Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2025-265047

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Clinical reasoning skills are essential competencies for medical students; therefore, effective, evidence-informed teaching methodologies are needed worldwide. This study investigated the benefits of team-based learning (TBL) for developing the skills in medical students. METHOD: A mixed-methods sequential explanatory design was used to investigate the effectiveness of TBL for medical students acquiring clinical reasoning skills. The study participants comprised 92 fourth-year medical students at Yokohama City University School of Medicine, participating in TBL sessions that covered 10 major clinical symptoms identified in the core curriculum. Each session lasted 240 min. Before and after the educational intervention, student performance was measured using the script concordance test (SCT) on a 30-point scale, and self-assessed clinical reasoning competency was measured on a 7-point Likert scale. The SCT included pre-tests and post-tests of 30 questions each, with students randomly assigned to one of two test sets. Following the quantitative evaluation, a qualitative content analysis was conducted to explore the advantages of TBL for learning clinical reasoning skills. The analytic categories were set according to the six levels of Fink's taxonomy of significant learning. RESULT: Student performance improved significantly after the educational intervention (A test: 16.5 ± 4.4 to 18.7 ± 4.5, p = 0.019; B test: 18.1 ± 3.7 to 19.8 ± 4.4, p = 0.028). After the educational intervention, self-assessed clinical reasoning competency was significantly higher in "recalling appropriate physical examination and tests on clinical hypothesis generation," "recalling appropriate differential diagnosis from patient's chief complaint," "verbalizing points that fit/don't fit the recalled differential diagnosis appropriately," "verbalizing and reflecting appropriately on own mistakes," "selecting keywords from the whole aspect of the patient," and "practicing the appropriate clinical reasoning process" (all p < 0.001). The content analysis extracted 23 subcategories and 233 codes of the advantages of TBL for learning clinical reasoning skills, covering all six levels of Fink's taxonomy of significant learning: Foundational knowledge (7 codes); Application (40 codes); Integration (69 codes); Human dimension (89 codes); Caring (8 codes); and Learning how to learn (20 codes). CONCLUSION: This study demonstrates that TBL supports the acquisition of critical clinical reasoning skills among medical students.

DOI： 10.1186/s12909-025-06784-w

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Publishing type：Research paper (scientific journal)  

DOI： 10.1515/dx-2024-0205

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

<jats:p>A 68-year-old Japanese man presented with recurrent paroxysmal toothache exclusively after alcohol consumption. The episodes occurred 2–3 hours after drinking, lasted 10-15 minutes, and were unrelated to exertion or eating, chewing, or brushing the teeth. Physical examination and laboratory tests were unremarkable. Vasospastic angina was suspected based on the episodic nature and association with alcohol. Symptoms resolved within 1-2 minutes of nitroglycerin administration, confirming the diagnosis of alcohol-induced vasospastic angina. This case highlights the importance of considering cardiac causes, including vasospastic angina, in patients with unexplained paroxysmal symptoms such as toothache, especially when triggered by alcohol consumption.</jats:p>

DOI： 10.12890/2025_005170

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11606-024-09277-6

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2024.10.008

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7759/cureus.77208

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2024.09.014

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2024.12.008

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Evidence for the pathogenesis and treatment of postacute coronavirus disease 2019 (COVID-19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID-19 pandemic. METHODS: Using a retrospective, cross-sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed COVID-19 exhibiting residual symptoms lasting ≥60 days postinfection who visited our clinic in January 2021-February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID-19 and excluded those that were exacerbations of existing diseases. RESULTS: During the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy. CONCLUSION: Not all symptoms that occur after COVID-19 should be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

DOI： 10.1002/jgf2.716

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2024.06.003

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11606-024-08794-8

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ejim.2024.05.020

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/postmj/qgae032

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

KEY CLINICAL MESSAGE: A whirl sign on contrast-enhanced abdominal CT scan is indicative of intestine twisted around the mesenteric vessels, and is observed in cases of strangulated obstruction, signaling compromised intestinal circulation. In cases of intestinal volvulus, surgery is necessary to untwist the affected bowel, and resection is necessary if necrosis is present. ABSTRACT: A 31-year-old Japanese man presented with acute lower abdominal pain and vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a 1440-degree clockwise torsion of superior mesenteric artery and a whirl sign. Intestinal volvulus in adulthood with a background of malrotation is extremely rare. Contrast-enhanced CT is effective for diagnosis.

