A Classification Method for General Medicine Physicians to Advance Field Research in Japan.

Purpose: General medicine physicians in Japan play diverse roles depending on their work environments; however, there is no clear definition. In the United States, the establishment of a definition for "hospitalists" has contributed to the accumulation of evidence. To develop research in general medicine and build evidence in Japan, there is an urgent need to establish a systematic classification method for general medicine physicians.

Association between referral letters and diagnostic errors: a single-center, cross-sectional study in general internal medicine in Japan.

Objectives: Referral documentation may either contribute to diagnostic excellence or play a role in diagnostic errors (DEs), but its exact impact remains unclear. This study investigates the association between referral documentation and DEs among patients initially evaluated by another hospital or department and subsequently referred to the general internal medicine (GIM) outpatient clinic of an acute care tertiary hospital in Japan.

Methods: This cross-sectional study analyzed outpatients who visited the GIM outpatient clinic between April 1, 2017 and March 31, 2023.

Spinal and bulbar muscular atrophy with hand tremors and chronic limb weakness, Kennedy disease.

Spinal and bulbar muscular atrophy (SBMA) is an X-linked neuromuscular disorder primarily affecting adult males due to the expansion of CAG repeats in the androgen receptor gene. It manifests as progressive lower motor neuropathy and androgen deficiency. A Japanese man in his late 50s presented with gradually progressive muscle weakness over 6 years.

Pregnancy-related abdominal wall neuropathy (PRAWN) presenting with combined anterior, lateral and posterior cutaneous nerve entrapment syndromes.

A woman in her third trimester of pregnancy presented with acute-onset, sharply localised abdominal and back pain that impaired her mobility. Physical examination revealed focal tenderness, positive Carnett's sign and reproducible pain on the pinch test. Laboratory tests and imaging findings revealed no abnormalities.

Autoimmune Polyglandular Syndrome Type 3b: A Key to Diagnosing Autoimmune Gastritis and Asymptomatic Primary Biliary Cholangitis.

Background: Autoimmune polyglandular syndrome type 3 (APS-3) encompasses autoimmune thyroid disease and other autoimmune disorders. APS-3 is further categorized into four subtypes, with APS-3B involving gastrointestinal autoimmune diseases. In this case, we diagnosed autoimmune gastritis, a condition challenging to identify based on endoscopic findings alone, and asymptomatic primary biliary cholangitis (PBC) through the recognition of APS-3B.

The Future of Hospital Medicine in Japan: Lessons From the United States Hospital Medicine System.

Purpose: To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan's emerging hospital medicine program.

Methods: A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions.

Pseudogout in an Acute-care Hospital: Hospitalists as the Key to Optimized Care.

Acute calcium pyrophosphate crystal arthritis (CPP) or pseudogout commonly affects older adults and may manifest as fever during hospitalization. However, its recognition as a cause of fever remains under-investigated, and diagnostic delays have been reported in approximately 27% of cases. This study evaluated the diagnostic and treatment accuracies of acute CPP in acute-care hospitals over a decade.

Evaluating ChatGPT in Qualitative Thematic Analysis With Human Researchers in the Japanese Clinical Context and Its Cultural Interpretation Challenges: Comparative Qualitative Study.

Background: Qualitative research is crucial for understanding the values and beliefs underlying individual experiences, emotions, and behaviors, particularly in social sciences and health care. Traditionally reliant on manual analysis by experienced researchers, this methodology requires significant time and effort. The advent of artificial intelligence (AI) technology, especially large language models such as ChatGPT (OpenAI), holds promise for enhancing qualitative data analysis.

Two decades of autopsy-detected diagnostic errors in Japan.

Objectives: Autopsy plays an essential role in detecting diagnostic errors and the findings from autopsies have the potential to reduce future errors. However, there are few reports from Japan on diagnostic errors based on autopsy diagnoses. This study aimed to detail diagnostic errors in autopsy reports in Japan.

Resident encounters with disruptive workplace behaviours in Japan: findings from a national cross-sectional study.

Importance: Disruptive workplace behaviours (DWBs) between healthcare professionals compromise patient care quality and organisational culture, impacting staff morale, communication and teamwork. Residents are particularly vulnerable to it from nurses and supervisors.

Objective: Elucidate factors associated with DWBs experienced by residents.

Genome Analysis of Japanese Yersinia pseudotuberculosis Strains Isolated From Kawasaki Disease Patients and Other Sources and Their Phylogenetic Positions in the Global Y. pseudotuberculosis Population.

Yersinia pseudotuberculosis (Ypt) is a gram-negative bacterium that infects both humans and animals primarily through fecal‒oral transmission. While Ypt causes acute gastroenteritis in humans, an association with Kawasaki disease (KD), a disease that primarily affects infants and young children and causes multisystemic vasculitis, has also been suspected. Although KD represents a significant health concern worldwide, the highest annual incidence rate is reported in Japan.

Enhancing quality of care for older adults: The age-friendly health system (4Ms framework) and the role of general medicine physicians as system-based complexologists.

The aging population presents critical challenges to global healthcare systems, with Japan expected to have 35% of its population aged 65 or older by 2040. Older adults often experience multimorbidity, cognitive impairments, and physical frailties, increasing healthcare utilization and costs. Traditional medical approaches that focus on organ-specific diagnoses are insufficient for addressing these multifaceted needs.

Diagnostic Techniques for Posterior Cutaneous Nerve Entrapment Syndrome.

This case report highlights the diagnostic process for posterior cutaneous nerve entrapment syndrome (POCNES) in an older adult female patient, with an emphasis on using video demonstrations to guide clinicians. POCNES should be diagnosed based on a combination of specific clinical features, including localized back pain accompanied by pinpoint tenderness lateral to the spinous process, cutaneous sensory abnormalities over the area of pain, severe pain response to pressure on the tender point, and normal clinical and imaging findings. This case demonstrates how these criteria were identified via a thorough physical examination captured on video to provide a visual guide for clinicians.

Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study.

Background: Lower gastrointestinal perforation (LGP) is an acute abdominal condition associated with a high mortality rate. Timely and accurate diagnosis is crucial. Nevertheless, a diagnostic delay has been estimated to occur in approximately one-third of the cases, and the factors contributing to this delay are yet to be clearly understood.

The Simplest Method for Fishhook Removal: The String-Yank Technique.

Fishing is a popular recreational activity worldwide, but complications arise when fishhooks become embedded in the skin. Barbed hooks, due to their design, are particularly challenging to remove. While many individuals attempt self-extraction, some present to emergency departments for medical intervention.

A Questionnaire Study of Leadership in General Medicine: General Physicians in Japan are Facing Challenges in Education and Research.

Purpose: General physicians are required to demonstrate diverse leadership skills depending on their environment. It is essential for them to understand the characteristics of the medical institutions to which they belong and put this understanding into practice. Leadership skills are acquired through experience and training, and their acquisition is a goal in various medical training programs.

The relation between resident mentorship and in-training examination scores: A nation-wide, cross-sectional study in Japan.

Background: Mentorship is a dynamic reciprocal relationship, wherein a novice (mentee) grows with the encouragement of an advanced careerist (mentor). It is widely implemented in medical training programs. However, there are few reports on mentorship's educational effects in the Japanese context.

Endogenous Cushing's Syndrome Due to Right Adrenal Adenoma Presenting With Bilateral Leg Oedema and Skin Ulceration.

Cushing's syndrome (CS) is a rare disorder characterized by an excess of glucocorticoids, leading to distinctive clinical manifestations. However, its presentation can be atypical, complicating diagnosis. We describe a 53-year-old woman's case of endogenous, adrenocorticotropic hormone (ACTH)-independent CS, presenting with bilateral leg edema and shin ulceration, without the classic signs of moon face or truncal obesity initially.

How can we help doctors stay in rural areas of Japan? A comparison in medical students' attitudes toward general practice and clinical research of a medical school in Japan and in Sweden.

Objective: In Sweden, primary healthcare centers play an important role in the performance of general practice, education, and clinical research. In Japan, general physicians or general practitioners are expected to be more active in the small-scale hospitals and clinics in rural areas. This study aimed to explore the differences in attitudes toward general practice and clinical research among medical students in Japan and Sweden to present solutions to help doctors stay in rural areas of Japan.

Lymphomatosis cerebri caused by adult T cell leukemia/lymphoma: a differential diagnosis for depression: a case report.

Background: Primary central nervous system lymphoma is rare, and primary central nervous system T cell lymphoma is relatively uncommon, contributing to < 5% of all cases. Lymphomatosis cerebri, a rare subtype of primary central nervous system lymphoma, is characterized by extensive white-matter lesions on magnetic resonance imaging and nonspecific symptoms, such as cognitive decline and depression. Reports of lymphomatosis cerebri in adult T cell leukemia/lymphoma are limited.