Journal of General and Family Medicine最新文献

{"title":"Cervical epidural abscess mimicking crowned dens syndrome","authors":"Nobumasa Okumura MD,&nbsp;Nana Akazawa-Kai MD,&nbsp;Naoya Itoh MD, DTM&H, PhD","doi":"10.1002/jgf2.780","DOIUrl":"https://doi.org/10.1002/jgf2.780","url":null,"abstract":"<p>An 88-year-old woman was diagnosed with crowned dens syndrome. Magnetic resonance imaging showed an abscess around the odontoid process. The patient was also found to have infective endocarditis.\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 3","pages":"267-268"},"PeriodicalIF":1.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871603","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 rehabilitation nutrition oral care process: Implementing the triad of rehabilitation, nutrition, and oral management","authors":"Hidetaka Wakabayashi","doi":"10.1002/jgf2.763","DOIUrl":"https://doi.org/10.1002/jgf2.763","url":null,"abstract":"<p>A specific framework called the rehabilitation nutrition oral care process has been developed to facilitate the triad of rehabilitation, nutrition and oral management. Each framework follows five key steps: assessment, diagnosis, goal setting, intervention, and monitoring. Of these, the diagnosis and goal setting steps are performed collaboratively by multidisciplinary teams specializing in rehabilitation, nutrition and oral management.\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":"114-115"},"PeriodicalIF":1.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581838","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":"Predicting 30-day mortality in older patients with suspected infections by adding performance status to quick sequential organ failure assessment","authors":"Masataka Kudo MD,&nbsp;Sho Sasaki MD, PhD,&nbsp;Toshihiko Takada MD, PhD,&nbsp;Kotaro Fujii MD, MPH,&nbsp;Yu Yagi MD,&nbsp;Tetsuhiro Yano MD, PhD,&nbsp;Ken-ei Sada MD, PhD,&nbsp;Shunichi Fukuhara DMSc,&nbsp;Narufumi Suganuma MD, PhD","doi":"10.1002/jgf2.764","DOIUrl":"https://doi.org/10.1002/jgf2.764","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quick Sequential Organ Failure Assessment (qSOFA) is a simple and easy tool for identifying patients with suspected infection, who are at a high risk of poor outcome. However, its predictive performance is still insufficient. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, a tool to evaluate physical function, has been recently reported to be useful in predicting the prognosis of patients with pneumonia. We aimed to evaluate the added value of ECOG-PS to qSOFA in predicting 30-day mortality in older patients admitted with suspected infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2018 and 2019, we prospectively collected data from adults aged 65 years or older, admitted with suspected infection at two acute care hospitals. Predictive performance was compared between two logistic regression models: one using qSOFA score alone (qSOFA model) and the other in which ECOG-PS was added to qSOFA (extended model).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1536 enrolled patients, 135 (8.8%) died within 30 days. The area under the curve of the extended model was significantly higher than that of the qSOFA model (0.67 vs. 0.64, <i>p</i> = 0.008). When the risk groups were categorized as follows: low (&lt;5%), intermediate (5%–10%), and high (≥10%), 5.0% of those who died and 2.1% of those who survived were correctly reclassified by the extended model with an overall categorized net reclassification improvement of 0.03 (95% confidence interval: −0.06 to 0.30).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding the ECOG-PS score could improve the performance of qSOFA in predicting mortality in older patients admitted with suspected infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"238-245"},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871450","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":"Do family physicians develop ambiguity tolerance as they gain experience? A multicenter cross-sectional study","authors":"Hirohisa Fujikawa MD, PhD,&nbsp;Takuya Aoki MD, PhD, MMA,&nbsp;Takayuki Ando MD, MPH, PhD,&nbsp;Junji Haruta MD, PhD","doi":"10.1002/jgf2.778","DOIUrl":"https://doi.org/10.1002/jgf2.778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a nationwide cross-sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra-short version of the Utrecht Work Engagement Scale, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well-being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"231-237"},"PeriodicalIF":1.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871753","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":"Erosive and annular lesions of the gastric mucosa: Not negligible signs of Treponema pallidum infection","authors":"Giulia Ciccarese MD, PhD,&nbsp;Antonio Facciorusso MD, PhD,&nbsp;Vanessa De Pace PhD,&nbsp;Francesco Drago MD","doi":"10.1002/jgf2.779","DOIUrl":"https://doi.org/10.1002/jgf2.779","url":null,"abstract":"&lt;p&gt;The interesting article about gastric syphilis recently published in your journal prompted us to make some observations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Several studies published in the last year have turned the spotlight on gastric syphilis.