Objective: To synthesize Japanese literature on community care for individuals with borderline personality disorder (BPD) and identify key providers, care settings, support components, and implementation challenges to inform primary care involvement in community BPD care.

Methods: We searched the Ichushi-Web and CiNii Research databases for Japanese-language publications on community-based care for individuals with BPD in Japan indexed through December 2025. We extracted data and synthesized findings regarding care settings and providers, support content, collaboration, and implementation challenges.

Results: The analysis included 24 publications (17 commentaries or feature articles and seven research articles or reports). Reported support included community living and crisis support, discharge and transition support, perinatal and family support, and interagency coordination. Collaboration often relied on personal relationships, and maintaining continuity of care was challenging.

Conclusion: The Japanese literature describes practical approaches to community care for BPD. Strengthening team-based management and primary care-linked care pathways may improve continuity and safety.

Objective: This study aimed to evaluate the impact of pre-employment education on self-efficacy among newly graduated nurses. The intervention consisted of a workshop collaboratively developed by academic and clinical institutions.

Materials and Methods: A single-group pretest–posttest design was employed. A one-day workshop was conducted in February 2025 for 24 newly graduated nurses scheduled for employment at a regional hospital. The workshop addressed proactive engagement, communication skills, stress management, and interaction with second-year nurses serving as role models. All 24 participants completed both pre- and post-workshop assessments. Self-efficacy was measured using the General Self-Efficacy Scale, and predictive factors were examined using validated instruments.

Results: Self-efficacy scores significantly increased from 7.9 ± 3.1 to 9.0 ± 3.3 after the workshop (P=0.040). Significant improvements were also observed in confidence in nursing skills (P=0.001), social skills (P=0.015), confidence in proactive behavior (P=0.012), and clarity of career image (P=0.001). Multiple regression analysis indicated that changes in career image (β=−0.479, P=0.011) and social skills (β=0.359, P=0.050) were significant predictors of self-efficacy improvement (adjusted R²=0.314).

Conclusion: The collaborative pre-employment workshop effectively enhanced self-efficacy in newly graduated nurses. Interventions that promote role modeling and interpersonal skill development before employment may represent a valuable approach to supporting professional readiness and retention.

Objective: This study aimed to identify the degree of influence of clinical educators for improving clinical nursing competencies of new graduate nurses assigned in intensive care unit (ICU) and also to suggest ways to educate new graduate nurses in the ICU.

Materials and Methods: A self-administered, unmarked web-based questionnaire survey method was employed. The quality of clinical educators was measured using the Clinical Educator Quality Scale, and the clinical nursing competency of new graduate nurses was measured using the Clinical Nursing Competence Self-Assessment Scale (CNCSS). Multiple regression analysis was performed with the four CNCSS factors as dependent variables and clinical educator quality and personal and organizational background as independent variables.

Results: A total of 125 participants responded to the survey; 57 (45.6%) were admitted to the ICU, while 68 (54.4%) to the surgical ward. In the ICUs, the “competence in basic nursing practice”, “competence in coordinating the care environment and team system”, and “competence in studying in nursing practice” influenced the attitude toward new graduate nurses. In the surgical wards, ‘sex and leadership’ influenced “competence in basic nursing practice”, and “competence in developing nursing care”. A supervisor who monitors their daily work and supports their job affected “competence in coordinating the care environment and team system” and “competence in studying nursing practice”.

Conclusion: We identified distinct factors that affected clinical nursing competence in ICUs and surgical wards. Therefore, new graduate nurses must be educated with different emphases, particularly in the ICUs.

Objective: Owing to geographic isolation, limited healthcare services, and aging populations, residents with illnesses living on highly isolated islands may engage more actively in health self-management. However, this assumption has not been empirically examined. The aim of this study was to compare health self-management behaviors among residents with illnesses according to the degree of island isolation.

Materials and Methods: A questionnaire survey was conducted in clinics on four remote islands administered by Goto City, Nagasaki Prefecture, Japan, between July and August 2025. Participants consisted of 65 and 64 individuals from islands with low and high levels of isolation, respectively.

Results: Preventive health behaviors differed according to the level of isolation. Attendance at lung and colorectal cancer screening was lower on highly isolated islands, likely reflecting reduced availability and accessibility. Illness coping behaviors also varied. Among residents of more isolated islands, fewer searched independently for health information before deciding whether to seek care, whereas a higher proportion reported not caring, even when feeling unwell.

