series analysis using prescription data in Okayama, Japan","authors":"Naoko Nakamura MD, MPH,&nbsp;Toshiharu Mitsuhashi MD, PhD,&nbsp;Naomi Matsumoto MD, PhD,&nbsp;Shunsaku Hayase BEc,&nbsp;Takashi Yorifuji MD, PhD","doi":"10.1002/jgf2.678","DOIUrl":"https://doi.org/10.1002/jgf2.678","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic has impacted healthcare behaviors, leading to fewer pediatric visits in Japan and potentially fewer visits by adult patients. However, existing Japanese studies on treatment interruptions have generally relied on questionnaire-based methods. In this study, we assessed the impact of the pandemic on antihypertensive treatment interruption using real-world prescription data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an interrupted time series analysis using the National Health Insurance Database in Okayama Prefecture, Japan. Participants included individuals aged 40–69 years with at least one antihypertensive prescription between 2018 and 2020. Treatment interruption was defined as a 3-month or longer gap in prescriptions after medication depletion. We used segmented Poisson regression with models unadjusted and adjusted for seasonality and over-dispersion to assess monthly treatment interruptions before and after Japan's April 2020 emergency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 23.0% of 55,431 participants experienced treatment interruptions. Cyclical fluctuations in interruptions were observed. The crude analysis indicated a 1.2-fold increase in treatment interruptions following the pandemic; however, the adjusted models showed no significant changes. Even among higher-risk groups, such as women, younger adults, and those with shorter prescriptions, no significant alterations were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found no significant impact of the COVID-19 pandemic on antihypertensive treatment interruption in Okayama Prefecture. The less severe outbreak in the area or increased use of telemedicine and extended prescriptions may have contributed to treatment continuity. Further research is needed using a more stable and comprehensive database, broader regional data, and detailed prescription records to validate and extend our findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140104429","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":"Japanese Patient Engagement Promotion Training (J-PEPT): Learning course on the implementation strategy of patient engagement","authors":"Masaru Kurihara MD,&nbsp;Shintaro Kosaka MD,&nbsp;Yusuke Yasumoto MD,&nbsp;Akie Yamaguchi,&nbsp;Tomomi Yoshida,&nbsp;Ayako Iyasu,&nbsp;Hideyuki Kashiwagi MD,&nbsp;Toru Kimura,&nbsp;Kiichi Enomoto,&nbsp;Kiyomi Tanno PhD,&nbsp;Keiko Inoue,&nbsp;Yaeko Ishihara,&nbsp;Noriko Iwaya,&nbsp;Aoki Takuya MD, PhD","doi":"10.1002/jgf2.665","DOIUrl":"10.1002/jgf2.665","url":null,"abstract":"<p>Since the end of the 20th century, patient safety has become a global issue.<span>¹</span> Although many patient safety measures (such as changing the behavior of healthcare providers) have been taken, the role of patients in safety measures has also become more important in recent years. Patient engagement (PE) is defined as patients, families, their representatives, and health professionals working in active partnerships at various levels across the healthcare system to improve health and healthcare.<span>²</span> PE to address safety issues that cannot be resolved by healthcare providers alone is considered by policy makers and healthcare providers. However, in Japan, there are barriers to improving patient safety, and one of them is the emphasis on patient centeredness, including PE.<span>¹</span> Translating patient-centered safety measures including PE from theory to implementation is challenging, making it a global issue; thus, it is important to create learning courses where PE can be taught. Therefore, to promote the PE implementation strategies in primary care, which have traditionally emphasized patient centeredness, we report a Japanese Patient Engagement Promotion Training (J-PEPT) course developed by the Committee on Quality and Patient Safety of the Japan Primary Care Association.</p><p>J-PEPT aims to provide participants with the necessary knowledge and skills to implement PE strategies in healthcare settings. It is held about twice a year and has been attended by more than 60 people from across the country to date. Participants include physicians, nurses, pharmacists, as well as patients. PE has been also emphasized when planning, involving not only healthcare professionals (including physicians), but also patients, families, and social scientists from various fields. This is designed such that participants can learn while incorporating diverse opinions, deepening their understanding of the importance of PE.