研究者業績
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  2. 横川 大樹

横川 大樹

ヨコカワ ダイキ  (Daiki Yokokawa)

基本情報

所属
千葉大学 医学部附属病院総合診療科 助教
株式会社OPQRST 取締役
学位
学士（医学）(2013年3月 福井大学)
博士（医学）(2020年3月 千葉大学大学院)
連絡先
dyokokawa6chiba-u.jp
研究者番号
80779869
ORCID ID
 https://orcid.org/0000-0003-0944-8664
J-GLOBAL ID
201601004510919660
Researcher ID
AAH-7097-2020
researchmap会員ID
B000251343
外部リンク

研究内容

私は医療機関において、臨床推論学の知識と経験を生かし、診断がつかない患者さんの症状についての診療を行っています。また研究機関においてはその臨床経験とコンピュータ・サイエンスの知識を生かして、人工知能（AI）が医師の診断を助ける未来を目指して、研究を行っています。

電子カルテや学術論文に医師が記載した文章には、AIを学習させるために必要な情報が多く含まれているとされています。私はWord2Vecという手法を主に用いて、文章内の医学単語をベクトル化することを試みています。ベクトル化することで、ある診断名と他の診断名がどれくらい似ているのかが距離として計算できます。この「疾患間距離」をもとに、診断支援システムの実用化につながる技術を作成し検証しています。

医師の専門資格

家庭医療専門医（日本プライマリ・ケア連合学会）　と

総合内科専門医（日本内科学会）　の2つの専門資格を有しています。

コモンディジーズ、慢性期管理、ワクチン・予防、家族のケア、メンタルヘルスなど、一人のひとをまるごと見て、問題点を解決するお手伝いをできるよう、日々診療と勉強に励んでいます。千葉大学病院では診断がついていない症候や健康問題についてチームで診療しています。

私生活

横川家の長男で一人っ子として、東京都で高校生まで過ごし、福井大学に進学しました。初めての雪国での生活に戸惑うことも多かったですが、福井での6年間は他に代えられない貴重な人生経験となりました。今は千葉県で家族と暮らしています。趣味はピアノ演奏、動画配信サービスでお笑い動画を見ること、ゲーム（デジタル・アナログ共）をすることです。趣味が講じて健康の知識を楽しく学ぶボードゲームの開発を有志と行っています。

SNS etc.

ORCID：https://orcid.org/0000-0003-0944-8664

KAKEN：https://nrid.nii.ac.jp/ja/nrid/1000080779869/

researchmap：https://researchmap.jp/dyokokawa6

ResearchGate：https://www.researchgate.net/profile/Daiki_Yokokawa

Publon：https://publons.com/researcher/3136313/daiki-yokokawa/

Facebook：https://www.facebook.com/dyokokawa6

Twitter：https://twitter.com/DaikiYokokawa/

GitHub；https://github.com/dyokokawa6

LinkedIn：https://www.linkedin.com/in/daiki-yokokawa/

HP：https://www.ho.chiba-u.ac.jp/section/soshin/index.html （千葉大学医学部附属病院 総合診療科）

HP：https://helpers.jp （地域医療ボードゲーム "Turn the Town" 作成団体）

HP：http://urbolab.info/ （まちづくりゲーム活動）

 