DOI： 10.1002/ccr3.9022

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Manual chart review using validated assessment tools is a standardised methodology for detecting diagnostic errors. However, this requires considerable human resources and time. ChatGPT, a recently developed artificial intelligence chatbot based on a large language model, can effectively classify text based on suitable prompts. Therefore, ChatGPT can assist manual chart reviews in detecting diagnostic errors. OBJECTIVE: This study aimed to clarify whether ChatGPT could correctly detect diagnostic errors and possible factors contributing to them based on case presentations. METHODS: We analysed 545 published case reports that included diagnostic errors. We imputed the texts of case presentations and the final diagnoses with some original prompts into ChatGPT (GPT-4) to generate responses, including the judgement of diagnostic errors and contributing factors of diagnostic errors. Factors contributing to diagnostic errors were coded according to the following three taxonomies: Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC) and Generic Diagnostic Pitfalls (GDP). The responses on the contributing factors from ChatGPT were compared with those from physicians. RESULTS: ChatGPT correctly detected diagnostic errors in 519/545 cases (95%) and coded statistically larger numbers of factors contributing to diagnostic errors per case than physicians: DEER (median 5 vs 1, p<0.001), RDC (median 4 vs 2, p<0.001) and GDP (median 4 vs 1, p<0.001). The most important contributing factors of diagnostic errors coded by ChatGPT were 'failure/delay in considering the diagnosis' (315, 57.8%) in DEER, 'atypical presentation' (365, 67.0%) in RDC, and 'atypical presentation' (264, 48.4%) in GDP. CONCLUSION: ChatGPT accurately detects diagnostic errors from case presentations. ChatGPT may be more sensitive than manual reviewing in detecting factors contributing to diagnostic errors, especially for 'atypical presentation'.

DOI： 10.1136/bmjoq-2023-002654

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2024.03.002

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.2147/IJGM.S459810

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2023.12.023

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Language：Japanese   Publisher：聖マリアンナ医科大学医学会  

新型コロナウイルス感染症は感染症法で5類感染症となり,日常生活はパンデミック前に戻りつつある。しかし,その罹患後症状については,診断法や治療が確立されておらず,長期にわたり苦しんでいる患者は少なくない。当院では2021年1月18日より,罹患後症状の診療に特化した新型コロナウイルス感染症後外来(後遺症外来)を開始した。これまでに約1,000名が紹介受診しており,その症状は倦怠感をはじめとして,頭痛や味覚嗅覚障害,記憶力の低下といったBrain fogと呼ばれる症状の他,気分の落ち込みや不安感など精神的な症状の訴えも多い。その背景には学校や仕事に行くことができない,周囲から理解がないという声の他,経済的困窮という社会的な問題を抱えていることもある。倦怠感では,自律神経障害の評価,抑うつの評価,生活習慣の乱れに伴う体重増加や筋力の評価を行うことが,Brain fogではSPECTによる脳血流の評価が重要である。罹患後症状は体位性頻脈症候群や片頭痛など新たな合併症が見つかることが多く,また既往疾患が再燃することも多い。罹患後症状としてまとめてしまうのではなく,症状からこれまでもよくあった疾患群を想定した問診,診察をして診断をつけ,治療を開始することが必要である。また身体的な症状のみならず心理的,社会的背景に目を向けて対応していくことも重要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00746&link_issn=&doc_id=20241028030024&doc_link_id=10.14963%2Fstmari.51.S169&url=https%3A%2F%2Fdoi.org%2F10.14963%2Fstmari.51.S169&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.2147/IMCRJ.S449310

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Diagnosis and management of psychogenic diseases such as conversion disorder, somatic symptom disorder (SSD), illness anxiety disorder, falsehood disorder, and psychotic disorder require an elaborate biopsychosocial approach and are often challenging. Herein, we propose the following points to differentiate medical diseases from these psychogenic diseases: correspondence between symptoms and objective findings or activities of daily living (ADL) impairment; placebo effect; clear provocative or palliative factors; progressive time course; paroxysmal or intermittent symptoms; unfamiliar but not strange expressions; symptoms worsen during sleep or rest.

DOI： 10.1002/jgf2.661

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2023.10.035

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Language：English  

DOI： 10.1515/dx-2023-0073

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2023.10.009

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1515/dx-2023-0181

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

DOI： 10.1002/jgf2.670

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jgf2.662

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/internalmedicine.2927-23

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2023-257831

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Prolonged symptoms that occur after COVID-19 (long-COVID) vary from mild, which do not interfere with daily life, to severe, which require long-term social support. This study assessed the secular trend in online searches on long-COVID in Japan. We conducted an observational study using data provided by Yahoo! JAPAN on the monthly search volume of query terms related to long-COVID from January 2020 to December 2022, including the search volume of the query "コロナ" (long-COVID in Japanese). The number of new cases of COVID-19 by month was used as a control for search trends, and the symptoms retrieved in conjunction with long-COVID were compared. Trends in online searches for each symptom of long-COVID were analyzed. The symptoms of long-COVID were classified according to "Component 1-Symptoms and Complaints" of the International Classification of Primary Care, 2nd edition (ICPC-2). Interest in long-COVID increased in response to peaks in the number of new cases of COVID-19 in Japan. The most frequent symptom searches with long-COVID were hair loss/baldness (3,530, 21,400, and 33,600 searches in 2020, 2021, and 2022, respectively), cough (340, 7,900 and 138,910 searches in 2020, 2021, and 2022, respectively), disturbance of smell/taste (230, 13,340, and 44,160 searches in 2020, 2021, and 2022, respectively), and headache (580, 6,180, and 42,870 searches in 2020, 2021, and 2022, respectively). In addition, the ranking of interest in "weakness/tiredness, general" in long-COVID increased each year (not in the top 10 in 2020, seventh in 2021, and second in 2022), and the absolute number of searches also increased. To our knowledge, this is the first study to investigate secular trends in online interest in long-COVID in the world. Continued monitoring of online interest in long-COVID is necessary to prepare for a possible increase in the number of patients with long-COVID.