</p><p>J-PEPT covers many topics regarding PE, including sessions on implementing PE in primary care using the “guide to improving patient safety in primary care settings by engaging patients and families”,<span>³</span> utilizing patient experiences, and exploring PE in telemedicine. Several measures have been taken to enhance J-PEPT's implementation in healthcare settings: first, interactive opportunities are provided to offer participants a chance to learn how to promote implementation in their respective healthcare settings. Second, a mindset that can serve as an implementation champion within healthcare institutions is conveyed. Finally, opportunities for patient input are always provided to participants to spark insights, treating the course itself as an opportunity for PE.</p><p>In each session, learning objectives are set, and a survey using a 5-point Likert scale (1: “strongly disagree” to 5: “strongly agree”) is conducted to assess whether these objectives have been achi","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139842495","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":"Author reply to the definition and evaluation of uncoordinated involvement of multiple healthcare providers; “Polydoctoring” as a component of care fragmentation among patients with multimorbidity","authors":"Takayuki Ando MD, MPH,&nbsp;Takashi Sasaki PhD,&nbsp;Yukiko Abe BA,&nbsp;Yoshinori Nishimoto MD, PhD,&nbsp;Takumi Hirata MD, MPH, PhD,&nbsp;Junji Haruta MD, PhD,&nbsp;Yasumichi Arai MD, PhD","doi":"10.1002/jgf2.676","DOIUrl":"https://doi.org/10.1002/jgf2.676","url":null,"abstract":"<p>We appreciate the opportunity to respond to the concerns raised in the letter<span>¹</span> regarding our article, “Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.”<span>²</span></p><p>First, we acknowledge the point that in Japan, organ-specific specialists often undertake primary care. This indeed contributes to the prevalence of polydoctoring as patients navigate through multiple healthcare providers. We agree that this unique aspect of Japanese healthcare necessitates a more nuanced understanding of polydoctoring, particularly how it impacts patients with multimorbidity. The propensity for patients to consult multiple healthcare providers is an important aspect of our study, and it is evident that this practice has deep roots in the structural makeup of Japanese healthcare.</p><p>Interestingly, our data indicated that approximately one-third of the participants were engaged in regular relationships with a single institution even though they have multimorbidity. This subset of the study population presents an important contrast to the polydoctoring narrative and suggests the presence of integrated care pathways for some patients. This variation in care-seeking behavior offers a unique perspective on patient autonomy and the choices made in managing their health within the existing healthcare framework.</p><p>The definition of high-risk polydoctoring is a critical area for further research. The delineation between necessary multidisciplinary care and potentially detrimental polydoctoring remains ambiguous and is subject to individual patient circumstances. Our study's threshold for high-risk polydoctoring may warrant reevaluation in future research to establish more precise criteria that can reliably predict adverse outcomes. Furthermore, it is important to note that fragmentation of care is influenced not only by the number of healthcare providers involved but also by the quality of coordination among them. However, objectively assessing the quality of coordination among various healthcare professionals remains a significant challenge in the current landscape.<span>³</span> Future research efforts should be directed toward developing methodologies to measure the quality of coordination of care, an aspect crucial for understanding and improving patient care.</p><p>Regarding the concerns about selection bias, the letter accurately identifies a significant limitation of our study. Our focus on independently living elderly individuals excluded patients receiving home-based medical care. This omits a crucial subset of patients who may be receiving the most comprehensive care, potentially skewing our understanding of polydoctoring in the broader spectrum of care delivery. The homebound patients, often with diminished physical function, represent a contrasting group to the ambulatory patients who were the focus of our s","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140104345","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":"Residents' learning and behavior about tool-guided clinical assessment of social determinants of health","authors":"Junki Mizumoto MD,&nbsp;Hirohisa Fujikawa MD, PhD,&nbsp;Masashi Izumiya MD, PhD,&nbsp;Shoko Horita MD, PhD,&nbsp;Masato Eto MD, PhD","doi":"10.1002/jgf2.674","DOIUrl":"10.1002/jgf2.674","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The specific dimensions of learners that have been impacted by educational programs related to social determinants of health (SDoH) remain unknown. This study aims to elucidate how learners are affected by postgraduate education (a single 90-min educational session) regarding tool-guided clinical assessment of patients' social backgrounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pretest-posttest design was utilized in which residents (postgraduate year (PGY) 1 or 2) and fellows in family medicine (PGY over 3) were recruited. Likert-type questions were developed based on previous qualitative findings. Participants answered these questions before, immediately after, and 1.5 months after the educational session on tool-guided clinical SDoH assessment. Paired-sample <i>t</i>-tests were used, and effect size was measured using Cohen's <i>d</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 114 residents and fellows participated. After the session, participants expressed more interest in knowing their patients' social backgrounds when considering how to address their patients and were more open to embracing a pre-established assessment framework. Participants also considered clinical skills related to SDoH as learnable and improved their attitude toward patients. They reported that they did not perform specific interventions related to SDoH within 1.5 months after the session. Unlike previous qualitative findings, their concern about the implementation of SDoH-related practices did not increase significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An educational session on tool-guided SDoH assessment may have a positive impact on learners' attitudes related to addressing patients' social backgrounds without fostering concerns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139531485","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":"The definition and evaluation of uncoordinated involvement of multiple healthcare providers; “Polydoctoring” as a component of care fragmentation among patients which multimorbidity","authors":"Yuki Ohnishi MD,&nbsp;Satoshi Watanuki MD","doi":"10.1002/jgf2.673","DOIUrl":"10.1002/jgf2.673","url":null,"abstract":"<p>We read with great interest the article by T Ando et al, and appreciate the authors' efforts to assess the influence of the uncoordinated involvement of multiple healthcare providers: “polydoctoring.” The analysis highlights that the involvement of multiple healthcare facilities in patient care is correlated with a higher likelihood of polypharmacy and increased outpatient medical costs.<span>¹</span> However, we would like to point out two concerns.</p><p>First, a significant issue in this study was that using the definition of “polydoctoring,” which refers only to having two or more regularly visited facilities, cannot appropriately evaluate the current situation in Japan. It might be unavoidable for today's elderly individuals in Japan to visit multiple medical institutions more than two. Historically, organ specialists played an important role in primary care settings in Japan, and we still have approximately 100,000 primary clinics run by organ specialists. The Japan Primary Care Association (JPCA) has started a training program to qualify doctors as General Practitioner/Family Physician specialists since 2017.<span>²</span> Although JPCA expects these doctors to address a wider variety of common problems such as eye problems and osteoporosis, as well as common medical conditions,<span>³</span> it is inevitable to face a transient lack of genuine primary care physicians who have completed a proper program. Therefore, in Japan, visiting multiple clinics is necessary for elderly people with coexisting chronic conditions that are beyond the scope of the primary care physicians they see. While the primary care system in Japan is still in development, thanks to universal access under the national health insurance system, elderly individuals can visit multiple medical facilities and enjoy health equity. There is no doubt that the establishment of the universal health insurance scheme in 1961 supports freedom to access medical facilities and services in Japan.<span>⁴</span> It might be effective to consider the medical specialties visited when renewing the definition of polydoctoring.</p><p>In addition, the sample selection was problematic. The authors enrolled individuals only from an independent-dwelling subset. Given the study result, if this survey were to include homebound elderly patients with multimorbidity, they would have fewer chances of receiving polypharmacy. Some elderly individuals, experiencing a decline in physical strength that makes it difficult to visit outpatient clinics, transition to home medical care, where their care should be consolidated. However, it was reported that the prevalence of inappropriate polypharmacy was 70% among older adults receiving home medical care.<span>⁵</span> Inappropriate prescriptions do not always appear to be associated with care fragmentation.