研究キーワード

 7

研究分野

 2

経歴

 6
もっとみる

学歴

 3

受賞

 2

論文

 55
  • Yasutaka Yanagita, Daiki Yokokawa, Fumitoshi Fukuzawa, Shun Uchida, Takanori Uehara, Masatomi Ikusaka
    BMC medical education 24(1) 536-536 2024年5月15日  
    BACKGROUND: An illness script is a specific script format geared to represent patient-oriented clinical knowledge organized around enabling conditions, faults (i.e., pathophysiological process), and consequences. Generative artificial intelligence (AI) stands out as an educational aid in continuing medical education. The effortless creation of a typical illness script by generative AI could help the comprehension of key features of diseases and increase diagnostic accuracy. No systematic summary of specific examples of illness scripts has been reported since illness scripts are unique to each physician. OBJECTIVE: This study investigated whether generative AI can generate illness scripts. METHODS: We utilized ChatGPT-4, a generative AI, to create illness scripts for 184 diseases based on the diseases and conditions integral to the National Model Core Curriculum in Japan for undergraduate medical education (2022 revised edition) and primary care specialist training in Japan. Three physicians applied a three-tier grading scale: "A" denotes that the content of each disease's illness script proves sufficient for training medical students, "B" denotes that it is partially lacking but acceptable, and "C" denotes that it is deficient in multiple respects. RESULTS: By leveraging ChatGPT-4, we successfully generated each component of the illness script for 184 diseases without any omission. The illness scripts received "A," "B," and "C" ratings of 56.0% (103/184), 28.3% (52/184), and 15.8% (29/184), respectively. CONCLUSION: Useful illness scripts were seamlessly and instantaneously created using ChatGPT-4 by employing prompts appropriate for medical students. The technology-driven illness script is a valuable tool for introducing medical students to key features of diseases.
  • Fumitoshi Fukuzawa, Yasutaka Yanagita, Daiki Yokokawa, Shun Uchida, Shiho Yamashita, Yu Li, Kiyoshi Shikino, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    JMIR medical education 10 e52674 2024年4月8日  
    BACKGROUND: Medical history contributes approximately 80% to a diagnosis, although physical examinations and laboratory investigations increase a physician's confidence in the medical diagnosis. The concept of artificial intelligence (AI) was first proposed more than 70 years ago. Recently, its role in various fields of medicine has grown remarkably. However, no studies have evaluated the importance of patient history in AI-assisted medical diagnosis. OBJECTIVE: This study explored the contribution of patient history to AI-assisted medical diagnoses and assessed the accuracy of ChatGPT in reaching a clinical diagnosis based on the medical history provided. METHODS: Using clinical vignettes of 30 cases identified in The BMJ, we evaluated the accuracy of diagnoses generated by ChatGPT. We compared the diagnoses made by ChatGPT based solely on medical history with the correct diagnoses. We also compared the diagnoses made by ChatGPT after incorporating additional physical examination findings and laboratory data alongside history with the correct diagnoses. RESULTS: ChatGPT accurately diagnosed 76.6% (23/30) of the cases with only the medical history, consistent with previous research targeting physicians. We also found that this rate was 93.3% (28/30) when additional information was included. CONCLUSIONS: Although adding additional information improves diagnostic accuracy, patient history remains a significant factor in AI-assisted medical diagnosis. Thus, when using AI in medical diagnosis, it is crucial to include pertinent and correct patient histories for an accurate diagnosis. Our findings emphasize the continued significance of patient history in clinical diagnoses in this age and highlight the need for its integration into AI-assisted medical diagnosis systems.
  • Kiyoshi Shikino, Miwa Sekine, Yuji Nishizaki, Yu Yamamoto, Taro Shimizu, Sho Fukui, Kazuya Nagasaki, Daiki Yokokawa, Takashi Watari, Hiroyuki Kobayashi, Yasuharu Tokuda
    BMC medical education 24(1) 316-316 2024年3月20日  
    BACKGROUND: In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education. METHODS: This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation. RESULTS: Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices. CONCLUSIONS: Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.
  • Yasutaka Yanagita, Daiki Yokokawa, Shun Uchida, Yu Li, Takanori Uehara, Masatomi Ikusaka
    2024年3月2日  
  • Kiyoshi Shikino, Yuji Nishizaki, Sho Fukui, Daiki Yokokawa, Yu Yamamoto, Hiroyuki Kobayashi, Taro Shimizu, Yasuharu Tokuda
    JMIR medical education 10 e54401 2024年2月29日  
    BACKGROUND: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. OBJECTIVE: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. METHODS: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. RESULTS: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. CONCLUSIONS: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.
  • Daiki Yokokawa, Yasutaka Yanagita, Yu Li, Shiho Yamashita, Kiyoshi Shikino, Kazutaka Noda, Tomoko Tsukamoto, Takanori Uehara, Masatomi Ikusaka
    Diagnosis (Berlin, Germany) 2024年2月23日  
  • Yasutaka Yanagita, Daiki Yokokawa, Fumitoshi Fukuzawa, Shun Uchida, Takanori Uehara, Masatomi Ikusaka
    2023年12月27日  
    Abstract Background Illness scripts, which are structured summaries of clinical knowledge concerning diseases, are crucial in disease prediction and problem representation during clinical reasoning. Clinicians iteratively enhance their illness scripts through their clinical practice. Because illness scripts are unique to each physician, no systematic summary of specific examples of illness scripts has been reported. Objective Generative artificial intelligence (AI) stands out as an educational aid in continuing medical education. The effortless creation of a typical illness script by generative AI could enhance the comprehension of disease concepts and increase diagnostic accuracy. This study investigated whether generative AI possesses the capability to generate illness scripts. Methods We used ChatGPT, a generative AI, to create illness scripts for 184 diseases based on the diseases and conditions integral to the National Model Core Curriculum for undergraduate medical education (2022 revised edition) and primary care specialist training in Japan. Three physicians applied a three-tier grading scale: “A” if the content of each disease’s illness script proves sufficient for training medical students, “B” if it is partially lacking but acceptable, and “C” if it is deficient in multiple respects. Moreover, any identified deficiencies in the illness scripts were discussed during the evaluation process. Results Leveraging ChatGPT, we successfully generated each component of the illness script for 184 diseases without any omission. The illness scripts received “A,” “B,” and “C” ratings of 56.0% (103/184), 28.3% (52/184), and 15.8% (29/184), respectively. Conclusion Useful illness scripts were seamlessly and instantaneously created by ChatGPT using prompts appropriate for medical students. The technology-driven illness script is a valuable tool for introducing medical students to disease conceptualization.
