COVID-19 vaccination is critical for residents of long-term care facilities (LTCFs), yet Japan's requirement for individual written consent creates dilemmas for residents with dementia who lack capacity. We examined consent practices and expected ethical support in Japanese LTCFs.
Methods
In August 2021, immediately after the priority vaccination for the elderly ended in July, a questionnaire was mailed to the directors of 4381 LTCFs nationwide.
Results
Valid responses were obtained from 495 facilities, and 24.0% of the respondents reported full vaccination coverage. The leading reason for non-vaccination was lack of family consent (50.9%), which surpassed resident refusal (8.1%). When resident consent could not be confirmed but a reachable family member existed, 98.3% were vaccinated based on family consent. When neither resident consent nor a contactable family member was available, 73.5% of residents were vaccinated based on an assessment of their best interests. Ethical issues were mainly handled via multidisciplinary conferences (73.1%) or managerial decisions (e.g., director judgment; 41.8%). For future support, facilities expected guidance from the local government or public health centers (53.3%) and LTCF associations (36.8%), followed by in-house ethics committees or consultation teams (36.0%).
Conclusion
Despite regulations requiring individual consent, many facilities proceeded with vaccination based on family consent or staff judgment. To ensure vaccinations are conducted in accordance with both the substituted judgment standard and the best interest standard, current regulations governing vaccination should be revised. Furthermore, external entities, especially local governments and sector associations, are expected to play key roles in supporting ethical decision-making in LTCFs.
{"title":"COVID-19 Vaccination Decision-Making for Residents With Dementia in Japanese Long-Term Care Facilities: A National Cross-Sectional Survey","authors":"Masayuki Oki, Noriko Nagao, Toshihiko Dozono, Keiko Kamiya, Yasuhiko Miura, Kei Takeshita","doi":"10.1002/jgf2.70093","DOIUrl":"https://doi.org/10.1002/jgf2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>COVID-19 vaccination is critical for residents of long-term care facilities (LTCFs), yet Japan's requirement for individual written consent creates dilemmas for residents with dementia who lack capacity. We examined consent practices and expected ethical support in Japanese LTCFs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In August 2021, immediately after the priority vaccination for the elderly ended in July, a questionnaire was mailed to the directors of 4381 LTCFs nationwide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Valid responses were obtained from 495 facilities, and 24.0% of the respondents reported full vaccination coverage. The leading reason for non-vaccination was lack of family consent (50.9%), which surpassed resident refusal (8.1%). When resident consent could not be confirmed but a reachable family member existed, 98.3% were vaccinated based on family consent. When neither resident consent nor a contactable family member was available, 73.5% of residents were vaccinated based on an assessment of their best interests. Ethical issues were mainly handled via multidisciplinary conferences (73.1%) or managerial decisions (e.g., director judgment; 41.8%). For future support, facilities expected guidance from the local government or public health centers (53.3%) and LTCF associations (36.8%), followed by in-house ethics committees or consultation teams (36.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite regulations requiring individual consent, many facilities proceeded with vaccination based on family consent or staff judgment. To ensure vaccinations are conducted in accordance with both the substituted judgment standard and the best interest standard, current regulations governing vaccination should be revised. Furthermore, external entities, especially local governments and sector associations, are expected to play key roles in supporting ethical decision-making in LTCFs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986953","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}
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare inflammatory arthritis of older adults. We report a 92-year-old man who presented with fatigue and distal pitting edema, fulfilling the clinical features of RS3PE. Although corticosteroids are typically effective, he showed an incomplete response and relapsed despite dose escalation. Addition of methotrexate resulted in complete remission, with normalization of inflammatory markers. Elderly-onset rheumatoid arthritis and paraneoplastic RS3PE were considered but were clinically unlikely. This case highlights that RS3PE can occur even in nonagenarians and may require disease-modifying therapy when corticosteroid responsiveness is insufficient.
{"title":"Recurrent Remitting Seronegative Symmetrical Synovitis With Pitting Edema in a Nonagenarian: An Atypical Clinical Course Requiring Methotrexate for Remission","authors":"Ken Sato","doi":"10.1002/jgf2.70098","DOIUrl":"https://doi.org/10.1002/jgf2.70098","url":null,"abstract":"<p>Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare inflammatory arthritis of older adults. We report a 92-year-old man who presented with fatigue and distal pitting edema, fulfilling the clinical features of RS3PE. Although corticosteroids are typically effective, he showed an incomplete response and relapsed despite dose escalation. Addition of methotrexate resulted in complete remission, with normalization of inflammatory markers. Elderly-onset rheumatoid arthritis and paraneoplastic RS3PE were considered but were clinically unlikely. This case highlights that RS3PE can occur even in nonagenarians and may require disease-modifying therapy when corticosteroid responsiveness is insufficient.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963916","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}
Depression and polypharmacy are both common among older adults and may be closely interrelated.
Methods
This systematic review and meta-analysis examined the association between depression and polypharmacy by searching EMBASE, PubMed, Web of Science, and PsycINFO from inception to 18 May 2023. The review was registered in PROSPERO (CRD42022343619).
Results
Eight studies met the inclusion criteria, with six rated high quality and two medium quality. Pooled analysis using a random-effects model demonstrated a strong association between depression and polypharmacy (OR = 2.49; 95% CI: 1.88–3.29; I² = 83%). Subgroup analyses revealed consistently elevated associations in both community-based and institutional/clinic-based populations.
