There exists little research elucidating the benefits of family medicine clinics for community with ample specialist healthcare resources.
Methods
We conducted mixed-methods research. Within the inaugural family medicine clinic, the following data was collected during the initial 2 months: (i) newly identified healthcare needs among scheduled outpatients; (ii) management of outpatients with complex health and social needs; and (iii) provision of home-visit care. Newly detected health care needs were summarized qualitatively using a summative content analysis. Patients' complexity was quantitatively scored using the Japanese version of the Patient Centred Assessment Method.
Results
Physicians identified 156 new needs and 13 complex cases. The complexity of patients receiving home-visit care was high.
Conclusions
This study demonstrates that an inaugural family medicine clinic adeptly addressed a diverse spectrum of patients' healthcare needs.
{"title":"Addressing healthcare needs in an inaugural family medicine clinic in a core city in Japan: Mixed-methods research","authors":"Junki Mizumoto MD, PhD, Maki Nishimura MD, MSc, Naoko Ishikawa MD, MSc, PhD, Kana Hisatake MD, Eri Satake, Shizuka Yamamoto, Shota Tsuno","doi":"10.1002/jgf2.777","DOIUrl":"https://doi.org/10.1002/jgf2.777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There exists little research elucidating the benefits of family medicine clinics for community with ample specialist healthcare resources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted mixed-methods research. Within the inaugural family medicine clinic, the following data was collected during the initial 2 months: (i) newly identified healthcare needs among scheduled outpatients; (ii) management of outpatients with complex health and social needs; and (iii) provision of home-visit care. Newly detected health care needs were summarized qualitatively using a summative content analysis. Patients' complexity was quantitatively scored using the Japanese version of the Patient Centred Assessment Method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physicians identified 156 new needs and 13 complex cases. The complexity of patients receiving home-visit care was high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates that an inaugural family medicine clinic adeptly addressed a diverse spectrum of patients' healthcare needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"269-272"},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.777","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871678","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}
Katie Monnickendam D.Clin.Psy, Peter Keohane D.Clin.Psy, Rebecca Magill D.Clin.Psy
Background
General practice is overwhelmed and understaffed. New models and modalities must be considered from the front door of healthcare. Like general practitioners (GPs), clinical psychologists are qualified to work across the age range and transdiagnostically.
Aim
To explore GPs' understanding of the role of a clinical psychologist and to examine what is helpful and unhelpful for GPs about working alongside a clinical psychologist within general practice.
Design and Setting
This research took place within a primary care general practice in the United Kingdom.
Method
Seven qualified GPs were recruited as participants using a purposive sampling method. Interpretative phenomenological analysis was used to analyze participant's experiences of working alongside clinical psychologists.
Results
Three superordinate themes and 12 subordinate themes were identified. First, GP clinical psychologists support patients directly by providing preventative care, reducing stigma, and offering a different perspective. Second, they support GP well-being and contribute to emotional and behavioral changes in staff. Third, they help to alleviate pressures on wider systems, ease navigation of external services, challenge dominant systems within healthcare, and support community interventions.
Conclusion
GP clinical psychologists impact general practice in multiple ways: indirectly through patient care, by GPs themselves, and by addressing wider systems. Future research is encouraged to explore the perspectives of other staff members and patient's experiences.
{"title":"“The future”: Interpretative phenomenological analysis of general practitioners' experiences of co-employed clinical psychologists","authors":"Katie Monnickendam D.Clin.Psy, Peter Keohane D.Clin.Psy, Rebecca Magill D.Clin.Psy","doi":"10.1002/jgf2.774","DOIUrl":"https://doi.org/10.1002/jgf2.774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>General practice is overwhelmed and understaffed. New models and modalities must be considered from the front door of healthcare. Like general practitioners (GPs), clinical psychologists are qualified to work across the age range and transdiagnostically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore GPs' understanding of the role of a clinical psychologist and to examine what is helpful and unhelpful for GPs about working alongside a clinical psychologist within general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>This research took place within a primary care general practice in the United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Seven qualified GPs were recruited as participants using a purposive sampling method. Interpretative phenomenological analysis was used to analyze participant's experiences of working alongside clinical psychologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three superordinate themes and 12 subordinate themes were identified. First, GP clinical psychologists support patients directly by providing preventative care, reducing stigma, and offering a different perspective. Second, they support GP well-being and contribute to emotional and behavioral changes in staff. Third, they help to alleviate pressures on wider systems, ease navigation of external services, challenge dominant systems within healthcare, and support community interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GP clinical psychologists impact general practice in multiple ways: indirectly through patient care, by GPs themselves, and by addressing wider systems. Future research is encouraged to explore the perspectives of other staff members and patient's experiences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"255-262"},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871722","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}
Severe hypercalcemia has an arrhythmogenic effect. We present a case of a young male falsely diagnosed with premature ventricular complexes attributed to heavy coffee consumption, while symptoms and electrocardiographic findings of hypercalcemia were disregarded. Delayed work-up identified extreme hypercalcemia, and subsequently, parathyroid adenoma was diagnosed. Medical and surgical management resulted in complete resolution. The misdiagnosis led to a substantial diagnostic delay.
{"title":"Extreme hypercalcemia secondary to parathyroid adenoma obscured by excessive coffee consumption and premature ventricular complexes","authors":"Yuval Avidan MD, Sameer Kassem MD, PhD","doi":"10.1002/jgf2.754","DOIUrl":"https://doi.org/10.1002/jgf2.754","url":null,"abstract":"<p>Severe hypercalcemia has an arrhythmogenic effect. We present a case of a young male falsely diagnosed with premature ventricular complexes attributed to heavy coffee consumption, while symptoms and electrocardiographic findings of hypercalcemia were disregarded. Delayed work-up identified extreme hypercalcemia, and subsequently, parathyroid adenoma was diagnosed. Medical and surgical management resulted in complete resolution. The misdiagnosis led to a substantial diagnostic delay.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"263-266"},"PeriodicalIF":1.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871521","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}
Clinical pallor has traditionally served as a screening tool for anemia; however, its assessment lacks objectivity. Therefore, this study aimed to investigate the correlation between skin and mucosal color, as measured by a spectrophotometer, and venous hemoglobin (Hb) values, to identify the optimal anatomical assessment site for detecting anemia.
Methods
A cross-sectional design. Ninety-two adult Japanese outpatients participated in the study. Using a spectrophotometer, the color of the lip and conjunctiva was measured indirectly, while the color of the nail, palm, and inside of the upper arm was measured directly. Colors were quantified using the L*a*b* color scale. This is an international color scale, where the L* value is an index of brightness, a* value is red/green, and b* value is yellow/blue. The color difference (ΔE*) was employed to evaluate the discriminability of anemia identification across different assessment sites. Additionally, Hb values were recorded, with anemia defined as Hb <12.0 g/dL.
Results
The a* values of the lip, conjunctiva, palm, and arm exhibited a positive correlation with Hb values and were significantly lower in the anemic group. While the ΔE* levels for the conjunctiva and lip were readily discernible by the human eye when comparing the normal and anemic groups, recognition at this level proved challenging for other sites.
Conclusion
The conjunctiva and lip demonstrate potential suitability for visual diagnosis of anemia. In the nail, palm, and arm, anemia detection may require highly trained observation. Consequently, reliance on these sites for anemia diagnosis may lead to potential oversight.
{"title":"An observational study to determine the optimal physical evaluation site for detecting anemia","authors":"Ken Horibata MD, PhD, Seigo Kondo MD, Shuji Hashimoto MD, Yousuke Takemura MD, PhD","doi":"10.1002/jgf2.776","DOIUrl":"https://doi.org/10.1002/jgf2.776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical pallor has traditionally served as a screening tool for anemia; however, its assessment lacks objectivity. Therefore, this study aimed to investigate the correlation between skin and mucosal color, as measured by a spectrophotometer, and venous hemoglobin (Hb) values, to identify the optimal anatomical assessment site for detecting anemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional design. Ninety-two adult Japanese outpatients participated in the study. Using a spectrophotometer, the color of the lip and conjunctiva was measured indirectly, while the color of the nail, palm, and inside of the upper arm was measured directly. Colors were quantified using the <i>L</i>*<i>a</i>*<i>b</i>* color scale. This is an international color scale, where the <i>L</i>* value is an index of brightness, <i>a</i>* value is red/green, and <i>b</i>* value is yellow/blue. The color difference (<i>Δ</i><i>E</i>*) was employed to evaluate the discriminability of anemia identification across different assessment sites. Additionally, Hb values were recorded, with anemia defined as Hb <12.0 g/dL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The <i>a</i>* values of the lip, conjunctiva, palm, and arm exhibited a positive correlation with Hb values and were significantly lower in the anemic group. While the <i>Δ</i><i>E</i>* levels for the conjunctiva and lip were readily discernible by the human eye when comparing the normal and anemic groups, recognition at this level proved challenging for other sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The conjunctiva and lip demonstrate potential suitability for visual diagnosis of anemia. In the nail, palm, and arm, anemia detection may require highly trained observation. Consequently, reliance on these sites for anemia diagnosis may lead to potential oversight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"246-254"},"PeriodicalIF":1.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871522","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}
An 88-year-old woman was diagnosed with crowned dens syndrome. Magnetic resonance imaging showed an abscess around the odontoid process. The patient was also found to have infective endocarditis.