  • Kosuke Ishizuka, Kiyoshi Shikino, Yu Li, Daiki Yokokawa, Tomoko Tsukamoto, Yasutaka Yanagita, Jumpei Kojima, Shiho Yamashita, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    Journal of General and Family Medicine 2023年11月29日  
  • JMIR Preprints 2023年9月12日  
  • Daiki Yokokawa, Kazutaka Noda, Takanori Uehara, Yasutaka Yanagita, Yoshiyuki Ohira, Masatomi Ikusaka
    Artificial intelligence in medicine 143 102604-102604 2023年9月  
    OBJECTIVE: The pathophysiological concepts of diseases are encapsulated in patients' medical histories. Whether information on the pathophysiology or anatomy of "infarction" can be preserved and objectively expressed in the distributed representation obtained from a corpus of scientific Japanese medical texts in the "infarction" domain is currently unknown. Word2Vec was used to obtain distributed representations, meanings, and word analogies of word vectors, and this process was verified mathematically. MATERIALS & METHODS: The texts were abstracts that were obtained by searching for "infarction," "abstract," and "case report" in the Japan Medical Journal Association's Ichushi Data Base. The abstracted text was morphologically analyzed to produce word sequences converted into their standard form. MeCab was used for morphological analysis and mecab-ipadic-NEologd and ComeJisyo were used as dictionaries. The accuracy of the known tasks for medical terms was evaluated using a word analogy task specific to the "infarction" domain. RESULTS: Only 33 % of the word analogy tasks for medical terminology were correct. However, 52 % of the new original tasks, which were specific to the "infarction" domain, were correct, especially those regarding anatomical differences. DISCUSSION: Documents related to "infarction" were collected from a corpus of Japanese medical documents and word-embedded expressions were obtained using Word2Vec. Terminology that had similar meanings to "infarction" included words such as "cavity" and "ischemia," which suggest the pathology of an infarction. CONCLUSION: The pathophysiological and anatomical features of an "infarction" may be retained in a distributed representation.
  • 上原 孝紀, 小林 美亜, 塚田 弥生, 太田 光泰, 大平 善之, 大坪 徹也, 中部 貴央, 野田 和敬, 横川 大樹, 生坂 政臣
    医学教育 54(Suppl.) 25-25 2023年7月  
  • Yasutaka Yanagita, Kiyoshi Shikino, Kosuke Ishizuka, Shun Uchida, Yu Li, Daiki Yokokawa, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    BMC medical education 23(1) 477-477 2023年6月27日  
  • Yasutaka Yanagita, Kiyoshi Shikino, Kosuke Ishizuka, Shun Uchida, Yu Li, Daiki Yokokawa, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    BMC medical education 23(1) 383-383 2023年5月25日  
    BACKGROUND: A clinical diagnostic support system (CDSS) can support medical students and physicians in providing evidence-based care. In this study, we investigate diagnostic accuracy based on the history of present illness between groups of medical students using a CDSS, Google, and neither (control). Further, the degree of diagnostic accuracy of medical students using a CDSS is compared with that of residents using neither a CDSS nor Google. METHODS: This study is a randomized educational trial. The participants comprised 64 medical students and 13 residents who rotated in the Department of General Medicine at Chiba University Hospital from May to December 2020. The medical students were randomly divided into the CDSS group (n = 22), Google group (n = 22), and control group (n = 20). Participants were asked to provide the three most likely diagnoses for 20 cases, mainly a history of a present illness (10 common and 10 emergent diseases). Each correct diagnosis was awarded 1 point (maximum 20 points). The mean scores of the three medical student groups were compared using a one-way analysis of variance. Furthermore, the mean scores of the CDSS, Google, and residents' (without CDSS or Google) groups were compared. RESULTS: The mean scores of the CDSS (12.0 ± 1.3) and Google (11.9 ± 1.1) groups were significantly higher than those of the control group (9.5 ± 1.7; p = 0.02 and p = 0.03, respectively). The residents' group's mean score (14.7 ± 1.4) was higher than the mean scores of the CDSS and Google groups (p = 0.01). Regarding common disease cases, the mean scores were 7.4 ± 0.7, 7.1 ± 0.7, and 8.2 ± 0.7 for the CDSS, Google, and residents' groups, respectively. There were no significant differences in mean scores (p = 0.1). CONCLUSIONS: Medical students who used the CDSS and Google were able to list differential diagnoses more accurately than those using neither. Furthermore, they could make the same level of differential diagnoses as residents in the context of common diseases. TRIAL REGISTRATION: This study was retrospectively registered with the University Hospital Medical Information Network Clinical Trials Registry on 24/12/2020 (unique trial number: UMIN000042831).
  • Rurika Sato, Daiki Yokokawa, Takanori Uehara, Tomoko Tsukamoto, Kazutaka Noda, Kiyoshi Shikino, Yasutaka Yanagita, Jumpei Kojima, Kosuke Ishizuka, Masatomi Ikusaka
    Diagnosis (Berlin, Germany) 2023年5月15日  
  • 大平 善之, 横川 大樹, 鋪野 紀好, 塚本 知子, 野田 和敬, 上原 孝紀, 生坂 政臣, 池上 亜希子
    日本プライマリ・ケア連合学会学術大会 14回 225-225 2023年5月  
  • Kiyoshi Shikino, Tomoko Tsukamoto, Kazutaka Noda, Yoshiyuki Ohira, Daiki Yokokawa, Yuta Hirose, Eri Sato, Tsutomu Mito, Takahiro Ota, Yota Katsuyama, Takanori Uehara, Masatomi Ikusaka
    BMC medical education 23(1) 272-272 2023年4月21日  
    BACKGROUND: To investigate whether speech recognition software for generating interview transcripts can provide more specific and precise feedback for evaluating medical interviews. METHODS: The effects of the two feedback methods on student performance in medical interviews were compared using a prospective observational trial. Seventy-nine medical students in a clinical clerkship were assigned to receive either speech-recognition feedback (n = 39; SRS feedback group) or voice-recording feedback (n = 40; IC recorder feedback group). All students' medical interviewing skills during mock patient encounters were assessed twice, first using a mini-clinical evaluation exercise (mini-CEX) and then a checklist. Medical students then made the most appropriate diagnoses based on medical interviews. The diagnostic accuracy, mini-CEX, and checklist scores of the two groups were compared. RESULTS: According to the study results, the mean diagnostic accuracy rate (SRS feedback group:1st mock 51.3%, 2nd mock 89.7%; IC recorder feedback group, 57.5%-67.5%; F(1, 77) = 4.0; p = 0.049), mini-CEX scores for overall clinical competence (SRS feedback group: 1st mock 5.2 ± 1.1, 2nd mock 7.4 ± 0.9; IC recorder feedback group: 1st mock 5.6 ± 1.4, 2nd mock 6.1 ± 1.2; F(1, 77) = 35.7; p < 0.001), and checklist scores for clinical performance (SRS feedback group: 1st mock 12.2 ± 2.4, 2nd mock 16.1 ± 1.7; IC recorder feedback group: 1st mock 13.1 ± 2.5, 2nd mock 13.8 ± 2.6; F(1, 77) = 26.1; p < 0.001) were higher with speech recognition-based feedback. CONCLUSIONS: Speech-recognition-based feedback leads to higher diagnostic accuracy rates and higher mini-CEX and checklist scores. TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials on June 14, 2022. Due to our misunderstanding of the trial registration requirements, we registered the trial retrospectively. This study was registered in the Japan Registry of Clinical Trials on 7/7/2022 (Clinical trial registration number: jRCT1030220188).
