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Background: Pediatric tendon injuries are rare but are associated with serious complications, such as permanent limb dysfunction, if not diagnosed and treated properly. However, there is a lack of data on their epidemiology and management in the emergency department (ED). The present study describes the characteristics and management of pediatric hand- and foot-tendon injuries in a Japanese pediatric ED., Methods: The present, retrospective, observational study, conducted from March, 2010 to March, 2023, enrolled children younger than 16 years who received a diagnosis of a tendon injury to the hands or feet at a pediatric ED in Tokyo Metropolitan Children's Medical Center. Visits to the ED for follow-up examinations were excluded. The patients' sex, age, arrival time, mechanism of injury, signs and symptoms, examinations, diagnoses, outcomes, and complications were extracted from their medical records., Results: Forty-two tendon injuries in 26 patients were included. Fifteen patients (58%) were male, and the median age was 9.5 years. Injuries occurred most frequently at home (58%) and most often involved a sharp object (42%). The median wound size was 2 cm. Tendon exposure occurred in 38% of patients and limited range of motion occurred in 83%. Tests performed in the ED included plain radiograph (100%) and ultrasonography (12%). Fracture complications occurred in three patients and nerve injury occurred in five. Orthopedic complications occurred in 15 patients (58%)., Conclusions: Pediatric hand and foot-tendon injuries had a high risk of orthopedic complications and characteristic features included large wound size, tendon exposure, and limited range of motion., (© 2025 Japan Pediatric Society.)

Objective: To determine the prevalence of frailty and examine its association with gastrointestinal-related quality of life (QOL) among older outpatients in a geriatric hospital. Methods: This cross-sectional study involved 1042 outpatients (age: ≥65 years) diagnosed using the revised Japanese version of the cardiovascular health study criteria. Data collection was performed by a multidisciplinary team. Results: Of the 1039 eligible subjects (male: n = 460 [44.3%]; mean age: 78.2 ± 6.1 years), 172 (16.6%) had frailty (male: n = 77 [44.8%]; mean age: 80.9 ± 6.2 years). The multivariate analysis revealed that age (odds ratio [OR]: 1.070, p < 0.001), QOL (OR: 0.982, p = 0.009), a history of falls (OR: 1.702, p = 0.029), sarcopenia (OR: 4.708, p < 0.001), steroid use (OR: 3.741, p = 0.001), analgesic drug use (OR: 2.056, p = 0.014), Mini Mental State Examination (OR: 0.915, p = 0.011), Geriatric Depression Scale 15 (OR: 1.101, p = 0.008), fullness-related QOL score (OR: 1.119, p = 0.010), chronic obstructive pulmonary disease assessment test (OR: 1.048, p = 0.007), and 10-item Eating Assessment Tool (OR: 1.071, p = 0.009) were related to frailty. Conclusions: The prevalence rate of frailty in older outpatients at a university hospital specializing in geriatric medicine was higher than that previously reported in community-dwelling individuals. Our study clarified that the fullness-related QOL score was related to frailty.

Objective: Integration of head-mounted virtual reality (VR) devices has been revolutionary in health professions education. In disaster preparedness training, VR simulation-based learning exposes health care professionals to the unique challenges of diverse scenarios, enhancing their adaptability. The aim of the study was to evaluate the effectiveness of a head-mounted VR tool for teaching basic radiation emergency medicine skills to medical students., Methods: The participants were 64 medical students (5th-year) who underwent a 3-hour training session in radiation emergency medicine that was conducted via head-mounted VR devices. Students scored their perceived emotion, performance, and self-efficacy at various time points in a self-reported online questionnaire., Results: Comparison of survey responses before and after the session showed significant differences in terms of neutral emotion ( P = 0.011), negative activating emotions ( P < 0.001), and negative deactivating emotions ( P = 0.004). The post-hoc test revealed statistically significant differences in negative activating emotions between before and during ( P < 0.05), and between before and after ( P < 0.05) the VR simulation. In addition, negative deactivation and neutral emotions changed significantly after the simulation., Conclusions: The use of head-mounted VR devices was effective in modulating medical students' emotions and contributed to improving their perceived performance in radiation emergency medicine.