</p><p>Accordingly, we suggest that this study cannot accurately evaluate the impact of care fragm","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139531242","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 proposal for coping strategies on burnout among Japanese resident physicians","authors":"Kosuke Ishizuka MD, PhD,&nbsp;Kiyoshi Shikino MD, PhD, MHPE, FACP,&nbsp;Akira Kuriyama MD, MPH, PhD,&nbsp;Yoshito Nishimura MD, MPH, PhD,&nbsp;Emiri Tanaka MS,&nbsp;Saori Nonaka MD,&nbsp;Michito Sadohara MD,&nbsp;Mitsuru Moriya MD, PhD,&nbsp;Noriko Yamamoto MD, PhD, FACP,&nbsp;Yohnosuke Wada MD, MPH,&nbsp;Tetsuya Makiishi MD, PhD","doi":"10.1002/jgf2.662","DOIUrl":"10.1002/jgf2.662","url":null,"abstract":"<p>To the Editor,</p><p>Burnout is a syndrome conceptualized by emotional exhaustion, depersonalization, and a diminished sense of personal achievement.<span>^{1, 2}</span> Physician burnout has several negative effects, including medical errors and mental ill health.<span>^{2, 3}</span> It is worth addressing that the prevalence of burnout among resident physicians in Japan is high at approximately 30%.<span>⁴</span> Herein, we, the members of the American College of Physicians Japan Chapter Physicians' Well-being Committee, report factors contributing to burnout of Japanese resident physicians and propose specific countermeasures (Table 1). Our recommendations are the result of focus group discussions with individuals of broad expertise and recent evidence, ensuring that they are grounded and directly relevant to the current challenges faced by resident physicians in Japan.</p><p>Poor communication and stress in relationships with medical staff and patients may contribute to burnout among resident physicians.<span>^{2, 3}</span> Because most physicians in Japan start their careers without previous work experience, their communication skills with medical staff and patients may be underdeveloped. Mentoring, sharing plans within the medical team, and changing the teams may improve Communication with other medical staff. Resident physicians should also learn skills for coping with difficult patients who display strong negative feelings toward the physician.<span>⁵</span> To cope with difficult patient encounters, metacognition of their own feelings, analysis on factors of difficult situations, and improvement in the capacity to empathize are important.<span>⁵</span></p><p>Long working hours, increased workload, sleep deprivation owing to duty shifts, and increased burden of COVID-19 treatment are also risk factors for burnout.<span>^{2, 3}</span> Measures in line with the work reform of physicians in Japan, such as limiting or reducing work, introducing night flow, and mandatory rest after shifts, may be effective. Resilience can be improved by addressing “motivation” through coaching, setting incremental goals, building on successes to increase confidence, and setting new goals.<span>¹</span></p><p>In Japan, factors contributing to burnout among resident physicians include rotations through multiple departments and affiliated hospitals and changes in the environment, including community medicine and “<i>tasuki-gake</i>” training (clinical training in which resident physicians work alternately between primary hospitals and external hospitals/clinics on a 1 year basis). It may be important to limit the number of patients to be assigned at the beginning of the rotation and to simultaneously assess the resident physician's performance. In addition, although changes in the environment increase the number of tasks to be acquired, it is important to modify one's mindset, for exam","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139156329","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":"Treatment of long COVID complicated by postural orthostatic tachycardia syndrome—Case series research","authors":"Tomoya Tsuchida MD, PhD,&nbsp;Yuki Ishibashi MD, PhD,&nbsp;Yoko Inoue MD,&nbsp;Kosuke Ishizuka MD, PhD,&nbsp;Kohta Katayama MD, PhD,&nbsp;Masanori Hirose MD, PhD,&nbsp;Yu Nakagama MD, PhD,&nbsp;Yasutoshi Kido MD, PhD,&nbsp;Yoshihiro Akashi MD, PhD,&nbsp;Takehito Otsubo MD, PhD,&nbsp;Takahide Matsuda MD, PhD,&nbsp;Yoshiyuki Ohira MD, PhD","doi":"10.1002/jgf2.670","DOIUrl":"10.1002/jgf2.670","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronavirus disease 2019 (COVID-19) sequelae, also known as long COVID, can present with various symptoms. Among these symptoms, autonomic dysregulation, particularly postural orthostatic tachycardia syndrome (POTS), should be evaluated. However, previous studies on the treatment of POTS complicated by COVID-19 are lacking. Therefore, this study aimed to investigate the treatment course of long COVID complicated by POTS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The medical records of patients who complained of fatigue and met the criteria for POTS diagnosis were reviewed. We evaluated the treatment days, methods and changes in fatigue score, changes in heart rate on the Schellong test, and social situation at the first and last visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two patients with long COVID complicated by POTS were followed up (16 males; median age: 28 years). The follow-up period was 159 days, and the interval between COVID-19 onset and initial hospital attendance was 97 days. Some patients responded to β-blocker therapy. Many patients had