Epidermolysis bullosa (EB) is a group of genetic skin diseases, which manifest as fragile skin and blistering in addition to many extracutaneous conditions. Pediatricians and primary care providers play an integral role in managing these patients with multifaceted care needs. There are many resources to navigate treating the various manifestations of EB and to assist with the partnership between pediatricians, dermatologists, and other specialists. There are also newly approved therapies for treating some forms of EB. As patients may only attend the multidisciplinary clinic for the management of their condition at designated intervals, the primary care provider becomes the first point of contact in many acute or healthcare maintenance visits. Using the resources and tips discussed herein, the pediatrician can work with the rest of the medical team to best optimize the clinical outcomes of patients with EB.
Limited evidence exists regarding the impact of baseline functional and cognitive impairments on the outcomes of patients with pneumonia.
We used medical and long-term care administrative databases in a prefecture in Japan that contained care need levels assessed using the national standardized certification system. We identified patients aged ≥65 years who were hospitalized for pneumonia between June 2014 and October 2018. The impairments were classified into four categories based on estimated total daily care time: no care needs, support levels 1–2, care needs level 1 (estimated care time of 25–49 min), care needs level 2–3 (50–89 min), and care needs level 4–5 (≥90 min). The primary outcome was the in-hospital mortality rate. Secondary outcomes were death and care needs at 6 months and 1 year after admission. We evaluated the outcomes based on care need levels and conducted multivariate analyses adjusting for potential confounders.
A total of 15,537 patients (mean age 83.9 years) were included. The in-hospital mortality rates for patients with no care needs, support levels 1–2 and care needs level 1, care needs levels 2–3, and care needs levels 4–5 were 10.5%, 15.9%, 21.1%, and 24.7%, respectively. The proportions of patients who died or experienced worsening care needs at 6 months were 43.6%, 60.4%, 60.0%, and 50.2%, respectively. Multivariable analyses demonstrated independent associations of preexisting care needs with both in-hospital mortality and long-term outcomes.
Preexisting long-term care needs are associated with short- and long-term outcomes in older inpatients with pneumonia.
Family physicians play a crucial role in assessing decision-making capacity, yet face challenges because of time constraints and lack of training. This article presents a structured framework to guide these assessments, ensuring ethical and efficient evaluations. By applying key principles—clarifying the decision at hand, assessing understanding, appreciation, reasoning, and expression—physicians can navigate complex cases while balancing patient autonomy with appropriate medical care.
LGBTQ+ patients often face discrimination in a healthcare setting, and LGBTQ+ healthcare professionals experience disproportionately high levels of workplace stress. The purpose of this research is (i) to explore healthcare professionals' experiences about LGBTQ+ patients and colleagues and (ii) evaluate LGBTQ+ healthcare professionals' experiences, challenges, and concerns in their workplace.
The Sexual Orientation, Gender Identity, and Gender Expression (SOGIE) Project of the Japan Federation of Democratic Medical Institutions (MIN-IREN) developed and distributed a questionnaire to assess staff experiences related to SOGI at their workplace.
A total of 6216 professionals participated. Of these, 443 (7.1%) reported witnessing or hearing about discrimination against LGBTQ+ patients, and 330 (5.3%) reported similar incidents involving LGBTQ+ colleagues. The most common source of knowledge was mass media. Approximately half of the participants described their workplace as welcoming to LGBTQ+ patients and colleagues. While 705 (11.3%) participants openly identified as allies, 2129 (34.3%) considered themselves allies at heart without expressing it. Some initiatives were identified to be prioritized. Among 133 (2.1%) participants identifying themselves as LGBTQ+, 41 participants reported disclosing their SOGI to some members in their workplaces. The most common workplace difficulty was the assumption of heterosexuality in all events.
Discrimination against the LGBTQ+ population in healthcare settings is prevalent. Many healthcare professionals who hold allyship at heart face some barriers to express it. LGBTQ+ healthcare professionals face various difficulties at their workplaces. Collaboration with LGBTQ+ healthcare professionals is needed to foster inclusivity and support a more affirming healthcare environment.
There exists little research elucidating the benefits of family medicine clinics for community with ample specialist healthcare resources.
