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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Japan is promoting physician-led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician-led home care and to identify associated factors.
This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician-led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10-point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause-specific Cox regression was conducted to identify factors associated with BI improvement.
A total of 660 patients were analyzed, with a median follow-up of 308 days. The one-year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause-specific Cox regression showed that patients with MMSE-J scores < 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement.
Following the initiation of physician-led home visits, approximately one-quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care.
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