Faculty Profiles - TOKUMASU Kazuki

Papers - TOKUMASU Kazuki

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Processes of increasing medical residents' intrinsic motivation: a qualitative study. Reviewed International journal

Kazuki Tokumasu, Mikako Obika, Haruo Obara, Makoto Kikukawa, Yoshito Nishimura, Fumio Otsuka

International journal of medical education 13 ( Suppl. ) 115 - 123 2022.4

Authorship：Lead author,　Corresponding author Language：English Publisher：INT JOURNAL MEDICAL EDUCATION-IJML

Objectives: This study aimed to determine qualitatively how medical residents develop intrinsic motivation to learn and work in clinical training settings. Methods: This study was a descriptive qualitative study, which is widely used in healthcare research. We conducted a semi-structured interview aimed to explore key participants' in-depth experiences and perspectives regarding intrinsic motivation. The authors interviewed seven postgraduate Japanese medical residents. The transcripts were analyzed using the sequential and thematic qualitative data analysis technique steps for coding and theorization, which entails coding steps from open to selective, writing a storyline using the final selective codes, and offering theories. Results: External stimulations (a self-handle environment and a near-peer role model) triggered the medical residents' cognitive process (gap recognition, awareness, and internalization) to intrinsic motivation. The residents' awareness of autonomy, responsibility, and independence played a vital role in this process. Furthermore, a psychological feeling of competence also reinforced their intrinsic motivation. Positive feedback and approval from attending physicians and patients' gratitude promoted residents' sense of competence. Conclusions: We illustrated a process for increasing medical residents' intrinsic motivation. The intrinsic motivation was triggered by external stimulations (a self-handle environment and a near-peer role model), which caused the cognitive process: gap recognition, awareness of important attitudes as a doctor (autonomy, responsibility, and independence), and internalization. Since the first step of this process was an external factor, there are potential benefits of designing an appropriate training environment for increasing medical residents' intrinsic motivation.

DOI： 10.5116/ijme.6250.1017

Impact of Lifestyle Changes on Body Weight Gain During Nationwide Lockdown Due to COVID-19 Pandemic. International journal

Chisa Nishida, Hiroyuki Honda, Yuki Otsuka, Hideharu Hagiya, Yasuhiro Nakano, Kohei Oguni, Kazuki Tokumasu, Yasue Sakurada, Mikako Obika, Fumio Otsuka

Journal of clinical medicine 14 ( 7 ) 2025.3

Language：English Publishing type：Research paper (scientific journal)

Background: During the coronavirus disease 2019 (COVID-19) pandemic, people in Japan were urged to stay at home as much as possible, and this resulted in significant changes in lifestyle behavior. The new lifestyle included factors affecting both energy intake and energy consumption, and it is now thought that weight gain during the lockdown was the result of complex effects. The aim of this study was to determine the relationships among lifestyle habits, laboratory data, and body weight gain during the lockdown using medical check-up data. Methods: A total of 3789 individuals who had undergone consecutive medical check-ups during the period from 2018 to 2020 were included in this study. Participants whose body weight had increased by 5% or more were divided into two groups: a before-lockdown group (participants who had gained weight between 2018 and 2019) and an after-lockdown group (participants who had gained weight between 2019 and 2020). Physical measurements, laboratory data, and answers to six questions about lifestyle habits, for which information was obtained from the records from medical check-ups, were compared in the two groups. Results: There was no significant difference between the distribution of weight changes in 2018-2019 before the lockdown and the distribution of weight changes in 2019-2020 after the lockdown. The before-lockdown and after-lockdown groups both included about 7% of the total participants (279 and 273 participants, respectively). Diastolic blood pressure and levels of AST, ALT, and LDL-C were significantly higher in the after-lockdown group than in the before-lockdown group. The percentages of participants with alcohol consumption and exercise habits were significantly higher in the after-lockdown group than in the before-lockdown group, and an analysis by gender showed that the differences were significant for women but not for men. Conclusions: The distributions of weight changes before and during the COVID-19 pandemic were similar. Exercise habits and alcohol consumption might have been unique factors causing weight gain during the COVID-19 pandemic, particularly in women. Our findings suggest that the impact of behavioral restrictions and lifestyle changes during a pandemic may be different in men and women.

