Journal of General and Family Medicine最新文献

{"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, Takashi Sasaki PhD, Yukiko Abe BA, Yoshinori Nishimoto MD, PhD, Takumi Hirata MD, MPH, PhD, Junji Haruta MD, PhD, 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><sup>1</sup></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><sup>2</sup></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><sup>3</sup></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":"25 2","pages":"116-117"},"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":"25 2","pages":"87-94"},"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":"&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, we would like to point out two concerns.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; 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,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; It might be effective to consider the medical specialties visited when renewing the definition of polydoctoring.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Inappropriate prescriptions do not always appear to be associated with care fragmentation.&lt;/p&gt;&lt;p&gt;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":"25 2","pages":"114-115"},"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":"&lt;p&gt;To the Editor,&lt;/p&gt;&lt;p&gt;Burnout is a syndrome conceptualized by emotional exhaustion, depersonalization, and a diminished sense of personal achievement.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Physician burnout has several negative effects, including medical errors and mental ill health.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; It is worth addressing that the prevalence of burnout among resident physicians in Japan is high at approximately 30%.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;/p&gt;&lt;p&gt;Poor communication and stress in relationships with medical staff and patients may contribute to burnout among resident physicians.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Long working hours, increased workload, sleep deprivation owing to duty shifts, and increased burden of COVID-19 treatment are also risk factors for burnout.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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 “&lt;i&gt;tasuki-gake&lt;/i&gt;” 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":"25 1","pages":"83-84"},"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":"25 1","pages":"53-61"},"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":"25 1","pages":"62-70"},"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":"25 1","pages":"85"},"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}

{"title":"Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study","authors":"Koshi Ota MD, MPH, PhD,&nbsp;Daisuke Nishioka MD, PhD,&nbsp;Emi Hamada RN,&nbsp;Kanna Ota MD,&nbsp;Yuriko Shibata MT,&nbsp;Akira Takasu MD","doi":"10.1002/jgf2.667","DOIUrl":"https://doi.org/10.1002/jgf2.667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13-month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true-positive results for bacteremia, and 324 (59.1%) patients showed true-negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone-iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7–22.6; <i>p</i> &lt; 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3–31.9, <i>p</i> &lt; 0.001 and 41.1%, 95% CI 22.2–59.9, <i>p</i> &lt; 0.001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"25 1","pages":"45-52"},"PeriodicalIF":1.6,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139480548","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 “Okusuri Charm” movement in Japan: Prescription drug accessories emerging on X (Twitter)","authors":"Tatsuki Ikejiri MD,&nbsp;Hayase Hakariya PhD,&nbsp;Haruna Kai,&nbsp;Natsuki Yokoyama BS,&nbsp;Arisa Hakariya MD","doi":"10.1002/jgf2.666","DOIUrl":"10.1002/jgf2.666","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In this digital age, social networks may offer an avenue for individuals to obtain drugs illicitly beyond the prescribed amount. Users on X (Twitter)® have ingeniously fabricated fashionable accessories that employ prescription drug sheets, termed “Okusuri Charm”.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study scrutinized the emerging “Okusuri Charm” trend, by searching the term in Japanese on X (Twitter)® and analyzing related posts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Alongside illegal prescription drug trading, individuals crafted accessories from drug sheets, particularly prescribed psychiatric drugs, and dealt with other users, leading to a growing trend this year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A positive outlook toward this trend is the emergence of a new artistic movement, but a pessimistic viewpoint is the creators' misuse of prescription drugs, potentially fostering illegal drug dealings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"25 1","pages":"77-80"},"PeriodicalIF":1.6,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138966752","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":"Concomitant spinal cord, vertebral body, and paraspinal muscle infarction","authors":"Yoshitaka Tomoda MD, PhD, FACP,&nbsp;Satoshi Fujita MD,&nbsp;Koji Uhara MD,&nbsp;Yusuke Yasumoto MD, MPH","doi":"10.1002/jgf2.669","DOIUrl":"10.1002/jgf2.669","url":null,"abstract":"&lt;p&gt;A 76-year-old woman presented to the emergency department with a sudden onset of back pain and numbness in her left lower extremity. Her sensory impairment initiated in the dorsal aspect of the foot, progressively radiating to encompass the entire lower limb within a span of 1 day. Her medical history included coronary heart disease. On examination, she had partial muscle weakness in her left lower extremities and hypoalgesia in her left lower extremity, which extended below T6 level, including bilateral lower extremities the following day. A laboratory analysis revealed a normal platelet count and no coagulopathy. Moreover, brain computed tomography (CT) and lumber magnetic resonance imaging (MRI) on Day 2 were unremarkable. However, follow-up T2-weighted MRI performed on Day 8 revealed a hyperintense lesion in the spinal cord at T5–T6 without spinal canal stenosis (Figure 1A,B). Additionally, T2-weighted MRI revealed high-intensity areas in the right half of the T6 vertebral body, and gadolinium-enhanced T1-weighted MRI revealed enhanced lesions in the right latissimus dorsi, which were findings consistent with spinal cord, vertebral body, and muscle infarction (Figure 1B,C). Contrast-enhanced CT revealed no evidence of aortic dissection or embolism. The patient's symptoms gradually improved after antiplatelet therapy including aspirin and clopidogrel, and she was subsequently transferred to the rehabilitation center.&lt;/p&gt;&lt;p&gt;Spinal cord infarction (SCI) is a rare condition that accounts for 1% of all strokes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although the etiology of SCI remains ambiguous, estimates have indicated that approximately 75% of SCI patients exhibit vascular risk factors. Moreover, various conditions, including aortic surgery, atherosclerosis, aortic dissection, cardiogenic embolism, or systemic hypotension, can cause SCI. The clinical features of SCI include rapid neurologic deficits with severe back pain, with an onset-to-nadir deficits duration of 12 h. Accurate diagnosis of SCI remains challenging and is based on a combination of clinical symptoms and characteristic MRI findings, including T2-hyperintense patterns and linear gadolinium enhancement. While MRI has been the most useful tool in the diagnosis of SCI, normal MRI findings are often observed within the first few hours after SCI. Furthermore, there are no specific therapies proven to limit SCI, and treatment for underlying causes is usually suggested. Mortality rates after SCI depend on the level or severity of ischemia or underlying etiology.&lt;/p&gt;&lt;p&gt;Thus, considering SCI, concomitant vertebral body infarction is uncommon, with reports showing a prevalence of 4%–8%.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Similarly, only a few cases of concomitant paraspinal muscle and vertebral infarctions have been reported.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, the simultaneous presence of vertebral and paraspinal muscle infarction offers valuable information regarding vascular involvement and can help rule out ","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"25 1","pages":"75-76"},"PeriodicalIF":1.6,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.669","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138966600","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}