Clinical research validity depends critically on sound sampling methodology and adequate sample size determination, yet many published studies demonstrate deficiencies in these fundamental aspects. This educational review addresses sampling techniques and sample size calculations in clinical research. The review covers probability sampling approaches, including simple random, systematic random, stratified, and cluster sampling methods, contrasting these with non-probability techniques such as convenience, purposive, snowball, and quota sampling. For each method, we discuss implementation strategies, inherent biases, and appropriate clinical applications. Sample size determination principles are presented across multiple study designs, encompassing cross-sectional prevalence studies, case–control investigations, cohort studies, randomized controlled trials, and correlational analyses. Key statistical concepts, including Type I and Type II errors, statistical power, effect size estimation, and variance considerations, are also explained. Additionally, some available software tools for sample size calculation are outlined to facilitate implementation. This review ultimately provides clinical researchers with essential knowledge to make informed methodological decisions that enhance study quality and contribute to the evidence base for healthcare decision-making.
{"title":"Sampling Methods and Sample Size Determination in Clinical Research: An Educational Review","authors":"Azzam Zrineh, Maysa Al-Usta, Abdallah Alwawi","doi":"10.1002/jgf2.70096","DOIUrl":"https://doi.org/10.1002/jgf2.70096","url":null,"abstract":"<p>Clinical research validity depends critically on sound sampling methodology and adequate sample size determination, yet many published studies demonstrate deficiencies in these fundamental aspects. This educational review addresses sampling techniques and sample size calculations in clinical research. The review covers probability sampling approaches, including simple random, systematic random, stratified, and cluster sampling methods, contrasting these with non-probability techniques such as convenience, purposive, snowball, and quota sampling. For each method, we discuss implementation strategies, inherent biases, and appropriate clinical applications. Sample size determination principles are presented across multiple study designs, encompassing cross-sectional prevalence studies, case–control investigations, cohort studies, randomized controlled trials, and correlational analyses. Key statistical concepts, including Type I and Type II errors, statistical power, effect size estimation, and variance considerations, are also explained. Additionally, some available software tools for sample size calculation are outlined to facilitate implementation. This review ultimately provides clinical researchers with essential knowledge to make informed methodological decisions that enhance study quality and contribute to the evidence base for healthcare decision-making.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891404","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}
<p>Morikawa et al. [<span>1</span>] demonstrate that patient satisfaction in primary care is significantly influenced by the contributions of non-physician staff, particularly nursing demeanor and care during waiting times. Their multivariable analysis identified nursing staff demeanor (PR 2.06) and waiting time care (PR 1.43) as independent predictors of satisfaction, underscoring that patient experience reflects the cumulative effect of multidisciplinary interactions rather than physician performance alone [<span>1</span>]. These findings offer important reflections for primary care practice, research, and policy development in the Philippines.</p><p>In many Philippine primary care settings, patient encounters begin well before the physician consultation. Nurses, midwives, and barangay health workers (BHWs) often serve as the first and most consistent points of contact [<span>2</span>]. The Japanese findings resonate strongly with this context, as Filipino patients interpret warmth, attentiveness, and respectful communication as manifestations of <i>malasakit</i>, a culturally embedded expression of care. Emphasizing nursing demeanor affirms the centrality of relational competence in patient experience, particularly in a system where non-physician staff carry substantial responsibilities for triage, counseling, health education, and emotional support [<span>3</span>].</p><p>Similarly, the importance of “waiting time care” aligns with the Philippine reality of long queues in both urban clinics and rural health units. Patient experience is shaped less by the duration of the wait and more by how patients are accompanied during that time. Simple gestures—status updates, brief conversations, blood pressure checks, or reassurance from BHWs—mitigate frustration and foster trust [<span>2</span>].</p><p>These insights suggest actionable strategies to enhance patient experience. Structured “waiting time care protocols” in <i>Konsulta</i> clinics and rural health units, led by nurses and BHWs, can provide consistent relational support during delays [<span>3</span>]. National training modules on compassionate communication for non-physician staff may improve relational quality without significant infrastructural investment. Strengthening the role of BHWs as patient navigators acknowledges their unique cultural and relational proximity to communities. Additionally, patient journey mapping can guide improvements in clinic workflows, ensuring that every interaction contributes positively to satisfaction [<span>1</span>].</p><p>Okayama proposes that the Longitudinal Integrated Clerkship is an innovative model of community-based clinical training in which non-physician staff are trained to provide culturally sensitive care, thereby enhancing patient-centeredness, fostering trust, and improving overall satisfaction, while also encouraging future healthcare professionals to value team-based, community-oriented practice [<span>4</span>]. For General and Family Med
