Search

Shun Yamashita,1 Hiroyuki Nagano,2 Taku Harada,3 Taiju Miyagami,4 Kosuke Ishizuka,5 Masatomi Ikusaka5 1Department of General Medicine, Saga University Hospital, Saga, Japan; 2Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 3Division of General Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan; 4Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; 5Department of General Medicine, Chiba University Hospital, Chiba, JapanCorrespondence: Shun Yamashita, Department of General Medicine, Saga University Hospital, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan, Tel +81952343238, Fax +81952342029, Email sy.hospitalist.japan@gmail.comAbstract: Demand is increasing for general medicine services in Japan, a super-aged society. The new medical specialty system introduced in 2019 obligates physicians to obtain a qualified specialty from among 19 basic specialty fields, including general medicine, before obtaining more advanced qualified subspecialties. The role of the department of general medicine in Japan varies in each hospital. Remuneration for medical services obtained by general medicine departments that mainly provide outpatient care is relatively low, making it difficult to fill positions in this department within a hospital. We conducted a narrative review and discussed ways to increase the status of hospital general medicine departments that mainly provide outpatient care. We consider the following four points to be important: improvement of diagnostic capabilities in the outpatient setting; playing a central role in education for medical students and residents; active involvement with patients who have diagnostic difficulties or social problems; and branding and promotion of the general medicine department. We envision that adopting an active approach to these points will increase the status of general medicine departments that mainly provide outpatient care within the hospital, allowing such newly established departments to start easily in Japanese hospitals in the future.Keywords: general medicine, outpatient, diagnostic capability, education, difficult diagnosis, branding

Taiju Miyagami,1 Toru Yamada,2 Yohei Kanzawa,3 Shunsuke Kosugi,4 Kazuya Nagasaki,5 Hiroyuki Nagano,6 Taro Shimizu,7 Kazutoshi Fujibayashi,1 Gautam A Deshpande,1 Toshio Naito1 1Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan; 2Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 3Department of General Internal Medicine, Akashi Medical Center, Hyogo, Japan; 4Department of General Internal Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan; 5Department of Internal Medicine, Mito Kyodo General Hospital, Ibaraki, Japan; 6Emergency Medicine and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan; 7Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, JapanCorrespondence: Toru YamadaDepartment of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan, Tel +81 3 5803 5229, Fax +81 3 5803 0276, Email toru.y.fmed@tmd.ac.jpPurpose: To identify the current ambiguous status of general medicine (GM) and assess current problems and weaknesses for further development of GM.Patients and Methods: This study adopted an observational design. GM practitioners were selected from the mailing lists of two primary professional associations for Japanese GM doctors. We included physicians currently working in a GM department, those self-described as GM doctors, and those board-certified in family medicine or general internal medicine. Respondents replied to survey questions about their sociodemographic data, job descriptions, and the requisite skills for practice. GM doctors’ job description and required skills were categorized into “clinical,” “management,” “education,” and “research.” Participants (n = 971) were compared based on job descriptions and important skills in each category by facility type, size, and position.Results: “Clinical” was indicated as the most important category for both job description and important skills, followed by “management,” “education,” and “research.” For job description details, “follow-up outpatient” (35.6%) ranked first for “clinical,” and “resident education” (57.3%) ranked first for “education.” By facility type and size, job description and important skills decreased for clinical and management categories as facility sizes increased; the opposite was true for “education.” “Research” was generally rated low. By position, no significant difference was found in effort or importance given to research.Conclusion: This study is the first survey on GM physicians across Japan. The results show that while Japanese GM physicians focus on and place importance on clinical practice, they are less involved in research and do not consider research skills to be important. The challenge for the future development of GM lies in research.Keywords: general medicine doctors, job description, observational study, research skills