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; Although stomach involvement is estimated at only 1% of syphilis patients, mainly in the secondary stage of the disease, the incidence of &lt;i&gt;T. pallidum&lt;/i&gt; infection is increasing worldwide&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;; therefore, we can also expect an increase in gastrointestinal syphilis.&lt;/p&gt;&lt;p&gt;We agree with the authors about the importance of considering syphilis in the differential diagnoses of gastrointestinal diseases when the patient complains of non-specific symptoms (abdominal pain, nausea, diarrhea, anorexia), physical examination detects epigastric tenderness, and endoscopy shows erosions and ulcerations, especially in an annular shape.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The annular lesion morphology may raise suspicion of syphilis not only in the stomach but especially in the skin. In our experience, cutaneous lesions with annular morphology, with both widespread and localized distribution, are among the most common atypical presentations of secondary syphilis.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The ancient definition of syphilis as the ‘great imitator’ based on its wide variety of manifestations is still actual since unusual manifestations can be found in up to 25% of the cases, especially in the secondary stage.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; As Iwamuro et al. described, the annular morphology of the lesions seems to be an early morphological pattern of gastric syphilis followed by erosions and ulcerations.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In the skin, the annular shape of the lesions is often associated with syphilis reinfection&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;; it is not known if it applies also to the mucosal lesions. Indeed, previous syphilis episodes may alter the clinical/laboratory presentations of a new &lt;i&gt;T. pallidum&lt;/i&gt; infection, which happens with more insidious cutaneous/mucosal manifestations.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; However, the heterogeneity of the clinical features in syphilis may be related to the multiple circulating genovariants of &lt;i&gt;T. pallidum&lt;/i&gt;, characterized by different virulence and tissue tropism.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;It would be interesting to know if the patient described by Itoh et al. has had a previous &lt;i&gt;T. pallidum&lt;/i&gt; infection and if he was screened for other sexually transmitted diseases besides HIV that can be acquired with syphilis, such as hepatitis B and C, &lt;i&gt;Chlamydia trachomatis&lt;/i&gt; and &lt;i&gt;Neisseria gonorrhoeae&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;In conclusion, gastric syphilis can clinically and histologically simulate other gastrointestinal diseases, including lymphoproliferative diseases, invasive carcinomas, tuberculosis, and Crohn's disease. Definitive diagnosis is made by PCR testing for &lt;i&gt;T. pallidum&lt;/i&gt; in paraffin-embedded tissues or immunohistochemical staining for &lt;i&gt;T. p","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"273-274"},"PeriodicalIF":1.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871754","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":"RETRACTION: The role of biofield energy treatment on psychological symptoms, mental health disorders, and stress-related quality of life in adult subjects: A randomized controlled clinical trial","authors":"","doi":"10.1002/jgf2.773","DOIUrl":"https://doi.org/10.1002/jgf2.773","url":null,"abstract":"<p><b>RETRACTION</b>: M. K. Trivedi, A. Branton, D. Trivedi, S. Mondal, and S. Jana, “The Role of Biofield Energy Treatment on Psychological Symptoms, Mental Health Disorders, and Stress-Related Quality of Life in Adult Subjects: A Randomized Controlled Clinical Trial,” <i>Journal of General and Family Medicine</i> 24, no. 3 (2023): 154–163, https://doi.org/10.1002/jgf2.606.</p><p>The above article, published online on 28 January 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Masanobu Okayama; the Japan Primary Care Association; and John Wiley &amp; Sons Australia, Ltd. The retraction has been agreed upon following an investigation into concerns raised by a third party, which revealed an inappropriate control group used as the placebo group of the trial, inconsistencies in the Psychological Questionnaire Scoring, highly implausible functional biomarker values that are out of the typical physiological range, and unsupported claims regarding the scientific evidence behind the biofield energy treatment. The authors were informed, however, the explanation and the partial raw data provided were deemed insufficient to address the concerns. Thus, the editors have lost confidence in the presented data and consider the results and conclusions of this manuscript insufficiently supported and substantially compromised. The authors disagree with the retraction.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"191"},"PeriodicalIF":1.