Conclusions
Depression is associated with polypharmacy among older adults. These findings underscore the importance of integrating mental health assessment into medication management strategies for older adults.
背景：抑郁症和多重用药在老年人中都很常见，并且可能密切相关。方法通过检索EMBASE、PubMed、Web of Science、PsycINFO等数据库，从数据库建立至2023年5月18日，对抑郁症与多药的关系进行系统评价和meta分析。该综述已在PROSPERO注册（CRD42022343619）。结果8项研究符合纳入标准，其中高质量6项，中等质量2项。采用随机效应模型进行的汇总分析显示，抑郁症与多药治疗之间存在很强的相关性（OR = 2.49; 95% CI: 1.88-3.29; I²= 83%）。亚组分析显示，在以社区为基础的人群和以机构/诊所为基础的人群中，相关性持续升高。结论老年人抑郁症与多药相关。这些发现强调了将心理健康评估纳入老年人药物管理策略的重要性。
{"title":"Association Between Depression and Polypharmacy in Older Adults—A Systematic Review and Meta-Analysis","authors":"Yi-Hsin Wang, Tsung-Yu Tsai, Hung-Chang Chou, Huei Chung","doi":"10.1002/jgf2.70094","DOIUrl":"https://doi.org/10.1002/jgf2.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Depression and polypharmacy are both common among older adults and may be closely interrelated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review and meta-analysis examined the association between depression and polypharmacy by searching EMBASE, PubMed, Web of Science, and PsycINFO from inception to 18 May 2023. The review was registered in PROSPERO (CRD42022343619).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies met the inclusion criteria, with six rated high quality and two medium quality. Pooled analysis using a random-effects model demonstrated a strong association between depression and polypharmacy (OR = 2.49; 95% CI: 1.88–3.29; I² = 83%). Subgroup analyses revealed consistently elevated associations in both community-based and institutional/clinic-based populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Depression is associated with polypharmacy among older adults. These findings underscore the importance of integrating mental health assessment into medication management strategies for older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904633","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}
Tranexamic acid (TXA) is sometimes used to relieve sore throat discomfort from acute upper-respiratory tract infection (URTI), but its clinical effect has not been demonstrated in robust randomized controlled trials.
Methods
The tranexamic acid for URTI study is a randomized double-blinded clinical trial that was conducted between November 2023 and March 2025. Patients with URTI and a sore throat (18–65 years old) were randomized to receive either 1 g placebo (lactose) or 1 g preparation of 50% TXA. Randomization was stratified according to age (< 45 vs. ≥ 45 years) and baseline sore throat visual analog scale (VAS) score (< 50 vs. ≥ 50). Change in the proportion of patients with sore throat score more than a moderate level within a 2-h period after taking TXA was the primary outcome. We also examined the difference in sore throat VAS scale score between before and 2 h after TXA was taken. Data were analyzed using analysis of covariance, controlling for stratification factors.
Results
We analyzed the 17 participants assigned to each group (total = 34). The groups were not significantly different in the proportion of patients whose sore throat had a moderate or greater impact on their day-to-day life (TXA 41.2% vs. placebo 47.1%; p = 1.00). Similarly, they did not significantly differ in mean change of sore throat score on VAS within 30 min (TXA 17.3 vs. placebo 13.1; p = 0.49). No side effects were reported.
Conclusion
TXA was not significantly better than a placebo at relieving acute URTI-associated sore throat.
{"title":"Tranexamic Acid for Acute Upper Respiratory Tract Infection-Associated Sore Throat Pain: A Randomized Controlled Trial","authors":"Naoto Ishimaru, Toshio Shimokawa, Masataka Ono, Shimpei Mizuki, Yohei Kanzawa, Takahiro Nakajima","doi":"10.1002/jgf2.70097","DOIUrl":"https://doi.org/10.1002/jgf2.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tranexamic acid (TXA) is sometimes used to relieve sore throat discomfort from acute upper-respiratory tract infection (URTI), but its clinical effect has not been demonstrated in robust randomized controlled trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The tranexamic acid for URTI study is a randomized double-blinded clinical trial that was conducted between November 2023 and March 2025. Patients with URTI and a sore throat (18–65 years old) were randomized to receive either 1 g placebo (lactose) or 1 g preparation of 50% TXA. Randomization was stratified according to age (< 45 vs. ≥ 45 years) and baseline sore throat visual analog scale (VAS) score (< 50 vs. ≥ 50). Change in the proportion of patients with sore throat score more than a moderate level within a 2-h period after taking TXA was the primary outcome. We also examined the difference in sore throat VAS scale score between before and 2 h after TXA was taken. Data were analyzed using analysis of covariance, controlling for stratification factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed the 17 participants assigned to each group (total = 34). The groups were not significantly different in the proportion of patients whose sore throat had a moderate or greater impact on their day-to-day life (TXA 41.2% vs. placebo 47.1%; <i>p</i> = 1.00). Similarly, they did not significantly differ in mean change of sore throat score on VAS within 30 min (TXA 17.3 vs. placebo 13.1; <i>p</i> = 0.49). No side effects were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TXA was not significantly better than a placebo at relieving acute URTI-associated sore throat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN000056394</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904664","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}
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}
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