  • Yasutaka Yanagita, Daiki Yokokawa, Shun Uchida, Junsuke Tawara, Masatomi Ikusaka
    JMIR Formative Research 2023年4月9日  査読有り
  • Yasutaka Yanagita, Daiki Yokokawa, Shun Uchida, Junsuke Tawara, Masatomi Ikusaka
    JMIR Preprints 2023年4月9日  
    UNSTRUCTURED<p>ChatGPT (Open AI, San Francisco, California, USA) has gained considerable attention because of its natural and intuitive responses. One limitation of OpenAI is its failure to perform reinforcement learning based on reliable information, thereby providing inaccurate or meaningless answers. Fortunately, on March 2023 update introduced GPT-4, which, according to internal evaluations, is expected to increase the likelihood of producing factual responses by 40% compared with its predecessor, GPT-3.5. We verified the accuracy of ChatGPT based on GPT-4 (ChatGPT4) and based on GPT-3.5 (ChatGPT3.5) by solving the Japanese National Medical Examination. We excluded questions containing figures and tables unsupported by ChatGPT. Of the 400 questions, 292 were analyzed. The correct response rate for ChatGPT4 was 81.5%, which was significantly higher than 42.8%, the rate for ChatGPT3.5. Moreover, ChatGPT4 surpassed the passing standard (&gt;72%) for the Japanese National Medical Examination, indicating its potential as a diagnostic and therapeutic decision aid for physicians. We anticipate that future updates of ChatGPT will further enhance its accuracy, making it an invaluable resource in the field of medicine.</p>
  • 佐藤 瑠璃香, 横川 大樹, 久富 隆之介, 小林 浩, 柳田 育孝, 山下 志保, 塚本 知子, 野田 和敬, 上原 孝紀, 生坂 政臣
    日本病院総合診療医学会雑誌 19(臨増1) 180-180 2023年2月  
  • Kosuke Ishizuka, Yoshiyuki Ohira, Takanori Uehara, Kazutaka Noda, Tomoko Tsukamoto, Kiyoshi Shikino, Daiki Yokokawa, Masatomi Ikusaka
    Diagnosis (Berlin, Germany) 10(2) 203-204 2023年1月19日  
  • Eriko Takeda, Yota Katsuyama, Daichi Sogai, Li Yu, Yasuyo Kumagae, Daiki Yokokawa, Yasushi Shinohara, Kiyoshi Shikino
    International journal of general medicine 16 5235-5240 2023年  
    PURPOSE: This study aimed to investigate cancer screening rates and the reasons for not undergoing screening among patients who regularly visited the Sanmu Medical Center. PATIENTS AND METHODS: This prospective observational study recruited patients aged ≥40 years with regular clinic visits to Sanmu Medical Center during October 2019. We conducted a self-administered survey to determine the patient's sex and whether they underwent cancer screening in 2019, and if not, the reason for the same. The primary outcome measure was the percentage of people who did not undergo cancer screening. RESULTS: A total of 198 responses (108 male respondents) were obtained. Among them, 189 were valid responses (valid response rate 94.5%). One hundred and twenty-nine patients (68.2%, 76 male) had not undergone screening. The most common reasons provided were "I have regular regular clinic visits and do not think they are necessary" (N = 65, 50.3%), "I underwent a gastroscopy within 2 years, a colorectal camera examination within a few years, and a chest radiography within a year" (42.5%), and "I have a separate complete medical checkup" (N = 15, 11.6%). Of the 65 patients who responded that their cancer screenings were unnecessary, 42 patients (64.6%) had not undergone a gastroscopy within 2 years, a colorectal camera examination within a few years, or a chest radiography or examination within a year. CONCLUSION: Roughly half of the respondents who did not undergo cancer screening elected to abstain because they believed that regular hospital visits were sufficient. Encouraging patients who regularly visit medical institutions to receive cancer screening is therefore necessary.
  • Yasutaka Yanagita, Yasushi Hayashi, Daiki Yokokawa, Masatomi Ikusaka
    European journal of case reports in internal medicine 10(5) 003874-003874 2023年  
    UNLABELLED: Angina bullosa haemorrhagica (ABH) is a disease of unknown cause that occurs most frequently in middle-aged and older adults and is characterized by the destruction of blood vessels in the submucosal layer of the middle pharynx and larynx centred on the soft palate, resulting in the formation of haemorrhagic blisters. It usually resolves within a day and heals without scarring within about a week. No treatment is necessary. However, cases of airway obstruction due to haematemesis have been reported, and this potential risk should be considered when tracheal intubation or upper gastrointestinal endoscopy is being performed. In this report, we describe the case of a 50-year-old man who developed a haematoma in the pharynx following upper endoscopy, which spontaneously ruptured and healed, leading to the diagnosis of ABH. The main purpose of this case report is to remind the reader that ABH improves without treatment, thus eliminating the need for unnecessary examination, and that there is a risk of airway obstruction depending on the site of the lesion. LEARNING POINTS: The key to the diagnosis of angina bullosa haemorrhagica (ABH) is a history of acute haemorrhagic vesicles caused by an external stimulus such as food or intubation, which resolve without scarring within a week or so.ABH can occur at any oropharyngeal site, but its occurrence in the pharyngeal region raises the risk of airway obstruction due to haematemesis.
  • Kosuke Ishizuka, Kiyoshi Shikino, Hiroki Tamura, Daiki Yokokawa, Yasutaka Yanagita, Shun Uchida, Yosuke Yamauchi, Yasushi Hayashi, Jumpei Kojima, Yu Li, Eri Sato, Shiho Yamashita, Nao Hanazawa, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    PloS one 18(1) e0279554 2023年  
    This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students' perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students' perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in "recalling appropriate differential diagnosis from patient's chief complaint" (F(1,97) = 5.295, p = 0.024) and "practicing the appropriate clinical reasoning process" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of "recalling appropriate history, physical examination, and tests on clinical hypothesis generation" (F(1,97) = 6.796, p = 0.011), "verbalizing and reflecting appropriately on own mistakes," (F(1,97) = 4.352, p = 0.040) "selecting keywords from the whole aspect of the patient," (F(1,97) = 5.607, p = 0.020) and "examining the patient while visualizing his/her daily life" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, "acquisition of knowledge" was the most frequent subcategory, followed by "leading the discussion," "smooth discussion," "getting feedback," "timely feedback," and "supporting the clinical reasoning process." Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one's own errors and selecting appropriate keywords from the whole aspect of the patient.
  • Daiki Yokokawa, Kazutaka Noda, Yasutaka Yanagita, Takanori Uehara, Yoshiyuki Ohira, Kiyoshi Shikino, Tomoko Tsukamoto, Masatomi Ikusaka
    BMC medical informatics and decision making 22(1) 322-322 2022年12月7日  