Hiromichi Maeda,1,* Ken-ichi Okada,2,* Tsutomu Fujii,3 Mari S Oba,4 Manabu Kawai,2 Seiko Hirono,2 Yasuhiro Kodera,5 Masayuki Sho,6 Takahiro Akahori,6 Yasuhiro Shimizu,7 Yoshiyasu Ambo,8 Naru Kondo,9 Yoshiaki Murakami,9 Jiro Ohuchida,10 Hidetoshi Eguchi,11 Hiroaki Nagano,12 Junichi Sakamoto,13 Hiroki Yamaue2 1Department of Surgery, Kochi Medical School, Nankoku, Kochi 780-8505, Japan; 2Second Department of Surgery, Wakayama Medical University, Wakayama 641-8510, Japan; 3Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; 4Department of Medical Statistics Faculty of Medicine, Toho University, Ota-ku, Tokyo 143-8540, Japan; 5Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8560, Japan; 6Department of Surgery, Nara Medical University, Kashihara, Nara 634-8521, Japan; 7Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan; 8Department of Surgery, Teine-Keijinkai Hospital, Sapporo, Hokkaido 006-8555, Japan; 9Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; 10Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 889-1692, Japan; 11Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan; 12Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan; 13Tokai Central Hospital, Kakamigahara, Gifu 504-8601, Japan*These authors contributed equally to this workCorrespondence: Hiroki YamaueSecond Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama 641-8510, JapanTel +81-73-441-0613Email yamaue-h@wakayama-med.ac.jpAim and Background: TJ-100 is a traditional Japanese medicine that affects inflammation and gastrointestinal motility, and is used as a preventive and treatment for paralytic ileus. This study aims at determining the effect of TJ-100 on the peritoneal levels of IFN-γ/IL-9, cytokines related to ileus, after pancreaticoduodenectomy (PD) in a clinical setting.Methods: This was a subsidiary study of the clinical trial investigating the effect of TJ-100 on postoperative bowel function. Ascites was collected from 180 patients using an abdominal drainage tube on postoperative day 1 and 3 after PD (POD 1 or POD 3) and used to measure 27 cytokines. We performed univariate and multivariate analyses using several perioperative variables and administration of TJ-100/placebo to determine the effect of TJ-100 on the levels of IFN-γ and IL-9.Results: Peritoneal levels of IL-9 and IFN-γ decreased between POD 1 and 3 (Wilcoxon signed-rank test p< 0.001). Multivariate analysis was performed after univariate analysis to select the variables and patients with a body mass index of ≥ 22 kg/m2, older age, use of epidural anesthesia, and longer surgery correlated with the levels of IL-9 and IFN-γ. However, we could not detect a correlation between the use of TJ-100 and cytokine levels in ascites either on POD 1 or 3.Conclusion: TJ-100 did not affect peritoneal IL-9 and IFN-γ levels after PD. This was in accordance with published clinical findings showing no improvement in bowel function after PD and TJ-100 treatment.Keywords: TNF, Kampo, Daikenchuto, herbal medicine, pancreatic cancer

This article discusses the severity and clinical course of tricuspid valve dysplasia (TVD) in fetuses and explores suitable cases for fetal treatment. The study presents the SAS score and TRIPP score for 20 TVD cases from 2013 to 2023. The results show that a SAS score and TRIPP score of 6 or higher indicate a higher risk of intrauterine fetal death (IUFD) and may be suitable for fetal treatment. The article concludes that stratifying severity using these scores is valuable in determining the need for fetal treatment. [Extracted from the article]

This article, published in the journal "Ultrasound in Obstetrics & Gynecology," discusses the utility of using fetal echocardiography to differentiate between a double aortic arch (DAA) and a right aortic arch with mirror image branching (mRAA). DAA is a condition that can cause airway and esophageal compression after birth, while mRAA rarely causes tracheal compressive symptoms. The study found that the angle between the right aortic arch and first branch (RF angle) was significantly sharper in the DAA group compared to the mRAA group. The researchers determined that an RF angle of less than 71° had 100% sensitivity and 75% specificity for the detection of DAA. [Extracted from the article]

This article discusses a case of incomplete double aortic arch (iDAA), a congenital vascular anomaly that can cause respiratory problems. The diagnosis of iDAA is challenging, especially during the fetal period. The article highlights the importance of a steep angle between the right aortic arch (RAA) and the first branch (RF angle) as a potential indicator of iDAA. The case study describes a fetus with a steep RF angle on prenatal fetal echocardiography, leading to the diagnosis of iDAA after birth. The article concludes that a steep RF angle in a case of RAA suggests the possibility of iDAA. [Extracted from the article]