Correction: New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting.

[This corrects the article DOI: 10.1371/journal.pone.0236130.].

Negative association between loneliness and healthy state among rural residents in Japan: a cross-sectional single region population-based survey.

Objective: Loneliness is an important health problem in rural areas of Japan because of its ageing and declining population. Therefore, we investigated the association between loneliness and health. Materials and Methods: Self-administered questionnaires were distributed to rural adult residents. The Japanese 3-item versions of the UCLA Loneliness Scale, self-rated health (SRH), and objective health status (whether the respondents had a physical and/or mental illness) were used. We defined a UCLA score of four points or more as loneliness, an SRH of four points or more as a subjective healthy state, and no physical or mental illness as an objective healthy state. The association was adjusted for sociodemographic data, lifestyle habits, and isolation risk using logistic regression analysis. Results: The five-year population decline rate in the target areas was 10.2 to 12.3%. Of the 2,700 participants, there were 1,211 male and 1,489 female respondents, with an average age of 65.4 years. Moreover, 358 (13.6%) were living alone, and 829 (31.5%) were living in couple-only households. Among the participants, 1,395 (53.2%) experienced loneliness, 1,751 (65.7%) had good self-rated health, and 1,587 (60.8%) had objective health status. Loneliness was negatively associated with good SRH (OR=0.56, CI=0.45-0.70) and objective health status (OR=0.57, CI=0.46-0.71) after adjusting for sociodemographic data, lifestyle habits, and the risk of isolation. Statistically significant confounding factors for subjective and/or objective health status were employment, not smoking, obesity, exercise, having a family doctor, having an above-average number of teeth, and the ability to leave home. Conclusion: In an ageing and declining population, loneliness is an independent factor affecting the health status of rural residents and is not limited to older adults. Therefore, measures to reduce it are needed.

Usefulness of a medical interview support application for residents: A pilot study.

To conduct an appropriate medical interview, education and clinical experience are necessary. The usefulness of computer-based medical diagnostic support systems has been reported in medical interviewing. However, only a few reports have actually applied these systems and noted changes in the quality of the medical interview of residents. We aimed to examine how the use of a medical interview support application changes the medical interviews of residents. The study was conducted on 15 residents (with less than two years post-graduation) and ran from November 2020 to March 2021. Faculty members played the role of simulated patients in 20 cases, and the residents conducted the medical interviews. In 10 of the 20 cases, a medical interview support application was used. After the interview, the residents were asked to list up to 10 differential diseases; the interview was considered appropriate if it included the disease portrayed by the simulated patient. Furthermore, the duration of the medical interview, the number of questions asked, and changes in stress parameters were evaluated. The use of a medical interview support application increased the percentage of appropriate medical interviews. Considering the frequency, the use of a medical interview support application increased the rate of appropriate medical interviews in the rare disease group, as well as the number of questions and duration of the interviews. No stress reduction was observed. The medical interview support application may be a useful tool in identifying appropriate differential diseases during medical interviews by residents.

New predictive models for falls among inpatients using public ADL scale in Japan: A retrospective observational study of 7,858 patients in acute care setting.

AIM: Most predictive models for falls developed previously were awkward to use because of their complexity. We developed and validated a new easier-to-use predictive model for falls of adult inpatients using easily accessible information including the public ADL scale in Japan. METHODS: We retrospectively analyzed data from Japanese adult inpatients in an acute care hospital from 2012 to 2015. Two-thirds of cases were randomly extracted to the test set and one-third to the validation set. Data including age, sex, activity of daily living (ADL), public scales in Japan of ADL "bedriddenness rank," and cognitive function in daily living, hypnotic medications, previous falls, and emergency admission were derived from hospital records. Falls during hospitalization were identified from incident reports. Two predictive models were created by multivariate analysis, each of which was assessed by area under the curve (AUC) from the validation set. RESULTS: A total of 7,858 adult participants were available. The AUC of model 1, using 13 factors-age, sex (male), emergency admission, use of ambulance, referral letter, admission to Neurosurgery, admission to Internal Medicine, use of hypnotic medication, permanent damage by stroke, history of falls, visual impairment, independence of eating, and bedriddenness rank-with low mutual collinearity and showing significant relationship by multivariate logistic regression analysis, was 0.789 in the validation set. The AUC of parsimonious model 2, using age and seven factors-sex (male), emergency admission, admission to Neurosurgery, use of hypnotic medication, history of falls, independence of eating, and bedriddenness rank-showing statistical significance by multivariate analysis in model 1, was 0.787 in the validation set. CONCLUSIONS: We proposed new predictive models for inpatients' fall using the public ADL scales in Japan, which had a higher degree of usability because of their use of simpler and fewer (8 or 13) predictors, especially parsimonious model 2.

