Journal of General and Family Medicine最新文献

Sarcopenia can be classified as age-, activity-, nutrition-, and disease-related. Hospital-associated sarcopenia, acute sarcopenia, and iatrogenic sarcopenia are activity-, nutrition-, and disease-related, not age-related. There is considerable overlap between hospital-associated sarcopenia and acute sarcopenia; however, they are distinct concepts. Some causes of hospital-associated sarcopenia and acute sarcopenia are iatrogenic.

We report a case of filicide which is an under-researched entity in Bangladesh. A 28-year-old lady visited with complaints of irregular eating followed by self-induced vomiting, poor anger control, irregular sleep, hopelessness, and suicidal thoughts for the last year. On the third visit, she admitted that she killed her 32-day-old baby by keeping it in a refrigerator. The case raises some forensic psychiatric complexities as the patient confessed it to the psychiatrist while family members know it as an accidental aspiration. It indicates the complex nature and dire need for psychosocial support in Bangladesh.

Here we report a case of sarcoidosis which demonstrated with bilateral ankle arthritis. We usually do not consider sarcoidosis routinely for the differential diagnosis of acute arthritis, however, up to 15 to 25% of sarcoidosis complicate arthritis, typically in ankle joints. Sarcoid arthritis is reported to occur mainly in young northern Europe women, whereas this case intimate that we should take sarcoidosis into account as the differential diagnosis of ankle arthralgia also among Asian men especially when combining upper respiratory symptoms.

In Japan, the Model Core Curriculum for Medical Education, which is the National Model Core Curriculum for Undergraduate Medical Education, was first published in 2001 and has since been revised to meet the needs of an aged society and the global standardization of medical education.¹ The model core curriculum was created by extracting core parts of the curriculum that should be commonly addressed by all universities when formulating their own curricula.¹

In Japan, the proportion of patients with multiple comorbid medical conditions and complex social backgrounds is anticipated to escalate. Reflecting this rapid demographic change, training medical professionals who can respond to the drastic changes is socially important. For this reason, a new expertise quality and ability “Generalism,” which is a comprehensive attitude to approach toward patients, has been incorporated to this updated version of the model core curriculum.¹ The objective of generalism is to “take a multi-systemic view of the patient's problems and consider the patient's psychosocial background to provide comprehensive, flexible medical care that responds to the needs of the patient and is not limited to one's own specialty, supporting the achievement of individual and societal well-being.”

The quality and ability set forth here and suitable for general medicine education. However, considering that only approximately 300 general medicine physicians are trained annually in Japan,² an efficient and effective educational strategy is required to achieve the learning objectives. In this letter, we propose educational strategies for generalism.

On-demand videos that can replace lectures should be made available and deployed as a shared resource throughout the country. In addition, support from academic organizations will be necessary to ensure high-quality teaching materials. Video materials for documentaries and cine-medications that allow students to visualize the actual site would also be useful. As a flipped classroom model, knowledge acquired in advance through video materials can be applied to early experiential training and clinical clerkships.³

It is also essential to share education resources (human resources, contents, and materials) in collaboration with diverse medical institutions outside the university rather than seeking resources only within the single university. Community hospitals and clinics are more likely to provide community-oriented medical education and experience in the primary care field than university hospitals, which are higher level medical institutions. Furthermore, simply sending medical students to the community is not an effective form of education; the faculty members teaching there must also be able to provide high-quality education.⁴ University hospitals, as conductors of the edu

Diagnostic excellence is based on six fundamental principles of healthcare quality proposed by the Institute of Medicine in 2001, which state that diagnoses must be safe, effective, patient-centered, timely, efficient, and equitable.