Ulcerative colitis (UC) is a chronic inflammatory disorder of the large intestine. Data on the comparative effectiveness of biological therapies such as vedolizumab (VDZ) and ustekinumab (UST) remain limited. This retrospective study compared the effectiveness and safety of VDZ and UST in UC patients. Between November 2018 and November 2023, 106 patients were included: 64 received VDZ and 42 received UST. Bio-failure was significantly higher ( p = 0.005) in the UST group versus the VDZ group. The remission rates at 6, 22, and 54 weeks in VDZ group were 51.6%, 61.3%, and 66.7%. The remission rates at 8, 24, and 56 weeks in the UST group were 66.7%, 65.0%, and 66.7%, respectively. Both treatments were comparable in inducing and maintaining clinical remission over 54-56 weeks, with no significant differences observed in the Lichtiger clinical activity index. Subgroup analyses highlighted the potential short-term effectiveness of UST among cases of bio-failure and a white blood cell level ≥ 9000/µL. Safety profiles were generally favorable, with no significant adverse events. Usutekinumab demonstrated effectiveness as a salvage therapy in patients who failed VDZ. Despite the increased disease severity in the UST group compared to the VDZ group, both groups demonstrated similar remission rates, suggesting UST shows significant efficacy even in moderate to severe UC.

Background and Objectives: The global shift towards competency-based medical education (CBME) has led to the development of national guidelines for CBME implementation (CBME Guides). The characteristics of CBME Guides from CBME-developed countries were analysed to inform the revision process for the CBME Guide in Japan, a CBME-developing country., Methods: Document analysis of CBME Guides from Canada, Singapore, the Netherlands, the United Kingdom, and the United States was conducted by six Japanese medical education experts. The process of analysing the CBME Guides was also reviewed., Results: While the CBME Guides contain many commonalities in structure and content, there is variation in terminology and forms of expression. The characteristics vary according to national systems, culture, and customs. The content of the Guides may have changed depending on the publication date, in line with changes in medical technology, medical needs, and advances in the understanding of CBME., Conclusions: Analysing CBME Guides from CBME-developed countries may lead to more meaningful revisions to a CBME-developing country's guide, enabling it to be better aligned with the local, social, cultural, and historical context of the country now and in the future.

In response to the growing expectation and recognized potential for integrating information and communication technology (ICT) into medicine, the Model Core Curriculum for Medical Education in Japan incorporated 'the ability to use information science and technology' as a new competency in its 2022 revision. This study aimed to identify specific learning objectives that medical students should achieve to acquire this competency. The research team developed an initial list of 107 learning objectives through a literature survey. Subsequently, two rounds of expert panel surveys were conducted to refine these objectives. Seventy-four medical education stakeholders participated in the expert panel, including medical and non-medical faculty, medical students, graduate students, and university staff. Through the expert panel surveys, 13 learning objectives were finally established from the initial list, consisting of three categories: 'Ethics and rules for dealing with information science and technology,' 'Principles of information science and technology necessary for medical care and surrounding society,' and 'Application of information science and technology in clinical practice.' Our investigation effectively identified essential components of competencies for integrating ICT into medical education. The identified learning objectives would provide valuable insights for designing curricula for undergraduates in the new era of information and artificial intelligence.

Background: Discrepancies existed between the medical knowledge sections of the Model Core Curriculum for Medical Education (MCC) and the Guidelines for the National Examination for Medical Practitioners (GNEMP) in Japan. These discrepancies have been one of the underlying factors hindering the development of learner-centered medical education in the country. The project team responsible for the 'Problem-Solving' section of the MCC aimed to address discrepancies between the disease lists in the MCC and the GNEMP., Method: We refined the disease list for the 2022 revision of the MCC using a three-phase process: (a) procedure development, (b) selection, and (c) adjudication. First, we developed a scoring system for sifting and prioritizing diseases in the GNEMP, selecting those that met our scoring criteria. An expert adjudication panel then finalized the list of diseases through discussion., Results: Among the 1,456 diseases identified in the GNEMP, 781 met the selection criteria. The adjudication panel selected 56 of these diseases to be newly added to the 2022 MCC, resulting in a total of 691 diseases., Conclusions: The list of diseases defined as required medical knowledge in the MCC was finalized through dialogue among medical education stakeholders, effectively minimizing discrepancies between the MCC and GNEMP.