Mobile medical services and experiential learning in community-based clinical clerkships enhancing medical students' positive perceptions of community healthcare.

Objective: Previous studies have investigated medical students' interest in family medicine, as well as their intentions to work in rural areas after taking part in community-based clinical clerkships. Community-based clerkships are designed to teach medical students community healthcare and to increase the number of physicians working in rural communities following their graduation. However, few studies have examined which clerkship experiences, specifically, enhance medical students' positive perceptions on community healthcare. This study aimed to examine the association between experiential learning in community-based clerkships and students' positive perceptions on community healthcare. Patients and Methods: From 2015 to 2017, we conducted a questionnaire survey of 290 final year medical students, before and after completion of their community-based clerkships. The survey asked the students about their perceptions (categorized into "Worthwhile" and "Confident") of community healthcare and experiential learning during their clerkships. We assessed 13 medical learning areas involving healthcare, medical care, welfare, and nursing care practice. Multivariable logistic regression was used to evaluate the factors associated with positive student perceptions. Results: Of the 290 students, 265 (91.3%) completed both the pre- and post-questionnaires. Of these, 124 (46.8%) were female, 67 (25.2%) were from small towns (of <100,000 people), and 87 (32.8%) selected clinical clerkships within depopulated areas. A total of 205 (73.3%) students reported positive perceptions on community healthcare. There was a significant association discovered between students' positive perceptions on community-based healthcare and them taking part in experiential learning in mobile medical services (43 [16.2%] students experienced mobile medical services-adjusted odds ratio 6.65, 95%, confidence intervals 1.67-26.4, p = 0.007). Conclusion: Medical students' positive perceptions on community healthcare were discovered to be associated with them taking part in experiential learning in mobile medical services during their community-based clerkships.

Thoracolithiasis.

Thoracoscopic image shows a thoracolith: its diameter was 13 mm and was soft and elastic, with a smooth surface. The core was black and was surrounded by yellow connective tissue. Given that mobility of the nodule is the key finding for the diagnosis, comparison with previous imaging studies is crucial.

Reduction of Postoperative Pain by Addition of Intravenous Acetaminophen after Total Hip Arthroplasty: A Retrospective Cohort Study.

We evaluated the analgesic effects of multimodal pain control in which intravenous acetaminophen (IV APAP) was added to the standard protocol for Japanese patients who had undergone a total hip arthroplasty (THA). We performed a retrospective cohort study of 180 patients aged 66.4±10.5 years (30% male) who had undergone a THA (Oct. 2014 to Feb. 2015) at our hospital. The control patients were administered the standard analgesic protocol: flurbiprofen axetil as a continuous intravenous infusion and oral celecoxib (NAPAP; n=109). The patients in the new analgesic protocol group received IV APAP in addition to the standard analgesic protocol (APAP; n=71). The primary outcome was the maximum value of postoperative pain the patients reported on a numerical rating scale (NRS) during the first 24 h post-surgery. A univariate analysis and multivariate analyses adjusted for age, sex, the stage of hip osteoarthritis, preoperative pain, and surgical time showed that the maximum postoperative pain NRS scores during the first 24 h after surgery was significantly lower when the APAP protocol was used. The addition of IV APAP to the current standard multimodal analgesia protocol for Japanese patients who have undergone a THA may decrease the patients' postoperative pain.

