Effectiveness of General Medicine in the Management of Rheumatoid Arthritis in Rural Settings: A Systematic Review and Meta-Ethnography.

Rheumatoid arthritis (RA) is a global autoimmune disease causing significant morbidity, particularly in rural areas with limited rheumatology care access. Primary care plays a crucial role in early RA detection and management. This systematic review evaluates RA management in rural primary care to identify ways to enhance quality of care.

Castleman Disease Presenting as Unexplained Abdominal Pain in a 93-Year-Old Woman: A Case Report.

Castleman disease (CD) is a rare lymphoproliferative disorder that can present with nonspecific symptoms, making diagnosis challenging, particularly in elderly patients. This case report describes a 93-year-old woman who presented with intermittent abdominal pain, which was unresponsive to standard treatments and showed no systemic signs of infection or malignancy. Initial imaging revealed scattered lymphadenopathy, raising concern for a lymphoproliferative disorder.

Pancytopenia and Acute Liver Failure Caused by Mild COVID-19 in an Older Patient: A Case Report.

An 89-year-old woman, living independently, presented to a community hospital with complaints of back pain and anterior chest pain after a fall at home. During her hospitalization, she was infected with COVID-19, and although her fever temporarily resolved with symptomatic treatment, she developed pancytopenia and liver dysfunction along with fever again. Blood tests and imaging studies ruled out acute cholangitis or hepatitis virus infection, and a diagnosis of myelosuppression and liver dysfunction due to multi-system inflammatory syndrome (MIS) was made.

Low Body Mass Index as a Significant Risk Factor for Hypoglycemia in Hospitalized Elderly Patients With Acute Pyelonephritis: A Retrospective Cohort Study.

Introduction Hypoglycemia is a significant clinical concern among hospitalized elderly patients, particularly those with acute illnesses such as pyelonephritis. It is associated with increased morbidity and mortality. Identifying specific risk factors for hypoglycemia in this vulnerable population is crucial to developing targeted interventions and improving patient outcomes.

Invasive Group A Streptococcal Meningitis Following COVID-19 Infection Complicated by Multisystem Inflammatory Syndrome: A Case Report.

We present a case of a 60-year-old woman who developed invasive group A streptococcal (GAS) meningitis following a COVID-19 infection, complicated by multisystem inflammatory syndrome (MIS). Initially diagnosed with COVID-19 based on fever, nasal obstruction, cough, and sore throat, her symptoms improved with symptomatic treatment, except for a persistent sore throat. She later presented with hematemesis and was found to have bacterial pneumonia and dehydration.

Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Fasciitis Mimicking Pseudogout in an Older Patient: A Diagnostic Challenge and Treatment Approach.

ANCA-associated fasciitis is a rare manifestation of ANCA-associated vasculitis (AAV) that can mimic other conditions, such as pseudogout, especially in elderly patients. We present the case of a 93-year-old woman who initially developed polyarthralgia, muscle pain, and difficulty walking, symptoms suggestive of pseudogout. However, after further investigation, including elevated myeloperoxidase (MPO)-ANCA levels and MRI findings, she was diagnosed with ANCA-associated fasciitis.

The development of an online-based rural community of practice framework for addressing health issues among rural citizens: a grounded theory approach.

Background: Health literacy facilitates an individual's ability to interpret and utilize medical information, thereby influencing their quality of life. Despite the benefits, the current oversaturation of information necessitates the support of healthcare professionals. Help-seeking behavior (HSB) is a term that describes the actions taken to assuage health concerns, and timely medical consultations are critical, especially for older individuals in rural areas who often face barriers to accessing care.

Impact of Chronic Organ Disorder Staging on Hospitalization Risk in Elderly Patients With Multimorbidity: A Retrospective Cohort Study.

Introduction Multimorbidity, defined as the coexistence of two or more chronic conditions, is increasingly prevalent in the aging population and is linked to adverse health outcomes, including hospitalization. Chronic organ disorder (COD) is a proposed framework in Japan to assess multimorbidity by categorizing organ dysfunction stages. This study investigates the association between COD stages and hospitalization rates in elderly patients with multimorbidity.

Advanced Gouty Nephropathy Complicated With Type 1 Renal Tubular Acidosis: A Case Report.

