Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 283
Filtrar
1.
Med Teach ; : 1-8, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34818129

RESUMO

PURPOSE: The relationship between duty hours (DH) and the performance of postgraduate residents is needed to establish appropriate DH limits. This study explores their relationship using the General Medicine In-training Examination (GM-ITE). MATERIALS AND METHODS: In this cross-sectional study, GM-ITE examinees of 2019 had participated. We analyzed data from the examination and questionnaire, including DH per week (eight categories). We examined the association between DH and GM-ITE score, using random-intercept linear models with and without adjustments. RESULTS: Five thousand five hundred and ninety-three participants (50.7% PGY-1, 31.6% female, 10.0% university hospitals) were included. Mean GM-ITE scores were lower among residents in Category 2 (45-50 h; mean score difference, -1.05; p < 0.001) and Category 4 (55-60 h; -0.63; p = 0.008) compared with residents in Category 5 (60-65 h; Reference). PGY-2 residents in Categories 2-4 had lower GM-ITE scores compared to those in Category 5. University residents in Category 1 and Category 5 showed a large mean difference (-3.43; p = 0.01). CONCLUSIONS: DH <60-65 h per week was independently associated with lower resident performance, but more DH did not improve performance. DH of 60-65 h per week may be the optimal balance for a resident's education and well-being.

3.
J Gen Fam Med ; 22(6): 356-358, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34754717

RESUMO

Background: Incident reporting can inform hospital safety. However, under-reporting is preventing this. Methods: We conducted a nationwide survey among Japanese physicians-in-training by including a questionnaire in the General Medicine In-Training Examination to assess incident reporting behavior and participation in patient safety lectures. Results: Responses of 6,164 physicians-in-training indicated that although 78% had attended patient safety lectures, 44% had not submitted an incident report in the previous year and 40.6% did not know how to submit an incident report. Conclusions: The discrepancy between attendance at safety courses and incident reporting behavior must be addressed to improve hospital safety.

5.
Clin Case Rep ; 9(10): e04629, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34646557

RESUMO

A 42-year-old woman presented with myalgia, which ameliorated a week after treatment. She was diagnosed with Graves' disease. The presence of concomitant autoimmune diseases is important considerations for patients with Graves' disease presenting with myalgia. Thyrotoxicosis should be included as a rare differential diagnosis for myalgia.

6.
Clin Case Rep ; 9(10): e04660, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34646558

RESUMO

Veillonella species rarely cause serious infections, but the incidence of infection has been increasing among immunocompromised individuals. This case of an epidural abscess and spondylitis caused by Veillonella parvula in a hemodialysis patient illustrates the importance of performing anaerobic blood culture in immunocompromised patients with signs of infection.

7.
Int J Gen Med ; 14: 6487-6495, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34675616

RESUMO

Purpose: In Japan, the General Medicine In-training Examination (GM-ITE) was developed by a non-profit organization in 2012. The GM-ITE aimed to assess the general clinical knowledge among residents and to improve the training programs; however, it has not been sufficiently validated and is not used for high-stake decision-making. This study examined the association between GM-ITE and another test measure, the Professional and Linguistic Assessments Board (PLAB) 1 examination. Methods: Ninety-seven residents who completed the GM-ITE in fiscal year 2019 were recruited and took the PLAB 1 examination in Japanese. The association between two tests was assessed using the Pearson product-moment statistics. The discrimination indexes were also assessed for each question. Results: A total of 91 residents at 17 teaching hospitals were finally included in the analysis, of whom 69 (75.8%) were women and 59 (64.8%) were postgraduate second year residents. All the participants were affiliated with community hospitals. Positive correlations were demonstrated between the GM-ITE and the PLAB scores (r = 0.58, p < 0.001). The correlations between the PLAB score and the scores in GM-ITE categories were as follows: symptomatology/clinical reasoning (r = 0.54, p < 0.001), physical examination/procedure (r = 0.38, p < 0.001), medical interview/professionalism (r = 0.25, p < 0.001), and disease knowledge (r = 0.36, p < 0.001). The mean discrimination index of each question of the GM-ITE (mean ± SD; 0.23 ± 0.15) was higher than that of the PLAB (0.16 ± 0.16; p = 0.004). Conclusion: This study demonstrates incremental validity evidence of the GM-ITE to assess the clinical knowledge acquisition. The results indicate that GM-ITE can be widely used to improve resident education in Japan.