    BACKGROUND: The pivot and cluster strategy (PCS) is a diagnostic reasoning strategy that automatically elicits disease clusters similar to a differential diagnosis in a batch. Although physicians know empirically which disease clusters are similar, there has been no quantitative evaluation. This study aimed to determine whether inter-disease distances between word embedding vectors using the PCS are a valid quantitative representation of similar disease groups in a limited domain. METHODS: Abstracts were extracted from the Ichushi Web database and subjected to morphological analysis and training using Word2Vec, FastText, and GloVe. Consequently, word embedding vectors were obtained. For words including "infarction," we calculated the cophenetic correlation coefficient (CCC) as an internal validity measure and the adjusted rand index (ARI), normalized mutual information (NMI), and adjusted mutual information (AMI) with ICD-10 codes as the external validity measures. This was performed for each combination of metric and hierarchical clustering method. RESULTS: Seventy-one words included "infarction," of which 38 diseases matched the ICD-10 standard with the appearance of 21 unique ICD-10 codes. When using Word2Vec, the CCC was most significant at 0.8690 (metric and method: euclidean and centroid), whereas the AMI was maximal at 0.4109 (metric and method: cosine and correlation, and average and weighted). The NMI and ARI were maximal at 0.8463 and 0.3593, respectively (metric and method: cosine and complete). FastText and GloVe generally resulted in the same trend as Word2Vec, and the metric and method that maximized CCC differed from the ones that maximized the external validity measures. CONCLUSIONS: The metric and method that maximized the internal validity measure differed from those that maximized the external validity measures; both produced different results. The cosine distance should be used when considering ICD-10, and the Euclidean distance when considering the frequency of word occurrence. The distributed representation, when trained by Word2Vec on the "infarction" domain from a Japanese academic corpus, provides an objective inter-disease distance used in PCS.
  • Hiroki Tamura, Kiyoshi Shikino, Daichi Sogai, Daiki Yokokawa, Shun Uchida, Yu Li, Yasutaka Yanagita, Yosuke Yamauchi, Jumpei Kojima, Kosuke Ishizuka, Tomoko Tsukamoto, Kazukata Noda, Takanori Uehara, Takahiro Imaizumi, Hitomi Kataoka, Masatomi Ikusaka
    Journal of general internal medicine 38(8) 1843-1847 2022年11月16日  
    BACKGROUND: Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult. OBJECTIVE: To investigate the association between physician empathy and difficult patient encounters (DPEs). DESIGN: Cross-sectional study. PARTICIPANTS: Participants were 18 generalist physicians with 3-8 years of experience. The investigation was conducted from August-September 2018 and April-May 2019 at six healthcare facilities. MAIN MEASURES: Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians' empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering. KEY RESULTS: The median JSE score was 114 (range: 96-126), and physicians with JSE scores 96-113 and 114-126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19-0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = -0.22, p < 0.01). CONCLUSION: Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty.
  • Fumitoshi Fukuzawa, Kiyoshi Shikino, Kosuke Ishizuka, Yosuke Yamauchi, Daiki Yokokawa, Akiko Ikegami, Takanori Uehara, Masatomi Ikusaka
    Annals of Internal Medicine: Clinical Cases 1(7) 2022年9月1日  査読有り
  • Kosuke Ishizuka, Daiki Yokokawa, Masatomi Ikusaka
    CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 194(28) E993 2022年7月25日  査読有り
  • Yu Li, Kiyoshi Shikino, Jiro Terada, Yusuke Katsumata, Toru Kinouchi, Ken Koshikawa, Daiki Yokokawa, Tomoko Tsukamoto, Kazutaka Noda, Masatomi Ikusaka
    Journal of General and Family Medicine 23(6) 370-375 2022年7月14日  査読有り
  • 上原 孝紀, 野田 和敬, 塚本 知子, 鋪野 紀好, 横川 大樹, 生坂 政臣
    医学教育 53(Suppl.) 80-80 2022年7月  
  • Daiki Yokokawa, Kiyoshi Shikino, Yasuhiro Kishi, Masatomi Ikusaka
    International Journal of General Medicine Volume 15 6309-6313 2022年7月  査読有り筆頭著者
    PURPOSE: This study aims to translate and ensure cross-cultural adaptation of a Japanese version of the INTERMED Self-Assessment Questionnaire (IMSA). METHODS: A family medicine physician, a medical education specialist, a psychiatrist who prepared the Japanese version of the INTERMED, and two members of the INTERMED consortium were selected as committee members. We used the standard forward and backward translation method to translate the IMSA into Japanese. After translating the original IMSA into Japanese, all committee members discussed and reached a consensus on the proposed translation. The back-translation was performed by an English native professional translator who did not know the original text. We contacted the INTERMED consortium and asked them to review the conceptual equivalence of the back-translated Japanese version with the original version; after two reviews, the members approved the Japanese version. Thereafter, we conducted cognitive debriefings with four patients and nine healthcare professionals to ensure cross-cultural adaptation. RESULTS: The members of the INTERMED consortium approved the use of the Japanese version. We modified some expressions and words, while retaining the original meaning, to make it easier for Japanese patients to understand. CONCLUSION: We developed a Japanese version of the IMSA. A future study will investigate the construct criterion-related validity and the reliability of the scale.
  • Daiki Yokokawa, Kazutaka Noda, Yasutaka Yanagita, Takanori Uehara, Yoshiyuki Ohira, Kiyoshi Shikino, Tomoko Tsukamoto, Masatomi Ikusaka
    BioRxiv 2022年6月25日  筆頭著者責任著者
  • Daiki Yokokawa, Kiyoshi Shikino, Yasuhiro Kishi, Toshiaki Ban, Shigeyoshi Miyahara, Yoshiyuki Ohira, Yasutaka Yanagita, Yosuke Yamauchi, Yasushi Hayashi, Kosuke Ishizuka, Yuta Hirose, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    BMJ open 12(4) e051891 2022年4月21日  査読有り筆頭著者責任著者
  • Kiyoshi Shikino, Tsutomu Mito, Yoshiyuki Ohira, Daiki Yokokawa, Yota Katsuyama, Takahiro Ota, Eri Sato, Yuta Hirose, Shiho Yamashita, Shingo Suzuki, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    Internal Medicine 2022年  査読有り
    Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.
  • Shun Uchida, Kiyoshi Shikino, Kosuke Ishizuka, Yosuke Yamauchi, Yasutaka Yanagita, Daiki Yokokawa, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    PloS one 17(6) e0270136 2022年  査読有り
    Deep tendon reflexes (DTR) are a prerequisite skill in clinical clerkships. However, many medical students are not confident in their technique and need to be effectively trained. We evaluated the effectiveness of a flipped classroom for teaching DTR skills. We recruited 83 fifth-year medical students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019. They were allocated to the flipped classroom technique (intervention group, n = 39) or the traditional technique instruction group (control group, n = 44). Before procedural teaching, while the intervention group learned about DTR by e-learning, the control group did so face-to-face. A 5-point Likert scale was used to evaluate self-confidence in DTR examination before and after the procedural teaching (1 = no confidence, 5 = confidence). We evaluated the mastery of techniques after procedural teaching using the Direct Observation of Procedural Skills (DOPS). Unpaired t-test was used to analyze the difference between the two groups on the 5-point Likert scale and DOPS. We assessed self-confidence in DTR examination before and after procedural