Aim: The requirement during the COVID-19 pandemic to provide extracorporeal membrane oxygenation (ECMO) treatment regardless of experience caused high levels of anxiety among healthcare professionals. The aim of the present study was to evaluate the effectiveness of an in situ interprofessional simulation training conducted to improve readiness and preparedness for ECMO management of patients with COVID-19 at a non-high-volume ECMO centre., Methods: Three emergency physicians, three clinical engineers and two nurses attended the 3-h simulation held at Hirosaki University Hospital in December 2021, during the COVID-19 pandemic. The training comprised a 30-min briefing, a 1-h ECMO circuit change session, a 1-h in-hospital transfer simulation for CT and a 30-min debriefing. Before and after the training, participants completed an online survey of their emotions, based on the Japanese version of the Medical Emotion Scale (J-MES). Related-samples Wilcoxon signed rank test was used to assess potential changes in emotional responses before and after the simulation, and p  < 0.05 was considered to indicate significance., Results: Participants' positive deactivating emotions increased from a median of 3.3 (range, 2.0-4.5) before the simulation to 4.0 (range, 2.5-5.0) after the simulation ( p  = 0.02), which indicates favourable performance according to the control value theory of educational psychology. There was no statistically significant change in other emotional categories., Conclusion: Participants' positive deactivating emotions increased significantly following an in situ ECMO simulation training, which indicates the efficacy of the training for improving the quality of ECMO management in patients with COVID-19., Competing Interests: The authors declare no conflicts of interest for this article., (© 2024 The Author(s). Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

A 42-year-old man was referred to our hospital because of anemia. The patient underwent gastroscopy and colonoscopy, but no bleeding site was detected. Abdominal contrast-enhanced computed tomography (CT) showed vascular dilatation along the wall of the small intestine. Small bowel capsule endoscopy and antegrade double-balloon endoscopy (DBE) were performed, and the patient was diagnosed with a small intestinal arteriovenous malformation (AVM). The AVM was clipped using DBE. After clipping, abdominal contrast-enhanced CT and small bowel angiography revealed the disappearance of the AVM. DBE may be a viable therapeutic option, helping avoid surgery and its associated risks.

Background: Japan is experiencing unprecedented decreasing birthrates. This preliminary study aimed to identify the municipalities in Aomori Prefecture that are successfully tacking declining birthrates using the Rurality Index for Japan (RIJ)., Methods: We obtained 100-level RIJ and census data from 1980 to 2020 for children (age < 15 years) in the municipal population of Aomori Prefecture., Results: The analysis revealed generally weak but significant relationships between population variables and the RIJ., Conclusions: The RIJ is effective for identifying good practice communities that have developed and implemented solutions to prevent declining birthrates at the community level., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2024 The Author(s). Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

An 86-year-old man presented with anemia. He underwent abdominal contrast-enhanced computed tomography, gastroscopy, and colonoscopy without any bleeding detected. Small bowel capsule endoscopy (SBCE) revealed a reddish polypoid lesion with blood oozing into the jejunum. Antegrade double-balloon endoscopy (DBE) revealed a 5 mm sized protrusion into the jejunum. Endoscopic mucosal resection (EMR) was difficult; the lesion was snared and resected before energization. Clips prevented further bleeding and the lesion's position was marked with a tattoo. Histopathological examination of the lesion led to a diagnosis of capillary hemangioma. After 11 months, the patient was again anemic. A reddish polypoid lesion oozing blood near the tattoo was found by SBCE. Another antegrade DBE showed a 7 mm sized protrusion near the tattoo. The lesion was successfully treated by EMR. Histopathological examination revealed the residual recurrence of a small intestinal capillary hemangioma. The patient recovered from anemia after the EMR. Two months later, SBCE showed no findings around the tattoo. Hemangiomas account for 7-10% of benign small intestinal tumors; most are cavernous hemangiomas, and capillary hemangiomas are rare. We report a rare case of a recurring small intestinal capillary hemangioma detected by SBCE and treated using DBE. We also review the literature.

Ustekinumab (UST) is an anti-IL-12/23p40 monoclonal antibody used to treat inflammatory bowel disease. The aim of this retrospective, multicenter study was to investigate the effectiveness of UST administration in achieving remission in patients with ulcerative colitis (UC) and to determine patient characteristics that influence its effectiveness. Of 88 UC patients who received UST from March 2020 to August 2023, 47 with traceable data and for whom 56 weeks had elapsed since the start of treatment received UST to induce remission. The remission rates at 8 weeks were 66% overall, 73.7% for Bio Naïve (never used biologics/JAK inhibitors), and 60.7% for Bio Failure (used biologics/JAK inhibitors) groups. Remission rates at 56 weeks were 70.2% overall, 73.7% for Bio Naïve, and 67.9% for Bio Failure groups. Ustekinumab showed good mid-to-long-term results in the induction of remission of UC in both Bio Naïve and Bio Failure groups. The group showing remission at 8 weeks had a significantly higher non-relapse or continuation rate (proportion of patients with no worsened symptoms necessitating surgery/drug change) at 56 weeks. Predictive factors for achieving remission after UST in UC were female gender, low body mass index, and low lymphocyte-to-monocyte ratio. Thus, UST is effective for moderate-to-severe UC.