Conclusion: Residents on more isolated islands were less active in health self-management behaviors than those on less isolated islands, possibly because of limited availability of healthcare services and closer relationships with medical professionals. These findings suggest that isolation from the mainland influences residents’ health self-management and represents a distinct form of geographic disparity. Considering these behavioral differences is important when allocating medical resources and developing telemedicine strategies for island communities.

Objective: Syphilis is a major re-emerging infectious disease, and pre-consultation support may be particularly important in rural and remote areas where access to confidential care is limited and stigma can delay help-seeking. We examined how communication features in ChatGPT-generated responses influence perceived consultation satisfaction and intention to seek professional care in a simulated syphilis-related anxiety scenario in Japan.

Patient/Materials and Methods: We conducted a controlled dialogue experiment in Japanese using standardized interactions between a simulated patient concerned about syphilis and ChatGPT (GPT-4o mini). Across 48 three-turn sessions, artificial intelligence (AI) responses varied by requested communication stance and personal information disclosure. Supportive communication features, stance alignment, personalization consistency, readability (jReadability), and information volume (character count) were coded. Three health professional evaluators rated consultation satisfaction using the Consultation and Relational Empathy (CARE) Measure and rated care-seeking intention using a Readiness Ruler.

Results: CARE scores showed moderate inter-rater reliability, whereas intention ratings showed low agreement. Two AI responses contained medical misinformation. In hierarchical regression analyses, longer responses and higher readability were associated with higher satisfaction, and among supportive communication behaviors, praise expressions independently associated with satisfaction. Satisfaction was strongly associated with care-seeking intention (β=0.80, P<0.001).

Conclusion: In Japanese-language simulated syphilis consultations, information volume, readability, and praise expressions were associated with higher perceived consultation satisfaction, which in turn was associated with greater intention to seek professional care. These findings suggest that conversational AI may serve as a low-threshold, anonymous pre-consultation support tool to encourage timely help-seeking, particularly in rural and remote settings where confidential access to sexual health services is limited. Low inter-rater agreement for intention ratings and the presence of misinformation underscore the need for robust outcome measurement and safety safeguards.

Objective: Efficient management of cardiovascular diseases (CVDs) is an essential function of regional medical care systems. In this regard, the compatibility of cardiac biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plays a crucial role.

Patient/Materials and Methods: A total of 1,007 participants were included in this study. To make NT-proBNP more compatible with BNP levels, we examined alternative cutoff NT-proBNP levels derived by curve-fitting as well as formulas to convert NT-proBNP to BNP levels derived by multivariable linear regression analyses.

Results: In comparison with alternative cutoffs or Formula #1, Formula #2, which included age, platelet count, and creatinine level as parameters, showed the best performance for improving the conformity between BNP and NT-proBNP levels. Using Formula #2, the concordance between BNP and NT-proBNP increased from 94.1% to 98.1% at a BNP cutoff of 40 pg/mL, and from 99.1% to 100.0% at a BNP cutoff of 100 pg/mL.

Conclusions: The selection of NT-proBNP cutoffs corresponding to BNP cutoffs and the application of conversion formulas improved the concordance between BNP and NT-proBNP levels to nearly 100%, which would greatly contribute to the efficient management of CVDs in the regional medical care system.

Objective: Inadequate provision of medical resources in depopulated areas is a challenge in many countries, and Japan is currently experiencing an aging society with a declining birth rate. In other countries, the shortage of medical resources, including community pharmacists, in depopulated areas has emerged as a salient issue, necessitating the development of effective solutions. With the emphasis on the separation between prescription and dispensation, the number of community pharmacists in Japan has increased over time. This study examined whether the increase in the number of community pharmacists over time has contributed to improving the distribution of pharmacists in depopulated areas.

Methods: Data from 2012 to 2022 were analyzed. The distribution of community pharmacists was assessed using Gini coefficients.

Results: In 2022, the number of community pharmacists had increased by 37,723, or 124.7%, from the corresponding number in 2012. The difference in the number of community pharmacists per population between depopulated and non-depopulated areas was large (the number in depopulated areas was approximately 60% of that in non-depopulated areas), and this difference remained similar over time. The increase in the number of community pharmacists from 2012 to 2022 resulted in a more equal distribution relative to the population. However, the Gini coefficient in municipalities classified as depopulated areas was significantly higher than that in municipalities classified as non-depopulated areas, and this situation did not change despite the increase in the number of community pharmacists.