DOI： 10.1371/journal.pone.0294261

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Language：English  

DOI： 10.1515/dx-2023-0040

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To assess the usefulness of case reports as sources for research on diagnostic errors in uncommon diseases and atypical presentations. CONTENT: We reviewed 563 case reports of diagnostic error. The commonality of the final diagnoses was classified based on the description in the articles, Orphanet, or epidemiological data on available references; the typicality of presentation was classified based on the description in the articles and the judgment of the physician researchers. Diagnosis Error Evaluation and Research (DEER), Reliable Diagnosis Challenges (RDC), and Generic Diagnostic Pitfalls (GDP) taxonomies were used to assess the factors contributing to diagnostic errors. SUMMARY AND OUTLOOK: Excluding three cases in that commonality could not be classified, 560 cases were classified into four categories: typical presentations of common diseases (60, 10.7 %), atypical presentations of common diseases (35, 6.2 %), typical presentations of uncommon diseases (276, 49.3 %), and atypical presentations of uncommon diseases (189, 33.8 %). The most important DEER taxonomy was "Failure/delay in considering the diagnosis" among the four categories, whereas the most important RDC and GDP taxonomies varied with the categories. Case reports can be a useful data source for research on the diagnostic errors of uncommon diseases with or without atypical presentations.

DOI： 10.1515/dx-2023-0030

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.amjmed.2023.07.008

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The gamification of learning increases student enjoyment, and motivation and engagement in learning tasks. This study investigated the effects of gamification using decision-making cards (DMCs) on diagnostic decision-making and cost using case scenarios. METHOD: Thirty medical students in clinical clerkship participated and were randomly assigned to 14 small groups of 2-3 medical students each. Decision-making was gamified using DMCs with a clinical information heading and medical cost on the front, and clinical information details on the back. First, each team was provided with brief clinical information on case scenarios. Subsequently, DMCs depending on the case were distributed to each team, and team members chose cards one at a time until they reached a diagnosis of the case. The total medical cost was then scored based on the number and contents of cards drawn. Four case scenarios were conducted. The quantitative outcomes including confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical costs were measured before and after our gamification by self-evaluation using a 7-point Likert scale. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using DMCs. RESULT: Confidence in effective clinical decision-making, motivation to learn diagnostic decision-making, and awareness of medical cost were significantly higher after the gamification. Furthermore, comparing the clinical case scenario tackled last with the one tackled first, the average medical cost of all cards drawn by students decreased significantly from 11,921 to 8,895 Japanese yen. In the content analysis, seven advantage categories of DMCs corresponding to clinical reasoning components were extracted (information gathering, hypothesis generation, problem representation, differential diagnosis, leading or working diagnosis, diagnostic justification, and management and treatment). CONCLUSION: Teaching medical students clinical reasoning using DMCs can improve clinical decision-making confidence and learning motivation, and reduces medical cost in clinical case scenarios. In addition, it can help students to acquire practical knowledge, deepens their understanding of clinical reasoning, and identifies several important clinical reasoning skills including diagnostic decision-making and awareness of medical costs. Gamification using DMCs can be an effective teaching method for improving medical students' diagnostic decision-making and reducing costs.

DOI： 10.1186/s12909-023-04808-x

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2023-257869

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

DOI： 10.7759/cureus.44516

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Key Clinical Message

The low sensitivity of ascites culture for acid‐fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on computed tomography may prompt suspicion of tuberculous peritonitis.

Abstract

A 47‐year‐old Nigerian man presented with fever, abdominal distention, and weight loss. Abdominal computed tomography revealed massive ascites and peritoneal thickening. Despite failing to culture acid‐fast bacilli from ascites, histological examination and culture of peritoneum revealed multidrug‐resistant tuberculosis peritonitis. Peritoneal biopsy is mandatory when tuberculosis peritonitis is suspected.

DOI： 10.1002/ccr3.7759

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2023-256363

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11606-023-08253-w

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

DOI： 10.1016/j.ajp.2023.103689

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Language：English  

DOI： 10.1186/s12909-023-04468-x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

BACKGROUND: Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult. OBJECTIVE: To investigate the association between physician empathy and difficult patient encounters (DPEs). DESIGN: Cross-sectional study. PARTICIPANTS: Participants were 18 generalist physicians with 3-8 years of experience. The investigation was conducted from August-September 2018 and April-May 2019 at six healthcare facilities. MAIN MEASURES: Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians' empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering. KEY RESULTS: The median JSE score was 114 (range: 96-126), and physicians with JSE scores 96-113 and 114-126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19-0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = -0.22, p < 0.01). CONCLUSION: Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty.

