MAY 2021 Volume 3-3

ISSN 2436-018X

JOURNAL OF HOSPITAL GENERAL MEDICINE

JHGM 2021：3(3)：71-78

Original article

Inflammatory Findings of Blood Test：
Comparison between Rheumatoid Arthritis and
Polymyalgia Rheumatica in Departments of
General Medicine

Sayato Fukui 1)※　　Akihiro Inui 1)　　Yudai Nakanishi 1)　　Takayuki Furusaka 1)
Mizue Saita 1)　　Yutaka Nakiri 2)　　Toshio Naito 1)

1）Department of General Medicine, Juntendo University Faculty of Medicine
2）Department of Internal Medicine and Rheumatology, Juntendo University Nerima Hospital

Key Words：arthralgia，rheumatoid arthritis，polymyalgia rheumatica，general medicine

[Objectives] This study aimed to compare inflammatory reaction of blood test between
rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR).
[Methods] Clinical information was extracted by chart review. Factors of RA and PMR were analysed by the independent t-test for continuous data or the chi-squared test for categorical data, followed by multivariable logistic regression model analysis.
[Patients or Materials] Participants comprised all inpatients RA and PMR of departments of general medicine between April 1, 2014 and July 31, 2020.
[Results] Fifty-three patients (male：female = 23：30；mean (± standard deviation) age, 74.90 ± 13.93 years) with a final diagnosis of arthralgia were included. PMR (29/53 cases；54.6%) was the most common, followed by RA (14/53 cases；26. 4%). Seronegative RA was more frequent than seropositive RA in this study. White blood cell count ( p = 0.01) and neutrophils ( p = 0.01) were significantly different in bivariate logistic regression analysis, but neither white blood cell (odds ratio (OR) 1. 00, 95% confidence interval (CI) 0. 99-1. 00；p = 0. 17) nor neutrophils (OR 0.95, 95%CI 0.87-1.05；p = 0.35) showed significant differences in multivariable regression analyses.
[Conclusions] Differentiating PMR from RA is difficult, at least serologically. General examination and consideration of differential diagnoses are thus important.

JHGM 2021：3(3)：79-83

Original article

Evaluating Cognitive Bias from Diagnostic Error Cases
Using the Cognitive Bias Codex

Taiju Miyagami1)※　　Taku Harada 2)3)　　Takashi Watari 4)　　Taro Shimizu 3)

1）Department of General Medicine, Juntendo University Faculty of Medicine
2）Division of General Medicine, Showa University Koto Toyosu Hospital
3）Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital
4）Postgraduate Clinical Training Center, Shimane University Hospital

Key Words：diagnostic error, Cognitive Bias Codex, cognitive bias

[Introduction] Cognitive biases are difficult to evaluate because there are so many that exist.
[Purpose] This study evaluated the efficacy of the “Cognitive Bias Codex” for assessing diagnostic errors.
[Methods] This was a cross-sectional observational study. Questionnaires were distributed to diagnostic error presenters at the meeting of the Japanese Society of Hospital General Medicine on September 14 and 15, 2019. Then, cases were divided into four groups：infection, vascular disease, tumor, and others. Cognitive biases were divided into four categories, including “too much information,” “not enough meaning,” “need to act fast,” and “what should we remember?”.
[Results] Twenty-one respondents met the inclusion criteria. (Inclusion rate was 87.5%). “Need to act fast” was the most common affecting factor, while “too much information” was the least. Vascular disease had a different trend than infection and tumor. “What should we remember?” was much more common in the vascular group.
[Discussion] The difference in trend may be because patients with vascular issues are more likely to require urgent attention after sudden onset. Future research into this may lead to emergency department-specific de-biasing if results are similar.
[Conclusions] The “Cognitive Bias Codex” can be used to effectively assess biases according to the given disease category.

JHGM 2021：3(3)：84-91

Original article

Prediction of aseptic meningitis among patients
with fever and headache

Hiroaki Takeoka 1)※　　Ken Horibata 1)　　Kazuhiko Ajisaka 1)　　Eishi Sakihara 1)
Hiroki Suzuyama 1)　　Tetsuya Hiyoshi 1)　　Hisatomi Arima 2)　　Shigeki Nabeshima 1)

1) General Medicine, Fukuoka University Hospital
2) Department of Preventive Medicine and Public Health, Fukuoka University

Key Words：meningitis, vomiting, Jolt accentuation, C-reactive protein, risk prediction

[Objective] Meningitis, especially aseptic meningitis, is frequently encountered in outpatient clinics. Lumbar puncture is commonly used to confirm a diagnosis of meningitis. In this hospitalbased observational study, we retrospectively investigated the medical records of patients with fever and headache to determine the clinical features of meningitis and clarify the role of lumbar puncture in diagnosis.
[Methods] Out of 189 patients with fever and headache as the chief complaints, the data of 103 patients with aseptic meningitis was compared with that of 86 patients with other diseases.
[Results] Age 30 years and over, time from first symptoms to medical examination more than six days, vomiting, Jolt accentuation and C-reactive protein (CRP) less than 3.0 were associated with meningitis. In the analysis of a scoring system, we developed based on these parameters, meningitis was more likely with a score of four or higher on the seven points scale, thus lumbar puncture should be considered for patients with scores of four or more.
[Conclusions] Based on the five identified risk factors, lumbar puncture should be considered if the score is 4 or higher on our new scoring system for meningitis, which would be useful as a diagnostic tool for aseptic meningitis.

