ABSTRACT
We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.
ABSTRACT
Background: Few studies have focused on the current state of referral and consultation practice between generalists and specialists at Japanese university hospitals.Methods: We retrospectively analyzed the electronic medical records of 513 outpatients (a cumulative total of 608 patients) who visited the Department of General Medicine of Toyama University Hospital between January and December 2016. All patients used our in-hospital consultation and referral service.Results: We referred 492 new patients to different specialists, with 40% referred to psychiatry, orthopedics, otolaryngology, and dermatology specialists. Our suspected diagnoses were correct for 285 of 395 patients (72%) who were referred to specialists to confirm the diagnosis. No abnormalities were observed in 86 patients (21%), and inappropriate referrals were made for 5 patients (1.2%). We also received 116 consultations from specialists, 66% of which were from orthopedics, psychiatry, gynecology, oral dental surgery, and neurosurgery specialists. Many of the referred patients had vague symptoms such as fever and general fatigue.Conclusion: Improving the practical skills of generalists regarding orthopedic and otolaryngologic problems may result in more appropriate referrals. Our department also served as a consultant for medical problems for specialists, especially orthopedic surgeons and psychiatrists.
ABSTRACT
<b>Purpose:</b> We report a case of delirium and convulsion after administration of olanzapine in a cancer patient with refractory vomiting. <b>Case report:</b> The patient was a male in his 70s who suffered from lung cancer. After chemotherapy, olanzapine was used for refractory nausea and vomiting. Since this treatment, the patient has experienced delirium and convulsions. While we modified some reversible causes of the delirium, the delirium did not improve. Discontinuation of olanzapine resulted in improvement of the delirium. Recurrent convulsions did not occur with sodium valproate. Olanzapine might increase the risk of delirium and convulsions.