一名88岁的妇女被诊断为冠齿综合征。磁共振成像显示齿状突周围有脓肿。患者还发现有感染性心内膜炎。
{"title":"Cervical epidural abscess mimicking crowned dens syndrome","authors":"Nobumasa Okumura MD, Nana Akazawa-Kai MD, Naoya Itoh MD, DTM&H, PhD","doi":"10.1002/jgf2.780","DOIUrl":"https://doi.org/10.1002/jgf2.780","url":null,"abstract":"<p>An 88-year-old woman was diagnosed with crowned dens syndrome. Magnetic resonance imaging showed an abscess around the odontoid process. The patient was also found to have infective endocarditis.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"267-268"},"PeriodicalIF":1.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A specific framework called the rehabilitation nutrition oral care process has been developed to facilitate the triad of rehabilitation, nutrition and oral management. Each framework follows five key steps: assessment, diagnosis, goal setting, intervention, and monitoring. Of these, the diagnosis and goal setting steps are performed collaboratively by multidisciplinary teams specializing in rehabilitation, nutrition and oral management.
{"title":"The rehabilitation nutrition oral care process: Implementing the triad of rehabilitation, nutrition, and oral management","authors":"Hidetaka Wakabayashi","doi":"10.1002/jgf2.763","DOIUrl":"https://doi.org/10.1002/jgf2.763","url":null,"abstract":"<p>A specific framework called the rehabilitation nutrition oral care process has been developed to facilitate the triad of rehabilitation, nutrition and oral management. Each framework follows five key steps: assessment, diagnosis, goal setting, intervention, and monitoring. Of these, the diagnosis and goal setting steps are performed collaboratively by multidisciplinary teams specializing in rehabilitation, nutrition and oral management.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"114-115"},"PeriodicalIF":1.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quick Sequential Organ Failure Assessment (qSOFA) is a simple and easy tool for identifying patients with suspected infection, who are at a high risk of poor outcome. However, its predictive performance is still insufficient. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, a tool to evaluate physical function, has been recently reported to be useful in predicting the prognosis of patients with pneumonia. We aimed to evaluate the added value of ECOG-PS to qSOFA in predicting 30-day mortality in older patients admitted with suspected infections.
Methods
Between 2018 and 2019, we prospectively collected data from adults aged 65 years or older, admitted with suspected infection at two acute care hospitals. Predictive performance was compared between two logistic regression models: one using qSOFA score alone (qSOFA model) and the other in which ECOG-PS was added to qSOFA (extended model).
Results
Of the 1536 enrolled patients, 135 (8.8%) died within 30 days. The area under the curve of the extended model was significantly higher than that of the qSOFA model (0.67 vs. 0.64, p = 0.008). When the risk groups were categorized as follows: low (<5%), intermediate (5%–10%), and high (≥10%), 5.0% of those who died and 2.1% of those who survived were correctly reclassified by the extended model with an overall categorized net reclassification improvement of 0.03 (95% confidence interval: −0.06 to 0.30).
Conclusions
Adding the ECOG-PS score could improve the performance of qSOFA in predicting mortality in older patients admitted with suspected infection.