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.773","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581988","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":"Spinal amyloid deposits are common among older patients undergoing spinal stenosis decompression surgery","authors":"Avni Madhani BA,&nbsp;Navya Kotturu BA,&nbsp;Denise Fine MS,&nbsp;Rabah Alreshq MD,&nbsp;Aziz Saade MD,&nbsp;Tony Tannoury MD,&nbsp;Chadi Tannoury MD,&nbsp;Frederick L. Ruberg MD","doi":"10.1002/jgf2.766","DOIUrl":"https://doi.org/10.1002/jgf2.766","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent advances in the management of transthyretin amyloid cardiomyopathy (ATTR-CM) have highlighted the need for early identification. Studies have demonstrated amyloid deposits in orthopedic surgical specimens, prompting a diagnosis of concurrent ATTR-CM. We sought to determine the prevalence of spinal amyloid deposits among patients undergoing spinal stenosis decompression surgery and whether the presence of deposits was associated with ATTR-CM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients &gt;60 years of age undergoing spinal stenosis decompression surgery were enrolled as part of a prospective, single-center, cohort study. Samples from the disc and ligamentum flavum were obtained during surgery. Patients with amyloid deposition on Congo red staining returned for standard-of-care clinical assessment consisting of blood testing, a transthoracic echocardiogram, nuclear pyrophosphate imaging when indicated, and an evaluation with a cardiologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 54 enrolled patients, 24 patients (44%; 95% CI, 31%–59%) were found to have spinal amyloid deposits. Amyloid-positive patients were older than amyloid-negative patients (70 years vs. 63 years, <i>p</i> &lt; 0.01). On follow-up testing, no amyloid-positive patients were found to have definitive ATTR-CM. However, 37% of amyloid-positive patients had abnormal cardiac biomarkers, and 36% of amyloid-positive patients had reduced global longitudinal strain on echocardiography, suggesting possible early disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Spinal amyloid deposits, in both the disc and ligamentum flavum, were found in 44% of older patients undergoing spinal stenosis decompression surgery. While none of these patients tested positive for ATTR-CM on early follow-up, subtle abnormalities in cardiac testing suggest that further follow-up testing is warranted to detect the advent of cardiac amyloidosis in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"222-230"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.766","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871453","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":"Withdrawal of life-sustaining treatment in Japanese home care: A cross-sectional survey","authors":"Kei Takeshita MD, PhD,&nbsp;Noriko Nagao RN, PhD,&nbsp;Toshihiko Dozono PhD,&nbsp;Keiko Kamiya LLM,&nbsp;Yasuhiko Miura MD, PhD","doi":"10.1002/jgf2.771","DOIUrl":"https://doi.org/10.1002/jgf2.771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In Japan, legal and social concerns exist about withdrawing life-sustaining treatment (LST) even at the end of life. This study aimed to investigate the experience of physicians and nurses involved in home care with LST withdrawal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A web-based questionnaire survey was conducted among physicians and nurses who were members of the Japanese Association for Home Care Medicine in 2020. The survey collected data on the experience of respondents with withdrawing LST, the decision-making processes involved in withdrawing treatment, and their experience with patients attempting voluntarily stopping eating and drinking (VSED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results from 203 respondents, including 150 physicians and 53 nurses, showed that the most commonly withdrawn LSTs were intravenous infusions (115 respondents), tube feeding (69 respondents), and oral administration of medicine (74 respondents). A few respondents withdrew respiratory management, such as mechanical ventilation (11 respondents) or home oxygen therapy (12 respondents). The main diagnoses of patients who had LSTs withdrawn were malignancy, senility, and dementia. Many respondents made decisions through discussions with the families of patients (117 respondents) or multidisciplinary discussions at their facilities (80 respondents). There were 23 respondents who made the decision alone, and they were all physicians. Thirty-two respondents had experience with patients who had completed VSED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It was found that many Japanese home care physicians and nurses had experienced withdrawal of LSTs, and a significant number among them had experienced patients attempting VSED. Given this situation, there is an urgent need to provide ethics support in Japanese home care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"213-221"},"PeriodicalIF":1.