This report describes the case of a 53-year-old woman with chronic kidney disease (CKD) exacerbated by a gout flare who presented with renal tubular acidosis (RTA), hypokalemia, and hyperuricemia. Despite outpatient management for gouty nephropathy, the patient experienced progressive hypokalemia, leading to hospitalization. Upon admission, she was diagnosed with type 1 RTA, characterized by metabolic acidosis and severe hypokalemia, refractory to initial potassium supplementation.

Persistent Fever in an Elderly Patient: Diagnostic Challenges and Management of Aspiration Pneumonitis and Organizing Pneumonia.

This case report describes an 85-year-old woman with a history of aspiration pneumonia who was admitted to a rural hospital with fever, vomiting, and decreased oxygenation. Initially diagnosed with aspiration pneumonia and acute pyelonephritis, she was treated with antibiotics. Despite this, her fever persisted, and subsequent imaging suggested aspiration pneumonitis or organizing pneumonia.

Factors Affecting Recurrent Staphylococcus aureus Bacteremia Among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Introduction Staphylococcus aureus bacteremia (SAB) poses a significant health risk, particularly among adults over 65 years old, due to age-related vulnerabilities and comorbidities. Recurrent SAB is associated with increased morbidity, prolonged hospitalizations, and higher healthcare costs, necessitating the identification of risk factors that contribute to these recurrent infections. Methods A retrospective cohort study was conducted at a rural community hospital to identify factors associated with recurrent SAB in older patients.

Aspiration as an Initial Symptom of Early-Stage Esophageal Cancer: A Case Report.

This case report discusses a rare presentation of esophageal adenocarcinoma located in the upper part of the esophagus in a 74-year-old male, where the sole initial symptom was silent aspiration. The absence of typical symptoms such as dysphagia or respiratory issues delayed the diagnosis of esophageal cancer. However, subsequent investigations, including endoscopy, revealed adenocarcinoma in the upper esophagus.

Prostate Cancer Care in Rural Primary Care Contexts: A Narrative Review.

Prostate cancer is highly prevalent among older men and poses significant health challenges, particularly in rural areas where access to specialized care is limited. This narrative review aims to evaluate the quality of prostate cancer care in rural primary care settings, identify gaps, and suggest strategies for improvement. A comprehensive narrative review was conducted using PubMed to identify relevant studies published between April 2000 and August 2024.

A case of idiopathic superior lumbar hernia repaired using a transabdominal laparoscopic approach.

The patient is a 78-year-old woman who presented to our hospital with left lumbar back pain as her chief complaint. She was diagnosed with superior lumbar hernia. There was no history of abdominal or lumbar surgery, or trauma, so the condition was considered idiopathic.

Deepening the Understanding of Inflammatory Conditions Through Rheumatology Education in Family Medicine: An Autoethnography.

Introduction Rheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis, significantly affect quality of life and require comprehensive management, especially where rheumatologists are scarce. Family physicians in rural settings play a crucial role in providing this care. This study aims to elucidate the educational process for family physicians in managing RA within rural hospitals.

Community Health Dialogue Implementation for the Solution of Loneliness in Rural Communities: Autoethnography.

Introduction: Isolation and loneliness among older adults in rural communities pose significant risks to physical and mental health, leading to higher rates of morbidity and mortality. This study investigates the impact of continual rural health dialogues facilitated by family physicians on reducing loneliness and enhancing community health in Unnan City, Shimane Prefecture, Japan.

Method: Using a constructivist grounded theory approach, we conducted a qualitative study involving 165 participants over 65 from five rural communities between April 2022 and March 2024.

The effect of management of older patients with heart failure by general physicians on mortality and hospitalization rates: a retrospective cohort study.

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates.

The Relationship Between Hyperalbuminemia and Unscheduled Medical Visits: A Retrospective Cohort Study.

Introduction Hyperalbuminemia, defined as elevated serum albumin levels, may influence healthcare utilization, particularly unscheduled medical visits. The sympathetic nervous system (SNS) regulates serum albumin, which is crucial for maintaining oncotic pressure and substance transport. SNS instability, linked to chronic diseases, can impact albumin levels.

Association Between Pneumococcal Vaccination Uptake and Loneliness Among Regular Patients in Rural Community Hospitals: A Cross-Sectional Study.

Introduction Vaccination is essential for preventing infectious diseases such as pneumonia and seasonal viral infections. The COVID-19 pandemic has underscored the critical role of vaccination in public health. However, vaccination uptake can be influenced by biopsychosocial conditions.

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach.

Background: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes.