Evaluating ChatGPT's effectiveness and tendencies in Japanese internal medicine.

INTRODUCTION: ChatGPT, a large-scale language model, is a notable example of AI's potential in health care. However, its effectiveness in clinical settings, especially when compared to human physicians, is not fully understood. This study evaluates ChatGPT's capabilities and limitations in answering questions for Japanese internal medicine specialists, aiming to clarify its accuracy and tendencies in both correct and incorrect responses. METHODS: We utilized ChatGPT's answers on four sets of self-training questions for internal medicine specialists in Japan from 2020 to 2023. We ran three trials for each set to evaluate its overall accuracy and performance on nonimage questions. Subsequently, we categorized the questions into two groups: those ChatGPT consistently answered correctly (Confirmed Correct Answer, CCA) and those it consistently answered incorrectly (Confirmed Incorrect Answer, CIA). For these groups, we calculated the average accuracy rates and 95% confidence intervals based on the actual performance of internal medicine physicians on each question and analyzed the statistical significance between the two groups. This process was then similarly applied to the subset of nonimage CCA and CIA questions. RESULTS: ChatGPT's overall accuracy rate was 59.05%, increasing to 65.76% for nonimage questions. 24.87% of the questions had answers that varied between correct and incorrect in the three trials. Despite surpassing the passing threshold for nonimage questions, ChatGPT's accuracy was lower than that of human specialists. There was a significant variance in accuracy between CCA and CIA groups, with ChatGPT mirroring human physician patterns in responding to different question types. CONCLUSION: This study underscores ChatGPT's potential utility and limitations in internal medicine. While effective in some aspects, its dependence on question type and context suggests that it should supplement, not replace, professional medical judgment. Further research is needed to integrate Artificial Intelligence tools like ChatGPT more effectively into specialized medical practices.

ChatGPT's Potential in Enhancing Physician Efficiency: A Japanese Case Study.

Artificial intelligence (AI), particularly ChatGPT, developed by OpenAI (San Francisco, CA, USA), is making significant strides in the medical field. In a simulated case study, a 66-year-old Japanese female patient's dialogue with a physician was transcribed and inputted into ChatGPT to assess its efficacy in drafting medical records, formulating differential diagnoses, and establishing treatment plans. The results showed a high similarity between the medical summaries generated by ChatGPT and those of the attending physician. This suggests that ChatGPT has the potential to assist physicians in clinical reasoning and reduce the administrative burden, allowing them to spend more time with patients. However, there are limitations, such as the system's reliance on linguistic data and occasional inaccuracies. Despite its potential, the ethical implications of using patient data and the risk of AI replacing clinicians emphasize the need for continuous evaluation, rigorous oversight, and the establishment of comprehensive guidelines. As AI continues to integrate into healthcare, it is crucial for physicians to ensure that technology complements, rather than replaces, human expertise, with the primary focus remaining on delivering high-quality patient care.

Bridging the Language Gap: The Role of Human-Mediated Translation in Japanese Medical Settings.

Introduction Foreign residents in Japan often face challenges accessing healthcare due to language barriers, potentially leading to health inequities. This study aimed to assess the utilization and impact of human-mediated translation services in a specific medical setting in Tokyo. Methods A retrospective investigation was conducted on medical records of foreign patients who utilized human-mediated translation services at Navitas Clinic Tachikawa (Tachikawa, Tokyo, Japan) from November 2017 to December 2021. Data on age, gender, language used, department visited, diagnosis, insurance status, and booking methods were analyzed. Results Out of the 124 foreign patients who utilized the human-mediated translation services during the study period, 69 (56%) were male, and 55 (44%) were female. The median age was 35 years, with a range from 3 to 61 years. English was the predominant language used by 34 patients (59%), followed by Chinese for nine patients (16%) and Spanish for four patients (7%). The majority, 107 patients (86%) visited the internal medicine department, nine patients (7%) consulted dermatology, and six patients (5%) visited pediatrics. Regarding insurance status, 47 patients (81%) were insured, three patients (5%) were uninsured by the Japanese national health insurance system, and eight patients (14%) were self-pay. The primary mode of appointment booking was at the reception desk, with 112 patients (90%) using this method, while 12 patients (10%) made reservations online. Conclusions The findings of this study underscore the importance of human-mediated translation services for improving healthcare accessibility for foreign residents in Japan, emphasizing the need to address language barriers and promote health equity in clinical settings. Future studies should also explore challenges faced in patient-physician interactions from a linguistic perspective and potential technological solutions to enhance these services.

Influenza vaccination uptake and attitudes among adult cancer patients in Japan: a web-based questionnaire survey before the 2020/2021 season.

