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ObjectivesEstimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated the discrimination and calibration of the 4C Score. This was a retrospective cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of suspected COVID-19 in EmeRgency care) network.Setting99 emergency departments (EDs) across the USA.ParticipantsPatients ≥18 years old, positive for SARS-CoV-2 in the ED, and hospitalised.Primary outcomeDeath within 30 days of the index visit. We performed logistic regression analysis, reporting multivariable risk ratios (MVRRs) and calculated the area under the ROC curve (AUROC) and mean prediction error for the original 4C Score and after dropping the C reactive protein (CRP) component.ResultsOf 6802 hospitalised patients with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). Score-specific mortalities in our sample were lower than in the 4C validation sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score did not substantially affect discrimination and 4C risk estimates were now close (mean prediction error 0.7%).ConclusionsWe independently validated 4C Score as predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We recommend dropping the CRP component of the score and using our recalibrated mortality risk estimates.

Abstract The epidemiology of elevations in blood pressure is incompletely characterized, particularly in Australia. Given the lack of evidence regarding the frequency and the optimal management of in‐hospital hypertension, the authors performed a multicenter retrospective cohort study of consecutive medical admissions in South Australia over a 2‐year period to investigate systolic blood pressure levels and their association with in‐hospital mortality. Among 16 896 inpatients, 76% had at least one systolic blood pressure reading of ≥140 mmHg and 11.7% of ≥180 mmHg during hospitalization. A statistically significant negative relationship was observed between having at least one reading ≥140 mmHg and a likelihood of in‐hospital mortality (odds ratio 0.41, 95% CI: 0.35 to 0.49, P

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly utilizing blended or longitudinal APPE models to offer experiential opportunities; however, there is a gap in the literature to support programs with delineating rotation-specific competencies when integrating two or more rotations together. Utilizing a survey instrument, PharmD students at two C/SOPs reported their onsite inpatient rotation sub-competency activities achieved within the four competency areas of Hospital/Health Pharmacy Systems, Medication Safety and Quality, Clinical Applications, and Professional Practice, which are listed in Appendix C of the 2016 Accreditation Council for Pharmacy Education Standards Guidance Document. Unpaired two-sample t-tests were performed to compare proportions of sub-competency activity occurrence in the two rotation settings. In total, 168 students reported inpatient activities related to the four competency areas, with 95–100% reporting their involvement in one or more sub-competency opportunities within each area. Of the 26 sub-competencies compared, 73% significantly facilitated the development of competency to a greater extent for one APPE inpatient rotation type over the other (p < 0.05). The findings can be utilized by C/SOPs to support the delineation of rotation-specific competencies when blending inpatient experiential opportunities.

Abstract Background An increased focus on quality and patient safety has led to the evolution of hospitalists. The number of hospitalists covering ward and outpatient care is on the rise in Japan. However, it is unclear what roles hospital workers themselves consider important in their practice. Therefore, this study investigated what hospitalists and non-hospitalist generalists in Japan consider important for the practice of their specialty. Methods This was an observational study that included Japanese hospitalists (1) currently working in a general medicine (GM) or general internal medicine department and (2) working at a hospital. Using originally developed questionnaire items, we surveyed the items important to hospitalists and non-hospitalist generalists. Results There were 971 participants (733 hospitalists, 238 non-hospitalist) in the study. The response rate was 26.1%. Both hospitalists and non-hospitalists ranked evidence-based medicine as the most important for their practice. In addition, hospitalists ranked diagnostic reasoning and inpatient medical management as the second and third most important roles for their practice, while non-hospitalists ranked inpatient medical management and elderly care as second and third. Conclusions This is the first study investigating the roles Japanese hospitalists consider important and comparing those to that of non-hospitalist generalists. Many of the items that hospitalists considered important were those that hospitalists in Japan are working on within and outside academic societies. We found that diagnostic medicine and quality and safety are areas that are likely to see further evolution as hospitalists specifically emphasized on them. In the future, we expect to see suggestions and research for further enhancing the items that hospital workers value and emphasise upon.

Abstract Importance Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. Objective To determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system. Design Nationwide cross-sectional study. Setting Medical residents in Japan who attempted the GM-ITE in their first or second year were surveyed. Participants A total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021. Main measures GM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge. Results When compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and “Other/Not decided” groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time. Conclusions Levels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems.

As future healthcare professionals, medical and dentistry students have an ethical responsibility to establish higher standards of ethics and professionalism in their interactions with patients. Therefore, expanding their knowledge and awareness of ethical concepts, professional behavior, and ethical patient treatment is essential. The aim of this research was to gather information about general medicine and dentistry students' awareness of ethical concepts, professional behavior, and ethical patient treatment. The questionnaire included 16 questions divided into four sections. The study found that most students agreed with basic professional health ethical principles, and that there was no significant difference between the students' directions (general medicine or dentistry) and the year of study (first and fourth). In this research, general medicine and dental students, in general, indicated a good level of awareness of ethical principles, professional behavior, and ethical patient treatment.

Key Clinical Message Diagnosis of complex lymphatic anomalies can be difficult, and biopsies can be associated with significant morbidity. Mediastinal masses with features such as osseous involvement warrant thorough noninvasive evaluation prior to biopsy.

Key Clinical Message Hemothorax is a rare and potentially fatal condition characterized by pleural effusion containing over 50% of the patient's hematocrit. A massive hemothorax involves blood loss exceeding 1.5 L. Common causes include chest trauma, invasive thoracic procedures, anticoagulant medications, vascular anomalies, malignancies, and hematologic abnormalities. Spontaneous hemothorax may be seen in conjunction with pulmonary infarction and spontaneous pneumothorax. Anticoagulation is a key therapeutic strategy for certain thromboembolic events, such as pulmonary embolism. Historically, these events were treated with vitamin K antagonists (VKAs), which have demonstrated variable plasma concentrations and an increased risk of hemorrhage. With the advent of direct oral anticoagulants (DOACs), treatment has become as effective as VKAs while significantly reducing the risk of hemorrhage. However, some researchers have speculated that hemorrhagic complications in certain cases could be worse with DOACs than with VKAs. In the case presented here, we identified a genuine association between the use of rivaroxaban and spontaneous hemothorax following the initiation of treatment for pulmonary embolism.

The epidemiology of elevations in blood pressure is incompletely characterized, particularly in Australia. Given the lack of evidence regarding the frequency and the optimal management of in‐hospital hypertension, the authors performed a multicenter retrospective cohort study of consecutive medical admissions in South Australia over a 2‐year period to investigate systolic blood pressure levels and their association with in‐hospital mortality. Among 16 896 inpatients, 76% had at least one systolic blood pressure reading of ≥140 mmHg and 11.7% of ≥180 mmHg during hospitalization. A statistically significant negative relationship was observed between having at least one reading ≥140 mmHg and a likelihood of in‐hospital mortality (odds ratio 0.41, 95% CI: 0.35 to 0.49, P <.001). Our results suggest that elevations in systolic blood pressure are common in Australian medical inpatients. However, the inverse association observed between systolic blood pressure values ≥140 mmHg and in‐hospital mortality warrants further research to determine the clinical significance and optimal management of blood pressure elevations in this group. [ABSTRACT FROM AUTHOR]

This review proposes an analysis of some of the many possible psychotherapeutic treatment approaches and modalities that are most effective at present according to the latest guidelines. Psychotherapy, often underestimated, plays a key role in the integrated treatment of patients presenting with various forms of psychological distress and/or psychiatric disorders and is an essential element in the healing process. The usefulness of psychological supports is too often poorly considered in general practice clinics, while its scientific value has also been recognized by Evidence Based Medicine. This paper has set out to examine the most effective current psychotherapies for the treatment of the most prevalent psychological and psychiatric disorders at present, with a focus on the so-called third-wave or third-generation psychotherapy approaches (DBT, ST, EMDR, MBT, TMI, MBCT), which represent an evolution of standard TCC and arise precisely from the need to integrate the concreteness and Evidenced-based efficacy of TCC with the most powerful elements of the psychoanalytic approach, thus creating a unique, comprehensive and integrated synthesis. [ABSTRACT FROM AUTHOR]

