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水谷 直也大学院医学系研究科 未来社会医学専攻助教
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■ 論文- ABSTRACT Background Case reports are an important academic output for general medicine physicians; however, publication rates in Japan remain low, and barriers to preparing case reports have not been fully clarified. Thus, we aimed to identify barriers perceived by Japanese general medicine physicians when writing case reports. Methods A web‐based questionnaire survey was administered to physician members of JPCA between November and December 2021. Sixteen potential barriers identified in previous studies were assessed using an 11‐point Likert scale (0–10). Participants were categorized into two groups based on their experience writing case reports. Group comparisons were performed using the Mann–Whitney test and chi‐squared test. Logistic regression analyses, adjusted for age and sex, were conducted to estimate adjusted odds ratios (aORs) for each barrier. Results Overall, 315 physicians responded to the survey (response rate: 10.2%). Of these, 159 (50.4%) had experience in writing case reports. Fifteen of the 16 barrier items scored significantly higher among inexperienced physicians. The aORs were significantly elevated for 13 items, excluding financial factors. The major barriers included lack of sufficient medical documentation to write a report (aOR: 7.99), unfamiliarity with writing case reports (aOR: 6.44), not recognizing suitable cases (aOR: 4.79), and difficulty identifying the main case points and clinical messages (aOR: 3.80). Experienced physicians not “having adequate time to write” remained the main obstacle (69.8%). Conclusions Barriers to writing case reports vary markedly by experience. Systematic education, strengthened mentorship, and organizational support for protected academic time are essential to promoting case report writing among general medicine physicians.Wiley, 2026年06月, Journal of General and Family Medicine, 27(4) (4)研究論文（学術雑誌）
- Background/Objectives: International guidelines-including the 2017 Japanese Circulation Society-recommend antibiotic prophylaxis before invasive dental procedures only for patients with clearly defined cardiac conditions at increased risk of infective endocarditis (IE), primarily Class I or IIa. However, IE prevention is not systematically incorporated into Japanese dental education, and dentists' understanding of these indications remains unclear. We assessed dentists' knowledge of guideline-based cardiac and procedural indications for prophylaxis, as well as their clinical practices regarding timing, duration, and antibiotic selection. Methods: A self-administered questionnaire was mailed to 3109 members of the Hyogo Dental Association. The survey evaluated recognition of Class I and IIa cardiac indications, dental procedures requiring prophylaxis, and self-reported prophylactic practices. Respondents were grouped by years of practice (≤20 vs. ≥21 years). Results: Overall, 367 dentists responded (11.8%). Correct identification of Class I indications was high for prosthetic valves (83.4%) and previous IE (93.7%) but low for complex congenital heart disease (55.5%) and post-shunt surgery (52.0%). Recognition of Class IIa indications was limited (36.4-51.1%). Awareness of procedural indications was high for tooth extraction (92.9%) and periodontal surgery (84.3%) but low for subgingival scaling (47.6%) and root canal treatment (36.7%). Only 60.5% of dentists correctly understood that prophylaxis is indicated for a Class I/IIa cardiac condition and an invasive dental procedure. Furthermore, 32.5% of dentists administered antibiotics within 1 h before treatment, and single-dose regimens were uncommon (14.7%). Multi-day regimens were frequently used. Amoxicillin was the most commonly selected antibiotic (40.8%). No major differences were observed between the groups. Conclusions: Although dentists demonstrated good awareness of major procedural indications, substantial gaps remain in recognizing Class I and IIa cardiac indications and in adhering to guideline-recommended timing and duration. Targeted education and improved collaboration between medical and dental professionals are needed to promote evidence-based IE prevention and reduce unnecessary antibiotic use.2026年02月, Healthcare (Basel, Switzerland), 14(4) (4), 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: In this study, we compared four practice areas showing a medium-term effect of community-based medical education (CBME) with those that did not examine more effective practice content. METHODS: This observational study analyzed summer internship programs between 2015 to 2019 undertaken by Hyogo Prefecture community-based physicians who initiated training for regional quota students in 2017-2021. For applying to become a resident in each hospital, risk ratios (RRs) and 95% confidence intervals (CIs) were calculated based on the presence or absence of practice experience and grade of experience for each region. The content of practical CBME training in Tamba and three other regions was compared. RESULTS: Ninety-four participants were included (58 men and 36 women). CBME experience in Tamba during their senior years significantly increased the number of applicants for initial residency training compared with the number of participants who had no CBME experience in a determined region (RR=1.58, 95% CI: 1.04-2.39) and who experienced CBME during their junior years (RR=2.23, 95% CI: 1.15-4.33). In contrast to other regions, practice times in Tamba were longer for fostering empathy toward the community, understanding local healthcare needs, and building harmony with community residents. CONCLUSIONS: CBME with such training content enhances interaction with residents, thus demonstrating its educational value for the first time. As a next step, we should consider interviewing participants directly about their interactions with residents and whether CBME influenced their choice of place of employment.2025年07月, Cureus, 17(7) (7), e88174, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVE: This study examined the barriers to writing case reports among Japanese physicians who participated in a web study series titled "Let's Write a Case Report! What you need to do to be Accepted" and explored differences in these barriers based on physicians' years of experience. METHODS: The study design was cross-sectional in nature. Throughout August and November 2020, the respondents participated in the web study sessions. Using an 11-point scale, from -5 (not a barrier at all) to 0 (neither) to 5 (very much of a barrier), the 16 items interrogated which elements could be barriers to case report writing. Participants were divided into two groups: those with 10 or fewer years of postgraduation experience and those with 11 or more years of postgraduation experience. The basic attributes and possible barriers were compared between the groups using chi-squared and t-tests. RESULTS: In total, 53 (62.4%) participants responded to the web-based questionnaire. In a comparison between the two groups, the following barriers were significantly higher in the 10 years or fewer group: having sufficient medical documentation to write a report, knowing how to write a case report, determining the main case points and clinical message, knowing how to search the literature, knowing how to obtain literature, meeting the financial cost of accessing literature. Although there were no significant differences, only the lack of motivation to write papers was perceived as a barrier by the 11 years or more group. CONCLUSIONS: Determining the main case points and clinical message, selecting an appropriate journal for submission, and having adequate time to write a paper were the major barriers to writing a case report. Paper-writing motivation was crucial for those with longer clinical experience and experience in writing papers. These barriers were significantly more pronounced among those with fewer than 10 years of clinical experience than among those with 11 or more years of experience. Providing targeted support in developing case points and clinical messages will lead to an increase in the rate of case report writing.2025年04月, Cureus, 17(4) (4), e81857, 英語, 国際誌研究論文（学術雑誌）
- 統合失調症の63歳男性が，1か月前からの食欲不振と下腿浮腫を主訴に受診した．上部消化管内視鏡検査で胃体上部から胃角部に肉眼型分類3型胃癌（病理：tubular adenocarcinoma，moderately differentiated type）を認めた．血清総蛋白4.7 g/dL，血清アルブミン1.5 g/dLで，造影CT・造影MRI，腹水検査で遠隔転移は認めず，進行胃癌cT4bN2M0，cStageⅢCと臨床診断した．低アルブミン血症はアルブミン投与に不応性で，審査腹腔鏡で癌性腹膜炎所見は認めなかった．消化管シンチグラフィで，胃癌から消化管への蛋白漏出を確認した．文献レビューで蛋白漏出性胃癌の臨床的特徴を検討した．胃体部や前庭部のBorrmann 0ないし1型腫瘍で，最大腫瘍径が10 cm近く，カリフラワー状外観を示す場合は蛋白漏出性胃癌の可能性が高く，癌性腹膜炎との鑑別のため，99mTc-HSAシンチグラフィと審査腹腔鏡を積極的に実施すべきである．一般社団法人 日本プライマリ・ケア連合学会, 2024年09月, 日本プライマリ・ケア連合学会誌, 47(3) (3), 89 - 98, 日本語
- Because the β-lactam ring has a molecular structure similar to that of gamma-aminobutyric acid (GABA) neurotransmitters, it binds to GABA A receptors and inhibits GABAergic transmission, causing AAE. The possibility of antimicrobial-associated encephalopathy should be considered in cases of neurological or psychiatric symptoms after initiating an antimicrobial regimen.2024年04月, Clinical case reports, 12(4) (4), e8665, 英語, 国際誌研究論文（学術雑誌）