We conducted mixed-methods research. Within the inaugural family medicine clinic, the following data was collected during the initial 2 months: (i) newly identified healthcare needs among scheduled outpatients; (ii) management of outpatients with complex health and social needs; and (iii) provision of home-visit care. Newly detected health care needs were summarized qualitatively using a summative content analysis. Patients' complexity was quantitatively scored using the Japanese version of the Patient Centred Assessment Method.
Physicians identified 156 new needs and 13 complex cases. The complexity of patients receiving home-visit care was high.
This study demonstrates that an inaugural family medicine clinic adeptly addressed a diverse spectrum of patients' healthcare needs.
We report a rare case of an elderly Japanese man diagnosed with sporadic gastric Burkitt lymphoma. Esophagogastroduodenoscopy showed nodular and ulcerated lesions in the lesser curvature of the stomach. Pathological analysis of showed that the gastric lesions are characterized by a diffuse and dense accumulation of dark atypical lymphocytes (night) and a scattered distribution of bright foamy macrophages (stars) that give the classic “starry sky” appearance.
General practice is overwhelmed and understaffed. New models and modalities must be considered from the front door of healthcare. Like general practitioners (GPs), clinical psychologists are qualified to work across the age range and transdiagnostically.
To explore GPs' understanding of the role of a clinical psychologist and to examine what is helpful and unhelpful for GPs about working alongside a clinical psychologist within general practice.
This research took place within a primary care general practice in the United Kingdom.
Seven qualified GPs were recruited as participants using a purposive sampling method. Interpretative phenomenological analysis was used to analyze participant's experiences of working alongside clinical psychologists.
Three superordinate themes and 12 subordinate themes were identified. First, GP clinical psychologists support patients directly by providing preventative care, reducing stigma, and offering a different perspective. Second, they support GP well-being and contribute to emotional and behavioral changes in staff. Third, they help to alleviate pressures on wider systems, ease navigation of external services, challenge dominant systems within healthcare, and support community interventions.
GP clinical psychologists impact general practice in multiple ways: indirectly through patient care, by GPs themselves, and by addressing wider systems. Future research is encouraged to explore the perspectives of other staff members and patient's experiences.
Video review is widely recognized as an effective method for teaching communication; however, it can increase educators' workload and learners' stress.
We utilized Tsucom, an online platform developed by BonBon, Inc., which enables asynchronous video communication instead of traditional styles. An 11-min and 42-s consultation video from a fifth-year resident was uploaded, and 10 physicians provided 30 text-based feedback.
In this pilot survey, the utility and ease of use were rated 4.4 and 4.1 out of 5, respectively.
While asynchronous online video reviews provided flexibility and greater participation, challenges remain, and further trials and evaluations were deemed necessary.
Given that acute bacterial meningitis (ABM), as community-acquired meningitis, is considered a life-threatening medical emergency, early diagnosis and immediate onset of antibiotic therapy are of great importance. Here, we aimed to compare both the laboratory and glucometer assessment of cerebrospinal fluid (CSF)/serum glucose ratio in patients with suspected ABM. In addition, the prognostic value of the CSF/serum glucose ratio on the mortality rate was also evaluated.
In this cross-sectional, single-center study, all demographic and clinical characteristics of patients who attended the emergency department were evaluated. A total of 200 patients with clinical suspicion of ABM underwent lumbar puncture (LP) and were simultaneously recruited for CSF and serum glucose measurement using both laboratory tests and a point-of-care glucometer device. Data analysis was performed using SPSS ver. 20.0.
Out of 200 suspected subjects with a mean age of 52.66 ± 6.64 years (male = 113, 56.5%), 23 patients (11.5%) were identified with confirmed ABM. The study findings showed a close correlation between the laboratory and glucometer-measured CSF/serum glucose ratio. The sensitivity and specificity of the glucose ratio measured by the laboratory test were 91.3% and 86.4%, respectively. A similar result was also observed by glucometer measurement (Sensitivity: 91.3%, Specificity: 89.3%, p < 0.001). However, the mean time needed for CSF glucose measurement was significantly longer in the laboratory method compared to the glucometer-based assessment (p < 0.0001). Notably, the CSF/serum glucose ratio was considerably lower in deceased patients (n = 9, p < 0.05).
Despite the similar accuracy of the CSF/serum glucose ratio using either a laboratory test or glucometer for ABM diagnosis, the present study highlighted that the laboratory turnaround time was significantly improved using a glucometer, which could be considered a reliable aid to the prognosis of mortality.
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