DOI： 10.1007/s11606-022-07936-0

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Language：Japanese   Publisher：(一社)米国内科学会日本支部  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A clinical diagnostic support system (CDSS) can support medical students and physicians in providing evidence-based care. In this study, we investigate diagnostic accuracy based on the history of present illness between groups of medical students using a CDSS, Google, and neither (control). Further, the degree of diagnostic accuracy of medical students using a CDSS is compared with that of residents using neither a CDSS nor Google. METHODS: This study is a randomized educational trial. The participants comprised 64 medical students and 13 residents who rotated in the Department of General Medicine at Chiba University Hospital from May to December 2020. The medical students were randomly divided into the CDSS group (n = 22), Google group (n = 22), and control group (n = 20). Participants were asked to provide the three most likely diagnoses for 20 cases, mainly a history of a present illness (10 common and 10 emergent diseases). Each correct diagnosis was awarded 1 point (maximum 20 points). The mean scores of the three medical student groups were compared using a one-way analysis of variance. Furthermore, the mean scores of the CDSS, Google, and residents' (without CDSS or Google) groups were compared. RESULTS: The mean scores of the CDSS (12.0 ± 1.3) and Google (11.9 ± 1.1) groups were significantly higher than those of the control group (9.5 ± 1.7; p = 0.02 and p = 0.03, respectively). The residents' group's mean score (14.7 ± 1.4) was higher than the mean scores of the CDSS and Google groups (p = 0.01). Regarding common disease cases, the mean scores were 7.4 ± 0.7, 7.1 ± 0.7, and 8.2 ± 0.7 for the CDSS, Google, and residents' groups, respectively. There were no significant differences in mean scores (p = 0.1). CONCLUSIONS: Medical students who used the CDSS and Google were able to list differential diagnoses more accurately than those using neither. Furthermore, they could make the same level of differential diagnoses as residents in the context of common diseases. TRIAL REGISTRATION: This study was retrospectively registered with the University Hospital Medical Information Network Clinical Trials Registry on 24/12/2020 (unique trial number: UMIN000042831).

DOI： 10.1186/s12909-023-04370-6

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2023-255404

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1515/dx-2022-0132

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/qjmed/hcad063

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The long-term symptoms of coronavirus disease 2019 (COVID-19), i.e., long COVID, have drawn research attention. Evaluating its subjective symptoms is difficult, and no established pathophysiology or treatment exists. Although there are several reports of long COVID classifications, there are no reports comparing classifications that include patient characteristics, such as autonomic dysfunction and work status. We aimed to classify patients into clusters based on their subjective symptoms during their first outpatient visit and evaluate their background for these clusters. METHODS: Included patients visited our outpatient clinic between January 18, 2021, and May 30, 2022. They were aged ≥ 15 years and confirmed to have SARS-CoV-2 infection and residual symptoms lasting at least 2 months post-infection. Patients were evaluated using a 3-point scale for 23 symptoms and classified into five clusters (1. fatigue only; 2. fatigue, dyspnea, chest pain, palpitations, and forgetfulness; 3. fatigue, headache, insomnia, anxiety, motivation loss, low mood, and forgetfulness; 4. hair loss; and 5. taste and smell disorders) using CLUSTER. For continuous variables, each cluster was compared using the Kruskal-Wallis test. Multiple comparison tests were performed using the Dunn's test for significant results. For nominal variables, a Chi-square test was performed; for significant results, a residual analysis was conducted with the adjusted residuals. RESULTS: Compared to patients in other cluster categories, those in cluster categories 2 and 3 had higher proportions of autonomic nervous system disorders and leaves of absence, respectively. CONCLUSIONS: Long COVID cluster classification provided an overall assessment of COVID-19. Different treatment strategies must be used based on physical and psychiatric symptoms and employment factors.

DOI： 10.1007/s10238-023-01057-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

A 77-year-old man arrived at our hospital with bilateral shoulder pain persisting for several months and headache for 1 month. Giant cell arteritis with polymyalgia rheumatica was suspected. However, considering his medical history of testing positive for syphilis, we submitted a sample for a syphilis serology test, which yielded positive results. The Treponema pallidum hemagglutination assay of cerebrospinal fluid was positive, and a temporal artery biopsy revealed vasculitis, confirming the diagnosis of tertiary syphilis. He was successfully treated for two weeks with penicillin G infusions. Symptoms reminiscent of giant cell arteritis and polymyalgia rheumatica may reveal syphilis, which is called the "great imitator."

DOI： 10.2169/internalmedicine.9779-22

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11606-023-08046-1

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Language：English   Publishing type：Research paper (scientific journal)  

We propose five important strategies for young generalists to write original research and papers. We hope that even beginners will understand and practice these five strategies, and help young generalist to write research papers based on clinical questions that arise in their daily practice.

DOI： 10.1002/jgf2.603

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

A 48-year-old man visited our emergency room after experiencing sudden left back pain, diaphoresis, and nausea. The patient underwent physical and laboratory examinations. Physical examination revealed tenderness in the left costovertebral angle. Laboratory examination revealed a slight elevation in D-dimer levels. Contrast-enhanced computed tomography revealed a bilateral pulmonary embolism and left renal infarction. Back pain was resolved following anticoagulation therapy with heparin. Transesophageal echocardiography revealed a patent foramen ovale (PFO). The patient was discharged on an anticoagulant, apixaban. Identifying the cause of paradoxical embolisms, such as an atrial septal defect or PFO, in cases with an arterial embolism in a young patient with no underlying disease is important.