8.
J Gen Fam Med ; 22(5): 278-287, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34484995

RESUMO

Background: Autopsy has had an essential role in ensuring the quality of education and medical care. However, its role in clinical residency has not been clarified. This study assessed actual autopsy circumstances during clinical residency and evaluated the association between autopsy and clinical knowledge. Methods: We conducted a cross-sectional study involving postgraduate second year residents in Japan who took the General Medicine In-Training Examination in 2019. We modeled the General Medicine In-Training Examination scores of the residents to examine their association with autopsy experiences and the number of autopsy experiences to assess its predictors. Results: Of 2715 postgraduate second year residents, 353 (13.8%) had no autopsy participation, and 1015 (39.7%) had only one experience. Although autopsy participation was not related to the mean General Medicine In-Training Examination score, the residents' clinicopathological conference participation, self-study for more than 60 min per day, and wish to be pathologists were significantly associated with autopsy experiences. They experienced more autopsies when they belonged to small-sized hospitals in rural areas performing many autopsies. Conclusion: We reported the current status of autopsy in clinical residency and showed that more than half of the residents experienced no or only one autopsy. General Medicine In-Training Examination scores were not correlated with the number of autopsy experiences.

9.
J Gen Fam Med ; 22(5): 293, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34484998

RESUMO

Ceftriaxone-associated pseudolithiasis.

11.
Respir Care ; 66(11): 1713-1719, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34493609

RESUMO

BACKGROUND: A cough peak flow (CPF) of < 60 L/min was associated with increased risk of extubation failure after a successful spontaneous breathing trial (SBT). Passive cephalic excursion of the diaphragm (PCED), measured by ultrasonography during cough expiration, was reported to predict CPF in healthy adults. We hypothesized that PCED, diaphragm peak velocity, or both during cough, as measured by ultrasonography, might predict CPF and extubation outcomes in mechanically ventilated patients. This study attempted to identify associations of diaphragm movement during cough, as assessed by ultrasonography with simultaneously measured CPF, and to determine predictive values of ultrasonographic indices for extubation outcomes after a successful SBT. METHODS: In the study, 252 mechanically ventilated subjects with a successful SBT were enrolled in a prospective cohort study. Right hemidiaphragm passive cephalic excursion and peak velocity were measured by ultrasonography during voluntary cough expiration with maximum effort. CPF was measured simultaneously by ultrasonography. RESULTS: A multiple regression model adjusted for age and sex showed a significant association between PCED and CPF (P < .001, adjusted ß coefficient 11.4, 95% CI 8.88-14.0, adjusted R2 = 0.287) and between diaphragm peak velocity and CPF (P < .001, adjusted ß coefficient 1.71, 95% CI 1.91-2.24, adjusted R2 = 0.235). The areas under the curves of PCED, diaphragm peak velocity, and CPF for extubation failure were 0.791 (95% Cl 0.668-0.914), 0.587 (95% Cl 0.426-0.748), and 0.765 (95% Cl 0.609-0.922), respectively. CONCLUSIONS: PCED on ultrasonography was significantly associated with CPF and extubation failure after a successful SBT. Future studies should investigate if this method is applicable for determination of tracheostomy decannulation in stable patients in general wards.


Assuntos
Extubação , Tosse , Adulto , Tosse/etiologia , Diafragma/diagnóstico por imagem , Humanos , Estudos Prospectivos , Ultrassonografia
13.
Sci Rep ; 11(1): 16717, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408235

RESUMO

The Ottawa subarachnoid hemorrhage (OSAH) rule is a validated clinical prediction rule for ruling out subarachnoid hemorrhage (SAH). Another SAH rule (Ottawa-like rule) was developed in Japan but was not well validated. We aimed to validate both rules by examining the sensitivity for ruling out SAH in Japanese patients diagnosed with SAH. We conducted a retrospective cohort study by reviewing the medical records of consecutive adult patients hospitalized with SAH at a tertiary-care teaching hospital in Japan who visited our emergency department between July 2009 and June 2019. Sensitivity and its 95% confidence interval (CI) were estimated for each rule for the diagnosis of SAH. In a total of 280 patients with SAH, 56 (20.0%) patients met the inclusion criteria and were analyzed for the OSAH rule, and a sensitivity of the OSAH rule was 56/56 (100%; 95% CI 93.6-100%). While, 126 (45%) patients met the inclusion criteria of the Ottawa-like rule, and the rule showed a sensitivity of 125/126 (99.2%; 95%CI 95.7-100%). The OSAH rule showed 100% sensitivity among our Japanese patients diagnosed with SAH. The implementation of the Ottawa-like rule should be cautious because the false-negative rate is up to 4%.


