1
|
Otsuki T, Ishizuka K, Eto H, Nakano H, Kato Y, Sudo H, Motohashi I, Ie K, Ohira Y, Okuse C. Anti-TIF1-γ Antibody-Positive Dermatomyositis Leading to Identification of Diffuse Large B-Cell Lymphoma. J Gen Intern Med 2024:10.1007/s11606-024-08794-8. [PMID: 38710865 DOI: 10.1007/s11606-024-08794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Takuya Otsuki
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Shukugawara, Tama, Kawasaki, Kanagawa, 214-8525, Japan.
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Hiromitsu Eto
- Department of Dermatology, Ofuna Chuo Hospital, Kamakura, Japan
| | - Hiroyasu Nakano
- Department of Internal Medicine, Ofuna Chuo Hospital, Kamakura, Japan
| | - Yo Kato
- Department of Pathology, Ofuna Chuo Hospital, Kamakura, Japan
| | - Hiroshi Sudo
- Department of Internal Medicine, Ofuna Chuo Hospital, Kamakura, Japan
| | - Iori Motohashi
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Shukugawara, Tama, Kawasaki, Kanagawa, 214-8525, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Shukugawara, Tama, Kawasaki, Kanagawa, 214-8525, Japan
| | - Yoshiyuki Ohira
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Chiaki Okuse
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Shukugawara, Tama, Kawasaki, Kanagawa, 214-8525, Japan
| |
Collapse
|
2
|
Aoki N, Ishizuka K, Otsuki T, Ie K. Mikulicz Disease. Am J Med 2024; 137:e75-e76. [PMID: 38163535 DOI: 10.1016/j.amjmed.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Nozomi Aoki
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Takuya Otsuki
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| |
Collapse
|
3
|
Araki A, Ishizuka K, Uchida R, Ie K. Mesenteric phlebosclerosis caused by traditional Chinese herbal medicine. Postgrad Med J 2024:qgae032. [PMID: 38493357 DOI: 10.1093/postmj/qgae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Akiho Araki
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Ryuji Uchida
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| |
Collapse
|
4
|
Yokoi A, Ishizuka K, Motohashi I, Hiwatari M, Asakura T, Ie K. Giant Hepatic Cyst. Am J Med 2024:S0002-9343(24)00137-2. [PMID: 38479609 DOI: 10.1016/j.amjmed.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Ai Yokoi
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Iori Motohashi
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Hiwatari
- Department of Gastroenterological and General Surgery, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Takeshi Asakura
- Department of Gastroenterological and General Surgery, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| |
Collapse
|
5
|
Goto M, Ishizuka K, Ie K, Okuse C. Postherpetic abdominal pseudohernia. BMJ Case Rep 2023; 16:e257831. [PMID: 38056925 DOI: 10.1136/bcr-2023-257831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Miharu Goto
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| |
Collapse
|
6
|
Ie K, Ishizuka K, Otsuki T, Okuse C. Ruptured Baker's cyst presenting with a palpable popliteal mass and crescent sign. BMJ Case Rep 2023; 16:e257869. [PMID: 37793850 PMCID: PMC10551967 DOI: 10.1136/bcr-2023-257869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takuya Otsuki
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| |
Collapse
|
7
|
Ie K, Kushibuchi M, Tsuchida T, Motohashi I, Hirose M, Albert SM, Kimura M. The relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy: A nationwide survey among Japanese mothers. J Gen Fam Med 2023; 24:215-222. [PMID: 37484125 PMCID: PMC10357099 DOI: 10.1002/jgf2.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
Background Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy has not been fully investigated. The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy among mothers in Japan. Method This cross-sectional survey-based study included 4516 mothers. Using a chi-square test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID-19 vaccine hesitancy. Results Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID-19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine-hesitant (IRR = 0.90, 95% CI = 0.84-0.96) after adjusting for potential confounders. Conclusion This study suggested that having a usual source of primary care may contribute to lower parental COVID-19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.
Collapse
Affiliation(s)
- Kenya Ie
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
- Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvaniaUSA
| | - Mio Kushibuchi
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
| | - Tomoya Tsuchida
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
| | - Iori Motohashi
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
| | - Masanori Hirose
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
| | - Steven M. Albert
- Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvaniaUSA
| | - Miyako Kimura
- Department of Preventive MedicineSt Marianna University School of MedicineKawasaki‐shiJapan
| |
Collapse
|
8
|
Takaesu Y, Sakurai H, Aoki Y, Takeshima M, Ie K, Matsui K, Utsumi T, Shimura A, Okajima I, Kotorii N, Yamashita H, Suzuki M, Kuriyama K, Shimizu E, Mishima K, Watanabe K, Inada K. Treatment strategy for insomnia disorder: Japanese expert consensus. Front Psychiatry 2023; 14:1168100. [PMID: 37229388 PMCID: PMC10203548 DOI: 10.3389/fpsyt.2023.1168100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments. Methods Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. Results The primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations. Conclusion Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.
Collapse
Affiliation(s)
- Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Department of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Yumi Aoki
- Department of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, Japan
- Psychiatric and Mental Health Nursing, St. Luke’s International University, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Nozomu Kotorii
- Kotorii Isahaya Hospital, Nagasaki, Japan
- Department of Psychiatry, School of Medicine, Kurume University, Fukuoka, Japan
| | | | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Kitasato University, Tokyo, Japan
| |
Collapse
|
9
|
Kawada S, Moriya J, Wakabayashi H, Kise M, Okada T, Ie K. Mental health training in family medicine residencies: International curriculum overview. J Gen Fam Med 2023; 24:63-71. [PMID: 36909792 PMCID: PMC10000257 DOI: 10.1002/jgf2.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023] Open
Abstract
Integration of mental health into primary care has become a global trend, and many countries have developed mental health training in primary care. However, systematic mental health training for family physicians is insufficient in Japan. The newly established Japan Primary Care Association Mental Health Committee surveyed the current status of mental health training curricula in family medicine residency internationally. Participants were individuals involved in family medicine residency programs who were from Australia, Brazil, Hong Kong, the Philippines, Taiwan, the United Kingdom, and the United States. The results revealed that many academic societies have created competency lists and curriculum guidelines for mental health training; however, the implementation varied. This study is novel as it examined and compared different countries' curriculum; the findings of which can be used as a reference to develop future mental health training curriculum in Japan.
