Journal of General and Family Medicine最新文献

Background: Clinicians routinely make micro-level allocation decisions at the bedside-how much time to spend, which tests to order, or how intensively to treat. While fairness and efficiency have been studied, little is known about how patients' social backgrounds shape these decisions under universal coverage. In Japan, where financial access and free provider choice minimize monetary barriers, bedside allocation may often occur implicitly and through local negotiation rather than explicit protocols.

Methods: We conducted semi-structured interviews with 12 physicians across internal medicine, emergency, and community care settings. Transcripts were analyzed using reflexive thematic analysis to examine how social factors-such as family support, logistics/transport, and patient capability/engagement-enter allocation reasoning.

Results: Three recurring reasoning tendencies emerged: Strict Egalitarians, who minimize social factors and seek uniform plans; Contextual Pragmatists, who adjust when family or logistical support is weak; and Responsibility-Sensitive Allocators, who weigh engagement and self-management after addressing practical barriers. These were not fixed categories-clinicians shifted among them case-by-case, influenced by team norms and local capacity. Across tendencies, stewardship and balance were emphasized, yet reasoning remained largely implicit and negotiated.

Conclusion: Japan's "implicit and negotiated" bedside allocation enables flexibility and trust but can obscure the ethical rationale for daily decisions. Future empirical and normative work should clarify when egalitarian, pragmatic, or responsibility-sensitive reasoning is ethically warranted and how to make reasons transparent without impeding workflow. This study suggests the practical value of maintaining flexibility while ensuring that allocation decisions remain explainable and revisable-a stance we term "answerable flexibility."

Objective: Although symptom assessment is fundamental to palliative care, its independent impact on survival remains unclear. This study addresses survival time differences between high and low symptom burden, assessed using the Edmonton Symptom Assessment System (ESAS), among terminal cancer patients (PPS ≤ 30) at Naresuan University Hospital.

Material and methods: A bidirectional observational cohort study was conducted from October 1, 2019, to January 31, 2024. Patients were categorized into high or low symptom distress groups based on ESAS physical, emotional, and total symptom scores. Multivariable models adjusted for age, sex, BMI, Charlson Comorbidity Index, and metastatic sites. Survival impact was quantified using restricted mean survival time (RMST) and hazard ratios (HR).

Results: A total of 143 terminal cancer patients were included; 76 were males (53.15%) and the average age was 66.17 ± 12.11 years. HRs for high physical, emotional, and total symptom distress scores (TSDS) were 1.50 (95% CI: 1.02-2.20), 1.02 (95% CI: 0.64-1.63), and 1.34 (95% CI: 0.91-1.97), respectively. Only the physical domain remained significant after adjustment. RMST demonstrated that patients with high physical burden experienced a significant survival reduction of 3.70 days (95% CI: -7.17 to -0.23) within a 28-day follow-up period.

Conclusions: High physical symptom burden is significantly associated with shorter survival in terminal cancer patients. These findings highlight the prognostic importance of physical symptoms, emphasizing the need for effective symptom management to optimize remaining survival time.

Aseptic meningitis occasionally causes neuropathic pain in a dermatomal distribution, but widespread non-dermatomal pain is extremely rare. We report a case of a 62-year-old man with ulcerative colitis who developed neuropathic pain involving the head, trunk, and limbs. Cerebrospinal fluid analysis and brain MRI confirmed aseptic meningitis. Although vitamin B12 deficiency and cervical spondylotic myelopathy were present, they did not explain the symptoms. The pain improved with oral analgesics. This case highlights aseptic meningitis as a possible cause of non-dermatomal neuropathic pain.

This article is an official position paper that summarizes current evidence and offers recommendations for spiritual care in rehabilitation nutrition. Spirituality is defined as pertaining to the fundamental questions and desires of human existence, encompassing meaning, purpose, dignity, and connection. Spiritual pain is a state of lost meaning related to temporality, relationship, autonomy, and independence, manifesting due to end-of-life, permanent disability, and loss. Rehabilitation nutrition plays a vital role in alleviating this pain by supporting functions, nutritional status, and the patient's sense of meaning and hope. Practice involves interdisciplinary collaboration utilizing specific approaches related to the four dimensions, such as active listening and empathy, presence, maintaining hope, and fostering gratitude and forgiveness. To implement this holistic care effectively, education and training for healthcare workers are required, emphasizing respect for both the patient's and their own spiritual aspects. Ultimately, incorporating spiritual care into rehabilitation nutrition is crucial for improving patient well-being.