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Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees. We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE). Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy. This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with the pulmonary features of being underweight in older men.

A letter to the editor is presented in which the authors discuss their study conducted to examine the association of admission due to gastrointestinal hemorrhage with the use of antithrombotic drugs or aspirin among older patients.

A letter to the editor is presented wherein the authors discuss a study which was conducted to study adverse drug reactions (ADR) in elderly patients taking six or more drugs by using the inpatient database of a geriatric department.

A letter to the editor is presented which is concerned with research which investigated the factors associated with prolonged hospital stays in a geriatric ward in a university hospital in Japan.

• The bleeding risk of oral anticoagulant use in very old patients remains controversial. • The outcomes of prescribing oral anticoagulants were observed in a hospital-based study. • Patients with disability had a higher incidence of stroke even though they took oral anticoagulants. • Disability level could be a surrogate marker for optimizing oral anticoagulant treatment. Background: Atrial fibrillation (AF) in patients aged ≥75 is one of the major risk factors for stroke, and prescription of oral anticoagulants (OACs) should be considered in these patients. We investigated the use of OAC' for patients certificated for long-term care (LTC) insurance, who have a high risk of bleeding among older patients. Methods and Results: From 1169 consecutive inpatients aged 75 or older who were admitted to the geriatric ward of The University of Tokyo Hospital between 2012 and 2017, we identified 175 patients (men 48%, mean age 85.5 years) who had AF during admission. The patients' background, prescription of OACs on discharge, and the level of LTC insurance were checked. Patients were followed up for 1 to 5 years. Major bleeding, stroke, and all-cause mortality were investigated as outcomes. Among patients with AF, 63.4% were taking OACs. In multivariate analysis, older age, low BMI and no history of stroke were significant factors for not prescribing OACs. Care level patients with OACs had a higher incidence of stroke than others. There was no difference, irrespective of OAC prescription and disability level, in incidence of major bleeding. Care level patients without OACs had higher mortality than others. Conclusions: These results suggest that older care level patients with AF may benefit less from OACs. [ABSTRACT FROM AUTHOR]