Assuntos
Hospitais de Ensino , Hemorragia Subaracnóidea/diagnóstico , Centros de Atenção Terciária , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
J Gen Fam Med ; 22(4): 169-170, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34221789
15.
J Gen Fam Med ; 22(4): 171-172, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34221790

RESUMO

Tokyo's Olympic and Paralympic Games set to begin in late July 2021 without spectators from abroad, but vaccine rollout has been slow in Japan compared with other developed countries. In this study, COVID-19 epidemic curve in Tokyo is developed based on weekly reported data from January 23, 2020, until April 16, 2021. The maximum daily number of infected cases in Tokyo in August 2021 would be 7,991 if the current pace of vaccinations would be used (1/1,000 per day). This daily number is greater than the highest daily cases (2,447) recorded on January 7, 2021. However, if the rollout pace could be doubled (1/500 per day), the peak daily new cases would be 4,470 in August. If it could be quadrupled (1/250 per day), the peak would be noted at 2,128 in July and the highest number in August would be 1,977. If vaccine rollout could not be enhanced, the cancellation might be an acceptable decision, since health is the most precious to local people and our Olympians.

16.
J Gen Fam Med ; 22(4): 173-181, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34221791

RESUMO

To break the chains of SARS-CoV-2 transmission and contain the coronavirus disease 2019 (COVID-19) pandemic, population-wide testing has been practiced in various countries. However, scant research has addressed this topic in Japan. In this modeling exercise, we extracted the number of daily reported cases of COVID-19 in Okinawa from October 1 to November 30, 2020, and explored possible scenarios for decreasing COVID-19 incidence by combining population-wide screening and/or social distancing policy. We reveal that permanent lockdown can be theoretically replaced by mass testing but sufficient target population at an adequate frequency must be mobilized. In addition, solely imposing a circuit breaker will not bring a favorable outcome in the long run, and mass testing presents implications for minimizing a period of lockdown. Our results highlight the importance of incentivizing citizens to join the frequent testing and ensure their appropriate isolation. This study also suggests that early containment of COVID-19 will be feasible in prefectures where the mobility is low and/or can be easily controlled for its geographic characteristics. Rigorous investment in public health will be manifestly vital to contain COVID-19.

19.
Intern Emerg Med ; 16(8): 2129-2137, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33983474

RESUMO

Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. ß-lactams are ineffective against atypical pathogen including Mycoplasma pneumoniae. We used molecular examinations to develop a decision tree to predict atypical pathogens with CAP and to examine the prevalence of macrolide resistance in Mycoplasma pneumoniae. We conducted a prospective observational study of patients aged ≥ 18 years who had fever and respiratory symptoms and were diagnosed with CAP in one of two community hospitals between December 2016 and October 2018. We assessed combinations of clinical variables that best predicted atypical pathogens with CAP by classification and regression tree (CART) analysis. Pneumonia was defined as respiratory symptoms and new infiltration recognized on chest X-ray or chest computed tomography. We analyzed 47 patients (21 females, 44.7%, mean age: 47.6 years). Atypical pathogens were detected in 15 patients (31.9%; 12 Mycoplasma pneumoniae, 3 Chlamydophila pneumoniae). Ten patients carried macrolide resistant Mycoplasma pneumoniae (macrolide resistant rate 83.3%). CART analysis suggested that factors associated with presence of atypical pathogens were absence of crackles, age < 45 years, and LD ≥ 183 U/L (sensitivity 86.7% [59.5, 98.3], specificity 96.9% [83.8, 99.9]). ur simple clinical decision rules can be used to identify primary care patients with CAP that are at risk for atypical pathogens. Further research is needed to validate its usefulness in various populations.Trial registration Clinical Trial (UMIN trial ID: UMIN000035346).

20.
Clin Case Rep ; 9(5): e04108, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34026150

RESUMO

Streptococcus suis causes a zoonotic disease that commonly manifests as meningitis. People handle pork or its derivatives are at a high risk of infection. Handwashing and donning personal protective equipment are the practical preventive measures.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...