背景快速顺序器官衰竭评估（qSOFA）是一种简单易用的工具，用于识别疑似感染的患者，这些患者预后不良的风险很高。然而，其预测性能仍然不足。东部肿瘤合作组表现状态（ECOG-PS）评分是一种评估身体功能的工具，最近有报道称，该评分可用于预测肺炎患者的预后。我们的目的是评估ECOG-PS与qSOFA在预测疑似感染住院的老年患者30天死亡率方面的附加价值。方法2018年至2019年期间，我们前瞻性地收集了两家急症医院65岁及以上疑似感染的成年人的数据。比较两种逻辑回归模型的预测性能：一种是单独使用qSOFA评分（qSOFA模型），另一种是将ECOG-PS添加到qSOFA（扩展模型）。结果1536例入组患者中，135例（8.8%）在30天内死亡。扩展模型的曲线下面积显著高于qSOFA模型（0.67 vs. 0.64, p = 0.008）。当风险组分为低（<5%）、中（5% - 10%）和高（≥10%）时，5.0%的死亡和2.1%的幸存者被扩展模型正确地重新分类，总体分类净重新分类提高0.03（95%置信区间：- 0.06至0.30）。结论加入ECOG-PS评分可提高qSOFA预测疑似感染老年患者死亡率的效果。
{"title":"Predicting 30-day mortality in older patients with suspected infections by adding performance status to quick sequential organ failure assessment","authors":"Masataka Kudo MD, Sho Sasaki MD, PhD, Toshihiko Takada MD, PhD, Kotaro Fujii MD, MPH, Yu Yagi MD, Tetsuhiro Yano MD, PhD, Ken-ei Sada MD, PhD, Shunichi Fukuhara DMSc, Narufumi Suganuma MD, PhD","doi":"10.1002/jgf2.764","DOIUrl":"https://doi.org/10.1002/jgf2.764","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Quick Sequential Organ Failure Assessment (qSOFA) is a simple and easy tool for identifying patients with suspected infection, who are at a high risk of poor outcome. However, its predictive performance is still insufficient. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, a tool to evaluate physical function, has been recently reported to be useful in predicting the prognosis of patients with pneumonia. We aimed to evaluate the added value of ECOG-PS to qSOFA in predicting 30-day mortality in older patients admitted with suspected infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2018 and 2019, we prospectively collected data from adults aged 65 years or older, admitted with suspected infection at two acute care hospitals. Predictive performance was compared between two logistic regression models: one using qSOFA score alone (qSOFA model) and the other in which ECOG-PS was added to qSOFA (extended model).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1536 enrolled patients, 135 (8.8%) died within 30 days. The area under the curve of the extended model was significantly higher than that of the qSOFA model (0.67 vs. 0.64, <i>p</i> = 0.008). When the risk groups were categorized as follows: low (<5%), intermediate (5%–10%), and high (≥10%), 5.0% of those who died and 2.1% of those who survived were correctly reclassified by the extended model with an overall categorized net reclassification improvement of 0.03 (95% confidence interval: −0.06 to 0.30).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding the ECOG-PS score could improve the performance of qSOFA in predicting mortality in older patients admitted with suspected infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"238-245"},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance.
Methods
This was a nationwide cross-sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra-short version of the Utrecht Work Engagement Scale, respectively.
Results
173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6.
Conclusions
Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well-being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.
{"title":"Do family physicians develop ambiguity tolerance as they gain experience? A multicenter cross-sectional study","authors":"Hirohisa Fujikawa MD, PhD, Takuya Aoki MD, PhD, MMA, Takayuki Ando MD, MPH, PhD, Junji Haruta MD, PhD","doi":"10.1002/jgf2.778","DOIUrl":"https://doi.org/10.1002/jgf2.778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a nationwide cross-sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra-short version of the Utrecht Work Engagement Scale, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well-being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"231-237"},"PeriodicalIF":1.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giulia Ciccarese MD, PhD, Antonio Facciorusso MD, PhD, Vanessa De Pace PhD, Francesco Drago MD
<p>The interesting article about gastric syphilis recently published in your journal prompted us to make some observations.<span><sup>1</sup></span> Several studies published in the last year have turned the spotlight on gastric syphilis.<span><sup>1-3</sup></span> Although stomach involvement is estimated at only 1% of syphilis patients, mainly in the secondary stage of the disease, the incidence of <i>T. pallidum</i> infection is increasing worldwide<span><sup>2</sup></span>; therefore, we can also expect an increase in gastrointestinal syphilis.</p><p>We agree with the authors about the importance of considering syphilis in the differential diagnoses of gastrointestinal diseases when the patient complains of non-specific symptoms (abdominal pain, nausea, diarrhea, anorexia), physical examination detects epigastric tenderness, and endoscopy shows erosions and ulcerations, especially in an annular shape.<span><sup>2</sup></span> The annular lesion morphology may raise suspicion of syphilis not only in the stomach but especially in the skin. In our experience, cutaneous lesions with annular morphology, with both widespread and localized distribution, are among the most common atypical presentations of secondary syphilis.<span><sup>4</sup></span> The ancient definition of syphilis as the ‘great imitator’ based on its wide variety of manifestations is still actual since unusual manifestations can be found in up to 25% of the cases, especially in the secondary stage.