teaching using a free description questionnaire in the two groups. Additionally, in the intervention group, focus group interviews (FGI) (7 groups, n = 39) were conducted to assess the effectiveness of the flipped classroom after procedural teaching. Pre-test self-confidence in the DTR examination was significantly higher in the intervention group than in the control group (2.8 vs. 2.3, P = 0.005). Post-test self-confidence in the DTR examination was not significantly different between the two groups (3.9 vs. 4.1, P = 0.31), and so was mastery (4.3 vs. 4.1, P = 0.68). The questionnaires before the procedural teaching revealed themes common to the two groups, including "lack of knowledge" and "lack of self-confidence." Themes about prior learning, including "acquisition of knowledge" and "promoting understanding," were specific in the intervention group. The FGI revealed themes including "application of knowledge," "improvement in DTR technique," and "increased self-confidence." Based on these results, teaching DTR skills to medical students in flipped classrooms improves readiness for learning and increases self-confidence in performing the procedure at a point before procedural teaching.
  • Kosuke Ishizuka, Kiyoshi Shikino, Daiki Yokokawa, Masatomi Ikusaka
    Radiology case reports 16(10) 2886-2889 2021年10月  査読有り
    Follicular lymphoma is clinically classified as a common type of indolent non-Hodgkin's lymphoma, and its clinical diagnosis is difficult because B symptoms and elevated soluble interleukin-2 receptor (sIL-2R) levels are less frequent in follicular lymphoma than in other lymphomas. We report a case of follicular lymphoma masquerading immunoglobulin G4-related disease (IgG4-RD) with elevated IgG4 levels. A 67-year-old man presented to our hospital with a 1-year history of deep right supraclavicular and para-aortic lymph node lymphadenopathy on plain computed tomography (CT) findings along with elevated IgG4 levels, and the 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan showed heterogeneous diffuse FDG uptake in the liver, and FDG uptake was noted at multiple sites in the enlarged right supraclavicular and para-aortic lymph nodes. Excisional biopsy of the right supraclavicular lymph node, performed under general anesthesia, showed a tumor-like structure mimicking a normal germinal center in the lymphoid follicle; immunostaining was positive for B-cell lymphoma 2 and CD10 proteins with some plasma cells stained with IgG, only 30% of them were positive for IgG4, and no marked fibrosis characteristic of IgG4-RD was observed; therefore, follicular lymphoma was diagnosed, and all symptoms, including FDG uptake, improved with rituximab monotherapy. Differential diagnoses of slowly progressive generalized lymphadenopathy over the years with elevated serum IgG4 levels include IgG4-RD, Castleman's disease, and indolent lymphoma. Multiple accumulation in the liver on FDG-PET/CT, if found, may suggest indolent lymphoma among them.
  • Norihisa Tada, Kosuke Ishizuka, Daiki Yokokawa, Masatomi Ikusaka
    Postgraduate medical journal 2021年8月19日  査読有り
  • Kosuke Ishizuka, Daiki Yokokawa, Takahiro Mori, Masatomi Ikusaka
    BMJ case reports 14(8) 2021年8月16日  査読有り
  • Kiyoshi Shikino, Claudia A Rosu, Daiki Yokokawa, Shingo Suzuki, Yusuke Hirota, Katsumi Nishiya, Masatomi Ikusaka
    BMC medical education 21(1) 428-428 2021年8月13日  査読有り
    BACKGROUND: Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians' confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach's value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. METHODS: We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach's effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students' thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. RESULTS: The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom's taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom's taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen's kappa = 0.81). CONCLUSIONS: Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom's taxonomy. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434 ).
  • Kosuke Ishizuka, Daiki Yokokawa, Takahiro Mori, Tomonori Kato, Masatomi Ikusaka
    The American journal of medicine 134(9) e488-e489 2021年5月1日  査読有り
  • Kosuke Ishizuka, Daiki Yokokawa, Masatomi Ikusaka
    Journal of general and family medicine 22(3) 148-149 2021年5月  査読有り
    A 51-year-old man experienced sudden abdominal pain from the umbilicus to the right flank 5 days before his hospital visit. His abdominal pain disappeared when the examiner lifted his upper body in the sitting position. MRI revealed posterior intervertebral disc protrusion in the right paramedian region at the 9th/10th thoracic vertebrae. With the treatment, it is reported that traction is the appropriate initial approach for spine radiculopathy. Improvement with upper body traction performed in this case, which is a previously unreported maneuver, appears to be useful for diagnosis because it eliminates the influence of gravity and reduces intradiscal pressure.
  • Daiki Yokokawa, Takanori Uehara, Masatomi Ikusaka
    Journal of general and family medicine 22(2) 92-93 2021年3月  査読有り筆頭著者責任著者
    A 72-year-old woman presented with a 3-day history of nausea, vomiting, and fever. She had rheumatoid arthritis and was taking prednisolone (10 mg), cyclosporine (150 mg), and actarit (200 mg) daily. Computed tomography revealed gases were detected in the bladder wall, and emphysematous cystitis was diagnosed. When an immunocompromised host is suspected of a severe urinary tract infection but lacks specific signs or symptoms such as costovertebral angle tapping pain, emphysematous cystitis should be considered.
  • Yuta Hirose, Kiyoshi Shikino, Yoshiyuki Ohira, Sumihide Matsuoka, Chihiro Mikami, Hayami Tsuchiya, Daiki Yokokawa, Akiko Ikegami, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    BMC family practice 22(1) 42-42 2021年2月22日  査読有り
    BACKGROUND: Patient awareness surveys on polypharmacy have been reported previously, but no previous study has examined the effects of sending feedback to health professionals on reducing medication use. Our study aimed to conduct a patient survey to examine factors contributing to polypharmacy, feedback the results to health professionals, and analyze the resulting changes in the number of polypharmacy patients and prescribed medications. METHODS: After conducting a questionnaire survey of patients in Study 1, we provided its results to the healthcare professionals, and then surveyed the number of polypharmacy patients and oral medications using a before-after comparative study design in Study 2. In Study 1, we examined polypharmacy and its contributing factors by performing logistic regression analysis. In Study 2, we performed a t-test and a chi-square test. RESULTS: In the questionnaire survey, significant differences were found in the following 3 items: age (odds ratio (OR) = 3.14; 95% confidence interval (CI) = 2.01-4.91), number of medical institutions (OR = 2.34; 95%CI = 1.50-3.64), and patients' difficulty with asking their doctors to deprescribe their medications (OR = 2.21; 95%CI = 1.25-3.90). After the feedback, the number of polypharmacy patients decreased from 175 to 159 individuals and the mean number of prescribed medications per patient decreased from 8.2 to 7.7 (p < 0.001, respectively). CONCLUSIONS: Providing feedback to health professionals on polypharmacy survey results may lead to a decrease in the number of polypharmacy patients. Factors contributing to polypharmacy included age (75 years or older), the number of medical institutions (2 or more institutions), and patients' difficulty with asking their physicians to deprescribe their medications. Feedback to health professionals reduced the percentage of polypharmacy patients and the number of prescribed medications. TRIAL REGISTRATION: UMIN. Registered 21 June 2020 - Retrospectively registered, https://www.umin.ac.jp/ctr/index-j.htm.