DOI： 10.7759/cureus.35433

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：{SMC} Media  

<jats:p>A 45-year-old Japanese woman presented with difficulty moving her left shoulder. Ten months previously, the day after she had received her second dose of the BNT162b2 mRNA COVID-19 vaccine, a severe stabbing pain occurred in her entire left upper extremity. The pain resolved within 2 weeks, although she developed difficulty moving her left shoulder. A left winged scapula was observed. Electromyography showed left upper brachial plexopathy with acute axonal involvement and abundant acute denervation potentials, consistent with Parsonage-Turner syndrome (PTS). PTS should be considered in patients with post-neuralgic motor paralysis of the unilateral upper extremity, which can occur after COVID-19 vaccination.</jats:p>

DOI： 10.12890/2023_003779

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Language：Japanese   Publisher：(一社)日本内科学会  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students' perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students' perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in "recalling appropriate differential diagnosis from patient's chief complaint" (F(1,97) = 5.295, p = 0.024) and "practicing the appropriate clinical reasoning process" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of "recalling appropriate history, physical examination, and tests on clinical hypothesis generation" (F(1,97) = 6.796, p = 0.011), "verbalizing and reflecting appropriately on own mistakes," (F(1,97) = 4.352, p = 0.040) "selecting keywords from the whole aspect of the patient," (F(1,97) = 5.607, p = 0.020) and "examining the patient while visualizing his/her daily life" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, "acquisition of knowledge" was the most frequent subcategory, followed by "leading the discussion," "smooth discussion," "getting feedback," "timely feedback," and "supporting the clinical reasoning process." Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one's own errors and selecting appropriate keywords from the whole aspect of the patient.

DOI： 10.1371/journal.pone.0279554

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：{SMC} Media  

<jats:p>A 32-year-old woman presented to the outpatient clinic with persistent fever, anterior neck pain, and palpitations over the past week which developed 2 days after she had received the first dose of the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine. On examination, the patient’s heart rate was 140 beats per minute and the thyroid gland was tender on palpation. Laboratory studies showed a low serum TSH level with elevated free thyroxine. Thyroid ultrasound revealed low-echoic lesions compatible with the site of tenderness. The patient was diagnosed with subacute thyroiditis and treatment was initiated with acetaminophen and propranolol, which resulted in symptom resolution within 2 weeks. Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging.</jats:p>

DOI： 10.12890/2023_003735

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Medical students and junior residents have five concerns about general medicine training, and senior residents and young academic generalists respond to these concerns. We hope that this paper will help to dispel some common concerns for those who wish to become specialists in general medicine.

DOI： 10.1002/jgf2.584

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2022-252839

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1016/j.amjmed.2022.10.008

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

We propose the following five tips as important processes for writing clinical image reports: select a suitable case for the clinical image report; take appropriate images; select a journal for submission; prepare models of clinical image reports; and create templates for structuring clinical image reports in advance. We hope that these five tips will help beginners and young general physicians write clinical image reports.

DOI： 10.1002/jgf2.569

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jgf2.569

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/qjmed/hcac171

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American College of Physicians  

DOI： 10.7326/aimcc.2022.0179

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2022-251810

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Publishing type：Research paper (scientific journal)   Publisher：Informa UK Limited  

DOI： 10.2147/ijgm.s368021

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1056/NEJMicm2119475

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：{CMA} Impact Inc.  

DOI： 10.1503/cmaj.211677

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/qjmed/hcac122

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

A 23-year-old Japanese woman presented with a 1-month history of dyspnoea and chest discomfort. Since the symptoms improved with dynamic and sensory stimulation and also caused insomnia, we considered a variant of restless legs syndrome (RLS) called 'restless chest syndrome', although there were no symptoms in the extremities. We initiated oral administration of pramipexole 0.25 mg daily, and her symptoms, including dyspnoea, chest discomfort and insomnia, improved within 1 week. RLS should be considered in the differential diagnosis in patients who present with abnormal sensations that worsen at night, with insomnia, regardless of the site of the symptoms. LEARNING POINTS: In restless legs syndrome, rare localised sensations in the chest, back, abdomen, face, arm and perineum rather than the lower extremities, have been reported.Dynamic stimuli, intellectual activity and sensory stimuli have been reported to temporarily ease restless legs syndrome symptoms.Restless legs syndrome should be considered in patients who present with abnormal sensations that worsen at night, with insomnia, regardless of the site of the symptoms.