Collapse
Affiliation(s)
- Shogo Kawada
- Japan Primary Care Association Mental Health Committee Tokyo Japan.,Kameda Family Clinic Tateyama Chiba Japan
| | - Junko Moriya
- Japan Primary Care Association Mental Health Committee Tokyo Japan.,Department of Psychosomatic Medicine Tokyu Hospital Tokyo Japan
| | - Hideki Wakabayashi
- Japan Primary Care Association Mental Health Committee Tokyo Japan.,Department of Community Medicine, Kameyama Mie University School of Medicine Tsu Japan.,Department of General Medicine Mie University Hospital Tsu Japan
| | - Morito Kise
- Japan Primary Care Association Mental Health Committee Tokyo Japan.,Centre for Family Medicine Development Japanese Health and Welfare Co-operative Federation Tokyo Japan.,Kawasaki Health Co-operation Kuji Clinic Kawasaki Japan
| | | | - Kenya Ie
- Japan Primary Care Association Mental Health Committee Tokyo Japan.,Department of General Internal Medicine Kawasaki Municipal Tama Hospital Kawasaki Japan.,Department of General Internal Medicine St. Marianna University School of Medicine Kawasaki Japan
| |
Collapse
|
10
|
Iizuka Y, Tsuchida T, Ashikaga K, Ie K, Matsuda T, Ishizuka K, Okuse C, Matsuda T, Ohira Y. Patent Foramen Ovale Complicated With Renal Infarction and Pulmonary Embolism: A Case Report With Literature Review. Cureus 2023; 15:e35433. [PMID: 36994257 PMCID: PMC10041057 DOI: 10.7759/cureus.35433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
A 48-year-old man visited our emergency room after experiencing sudden left back pain, diaphoresis, and nausea. The patient underwent physical and laboratory examinations. Physical examination revealed tenderness in the left costovertebral angle. Laboratory examination revealed a slight elevation in D-dimer levels. Contrast-enhanced computed tomography revealed a bilateral pulmonary embolism and left renal infarction. Back pain was resolved following anticoagulation therapy with heparin. Transesophageal echocardiography revealed a patent foramen ovale (PFO). The patient was discharged on an anticoagulant, apixaban. Identifying the cause of paradoxical embolisms, such as an atrial septal defect or PFO, in cases with an arterial embolism in a young patient with no underlying disease is important.
Collapse
|
11
|
Sakurai H, Inada K, Aoki Y, Takeshima M, Ie K, Kise M, Yoshida E, Tsuboi T, Yamada H, Hori H, Inada Y, Shimizu E, Mishima K, Watanabe K, Takaesu Y. Management of unspecified anxiety disorder: Expert consensus. Neuropsychopharmacol Rep 2023. [PMID: 36811273 DOI: 10.1002/npr2.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS Treatment guidelines with respect to unspecified anxiety disorder have not been published. The aim of this study was to develop a consensus among field experts on the management of unspecified anxiety disorder. METHODS Experts were asked to evaluate treatment choices based on eight clinical questions concerning unspecified anxiety disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). According to the responses from 119 experts, the choices were categorized into first-, second-, and third-line recommendations. RESULTS Benzodiazepine anxiolytic use was not categorized as a first-line recommendation for the primary treatment of unspecified anxiety disorder, whereas multiple nonpharmacological treatment strategies, including coping strategies (7.9 ± 1.4), psychoeducation for anxiety (7.9 ± 1.4), lifestyle changes (7.8 ± 1.5), and relaxation techniques (7.4 ± 1.8), were categorized as first-line recommendations. Various treatment strategies were categorized as first-line recommendations when a benzodiazepine anxiolytic drug did not improve anxiety symptoms, that is, differential diagnosis (8.2 ± 1.4), psychoeducation for anxiety (8.0 ± 1.5), coping strategies (7.8 ± 1.5), lifestyle changes (7.8 ± 1.5), relaxation techniques (7.2 ± 1.9), and switching to selective serotonin reuptake inhibitors (SSRIs) (7.0 ± 1.8). These strategies were also highly endorsed when tapering the dosage of or discontinuing benzodiazepine anxiolytic drugs. There was no first-line recommendation regarding excusable reasons for continuing benzodiazepine anxiolytics. CONCLUSIONS The field experts recommend that benzodiazepine anxiolytics should not be used as a first-line option for patients with unspecified anxiety disorder. Instead, several nonpharmacological interventions and switching to SSRIs were endorsed for the primary treatment of unspecified anxiety disorder and as alternatives to benzodiazepine anxiolytics.
Collapse
Affiliation(s)
- Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke's International University, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Morito Kise
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Eriko Yoshida
- Department of General Internal Medicine, Kawasaki Kyodo Hospital, Kawasaki Health Cooperative Association, Kanagawa, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo Medicial University, Hyogo, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasushi Inada
- Medical corporation YUJIN-KAI Inada Clinic, Osaka, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
12
|
Ie K, Machino R, Albert SM, Tomita S, Kushibuchi M, Hirose M, Matsuda T, Okuse C, Ohira Y. Deprescribing as an Opportunity to Facilitate Patient-Centered Care: A Qualitative Study of General Practitioners and Pharmacists in Japan. Int J Environ Res Public Health 2023; 20:3543. [PMID: 36834238 PMCID: PMC9962748 DOI: 10.3390/ijerph20043543] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Deprescribing has recently been applied to address polypharmacy, particularly among older adults. However, the characteristics of deprescribing that are likely to improve health outcomes have not been well studied. This study explored the experiences and perspectives of general practitioners and pharmacists with regard to deprescribing in older adults with multimorbidity. A qualitative study was conducted involving eight semi-structured focus group interviews with 35 physicians and pharmacists from hospitals, clinics, and community pharmacies. Thematic analysis was applied to identify themes using the theory of planned behavior as a guide. The results illustrated a metacognitive process, as well as influencing factors, through which healthcare providers commit to shared decision making for deprescribing. Healthcare providers acted on the basis of their attitudes and beliefs on deprescribing, the influence of subjective norms, and perceived behavioral control for deprescribing. These processes are influenced by factors such as drug class, prescribers, patients, deprescribing experience, and environment/education. Healthcare providers' attitudes, beliefs, and behavioral control (along with deprescribing strategies) evolve in a dynamic interplay with experience, environment, and education. Our results can serve as a foundation for the development of effective patient-centered deprescribing to improve the safety of pharmaceutical care for older adults.