JHGM 2021：3(3)：92-96

Case report

Usefulness of portable chest radiography
and blood sampling for prompt medical response
in COVID-19 isolation facilities：
two cases of moderate stage I COVID-19

Shin Takayama 1)2)3)※　　Rie Ono 1)2) 　　Ryutaro Arita1)2) 　　Natsumi Saito1)2)
Satoko Suzuki 1)2) 　　Yasunori Tadano 1) 　　Tetsuya Akaishi 1) 　　Junichi Tanaka 1)
Takeshi Kanno 1) 　　Akiko Kikuchi 1)2)3) 　　Minoru Ohsawa 1)2)3)
Ko Onodera 1) 　　Michiaki Abe 1)　　Keisuke Ido 4)
Naoki Nakamura 4)　　Masaharu Nakayama 4) 　　Tadashi Ishii 1)2)3)

1) Department of Education and Support for Regional Medicine, Tohoku University Hospital
2) Department of Kampo Medicine, Tohoku University Hospital
3) Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine
4) Medical Informatics, Tohoku University Graduate School of Medicine

Key Words：COVID-19, Isolation facility, portable chest X-ray, blood sampling, doctor visit

　　We report on two COVID-19 patients who received symptomatic therapy or were transferred to the hospital based on an examination in an isolation facility. The first case was that of a patient with moderate I stage COVID-19 examined by portable chest radiography. He received kampo treatment, and his respiratory symptoms improved. The second case was also of a patient with moderate I stage COVID-19 examined by portable chest radiography. However, body temperature was over 38 ℃ with an increase in white blood cell count and C-reactive protein level. Although the patient’s oxygen saturation did not decrease, the patient was transferred to the hospital to receive advanced treatment because of persistent symptoms and unfavorable examination results. To our knowledge, chest radiography and blood sampling test along with a doctor visit to isolation facilities have never been reported in Japan.
　　Due to restricted medical resources under the growing COVID-19 spread, hospitals that can receive COVID-19 patients are limited. The present cases suggest that objective examination with chest radiography and blood sampling is simple but provides important information to manage COVID-19 patients in isolation facilities.

JHGM 2021：3(3)：97-98

Brief report

Fitz-Hugh-Curtis Syndrome with diagnostic CT findings

Ko Harada ※　　Masayuki Kishida

Department of General Medicine, Okayama City Hospital

Key Words：Fitz-Hugh-Curtis syndrome, perihepatitis, pelvic inflammatory disease

JHGM 2021：3(3)：99-103

Brief report

Case Series of Elderly COVID-19 patients treated
in a Single Center：The Importance of Managing Cases
Considered Mild-to-Moderate

Kenichiro Yaita 1)2)※　　Hiroki Takeuchi 1)3)　　Hideo Miura 3)
Sakae Yonemura 4)　　Kohei Isa 5)Wataru Kawasaki 6)
Mai Yamanaka 1)7)　　Sachiko Nadayoshi 1)8)　　Kazumi Yamamoto 3)

1) Infection Control Team, Chidoribashi General Hospital
2) Division of Infectious Diseases, Chidoribashi General Hospital
3) Department of General Internal Medicine, Chidoribashi General Hospital
4) Department of Diabetes and Endocrinology, Chidoribashi General Hospital
5) Junior Resident Doctors, Chidoribashi General Hospital
6) Department of Rehabilitation, Chidoribashi General Hospital
7) Infection Control Room, Chidoribashi General Hospital
8) Nursing Department, Fukuoka Iryo Dan

Key Words：COVID-19, elderly, mild-to-moderate cases

JHGM 2021：3(3)：104-105

Key Image of General Medicine

Primary splenic lymphoma,
of Anaplastic Large Cell Lymphoma

Hiroki Isono

Department of General Medicine, HITO Medical Center

Key Words：splenomegaly

JHGM 2021：3(3)：106-107

Key Image of General Medicine

Mask-Induced Facial Cellulitis During
the COVID-19 Pandemic

Takashi Nakagawa ※　　Hiroki Takahashi

Department of General Internal Medicine, National Hospital Organization Sendai Medical Center

Key Words：mask, facial cellulitis, COVID-19

JHGM 2021：3(3)：108-110

Special contribution

Five tips on clinical research
for young Japanese generalists

Masaki Tago 1)※　　Takashi Watari 2)　　Kiyoshi Shikino 3)
Yosuke Sasaki 4)　　Hiromizu Takahashi 5)　　Taro Shimizu 6)

1) Department of General Medicine, Saga University Hospital
2) General Medicine Center, Shimane University Hospital
3) Department of General Medicine, Chiba University Hospital
4) Department of General Medicine and Emergency Care, Toho University School of Medicine
5) Department of General Medicine, Faculty of Medicine, Juntendo University
6) Department of Diagnostic and Generalist Medicine, Dokkyo Medical University

Key Words：academic activity, clinical research, general medicine

Abstract
　　Research is essential for the development of general medicine as an academic discipline. We conducted an interactive interview survey and systematic narrative literature review with six academic generalists actively involved in research to clarify the aspects that beginner researchers should focus on while conceiving research ideas and submitting them for publication. During the interviews, we debated the points general practitioners should keep in mind for successful research and ascertained five tips for general physicians to start research and get their manuscripts accepted by international academic journals. The five tips consist of the following items, 1：Getting started and remaining motivated；2：Establishing relationships with others；3：Work management；4：Maintaining the research environment；5：Submission of papers. We hope that these five clinical research tips based on our own academic experience will help Japanese generalists to conduct clinical research.