Morikawa等人[bbb]证明，初级保健中的患者满意度受到非医生工作人员的贡献的显著影响，特别是护理行为和等待时间的护理。他们的多变量分析发现，护理人员的行为举止（PR为2.06）和等待时间护理（PR为1.43）是满意度的独立预测因子，强调患者体验反映了多学科互动的累积效应，而不仅仅是医生的表现[10]。这些发现为菲律宾的初级保健实践、研究和政策制定提供了重要的反思。在菲律宾的许多初级保健机构中，患者接触早在医生咨询之前就开始了。护士、助产士和村卫生工作者通常是第一个和最一致的接触点。日本的研究结果与这一背景产生了强烈的共鸣，因为菲律宾患者将温暖、关注和尊重的沟通视为malasakit的表现，这是一种文化中嵌入的关怀表达。强调护理行为肯定了关系能力在患者体验中的中心地位，特别是在一个非医生人员承担分诊、咨询、健康教育和情感支持等重大责任的系统中。同样，“等待时间护理”的重要性与菲律宾城市诊所和农村卫生单位排长队的现实相一致。病人的经历与其说是由等待的时间长短决定的，不如说是由在等待期间如何陪伴病人决定的。简单的手势——状态更新，简短的谈话，血压检查，或者来自bhws的安慰——都能减轻挫败感，培养信任。这些见解为提高患者体验提供了可行的策略。由护士和保健医生领导的康苏塔诊所和农村保健单位的结构化“等待时间护理协议”可在延误期间提供一致的关系支持。针对非医师员工的同情心沟通的国家培训模块可以在没有重大基础设施投资的情况下提高关系质量。加强bhw作为患者导航员的作用承认他们与社区的独特文化和关系接近。此外，患者旅程地图可以指导临床工作流程的改进，确保每一次互动都对满意度有积极的贡献。Okayama提出，纵向综合实习是一种创新的基于社区的临床培训模式，在这种模式中，非医生员工接受培训，提供文化敏感的护理，从而增强以患者为中心，培养信任，提高整体满意度，同时也鼓励未来的医疗保健专业人员重视以团队为基础，以社区为导向的实践bbb。对于全科医学和家庭医学，这些发现建议了未来的研究方向：检查bhw对患者满意度的贡献，评估将关系实践整合到临床操作中的干预措施。政策方面，将患者体验指标——特别是那些与非医生互动相关的指标——纳入PhilHealth Konsulta认证，可以激励整体的、以团队为基础的护理，与《全民医疗法案》高效、以人为本的初级保健目标保持一致。最后，Morikawa等人强调了菲律宾社区长期认可的原则：治疗本质上是关系的，高质量的护理依赖于整个医疗团队的协调参与。将菲律宾人的关系价值观融入到实践中，并赋予非医生员工权力，可以增强以患者为中心、文化响应能力和同情心。将这些相关实践整合到培训、认证和日常操作中，为实现更全面、公平和有效的初级保健提供了一条途径。Jeff Clyde G. Corpuz：概念化，调查，写作-原稿，写作-审查和编辑。作者没有什么可报道的。作者声明无利益冲突。这篇文章链接到https://doi.org/10.1002/jgf2.70073.The，作者没有什么可报告的。
{"title":"Non-Physician Contributors to Patient Satisfaction: Insights for Strengthening Philippine Primary Care","authors":"Jeff Clyde G. Corpuz","doi":"10.1002/jgf2.70095","DOIUrl":"https://doi.org/10.1002/jgf2.70095","url":null,"abstract":"<p>Morikawa et al. [<span>1</span>] demonstrate that patient satisfaction in primary care is significantly influenced by the contributions of non-physician staff, particularly nursing demeanor and care during waiting times. Their multivariable analysis identified nursing staff demeanor (PR 2.06) and waiting time care (PR 1.43) as independent predictors of satisfaction, underscoring that patient experience reflects the cumulative effect of multidisciplinary interactions rather than physician performance alone [<span>1</span>]. These findings offer important reflections for primary care practice, research, and policy development in the Philippines.</p><p>In many Philippine primary care settings, patient encounters begin well before the physician consultation. Nurses, midwives, and barangay health workers (BHWs) often serve as the first and most consistent points of contact [<span>2</span>]. The Japanese findings resonate strongly with this context, as Filipino patients interpret warmth, attentiveness, and respectful communication as manifestations of <i>malasakit</i>, a culturally embedded expression of care. Emphasizing nursing demeanor affirms the centrality of relational competence in patient experience, particularly in a system where non-physician staff carry substantial responsibilities for triage, counseling, health education, and emotional support [<span>3</span>].</p><p>Similarly, the importance of “waiting time care” aligns with the Philippine reality of long queues in both urban clinics and rural health units. Patient experience is shaped less by the duration of the wait and more by how patients are accompanied during that time. Simple gestures—status updates, brief conversations, blood pressure checks, or reassurance from BHWs—mitigate frustration and foster trust [<span>2</span>].</p><p>These insights suggest actionable strategies to enhance patient experience. Structured “waiting time care protocols” in <i>Konsulta</i> clinics and rural health units, led by nurses and BHWs, can provide consistent relational support during delays [<span>3</span>]. National training modules on compassionate communication for non-physician staff may improve relational quality without significant infrastructural investment. Strengthening the role of BHWs as patient navigators acknowledges their unique cultural and relational proximity to communities. Additionally, patient journey mapping can guide improvements in clinic workflows, ensuring that every interaction contributes positively to satisfaction [<span>1</span>].</p><p>Okayama proposes that the Longitudinal Integrated Clerkship is an innovative model of community-based clinical training in which non-physician staff are trained to provide culturally sensitive care, thereby enhancing patient-centeredness, fostering trust, and improving overall satisfaction, while also encouraging future healthcare professionals to value team-based, community-oriented practice [<span>4</span>]. For General and Family Med","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887298","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}
Practice-Based Research Networks (PBRNs) have historically been effective support mechanisms for primary care research. Although the number of PBRNs worldwide has increased, their numbers in Japan are relatively limited. This study aims to elucidate the current PBRN landscape in Japan and the process of establishing a new PBRN to encourage the formation of similar networks.