Public subsidies and the recommendation of child vaccines among primary care physicians: a nationwide cross-sectional study in Japan.

OBJECTIVE: Although public subsidies and physician recommendations for vaccination play key roles in increasing childhood vaccination coverage, the association between them remains uncertain. This study aimed to identify the association between awareness of public subsidies and recommendations for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)) and human papillomavirus (HPV) vaccinations among primary care physicians in Japan. DESIGN: This is a cross-sectional study. SETTING: In 2012, a questionnaire was distributed among 3000 randomly selected physicians who were members of the Japan Primary Care Association. PARTICIPANTS: From the questionnaire, participants were limited to physicians who administered childhood vaccinations. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary measures were participants' awareness of public subsidies and their recommendation levels for Hib, PCV and HPV vaccines. Multiple logistic regression analysis was performed to investigate the association between awareness and recommendation, with adjustment for possible confounders. RESULTS: The response rate was 25.8% (743/2880). Of 743 physician respondents, 434 were included as analysis subjects. The proportions of those who recommended vaccinations were 57.1% for Hib, 54.1% for PCV and 58.1% for HPV. For each vaccine, multivariable analyses showed physicians who were aware of the subsidy were more likely to recommend vaccination than those who were not aware: the adjusted ORs were 4.21 (95% CI 2.47 to 7.15) for Hib, 4.96 (95% CI 2.89 to 8.53) for PCV and 4.17 (95% CI 2.00 to 8.70) for HPV. CONCLUSIONS: Primary care physicians' awareness of public subsidies was found to be associated with their recommendations for the Hib, PCV and HPV vaccines. Provision of information about public subsidies to these physicians may increase their likelihood to recommend vaccination.

Bright spine.

The spine is homogeneously osteosclerotic and which appears to have no particular abnormal findings, however, that was proved to be a result of multiple metastases from prostate cancer. We should consider the possibility of prostate cancer if we see a "bright spine" on X-ray examination.

Do you know otitis media with ANCA-Associated Vasculitis (OMAAV)?

Hearing loss is often the only symptom of OMAAV at initial presentation, thus making early diagnosis difficult. We present OMAAV in a 70-year-old woman with hearing loss and dry cough. Otoscopy showed otitis media with effusion. Audiometry showed mixed hearing loss, especially in the right ear. Serum myeloperoxidase antineutrophil cytoplasmic antibody was positive. Image analyses showed lung lesion and interstitial pneumonia, while bronchoscopy showed possible microscopic polyangiitis. After starting and tapering prednisolone, respiratory and otologic symptoms improved. When examining patients with acute otologic symptoms and suspected lung and/or renal disease, OMAAV should be included in differential diagnosis.

Change of Oral to Topical Corticosteroid Therapy Exacerbated Glucose Tolerance in a Patient with Plaque Psoriasis.

BACKGROUND Psoriasis is known as the most frequent disease treated by long-term topical steroids. It is also known that patients with thick, chronic plaques require the highest potency topical steroids. However, the treatment is limited to up to four weeks due to risk of systemic absorption. CASE REPORT An 80-year-old man was diagnosed with type 2 diabetes 16 years before, and was being administered insulin combined with alpha glucosidase inhibitor. He was diagnosed with plaque psoriasis and his oral steroid treatment was switched to topical steroid treatment due to lack of improvement and poorly controlled blood glucose level. The hypoglycemic events improved after the psoriatic lesions improved. CONCLUSIONS Control of blood glucose level is difficult at the very beginning of topical steroid treatment for psoriasis especially if a patient is receiving insulin treatment. Intense monitoring of blood glucose level during initiation of topical steroid treatment is necessary to prevent unfavorable complications.

Physiological and pathological clinical conditions and light scattering in brain.