DOI： 10.12890/2022_003398

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Language：English  

DOI： 10.1016/j.amjmed.2022.02.026

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Language：English  

Anterior cutaneous nerve entrapment syndrome (ACNES) involves pain in the abdominal wall due to nerve compression or ischemia. The diagnosis of ACNES is challenging with the pain often inclined to be diagnosed as psychological in origin. A 20-year-old woman presenting with abdominal pain was initially diagnosed with mesenteric lymphadenitis and prescribed pain relievers. However, following worsened pain, she was hospitalized. Blood examinations, abdominal and gynecological ultrasonography, and gastrocolonoscopy yielded no abnormal findings, leading to suspicions of psychological factors. As the patient experienced sharp abdominal pain on movement, but not at rest, which was temporarily relieved by lidocaine injections, she was diagnosed with ACNES. Rectus abdominal resection was performed but the pain relapsed. Laparoscopic surgery was performed to cut the nerve that caused the pain. After three surgeries, the patient was completely symptom-free. ACNES should be considered as a differential diagnosis for intractable abdominal pain. For recurrent relapses, the triggering nerves must be carefully identified for the successful treatment of ACNES.

DOI： 10.7759/cureus.26497

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Language：English  

DOI： 10.1016/j.amjmed.2022.02.028

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Public Library of Science ({PLoS})  

Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n = 39) or the traditional technique instruction group (control group, n = 44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1 = no confidence, 5 = confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the difference between the two groups on the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n = 39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching. Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P = 0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P = 0.31), and so was mastery (4.3 vs. 4.1, P = 0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including "lack of knowledge" and "lack of self-confidence." Themes about prior learning, including "acquisition of knowledge" and "promoting understanding," were specific in the intervention group. The FGI revealed themes including "application of knowledge," "improvement in DTR technique," and "increased self-confidence." Based on these results, teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.

DOI： 10.1371/journal.pone.0270136

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/emermed-2020-211060

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To clarify the factors associated with prolonged hospital stays, focusing on the COMplexity PRediction Instrument (COMPRI) score's accuracy in predicting the length of stay of newly hospitalised patients in general internal medicine wards. DESIGN: A case-control study. SETTING: Three general internal medicine wards in Chiba Prefecture, Japan. PARTICIPANTS: Thirty-four newly hospitalised patients were recruited between November 2017 and December 2019, with a final analytic sample of 33 patients. We included hospitals in different cities with general medicine outpatient and ward facilities, who agreed to participate. We excluded any patients who were re-hospitalised within 2 weeks of a prior discharge. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients' COMPRI scores and their consequent lengths of hospital stay. RESULTS: The 17 patients (52%) allocated to the long-term hospitalisation group (those hospitalised ≥14 days) had a significantly higher average age, COMPRI score and percentage of participants with comorbid chronic illnesses than the short-term hospitalisation group (<14 days). A logistic regression model (model A, comprising only the COMPRI score as the explanatory variable) and a multiple logistic regression model (model B, comprising variables other than the COMPRI score as explanatory variables) were created as prediction models for the long-term hospitalisation group. When age ≥75 years, a COMPRI score ≥6 and a physician with 10 years' experience were set as explanatory variables, model A showed better predictive accuracy compared with model B (fivefold cross-validation, area under curve of 0.87 vs 0.78). The OR of a patient with a COMPRI score of ≥6 joining the long-term hospitalisation group was 4.25 (95% CI=1.43 to 12.63). CONCLUSIONS: Clinicians can use the COMPRI score when screening for complexity assessment to identify hospitalised patients at high risk of prolonged hospitalisation. Providing such patients with multifaceted and intensive care may shorten hospital stays.

DOI： 10.1136/bmjopen-2021-051891

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

In malignant mesotheliomas, cases involving the peritoneum as the primary site are rare, accounting for approximately 10% of all mesothelioma cases. We report a case of medical-type peritoneal mesothelioma leading to death 2 months after the onset of fever of unknown origin, along with a review of the literature. A 76-year-old man presented with a fever of unknown origin over 4 weeks. Thoracoabdominal computed tomography (CT) scan showed increased mesenteric adipose tissue density. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed diffuse hyperaccumulation in the mesentery and hyperaccumulation in the intraperitoneal and parasternal lymph nodes. A thoracoscopic biopsy of the parasternal lymph nodes revealed metastatic peritoneal mesothelioma. The treatment plan was discussed with him and his family, and the best supportive care was provided. 2 months later, he died from multiple organ failure. Underlying malignant tumors cause 38% of mesenteric panniculitis cases. Symptoms accompanied by lymphadenopathy within the area of mesenteric panniculitis are highly suggestive of malignancy. Peritoneal mesothelioma can be classified as (1) classical, which is accompanied by abdominal pain, ascites, and abdominal masses; (2) surgical, which is accompanied by hernia incarceration and intestinal occlusion; and (3) medical, wherein systemic symptoms, such as fever and weight loss, are primarily observed. The medical-type peritoneal mesothelioma, wherein systemic symptoms are primarily observed, has a poorer prognosis than the other types. FDG-PET/CT is an effective diagnostic modality for peritoneal mesothelioma and typically shows diffuse hyperaccumulation along the peritoneal surface.