Methods
We conducted a national cross-sectional descriptive study in which six PBRNs in Japan were identified using the Agency for Healthcare Research and Quality PBRN Registry. Detailed information regarding their PBRN characteristics and activities was collected using a standardized Excel template. We further conducted an embedded illustrative case study of the experiences and lessons learned from initiating a PBRN, using data gathered from the steering committee members of the network and document review.
Results
Six primary care-focused PBRNs were found in regions ranging from large cities to isolated islands. Their relationships with academic external stakeholders also vary. All networks were established within the past 15 years, with most encountering funding challenges. The illustrative case study highlighted several key lessons, including the significance of motivation, necessity for clear membership and defined roles of PBRN members, the governance structure of the PBRN organizational diagram, and the importance of sustainable activities and funding.
Conclusions
PBRNs play a crucial role in building a sustainable foundation of evidence for primary care research. Support from the Japan Primary Care Association committees and the Global PBRN Initiative significantly aids in advancing PBRN activities, ultimately enhancing primary care research in Japan.
{"title":"Practice-Based Research Network Activities and Future Nationwide Plans in Japan","authors":"Hirotomo Yamanashi, Anna Dania, Makoto Kaneko, Takamasa Watanabe, Takahiro Mochizuki, Moe Kuroda, Mariko Ishisaka, Tadao Okada, Takuya Aoki, Yoshihiro Okura, Hiroshi Takayanagi, Jun Hamano, Hideki Mori, Koichiro Kadota, Yuya Motoishi, Jun Miyata, Koichiro Hamada, Shingo Masuda, Takahiro Maeda","doi":"10.1002/jgf2.70091","DOIUrl":"https://doi.org/10.1002/jgf2.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Practice-Based Research Networks (PBRNs) have historically been effective support mechanisms for primary care research. Although the number of PBRNs worldwide has increased, their numbers in Japan are relatively limited. This study aims to elucidate the current PBRN landscape in Japan and the process of establishing a new PBRN to encourage the formation of similar networks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a national cross-sectional descriptive study in which six PBRNs in Japan were identified using the Agency for Healthcare Research and Quality PBRN Registry. Detailed information regarding their PBRN characteristics and activities was collected using a standardized Excel template. We further conducted an embedded illustrative case study of the experiences and lessons learned from initiating a PBRN, using data gathered from the steering committee members of the network and document review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six primary care-focused PBRNs were found in regions ranging from large cities to isolated islands. Their relationships with academic external stakeholders also vary. All networks were established within the past 15 years, with most encountering funding challenges. The illustrative case study highlighted several key lessons, including the significance of motivation, necessity for clear membership and defined roles of PBRN members, the governance structure of the PBRN organizational diagram, and the importance of sustainable activities and funding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PBRNs play a crucial role in building a sustainable foundation of evidence for primary care research. Support from the Japan Primary Care Association committees and the Global PBRN Initiative significantly aids in advancing PBRN activities, ultimately enhancing primary care research in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970067","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}
<p>On June 22, 2025, the Committee on Social Determinants of Health (SDH) organized a symposium at the Japan Primary Care Association (JPCA) Annual Conference in Sapporo to explore how primary care professionals can effectively address complex and challenging issues faced by patients. The symposium offered both theoretical frameworks and practical strategies, and it was broadcast live as well as made available on demand.</p><p>The symposium began with a lecture by a psychosomatic medicine specialist with extensive expertise in trauma-informed care. He provided practical insights into addressing trauma in primary care [<span>1, 2</span>] (Table 1).</p><p>Next, a mental health social worker specializing in home care shared experiences of working with patients who present with complex complaints rooted in ACEs. She highlighted how seemingly incomprehensible behaviors and thought patterns often trace back to trauma and ACEs. Intervening to stabilize patients' living conditions took precedence while simultaneously validating their anxiety and sense of displacement. The speaker emphasized the importance of walking alongside patients in a supportive manner. She also reported that before reaching the clinic, many patients receive help from multiple supporters, underscoring the need for primary care professionals to imagine and acknowledge the struggles patients face in accessing care and to coordinate collaboratively.