  • Ishizuka K, Shikino K, Yokokawa D, Ikusaka M
    2021年2月  
  • Shikino K, Rosu CA, Yokokawa D, Suzuki S, Hirota Y, Nishiya K, Ikusaka M
    2021年1月  
  • Daiki Yokokawa, Yoshiyuki Ohira, Akiko Ikegami, Kiyoshi Shikino, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    Journal of General and Family Medicine 23(2) 87-93 2021年  査読有り筆頭著者責任著者
    Background: The supply of primary care physicians is associated with better health outcomes and a lower total cost of health services. However, the effect of the presence or absence of primary care physicians on health-related quality of life (QOL) is unknown. We comparatively investigated the health-related QOL of ordinary citizens according to the presence or absence of a primary care physician. Methods: We conducted an observational cross-sectional study using a propensity score analysis. A questionnaire on health-related QOL (SF-36v2, age, gender, presence or absence of a primary care physician, and chronic disease status) was mailed to 2200 individuals identified through stratified random sampling. We used propensity scores to compensate for covariates and analyzed three component SF-36 summary scores and subscale scores of the “primary care physician” and “no primary care physician” groups. Results: Valid responses were received from 1095 individuals (49.8%). The “primary care physician group” comprised 653 individuals (59.6%). The physical health component scores of the “primary care physician group” were significantly lower than those of the “no primary care physician group,” and the “mental health component” scores were significantly higher (p = 0.032, p = 0.009). For the subscales, scores for “vitality” and “mental health” were significantly higher in the “primary care physician group” (p = 0.014, p = 0.018). Conclusions: Patients who had a primary care physician with whom they could comfortably consult at any time had a high mental health component score, and low physical health component score in the health-related QOL.
  • Yoji Hoshina, Kiyoshi Shikino, Yosuke Yamauchi, Yasutaka Yanagita, Daiki Yokokawa, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    PloS one 16(7) e0253884 2021年  査読有り
    During clinical reasoning case conferences, a learner-centered approach using teleconferencing can create a psychologically safe environment and help learners speak up. This study aims to measure the psychological safety of students who are supposed to self-explain their clinical reasoning to conference participants. This crossover study compared the effects of two clinical reasoning case conference methods on medical students' psychological safety. The study population comprised 4th-5th year medical students participating in a two-week general medicine clinical clerkship rotation, from September 2019 to February 2020. They participated in both a learner-centered approach teleconference and a traditional, live-style conference. Teleconferences were conducted in a separate room, with only a group of students and one facilitator. Participants in group 1 received a learner-centered teleconference in the first week and a traditional, live-style conference in the second week. Participants assigned to group 2 received a traditional, live-style conference in the first week and a learner-centered approach teleconference in the second week. After each conference, Edmondson's Psychological Safety Scale was used to assess the students' psychological safety. We also counted the number of students who self-explained their clinical reasoning processes during each conference. Of the 38 students, 34 completed the study. Six out of the seven psychological safety items were significantly higher in the learner-centered approach teleconferences (p<0.01). Twenty-nine (85.3%) students performed self-explanation in the teleconference compared to ten (29.4%) in the live conference (p<0.01). A learner-centered approach teleconference could improve psychological safety in novice learners and increase the frequency of their self-explanation, helping educators better assess their understanding. Based on these results, a learner-centered teleconference approach has the potential to be a method for teaching clinical reasoning to medical students.
  • Kosuke Ishizuka, Kiyoshi Shikino, Yosuke Yamauchi, Yasutaka Yanagita, Daiki Yokokawa, Akiko Ikegami, Tomoko Tsukamoto, Kazutaka Noda, Takanori Uehara, Masatomi Ikusaka
    Internal medicine (Tokyo, Japan) 59(22) 2857-2862 2020年11月15日  査読有り
    Objective This case series aimed to investigate the clinical and pathological characteristics of persistent postural perceptual dizziness (PPPD). Methods We retrospectively examined the medical records of patients with chronic dizziness in our department, and tracked the percentage of PPPD, the age and sex, disorder duration, exacerbating factors for dizziness, and duration of momentary worsening dizziness. We also examined the duration of momentary worsening dizziness in cases of depression, anxiety disorder, and somatic symptom disorder. Results Among 229 patients with chronic dizziness, 14.4% (33/229) met the diagnostic criteria for PPPD. PPPD was the second most common disorder of patients with chronic dizziness after depression. The median age of patients with PPPD was 75 (75.8% female) and the median duration of the disorder was 60 months (range: 3-360 months). The exacerbating factors were motion without regard to direction or position (90.9%), upright posture (66.7%), and exposure to moving visual stimuli or complex visual patterns (30.3%). While the duration of momentary worsening dizziness was less than 10 minutes in 93.9% of patients with PPPD, the duration in patients with depression, anxiety disorder, and somatic symptom disorder were 3.6 % (2/55), 16.1% (5/31), and 0% (0/11), respectively. When the duration was less than 10 minutes, the odds ratios of PPPD for depression and anxiety disorder were 46.5 (95% CI: 6.1-362.0) and 40.3 (95% CI: 7.4-219.3), respectively. Conclusion Short episodes of momentary worsening dizziness constitute a distinctive feature of PPPD that may be useful for differentiating PPPD from other types of psychogenic dizziness.
  • Daiki Yokokawa, Kiyoshi Shikino, Masatomi Ikusaka
    Journal of general and family medicine 21(6) 270-271 2020年11月  査読有り筆頭著者責任著者
    A 61-year-old Japanese man presented with a 2-month history of colicky abdominal pain and watery diarrhea. He had begun organic farming using cattle manure 1 year previously.
  • Ishizuka K, Yokokawa D, Mori T, Kato T, Yamamoto D, Ikusaka M
    The American journal of medicine 134(3) e215-e216 2020年9月  査読有り
  • Kosuke Ishizuka, Takanori Uehara, Daiki Yokokawa, Kazutaka Noda, Masatomi Ikusaka
    QJM: An International Journal of Medicine 2020年5月5日  査読有り