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871523","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":"Factors associated with hypertonic dehydration in older Japanese outpatients","authors":"Azuna Kinoshita RN, PHN, MSN,&nbsp;Takafumi Yonemitsu MD, PhD,&nbsp;Nobuyuki Miyai PhD,&nbsp;Akira Yonemitsu MD, PhD","doi":"10.1002/jgf2.767","DOIUrl":"https://doi.org/10.1002/jgf2.767","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertonic dehydration is common among older adults and is associated with increased mortality and the incidence of several diseases, such as renal failure and cardiovascular complications. Herein, we aimed to statistically identify risk factors for hypertonic dehydration in older adults in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included outpatients aged ≥65 years who visited an internal medicine clinic between March and November 2021. Hypertonic dehydration was determined using serum osmolality (≥300 mOsm/kg) calculated from blood sodium, urea nitrogen, and glucose levels. The body composition of each participant was estimated using bioelectrical impedance analysis. The participants were instructed to record their fluid intake for two consecutive days. We conducted multivariate analysis to examine factors associated with hypertonic dehydration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 104 participants (male: 32.7%, mean: 76.6 years) were enrolled. The prevalence of hypertonic dehydration among study participants was 30.8%. After adjusting for potential confounding factors, the daily fluid intake per body weight, body mass index, body fat percentage, diabetes mellitus, and number of medications were significantly associated with hypertonic dehydration. Odds ratios for hypertonic dehydration were 5.47 for daily fluid intake per body weight &lt;20 mL/kg/day (vs. ≥30 mL/kg/day), 2.55 for body mass index ≥25 kg/m² (vs. &lt;25 kg/m²), and 3.66 for number of medications ≥10 (vs. &lt;6). The area under the receiver operating characteristic curve was 0.712 (95% confidence interval, 0.606<b>–</b>0.817; <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Decreased fluid intake, obesity, diabetes mellitus, and polypharmacy were independently associated with hypertonic dehydration in older Japanese outpatients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"205-212"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871720","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":"Developing sustainable generalism education in community settings: Insights from the JPCA (Japan Primary Care Association) Conference, 2024","authors":"Shinji Matsumura MD, MSHS, PhD,&nbsp;Yoshiko Yamaguchi MD, PhD, MHPE,&nbsp;Fumiko Okazaki MD, PhD, MHPE,&nbsp;Fuminao Kitanishi MD,&nbsp;Satsuki Tomita MD, PhD,&nbsp;Hiroshi Takagi MD, PhD","doi":"10.1002/jgf2.770","DOIUrl":"https://doi.org/10.1002/jgf2.770","url":null,"abstract":"<p>The principle of being a generalist, or “generalism,” is increasingly recognized as a core component of medical education internationally. Given that primary care medicine is essential in many countries, training medical students and residents in “generalism,” the fundamental aspect of primary care, remains a contemporary challenge.<span>^{1, 2}</span> In this context, the revised Model Core Curriculum in Japan for 2022 emphasizes Generalism (GE), and education of “generalism” is gaining even greater importance.<span>³</span></p><p>Although most medical education occurs at higher-level institutions and hospitals, educational resources in community settings are comparatively scarce. Various barriers to community-based education have been identified, including the limited number of faculty, the dual burden of clinical and teaching responsibilities, and the lack of effective educational materials for learners and supervisors. These challenges hinder the consistent quality of “generalism” education.<span>⁴</span> Some countries have introduced “community preceptors,” experienced clinicians serving as teaching faculty. Although advanced models exist, further expansion and multifaceted support are needed.<span>⁵</span></p><p>To promote postgraduate and undergraduate “generalism,” education in the community, the authors conducted an interactive discussion and brainstorming session at the 15th Academic Conference of the JPCA (Japan Primary Care Association) in May 2024. During this session, we gathered various perspectives on future community education programs in the context of ‘generalism’ from primary care providers, university faculty, local supervisors, residents, and medical students, all of whom play a crucial role in this endeavor.</p><p>As community preceptors, the authors believe that urgent curriculum development and validation in the local context of community medicine and ‘generalism’ are essential. Such efforts will not only address current challenges but also ensure the sustainability and effectiveness of medical education in community settings.</p><p>SM conceptualized and drafted the manuscript with input from all authors. All authors reviewed and approved the final version of the manuscript for publication.</p><p>The authors have stated explicitly that there are no conflicts of interest in connection with this article.</p><p>None.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"275-276"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871721","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}