</p><p>Following this, a nurse with rich experience in primary care presented a case involving a patient who made threatening calls to hospital staff outside of regular hours. By first ensuring the safety of all personnel and then carefully gathering information about the patient's background, the team uncovered a life history marked by various anxieties and prides. These insights helped explain the patient's aggressive behavior as a form of dissociation. Through this empathic approach, the care team developed a new perspective on the patient, which ultimately led to the disappearance of threatening behavior.</p><p>The symposium concluded with a lively discussion with attendees. We discussed the importance of promoting trauma-informed care for healthcare staff, particularly by fostering psychological safety in the workplace. In response to a comment from a participant who felt isolated as the sole family physician handling complex cases, speakers emphasized the necessity of team-based collaboration in managing such cases. Rather than focusing solely on solving problems, primary care professionals should take pleasure in deepening their understanding of patients, as this process can reveal their own blind spots and foster growth. This approach aligns with six guiding principles to a trauma-informed approach introduced by Substance Abuse and Mental Health Services Administration (SAMHSA): (1) Safety, (2) Trustworthiness and Transparency, (3) Peer Support, (4) Collaboration and Mutuality, (5) Empowerment, Voice, and Choice, and (6) Cultural, Hi
{"title":"Theoretical Frameworks and Practical Strategies About Trauma-Informed Care in Primary Care Setting: Activity Report","authors":"Junki Mizumoto, Yusuke Suzuki, Yukari Tani, Saori Horo, Shota Utotani, Gemmei Iizuka, Maki Nishimura, Yuko Takeda","doi":"10.1002/jgf2.70090","DOIUrl":"https://doi.org/10.1002/jgf2.70090","url":null,"abstract":"<p>On June 22, 2025, the Committee on Social Determinants of Health (SDH) organized a symposium at the Japan Primary Care Association (JPCA) Annual Conference in Sapporo to explore how primary care professionals can effectively address complex and challenging issues faced by patients. The symposium offered both theoretical frameworks and practical strategies, and it was broadcast live as well as made available on demand.</p><p>The symposium began with a lecture by a psychosomatic medicine specialist with extensive expertise in trauma-informed care. He provided practical insights into addressing trauma in primary care [<span>1, 2</span>] (Table 1).</p><p>Next, a mental health social worker specializing in home care shared experiences of working with patients who present with complex complaints rooted in ACEs. She highlighted how seemingly incomprehensible behaviors and thought patterns often trace back to trauma and ACEs. Intervening to stabilize patients' living conditions took precedence while simultaneously validating their anxiety and sense of displacement. The speaker emphasized the importance of walking alongside patients in a supportive manner. She also reported that before reaching the clinic, many patients receive help from multiple supporters, underscoring the need for primary care professionals to imagine and acknowledge the struggles patients face in accessing care and to coordinate collaboratively.</p><p>Following this, a nurse with rich experience in primary care presented a case involving a patient who made threatening calls to hospital staff outside of regular hours. By first ensuring the safety of all personnel and then carefully gathering information about the patient's background, the team uncovered a life history marked by various anxieties and prides. These insights helped explain the patient's aggressive behavior as a form of dissociation. Through this empathic approach, the care team developed a new perspective on the patient, which ultimately led to the disappearance of threatening behavior.</p><p>The symposium concluded with a lively discussion with attendees. We discussed the importance of promoting trauma-informed care for healthcare staff, particularly by fostering psychological safety in the workplace. In response to a comment from a participant who felt isolated as the sole family physician handling complex cases, speakers emphasized the necessity of team-based collaboration in managing such cases. Rather than focusing solely on solving problems, primary care professionals should take pleasure in deepening their understanding of patients, as this process can reveal their own blind spots and foster growth. This approach aligns with six guiding principles to a trauma-informed approach introduced by Substance Abuse and Mental Health Services Administration (SAMHSA): (1) Safety, (2) Trustworthiness and Transparency, (3) Peer Support, (4) Collaboration and Mutuality, (5) Empowerment, Voice, and Choice, and (6) Cultural, Hi","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983832","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}
Crohn's disease can present with various extraintestinal symptoms; however, laryngeal involvement, particularly epiglottic ulcers, is rare. A 52-year-old man presented with a sore throat. Laryngeal endoscopy revealed an epiglottic ulcer. He had no gastrointestinal symptoms. Further evaluation revealed a bamboo joint-like appearance in the stomach and aphthous ulcers in the terminal ileum; thus, Crohn's disease was diagnosed. Treatment with prednisolone and mesalazine resulted in the resolution of symptoms without relapse. This case highlights that Crohn's disease can cause isolated epiglottic ulcers even in the absence of gastrointestinal symptoms and should be considered in the differential diagnosis of refractory throat ulcers.