Collapse
Affiliation(s)
- Kenya Ie
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15621, USA
| | - Reiko Machino
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15621, USA
| | - Shiori Tomita
- Tama Family Clinic, Kawasaki 214-0013, Japan
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Mio Kushibuchi
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
| | - Masanori Hirose
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
| | - Takahide Matsuda
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
| | - Chiaki Okuse
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki 214-8525, Japan
| | - Yoshiyuki Ohira
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki 214-8525, Japan
| |
Collapse
|
13
|
Ie K, Ishizuka K, Sakai T, Motohashi I, Asai S, Okuse C. Subacute Thyroiditis Developing Within 2 Days of Vaccination Against COVID-19 with BNT162b2 mRNA. Eur J Case Rep Intern Med 2023. [DOI: 10.12890/2022_003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 32-year-old woman presented to the outpatient clinic with persistent fever, anterior neck pain, and palpitations over the past week which developed 2 days after she had received the first dose of the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine. On examination, the patient’s heart rate was 140 beats per minute and the thyroid gland was tender on palpation. Laboratory studies showed a low serum TSH level with elevated free thyroxine. Thyroid ultrasound revealed low-echoic lesions compatible with the site of tenderness. The patient was diagnosed with subacute thyroiditis and treatment was initiated with acetaminophen and propranolol, which resulted in symptom resolution within 2 weeks. Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan; Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsubasa Sakai
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan; Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Iori Motohashi
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan; Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Shiko Asai
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki-city, Japan; Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| |
Collapse
|
14
|
Ie K, Ishizuka K, Sakai T, Motohashi I, Asai S, Okuse C. Subacute Thyroiditis Developing Within 2 Days of Vaccination Against COVID-19 with BNT162b2 mRNA. Eur J Case Rep Intern Med 2023; 10:003735. [PMID: 36819651 PMCID: PMC9930880 DOI: 10.12890/2023_003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023] Open
Abstract
A 32-year-old woman presented to the outpatient clinic with persistent fever, anterior neck pain, and palpitations over the past week which developed 2 days after she had received the first dose of the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine. On examination, the patient's heart rate was 140 beats per minute and the thyroid gland was tender on palpation. Laboratory studies showed a low serum TSH level with elevated free thyroxine. Thyroid ultrasound revealed low-echoic lesions compatible with the site of tenderness. The patient was diagnosed with subacute thyroiditis and treatment was initiated with acetaminophen and propranolol, which resulted in symptom resolution within 2 weeks. Clinicians should be aware that subacute thyroiditis may occur within a few days following COVID-19 vaccination, especially in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations, because differentiating them from early non-specific adverse reactions can be challenging. LEARNING POINTS Cases of subacute thyroiditis after vaccination, including against COVID-19, have been increasingly reported.Subacute thyroiditis should be considered in patients with anterior cervical pain with no significant abnormal pharyngeal findings and/or severe palpitations after COVID-19 vaccination because these can be diagnostic clues.It is important to note that this condition can occur as early as a few days after vaccination, in order to avoid diagnostic pitfalls.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kosuke Ishizuka
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsubasa Sakai
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Iori Motohashi
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Shiko Asai
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| |
Collapse
|
15
|
Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y. Physicians' attitudes toward hypnotics for insomnia: A questionnaire-based study. Front Psychiatry 2023; 14:1071962. [PMID: 36865069 PMCID: PMC9971924 DOI: 10.3389/fpsyt.2023.1071962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Benzodiazepines and non-benzodiazepines are still widely prescribed despite safety concerns and the introduction of novel hypnotics (orexin receptor antagonists [ORA] and melatonin receptor agonists [MRA]), which may be influenced by physicians' attitudes toward hypnotics. METHODS A questionnaire survey was administered to 962 physicians between October 2021 and February 2022, investigating frequently prescribed hypnotics and the reasons for their selection. RESULTS ORA were the most frequently prescribed at 84.3%, followed by non-benzodiazepines (75.4%), MRA (57.1%), and benzodiazepines (54.3%). Compared to non-frequent prescribers of hypnotics, a logistic regression analysis showed that frequent ORA prescribers were more concerned with efficacy (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.01-2.54, p = 0.044) and safety (OR: 4.52, 95% CI: 2.99-6.84, p < 0.001), frequent MRA prescribers were more concerned with safety (OR: 2.48, 95% CI: 1.77-3.46, p < 0.001), frequent non-benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001), and frequent benzodiazepine prescribers were more concerned with efficacy (OR: 4.19, 95% CI: 2.91-6.04, p < 0.001) but less concerned with safety (OR: 0.25, 95% CI: 0.16-0.39, p < 0.001). DISCUSSION This study suggested that physicians believed ORA to be an effective and safe hypnotic and were compelled to prescribe benzodiazepine and non-benzodiazepine frequently, choosing efficacy over safety.