Little is known about the contribution of general medicine to perioperative and consultative care in Australia. A descriptive observational study was undertaken at a quaternary institution to evaluate the characteristics of perioperative and nonoperative consultations undertaken by general medicine. Results demonstrated patterns of engagement within a 'traditional' model of perioperative care and highlighted several opportunities for a redesign to a more proactive and collaborative cross‐disciplinary model. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pulmonary sarcoidosis can manifest in different radiologic patterns. Typical manifestations in high‐resolution computed tomography are bilateral perihilar lymphadenopathy, micronodules, and fibrotic changes. Atypical manifestations are mass‐like or alveolar opacities, honeycomb‐like cysts, miliary opacities, tracheobronchial involvement, and pleural disease. Cystic bronchiectasis in pulmonary sarcoidosis is rare, with only a few reported cases in the literature. We present another case of cystic bronchiectasis with a honeycomb‐like pattern in pulmonary sarcoidosis and with cardiac involvement. This case was presented as an abstract poster at the American Thoracic Society conference in 2022. [ABSTRACT FROM AUTHOR]

Despite the controversy over the effectiveness of homeopathy, it is one of the complementary methods whose prevalence is increasing worldwide. Researching the reasons, as well as the health problems, for which people use homeopathy can provide answers for health care in general. The purpose of this study was to analyze the available publications and investigate the reasons for using the method among Bulgarians. A transversal survey was conducted among a sample of the Bulgarian population in 2022. A total of 555 completed surveys were received (women ‒ 486, men ‒ 69). Results. Over 90% of respondents used homeopathy. The main reasons for this are its effectiveness, holistic, individual approach and lack of side effects. Respondents used homeopathic treatment for a wide range of health problems encountered in general medical practice, with the largest proportion citing general health, respiratory, childhood, infectious and ear, throat and nose diseases. Allergies, skin, digestive and psychological problems are also often mentioned. A relatively small share of participants indicates more serious diseases such as cardiovascular, oncological and endocrine diseases. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case report presents a child with PURA‐related neurodevelopmental disorder, caused by the heterozygous pathogenic variant c.175C>T (p.Gln59*). The clinical symptoms included microcephaly, brachygnathia, central and peripheral hypotonia, and developmental delay (non‐verbal), among others. On comparison with published literature, even patients with the same mutation present different clinical symptoms. This case report presents a child with PURA‐related neurodevelopmental disorder, caused by the heterozygous pathogenic variant c.175C>T (p.Gln59*), whose symptoms included microcephaly, brachygnathia, the development of a high anterior hairline, hip dysplasia, strabismus, severe hypotonia, developmental delay (non‐meaningful verbal), feeding difficulties, and respiratory difficulties. His development ceased with age, such that his development at 10 years corresponded to an infant of 6 months. Moreover, even patients with the same variant can have different clinical symptoms, such as the presence or absence of epilepsy or congenital malformations. Therefore, we should follow his long‐term clinical course and provide medical support as necessary. [ABSTRACT FROM AUTHOR]

Background and Aims: Marburg virus (MARV) has regularly affected people since 1967 causing multiple outbreaks. There are presently no authorized therapies for the fatal Marburg virus disease (MVD), which poses an imminent risk to global public health. The MVD has so far claimed the lives of numerous people, with an increased number of cases being seen throughout the African continent. Hence, a review was carried out to analyze the geographical distribution of MVD, mortality, routes of transmission, and diagnostic and treatment modalities. Methods: PubMed, Scopus, Web of Science, Google Scholar, and ProMED servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. Results: A total of 11 studies (7 case reports and 4 case series) were included in the final analysis, and 21 cases of MVD were analyzed. The most frequent symptoms were fever (66.67%), vomiting (57.14%), headache (52.38%), diarrhea (52.38%), and pain (47.62%). The most commonly used diagnostic test was RT‐PCR (42.11%). Contact transmission (50%) and zoonotic transmission (37.5%) were the most prevalent routes of transmission. Antibiotics (61.5%) were the first line of treatment. The most common complications were hemorrhage (60%) and coagulopathies (33.3%). The mortality rate was 57.1%. Conclusion: To avoid disastrous consequences, it is essential to reiterate the necessity of early diagnosis and treatment of MVD. Key Points: The study provides a detailed analysis of clinical presentation, modes of transmission, complications, diagnostic methods, and treatment modalities of Marburg virus disease (MVD).The results of the systematic review supports the high mortality rate of MVD.Various countries affected in different outbreaks are enlisted in the study. [ABSTRACT FROM AUTHOR]