<span><sup>4</sup></span> As Iwamuro et al. described, the annular morphology of the lesions seems to be an early morphological pattern of gastric syphilis followed by erosions and ulcerations.<span><sup>2</sup></span> In the skin, the annular shape of the lesions is often associated with syphilis reinfection<span><sup>5</sup></span>; it is not known if it applies also to the mucosal lesions. Indeed, previous syphilis episodes may alter the clinical/laboratory presentations of a new <i>T. pallidum</i> infection, which happens with more insidious cutaneous/mucosal manifestations.<span><sup>5</sup></span> However, the heterogeneity of the clinical features in syphilis may be related to the multiple circulating genovariants of <i>T. pallidum</i>, characterized by different virulence and tissue tropism.<span><sup>4</sup></span></p><p>It would be interesting to know if the patient described by Itoh et al. has had a previous <i>T. pallidum</i> infection and if he was screened for other sexually transmitted diseases besides HIV that can be acquired with syphilis, such as hepatitis B and C, <i>Chlamydia trachomatis</i> and <i>Neisseria gonorrhoeae</i>.</p><p>In conclusion, gastric syphilis can clinically and histologically simulate other gastrointestinal diseases, including lymphoproliferative diseases, invasive carcinomas, tuberculosis, and Crohn's disease. Definitive diagnosis is made by PCR testing for <i>T. pallidum</i> in paraffin-embedded tissues or immunohistochemical staining for <i>T. p
{"title":"Erosive and annular lesions of the gastric mucosa: Not negligible signs of Treponema pallidum infection","authors":"Giulia Ciccarese MD, PhD, Antonio Facciorusso MD, PhD, Vanessa De Pace PhD, Francesco Drago MD","doi":"10.1002/jgf2.779","DOIUrl":"https://doi.org/10.1002/jgf2.779","url":null,"abstract":"<p>The interesting article about gastric syphilis recently published in your journal prompted us to make some observations.<span><sup>1</sup></span> Several studies published in the last year have turned the spotlight on gastric syphilis.<span><sup>1-3</sup></span> Although stomach involvement is estimated at only 1% of syphilis patients, mainly in the secondary stage of the disease, the incidence of <i>T. pallidum</i> infection is increasing worldwide<span><sup>2</sup></span>; therefore, we can also expect an increase in gastrointestinal syphilis.</p><p>We agree with the authors about the importance of considering syphilis in the differential diagnoses of gastrointestinal diseases when the patient complains of non-specific symptoms (abdominal pain, nausea, diarrhea, anorexia), physical examination detects epigastric tenderness, and endoscopy shows erosions and ulcerations, especially in an annular shape.<span><sup>2</sup></span> The annular lesion morphology may raise suspicion of syphilis not only in the stomach but especially in the skin. In our experience, cutaneous lesions with annular morphology, with both widespread and localized distribution, are among the most common atypical presentations of secondary syphilis.<span><sup>4</sup></span> The ancient definition of syphilis as the ‘great imitator’ based on its wide variety of manifestations is still actual since unusual manifestations can be found in up to 25% of the cases, especially in the secondary stage.<span><sup>4</sup></span> As Iwamuro et al. described, the annular morphology of the lesions seems to be an early morphological pattern of gastric syphilis followed by erosions and ulcerations.<span><sup>2</sup></span> In the skin, the annular shape of the lesions is often associated with syphilis reinfection<span><sup>5</sup></span>; it is not known if it applies also to the mucosal lesions. Indeed, previous syphilis episodes may alter the clinical/laboratory presentations of a new <i>T. pallidum</i> infection, which happens with more insidious cutaneous/mucosal manifestations.<span><sup>5</sup></span> However, the heterogeneity of the clinical features in syphilis may be related to the multiple circulating genovariants of <i>T. pallidum</i>, characterized by different virulence and tissue tropism.<span><sup>4</sup></span></p><p>It would be interesting to know if the patient described by Itoh et al. has had a previous <i>T. pallidum</i> infection and if he was screened for other sexually transmitted diseases besides HIV that can be acquired with syphilis, such as hepatitis B and C, <i>Chlamydia trachomatis</i> and <i>Neisseria gonorrhoeae</i>.</p><p>In conclusion, gastric syphilis can clinically and histologically simulate other gastrointestinal diseases, including lymphoproliferative diseases, invasive carcinomas, tuberculosis, and Crohn's disease. Definitive diagnosis is made by PCR testing for <i>T. pallidum</i> in paraffin-embedded tissues or immunohistochemical staining for <i>T. p","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 3","pages":"273-274"},"PeriodicalIF":1.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
RETRACTION: M. K. Trivedi, A. Branton, D. Trivedi, S. Mondal, and S. Jana, “The Role of Biofield Energy Treatment on Psychological Symptoms, Mental Health Disorders, and Stress-Related Quality of Life in Adult Subjects: A Randomized Controlled Clinical Trial,” Journal of General and Family Medicine 24, no. 3 (2023): 154–163, https://doi.org/10.1002/jgf2.606.