DOI： 10.3390/jcm14072242

Involvement of a Novel Variant of FGFR1 Detected in an Adult Patient with Kallmann Syndrome in Regulation of Gonadal Steroidogenesis. Reviewed International journal

Yoshiaki Soejima, Yuki Otsuka, Marina Kawaguchi, Kohei Oguni, Koichiro Yamamoto, Yasuhiro Nakano, Miho Yasuda, Kazuki Tokumasu, Keigo Ueda, Kosei Hasegawa, Nahoko Iwata, Fumio Otsuka

International journal of molecular sciences 26 ( 6 ) 2025.3

Language：English Publishing type：Research paper (scientific journal)

Fibroblast growth factor receptor 1 (FGFR1), also known as KAL2, is a tyrosine kinase receptor, and variants of FGFR1 have been detected in patients with Kallmann syndrome (KS), which is a congenital developmental disorder characterized by central hypogonadism and anosmia. Herein, we report an adult case of KS with a novel variant of FGFR1. A middle-aged male was referred for a compression fracture of a lumbar vertebra. It was shown that he had severe osteoporosis, anosmia, gynecomastia, and a past history of operations for cryptorchidism. Endocrine workup using pituitary and gonadal stimulation tests revealed the presence of both primary and central hypogonadism. Genetic testing revealed a novel variant of FGFR1 (c.2197_2199dup, p.Met733dup). To identify the pathogenicity of the novel variant and the clinical significance for the gonads, we investigated the effects of the FGFR1 variant on the downstream signaling of FGFR1 and gonadal steroidogenesis by using human steroidogenic granulosa cells. It was revealed that the transfection of the variant gene significantly impaired FGFR1 signaling, detected through the downregulation of SPRY2, compared with that of the case of the forced expression of wild-type FGFR1, and that the existence of the variant gene apparently altered the expression of key steroidogenic factors, including StAR and aromatase, in the gonad. The results suggested that the novel variant of FGFR1 detected in the patient with KS was linked to the impairment of FGFR1 signaling, as well as the alteration of gonadal steroidogenesis, leading to the pathogenesis of latent primary hypogonadism.

DOI： 10.3390/ijms26062713

Course of General Fatigue in Patients with Post-COVID-19 Conditions Who Were Prescribed Hochuekkito: A Single-Center Exploratory Pilot Study. Reviewed International journal

Kazuki Tokumasu, Nobuyoshi Matsuki, Yuki Otsuka, Yoko Sakamoto, Keigo Ueda, Yui Matsuda, Yasue Sakurada, Hiroyuki Honda, Yasuhiro Nakano, Toru Hasegawa, Ryosuke Takase, Daisuke Omura, Fumio Otsuka

Journal of clinical medicine 14 ( 4 ) 2025.2

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Background: After the start of the COVID-19 pandemic, general fatigue in patients with long COVID and post-COVID-19 conditions (PCC) became a medical issue. Although there is a lack of evidence-based treatments, Kampo medicine (traditional Japanese medicine) has gained attention in Japan. At an outpatient clinic in Japan specializing in long COVID, 24% of all prescriptions were Kampo medicines, and 72% of Kampo medicine prescriptions were hochuekkito. However, there has been no prospective, quantitative study on the course of fatigue in patients with long COVID and PCC who were prescribed hochuekkito. The aim of this study was to clarify the course of fatigue in those patients. Methods: This study included patients aged 18 years or older with general fatigue who visited the long COVID specialized outpatient clinic at Okayama University Hospital and consented to participate after being prescribed hochuekkito. We reviewed the backgrounds of the patients, and we evaluated the patients' fatigue assessment scale in person or online. Results: Twenty patients were enrolled in this study from September to December in 2023. The average age of the patients was 42.9 years (SD: 15.8 years) and 12 patients (60%) were female. After hochuekkito administration, the fatigue assessment scale score decreased from 35.9 (SD: 5.9) at the initial visit to 31.2 (SD: 9.4) after 8 weeks, indicating a trend for improvement in fatigue (difference: 4.7; 95% CI: 0.5-8.9). Conclusions: A trend for improvement in fatigue was observed in patients with long COVID and PCC who were prescribed hochuekkito, indicating a potential benefit of hochuekkito for general fatigue in such patients. General fatigue in patients with long COVID or PCC can be classified as post-infectious fatigue syndrome and is considered a condition of qi deficiency in Kampo medicine, for which hochuekkito is appropriately indicated.

DOI： 10.3390/jcm14041391

Interrelationships Between Plasma Levels of Brain Natriuretic Peptide and Prolonged Symptoms Due to Long COVID. Reviewed International journal

Yohei Masuda, Yuki Otsuka, Kazuki Tokumasu, Hiroyuki Honda, Yasue Sakurada, Yui Matsuda, Yasuhiro Nakano, Ryosuke Takase, Daisuke Omura, Toru Hasegawa, Keigo Ueda, Fumio Otsuka

Journal of clinical medicine 14 ( 3 ) 2025.1

Language：English Publishing type：Research paper (scientific journal)

Objectives: Evidence for the usefulness of biomarkers that aid in diagnosis, assessment of severity, and prediction of prognosis in patients with long COVID is limited. The aim of this study was to clarify the characteristics of brain natriuretic peptide (BNP) in long COVID. Methods: We conducted a retrospective observational study of patients who visited the COVID-19 aftercare outpatient clinic at Okayama University Hospital from February 2021 to April 2024. Results: A total of 428 patients were enrolled in this study, and the patients were divided into a group with normal BNP (n = 314, ≤18.4 pg/mL) and a group with increased BNP (n = 114, >18.4 pg/mL). The long COVID group with increased BNP had a higher proportion of females (44.3% vs. 73.7%, p < 0.01) and an older median age (38 vs. 51 years, p < 0.01). Fatigue and brain fog were commonly manifested in both groups, while dyspnea was a more frequent complaint in the group with increased BNP. Various symptoms including fatigue, palpitations, and taste and/or olfactory disorders were associated with elevated BNP (23 to 24 pg/mL). Memory impairment was also linked to higher BNP (OR: 2.36, p = 0.05). In long COVID patients, plasma BNP elevation appears to be more pronounced in females and is often related to cardiogenic factors, in which inflammatory responses are also involved. Conclusions: Plasma BNP measurement may be useful for evaluating the severity of long COVID, especially in female patients and those with respiratory symptoms and/or memory impairment.

DOI： 10.3390/jcm14030817

What medical students and residents learned from reflection through patients' perspectives: a qualitative study. Reviewed International journal

Kazuki Tokumasu, Puthiery Va, Haruo Obara, Lisa Rucker

International journal of medical education 15 150 - 158 2024.12

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The purposes of this study were to identify reflective processes from patients' points of view for difficult patient-doctor interactions and learn how the processes made medical students and residents aware of their own medical practice. These processes were compared in two countries (US and Japan). METHODS: The study was a descriptive qualitative study utilizing semi-structured interviews. Participants were from US and Japan. We analyzed the data using reflective thematic analysis of the implementation of reflections (from a patient's point of view) into medical clinical education and training from a constructivism paradigm. RESULTS: We included twenty participants each from US and Japan by convenience sampling. The participants were medical students during clinical clerkship and post graduate year-1, 2, and 3 medical residents. Medical students and residents realized four cognitions (different expectations of patients and doctors, language communication barrier, time restriction and healthcare system challenges) from reflections from patients' perspectives. Subsequently, medical students and residents identified three types of awareness (appropriate communication, empathy, and patient-doctor relationship of trust). During these reflections from patients' perspectives, the medical students and residents had a willingness to change future behavior. CONCLUSIONS: This study revealed one aspect of medical students' and residents' cognitions and awareness of clinical experiences through reflection from patients' perspectives. This cognitive process aligns the ideas of medical students and residents more closely with the patients' perceptions and influences their willingness to change their behavior. This process enables comprehensive realization in person-centered care.

DOI： 10.5116/ijme.6741.f16c

Clinical characteristics of female long COVID patients with menstrual symptoms: a retrospective study from a Japanese outpatient clinic. Reviewed International journal

Yasue Sakurada, Yui Matsuda, Kanon Motohashi, Toru Hasegawa, Yuki Otsuka, Yasuhiro Nakano, Kazuki Tokumasu, Koichiro Yamamoto, Naruhiko Sunada, Hiroyuki Honda, Hideharu Hagiya, Keigo Ueda, Fumio Otsuka

Journal of psychosomatic obstetrics and gynaecology 45 ( 1 ) 2305899 - 2305899 2024.12

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: To elucidate the impact of long COVID on menstruation and mental health, medical records of patients with long COVID were evaluated. METHODS: Symptoms of long COVID, QOL, mental health, and related endocrine data were compared between two groups with and without menstrual disturbances. RESULTS: Of 349 female patients who visited our clinic between February 2021 and March 2023, 223 patients with long COVID (aged 18-50 years) were included. Forty-four (19.7%) of the patients had menstrual symptoms associated with long COVID. The patients with menstrual symptoms were older than those without menstrual symptoms (42.5 vs. 38 years). The percentage of patients with menstrual symptoms was higher during the Omicron phase (24%) than during the Preceding (13%) and Delta (12%) phases. Cycle irregularity was the most frequent (in 63.6% of the patients), followed by severe pain (25%), heavy bleeding (20.5%), perimenopausal symptoms (18.2%), and premenstrual syndrome (15.9%). Fatigue and depression were the most frequent complications. Scores for fatigue and for QOL were significantly worse in long COVID patients with menstrual symptoms. Results of endocrine examinations showed significantly increased cortisol levels in patients with menstrual complaints. CONCLUSION: Long COVID has an impact on menstrual conditions and on QOL related to menstrual conditions.

DOI： 10.1080/0167482X.2024.2305899

圧迫骨折と女性化乳房を契機に精査し、AGHDを合併した新規KAL2バリアントによるKallmann症候群と診断しえた1例

副島佳晃, 大塚勇輝, 川口満理奈, 大國皓平, 中野靖浩, 安田美帆, 徳増一樹, 植田圭吾, 長谷川高誠, 大塚文男

日本内分泌学会雑誌 100 ( 4 ) 1077 - 1077 2024.12

Comparative Analysis of Diagnostic Performance: Differential Diagnosis Lists by LLaMA3 Versus LLaMA2 for Case Reports Reviewed International journal

Takanobu Hirosawa, Yukinori Harada, Kazuki Tokumasu, Tatsuya Shiraishi, Tomoharu Suzuki, Taro Shimizu

JMIR Formative Research 8 e64844 - e64844 2024.11

Language：English Publishing type：Research paper (scientific journal) Publisher：JMIR Publications Inc.

Background

Generative artificial intelligence (AI), particularly in the form of large language models, has rapidly developed. The LLaMA series are popular and recently updated from LLaMA2 to LLaMA3. However, the impacts of the update on diagnostic performance have not been well documented.

Objective

We conducted a comparative evaluation of the diagnostic performance in differential diagnosis lists generated by LLaMA3 and LLaMA2 for case reports.

Methods

We analyzed case reports published in the American Journal of Case Reports from 2022 to 2023. After excluding nondiagnostic and pediatric cases, we input the remaining cases into LLaMA3 and LLaMA2 using the same prompt and the same adjustable parameters. Diagnostic performance was defined by whether the differential diagnosis lists included the final diagnosis. Multiple physicians independently evaluated whether the final diagnosis was included in the top 10 differentials generated by LLaMA3 and LLaMA2.

Results

In our comparative evaluation of the diagnostic performance between LLaMA3 and LLaMA2, we analyzed differential diagnosis lists for 392 case reports. The final diagnosis was included in the top 10 differentials generated by LLaMA3 in 79.6% (312/392) of the cases, compared to 49.7% (195/392) for LLaMA2, indicating a statistically significant improvement (P<.001). Additionally, LLaMA3 showed higher performance in including the final diagnosis in the top 5 differentials, observed in 63% (247/392) of cases, compared to LLaMA2’s 38% (149/392, P<.001). Furthermore, the top diagnosis was accurately identified by LLaMA3 in 33.9% (133/392) of cases, significantly higher than the 22.7% (89/392) achieved by LLaMA2 (P<.001). The analysis across various medical specialties revealed variations in diagnostic performance with LLaMA3 consistently outperforming LLaMA2.

Conclusions

The results reveal that the LLaMA3 model significantly outperforms LLaMA2 per diagnostic performance, with a higher percentage of case reports having the final diagnosis listed within the top 10, top 5, and as the top diagnosis. Overall diagnostic performance improved almost 1.5 times from LLaMA2 to LLaMA3. These findings support the rapid development and continuous refinement of generative AI systems to enhance diagnostic processes in medicine. However, these findings should be carefully interpreted for clinical application, as generative AI, including the LLaMA series, has not been approved for medical applications such as AI-enhanced diagnostics.

DOI： 10.2196/64844

Effectiveness of the educational training program for Japanese chief residents: A one‐year pilot study

Toshinori Nishizawa, Kazuya Nagasaki, Kazuki Tokumasu, Shunsuke Kosugi, Tadayuki Hashimoto, Kosuke Tanaka, Koma Hotta, Sho Isoda, Aiko Harada, Shinya Ishigame, Takuma Hata, Masayuki Nogi

Journal of General and Family Medicine 26 ( 1 ) 100 - 105 2024.10

Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

Abstract

Background

Multi‐institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.

Methods

Six participants completed self‐assessment questionnaires at three points: before, immediately after, and 6 months post‐program. Knowledge and behavior changes were compared using the Mann–Whitney U test.

Results

Significant improvements in knowledge were observed and maintained at 6 months. However, behavioral changes were limited, with significant improvements only in counseling skills.

Conclusion

The program effectively increased knowledge but faced challenges in translating it into sustained behavioral change.

DOI： 10.1002/jgf2.744

Comparative Study to Evaluate the Accuracy of Differential Diagnosis Lists Generated by Gemini Advanced, Gemini, and Bard for a Case Report Series Analysis: Cross-Sectional Study Reviewed International journal

Takanobu Hirosawa, Yukinori Harada, Kazuki Tokumasu, Takahiro Ito, Tomoharu Suzuki, Taro Shimizu

JMIR Medical Informatics 12 e63010 - e63010 2024.10

Language：English Publishing type：Research paper (scientific journal) Publisher：JMIR Publications Inc.

Background

Generative artificial intelligence (GAI) systems by Google have recently been updated from Bard to Gemini and Gemini Advanced as of December 2023. Gemini is a basic, free-to-use model after a user’s login, while Gemini Advanced operates on a more advanced model requiring a fee-based subscription. These systems have the potential to enhance medical diagnostics. However, the impact of these updates on comprehensive diagnostic accuracy remains unknown.

Objective

This study aimed to compare the accuracy of the differential diagnosis lists generated by Gemini Advanced, Gemini, and Bard across comprehensive medical fields using case report series.

Methods

We identified a case report series with relevant final diagnoses published in the American Journal Case Reports from January 2022 to March 2023. After excluding nondiagnostic cases and patients aged 10 years and younger, we included the remaining case reports. After refining the case parts as case descriptions, we input the same case descriptions into Gemini Advanced, Gemini, and Bard to generate the top 10 differential diagnosis lists. In total, 2 expert physicians independently evaluated whether the final diagnosis was included in the lists and its ranking. Any discrepancies were resolved by another expert physician. Bonferroni correction was applied to adjust the P values for the number of comparisons among 3 GAI systems, setting the corrected significance level at P value <.02.

Results

In total, 392 case reports were included. The inclusion rates of the final diagnosis within the top 10 differential diagnosis lists were 73% (286/392) for Gemini Advanced, 76.5% (300/392) for Gemini, and 68.6% (269/392) for Bard. The top diagnoses matched the final diagnoses in 31.6% (124/392) for Gemini Advanced, 42.6% (167/392) for Gemini, and 31.4% (123/392) for Bard. Gemini demonstrated higher diagnostic accuracy than Bard both within the top 10 differential diagnosis lists (P=.02) and as the top diagnosis (P=.001). In addition, Gemini Advanced achieved significantly lower accuracy than Gemini in identifying the most probable diagnosis (P=.002).

Conclusions

The results of this study suggest that Gemini outperformed Bard in diagnostic accuracy following the model update. However, Gemini Advanced requires further refinement to optimize its performance for future artificial intelligence–enhanced diagnostics. These findings should be interpreted cautiously and considered primarily for research purposes, as these GAI systems have not been adjusted for medical diagnostics nor approved for clinical use.

DOI： 10.2196/63010

COVID-19罹患後症状の患者における就労状況への影響

松田祐依, 櫻田泰江, 大塚勇輝, 徳増一樹, 中野靖浩, 砂田匠彦, 本多寛之, 長谷川徹, 高瀬了輔, 大村大輔, 植田圭吾, 大塚文男

日本病院総合診療医学会雑誌 20 ( 臨増2 ) 263 - 263 2024.9

COVID-19罹患後症状の女性患者にみられる月経異常とストレスの関係

櫻田泰江, 松田祐依, 長谷川徹, 大塚勇輝, 中野靖浩, 徳増一樹, 砂田匠彦, 本橋花音, 本多寛之, 植田圭吾, 大塚文男

日本病院総合診療医学会雑誌 20 ( 臨増2 ) 263 - 263 2024.9

Postgraduate Year Two Medical Residents' Awareness of Personal Development as a Physician during the Management of Inpatients: A Qualitative Study. Reviewed International journal

Kazuki Tokumasu, Haruo Obara, Takanobu Hirosawa, Hiroko Ogawa, Fumio Otsuka

Healthcare (Basel, Switzerland) 12 ( 16 ) 2024.8

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Clinical experiences, helping relationships, and reflection are key factors for personal development for physicians. However, few studies have shown which experiences are important for personal growth and how medical residents specifically use their experiences for personal growth. The aim of this study was to identify from the medical residents' perspective which clinical experiences contribute to their personal development. We employed a qualitative design, conducting semi-structured interviews with ten postgraduate year two medical residents at a Japanese teaching hospital. The interviews were transcribed in interview memos, anonymized, and subjected to reflective thematic analysis to generate themes relevant to personal and professional development. Successful clinical experiences with autonomy and responsibility in clinical management were shown to be essential points for personal development as a physician. Autonomy in this study was the attitude of making one's own choices when managing patients. Responsibility was the obligation of the resident to take charge of a patient. Instructing junior trainees, appreciation received from patients, and approval granted by attending physicians reinforced their feelings of personal growth. The realization of what experiences and concepts influence medical residents' personal growth and development will make their professional development more effective.

DOI： 10.3390/healthcare12161621

Clinical and endocrine features of orthostatic intolerance detected in patients with long COVID. Reviewed International journal

Atsushi Kato, Kazuki Tokumasu, Koichiro Yamamoto, Yuki Otsuka, Yasuhiro Nakano, Hiroyuki Honda, Naruhiko Sunada, Yasue Sakurada, Yui Matsuda, Toru Hasegawa, Ryosuke Takase, Keigo Ueda, Fumio Otsuka

Scientific reports 14 ( 1 ) 17025 - 17025 2024.7

Language：English Publishing type：Research paper (scientific journal)

Orthostatic intolerance (OI) is a key symptom of long COVID; however, the pathophysiology remains unknown. Among 688 long COVID patients who visited our clinic during the period from February 2021 to April 2023, 86 patients who were suspected of having OI and who underwent an active standing test (ST) were investigated to elucidate the clinical characteristics of OI in patients with long COVID. Of the 86 patients, 33 patients (38%) were ST-positive. Nausea and tachycardia in daily life were frequent complaints in the ST-positive group. The increase in heart rate (HR) during the ST was significantly greater during a 10-min period after standing in the ST-positive group (+ 30 bpm) than in the ST-negative group (+ 16 bpm). The initial increase in diastolic blood pressure (DBP) just after standing was significantly greater in the ST-positive group (+ 14 mmHg) than in the ST-negative group (+ 9 mmHg). Serum cortisol levels in the ST-positive patients aged over 20 years were higher and growth hormone levels in the patients under 20 years of age were lower than those in the ST-negative group. Autonomous nervous symptoms, transient DBP rise with increasing HR after standing, and endocrine dysfunctions are helpful for detecting OI related to long COVID.

DOI： 10.1038/s41598-024-67815-y

Reliability and Validity of the Japanese Version of the Fatigue Assessment Scale. Reviewed

Kazuki Tokumasu, Nobuyoshi Matsuki, Hirohisa Fujikawa, Yoko Sakamoto, Fumio Otsuka

Internal medicine (Tokyo, Japan) 2024.7

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Objective General fatigue is one of the most frequent chief complaints in primary care, and an accurate assessment of fatigue has a direct impact on a patient's quality of life and treatment decisions. The Fatigue Assessment Scale (FAS), a measure of general fatigue, is useful for assessing fatigue in diverse cultures and diseases. However, there has been no study showing the reliability and validity of the scale in the Japanese context. The present study assessed the reliability and validity of the Japanese version of the FAS. Methods This study was conducted on 649 patients with long COVID who had a high frequency of general fatigue. To test the structural validity of the FAS, the patients were randomly divided into two groups: one in which an exploratory factor analysis (EFA) was conducted and one in which a confirmatory factor analysis (CFA) was conducted. Cronbach's alpha was calculated to assess internal consistency reliability. Results As 58 patients had missing values, we analyzed the data of 591 patients. The EFA led to an FAS comprising two factors. The CFA showed an acceptable fit for this two-factor model. The internal consistency was found to be good (Cronbach's alpha =0.89). Conclusion This study verified the structural validity and internal consistency and reliability of the Japanese version of the FAS. The results indicate that the Japanese version of the FAS is useful for assessing general fatigue in patients with long COVID in Japan.

DOI： 10.2169/internalmedicine.4101-24

Importance of Blood Glucose Measurement for Predicting the Prognosis of Long COVID: A Retrospective Study in Japan. Reviewed International journal

Sho Yokoyama, Hiroyuki Honda, Yuki Otsuka, Kazuki Tokumasu, Yasuhiro Nakano, Yasue Sakurada, Yui Matsuda, Naruhiko Sunada, Toru Hasegawa, Ryosuke Takase, Daisuke Omura, Yoshiaki Soejima, Keigo Ueda, Masayuki Kishida, Fumio Otsuka

Journal of clinical medicine 13 ( 14 ) 2024.7

Language：English Publishing type：Research paper (scientific journal)

Purpose: The present study aimed to clarify the effects of a hyperglycemic condition on the clinical consequences of long COVID. Methods: Among 643 patients who visited the outpatient clinic of our hospital from February 2021 to September 2023, long COVID patients were classified into a hyperglycemic (HG) group with casual blood glucose levels above 140 mg/dL and a normoglycemic (NG) group. The patients' backgrounds, clinical symptoms, health status including the QOL evaluation scale (EQ-5D-5L), self-rating depression scale (SDS), and F-scale questionnaire (FSSG), blood test data, and recovery periods were analyzed. Results: The NG group included 607 patients with long COVID and the HG group included 36 patients with long COVID. Patients in the HG group were older than those in the NG group (55 vs. 41 years; p < 0.001) and included a larger percentage of males (67% vs. 44%; p = 0.009). The HG group had a larger percentage of patients with moderate-to-severe conditions in the acute infection phase (28% vs. 12%; p = 0.008), a higher BMI (25 vs. 22 kg/m2; p < 0.001), higher blood pressure (138/81 vs. 122/72 mmHg; p < 0.001), and a larger percentage of patients with an alcohol drinking habit (53% vs. 34%; p = 0.031). Long COVID symptoms and self-rated scales were not differed between the two groups; however, the laboratory data showed that liver and renal functions and metabolic data were significantly worse in the HG group. Although there was no apparent difference between the two groups in duration from the infection to the first visit, the HG group had a significantly longer period of recovery from long COVID (median period of 421 vs. 294 days; p = 0.019). Conclusion: A hyperglycemic state associated with other lifestyle-related diseases is associated with the prolongation of recovery from long COVID.

DOI： 10.3390/jcm13144099

Changes in Working Situations of Employed Long COVID Patients: Retrospective Study in Japanese Outpatient Clinic. Reviewed International journal

Yui Matsuda, Yasue Sakurada, Yuki Otsuka, Kazuki Tokumasu, Yasuhiro Nakano, Naruhiko Sunada, Hiroyuki Honda, Toru Hasegawa, Ryosuke Takase, Daisuke Omura, Keigo Ueda, Fumio Otsuka

Journal of clinical medicine 13 ( 13 ) 2024.6

Language：English Publishing type：Research paper (scientific journal)

Purpose: The present study aimed to uncover the impact of long COVID on the working situations of Japanese patients. Methods: Changes in the working situations of the patients who visited our long COVID clinic were evaluated from medical records for the aspects of physical status, quality of life (QOL), and mental conditions. Results: Of 846 long COVID patients who visited our clinic from February 2021 to December 2023, 545 employed patients aged between 18 and 65 years were included in this study. A total of 295 patients (54.1%) with long COVID (median age: 43 years, female: 55.6%) experienced changes in their working status. Those patients included 220 patients (40.4%) who took a leave of absence, 53 patients (9.7%) who retired, and 22 patients (4%) with reduced working hours. Most of the patients (93.2%) with changes in working conditions had mild disease severity in the acute phase of COVID-19. The majority of those patients with mild disease severity (58.8%) were infected in the Omicron-variant phase and included 65.3% of the female patients. The major symptoms in long COVID patients who had changes in their working situations were fatigue, insomnia, headache, and dyspnea. Scores indicating fatigue and QOL were worsened in long COVID patients who had changes in their working situations. In addition, 63.7% of the long COVID patients with changes in their working situations had decreases in their incomes. Conclusions: Changes in the working situation of long COVID patients who were employed had a negative impact on the maintenance of their QOL.

DOI： 10.3390/jcm13133809

Evaluating ChatGPT-4’s Accuracy in Identifying Final Diagnoses Within Differential Diagnoses Compared With Those of Physicians: Experimental Study for Diagnostic Cases Reviewed International journal

Takanobu Hirosawa, Yukinori Harada, Kazuya Mizuta, Tetsu Sakamoto, Kazuki Tokumasu, Taro Shimizu

JMIR Formative Research 8 e59267 - e59267 2024.6

Language：English Publishing type：Research paper (scientific journal) Publisher：JMIR Publications Inc.

Background

The potential of artificial intelligence (AI) chatbots, particularly ChatGPT with GPT-4 (OpenAI), in assisting with medical diagnosis is an emerging research area. However, it is not yet clear how well AI chatbots can evaluate whether the final diagnosis is included in differential diagnosis lists.

Objective

This study aims to assess the capability of GPT-4 in identifying the final diagnosis from differential-diagnosis lists and to compare its performance with that of physicians for case report series.

Methods

We used a database of differential-diagnosis lists from case reports in the American Journal of Case Reports, corresponding to final diagnoses. These lists were generated by 3 AI systems: GPT-4, Google Bard (currently Google Gemini), and Large Language Models by Meta AI 2 (LLaMA2). The primary outcome was focused on whether GPT-4’s evaluations identified the final diagnosis within these lists. None of these AIs received additional medical training or reinforcement. For comparison, 2 independent physicians also evaluated the lists, with any inconsistencies resolved by another physician.

Results

The 3 AIs generated a total of 1176 differential diagnosis lists from 392 case descriptions. GPT-4’s evaluations concurred with those of the physicians in 966 out of 1176 lists (82.1%). The Cohen κ coefficient was 0.63 (95% CI 0.56-0.69), indicating a fair to good agreement between GPT-4 and the physicians’ evaluations.

Conclusions

GPT-4 demonstrated a fair to good agreement in identifying the final diagnosis from differential-diagnosis lists, comparable to physicians for case report series. Its ability to compare differential diagnosis lists with final diagnoses suggests its potential to aid clinical decision-making support through diagnostic feedback. While GPT-4 showed a fair to good agreement for evaluation, its application in real-world scenarios and further validation in diverse clinical environments are essential to fully understand its utility in the diagnostic process.

DOI： 10.2196/59267

新型コロナウイルス感染症罹患後症状における睡眠障害の特徴と推移 Reviewed

大塚文男, 砂田匠彦, 大塚勇輝, 徳増一樹, 本多寛之, 古川雅規

日本病院総合診療医学会雑誌 20 ( 3 ) 129 - 134 2024.5

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