- Dengue fever (DF) can be complicated by hemophagocytic lymphohistiocytosis (HLH). Steroid administration is markedly effective for this hematologic complication, and for other viral infections. We present a rare case of DF-associated HLH that improved with steroid-sparing supportive care. A 47-year-old Japanese male with diabetes mellitus and no history of DF traveled to the Philippines 10 days before his hospitalization. Three days before emergency admission, he experienced fever and joint pain and was referred to our hospital for suspected DF, after blood tests indicated liver damage and thrombocytopenia. Erythema of the extremities and trunk appeared on day 2, and the next day neutrophils were 550 cells/μL, platelets 29,000 cells/μL, ferritin 9840 ng/mL, and fibrinogen 141 mg/dL. Bone marrow aspirate revealed hemophagocytic lymphohistiocytosis, and he was diagnosed with HLH. On day 4, the symptoms and findings improved; only supportive care without steroids was continued. He tested positive for dengue virus antigen on admission. He was discharged on day 9 of hospitalization in good general condition with no vascular leakage or bleeding and recovery of blood cells. Although steroid administration is markedly effective in cases of DF complicated by HLH, this case suggests that such cases can resolve with steroid-sparing supportive care.2023年11月, Tropical medicine and infectious disease, 8(11) (11), 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVE: To examine the significant events experienced by initial trainees during community medicine training, evaluate their impact on community medicine practice, and support improvements in rural community medicine training. RESULTS: Three faculty teachers independently evaluated the reports of 25 residents who had completed a four-week community medicine training in a rural area to analyze major events. The reports were analyzed using topics from the Model Core Curriculum for Medical Education that relate to rural medicine. The most frequently reported items were identified as follows: Primary care: 9 (36.0%); integrated community care systems: 8 (32.0%); medical care in the local community: 7 (28.0%); home health care and systems, patient-physician relationship, and end-of-life medical treatment and care: 6 each (24.0%). Reports from residents describing events related to home health care and systems and end-of-life medical treatment and care were related to more than one item.2023年10月, BMC research notes, 16(1) (1), 299 - 299, 英語, 国際誌研究論文（学術雑誌）
- Milk-alkali syndrome, which is characterized by hypercalcemia, metabolic alkalosis, and renal dysfunction, typically results from the ingestion of large amounts of calcium and absorbable alkaline products. However, these symptoms can also manifest when alkalosis and calcium loading occur simultaneously, owing to other factors. We report a case of milk-alkali syndrome caused by loop-diuretic-induced alkaline load and polypharmacy in an 85-year-old Japanese woman with multiple comorbidities, including osteoporosis, hypertension, type 2 diabetes, dyslipidemia, and Parkinson's disease. The patient regularly took 14 drugs, including calcium L-aspartate, eldecalcitol, celecoxib, and a fixed-dose combination of losartan and hydrochlorothiazide. Immediately before admission, furosemide was administered for the treatment of edema. The patient presented with chest discomfort, general malaise, and clinical signs of dehydration, hypercalcemia, hypophosphatemia, hypokalemia, and hypomagnesemia, accompanied by electrocardiogram abnormalities, renal dysfunction, and chloride-resistant metabolic alkalosis. The hypercalcemia was specifically induced by calcium L-aspartate and eldecalcitol. The hypomagnesaemia and hypophosphatemia were caused by diuretics and hypercalcemia. Thus, all the oral medications were discontinued, and rehydration and electrolyte correction therapy were administered. The final diagnosis was milk-alkali syndrome caused by the concomitant use of loop diuretics and other medications, without absorbable alkaline preparation use. This case underscores the importance of considering drug-related factors, checking concomitant medications, and being aware of the benefits, harmful effects, and side effects of polypharmacy in older adults with multimorbidity.2023年07月, Medicina (Kaunas, Lithuania), 59(7) (7), 英語, 国際誌研究論文（学術雑誌）
- (一社)日本病院総合診療医学会, 2021年09月, 日本病院総合診療医学会雑誌, 17(臨増2) (臨増2), 101 - 101, 日本語多剤併用によりミルクアルカリ症候群を来した1例
- (一社)日本プライマリ・ケア連合学会, 2021年05月, 日本プライマリ・ケア連合学会学術大会, 12回, np635 - np635, 日本語ケースレポートポート論文作成の障壁となる要因の検討(第3報)
- (一社)日本プライマリ・ケア連合学会, 2021年05月, 日本プライマリ・ケア連合学会学術大会, 12回, np635 - np635, 日本語ケースレポートポート論文作成の障壁となる要因の検討(第3報)
- (一社)日本プライマリ・ケア連合学会, 2019年12月, 日本プライマリ・ケア連合学会誌, 42(4) (4), 205 - 208, 日本語
- 2024年, 日本プライマリ・ケア連合学会誌(Web), 47(3) (3)アルブミン投与不応性の漏出性腹水から蛋白漏出性胃癌の診断に至った1例
- 2022年, 日本プライマリ・ケア連合学会学術大会(Web), 13th文献レビューによる蛋白漏出性胃癌の臨床的特徴について
- 2022年, 日本プライマリ・ケア連合学会学術大会(Web), 13th日本プライマリ・ケア連合学会(JPCA)医師会員におけるケースレポートポート作成の障壁となる要因の検討
- 2021年, 日本プライマリ・ケア連合学会学術大会(Web), 12th多剤併用によりミルクアルカリ症候群による高Ca血症を来した1例
- 2021年, 日本プライマリ・ケア連合学会学術大会(Web), 12th在宅介護スコアを用いた病院死と在宅死に影響を与える因子の検討
- 2021年, 日本プライマリ・ケア連合学会学術大会(Web), 12thアルブミン投与不応性の漏出性腹水から蛋白漏出性胃癌の診断に至った1例
- 2020年, 日本プライマリ・ケア連合学会学術大会(Web), 11th非ステロイド性消炎鎮痛薬と比較した偽痛風に対するアセトアミノフェンの有効性と有害事象の後方視的検討
- 2020年, 日本プライマリ・ケア連合学会学術大会(Web), 11thケースレポートポート論文作成の障壁となる要因の検討 第2報
- 2019年, 日本プライマリ・ケア連合学会誌(Web), 42(4) (4)健康診断の二次検査で偶発的に発見された特発性気腹症の1例
- 2019年, 日本プライマリ・ケア連合学会学術大会(Web), 10th「勉強会を始めよう!-継続するカンファレンス開催のために必要なこと-」:第16回秋季セミナーの活動報告
- 2019年, 日本プライマリ・ケア連合学会学術大会(Web), 10th膀胱刺激症状を呈する成年男性2事例に対する診断推論を振り返って