IntroductionCareer firefighters experience chronic circadian rhythm disruption, increasing their risk of cardiometabolic disease. The recent discovery that eating patterns regulate circadian rhythmicity in metabolic organs has raised the hypothesis that maintaining a consistent daily cycle of eating and fasting can support circadian rhythms and reduce disease risks. Preclinical animal studies and preliminary clinical trials have shown promising effects of time-restricted eating (TRE) to reduce disease risk without compromising physical performance. However, there is a lack of research on TRE in shift workers including firefighters. This study aims to investigate the feasibility and efficacy of 10-hour TRE on health parameters that contribute to cardiometabolic disease risks among career firefighters who work on a 24-hour shift schedule.Methods and analysesThe Healthy Heroes Study is a randomised controlled parallel open-label clinical trial with 150 firefighters over 1 year. Firefighters are randomised with a 1:1 ratio to either the control or intervention group. The control group receives Mediterranean diet nutritional counselling (standard of care, 'SOC'). The intervention group receives the same SOC and a self-selected 10-hour TRE window. After the 2-week baseline, participants enter a 3-month monitored intervention, followed by a 9-month self-guided period with follow-up assessments. The impact of TRE on blood glucose, body weight, body composition, biomarkers (neuroendocrine, inflammatory and metabolic), sleep and mood is evaluated. These assessments occur at baseline, at the end of intervention and at 6, 9 and 12-month follow-ups. Temporal calorie intake is monitored with the smartphone application myCircadianClock throughout the study. Continuous glucose monitors, wrist-worn actigraphy device and questionnaires are used to monitor glucose levels, activity, sleep and light exposure.Ethics and disseminationThe study was approved by the Institutional Review Boards of the University of California San Diego and the Salk Institute for Biological Studies. Results will be disseminated through peer-reviewed manuscripts, reports and presentations.Trial registration numberNCT03533023; Pre result.

ObjectiveStudies describe COVID-19 patient characteristics and outcomes across populations, but reports of variation across healthcare facilities are lacking. The objectives were to examine differences in COVID-19 patient volume and mortality across facilities, and understand whether facility variation in mortality was due primarily to differences in patient versus facility characteristics.DesignObservational cohort study with multilevel mixed effects logistic regression modelling.SettingThe Veterans Health Administration (VA) is the largest healthcare system in the USA.ParticipantsPatients with COVID-19.Main outcomeAll-cause mortality within 45 days after COVID-19 testing (March-May, follow-up through 16 July 2020).ResultsAmong 13 510 patients with COVID-19, 3942 (29.2%) were admitted (2266/3942 (57.5%) ward; 1676/3942 (42.5%) intensive care unit (ICU)) and 679/3942 (17.2%) received mechanical ventilation. Marked heterogeneity was observed across facilities in median age (range: 34.3-83.9 years; facility mean: 64.7, SD 7.2 years); patient volume (range: 1-737 at 160 facilities; facility median: 48.5, IQR 14-105.5); hospital admissions (range: 1-286 at 133 facilities; facility median: 11, IQR 1-26.5); ICU caseload (range: 1-85 at 115 facilities; facility median: 4, IQR 0-12); and mechanical ventilation (range: 1-53 at 90 facilities; facility median: 1, IQR 0-5). Heterogeneity was also observed in facility mortality for all patients with COVID-19 (range: 0%-29.7%; facility median: 8.9%, IQR 2.4%-13.7%); inpatients (range: 0%-100%; facility median: 18.0%, IQR 5.6%-28.6%); ICU patients (range: 0%-100%; facility median: 28.6%, IQR 14.3%-50.0%); and mechanical ventilator patients (range: 0%-100%; facility median: 52.7%, IQR 33.3%-80.6%). The majority of variation in facility mortality was attributable to differences in patient characteristics (eg, age).ConclusionsMarked heterogeneity in COVID-19 patient volume, characteristics and mortality were observed across VA facilities nationwide. Differences in patient characteristics accounted for the majority of explained variation in mortality across sites. Variation in unadjusted COVID-19 mortality across facilities or nations should be considered with caution.

Background and purpose: Responsive medical education considers the priority of society's health issues in all its operational areas, and its goal is to train doctors who want and can serve their society. Based on this, the aim of this research was to design and validate an ideal model for social responsiveness in general medical education. Materials and methods: In this study, grounded theory as a qualitative approach was used. The participants included 21 key informants of medical education (managers, supervisors, doctors of academic staff, and educational-therapeutic centers leadership) in Mazandaran province who were selected by snowball purposive sampling. Data were collected using semi-structured interviews. Data analysis was done at three stages of open, axial, and selective coding, and based on that, the qualitative research model was designed. Also, acceptability index was used for accreditation. Results: The research showed 104 concepts shaped by 29 main categories which define a paradigmatic model of social accountability in general medical education at six inclusive layers (causal conditions, contextual conditions, intervening conditions, central phenomenon, strategies, and consequences) to be deep and rich. Conclusion: The present study, by applying grounded theory, proposes a holistic-systematic perspective and model on social accountability in education that can be used by the Ministry of Health, Treatment and Medical Education and policy makers and planners.