{"title":"Epiglottic Ulceration as an Initial Manifestation of Crohn's Disease","authors":"Niina Yamashita, Yoshiki Morihisa, Hiroaki Nishioka","doi":"10.1002/jgf2.70089","DOIUrl":"https://doi.org/10.1002/jgf2.70089","url":null,"abstract":"<p>Crohn's disease can present with various extraintestinal symptoms; however, laryngeal involvement, particularly epiglottic ulcers, is rare. A 52-year-old man presented with a sore throat. Laryngeal endoscopy revealed an epiglottic ulcer. He had no gastrointestinal symptoms. Further evaluation revealed a bamboo joint-like appearance in the stomach and aphthous ulcers in the terminal ileum; thus, Crohn's disease was diagnosed. Treatment with prednisolone and mesalazine resulted in the resolution of symptoms without relapse. This case highlights that Crohn's disease can cause isolated epiglottic ulcers even in the absence of gastrointestinal symptoms and should be considered in the differential diagnosis of refractory throat ulcers.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987037","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}
In a previous study, a reduction in hypnotic-related fall and injury incidence rates was revealed after the hospital-wide standardization of hypnotic bundles for insomnia. Subsequently, a subgroup analysis was conducted to identify high-efficacy groups for new hypnotic bundles.
Methods
Total fall rates, hypnotic-related fall rates, and injury incidences before and after standardization of the new bundle were analyzed using seven subgroups: sex, age > 75 years, stroke, pneumonia, heart failure, fragility fractures, and dementia. Information on patients who fell, excluding pediatric patients, was collected from the Saitama Citizens Medical Center database.
Results
No subgroups with reduced fall rates were identified after standardization. Hypnotic-related fall rates were reduced after the standardization in males (incidence risk ratio [IRR]: 0.65, 95% confidence interval [CI]: 0.51–0.84) and those > 75 years old (IRR: 0.68, 95% CI: 0.54–0.85).
Conclusions
Hospital-wide efforts to standardize hypnotic bundles for insomnia may be more useful than efforts for a limited group. Even with interprofessional work, effective fall prevention practices can be challenging. Efforts to manage the risk of falls may shift to trauma prevention hospital-wide actions.
{"title":"Investigation of High Efficacy Groups for Hospital-Wide Standardized Hypnotic Bundles on Insomnia: A Subgroup Analysis of the COBATON Study","authors":"Yuta Yoshino, Naoko Fudaka, Miyuki Ogawa","doi":"10.1002/jgf2.70087","DOIUrl":"https://doi.org/10.1002/jgf2.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In a previous study, a reduction in hypnotic-related fall and injury incidence rates was revealed after the hospital-wide standardization of hypnotic bundles for insomnia. Subsequently, a subgroup analysis was conducted to identify high-efficacy groups for new hypnotic bundles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Total fall rates, hypnotic-related fall rates, and injury incidences before and after standardization of the new bundle were analyzed using seven subgroups: sex, age > 75 years, stroke, pneumonia, heart failure, fragility fractures, and dementia. Information on patients who fell, excluding pediatric patients, was collected from the Saitama Citizens Medical Center database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No subgroups with reduced fall rates were identified after standardization. Hypnotic-related fall rates were reduced after the standardization in males (incidence risk ratio [IRR]: 0.65, 95% confidence interval [CI]: 0.51–0.84) and those > 75 years old (IRR: 0.68, 95% CI: 0.54–0.85).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hospital-wide efforts to standardize hypnotic bundles for insomnia may be more useful than efforts for a limited group. Even with interprofessional work, effective fall prevention practices can be challenging. Efforts to manage the risk of falls may shift to trauma prevention hospital-wide actions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964254","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}
Ensuring sustainable healthcare delivery in rural Japan is a policy priority. However, the relationship between geographic rurality, as measured objectively, and the financial performance of public hospitals essential to these areas remains underexplored.
Objective
To examine the association between the Rurality Index for Japan (RIJ) and the likelihood of ordinary and medical service deficits in public hospitals, while adjusting for hospital size and bed occupancy rate.
Methods
We conducted a nationwide cross-sectional study using the fiscal year 2022 yearbook from Japan's Ministry of Internal Affairs and Communications. The primary outcomes were ordinary and medical service deficits, defined as a balance ratio of < 100%. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for RIJ quartiles, with hospital size and bed occupancy rate as covariates.
Results
A total of 643 hospitals were analyzed. In unadjusted analyses, the highest rurality quartile (Q4) was associated with significantly higher odds of ordinary deficit (OR 1.79, 95% CI 1.11–2.88). However, in multivariable analyses, no statistically significant independent association was found between RIJ and either deficit. Conversely, larger hospitals (≥ 300 beds; aOR 0.53, 95% CI 0.32–0.89) and those with higher bed occupancy rates (≥ 65.6%) were significantly associated with lower odds of ordinary deficit.
Conclusion
Hospital size and bed occupancy rate, rather than geographic rurality itself, are key structural factors associated with the financial sustainability of public hospitals in Japan.
背景：确保日本农村地区可持续的医疗保健服务是一项政策重点。然而，客观衡量的地理乡村性与对这些地区至关重要的公立医院的财务绩效之间的关系仍未得到充分探讨。目的在调整医院规模和床位占用率的情况下，探讨日本农村指数（RIJ）与公立医院普通服务赤字和医疗服务赤字可能性的关系。我们使用日本内务和交通部的2022财年年鉴进行了一项全国性的横断面研究。主要结局是日常和医疗服务赤字，定义为余额比率为100%。以医院规模和床位入住率为协变量，采用多变量logistic回归估计RIJ四分位数的调整优势比（aORs）和95%置信区间（95% ci）。结果共分析643家医院。在未经调整的分析中，最高的农村四分位数（Q4）与普通缺陷的几率显著较高相关（OR 1.79, 95% CI 1.11-2.88）。然而，在多变量分析中，没有发现RIJ和两种缺陷之间有统计学意义的独立关联。相反，较大的医院（≥300张床位；aOR 0.53, 95% CI 0.32-0.89）和床位占用率较高的医院（≥65.6%）与普通赤字的发生率较低显著相关。结论医院规模和床位占用率是影响日本公立医院财务可持续性的关键结构性因素，而非地理乡村性本身。
{"title":"Association Between Rurality and Financial Performance of Public Hospitals in Japan: A Nationwide Cross-Sectional Study","authors":"Kota Sakaguchi, Takafumi Abe, Ayako Erabi, Tomotoshi Iseki, Kaneko Makoto, Yoshihiko Shiraishi, Takashi Watari","doi":"10.1002/jgf2.70088","DOIUrl":"https://doi.org/10.1002/jgf2.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ensuring sustainable healthcare delivery in rural Japan is a policy priority. However, the relationship between geographic rurality, as measured objectively, and the financial performance of public hospitals essential to these areas remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association between the Rurality Index for Japan (RIJ) and the likelihood of ordinary and medical service deficits in public hospitals, while adjusting for hospital size and bed occupancy rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide cross-sectional study using the fiscal year 2022 yearbook from Japan's Ministry of Internal Affairs and Communications. The primary outcomes were ordinary and medical service deficits, defined as a balance ratio of < 100%. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for RIJ quartiles, with hospital size and bed occupancy rate as covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 643 hospitals were analyzed. In unadjusted analyses, the highest rurality quartile (Q4) was associated with significantly higher odds of ordinary deficit (OR 1.79, 95% CI 1.11–2.88). However, in multivariable analyses, no statistically significant independent association was found between RIJ and either deficit. Conversely, larger hospitals (≥ 300 beds; aOR 0.53, 95% CI 0.32–0.89) and those with higher bed occupancy rates (≥ 65.6%) were significantly associated with lower odds of ordinary deficit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hospital size and bed occupancy rate, rather than geographic rurality itself, are key structural factors associated with the financial sustainability of public hospitals in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969647","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}
Understanding how administrative errors, such as prescription and appointment scheduling omissions, and patient confidentiality breaches impact trust in physicians is crucial for improving patient-physician relationships and healthcare outcomes. To investigate the association between administrative errors, general trust in physicians, and interpersonal trust in a physician, we surveyed adults across Japan.