Collapse
Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke's International University, Tokyo, Japan.,Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Eichi Tsuru
- Department of Neurosurgery, Munakata Suikokai General Hospital, Fukuoka, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan
| | - Morito Kise
- Centre for Family Medicine Development, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan.,Department of Neuropsychiatry, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| |
Collapse
|
16
|
Takeshima M, Aoki Y, Ie K, Katsumoto E, Tsuru E, Tsuboi T, Inada K, Kise M, Watanabe K, Mishima K, Takaesu Y. Attitudes and Difficulties Associated with Benzodiazepine Discontinuation. Int J Environ Res Public Health 2022; 19:15990. [PMID: 36498061 PMCID: PMC9741206 DOI: 10.3390/ijerph192315990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Long-term use of benzodiazepine receptor agonists (BZDs) may depend on clinicians' BZD discontinuation strategies. We aimed to explore differences in strategies and difficulties with BZD discontinuation between psychiatrists and non-psychiatrists and to identify factors related to difficulties with BZD discontinuation. Japanese physicians affiliated with the Japan Primary Care Association, All Japan Hospital Association, and Japanese Association of Neuro-Psychiatric Clinics were surveyed on the following items: age group, specialty (psychiatric or otherwise), preferred time to start BZD reduction after improvement in symptoms, methods used to discontinue, difficulties regarding BZD discontinuation, and reasons for the difficulties. We obtained 962 responses from physicians (390 from non-psychiatrists and 572 from psychiatrists), of which 94.0% reported difficulty discontinuing BZDs. Non-psychiatrists had more difficulty with BZD discontinuation strategies, while psychiatrists had more difficulty with symptom recurrence/relapse and withdrawal symptoms. Psychiatrists used more candidate strategies in BZD reduction than non-psychiatrists but initiated BZD discontinuation after symptom improvement. Logistic regression analysis showed that psychosocial therapy was associated with less difficulty in BZD discontinuation (odds ratio, 0.438; 95% confidence interval, 0.204-0.942; p = 0.035). Educating physicians about psychosocial therapy may alleviate physicians' difficulty in discontinuing BZDs and reduce long-term BZD prescriptions.
Collapse
Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010-8543, Japan
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki 214-8525, Japan
| | - Eiichi Katsumoto
- Katsumoto Mental Clinic, 10-13 Horikoshicho, Tennoji-ku, Osaka City 543-0056, Japan
| | - Eichi Tsuru
- Department of Neurosurgery, Munakata Suikokai General Hospital, 5-7-1 Himakino, Fukutsu-shi 811-3298, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Kitasato University, Kitazato, Sagamihara shi 252-0329, Japan
| | - Morito Kise
- Centre for Family Medicine Development, Japanese Health and Welfare Co-Operative Federation, 3-25-1 Hyakunincho, Shinjuku-ku, Tokyo 169-0073, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010-8543, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara-cho, Nakagami-gun, Nishihara 903-0215, Japan
| |
Collapse
|
17
|
Otsuki T, Ishizuka K, Hirose M, Ie K. Hoagland sign in infectious mononucleosis. BMJ Case Rep 2022; 15:15/11/e252839. [DOI: 10.1136/bcr-2022-252839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
18
|
Ie K, Sakai T, Kurosu E, Motohashi I, Yagihashi K, Okuse C, Matsuda T. A Long-term Persistent Vascular Fluorodeoxyglucose Uptake in a Patient with Large-vessel Vasculitis. Intern Med 2022; 61:357-360. [PMID: 34334568 PMCID: PMC8866796 DOI: 10.2169/internalmedicine.7772-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of large-vessel vasculitis in a 57-year-old woman who developed an intermittent fever and weight loss. While contrast-enhanced computed tomography was noncontributory, positron emission tomography-computed tomography (PET-CT) revealed the diffuse, intense uptake of fluorodeoxyglucose (FDG) in the aorta and its branches. Although she had no signs of relapse after successful oral corticosteroid therapy, PET-CT at 30 months revealed a persistent FDG uptake in the large vessels, which warranted regular follow-up imaging for vascular complications. In cases with an intense FDG uptake at the diagnosis, PET-CT follow-up after clinical remission may help predict the risk of relapse and vascular complications.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Japan
| | - Tsubasa Sakai
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Japan
| | - Eri Kurosu
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Japan
| | - Iori Motohashi
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Japan
| | | | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Japan
| | - Takahide Matsuda
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| |
Collapse
|
19
|
Shinkai M, Tsushima K, Tanaka S, Hagiwara E, Tarumoto N, Kawada I, Hirai Y, Fujiwara S, Komase Y, Saraya T, Koh H, Kagiyama N, Shimada M, Kanou D, Antoku S, Uchida Y, Tokue Y, Takamori M, Gon Y, Ie K, Yamazaki Y, Harada K, Miyao N, Naka T, Iwata M, Nakagawa A, Hiyama K, Ogawa Y, Shinoda M, Ota S, Hirouchi T, Terada J, Kawano S, Ogura T, Sakurai T, Matsumoto Y, Kunishima H, Kobayashi O, Iwata S. Efficacy and Safety of Favipiravir in Moderate COVID-19 Pneumonia Patients without Oxygen Therapy: A Randomized, Phase III Clinical Trial. Infect Dis Ther 2021; 10:2489-2509. [PMID: 34453234 PMCID: PMC8396144 DOI: 10.1007/s40121-021-00517-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/27/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), is an enveloped, single-stranded RNA virus. Favipiravir is an orally administrable antiviral drug whose mechanism of action is to selectively inhibit RNA-dependent RNA polymerase. A preliminary trial in COVID-19 patients reported significant improvements across a multitude of clinical parameters, but these findings have not been confirmed in an adequate well-controlled trial. We conducted a randomized, single-blind, placebo-controlled Phase III trial assessing the efficacy and safety of favipiravir in patients with moderate pneumonia not requiring oxygen therapy. Methods COVID-19 patients with moderate pneumonia (SpO2 ≥ 94%) within 10 days of onset of fever (temperature ≥ 37.5 °C) were assigned to receive either placebo or favipiravir (1800 mg twice a day on Day 1, followed by 800 mg twice a day for up to 13 days) in a ratio of 1:2. An adaptive design was used to re-estimate the sample size. The primary endpoint was a composite outcome defined as the time to improvement in temperature, oxygen saturation levels (SpO2), and findings on chest imaging, and recovery to SARS-CoV-2-negative. This endpoint was re-examined by the Central Committee under blinded conditions. Results A total of 156 patients were randomized. The median time of the primary endpoint was 11.9 days in the favipiravir group and 14.7 days in the placebo group, with a significant difference (p = 0.0136). Favipiravir-treated patients with known risk factors such as obesity or coexisting conditions provided better effects. Furthermore, patients with early-onset in the favipiravir group showed higher odds ratio. No deaths were documented. Although adverse events in the favipiravir group were predominantly transient, the incidence was significantly higher. Conclusions The results suggested favipiravir may be one of options for moderate COVID-19 pneumonia treatment. However, the risk of adverse events, including hyperuricemia, should be carefully considered. Trial registration Clinicaltrials.jp number: JapicCTI-205238. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00517-4.