Influenza vaccination is necessary to reduce severe influenza complications, especially in immunocompromised people such as cancer patients. However, few studies have examined influenza vaccination uptake among adult Japanese patients with cancer; their attitudes toward vaccination, as well as factors related to vaccine hesitancy, are unclear. From September 1 to October 31, 2020, we disseminated a web-based questionnaire to patients with a history of cancer via snowball sampling through e-mails and social media of two Japanese cancer patients associations. A total of 163 surveys were completed. One hundred (61.3%) participants received an influenza vaccination in the 2019/2020 season, and the main reasons for vaccination were as follows: recommendation by medical professionals, positive awareness of vaccination through books or the internet, and provision of vaccination in the workplace. The main reasons for not receiving a vaccination were fear of adverse events, lack of concern about influenza infection, and lack of trust in vaccine effectiveness. In terms of the 2020/2021 season, 120 participants (73.6%) reported their intention to receive an influenza vaccination. Multiple regression analysis showed that significant factors for positive intention were the the treatment without chemotherapy (p = .009), vaccination history in the 2019/2020 season (p < .001), prior experience of influenza infection (p = .043), and the perception that influenza vaccination was more important due to the coronavirus disease pandemic (p = .050). This preliminary survey revealed a relatively modest influenza vaccine coverage among adult Japanese patients with cancer and identified several factors related to positive intention toward vaccination.

A Case of Exacerbation of Subclinical Hyperthyroidism after First Administration of BNT162b2 mRNA COVID-19 Vaccine.

COVID-19 vaccines are the most critical measure for controlling the COVID-19 pandemic; however, we have little information on their complications. We experienced a case of a patient who developed hyperthyroidism complicated with atrial fibrillation and heart failure on the sixth day after the first dose of COVID-19 vaccination. This case report shows the importance of considering hyperthyroidism as a possible complication after COVID-19 vaccination.

Association between Syphilis Incidence and Dating App Use in Japan.

INTRODUCTION: The cause of the syphilis resurgence in Japan is still unknown. In this study, we hypothesized that the spread of mobile dating software for use on mobile phones might have contributed to it. We investigated possible contributing factors of the syphilis resurgence in Japan. METHODS: We retrieved the number of reported cases of syphilis, human immunodeficiency virus infection, carbapenem-resistant Enterobacteriaceae infection, invasive Streptococcus pneumoniae infection, general population, foreign national residents, international overnight guests, detachment-type sex trade shops, physician density, and smartphone penetration rate at the prefectural level in 2017. We also obtained the number of three major dating app users in each prefecture. Using them, we performed association analyses. RESULTS: The median of syphilis incidence per 100,000 prefectural population was 2.34 (range 0.72 to 12.90). The values of Spearman's rank correlation coefficients between syphilis incidence and app penetration rates were 0.59 (p < 0.001) for app 1, 0.57 (p < 0.001) for app 2, and 0.56 for app 3 (p < 0.001). The values of correlation coefficient between syphilis incidence and prefectural population (0.50, p < 0.001), foreign national residents per prefectural population (0.46, p = 0.001), and smartphone penetration rate (0.54, p < 0.001) were significant, while international overnight guests per prefectural population (0.19, p = 0.19), sex trade shops (0.24, p = 0.10), and physician density (0.10, p = 0.52) were not. In the multiple regression analyses, the contents of an optimized model included the following two factors: for app 1 penetration rate (0.39, p < 0.001) and the number of sex trade shops per prefectural population (0.18, p = 0.008) with the adjusted R-squared value 0.49 and F value 22.97 (p < 0.001). CONCLUSIONS: Dating app penetration rate was significantly associated with syphilis incidence. The popularization of social media is a possible contributing factor in the syphilis resurgence in Japan. Information concerning the use of social media should be included in future studies on transmission and prevention of sexually transmitted infections.

Geographical Profiles of COVID-19 Outbreak in Tokyo: An Analysis of the Primary Care Clinic-Based Point-of-Care Antibody Testing.

