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Objective This study clarifies the involvement of gender and pre-existing diabetes mellitus (DM) in the clinical characteristics of polymyalgia rheumatica (PMR). Methods The clinical records of patients diagnosed with PMR in our department between January 2011 and June 2021, especially in terms of gender and DM were retrospectively analysed. Results We identified 89 patients with the median age of 75.37 cases were men and 52 cases were women. Pre-existing DM was found in 21 patients (23.6%). Male PMR patients exhibited a higher complication rate of pre-existing DM and C-reactive protein (CRP) levels at diagnosis (p = .04 and p Conclusion Male PMR patients might have a varying pathophysiology from female patients in terms of high inflammation levels accompanied by a high prevalence rate of pre-existing DM and need a gender-specific approach.

Background: Benign paroxysmal positional vertigo (BPPV) is a common disease that is characterized as vertigo associated with a rapid change of the head position. The Dix-Hallpike (D-H) maneuver is considered the gold standard test for the diagnosis of posterior canal BPPV. There is high-quality and compelling evidence that patients diagnosed with posterior canal BPPV should be offered expeditious treatment with Epley maneuver (EM) in Cochrane review 2014. Several randomized controlled trials on the efficacy of EM on BPPV have been published since 2014, but the integrated results of these trials are not yet clear. Furthermore, the efficacy of EM in primary care settings (family doctor or general physician) was not much researched. Methods: We conducted a systematic review and meta-analysis of randomized sham-controlled trials of the EM for treatment of posterior canal BPPV. The objective of this systematic review is to clarify the efficacy of the EM for BPPV in primary care settings and subspecialty settings. The outcome of interest is a resolution of vertigo. We will include randomized controlled trials that assess the efficacy of EM. We used a systematic review protocol template(dx.doi.org/10.17504/protocols.io.biqrkdv6). We followed the Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 for preparing this protocol Ethical consideration and dissemination: We will only use openly available data. Ethical approval is not necessary. We will publish this systematic review in peer-reviewed journals.

The aim of this study was to determine the factors that are associated with prolonged mechanical ventilation in elderly patients. Retrospective cohort study Single tertiary hospital in Japan We retrospectively identified 228 patients aged 75 years or older who were admitted to a single tertiary care center in Japan between January 1, 2014 and December 31, 2017 because of endogenous diseases and underwent mechanical ventilation. The primary outcome was extubation difficulty, which was defined as the need for mechanical ventilation for more than 14 days after intubation, reintubation within 72 hours after extubation, tracheotomy or extubation, or death within 14 days after intubation. A multivariate analysis showed that age (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.66–1.38; P = .80), gender (OR = 0.56; 95%CI = 0.27–1.17; P = .13), body mass index (BMI) (OR = 1.05; 95%CI = 0.98–1.14; P = .16), smoking history (OR = 0.64; 95%CI = 0.29–1.41; P = .27), Activities of daily living (ADL) (OR = 0.95; 95%CI = 0.49–1.83; P = .87), and modified acute physiology and chronic health evaluation (APACHE) II score (OR = 1.02; 95%CI = 0.95–1.09; P = .61) were not statistically significantly different. However, there were statistically significant differences in extubation difficulty between patients with diabetes mellitus (OR = 2.3; 95%CI = 1.01–5.12; P = .04) and those with cardiovascular disease diagnosis on admission (OR = 0.31; 95%CI = 0.1–0.97; P = .04). Diabetes mellitus and cardiovascular disease diagnosis on admission were factors that were associated with prolonged mechanical ventilation in the elderly. The results of this study may help to support shared decision making with patients or surrogate decision makers at the start of intensive care in the elderly.

ObjectivesThe rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX.DesignMulticentred, prospective, cohort studySettingThis study was conducted on five rural islands in Okinawa, Japan.ParticipantsThe study participants were all island inhabitants aged 65 years or older.Primary outcome measuresThis study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1 year.ResultsOf 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient’s PX scores (OR per 1 SD increase=1.62, 95% CI 1.02–2.61).ConclusionsPhysicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient–doctor relationships on the rural islands.