Abstract Background Communication skills required for doctors do not consist of simple uses of particular linguistic forms but include uses that are sensitive to the interactional context. In consultations where the doctors have pre‐existing information about their patients, this can complicate the context of problem solicitation. We investigated how doctors tailor opening questions to a context in which they get pre‐existing information from a medical questionnaire (MQ) filled out by the patients. Methods The data for this study were 87 video recordings of first visits to the department of general medicine at a university hospital in Japan. We qualitatively analyzed doctors' practices in problem solicitation in an opening phase using conversation analysis and triangulated it with quantitative analysis. Results Open‐ended questions accounted for 26.4% of opening questions. Among the closed‐ended questions, 75.0% were confirming questions about symptoms. In cases with open‐ended questions, doctors minimized the relevance of the MQ to problem solicitation by giving license to repeat the description from the MQ. In cases with closed‐ended questions, doctors highlighted the relevance of the MQ by sharing the MQ. Through these practices, they avoided patients' possible confusion about problem presentation while simultaneously maximizing the possibility of soliciting the patients' narratives. Conclusions Doctors adjusted the level of relevance of pre‐existing information to problem solicitation through both verbal and nonverbal management of the MQ. It will be useful to instruct such context‐dependent practices to improve communication skills in medical school curriculum.

Takashi Watari,1– 3 Ashwin Gupta2,3 1General Medicine Center, Shimane University, Izumo, Shimane, Japan; 2Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 3Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USACorrespondence: Takashi Watari, Shimane University Hospital, General Medicine Center, 89-1, Enya-cho, Izumo shi, Shimane, 693-8501, Japan, Tel +81-853-20-2005, Fax +81-853-20-2375, Email wataritari@gmail.comPurpose: Although research in general medicine is important, the contributions and characteristics of general medicine physicians (GMPs) in university hospitals (UH) and community healthcare facilities (CHF) remains unclear. Therefore, this study examines the popularity of research by affiliation, characteristics of journal publication, annual trends, and differences in impact factors (IFs) of journal publications.Methods: This study is a secondary bibliometric analysis of articles in international journals published in PubMed over the past six years (2015– 2020). The analysis compared English articles published by either UH- or CHF-affiliated GMPs in Japan in terms of, among other things, article type, research field, and IF.Results: Of the 2372 articles analyzed, 1688 (71.2%) were published by physicians affiliated with UHs, 62.6% of which were original. Basic research, international collaboration, and ratio of IFs were significantly higher for such papers. In contrast, the number of CHF articles were significantly higher in the areas of clinical research and practice, with a greater proportion of case reports. There was no significant difference in IF between the disciplines within each affiliation, but the IF was the highest in experimental basic research and the lowest in medical and clinical education. In the six-year time series, the number of original papers by UHs and CHFs increased roughly twofold between 2015 and 2020, but the number of articles in the areas of medical education and healthcare quality and safety remained mostly unchanged.Conclusion: The number of international papers published by Japanese GMPs has increased since 2015, particularly in terms of original papers and clinical research from UHs. However, there was no significant difference in the IF between UH and CHF publications. Our findings can guide the development of indicators, research, and education strategies regarding Japanese GMPs’ research performance.Keywords: bibliometric study, general medicine, academic generalist, publication, university hospitals

The letter published in the journal "Medical Principles & Practice" discusses the emerging role of artificial intelligence (AI) in patient education, specifically focusing on the performance of language models in answering medical questions. The authors highlight methodological weaknesses in a previous study, such as a small sample size and limited evaluation of relevance and context accuracy. They suggest future research directions, including comparing different language models on a larger dataset and exploring the integration of these models into clinical decision support systems. The letter also emphasizes the importance of addressing ethical implications, transparency, and bias in AI technologies to ensure safe and responsible implementation in healthcare settings. [Extracted from the article]

IntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within integrated healthcare delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improving collaboration between medical providers and community-based DCs, or embedding DCs in medical settings such as hospitals or community health centres, will improve access to evidence-based care for musculoskeletal conditions.Methods and analysesThis scoping review will map studies of DCs working with or within integrated healthcare delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (eg, shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention, implementation strategies and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based survey.Ethics and disseminationEthics approval will not be obtained for this review of published and publicly accessible data, but will be obtained for the web-based survey. Our results will be disseminated through conference presentations and a peer-reviewed publication. Our findings will inform implementation strategies that support the adoption of chiropractic care within integrated healthcare delivery systems.