Introduction: The primary care clinic plays a major role in triage for coronavirus disease 2019 (COVID-19), where seroprevalence in the setting of primary care clinic remains less clear. As a point-of-care immunodiagnostic test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the serosurvey represents an alternative to the polymerase chain reaction (PCR) test to measure the magnitude of COVID-19 outbreak in the communities lacking sufficient diagnostic capability for PCR testing. Methods: We assessed seropositivity for the SARS-CoV-2 IgG between April 21 and May 20, 2020, at 2 primary care clinics in Tokyo, Japan. Results: The overall positive percentage of SARS-CoV-2 IgG was 3.83% (95% confidence interval [CI]: 2.76-5.16) for the entire cohort (n = 1071). The 23 special wards of central Tokyo exhibited a significantly higher prevalence compared with the other areas of Tokyo after classification by residence (P = .02, 4.68% [3.08-6.79] vs 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). In central Tokyo, the southern area showed the highest seroprevalence compared with the other areas (7.92% [3.48-15.01]), corresponding to the cumulative number of confirmed COVID-19 patients by PCR test reported by the Tokyo Metropolitan Government. Conclusion: The seroprevalence surveyed in this study was too low for herd immunity, suggesting the need for robust disease control and prevention. A regional-level approach, rather than state- or prefectural-level, could be of importance in ascertaining detailed profiles of the COVID-19 outbreak.

Demographic and geographical characteristics of pediatric patients presenting to a convenient clinic at a large railway station in a metropolitan area of Tokyo.

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo.We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records.Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients' median age was 3 years (interquartile range, 1-6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 AM and 3 PM, respectively. Approximately 20% of weekday visits occurred after 6 PM, when other pediatricians' offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 PM. The overall median waiting time was 650 seconds (interquartile range, 429-1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%).The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 PM. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.

Patients' demographics of a convenient clinic located in a large railway station in metropolitan Tokyo area.

Hidden barriers to visit a medical facility especially for young busy workers have been neglected in the aging society. The aim of this cross-sectional study is to analyze demographics of patients who had visited the first known convenient clinic located inside a railway station, which is adjusted to the lifestyle of working generations.We analyzed de-identified data of patients who had visited the department of internal medicine of a clinic, which is located inside a railway station building and offers primary care with after-hours accessibility in Tokyo, between August 2013 and June 2016. Data were collected on patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and patients' addresses using the electronic health and billing records.Overall, 28,001 patients visited 87,126 times. Number of visits increased in winter season compared with the other seasons. Sixty-one percent were women and the median age of all patients was 38 years (range, 0-102). The number of visits on Mondays was the highest in a week and the most frequent visiting time was between 6 and 7 p.m. The number of visits of working generations (from 15 to 65 years old) and men increased after 6 p.m. and on weekends. The 3 most common diagnoses were upper respiratory tract infection (22,457), allergic rhinitis (20,916), and hypertension (4869). The number of individuals who were referred to other medical institutions was 1022 (1.2%). The median waiting time was 748 seconds (range, 2-5344). The number of visits from within 2-, 5-, and 10-mile radius from our clinic was 41,696 (50.6%), 63,190 (76.7%), and 75,015 (91.1%), respectively, and patients' addresses were mainly located along the railway network.The locational and temporal convenience of our clinic has attracted the unmet medical demands especially for young workers who have difficulty in visiting conventional medical institutions.

Delayed Diagnosis of Herpes Zoster Infection due toLong-Term Pregabalin Treatment for Lumbar Spinal Canal Stenosis: A Case Report.

INTRODUCTION: Lumbar spinal stenosis is a common disease among elderly adults, and pregabalin is increasingly used for pain relief in this disease. However, little is known about whether pregabalin may cause any undesirable outcomes when used conjointly with other medications in elderly people. We report a case of herpes zoster infection, the initial symptom of which was obscured due to the use of a combination of pregabalin, tramadol, and acetaminophen for lumbar spinal canal stenosis. CASE REPORT: In February 2018, a 72-year-old Japanese man presented with eruption without pain on his right shoulder. As an itching sensation and pain gradually emerged, he visited the clinic10days after the initial appearance of the eruption. He was diagnosed with lumbar spinal canal stenosis, in 2014, and had been prescribed a combination of tramadol, acetaminophen, and pregabalin for pain relief. He was diagnosed with herpes zoster infection, and valacyclovir was prescribed for 7 days. His symptoms were relieved on the 10thdayafter the initial presentation. CONCLUSION: The use of multiple analgesic agents, including pregabalin, may conceal pain associated with herpes zoster infection and delay its early diagnosis, possibly leading to a worse outcome of the disorder.

Concerns about unapproved meningococcal vaccination for eculizumab therapy in Japan.

An orphan medicinal product, eculizumab is approved in Japan and globally for treating paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome. Eculizumab therapy can cause late complement pathway deficiencies that predispose patients to meningococcal infections. Although meningococcal vaccinations are typically considered mandatory for eculizumab therapy, no approved vaccine is available in Japan as of March, 2014. Advertising unapproved, privately imported pharmaceuticals is prohibited under Japanese pharmaceutical law; detailed information concerning the unapproved meningococcal vaccines is therefore not widely available. The situation jeopardizes the safety of patients receiving eculizumab therapy, and Japanese clinicians are advised caution when prescribing this therapy.