Background: Rewarming therapies for accidental hypothermia (AH) include extracorporeal membrane oxygenation (ECMO) and non-ECMO related (conventional) therapies. However, there are limited data available to inform the selection of conventional rewarming therapy. The aim of the present study was to explore what patients' factors and which rewarming therapy predicted favorable prognosis., Methods: This study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate., Results: Of the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94-1.00) and SOFA score (OR: 0.73, 95% CI: 0.67-0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15-4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75-1.53)., Conclusion: No conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Peer learning has been recognized for its effectiveness in health professional education. However, its effects on clinical research education are not clear and were explored qualitatively in this study., Methods: The peer-learning method was implemented in a clinical research education seminar for early-career physicians at a children's and mothers' hospital in 2019. We conducted semistructured interviews with participants about peer-learning experience and qualitatively analyzed verbatim transcripts using Engeström's "activity theory" framework., Results: From framework analysis, learning processes were extracted mainly in four domains, namely, (a) instrument and its usage: research design and its match with research question, (b) outcome: research result, (c) community: seminar, and (d) division of labor: roles of participants and staff., Conclusions: In this report of a peer-learning trial in postgraduate clinical research education, the following two pathways of peer-learning effects were abstracted. The indirect pathway was the presentations by experienced participants providing concrete examples of research processes. The direct pathway was the questions from experienced participants to beginners about specific and concrete questions. There were also two points to consider in peer learning in clinical research education: gaps in premise knowledge and beginners' frustration about expected outcomes. We believe that these extracted pathways and points imply the significance and considerations for continuing the peer-learning trial in clinical research education. Future tasks are to promote clinical research education with a view to the learning effects, not only on individuals, but also on groups., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Hiro Nakao et al.)

As the interest in point-of-care ultrasound (POCUS) for investigating pediatric abdominal emergencies has been growing, an increasing number of literatures about abdominal POCUS has been published. We describe a noteworthy instance of a systematic approach using abdominal POCUS for detecting unilateral renal agenesis (URA) in previously healthy children with suspected intussusception. A previously healthy three-year-old girl was brought to our emergency department (ED) due to abdominal pain and bloody diarrhea. POCUS was performed to investigate the presence of intussusception. POCUS was able to rule out intussusception and detect URA. The investigation led the patient to a proper nephrology follow-up. When performing abdominal POCUS to evaluate gastrointestinal pathologies, it is important to pay attention to concomitant congenital anomalies of the kidney and urinary tract (CAKUT)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mori et al.)

A woman in her 80s was taken to the hospital after falling off a ladder and underwent a contrast-enhanced CT scan, which revealed disruption of the contrast effect in the right internal jugular vein, with multiple rib fractures and haemopneumothorax. Following reduction of the subcutaneous emphysema with treatment, the diameter of her right internal jugular vein enlarged over time, becoming equal to that on the contralateral side. It is important to diagnose compression of the internal jugular vein due to subcutaneous emphysema, because the treatment strategy varies according to the aetiology., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We experienced a case of treatment-resistant eosinophilic gastrointestinal disease (EGID). The patient, a 46-year-old man, presented with a fever, persistent abdominal pain, and an elevated peripheral eosinophil count. Eosinophil infiltration of the intestinal mucosa was also observed, and EGID was diagnosed. Corticosteroid therapy was initiated, but no improvement was seen. However, after mepolizumab (anti-interleukin 5 antibody) was administered, the patient's disease was controlled. Currently, the indications for mepolizumab are limited to bronchial asthma and paraneoplastic eosinophilic polyangiitis, but the experience herein reported suggests its usefulness in the treatment of EGID.

