Journal of rural medicine : JRM最新文献

Objective: Efforts have been made in Japan to transition individuals with mental disorders from inpatient medical care to community life. To promote the development of a community-based comprehensive care system that effectively addresses mental disorders, it is essential to clarify the issues from an individual's perspective. This study aimed to examine the perspectives of individuals with mental disorders who have experienced long-term hospitalization to support their continued life in the community from the viewpoint of personal recovery.

Materials and methods: A descriptive, qualitative study was conducted. Nine individuals with mental disabilities living in Japan were interviewed. The interviews were conducted between September 2021 and December 2023 using a semi-structured format guided by the interview protocol. The interview transcripts were analyzed using reflexive thematic analysis.

Results: Seven themes regarding future life were identified: "desire to live in one's own way", "realizing hopes and goals", "desire to connect with the society and others", "positive attitude toward the future", "concerns and preparations for one's own later life and that of one's family", "an uncertain future", and "improvement of physical symptoms". Eight themes associated with issues in community living were identified: "difficulty in controlling symptoms and self-management of medication", "impact of deteriorating health on daily life, employment, and studies", "social withdrawal and loss of connection with others", "excessive interference from family members and deterioration of relationships", "caring for elderly parents and their health issues", "lack of understanding and support from others", "difficulty in utilizing public support", and "sustainable housing and financial issues".

Conclusion: Professionals must believe in the ability of individuals with mental disorders to achieve personal recovery and persistently support their choices and decisions. It is necessary to build a recovery-oriented and comprehensive community care system that responds to mental disorders based on the needs of community-dwelling patients.

Objective: This study examined the relationships among lower limb skeletal muscle characteristics, walking function, and daily physical activity in community-dwelling, independently living older women. This serves as a fundamental study for the prevention and early detection of sarcopenia, using ultrasonography-based muscle mass and quality assessment.

Patients and methods: The participants were 53 community-dwelling women aged 66-89 years, who were independent in activities of daily living (ADL). Age, physical characteristics (height, weight, body fat percentage, skeletal muscle mass, and skeletal muscle index [SMI]), walking function, physical activity level, fall occurrence in the past month, and gastrocnemius muscle parameters (muscle thickness, fascial thickness, and muscle echo intensity) were assessed. Correlation analyses were conducted and intra-examiner reliability was confirmed using the intraclass correlation coefficient.

Results: The participants' median age was 77.0 years, height was 150.3 cm, weight was 51.0 kg, body fat percentage was 30.6%, and SMI was 6.5 kg/m². Overall, 11.3% of participants had an SMI below the sarcopenia threshold. The gastrocnemius muscle parameters showed the strongest correlations; muscle thickness had weak positive correlations with SMI, walking function, and physical activity, but negative correlations with age and total movement time. Fascial thickness correlated positively with weight and body fat percentage but negatively with walking function. Muscle echo intensity was positively correlated with age and negatively correlated with SMI, walking speed, step count, and housework time.

Conclusion: Although all the participants lived independently, 11.3% had an SMI below the sarcopenia threshold, highlighting the need for early prevention. Gastrocnemius muscle parameters were significantly associated with age, physical characteristics, walking function, and activity level. Reduced physical activity may contribute to muscle degeneration and impaired walking even in independent individuals. Combining muscle echo intensity and fascial thickness may enhance muscle quality assessment, aiding in the prevention and early detection of sarcopenia.

Objective: Venous malformations (VMs) are low-flow blood reservoir mass lesions with spongy or cystic venous lumens caused by dilation of the venous system vasculature. A VM is a congenital lesion that presents at birth and enlarges during childhood as the host grows. Subcutaneous lesions due to VMs are rarely diagnosed at an advanced age. We report a case of axillary VM in an older patient.

Patient: A 92-year-old man was suspected of having left axillary lymphadenopathy (single nodule, 23 mm long) on chest computed tomography (CT) scan. Seven years earlier, a chest CT scan showed a small, 13 mm nodule in the same area.

Results: On ultrasound elastography, the lesion did not appear hard, however, color Doppler imaging revealed abundant blood flow, suggesting a malignant lesion. Histologically, the lesions were consistent with VM.

Conclusion: VMs should be considered a differential diagnosis for superficial lymphadenopathy, even in older patients.