Methods
Participants were adults aged ≥ 20 years who had received treatment at least twice for non-communicable diseases within the past 6 months. The exposure variables were past experiences with prescription errors, confidentiality breaches, and appointment scheduling omissions by personal physicians treating their non-communicable diseases. General trust and interpersonal trust in a physician were measured using the Japanese version of the Wake Forest Physician Trust Scale.
Results
Among the 661 participants, nearly 14% reported experiencing at least one type of administrative error. Prescription errors were associated with a significant decrease in general trust in physicians (−9.78 points, 95% confidence interval [CI]: −13.74 to −5.81). Confidentiality breaches had the most significant negative impact on interpersonal trust (−14.09 points, 95% CI: −24.35 to −3.83), followed by appointment scheduling omissions (−13.56 points, 95% CI: −22.48 to −4.65). Mediation analysis revealed that the association between prescription errors and reduced general trust was partially mediated by decreased trust in personal physicians.
Conclusions
Administrative errors during care for non-communicable diseases significantly undermine patients' trust in physicians. Physicians should prioritize improving their practices, particularly regarding prescription errors, as these errors have broader implications for the public's perception of physicians.
{"title":"The Effect of Three Key Administrative Errors on Patient Trust in Physicians: Prescription Errors, Confidentiality Breaches, and Appointment Scheduling Omissions","authors":"Tetsuro Aita, Yoshia Miyawaki, Yu Katayama, Kosuke Sakurai, Nao Oguro, Takafumi Wakita, Nobuyuki Yajima, Ashwin B. Gupta, Noriaki Kurita","doi":"10.1002/jgf2.70086","DOIUrl":"https://doi.org/10.1002/jgf2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Understanding how administrative errors, such as prescription and appointment scheduling omissions, and patient confidentiality breaches impact trust in physicians is crucial for improving patient-physician relationships and healthcare outcomes. To investigate the association between administrative errors, general trust in physicians, and interpersonal trust in a physician, we surveyed adults across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were adults aged ≥ 20 years who had received treatment at least twice for non-communicable diseases within the past 6 months. The exposure variables were past experiences with prescription errors, confidentiality breaches, and appointment scheduling omissions by personal physicians treating their non-communicable diseases. General trust and interpersonal trust in a physician were measured using the Japanese version of the Wake Forest Physician Trust Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 661 participants, nearly 14% reported experiencing at least one type of administrative error. Prescription errors were associated with a significant decrease in general trust in physicians (−9.78 points, 95% confidence interval [CI]: −13.74 to −5.81). Confidentiality breaches had the most significant negative impact on interpersonal trust (−14.09 points, 95% CI: −24.35 to −3.83), followed by appointment scheduling omissions (−13.56 points, 95% CI: −22.48 to −4.65). Mediation analysis revealed that the association between prescription errors and reduced general trust was partially mediated by decreased trust in personal physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Administrative errors during care for non-communicable diseases significantly undermine patients' trust in physicians. Physicians should prioritize improving their practices, particularly regarding prescription errors, as these errors have broader implications for the public's perception of physicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987283","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}
Although advance care planning (ACP) has been vigorously promoted by the Japanese government, it remains unfamiliar to the general public. This study explored citizens' perspectives on ACP conversations in clinical settings using a newly developed handbook to support such discussions.
Methods
A qualitative study using four focus group interviews was conducted in March 2024 with 15 citizens aged 53–77, recruited through local networks. Participants included cancer survivors, family caregivers, and individuals with bereavement experiences and/or professional experience in healthcare. The interviews were transcribed verbatim and analyzed thematically.
Results
Four main themes emerged: (1) positive responses to ACP, (2) expectations for the broader promotion of ACP, (3) concerns regarding ACP and the use of the Handbook, and (4) real-life experiences related to ACP. Many participants expressed willingness to engage in ACP, and the Handbook was valued as a concrete tool for structuring conversations. Concerns were raised about whether healthcare professionals would have time and readiness to engage in ACP in busy hospital settings, suggesting a misalignment between citizens' openness to ACP and professionals' assumptions about patients' reluctance.
Conclusions
This study highlights the perspectives of relatively healthy citizens, an area that remains understudied. A proactive segment of the public willing to engage in ACP was identified. To support this, practical tools such as the Handbook should be accompanied by institutional support and professional readiness. Encouraging dialogue among citizens themselves may further help foster broader social momentum for ACP in Japan.
虽然日本政府大力推行提前照护计划（advance care planning， ACP），但对于普通民众来说，它仍然是一个陌生的概念。本研究探讨公民的观点在ACP对话在临床设置使用新开发的手册来支持这样的讨论。方法采用4次焦点小组访谈的定性研究方法，于2024年3月通过当地网络招募了15名年龄在53 ~ 77岁之间的市民。参与者包括癌症幸存者、家庭照顾者以及有丧亲经历和/或医疗保健专业经验的个人。采访被逐字记录下来，并按主题进行分析。结果调查结果显示了四个主要主题：(1)对ACP的积极回应；(2)对ACP更广泛推广的期望；(3)对ACP和手册使用的关注；(4)与ACP相关的现实体验。许多与会者表示愿意参加非加太计划，《手册》被认为是组织对话的具体工具。人们担心，在繁忙的医院环境中，医疗保健专业人员是否有时间和准备参与ACP，这表明公民对ACP的开放程度与专业人员对患者不情愿的假设之间存在不一致。本研究强调了相对健康公民的观点，这一领域仍未得到充分研究。我们发现有一部分积极主动的公众愿意参与ACP。为了支持这一点，诸如《手册》之类的实用工具应伴随着机构支持和专业准备。鼓励公民之间的对话可能进一步有助于促进日本ACP更广泛的社会动力。
{"title":"Perspectives of Japanese Citizens on Advance Care Planning in Clinical Settings: Findings From a Focus Group Study","authors":"Michiko Abe, Chikako Banjo, Machiko Inoue","doi":"10.1002/jgf2.70084","DOIUrl":"https://doi.org/10.1002/jgf2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although advance care planning (ACP) has been vigorously promoted by the Japanese government, it remains unfamiliar to the general public. This study explored citizens' perspectives on ACP conversations in clinical settings using a newly developed handbook to support such discussions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study using four focus group interviews was conducted in March 2024 with 15 citizens aged 53–77, recruited through local networks. Participants included cancer survivors, family caregivers, and individuals with bereavement experiences and/or professional experience in healthcare. The interviews were transcribed verbatim and analyzed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four main themes emerged: (1) positive responses to ACP, (2) expectations for the broader promotion of ACP, (3) concerns regarding ACP and the use of the Handbook, and (4) real-life experiences related to ACP. Many participants expressed willingness to engage in ACP, and the Handbook was valued as a concrete tool for structuring conversations. Concerns were raised about whether healthcare professionals would have time and readiness to engage in ACP in busy hospital settings, suggesting a misalignment between citizens' openness to ACP and professionals' assumptions about patients' reluctance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the perspectives of relatively healthy citizens, an area that remains understudied. A proactive segment of the public willing to engage in ACP was identified. To support this, practical tools such as the Handbook should be accompanied by institutional support and professional readiness. Encouraging dialogue among citizens themselves may further help foster broader social momentum for ACP in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964390","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}
We report an 80-year-old man with type 2 diabetes who presented with life-threatening hypoglycemia (36 mg/dL) and coma, requiring high-dose insulin (74 units/day). Exogenous insulin antibody syndrome (EIAS) was suspected due to his glycemic instability and high insulin requirements. Subsequent testing confirmed elevated insulin antibodies (8.7 U/mL). Switching insulin analogues (to 32 units/day) promptly achieved stable glycemic control. This case highlights that EIAS, an under-recognized cause of unpredictable glycemia in insulin-treated diabetes, should be considered in patients with severe hypoglycemia and high insulin requirements. Modifying the insulin regimen is key for diagnosis and treatment.
{"title":"Exogenous Insulin Antibody Syndrome: An Overlooked Cause of Severe Hypoglycemia and Insulin Resistance in a Patient With Type 2 Diabetes Treated With Insulin","authors":"Kazuki Miyaue, Hiroki Isono","doi":"10.1002/jgf2.70085","DOIUrl":"https://doi.org/10.1002/jgf2.70085","url":null,"abstract":"<p>We report an 80-year-old man with type 2 diabetes who presented with life-threatening hypoglycemia (36 mg/dL) and coma, requiring high-dose insulin (74 units/day). Exogenous insulin antibody syndrome (EIAS) was suspected due to his glycemic instability and high insulin requirements. Subsequent testing confirmed elevated insulin antibodies (8.7 U/mL). Switching insulin analogues (to 32 units/day) promptly achieved stable glycemic control. This case highlights that EIAS, an under-recognized cause of unpredictable glycemia in insulin-treated diabetes, should be considered in patients with severe hypoglycemia and high insulin requirements. Modifying the insulin regimen is key for diagnosis and treatment.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970189","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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