Background: Early detection of autism spectrum disorder (ASD) is essential to provide children with timely treatment and support. Evidence-based screening measures make it possible to identify children with suspected ASD at an early stage. Although Japan has a universal healthcare system that covers well-child visits, detection rates of developmental disorders, including ASD, at 18 months vary widely between municipalities (0.2%-48.0%). The reasons for this high level of variation are poorly understood. The present study aims to describe the barriers and facilitators of incorporating ASD identification during well-child visits in Japan., Methods: This is a qualitative study that conducts semi-structured in-depth interviews in two municipalities of Yamanashi Prefecture. We recruited all public health nurses (n = 17) and paediatricians (n = 11) involved in the well-child visit in each municipality and caregivers of children who also participated in the visits during the study period (n = 21)., Results: We identified four themes characterizing the process of ASD identification in the target municipalities: (1) Identification of children with ASD is driven by caregivers' sense of concern, acceptance and awareness. (2) Multidisciplinary cooperation and shared decision-making is limited. (3) Skills and training for developmental disabilities screening are underdeveloped. (4) Caregivers' expectations shape the interaction in important ways., Conclusions: Non-standardization of screening methods, limited knowledge and skills on screening and child development among healthcare providers and poor coordination among healthcare providers and caregivers are the main barriers to effective early detection of ASD through well-child visits. The findings suggest the importance of promoting a child-centred care approach through the application of evidence-based screening measures and effective information sharing., (© 2023 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Background: The effectiveness of peer learning has been recognized and discussed by many scholars, and implemented in the formal curriculums of medical schools internationally. However, there is a general dearth of studies in measuring the objective outcomes in learning., Methods: We investigated the objective effect of near-peer learning on tutee's emotions and its equivalence within the formal curriculum of a clinical reasoning Problem Based Learning session in a Japanese medical school. Fourth-year medical students were assigned to the group tutored by 6 th -year students or by faculties. The positive activating emotion, positive deactivating emotion, negative activating emotion, negative deactivating emotion, Neutral emotion were measured using the Japanese version of the Medical Emotion Scale (J-MES), and self-efficacy scores were also assessed. We calculated the mean differences of these variables between the faculty and the peer tutor groups and were statistically analyzed the equivalence of these scores. The equivalence margin was defined as a score of 0.4 for J-MES and 10.0 for the self-efficacy score, respectively., Results: Of the 143 eligible participant students, 90 were allocated to the peer tutor group and 53 were allocated to the faculty group. There was no significant difference between the groups. The 95% confidence interval of the mean score difference for positive activating emotions (-0.22 to 0.15), positive deactivating emotions (-0.35 to 0.18), negative activating emotions (-0.20 to 0.22), negative deactivating emotions (-0.20 to 0.23), and self-efficacy (-6.83 to 5.04) were withing the predetermined equivalence margins for emotion scores, meaning that equivalence was confirmed for these variables., Conclusions: Emotional outcomes were equivalent between near-peer PBL sessions and faculty-led sessions. This comparative measurement of the emotional outcomes in near-peer learning contributes to understanding PBL in the field of medical education., (© 2023. The Author(s).)

Poor metabolic health during pregnancy is associated with health concerns for pregnant individuals and their offspring. Lower socioeconomic status (SES) is one risk factor for poor metabolic health, and may be related to limited access to healthful and affordable foods (e.g., living in a food desert). This study evaluates the respective contributions of SES and food desert severity on metabolic health during pregnancy. The food desert severity of 302 pregnant individuals was determined using the United States Department of Agriculture Food Access Research Atlas. SES was measured using total household income adjusted for household size, years of education, and amount of reserve savings. Information about participants' glucose concentrations one hour following an oral glucose tolerance test during the second trimester was extracted from medical records and percent adiposity during the second trimester was assessed using air displacement plethysmography. Information about participants' nutritional intake during the second trimester was obtained by trained nutritionists via three unannounced 24-h dietary recalls. Structural equation models showed that lower SES predicted higher food desert severity (β = - 0.20, p = 0.008) and higher adiposity (β = - 0.27, p = 0.016) and consumption of a more pro-inflammatory diet (β = - 0.25, p = 0.003) during the second trimester of pregnancy. Higher food desert severity also predicted higher percent adiposity during the second trimester (β = 0.17, p = 0.013). Food desert severity significantly mediated the relationship between lower SES and higher percent adiposity during the second trimester (β indirect  = - 0.03, 95% CI [- 0.079, - 0.004]). These findings indicate that access to healthful and affordable foods is a mechanism by which SES contributes to adiposity during pregnancy and may inform interventions intended to improve metabolic health during pregnancy., (© 2023. The Author(s).)