Collapse
Affiliation(s)
- Masaharu Shinkai
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Shingo Tanaka
- Department of Otolaryngology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection control, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuji Hirai
- Department of Infectious Diseases, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Sho Fujiwara
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yuko Komase
- Department of Respiratory Internal Medicine, St. Marianna University Yokohama City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa, Tokyo, 190-8531, Japan
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
| | - Megumi Shimada
- Department of General Internal Medicine, Tokai University Oiso Hospital, 21-1 Gakkyo, Oiso-machi, Naka-gun, Kanagawa, 259-0198, Japan
| | - Daiki Kanou
- Department of Respiratory Internal Medicine, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Shinichi Antoku
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawa-ku, Tokyo, 133-0052, Japan
| | - Yujiro Uchida
- Department of General Medicine, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8561, Japan
| | - Yutaka Tokue
- Infection Control and Prevention Center, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Mikio Takamori
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yasuhiro Gon
- Department of Respiratory Medicine, Nihon University Itabashi Hospital, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Yoshitaka Yamazaki
- Department of Respiratory and Infectious Diseases, Nagano Prefectural Shinshu Medical Center, 1332 Suzaka, Suzaka, Nagano, 382-8577, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Naoki Miyao
- Department of Internal Medicine, Nippon Koukan Hospital, 1-2-1 Kokandori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0852, Japan
| | - Takashi Naka
- Department of Neurology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Kazutoshi Hiyama
- Department of Infectious Diseases, National Hospital Organization Fukuokahigashi Medical Center, 1-1-1 Chidori, Koga, Fukuoka, 811-3195, Japan
| | - Yoshihiko Ogawa
- Department of Infectious Diseases, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai, Osaka, 593-8304, Japan
| | - Masahiro Shinoda
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Shinichiro Ota
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Takatomo Hirouchi
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo, 140-8522, Japan
| | - Jiro Terada
- Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Shuichi Kawano
- Department of Internal Medicine, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomiokahigashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan
| | - Tsutomu Sakurai
- Scientific Information Department, FujiFilm Toyama Chemical Co., Ltd., 3-4-8 Hatchobori, Chuo-ku, Tokyo, 104-0032, Japan
| | - Yoshihiko Matsumoto
- Scientific Information Department, FujiFilm Toyama Chemical Co., Ltd., 3-4-8 Hatchobori, Chuo-ku, Tokyo, 104-0032, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, School of Medicine, St. Marianna University, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Osamu Kobayashi
- Department of Infectious Diseases, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| |
Collapse
|
20
|
Ie K, Aoshima S, Yabuki T, Albert SM. A narrative review of evidence to guide deprescribing among older adults. J Gen Fam Med 2021; 22:182-196. [PMID: 34221792 PMCID: PMC8245739 DOI: 10.1002/jgf2.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/24/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Potentially inappropriate prescription and polypharmacy are well‐known risk factors for morbidity and mortality among older adults. However, recent systematic reviews have failed to demonstrate the overall survival benefits of deprescribing. Thus, it is necessary to synthesize the current evidence to provide a practical direction for future research and clinical practice. This review summarizes the existing body of evidence regarding deprescribing to identify useful intervention elements. There is evidence that even simple interventions, such as direct deprescribing targeted at risky medications and explicit criteria‐based approaches, effectively reduce inappropriate prescribing. On the other hand, if the goal is to improve clinical outcomes such as hospitalization and emergency department visits, patient‐centered multimodal interventions such as a combination of medication review, multidisciplinary collaboration, and patient education are likely to be more effective. We also consider the opportunities and challenges for deprescribing within the Japanese healthcare system.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan.,Division of General Internal Medicine Department of Internal Medicine Kawasaki Municipal Tama Hospital Kawasaki Japan.,Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Pittsburgh PA USA
| | | | - Taku Yabuki
- Department of Internal Medicine Tochigi Medical Center Tochigi Japan
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences University of Pittsburgh Graduate School of Public Health Pittsburgh PA USA
| |
Collapse
|
21
|
Tsuchida T, Ie K, Okuse C, Hirose M, Nishisako H, Torikai K, Tanaka T, Kunishima H, Matsuda T. Determining the factors affecting serum presepsin level and its diagnostic utility: A cross-sectional study. J Infect Chemother 2021; 27:585-591. [PMID: 33454214 DOI: 10.1016/j.jiac.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study aimed to identify factors affecting presepsin levels and to determine their diagnostic utility. METHODS This cross-sectional study was conducted at an outpatient clinic and emergency department at an acute care hospital in Japan between January 2015 and December 2017. We enrolled 1,840 consecutive outpatients with at least one measurement of serum presepsin, who were suspected of having bacterial infection. The outcome variables were bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections diagnoses, based on the chart review. We collected blood analysis data on the patients' presepsin levels. RESULTS There was a significant association between presepsin level and the diagnosis of bacterial infection even when adjusted for age, sex, renal function, and biliary enzyme levels. An increase of 1 unit in the log of presepsin values resulted in a relative risk ratio of 1.71 (1.09-2.66), 2.1 (1.58-2.79), 2.93 (2.05-4.19), 4.7(2.90-7.61), and 2.41(1.70-3.43), for bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections, respectively. CONCLUSIONS Presepsin showed a statistically significant increase in the diagnosis of bacterial infections (lower respiratory tract infections, urinary tract infections, cholangitis, and non-severe patients) in a community hospital setting. However, in patients with renal dysfunction, presepsin levels should be interpreted with caution.
Collapse
Affiliation(s)
- Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan; General Medicine Center, Kawasaki Municipal Tama Hospital, 1-30-37 Syukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan; General Medicine Center, Kawasaki Municipal Tama Hospital, 1-30-37 Syukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Masanori Hirose
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan; General Medicine Center, Kawasaki Municipal Tama Hospital, 1-30-37 Syukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Hisashi Nishisako
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan; General Medicine Center, Kawasaki Municipal Tama Hospital, 1-30-37 Syukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Keito Torikai
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Taku Tanaka
- General Medicine Center, Kawasaki Municipal Tama Hospital, 1-30-37 Syukugawara, Tama-ku, Kawasaki, Kanagawa, 214-8525, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takahide Matsuda
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| |
Collapse
|
22
|
Ie K, Chou E, Boyce RD, Albert SM. Fall Risk-Increasing Drugs, Polypharmacy, and Falls Among Low-Income Community-Dwelling Older Adults. Innov Aging 2021; 5:igab001. [PMID: 33644415 PMCID: PMC7899132 DOI: 10.1093/geroni/igab001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Medication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults. Research Design and Methods This retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, United States. Three measures of medication exposure were assessed: (a) total number of regular medications (polypharmacy); (b) counts of potentially inappropriate medications derived from current prescription guidance tools (Fall Risk-Increasing Drugs [FRIDs], Beers Criteria); and (c) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs). Results Overall 343 older adults were included and there were 236 months with falls during 2,316 activity-adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the 6 measures of medication risk assessed in multivariate models, only the use of 2 or more FRIDs (adjusted IRR 1.67 [95% CI: 1.04-2.68]) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants. Discussion and Implications The presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.,Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Eric Chou
- Department of Biomedical Informatics, University of Pittsburgh, Pennsylvania, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pennsylvania, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| |
Collapse
|
23
|
Ie K, Murata A, Tahara M, Komiyama M, Ichikawa S, Takemura YC, Onishi H. Relationship between medical students' career priority and specialty choice: A nationwide multicenter survey. J Gen Fam Med 2020; 21:219-225. [PMID: 33304715 PMCID: PMC7689223 DOI: 10.1002/jgf2.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The shortage of physicians in several specialties has been brought to public attention in several countries. However, little is known about factors affecting medical students' specialty choice. The objectives of our study were to illustrate medical students' career priority clusters and to assess their association with specialty preference. METHODS We conducted a nationwide multicenter survey in 2015 at 17 medical schools. The study participants were asked their top three specialty preferences, demographic characteristics, and 14 career priority questions. Multilevel logistic regression models were used to determine the effect of each variable on student career choice. RESULTS A total of 1264 responses were included in the analyses. The top five specialty choices were internal medicine: 833, general practice: 408, pediatrics: 372, surgery: 344, and emergency medicine: 244. An exploratory factor analysis mapped the 14 career priorities into 3-factor solution: "primary care orientation," "advanced and specific care," and "personal life orientation." Multilevel logistic regression models yielded satisfactory accuracy with the highest ROC curve (AUROC) noted in surgery (0.818), general practice (0.769), and emergency medicine (0.744). The career priorities under "primary care orientation" had positive association with choosing general practice, emergency medicine, internal medicine, and pediatrics. The "advanced and specific care" career priorities facilitated surgery and emergency medicine choice, while reducing the likelihood of choosing less procedure-oriented specialties, such as internal medicine, general practice, and pediatrics. CONCLUSIONS Our results demonstrated medical students' career priorities and their association with specialty preference. Individualized career support may be beneficial for both medical students and each specialty fields.
Collapse
Affiliation(s)
- Kenya Ie
- Department of General Internal MedicineTama Municipal HospitalKanagawaJapan
- Department of General Internal MedicineSt. Marianna University School of MedicineKanagawaJapan
| | | | | | | | - Shuhei Ichikawa
- Department of Education and Research in Family and Community MedicineMie University Graduate School of MedicineMieJapan
| | - Yousuke C. Takemura
- Department of Family MedicineMie University School of MedicineMieJapan
- Department of Family MedicineGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Hirotaka Onishi
- International Research Center for Medical EducationGraduate School of MedicineThe University of TokyoTokyoJapan
| |
Collapse
|
24
|
Ie K, Hirose M, Sakai T, Motohashi I, Aihara M, Otsuki T, Tsuboya A, Matsumoto H, Hashi H, Inoue E, Takahashi M, Komiya E, Itoh Y, Tsuchida T, Kurosu E, Albert SM, Okuse C, Matsuda T. Protocol of a randomised controlled trial on the efficacy of medication optimisation in elderly inpatients: medication optimisation protocol efficacy for geriatric inpatients (MPEG) trial. BMJ Open 2020; 10:e041125. [PMID: 33046478 PMCID: PMC7552871 DOI: 10.1136/bmjopen-2020-041125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Whether medication optimisation improves clinical outcomes in elderly individuals remains unclear. The current study aims to evaluate the effect of multidisciplinary team-based medication optimisation on survival, rehospitalisation and unscheduled hospital visits in elderly patients. METHODS AND ANALYSIS We report the protocol of a single-centre, open-label, randomised controlled trial. The enrolled subjects will be medical inpatients, aged 65 years or older, admitted to a community hospital and receiving five or more regular medications. The participants will be randomly assigned to receive either an intervention for medication optimisation or the usual care. The intervention will consist of a multidisciplinary team-based medication review, followed by a medication optimisation proposal based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment criteria and an implicit medication optimisation protocol. Medication optimisation summaries will be sent to primary care physicians and community pharmacists on discharge. The primary outcome will be a composite of death, unscheduled hospital visits and rehospitalisation until 48 weeks after randomisation. Secondary outcomes will include each of the primary endpoints, the number of prescribed medications, quality of life score, level of long-term care required, drug-related adverse events, death during hospitalisation and falls. Participants will be followed up for 48 weeks with bimonthly telephone interviews to assess the primary and secondary outcomes. A log-rank test stratified by randomisation factors will be used to compare the incidence of the composite endpoint. The study was initiated in 2019 and a minimum of 500 patients will be enrolled. ETHICS AND DISSEMINATION The study protocol has been approved by the Institutional Ethical Committee of St. Marianna University School of Medicine (No. 4129). The results of the current study will be submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER UMIN000035265.