Conclusion: Although the number of community pharmacists increased, it had only a limited impact on correcting the imbalance between depopulated and non-depopulated areas, leaving the problem unresolved in depopulated areas. We hope that these results will facilitate efforts to optimize medical resources in depopulated areas.

Objective: The dispatch of a locum doctor (DLD) system is an important aspect of the clinical settings in remote islands, where securing doctors is a major challenge. This study investigated the conditions associated with DLD requests and observed an association between DLD requests and several regional factors in rural clinics on remote islands in Japan.

Materials and Methods: Questionnaires regarding DLD requests were mailed to all rural clinics on remote islands managed under the rural plans of the prefectural governments of Japan in December 2022. The regional factors assessed included population size (large remote islands: population ≥1,000 people), doctor staffing on islands (single or multiple doctors within an island), and distance between rural clinics and the nearest core hospitals, which are designated at the prefectural level of Japan to support and collaborate with rural clinics (long distance, ≥25 km). The association between DLD requests and regional characteristics was analyzed with and without DLD requests.

Results: Of the 72 rural clinics (32%) that responded completely to the questionnaire, 27 (38%) had made DLD requests. In the logistic regression analysis, DLD requests were positively associated with long distances from core hospitals (odds ratio [OR]=3.82, 95% confidence interval [CI]: 1.26–11.6) and the presence of a single doctor on the island (OR=5.24, 95% CI: 1.73–15.9).

Conclusion: These results indicate that DLD requests may be more frequent from remote islands, which were far from core hospitals, and those staffed by a single doctor. Measures based on these results may contribute to the development of efficient medical support systems for remote islands in Japan.

Objective: Evidence on advance care planning (ACP) in secondary-level emergency departments (EDs) in Japan is limited. We aimed to compare ACP status between home-dwelling and nursing-home older adults presenting to a secondary-level ED.

Patients and Methods: We conducted a retrospective cross-sectional study in a non-tertiary ED in a regional city, where 30% of residents were aged ≥65 years. Consecutive patients aged ≥75 years transported by ambulance and requiring admission during weekday daytime hours between January and July 2024 were assessed at admission using semi-structured interviews. We recorded ACP awareness, prior discussions on advance directives, treatment preferences, and do-not-attempt resuscitation (DNAR) status. Patients were stratified into home (Group H) and nursing home (Group N) residents. Multivariable logistic regression was conducted with consultation experience in AD (yes/no) as the dependent variable; independent variables were residential status (nursing home vs. home-dwelling), dementia, mobility, age, and sex.

Results: Of 161 patients, 75 were classified into Group H and 86 into Group N. Only seven (4.4%) recognized “ACP/Jinsei Kaigi”. Treatment wishes were confirmed in 28 patients (17%) overall and in six (7%) in Group N. Advance directives discussions were more common in Group N than Group H (58% vs. 19%, P<0.001), with higher proportions declining invasive treatment (85% vs. 63%, P=0.001) and selecting DNAR (84% vs. 60%, P=0.001). Adjusted analyses revealed independent associations of advance directives consultation with older age (adjusted odds ratio [aOR], 1.08; 95% confidence interval [CI], 1.02–1.14), dementia (aOR, 2.43; 95% CI, 1.03–5.73), and nursing-home residence (aOR, 2.96; 95% CI, 1.18–7.39).

Conclusion: ACP implementation remains low. Older age, dementia, and nursing home residence were independently associated with advance directives consultations. These findings may help identify patients who warrant structured ACP reviews; however, prospective multicenter studies are needed to confirm their clinical implications.

Objective: Rural Japan is facing rapid aging, depopulation, and shortages of physicians. Community-based medical education (CBME) was introduced to cultivate future physicians in rural and underserved regions. The impact of participatory clerkships, in which students actively join healthcare teams should be defined.

Methods: From 2015 to 2017, fifth-year medical students (n=132) from a Medical University completed clerkships at a rural hospital. The students participated in outpatient clinics, inpatient wards, home care, and case conferences alongside residents and attending physicians. Daily reflection sheets were collected and analyzed qualitatively, and the learning needs were categorized into four domains.

Results: A total of 486 comments were analyzed. Most learning needs concerned general clinical knowledge and skills (65%), followed by patient communication (10.2%); community-specific medicine (14%); and other reflections, including self-attitude (10.7%). Students emphasized medical interviewing, clinical reasoning, and basic procedures as core areas for further learning in general clinical knowledge and skills.

Conclusion: Participatory CBME in a rural hospital provides rich opportunities for clinical learning, equivalent to those in urban university hospital rotations, while fostering awareness of rural practices and community care. Our findings suggest that participatory clerkships effectively enhance both clinical competencies and motivation for rural practice.

Objective: We present a case of middle-shaft clavicle stress fracture after push-ups in a nonathletic adult.

Patient: A 34-year-old healthy male, who did hundreds of push-ups every day for over 4 months, developed a sudden exacerbation of shoulder pain and mid-clavicular swelling, in the setting of approximately one week of prodromal pain. Plain radiographs of the clavicle revealed a minimally displaced midshaft fracture. A middle-shaft clavicular stress fracture was diagnosed based on the patient’s history and clinical findings.

Conclusion: To our knowledge, this is the first reported case of a diaphyseal clavicle stress fracture in a non-athletic adult that occurred after excessive daily push-ups. Even in nonathletic patients, clavicular stress fractures should be included in the differential diagnosis of shoulder pain.

Objective: To report a case of pyothorax-associated lymphoma that was difficult to distinguish from chronic expanding hematoma because of a prolonged stable clinical course and serum soluble interleukin-2 receptor levels that remained within the reference range.

Patient: An 82-year-old woman with a history of thoracoplasty presented with a calcified thoracic mass.

Results: The mass remained radiologically stable, and soluble interleukin-2 receptor levels remained within the reference range (423 U/mL) for more than 2 years. Because of her advanced age and the absence of specific tumor markers, invasive biopsy was deferred. The patient subsequently developed rapid disease progression with systemic metastases and markedly elevated soluble interleukin-2 receptor levels. Autopsy confirmed Epstein–Barr virus-positive diffuse large B-cell lymphoma.

Conclusion: Pyothorax-associated lymphoma may present with an indolent course and soluble interleukin-2 receptor levels within the reference range, particularly when the tumor is encapsulated. In elderly patients with chronic pyothorax, malignancy should not be excluded solely based on stable morphology and normal biomarkers; early functional imaging is recommended.

Objective: We report the case of a 75-year-old woman who presented with a hypoechoic liver mass and a two-week history of frequent urination, low-grade fever, and fatigue for 2 weeks.

Case report: A liver abscess was diagnosed based on an elevated inflammatory response and imaging findings, and was drained percutaneously. Klebsiella pneumoniae was isolated from both the urine and pus cultures, indicating an invasive infection secondary to a urinary tract source. The following day, the patient experienced ocular pain, blurred vision, and conjunctival hyperemia and was diagnosed and treated for endophthalmitis. After treatment, she became blind in the right eye; however, her vision in the left eye was preserved.

Conclusion: This case highlights that invasive liver abscess syndrome should be considered in patients with K. pneumoniae infection and that liver abscesses should be treated promptly in patients with extrahepatic symptoms.

Objective: Ganglion cysts are benign soft-tissue tumors that are relatively rare in the foot. Although most foot ganglia are asymptomatic, cases of structural compromise and pathological fractures are rare.

Patient: A 65-year-old woman presented with right lateral foot pain without direct trauma. Physical examination revealed a soft, non-erythematous mass between the fourth and fifth metatarsals. Imaging demonstrated a scalloping depression at the fourth metatarsal and a pathological fracture of the fifth metatarsal shaft.

Results: A surgical excision was performed by tracing the cyst to the fourth metatarsophalangeal joint. The fifth metatarsal was stabilized using a four-hole plate. Bony union was achieved at six weeks with pain resolution.

Conclusion: This case highlights the importance of considering the mechanical compression exerted by the cyst and possible osteoporosis as contributing factors. Complete excision with stalk removal combined with fixation is recommended to prevent recurrence and to optimize functional outcomes.

Objective: We report a case of an emergency Hartmann procedure with splenic flexure mobilization performed under combined spinal-epidural anesthesia (CSEA) in a patient with severe chronic obstructive pulmonary disease (COPD).

Patient and Methods: An 88-year-old man with severe COPD requiring home oxygen therapy presented with abdominal pain, constipation, and vomiting. Computed tomography revealed an obstructing sigmoid colon tumor with a mesocolic abscess, suspected proximal perforation, diffuse ascites, and synchronous hepatic metastases. Previous spirometric assessments demonstrated the following findings: vital capacity (VC), 2.77 L; %VC, 91.4%; forced expiratory volume in 1 second (FEV₁), 0.75 L; %predicted FEV₁, 33.5%; and FEV₁/forced vital capacity (FVC), 35.2%. CSEA was selected because general anesthesia posed a high risk of postoperative pulmonary complications.