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Key Clinical Message Pulmonary sarcoidosis can manifest in different radiologic patterns. Typical manifestations in high‐resolution computed tomography are bilateral perihilar lymphadenopathy, micronodules, and fibrotic changes. Atypical manifestations are mass‐like or alveolar opacities, honeycomb‐like cysts, miliary opacities, tracheobronchial involvement, and pleural disease. Cystic bronchiectasis in pulmonary sarcoidosis is rare, with only a few reported cases in the literature. We present another case of cystic bronchiectasis with a honeycomb‐like pattern in pulmonary sarcoidosis and with cardiac involvement. This case was presented as an abstract poster at the American Thoracic Society conference in 2022.

Key Clinical Message Poncet's disease is an acute onset reactive polyarthritis associated with tuberculosis infection. Although uncommon, the diagnosis should be considered among patients presenting with symmetrical polyarthritis in tuberculosis‐endemic regions. Abstract This is a case report of Poncet's disease presenting as bilateral knee and wrist pain associated with swelling. Joint x‐rays and immunological assays were normal. A chest x‐ray and Gene‐Xpert diagnosed tuberculosis. A complete resolution of symptoms was attained following the completion of antituberculous therapy regimen.

Abstract Background and Aims Marburg virus (MARV) has regularly affected people since 1967 causing multiple outbreaks. There are presently no authorized therapies for the fatal Marburg virus disease (MVD), which poses an imminent risk to global public health. The MVD has so far claimed the lives of numerous people, with an increased number of cases being seen throughout the African continent. Hence, a review was carried out to analyze the geographical distribution of MVD, mortality, routes of transmission, and diagnostic and treatment modalities. Methods PubMed, Scopus, Web of Science, Google Scholar, and ProMED servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. Results A total of 11 studies (7 case reports and 4 case series) were included in the final analysis, and 21 cases of MVD were analyzed. The most frequent symptoms were fever (66.67%), vomiting (57.14%), headache (52.38%), diarrhea (52.38%), and pain (47.62%). The most commonly used diagnostic test was RT‐PCR (42.11%). Contact transmission (50%) and zoonotic transmission (37.5%) were the most prevalent routes of transmission. Antibiotics (61.5%) were the first line of treatment. The most common complications were hemorrhage (60%) and coagulopathies (33.3%). The mortality rate was 57.1%. Conclusion To avoid disastrous consequences, it is essential to reiterate the necessity of early diagnosis and treatment of MVD.

Key Clinical Message This case report presents a child with PURA‐related neurodevelopmental disorder, caused by the heterozygous pathogenic variant c.175C>T (p.Gln59*). The clinical symptoms included microcephaly, brachygnathia, central and peripheral hypotonia, and developmental delay (non‐verbal), among others. On comparison with published literature, even patients with the same mutation present different clinical symptoms. Abstract This case report presents a child with PURA‐related neurodevelopmental disorder, caused by the heterozygous pathogenic variant c.175C>T (p.Gln59*), whose symptoms included microcephaly, brachygnathia, the development of a high anterior hairline, hip dysplasia, strabismus, severe hypotonia, developmental delay (non‐meaningful verbal), feeding difficulties, and respiratory difficulties. His development ceased with age, such that his development at 10 years corresponded to an infant of 6 months. Moreover, even patients with the same variant can have different clinical symptoms, such as the presence or absence of epilepsy or congenital malformations. Therefore, we should follow his long‐term clinical course and provide medical support as necessary.

Key Clinical Message Patients with a recent history of peritoneal dialysis catheter removal in the setting of immunosuppression should be monitored for rare Listeria bacterial peritonitis. This infection should be managed with ampicillin and gentamicin. Abstract There are scattered reports to date of patients with peritonitis caused by Listeria monocytogenes. Listeria peritonitis is more commonly reported in patients with cirrhosis and those receiving peritoneal dialysis. We present a case of L. monocytogenes peritonitis in a patient with end‐stage renal disease due to lupus nephritis actively on hemodialysis months after peritoneal dialysis catheter removal.

Background: An increased focus on quality and patient safety has led to the evolution of hospitalists. The number of hospitalists covering ward and outpatient care is on the rise in Japan. However, it is unclear what roles hospital workers themselves consider important in their practice. Therefore, this study investigated what hospitalists and non-hospitalist generalists in Japan consider important for the practice of their specialty. Methods: This was an observational study that included Japanese hospitalists (1) currently working in a general medicine (GM) or general internal medicine department and (2) working at a hospital. Using originally developed questionnaire items, we surveyed the items important to hospitalists and non-hospitalist generalists. Results: There were 971 participants (733 hospitalists, 238 non-hospitalist) in the study. The response rate was 26.1%. Both hospitalists and non-hospitalists ranked evidence-based medicine as the most important for their practice. In addition, hospitalists ranked diagnostic reasoning and inpatient medical management as the second and third most important roles for their practice, while non-hospitalists ranked inpatient medical management and elderly care as second and third. Conclusions: This is the first study investigating the roles Japanese hospitalists consider important and comparing those to that of non-hospitalist generalists. Many of the items that hospitalists considered important were those that hospitalists in Japan are working on within and outside academic societies. We found that diagnostic medicine and quality and safety are areas that are likely to see further evolution as hospitalists specifically emphasized on them. In the future, we expect to see suggestions and research for further enhancing the items that hospital workers value and emphasise upon. [ABSTRACT FROM AUTHOR]

Background: With the new licensing regulations for doctors coming into force, medical faculties are faced with the task of recruiting and qualifying more GP colleagues to train students in their practices. Objective: The aim of the study was to determine the motivation of GPs to train students in their own medical practices. Method: A cross-sectional survey of Thuringian GPs was conducted from April to May 2020. 21 items on motivation, incentives and barriers were recorded and examined using univariate and multivariate analyses. Results: The response rate was 35.8% (538/1,513). The GPs surveyed considered themselves motivated to train students in their medical practices. The motives can be described as predominantly intrinsic: the mutual exchange of knowledge, desire to share knowledge and to promote future doctors. Incentives included the opportunity to keep up to date with the latest knowledge, further training and contacts with colleagues. Barriers to teaching in the own medical practice were concerns about not being able to treat the same number of patients, a possible disruption of practice operations and lack of space. An analysis of the subgroups of GPs who were not yet teaching physicians indicated similar motives and barriers regarding training students in their practices, with a slightly lower overall motivation. Conclusion: The results describe the facets of the motivation of Thuringian GPs to train students and can be helpful for the expansion of a sustainable network of training GP practices. It is essential to address motives, to counter difficulties with individual solutions and to create targeted incentives. [ABSTRACT FROM AUTHOR]

La médecine interne prend en charge des patients notamment adressés par les urgences ou par la médecine libérale. Dans le contexte de saturation des urgences et de manque de lits de médecine, la spécialité doit s'inscrire dans un « virage ambulatoire », notamment par un renforcement des liens ville-hôpital. Notre objectif était d'évaluer un nouveau parcours de soin en médecine interne au CHU de Nîmes. Notre service a élaboré un projet institutionnel intitulé RAPIDO pour « Réseau d'Aide à la PrIse en charge Diagnostique et d'Orientation ». Le médecin généraliste adresseur contacte sur une ligne téléphonique spécifique un interniste senior qui peut proposer, après évaluation, une consultation dans un délai de moins de 15 jours. Un avis synthétique est ensuite remis au patient. Entre novembre 2020 et novembre 2021, 254 patients ont été vus via RAPIDO. Le délai moyen de prise en charge était de 6,4 (±4,5) jours pour des symptômes évoluant depuis 2 semaines à 3 mois dans 43 % (n = 109) des cas. Le motif d'appel était, dans 28 % des cas (n = 84), une suspicion de maladie systémique et, dans 16 %, un signe fonctionnel d'un appareil. Un diagnostic était posé dans 89 % des cas. Le dispositif était économiquement équilibré. Un parcours de consultation rapide de médecine interne à destination des médecins généralistes semble être une offre de soin pertinente, faisable et viable, pouvant être transposée dans tout type d'établissement de santé, à condition de prévoir au préalable les moyens humains suffisants. Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n = 109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n = 84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated. [ABSTRACT FROM AUTHOR]