Myotonic dystrophy is a hereditary neurological disease. While cardiovascular complications have been recognized, recent reports indicate that it increases the risk of deep vein thrombosis and pulmonary embolism (DVT/PE) compared to other dystrophies and healthy individuals with dyspraxia and a history of DVT as risk factors. It is important to consider myotonic dystrophy in patients with repeated idiopathic DVT/PE and to provide appropriate medical consultation.
Lemierre's syndrome is a fatal condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Early diagnosis of Lemierre's syndrome in primary care remains challenging because of its rarity and common initial symptoms like fever and sore throat. The COVID-19 pandemic has increased the difficulty of diagnosis, along with many diagnostic delays. Herein, we report a case in which an IJV thrombus was detected using point-of-care ultrasound (POCUS), leading to the diagnosis of Lemierre's syndrome. During the COVID-19 pandemic, POCUS was a simple and noninvasive technique for screening Lemierre's syndrome without radiation and low droplet exposure.
Having highly educated spouses may influence physicians' choice of practice location.
We analyzed a representative physician sample in the 2020 Japan Population Census.
Regression analyses adjusting for physicians' characteristics showed that physicians married to highly educated (with a graduate degree) spouses were less likely to practice in low physician supply areas (LPSAs) than other married physicians (adjusted, 7.8% vs. 9.1%; adjusted odds ratio, 0.84; 95% CI, 0.72–0.98).
Having highly educated spouses was associated with a lower likelihood of practicing in LPSAs. Qualitative research is needed to explore how spousal academic attainment influences physicians' practice location choices.
Designed and implemented over two decades ago, the Chronic Care Model is a well-established chronic disease management framework that has steered several healthcare systems in successfully improving the clinical outcomes of patients with type 2 diabetes mellitus. Research evidence cements the role of the Chronic Care Model (with its six key elements of organization of healthcare delivery system, self-management support, decision support, delivery system design, clinical information systems, and community resources and policies) as an integrated framework to revamp the type 2 diabetes mellitus-related clinical practice and care that betters the patient care and clinical outcomes. The current review is an evidence-lit summary of importance of use of Chronic Care Model in primary care and their impact on clinical outcomes for patients afflicted with one of the most debilitating metabolic diseases, type 2 diabetes mellitus.
Comprehensive understanding of emergency referrals (EmR), encompassing reasons for encounters (RFEs) and diagnoses, is crucial for primary care physicians (PCPs). Comparing EmR rates and subsequent admission rates can potentially enhance the quality of primary care for EmR practice. However, no study has evaluated RFEs among patients with EmRs. This study aimed to identify RFE/diagnosis in relation to subsequent admission among patients receiving EmR.
We conducted a retrospective cohort study at an urban family physician teaching clinic in Kawasaki City, Japan. Our cohort recruited consecutive EmR episodes with their medical records and admissions confirmed through response letters from receiving hospitals. Using the 2nd edition of the International Classification of Primary Care, we explored the frequency of RFEs and diagnoses, calculating EmR rates and admission rates as primary outcomes. Bivariate analyses were employed to compare admission and non-admission cases.
The present study encompassed 162 EmR episodes out of 47,901 visits, yielding an EmR rate of 3.38/1000 visits. Among 153 completely followed episodes, 99 patients were emergently admitted, resulting in a 64.7% admission rate. The admission group exhibited significantly higher age and a greater prevalence of dementia. Descriptive analysis revealed fever and pneumonia as the most frequent RFE and diagnosis, respectively, with significant differences between admission and non-admission groups.
The present study reports EmR and admission rates following EmR, highlighting differences in patient characteristics, RFEs, and diagnoses. The findings offer insights to enhance PCPs' EmR practices and serve as a benchmark for the scope of EmR practice.
Chronic cerebrospinal fluid leak with spinal cord compression can mimic the symptoms of ALS, with a snake-eyes appearance on MRI.
Mentorship is a dynamic reciprocal relationship, wherein a novice (mentee) grows with the encouragement of an advanced careerist (mentor). It is widely implemented in medical training programs. However, there are few reports on mentorship's educational effects in the Japanese context. This study investigated the association between mentorship and in-training examination scores during a clinical residency program in Japan.
A cross-sectional study was conducted in Japan, involving first and second year postgraduate (PGY-1 and PGY-2) residents set to take the General Medicine In-Training Examination (GM-ITE) at the end of the academic year of 2021. The GM-ITE, developed by a non-profit organization in 2012, assesses the overall clinical knowledge of PGY-1 and PGY-2 residents. Data on mentorship were obtained through an electronic survey, conducted immediately after the GM-ITE. The association between a resident's self-reported identification of at least one mentor and GM-ITE score was analyzed at multiple levels.
Of the total 4929 residents, 3266 (66.3%) reported having mentors. However, there was no association between mentorship and GM-ITE scores (adjusted score difference [aSD] = −0.22; 95% confidence interval [95% CI]: −0.64 to 0.19).
Among Japanese residents, in-training examination scores were not associated with mentorship.
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