MRI of preterm infants at term commonly reveals subtle brain lesions such as diffuse white matter injury, which are linked with later cognitive impairments. The timing and mechanism of such injury remains unclear. The reduced scattering coefficient of near-infrared light (µs') has been shown to correlate linearly with gestational age in neonates. To identify clinical variables associated with brain µs', 60 preterm and full-term infants were studied within 7 days of birth. Dependence of µs' obtained from the frontal head on clinical variables was assessed. In the univariate analysis, smaller µs' was associated with antenatal glucocorticoid, emergency Caesarean section, requirement for mechanical ventilation, smaller gestational age, smaller body sizes, low 1- and 5-minute Apgar scores, higher cord blood pH and PO2, and higher blood HCO3(-) at the time of study. Multivariate analysis revealed that smaller gestational age, requirement for mechanical ventilation, and higher HCO3(-) at the time of study were correlated with smaller µs'. Brain µs' depended on variables associated with physiological maturation and pathological conditions of the brain. Further longitudinal studies may help identify pathological events and clinical conditions responsible for subtle brain injury and subsequent cognitive impairments following preterm birth.

The Symptoms of Gastroesophageal Reflux Disease Correlate with High Body Mass Index, the Aspartate Aminotransferase/Alanine Aminotransferase Ratio and Insulin Resistance in Japanese Patients with Non-alcoholic Fatty Liver Disease.

OBJECTIVE: This study was designed to compare the association between the body mass index (BMI) and symptoms of gastroesophageal reflux disease (GERD) in allegedly normal subjects undergoing regular medical checkups and subjects diagnosed with non-alcoholic fatty liver disease (NAFLD). Additionally, the correlation between the BMI and GERD symptoms was evaluated in subjects with NAFLD. METHODS: This study included 50 patients with NAFLD and 228 normal subjects evaluated during regular medical checkups. The height, weight, BMI, frequency scale for the symptoms of GERD (FSSG), and serum concentrations of triglycerides and γ-GTP were compared between the two groups. In the NAFLD group, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations were measured and insulin resistance was calculated using the quantitative insulin sensitivity check index (QUICKI). RESULTS: The total FSSG score moderately correlated with the BMI in the NAFLD group (r=0.342, p=0.015), but correlated negatively in the control group (r=-0.014, p=0.831). The FSSG score in the NAFLD group also negatively correlated with the AST/ALT ratio (r=-0.319) and insulin resistance calculated using the QUICKI score (r=-0.288). The BMI in the NAFLD group moderately correlated with the acid-reflux related score on the FSSG (r=0.389), and both the AST/ALT ratio (r=-0.344) and QUICKI score (r=-0.330) negatively correlated with the dyspepsia score on the FSSG. CONCLUSION: Obesity evaluated by the BMI was a significant risk factor for the exacerbation of GERD symptoms in subjects with NAFLD.

Mentoring the next generation of physician-scientists in Japan: a cross-sectional survey of mentees in six academic medical centers.

BACKGROUND: Physician-scientists play key roles in biomedical research across the globe, yet prior studies have found that it is increasingly difficult to recruit and retain physician-scientists in research careers. Access to quality research mentorship may help to ameliorate this problem in the U.S., but there is virtually no information on mentoring in academic medicine in Japan. We conducted a survey to determine the availability and quality of mentoring relationships for trainee physician-scientists in Japan. METHODS: We surveyed 1700 physician-scientists in post-graduate research training programs in 6 academic medical centers in Japan about mentorship characteristics, mentee perceptions of the mentoring relationship, and attitudes about career development. RESULTS: A total of 683 potential physician-scientist mentees completed the survey. Most reported that they had a departmental mentor (91%) with whom they met at least once a month; 48% reported that they were very satisfied with the mentoring available to them. Mentoring pairs were usually initiated by the mentor (85% of the time); respondents identified translational research skills (55%) and grant writing (50%) as unmet needs. Mentoring concerning long-term career planning was significantly associated with the intention to pursue research careers, however this was also identified by some mentees as an unmet need (35% desired assistance; 15% reported receiving it). CONCLUSIONS: More emphasis and formal training in career mentorship may help to support Japanese physician-scientist mentees to develop a sense of self-efficacy to pursue and stay in research careers.