Purpose: This study aimed to investigate the efficacy of the keyword method in improving outcomes for patients with unstable circulation.

Methods: Patients with unstable circulation were selected from the Japan Doctor Helicopter (DH) Registry System (JDRS) database. Unstable circulation was defined as systolic blood pressure of less than 90 mmHg when emergency medical technicians (EMTs) contacted the patients. The following details of the dispatch activity were collected from the JDRS database: whether the request for the DH dispatch was made before (Keyword) or after (Control) the EMTs contacted the patient, time from first call to DH contact, age, sex, initial vitals, DH intervention, disease classification, and outcome.

Results: There were 650 subjects in the Keyword group and 1,085 patients in the Control group. All the participants were evacuated from the scene. The duration from the first call to contact, respiratory rate, and the ratio of tracheal intubation to transfusion were significantly smaller in the Keyword group than in the Control group. The average systolic blood pressure and survival ratio in the Keyword group were significantly higher than those in the Control group. After matching the analysis to align with the patients' backgrounds, the observed tendencies persisted.

Conclusion: This is the first report to describe the keyword method as a prognostic factor in patients with unstable circulation who were evacuated by the DH using the JDRS. Future prospective studies are required to determine the accuracy of these results.

Objective: As artificial intelligence (AI) technologies advance rapidly, their integration into healthcare is transforming the clinical practice landscape. This study aimed to evaluate how second-year medical students perceive their professional mission in an AI-integrated medical future, through a structured essay task, using text-mining analysis to identify emerging themes and attitudes.

Methods: A total of 105 second-year medical students at Kagawa university in Japan completed an essay titled "What is your mission in the AI-driven medical world?". Responses were analyzed using KH Coder for frequency analysis, multidimensional scaling, and co-occurrence network mapping. Participants provided verbal informed consent and student anonymity was ensured.

Results: The most frequently used terms were medical, consider, think, doctor, AI, human, and patient. Three thematic clusters emerged: (1) career design, (2) AI and medicine, and (3) AI and human. Co-occurrence analysis revealed strong associations between "medical" and both "consider" and "patient", while "patient" was linked to both "AI" and "human", indicating thoughtful reflection on technology's impact on patient care.

Conclusion: Second-year medical students in Japan demonstrated critical engagement with the concept of mission formation in the context of AI in healthcare. Their essays reflected a balance between optimism for technological advancement and concern for preserving human-centered care. These findings highlight the importance of implementing systematic career education and future-oriented thinking that is aligned with the characteristics of Generation Z learners.

Objective: This study aimed to clarify the current status of collaboration between type-B continuous employment-support facilities and psychiatric care in Japan and determine the intention of these facilities toward medical collaboration.

Methods: A self-administered anonymous questionnaire survey was conducted by mail. Basic descriptive statistics were calculated for the questions with multiple-choice responses. For the free descriptions of medical collaborations, we grouped sentences with similar meanings and generated categories.

Result: Of type-B employment continuation support offices, 76% collaborated with psychiatrists. However, only 6% incurred an additional fee for the medical collaboration system. They attempted to collaborate with medical care by contacting doctors and nurses and accompanying them during medical examinations. Some respondents stated that they did not need to collaborate with medical care. Type-B facilities often require support from doctors and nurses regarding support for psychiatric symptoms, guidance on medication, and other problems related to illnesses and treatment. Other opinions suggested that persons with mental disabilities should solve their problems themselves without intervention by doctors or nurses and that the support they want is absent. Among type-B continuous employment-support facilities that do not hire nurses, 25% would be unable to hire them, although desired, because of financial difficulties or other reasons, and 72% did not consider doing so.

Conclusion: Among the type-B continuous employment-support facilities, 76% collaborated with the psychiatric department. Some respondents indicated that medical collaboration was "Not required". Among the types of support expected from doctors and nurses, those related to illness and treatment were the most commonly requested. But opinions emerged, including "No support is sought". Many type-B continuous employment-support facilities that do not employ nurses, do not consider hiring nurses, and the most common reason is "Economically difficult to hire".

Objective: Although gastrointestinal symptoms are common immediate reactions to food allergies (FA), the relationship between acute pancreatitis (AP) and FA remains unclear.