Collapse
Affiliation(s)
- Kenya Ie
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Masanori Hirose
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Tsubasa Sakai
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Iori Motohashi
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Mari Aihara
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Takuya Otsuki
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Ayako Tsuboya
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Hiroshi Matsumoto
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Hikari Hashi
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Masaki Takahashi
- Division of Medical Informatics, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Eiko Komiya
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Yuka Itoh
- Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Eri Kurosu
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki-shi, Kanagawa, Japan
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Takahide Matsuda
- Division of General Internal Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| |
Collapse
|
25
|
Affiliation(s)
- Iori Motohashi
- Departments of Department of General Internal Medicine Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| | - Tomonori Takano
- Departments of Department of General Internal Medicine Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| | - Kenya Ie
- Departments of Department of General Internal Medicine Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| | - Yuki Hashimoto
- Department of Dermatology Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| | - Saki Akino
- Department of Dermatology Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| | - Chiaki Okuse
- Departments of Department of General Internal Medicine Kawasaki Municipal Tama Hospital St Marianna University School of Medicine Kawasaki Japan
| |
Collapse
|
26
|
Ie K, Narushima M, Goto M, Merenstein J, Wilson S, Takemura Y. Developing and implementing a faculty development curriculum for Japanese family medicine residency faculty. J Gen Fam Med 2020; 21:71-76. [PMID: 32489759 PMCID: PMC7260160 DOI: 10.1002/jgf2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite the increase in family medicine residency in Japan, there are only a few structured faculty development (FD) programs. The objective of this project was to construct a consensus on core competencies of faculty to develop a faculty development curriculum in a Japanese family medicine context. METHODS In 2015, a private FD initiative in the Mie University initiated a curriculum development in collaboration with FD fellowship at the University of Pittsburgh. A literature review and subsequent Delphi process were conducted for core competency development. Based on the core competency list, we designed and implemented a 2-year part-time FD curriculum from 2016. A course evaluation using pre-post confidence level was held during March 2017. RESULTS Twenty-eight objectives were defined in five core domains: 1) care management/family medicine principle, 2) leadership/professional development, 3) administrative/management, 4) teaching, and 5) research/scholarly activity. A pre-post survey at the end of an academic year revealed a significant increase in learner confidence for "care management/family medicine principle" (P = .03), "teaching" (P < .01), and "research/scholarly activity" (P < .01), as well as the total score (P = .03). CONCLUSIONS A family medicine FD curriculum based on a faculty core competency list was developed by consensus in a Japanese family medicine context. The core competency was strongly context-oriented, and the relevance of the FD topics and opportunities to apply to the participants' current positions may be inevitable for learner engagement. Further curriculum refinements will be required to see whether the curriculum could be used for faculty development in other family medicine residencies.
Collapse
Affiliation(s)
- Kenya Ie
- Department of General Internal MedicineSt. Marianna University School of Medicine/Tama Municipal HospitalKanagawaJapan
| | | | - Michiko Goto
- Department of Education and Research in Family and Community MedicineMie University Graduate School of MedicineMieJapan
| | - Joel Merenstein
- Department of Family MedicineUPMC St. MargaretPittsburghPennsylvania
| | - Stephen Wilson
- Department of Family MedicineUniversity of PittsburghPittsburghPennsylvania
| | - Yousuke Takemura
- Mie University School of MedicineMieJapan
- Department of Family MedicineGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| |
Collapse
|
27
|
Takamura A, Ie K, Takemura Y. Overcoming challenges in primary care education: a trial of a longitudinal integrated clerkship in a rural community hospital setting in Japan. Educ Prim Care 2018; 26:122-6. [PMID: 25898305 DOI: 10.1080/14739879.2015.11494326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Akiteru Takamura
- Department of Medical Education, Kanazawa Medical University, 1-1 Uchinada-machi Daigaku, Kahoku-gun, Ishikawa, Japan.
| | - Kenya Ie
- Department of Family Medicine, Mie University, School of Medicine, Tsu, Japan
| | - Yousuke Takemura
- Department of Family Medicine, Mie University, School of Medicine, Tsu, Japan
| |
Collapse
|
28
|
Skef S, Ie K, Sauereisen S, Shelesky G, Haugh A. Treatments for de Quervain Tenosynovitis. Am Fam Physician 2018; 97:Online. [PMID: 30216006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Suzan Skef
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA
| | - Kenya Ie
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA
| | - Sandra Sauereisen
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA
| | - Gretchen Shelesky
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA
| | - Amy Haugh
- University of Pittsburgh Medical Center St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA
| |
Collapse
|
29
|
Affiliation(s)
- Daisuke Kato
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Kenya Ie
- Department of General Internal Medicine, St Marianna University School of Medicine, Miyamae-ku, Japan
| | - Hideki Wakabayashi
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| |
Collapse
|
30
|
Ie K, Murata A, Tahara M, Komiyama M, Ichikawa S, Takemura YC, Onishi H. What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan. Asia Pac Fam Med 2018; 17:2. [PMID: 29422773 PMCID: PMC5787259 DOI: 10.1186/s12930-018-0039-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/22/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. METHODS From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. RESULTS A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. CONCLUSIONS Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.