Obturator hernia: A diagnostic challenge.

PATIENT: Female, 90 FINAL DIAGNOSIS: Obturator hernia Symptoms: Epigastric pain • vomiting MEDICATION: - Clinical Procedure: - Specialty: Gastroenterology and Hepatology. OBJECTIVE: Challenging differential diagnosis. BACKGROUND: Obturator hernia (OH) can be difficult to diagnose because it shows only nonspecific signs and symptoms. Although pain in a lower limb caused by compression of the obturator nerve by the hernia in the obturator canal (Howship-Romberg sign) is a characteristic sign, its presence is rather rare. CASE REPORT: We herein describe the case of a 90-year-old woman with an OH that was difficult to diagnose because of her slight abdominal signs and symptoms on admission and subtle abdominal computed tomography (CT) findings. Although the CT images revealed the presence of an OH, this finding was overlooked because it contained only a part of the small intestine wall, which is called the Richter type. Fortunately, her condition improved dramatically with only conservative treatment. CONCLUSIONS: Although early diagnosis is essential to reduce morbidity and mortality, OH can be a diagnostic challenge even with abdominal CT.

Thyroid storm complicated by bicytopenia and disseminated intravascular coagulation.

PATIENT: Male, 23. FINAL DIAGNOSIS: Thyroid storm. SYMPTOMS: Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight loss. MEDICATION: -. CLINICAL PROCEDURE: -. SPECIALTY: Endocrinology and Metabolic. OBJECTIVE: Unusual clinical course. BACKGROUND: The clinical presentation of thyroid storm includes fever, tachycardia, hypertension, and neurological abnormalities. It is a serious condition with a high mortality rate. Furthermore, some other complications affect the clinical course of thyroid storm. Although it is reported that prognosis is poor when thyroid storm is complicated by disseminated intravascular coagulation syndrome (DIC) and leukopenia, reports of such cases are rare. CASE REPORT: A 23-year-old man presented with delirium, high pyrexia, diarrhea, and weight loss of 18 kg over 2 months. According to the criteria of Burch and Wartofsky, he was diagnosed with thyroid storm on the basis of his symptom-complex and laboratory data that confirmed the presence of hyperthyroidism. Investigations also found leukopenia, thrombocytopenia, and disseminated intravascular coagulation, all of which are very rare complications of thyroid storm. We successfully treated him with combined therapy including anti-thyroid medication, despite leukopenia. CONCLUSIONS: Early diagnosis and treatment are essential in ensuring a good outcome for patients with this rare combination of medical problems.

Severe eosinophilic pneumonia presenting during gemcitabine adjuvant chemotherapy.

Gemcitabine is widely accepted as the standard treatment for pancreatic cancer, but it can cause unpredictable side effects. Acute respiratory distress syndrome is a rare complication with gemcitabine, but is sometimes fatal. We describe a cured case of acute, severe gemcitabine-induced pulmonary toxicity. The patient was a 76-year-old man with pancreatic cancer who was receiving adjuvant gemcitabine chemotherapy after surgery. The patient received gemcitabine 1,000 mg/m2 on days 1, 8, and 15 for three 4-week cycles, with intervals of 1 week. He developed severe general fatigue on day 1 of the third cycle. Computed tomography showed diffuse ground-glass opacity with pleural effusion. There was no increase in ß-D-glucan, and cytomegalovirus antigenemia assays were negative. No bacteria or acid-fast bacilli were found. The number of eosinophils in bronchoalveolar lavage fluid was increased. Considering these data, we diagnosed eosinophilic pneumonia induced by gemcitabine. The patient was immediately treated with a steroid and neutrophil elastase inhibitor under respiratory supportive therapy. After 4 weeks, his pulmonary symptoms were markedly improved. Physicians should be cognizant of the possible association of serious pulmonary toxicity with gemcitabine treatment. A delay in diagnosis and treatment could lead to a fatal outcome.