Patient: A 3-year-old boy developed vomiting, dyspnea, and urticaria 30 min after eating a cashew nut (CN) and was diagnosed with anaphylaxis.

Results: The patient was diagnosed with AP based on markedly elevated serum pancreatic amylase activity (1,847 IU/L) and mild pancreatic enlargement on abdominal ultrasonography, despite the absence of abdominal pain. All symptoms resolved immediately after intramuscular adrenaline injection, and serum pancreatic amylase activity normalized after 3 days. CN allergy was diagnosed based on blood tests showing elevated serum levels of CN- and Ana o 3-specific immunoglobulin E.

Conclusions: This is the first reported case of AP associated with anaphylaxis due to a CN allergy. AP should be considered in patients with FA who present with gastrointestinal symptoms, even if vomiting is the only symptom and abdominal pain is absent. AP associated with anaphylaxis may resolve rapidly with appropriate treatment.

Objective: Following the novel coronavirus disease 2019 (COVID-19) outbreak that began in 2020, contact between hospitalized patients and their families was significantly restricted to prevent infection. In May 2023, COVID-19 was classified as a Class 5 infectious disease by the Japanese Ministry of Health, Labour and Welfare. Although restrictions have gradually been lifted in some areas, at the time of writing this report, our hospital has not lifted all visit restrictions. Understandably, patients in this situation experience mental distress due to a lack of support from family, friends, or partners. Although remote visits have been introduced as an alternative to in-person visits, their effectiveness remains unclear. In this study, we report three cases in which we examine the impact of remote visits via electronic devices on patients who were unable to receive in-person visits.

Patients: Among the inpatients referred to our hospital's palliative care team from April 2022 to March 2023, three who requested remote visits due to psychological distress caused by the inability to see their families were enrolled in this study.

Results: The degree of psychological distress in all cases reduced after conducting remote visits. However, cancer-related pain (in two patients) and postoperative wound pain (in one patient) showed no significant differences in severity. In one patient, anxiety was evoked following a remote visit. This was attributed to the patient's realization of their isolation from their family.

Conclusion: For patients whose family members are unable to conduct in-person visits due to visit restrictions for various reasons, remote visits may help alleviate psychological distress. Since remote visits can cause adverse emotional reactions in some cases, monitoring the mental status during and after remote visits is necessary.

Objective: Recent treatment advancements have improved the survival rates of patients with hematological malignancies, making hematopoietic stem cell transplantation (HSCT) a key curative option. However, despite ongoing awareness efforts, the number of bone marrow donor registrations has not significantly increased over time, possibly because of the impact of recent infectious disease outbreaks. This may affect patients requiring allogeneic HSCT. This study explored the experiences of adolescent and young adult (AYA) bone marrow donors.

Patient and methods: Using a qualitative descriptive research design, we conducted semi-structured interviews with six AYA individuals who had experience as bone marrow donors. The study was approved by the institutional ethics committee (022-03), and no conflicts of interest were disclosed.

Results: Seven categories and 23 subcategories were identified in this analysis. Participants reported a strong sense of duty as donors, but faced challenges such as family opposition, lack of understanding from employers, and concerns about the impact on work and family life. Despite these difficulties, donors often experienced personal growth and fulfillment through donation.

Conclusion: Nurses should recognize AYA bone marrow donors as a population that requires support, and consider strategies to increase the understanding and registration among this crucial demographic group.

Objective: We present a case of small intestinal perforation within an inguinal hernia following low-energy indirect trauma.

Patient: A 55-year-old man with a known right inguinal hernia which had no prior indication for surgery developed acute right groin pain after sudden braking caused his scooter handlebar to strike his right thigh.

Results: Physical examination and computed tomography (CT) scan of the abdomen and pelvis revealed multiple pockets of extraluminal air within the hernia sac, as well as gas bubbles in the surrounding intestinal contents. Based on these findings, we made a diagnosis of small intestinal perforation within the inguinal hernia.

Conclusion: Small intestinal perforation within an inguinal hernia is an uncommon but potentially life-threatening complication requiring emergent surgical intervention. Delays in diagnosis and management can lead to peritonitis, abscess formation, sepsis, and prolonged hospitalization. Therefore, clinicians should maintain a high index of suspicion for intestinal perforation in patients with inguinal hernias, even in the absence of direct trauma or subsequent low-energy injuries.