Collapse
Affiliation(s)
- Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital/St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki, Kanagawa 214-8525 Japan
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Akiko Murata
- Family Practice Center of Okayama, 292-1 Toyosawa, Katsuta-gun, Nagi-cho, Okayama 708-1323 Japan
| | - Masao Tahara
- Iwakura Station Tahara Clinic, 291-1 Chuzaiji, Iwakura, Sakyo-ku, Kyoto-shi, Kyoto 606-0021 Japan
| | - Manabu Komiyama
- Thank You All, Family Clinic Hiratsuka, 215-3 Okazaki, Hiratsuka-shi, Kanagawa 259-1212 Japan
| | - Shuhei Ichikawa
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Yousuke C. Takemura
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Hirotaka Onishi
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| |
Collapse
|
31
|
Abstract
Background: Prescription-related problems among older adults have been of great interest. However, few data are available regarding the prevalence of these problems in US family medicine residency practices (FMRPs). Objective: The aim of this research was to examine the prevalence of multimorbidity, polypharmacy, and potentially inappropriate medications (PIMs) use among older adults who visited 5 FMRPs more than once a year. Methods: A cross-sectional hospital record review for patients 65 years or older who visited 1 of the 5 university-affiliated FMRPs at least twice during January 1 to December 31, 2014, was conducted. The prevalence of multimorbidity (24 chronic index conditions), polypharmacy, and PIMs use was examined. Results: A total of 1084 patients were included in the analyses. The most common chronic conditions were hypertension (87.8%), hyperlipidemia (69.7%), and osteoarthritis (56.1%). The mean number of chronic conditions was 5.3 (SD 2.6). The prevalence of multimorbidity (≥2 chronic conditions) was 95.6%. Among these multimorbid older adults (N = 1036), the mean number of medication orders was 9.04 (SD 4.36) and 1.57 (SD 0.92) for PIMs, 86.1% met polypharmacy standards (≥5 medications), and 33.4% were prescribed one or more PIMs. The proportion of patients with fewer prescriptions at the last visit was 45.4% in the polypharmacy group and 38.0% in the PIMs group. Conclusion: Our results suggest a high level of morbidity and complexity among older adults receiving care in FMRPs. Improving the continuity of care as well as promoting interdisciplinary collaboration would have potential to reduce these prescription-related problems. Further research and education to address polypharmacy and PIMs among this population at FMRPs are required.
Collapse
Affiliation(s)
- Kenya Ie
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Felton
- University of Pittsburgh, Pittsburgh, PA, USA
- UPMC St Margaret, Pittsburgh, PA, USA
| | - Sydney Springer
- University of Pittsburgh, Pittsburgh, PA, USA
- UPMC St Margaret, Pittsburgh, PA, USA
| | - Stephen A. Wilson
- University of Pittsburgh, Pittsburgh, PA, USA
- UPMC St Margaret, Pittsburgh, PA, USA
| | | |
Collapse
|
32
|
Ie K, Ichikawa S, Takemura YC. Development of a questionnaire to measure primary care physicians' scope of practice. BMC Fam Pract 2015; 16:161. [PMID: 26526728 PMCID: PMC4630913 DOI: 10.1186/s12875-015-0357-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/06/2015] [Indexed: 12/04/2022]
Abstract
Background Despite an increase in research devoted to primary care attributes, the patient benefits and educational aspects of broad scope practice of primary care physicians (PCPs) have not been well studied, due to a lack of validated measurement in each country. The objective of this study was to develop and validate the Scope of Practice Inventory (SPI) to measure physicians’ scope of practice within the Japanese primary care setting. Methods The questionnaire was developed in seven phases: 1) item generation, 2) consensus method for necessity of each item, 3) Delphi process for the importance of each item, 4) pilot tests to limit the number of items, 5) preliminary cross-sectional study to examine factor structure and to validate the construct validity, 6) evaluation of internal consistency and intra-class reliability, and 7) evaluation of external validity. To confirm the interpretability of the SPI, the determinants of the SPI using a generalized linear model were evaluated. Results Among 359 items generated by a focus group, 180 reached a defined consensus on face and content validity after the Delphi process. After deletion of items with Kappa values less than 0.6, 120 items were selected for the preliminary study. The principle component analysis using responses from 451 PCPs eliminated 52 items. The final 68-point SPI had three subdomains: Inpatient care, 25 items; Urgent care and minor procedures, 27 items; and Ambulatory care, 16 items. Internal consistency and test-retest reliability for total SPI and each subdomain revealed acceptable reliability. Male sex, less years since graduation, working in a hospital, sub-urban or rural setting, having remote experience, and having board certification as a PCP were positively associated with higher SPI. Conclusions We developed a self-administered 68-point scale, the SPI, which had satisfactory validity and reliability. Primary care quality and educational research using SPI are expected to contribute to comprehensive and efficient health care systems in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0357-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kenya Ie
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. .,Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Shuhei Ichikawa
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yousuke C Takemura
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| |
Collapse
|
33
|
Ie K, Tahara M, Murata A, Komiyama M, Onishi H. Factors associated to the career choice of family medicine among Japanese physicians: the dawn of a new era. Asia Pac Fam Med 2014; 13:11. [PMID: 28392748 PMCID: PMC5377022 DOI: 10.1186/s12930-014-0011-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 09/23/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Despite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan. METHODS From December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization. RESULTS We extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics ("self-reliance," "pioneering spirit"), career direction ("community/rural-orientedness," "multifaceted orientation") and experience (e.g., "discomfort with fragmented care"). We divided the influencing factors that were identified for career choice into supporters (e.g., "role model"), conflict of career choice (e.g., "anxiety about diverse/broad practice"), and the dawn of a new era in family medicine in Japan (e.g., "lack of social recognition," "concern about livelihood," and "too few role models"). CONCLUSIONS Although the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a "pioneering spirit" and an "attitude of self-training." Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, "concern about livelihood" was specific among our respondents and was related to career choice in the dawn period. "Community-orientedness" and "multifaceted orientation" (which have aspects in common with previous studies' findings) would appear to be universal regardless of cultural and medical system differences. In our study, these universal factors were also found to be part of the attractiveness of family medicine from the practitioners' viewpoints, and these factors may become great influencers for family medicine candidates.
Collapse
Affiliation(s)
- Kenya Ie
- Department of Family Medicine, Mie University School of Medicine, Mie, Japan
| | - Masao Tahara
- Naniwa Clinic, Amagasaki Health Cooperative, Hyogo, Japan
| | - Akiko Murata
- Family Practice Center of Okayama, Okayama, Japan
| | | | - Hirotaka Onishi
- International Research Center for Medical Education, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
34
|
Ie K, Yoshizawa A, Hirano S, Izumi S, Hojo M, Sugiyama H, Kobayasi N, Kudou K, Maehara Y, Kawachi M, Miyakoshi K. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia]. Arerugi 2010; 59:831-838. [PMID: 20703069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 05/17/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. METHODS We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. RESULTS The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. CONCLUSION We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.
Collapse
Affiliation(s)
- Kenya Ie
- Department of Respirology, International Medical Center of Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|