Results: Hartmann procedure with splenic flexure mobilization was successfully completed under CSEA. The operative time was 144 min, and blood loss was 92 mL. Mild shoulder pain occurred during upper-abdominal manipulation; however, conversion to general anesthesia was not required. No postoperative respiratory complications occurred and the patient was discharged on postoperative day 31. The patient died 15 months after surgery because of the progression of colon cancer.

Conclusion: CSEA may be a feasible alternative for carefully selected high-risk patients undergoing emergency colorectal surgery, even when splenic flexure mobilization is required.

Background: Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is an extremely rare thyroid tumor that frequently arises in association with chronic lymphocytic thyroiditis. We report a rare case of SMECE and mucosa-associated lymphoid tissue (MALT) lymphoma diagnosed simultaneously in the same thyroid gland.

Case report: A man in his 60s with serological findings suggestive of Hashimoto’s thyroiditis was referred to our hospital after a thyroid nodule was incidentally detected on carotid ultrasonography. Fine-needle aspiration cytology revealed clusters of intermediate-type epithelial cells with an eosinophil-rich inflammatory background. Left thyroid lobectomy was performed to establish a diagnosis.

Results: Histologically, the tumor showed dense stromal sclerosis with nests of squamoid cells, intermediate-type cells, and mucin-producing cells, accompanied by marked eosinophilic infiltration. Immunohistochemistry demonstrated positivity for CK5/6, p63, and CK19 and negativity for thyroglobulin and TTF-1. Fluorescence in situ hybridization analysis revealed no MAML2 gene rearrangement. Chronic lymphocytic thyroiditis was present in the surrounding thyroid tissue, along with extranodal marginal zone lymphoma of the MALT.

Conclusion: This case suggests that chronic inflammatory conditions associated with Hashimoto’s thyroiditis may have contributed to the tumorigenesis of both the epithelial and lymphoid components. Recognizing this rare coexistence is important for accurate pathological diagnosis.

Objective: We report a rare case of Mycobacterium haemophilum flexor tenosynovitis in an immunocompetent adult and discuss the diagnostic challenges posed by this organism under standard culture conditions.

Patient and Methods: A 72-year-old Japanese man presented with chronic pain and swelling of the left thumb following a rose thorn injury and subsequent exposure to aquarium water. Magnetic resonance imaging revealed an effusion in the flexor tendon sheath. The patient underwent synovectomy and debridement. Acid-fast bacilli staining of intraoperative specimens was negative, and liquid mycobacterial culture at 37°C remained negative after 6 weeks.

Results: Local symptoms persisted with recurrent tenosynovial effusions. A repeat aspirate showed growth on Mycobacteria Growth Indicator Tube culture after 5 weeks, and the isolate was identified as M. haemophilum using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Symptoms resolved after drainage and oral antimicrobial therapy, with no recurrence at the 6-month follow-up.

Conclusion:M. haemophilum should be included in the differential diagnosis of distal-extremity tenosynovitis, particularly in patients with a history of contact with aquarium water. Negative cultures at 35–37°C does not exclude M. haemophilum infection. Close communication between clinicians and microbiology laboratories is essential to ensure appropriate culture conditions, including low incubation temperatures and iron/hemin supplementation.

Objective: This study describes a multidisciplinary, multi-generational case conference focusing on healthcare professionals’ emotional conflicts and moral distress—what we call “moyamoya” in Japanese—in clinical practice.

Materials and Methods: Five hybrid conferences were co-organized by Kyoto-Min-Iren and an independent study group. In each session, one anonymized case was presented. Discussions emphasized sharing emotional conflicts without criticism or seeking conclusions and encouraged dialogue from multiple professional perspectives. Participants included physicians, nurses, medical social workers, administrative staff, and medical students.

Results: The conferences appeared to generate diverse discussions and serendipitous insights. The dialogue may have promoted reflection similar to Significant Event Analysis and may foster mutual understanding by making interprofessional perspectives visible. It also appeared to offer opportunities to reconsider the problem-solving orientation common in daily practice and to share an approach attentive to patients’ life backgrounds. For young healthcare professionals and students, it may provide practical learning about the social determinants of health through socially vulnerable cases. However, the absence of thematic limits may pose challenges in facilitating discussions and aligning participants’ interests.

Conclusion: A case conference centered on emotional conflicts may foster reflective practice, interprofessional understanding, and learning beyond technical knowledge, while requiring structural refinement to enhance practical value.