Journal of General and Family Medicine最新文献

Background: Patients with somatoform pain experience physical pain that cannot be attributed to any underlying medical or physiological cause, and it is often thought to be related to psychological factors. Health professionals encounter difficulties identifying this specific type of chronic pain, leading to suboptimal treatment strategies. Therefore, we aimed to describe the characteristics of patients with somatoform pain, to support the identification of affected patients.

Methods: We collected and analyzed a cross-sectional survey data from 200 patients with somatoform pain admitted to one of three psychosomatic centers in Germany between August 2013 and July 2014. The survey contains 10 different categories, all of them referring to pain-related topics. Within the survey, we analyzed validated as well as non-validated questionnaires. Here, we present the following five: Personal data, Body: Pain perception, Cognition: Pain processing, Pain behavior, and Physical complaints.

Results: Our results highlight that most patients with somatoform pain experience it in several body parts and as persisting, lasting >12 h/day (50%), and constantly changing (71%). Furthermore, patients indicate feelings of helplessness, by agreeing to the expressions the pain controls me (70%). Finally, we found that pain is predominantly seen as suffering, failing to convey emotional pain, despite cognitively acknowledging the dependency of emotional and physical pain.

Conclusion: The study identified specific and distinctive characteristics in the emotional and behavioral responses of patients with somatoform pain, potentially distinguishing them from other patients with chronic pain.

Coaching in medical education is a valuable method for enhancing the well-being and job satisfaction of medical professionals, particularly through interactive conversations that foster self-awareness and independent action. A 90-min coaching training program, incorporating lectures and role-plays, was conducted to equip medical professionals with essential coaching skills. The program was well received, and there are plans to expand and tailor future programs to further develop these skills among various healthcare educators.

Background: Deprescribing is a critical component of clinical practice, especially in geriatric medicine. Nevertheless, the attributes of patients who are prepared for, interested in, and could potentially benefit from deprescribing have not been well examined. The Patient Perceptions of Deprescribing (PPoD) evaluates patients' overall readiness for deprescribing and is complemented by an 11-item validated short form (SF-PPoD). The objective of this study was to develop a Japanese version of the SF-PPoD and assess its reliability and validity within Japanese older adults with polypharmacy.

Methods: The SF-PPoD was translated, back-translated, and assessed in a cognitive interview. We conducted a cross-sectional survey with 196 patients aged 65 years or older with five or more medications using the Japanese version to test for reliability and validity. We examined internal consistency and construct validity to determine if the Japanese sample responses reproduce the two subscales in the original SF-PPoD. Finally, we examined intra-person replicability using the intraclass correlation coefficient, in which 100 participants were invited and 93 participated.

Results: 118 males and 78 females, with a mean age of 79.2 [SD 6.5] years, completed the survey. Confirmatory factor analysis of the Japanese version of SF-PPoD revealed satisfactory structural validity with two-dimensional structure, "Motivation for Deprescribing" and "Primary Care Physician Relationship." Cronbach's alpha showed good internal consistency, and test-retest demonstrated acceptable intra-rater reliability.

Conclusions: We developed and validated a Japanese version of SF-PPoD with an 11-item, two-dimensional structure consistent with the original SF-PPoD. This scale may facilitate shared decision-making for medication optimization among older adults living with multimorbidity.

We report a rare case of a 90-year-old woman with Stage IV lung cancer awaiting transfer to hospice care who developed sudden abdominal and knee skin mottling. Elevated inflammatory markers on blood tests and emergent computed tomography led to a diagnosis of acute mesenteric ischemia, and the patient passed away 7 h later. Skin mottling indicates decreased blood flow in the gastrointestinal tract and is observed during mesenteric ischemia. Abdominal skin mottling may serve as an important physical finding that is detected early and suggests circulatory failure and intestinal ischemia.

Background: Chronic periodontal disease primarily causes tooth loss and oral frailty and is linked to chronic conditions such as diabetes mellitus. However, its progression and broader studies on chronic diseases have not been well explored. This study aimed to investigate this association using claims data.

Methods: This retrospective cohort study used linked medical, dental, and pharmacy claims data from a local municipality in Japan. The study included participants aged 40-70 years who had received medical care between April 2017 and March 2018. Exposures included age, sex, and common chronic diseases previously reported to be associated with periodontal diseases (21 diseases). We defined the outcome, "progression of severe periodontitis" as the worsening of periodontal disease to a severe stage requiring surgery or tooth extraction, determined by the presence of a periodontal surgery code or a deeper probing pocket depth (≥6 mm) code along with the tooth extraction procedure code. The participants were followed up until March 2022, and multivariate analysis was conducted using Cox proportional hazard models.

Results: Among 28,846 participants, 1035 (3.6%) progressed to severe periodontal disease. In the multivariate analysis, only diabetes mellitus was significantly associated with severe periodontal disease, with a hazard ratio of 1.26 (95% confidence interval, 1.08-1.53) among all chronic diseases.

Conclusion: Patients with diabetes mellitus had a high risk of severe periodontal disease progression, suggesting that proactive dental visits should be recommended to prevent severe periodontal disease.

The process of mixed methods data analysis has long been understudied and needs clear guidance for researchers. This review article honors Michael D. Fetters' pioneering work on mixed methods data analysis, building on his concepts of integration, joint displays, and metainferences. This review summarizes existing mixed methods data analysis discussions and proposes advanced steps for the analysis process. Our approach involves identifying a research problem, collecting diverse data, selecting a mixed methods design, integrating the data within the design, using joint displays for analysis, and drawing metainferences. We illustrate our methods with a Japanese empirical research study from family medicine. This article contributes to the field of mixed methods research by detailing a practical process approach to mixed methods analysis combining recent procedures in the field of mixed methods research.

Background: The Patient-Centered Clinical Method (PCCM) plays an important role in family doctors' ability to communicate effectively with patients. Although the parenting experiences of healthcare providers can be utilized to communicate with patients, it is unclear how they contribute to family doctors' practice.

Methods: A qualitative descriptive study focusing on the parenting experiences of Japanese family doctors and their perceptions of how these experiences interfaced with their clinical practice of the PCCM was conducted. Participants were selected using snowball sampling, and the data were collected via semi-structured interviews while recording online, which were transcribed verbatim and analyzed using qualitative descriptive analysis, with data-derived codes being systematically applied and reflexively interpreted. The categories were refined concurrently with the interviews. Once it was established that no additional categories were required, the recruitment and analysis process was concluded.

Results: The eight participants were recruited, and the following themes were extracted; these were "Developing patience and new perspectives through raising children," "Empathizing with the experiences of others," "Building awareness of social factors and home context," "Reflecting on one's own words and behavior," "Forming partnerships with patients through shared parenting experiences," and "Facilitating interpersonal growth."

Conclusion: The communication skills that have been refined through personal experiences of raising children are transferable between professional and family situations. This research shows that such skills are not mutually exclusive to professional or family settings and can be used effectively to improve clinical practice as part of the PCCM model of consulting.

Background: Family physicians (FPs) are expected to identify, diagnose, and treat mental health problems. Despite challenges such as limited time and low confidence in their skill as mental health providers, FPs generally consider mental health as a meaningful part of their profession. However, the role of the FP in mental health services is not clearly established in Japan. Studies have not been performed in countries without an established role of FPs' in mental health care. This study investigated Japanese FP's attitudes, difficulties, and perceived significance in managing mental health problems.

Methods: Semi-structured interviews were conducted between September 2022 and February 2023. Participants were Japanese FPs involved in mental health care. Interview transcripts were subjected to thematic analysis.

Results: Thirteen FPs were interviewed. The FPs approached mental health problems "as a FP who provides holistic and comprehensive care" and "practice based on experience and self-reflection." The difficulties faced by FPs included "time management problems" and "referral management problems and conflicts." Regarding significance, FPs mentioned that "gaining a deeper understanding of humanity" is important for managing mental health problems.

Conclusions: The attitude of Japanese FPs toward mental health care was based on awareness of the FP's specialty. Despite difficulties such as time and referral management issues, managing mental health problems was generally considered rewarding for professional growth.