Journal of General and Family Medicine最新文献

Background: Studies on the accuracy of point-of-care (POC) testing using capillary samples are scarce. Therefore, this study aimed to assess the analytical accuracy of POC testing for white blood cell (WBC) and C-reactive protein (CRP) using capillary samples compared with conventional central laboratory testing using venous samples in a pediatric ambulatory care setting.

Methods: This was a retrospective study including patients younger than 18 years who underwent concurrent WBC and CRP evaluations via capillary and subsequent venous sampling within a 2-h window. Capillary and venous blood samples were collected using finger prick and standard venipuncture techniques, respectively. Capillary blood analysis was performed using a Microsemi CRP device. Venous samples were measured in the hospital's central laboratory. The agreement between the capillary POC and venous laboratory results was evaluated using Bland-Altman analysis.

Results: A total of 277 pediatric patients were included in this study. The median age of the participants was 1 year (interquartile range: 0-2 years). The mean difference between the capillary and venous measurements for WBC was -18 × 100/μL with 95% limits of agreement of -73 × 100/μL to 37 × 100/μL. The mean difference between the capillary and venous measurements for CRP was -0.25 mg/dL with 95% limits of agreement of -2.1 mg/dL to 1.6 mg/dL.

Conclusions: POC CRP testing via capillary sampling by finger prick demonstrated sufficient accuracy. POC CRP testing has the potential to be a valuable instrument for clinical decision making, particularly in screening febrile outpatient children.

Background: Our goal was to identify, and risk stratify primary care patients with microscopic hematuria (MH), describe the diagnostic evaluations they received, and determine whether the evaluations were consistent with the recommendations of the 2020 AUA/SUFU microscopic hematuria guidelines.

Methods: A retrospective review of patients presenting to primary care clinics with a diagnosis of MH was performed. The patient risk category was determined based on the 2020 AUA/SUFU guidelines. Diagnostic strategies were recorded, and guideline concordance was determined. Descriptive statistics were generated to describe outcomes.

Results: A total of 368 patients had a diagnosis of MH; 267/368 (72.6%) patients had all pertinent data available for risk stratification. One-hundred and fifty-six (58.4) patients were high-risk and 55 (35.3%) had a urologic visit. Forty-one of the 55 (75%) were diagnostically evaluated of which 13 (31.7%) were in-line with guideline recommendations. Eighty-two (30.7%) patients were at intermediate risk of which 33 (40.2%) had a urology visit. Of these 33 intermediate-risk patients, 27 (81.8%) were diagnostically evaluated, five (18.5%) of which were in-line with guideline recommendations. Twenty-nine patients were low risk of which 4 (13.8%) had a urology visit. Three of the four patients seen by urology (75%) were evaluated with imaging studies and none received a cystoscopy.

Conclusion: Almost 60% of the patients in our cohort were high-risk according to the AUA/SUFU 2020 guidelines. Across all strata, the majority of patients lacked a urology visit and diagnostic evaluation consistent with guideline recommendations. Future efforts should ensure appropriate urologic referral and optimize initial diagnostic strategies for patients with MH.

Despite being increasingly adopted in various regions, the model of Hospital-at-home can still appear to be confusing to many healthcare workers. The authors examined and summarized the existing concepts and implementations of Hospital-at-home. How Hospital-at-home contrasts to traditional inpatient models were outlined.

Background: The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale, the Community Assessment Risk Screen (CARS), and the Emergency Admission Risk Likelihood Index (EARLI) are scales that assess the risk of emergency department (ED) visits among home health care patients. This study validated these scales and explored factors that could improve their predictive accuracy among Japanese home health care patients.

Methods: This was a single-center retrospective cohort study. The primary outcome of unplanned ED visits was used to assess the validity of the DIVERT scale, CARS, and EARLI. Additionally, we examined whether the addition of patient age and receipt of advance care planning as variables on these assessments could enhance their precision.