DOI： 10.1016/j.radcr.2021.11.064

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/postgradmedj-2021-139851

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press ({OUP})  

DOI： 10.1093/qjmed/hcab293

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/qjmed/hcab245

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Language：Japanese   Publisher：(一社)日本泌尿器科学会総会事務局  

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Authorship：Lead author,　Corresponding author   Language：English  

A 66-year-old British man was referred to our department because of a 2.5 year history of bilateral paroxysmal weakness of the lower limbs. It occurred when he walked for about 10 minutes, so he would stop in place and spontaneously rest for up to 15 minutes. When carbamazepine 200 mg/day was administered, the severity and frequency of the symptoms reduced by half and resolved when the dose was increased to 300 mg/day. Even if no involuntary movement is observed, paroxysmal exercise-induced dyskinesia should be considered in patients with paroxysmal painless gait disturbance, and a therapeutic trial of anticonvulsants may be helpful.

DOI： 10.1002/jgf2.438

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

DOI： 10.1016/j.radcr.2021.07.008

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Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.1016/j.amjmed.2021.03.035

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/postgradmedj-2021-140985

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：{BMJ}  

DOI： 10.1136/bcr-2021-245443

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：{BMJ}  

DOI： 10.1136/bcr-2021-245102

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Stemmer's sign is useful in diagnosing lymphedema as it is present in 92% of the cases. Indocyanine green (ICG) lymphography is also useful for diagnosing lymphedema, and it allows them to see all the anatomy of the lymphatic vessels, leaking pumping capacity, and dermal reflux. The diagnostic ability of ICG lymphography and its evaluation capability for disease severity is similar to lymphoscintigraphy which is the gold-standard examination for extremity lymphoedema but with less invasiveness and a lower cost.

DOI： 10.1002/jgf2.425

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

DOI： 10.1007/s11606-021-06748-y

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Authorship：Lead author,　Corresponding author   Language：English  

A 51-year-old man experienced sudden abdominal pain from the umbilicus to the right flank 5 days before his hospital visit. His abdominal pain disappeared when the examiner lifted his upper body in the sitting position. MRI revealed posterior intervertebral disc protrusion in the right paramedian region at the 9th/10th thoracic vertebrae. With the treatment, it is reported that traction is the appropriate initial approach for spine radiculopathy. Improvement with upper body traction performed in this case, which is a previously unreported maneuver, appears to be useful for diagnosis because it eliminates the influence of gravity and reduces intradiscal pressure.

DOI： 10.1002/jgf2.405

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bcr-2020-240692

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

DOI： 10.1016/j.amjmed.2020.08.033

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Cleveland Clinic Journal of Medicine  

DOI： 10.3949/ccjm.88a.20019

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/qjmed/hcaa156

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

Objective This case series aimed to investigate the clinical and pathological characteristics of persistent postural perceptual dizziness (PPPD).Methods We retrospectively examined the medical records of patients with chronic dizziness in our department, and tracked the percentage of PPPD, the age and sex, disorder duration, exacerbating factors for dizziness, and duration of momentary worsening dizziness. We also examined the duration of momentary worsening dizziness in cases of depression, anxiety disorder, and somatic symptom disorder.Results Among 229 patients with chronic dizziness, 14.4% (33/229) met the diagnostic criteria for PPPD. PPPD was the second most common disorder of patients with chronic dizziness after depression. The median age of patients with PPPD was 75 (75.8% female) and the median duration of the disorder was 60 months (range: 3-360 months). The exacerbating factors were motion without regard to direction or position (90.9%), upright posture (66.7%), and exposure to moving visual stimuli or complex visual patterns (30.3%). While the duration of momentary worsening dizziness was less than 10 minutes in 93.9% of patients with PPPD, the duration in patients with depression, anxiety disorder, and somatic symptom disorder were 3.6 % (2/55), 16.1% (5/31), and 0% (0/11), respectively. When the duration was less than 10 minutes, the odds ratios of PPPD for depression and anxiety disorder were 46.5 (95% CI: 6.1-362.0) and 40.3 (95% CI: 7.4-219.3), respectively.Conclusion Short episodes of momentary worsening dizziness constitute a distinctive feature of PPPD that may be useful for differentiating PPPD from other types of psychogenic dizziness.

DOI： 10.2169/internalmedicine.5172-20

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/jgf2.331

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

28歳女。営業職でインドネシアに半年間出向し、1ヵ月前に帰国した。3週前から左顎下にリンパ節腫脹が出現し、2週前から左後頭部にも出現し受診した。頸部エコーで左顎下と後頭部に直径約2cmの境界明瞭、辺縁整、内部均一で低エコーのリンパ節腫脹を認めた。鑑別疾患としてEBウイルス感染症やCMV感染症を疑ったが、血液検査で肝機能障害や異型リンパ球は認められず、EBウイルス・CMVとも抗体価は既感染パターンであった。インドネシアで野良猫との接触歴があったことから猫ひっかき病も考慮したが、明らかな受傷はなく、強い圧痛や発赤を伴うリンパ節腫脹はみられなかった。また、鑑別疾患として、梅毒、リンパ節結核、急性HIV感染症も疑ったが、いずれも血清学的検査で否定された。インドネシア滞在中に十分加熱処理されていない豚肉や鶏肉の摂取歴があったためトキソプラズマ抗体価を測定したところ、IgM抗体、IgG抗体とも陽性であった。無治療で経過観察を行い、初診1ヵ月後に頸部リンパ節腫脹は軽快し、3ヵ月後にIgM抗体は陰性化した。