Arm span-height difference is correlated with gastroesophageal reflux symptoms in aged Japanese subjects.

Previous studies have indicated an association between the symptoms of gastroesophageal reflux disease (GERD) and aging plus height. In this study we investigated whether the arm span-height difference was related to GERD symptoms with a focus on aged subjects in the general population, since the arm span reflects the height in young adulthood before decreasing due to vertebral deformities from aging. A total of 285 elderly individuals (105 females) who visited nursing homes for the elderly in Japan were enrolled in this study. The GERD symptoms were evaluated by the Frequency Scale for the Symptoms of GERD (FSSG). The body weight, height and arm span were measured, and information regarding medications and complications were reviewed in each nursing record. 50.5% of women had more than 3 cm of arm span-height difference. In contrast, only 37.3% of men had more than 3 cm of arm span-height difference. The FSSG scores indicated more than 70% of subjects complained of any GERD symptoms. There was a significant correlation between the FSSG score and the arm span-height difference in the subjects with more than 3 cm of arm span-height difference (r = 0.236; p = 0.012). The correlation between the arm span-height difference and the FSSG score was significant only in women in females in the present study. In conclusion, our findings indicate that vertebral deformity evaluated by the arm span-height difference might have some positive relationship to the pathogenesis of GERD symptoms in elderly Japanese individuals.

Severe steroid-resistant thrombocytopenia secondary to cytomegalovirus infection in an immunocompetent adult.

Severe thrombocytopenia secondary to cytomegalovirus (CMV) infection is rare in immunocompetent hosts. We describe a case of severe thrombocytopenia secondary to CMV infection in an immunocompetent 30-year-old man who presented with pyrexia and bleeding tendency. A diagnosis of immune thrombocytopenia (ITP) was made following hematological and serological testing, and bone marrow aspiration. Acute CMV infection was confirmed by serological testing, antigenemia, and detection of CMV-DNA. Corticosteroid therapy was ineffective and intravenous immunoglobulin (IVIG) was therefore administered. This resulted in immediate recovery of the platelet count and cessation of nasal bleeding. Early IVIG administration should be considered in steroid-resistant cases.

Predictive value of self-reported patient information for the identification of lumbar spinal stenosis.

BACKGROUND: To our knowledge, no objective criterion has been identified for the diagnosis of lumbar spinal stenosis (LSS) and no study has evaluated the predictive value of self-reported patient information for the identification of LSS. OBJECTIVE: To develop and validate a prediction rule for the identification of LSS based on self-reported patient information alone. METHODS: Prospective derivation study using a coefficient-based multivariable logistic regression scoring method with internal validation with primary care clinics and orthopaedic departments of medical centres, as well as university and other hospitals. Participants were consecutive patients with primary symptoms of pain or numbness in the lower extremities. Physician-diagnosed LSS was the RESULTS: Of 468 patients included in the analysis, 47.3% were diagnosed with LSS and divided into derivation and validation sets. The following items were retained at the conclusion of the derivation process: age (<60, 60-70 and >70), duration of symptoms over 6 months, symptom improvement when bending forward, symptom improvement when bending backward, symptom exacerbation while standing up, intermittent claudication and urinary incontinence. To derive a risk score for each patient, integer-based scores were assigned and summed. In the validation data sets, prevalence of LSS in patients from the first to fourth risk score quartile were 13.3%, 47.6%, 55.2% and 65.5%, respectively. Further, the likelihood ratio in the low-risk category was 0.154. CONCLUSIONS: We developed a prediction rule for the identification of LSS based on self-reported patient information alone. Further, the likelihood ratio in the low-risk category was sufficiently low. This rule may be used for screening of LSS.