The above article, published online on 28 January 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Masanobu Okayama; the Japan Primary Care Association; and John Wiley & Sons Australia, Ltd. The retraction has been agreed upon following an investigation into concerns raised by a third party, which revealed an inappropriate control group used as the placebo group of the trial, inconsistencies in the Psychological Questionnaire Scoring, highly implausible functional biomarker values that are out of the typical physiological range, and unsupported claims regarding the scientific evidence behind the biofield energy treatment. The authors were informed, however, the explanation and the partial raw data provided were deemed insufficient to address the concerns. Thus, the editors have lost confidence in the presented data and consider the results and conclusions of this manuscript insufficiently supported and substantially compromised. The authors disagree with the retraction.
撤回：M. K. Trivedi， A. Branton， D. Trivedi， S. Mondal， S. Jana，“生物场能量治疗在成人受试者心理症状、精神健康障碍和压力相关生活质量中的作用：一项随机对照临床试验”，《普通与家庭医学杂志》，第24期。3 (2023): 154-163, https://doi.org/10.1002/jgf2.606.The上述文章于2023年1月28日在线发表在Wiley online Library （wileyonlinelibrary.com）上，经期刊总编辑冈山正信同意撤回；日本初级保健协会；约翰·威利&；澳大利亚之子有限公司在对第三方提出的担忧进行调查后，同意撤回该研究，该调查发现，使用不适当的对照组作为试验的安慰剂组，心理问卷评分不一致，超出典型生理范围的高度不可信的功能生物标志物值，以及关于生物场能量治疗背后的科学证据的不支持的主张。然而，提交人被告知，所提供的解释和部分原始数据被认为不足以解决所关切的问题。因此，编辑对所提交的数据失去了信心，并认为这篇手稿的结果和结论没有得到充分的支持，而且在很大程度上受到了损害。作者不同意撤稿。
{"title":"RETRACTION: The role of biofield energy treatment on psychological symptoms, mental health disorders, and stress-related quality of life in adult subjects: A randomized controlled clinical trial","authors":"","doi":"10.1002/jgf2.773","DOIUrl":"https://doi.org/10.1002/jgf2.773","url":null,"abstract":"<p><b>RETRACTION</b>: M. K. Trivedi, A. Branton, D. Trivedi, S. Mondal, and S. Jana, “The Role of Biofield Energy Treatment on Psychological Symptoms, Mental Health Disorders, and Stress-Related Quality of Life in Adult Subjects: A Randomized Controlled Clinical Trial,” <i>Journal of General and Family Medicine</i> 24, no. 3 (2023): 154–163, https://doi.org/10.1002/jgf2.606.</p><p>The above article, published online on 28 January 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Masanobu Okayama; the Japan Primary Care Association; and John Wiley & Sons Australia, Ltd. The retraction has been agreed upon following an investigation into concerns raised by a third party, which revealed an inappropriate control group used as the placebo group of the trial, inconsistencies in the Psychological Questionnaire Scoring, highly implausible functional biomarker values that are out of the typical physiological range, and unsupported claims regarding the scientific evidence behind the biofield energy treatment. The authors were informed, however, the explanation and the partial raw data provided were deemed insufficient to address the concerns. Thus, the editors have lost confidence in the presented data and consider the results and conclusions of this manuscript insufficiently supported and substantially compromised. The authors disagree with the retraction.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 2","pages":"191"},"PeriodicalIF":1.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.773","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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