psychiatric symptoms that required psychiatric intervention and selective serotonin reuptake inhibitor prescription. Changes in heart rate, performance status, and employment/education status improved from the first to the last visit. These outcomes were believed to be because of the effects of various treatment interventions and spontaneous improvements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that the condition of 94% of patients with POTS complicated by long COVID will improve within 159 days. Therefore, POTS evaluation should be considered when patients with long COVID complain of fatigue, and attention should be paid to psychological symptoms and the social context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139175800","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 mentorship and mental health among junior residents: A nationwide cross-sectional study in Japan","authors":"Kohta Katayama MD, PhD,&nbsp;Yuji Nishizaki MD, MPH, PhD,&nbsp;Toshihiko Takada MD, MPH, MSc, PhD,&nbsp;Koshi Kataoka MMSc,&nbsp;Nathan Houchens MD,&nbsp;Takashi Watari MD, MHQS, MCTM, PhD,&nbsp;Yasuharu Tokuda MD, MPH,&nbsp;Yoshiyuki Ohira MD, PhD","doi":"10.1002/jgf2.671","DOIUrl":"10.1002/jgf2.671","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study involving postgraduate year 1 and 2 (PGY-1 and PGY-2) residents in Japan who took the General Medicine In-Training Examination (GM-ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM-ITE completion. The primary outcome was the Patient Health Questionaire-2 (PHQ-2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ-2 positive. We examined associations between self-reported mentorship and PHQ-2 by multi-level analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ-2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ-2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A mentor-based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138994668","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":"Possible cause of abdominal internal oblique muscle hematoma induced by cough","authors":"Toshinori Nishizawa MD","doi":"10.1002/jgf2.672","DOIUrl":"10.1002/jgf2.672","url":null,"abstract":"<p>I have read with interest the article by Fujimori et al.<span>¹</span> This case involves a 40-year-old male patient who presented with an abdominal internal oblique muscle hematoma. The intriguing aspect of this case is that the hematoma occurred following a coughing episode, despite the absence of coagulation abnormalities.</p><p>Given this unique presentation, it is important to explore all possible underlying factors that could contribute to such an event. One potential cause is the presence of acquired hemophilia, specifically hemorrhagic acquired factor XIII deficiency.<span>²</span> While the patient's platelet count and routine coagulation parameters might appear normal, it is crucial to emphasize that the absence of overt platelet or coagulation abnormalities does not definitively rule out the possibility of acquired factor XIII deficiency.</p><p>Acquired factor XIII deficiency is a relatively common disease, but most cases are asymptomatic and do not lead to severe bleeding. However, symptomatic acquired factor XIII deficiency, presenting with hemorrhagic symptoms, is exceedingly rare. This condition can be classified into autoimmune, nonautoimmune, and idiopathic types. Autoimmune acquired factor XIII deficiency is infrequent, with the majority of hemorrhagic acquired factor XIII deficiency being nonautoimmune. Nonautoimmune hemorrhagic acquired factor XIII deficiency, typically presenting as a less severe bleeding disorder, is often attributed to overconsumption or reduced biosynthesis. This can be triggered by various conditions, including disseminated intravascular coagulation, major surgical procedures, liver diseases, and other related disorders. In cases where acquired factor XIII deficiency is suspected, referral to a hematologist is advised, accompanied by a thorough investigation for any underlying pathologies.<span>²</span></p><p>Since neither prolonged clotting times nor decreased platelet counts are seen, many cases with unexplained intramuscular and subcutaneous bleeding might be overlooked. However, depending on the site and the amount of bleeding, the bleeding can be fatal, so prompt diagnosis and appropriate treatment are essential. Clinicians should be alert for acquired factor XIII deficiency when seeing such patients and consider measuring the factor XIII activity.</p><p>In conclusion, I recommend further investigation into the possibility of acquired factor XIII deficiency in cases similar to the one described. The absence of overt platelet or coagulation abnormalities should not discourage the pursuit of this diagnostic avenue, as this disorder can present with severe bleeding.</p><p>The author declares no conflicts of interest for this article.</p><p>This work has never been presented.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995191","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}