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Language：English   Publisher：(一社)米国内科学会日本支部  

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

症例は60歳代男性で、心筋梗塞および大腸癌の既往があり、2型糖尿病、高血圧症、脂質異常症、後腹膜線維症の治療中であった。特別の誘因なく、右臀部の皮下血腫、体幹・四肢の紫斑が出現した。血小板数正常、PT正常であったが、APTT延長、lupus anticoagulant陰性、anti-cardiolipin抗体陰性であった。von Willebrand因子活性低下はなかったが、第VIII因子活性が低下し、第VIII因子インヒビター陽性により、後天性血友病Aと診断した。入院4日後からバイパス製剤に加えて、prednisolone(PSL)1mg/kg/日を開始したが改善せず、入院16日目からcyclophosphamide(CPA)100mg/日を追加した。APTTはその後改善したため、約2ヵ月後退院となった。本症例では後天性血友病Aに対して、PSL単独よりもPSLとCPAの併用療法が有効であったが、経過中にサイトメガロウイルス胃炎を発症した。免疫抑制と感染リスクは相反するため、患者背景に合わせて慎重に治療を行う必要がある。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J05937&link_issn=&doc_id=20150724460004&doc_link_id=%2Ffg3byoin%2F2015%2F000802%2F004%2F0019-0024%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg3byoin%2F2015%2F000802%2F004%2F0019-0024%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

大学病院総合診療科170名、渡辺医院210名、にわクリニック63名の受診患者に対し、半構造化面接調査を実施した。本研究で、大学総診科受診患者が同科に対して持つ他の臓器別専門科とは異なる期待として、(1)全身を総合的に診る、(2)適切に診断する、(3)適切な専門科へ振り分ける、(4)診断不明の患者を診察する、(5)医療面接・身体診察を重視する、が明らかになった。中でも(2)と(4)は、同じ総合診療を担う診療所よりも大学総診科に大きく期待する点と考えられた。さらに患者の一部は大学病院には(5)が不足していると感じていた。今後大学総診科としては、全専門領域にわたって広く研鑽を積み、医療面接や身体診察等の基本的臨床技能を充実することで診断能力を高めると同時に、患者のニーズと地域での役割を認識した上で診療に当たる必要性が感じられた。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05937&link_issn=&doc_id=20140717400010&doc_link_id=%2Ffg3byoin%2F2014%2F000602%2F010%2F0045-0049%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg3byoin%2F2014%2F000602%2F010%2F0045-0049%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

渡辺医院210名、にわクリニック63名、大学総診科170名の受診患者に対し、半構造化面接調査を実施した。本研究で、診療所受診患者が持つ期待として、(1)すぐに(気軽に、いつでも)受診できる、(2)信頼感、安心感、(3)(自宅、勤務先から)近い、(4)同じ医師が継続して診る、(5)話しやすさ、相談しやすさ、話を聞く、(6)待ち時間が短い、(7)(専門医への)紹介、(8)優しい・親切などの人柄の良さ、(9)全身を診る、が明らかになった。中でも(1)、(3)〜(6)は、同じ総合診療を担う大学総診科よりも診療所に大きく期待する点だと考えられた。さらに診療所間でも患者のニーズが異なる可能性が窺えた。今後地域の診療所は、臨床能力を高く維持することはもちろん、患者にとって物理的にも心理的にもアクセスが良く、継続して患者と関わることで患者を良く理解すると共に、診療所間での役割分担にも考慮して診療に当たる必要性が感じられた。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

大学病院総合診療科および地域診療所を受診した患者を対象に、受診理由とその背景となる病態の診断名を調査した。主症状の臓器カテゴリー別の最多は大学総診科では「全体、部位不特定の症状」、渡辺医院では「呼吸器」、にわクリニックでは「神経」であった。主症状の多様性は、2診療所より大学総診科が勝った。多い診断名は、大学総診科では身体表現性障害や気分変調症、診療所では高血圧症等の慢性疾患や急性上気道炎であった。患者が受診前に持っていた「総合診療科」に関する認識では、「診断不明の患者を診てくれる」「人間全体を総合的に診る」が多かった。大学総診科には、診断不明の患者に対して一人の人間全体を総合的に診るニーズがある一方、地域診療所には、日常の健康問題を気軽に相談でき、信頼される「かかりつけ医」機能が求められる。立場によらず、総合診療医には包括的な対応能力が必要と考えられる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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＜Point＞・指示簿は患者ケアに密接に関与するため,多職種に伝わりやすい指示簿を書く・指示簿の役割と指示の出し方を理解したうえで,指示簿を記載する・指示内容は経過に応じて,日々見直しを行う(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00974&link_issn=&doc_id=20210618080033&doc_link_id=issn%3D0022-1961%26volume%3D127%26issue%3D5%26spage%3D1167&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D127%26issue%3D5%26spage%3D1167&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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