Results: Altogether, 40 (17.8%) had at least one ED visit during the 6 months study period. In these patients, the DIVERT scale, CARS, and EARLI of the patients with ≥1 ED visit was superior compared with no ED visit (both p < 0.05). The area under the curve (AUC) of the DIVERT scale, CARS, and EARLI were 0.62, 0.59, and 0.60, respectively. Adding patient age and receipt of advance care planning improved the AUC in all three scales.

Conclusions: Our findings suggest that these assessment scales could be applicable to home health care patients in Japan. Furthermore, adding age and receipt of advance care planning as variables was found to enhance the predictive accuracy of the scales.

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. The Age-Friendly Health Systems (AFHS) framework, introduced in the U.S., offers a patient-centered, value-based approach to geriatric care, encompassing the "4Ms": Mentation, Mobility, Medication, and What Matters. These pillars prioritize cognitive health, physical function, appropriate medication use, and patient values. However, Japan has yet to implement this system widely. The integration of AFHS, with an additional focus on "Multicomplexity" (5Ms), aligns well with the core competencies of General and Family Medicine. This specialty is crucial in leading interdisciplinary efforts to enhance geriatric care, addressing fragmentation and variability in healthcare delivery. To successfully implement AFHS in Japan, general medicine physicians must be trained in managing complex conditions and coordinating care across specialties. This shift toward holistic, patientcentered care is essential for improving outcomes for older adults and reducing healthcare costs. Future research should focus on developing effective strategies for AFHS implementation and training healthcare teams for comprehensive care delivery.

Somatic symptom disorders (SSDs) present a complex interplay of physical and psychological factors, necessitating an integrative approach to diagnosis and management. This article explores the collaborative efforts between family medicine and psychiatry in addressing SSDs, emphasizing the importance of a multidisciplinary strategy for comprehensive patient care. Effective diagnosis involves recognizing the significance of both somatic symptoms and the patient's psychological response, with tools like structured clinical interviews and self-report questionnaires playing crucial roles. Management strategies include psychotherapeutic interventions such as cognitive behavioral therapy (CBT), pharmacological treatments, and lifestyle modifications, all tailored to the patient's needs. Communication strategies are vital in validating patients' experiences while addressing underlying psychiatric issues. Techniques such as active listening, biopsychosocial framing, and the teach-back method foster trust and improve treatment adherence. Cultural considerations and the use of interpreters enhance communication with diverse patient populations. Training programs for healthcare providers further improve competency in managing SSDs. This integrative approach aims to enhance patient outcomes by addressing the multifaceted nature of SSDs through collaborative care, effective communication, and comprehensive treatment planning.

Background: Multi-institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.

Methods: Six participants completed self-assessment questionnaires at three points: before, immediately after, and 6 months post-program. Knowledge and behavior changes were compared using the Mann-Whitney U test.

Results: Significant improvements in knowledge were observed and maintained at 6 months. However, behavioral changes were limited, with significant improvements only in counseling skills.

Conclusion: The program effectively increased knowledge but faced challenges in translating it into sustained behavioral change.

We present a 72-year-old man with end-stage renal disease and Hashimoto encephalopathy in whom a diagnosis of epidural emphysema because of esophageal perforation by a nasogastric tube placement. Although its imaging findings may be alarming to clinicians, close monitoring and conservative treatment are advisable.

COVID-19 has spread worldwide and significantly influenced economies. Refeeding syndrome (RFS) is a potentially fatal abnormalities of electrolytes and fluid that can occur in malnourished patients undergoing mechanical refeeding. Herein, we report the case of a man in his 20s with a normal body mass index who presented with RFS and vitamin B1 deficiency. Although it was uncommon under normal circumstances, it occurred because of the severe social situations that were prevalent in the COVID-19 era. In this era, physicians should carefully evaluate their patients' nutritional status to identify those at risk for RFS, even in young individuals.