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  • 横川 大樹, 水谷 元紀, 進谷憲亮
    2018年11月 - 現在 その他

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  • - 現在
    学会 日本プライマリ・ケア連合学会（外部リンク） 第6回 日本プライマリ・ケア連合学会学術大会, 2015/6/13-14, 筑波国際会議場 茨城県つくば市 第7回 日本プライマリ・ケア連合学会学術大会. 2016/06/12, 東京 第8回 日本プライマリ・ケア連合学会学術大会. 2016/05/13-14, 香川 第9回 日本プライマリ・ケア連合学会学術大会. 2018/06/16, 三重 第7回 日本プライマリ・ケア連合学会 関東甲信越ブロック地方会2018/11/18, 千葉県千葉市 第10回 日本プライマリ・ケア連合学会学術大会. 2019/05/18-19, 京都 第11回 日本プライマリ・ケア連合学会学術大会. 2020/07/23-8/31, Web 第12回日本プライマリ・ケア連合学会学術大会. 2021/05/22-23, Web 第13回日本プライマリ・ケア連合学会学術大会. 2022/06/11-12, 横浜+Web 第14回日本プライマリ・ケア連合学会学術大会. 2023/05/12-14, 名古屋 American College of Physicians Japan chapter American College of Physicians Japan chapter annual general meeting 2016. 2016/06/04, 京都 American College of Physicians Japan chapter annual general meeting 2017. 2017/07/09-2017/07/11, 京都 American College of Physicians Japan chapter annual general meeting 2018. 2018/06/02, 京都 American College of Physicians Japan chapter annual general meeting 2019. 2019/06/08-09, 京都 American College of Physicians Japan chapter annual general meeting 2021. 2021/06/26-27, Web American College of Physicians Japan chapter annual general meeting 2023. 2023/06/24-25, Web 日本内科学会 第114回 日本内科学会講演会. 2017/04/15, 東京国際フォーラム 第115回 日本内科学会講演会. 2018/04/14, 京都市勧業館「みやこめっせ」 日本内科学会 第657回関東地方会. 2020/02/08, 東京 第117回日本内科学会総会・講演会. 2020/08/07-09, 東京 第118回日本内科学会講演会, 2021/4/9-11, Web 第120回日本内科学会講演会, 2023/4/11-16, Web 日本医療情報学会 第39回 医療情報学連合大会（第20回日本医療情報学会学術大会）. 2019/11/21-24, 千葉 第40回医療情報学連合大会（第21回日本医療情報学会学術大会）. 2020/11/18-22, 浜松+Web 第8回「JAMI医用知能情報学研究会-JSAI医用人工知能研究会」合同研究会. 2019/11/22, 神奈川 第24回 日本医療情報学会春季学術大会. 2020/06/05-06, Web 第26回日本医療情報学会春季学術大会. 2022/06/30-07/02, 岡山+Web 人工知能学会 第8回「JAMI医用知能情報学研究会-JSAI医用人工知能研究会」合同研究会. 2019/11/22, 神奈川 第34回 人工知能学会全国大会, 2020/06/09-12, Web 第35回人工知能学会全国大会, 2021/06/08-11, Web 第36回人工知能学会全国大会, 2022/06/14-17, Web 日本メディカルAI学会 第3回日本メディカルAI学会 学術集会, 2021/06/11-12, Web 第4回日本メディカルAI学会 学術集会, 2022/06/10-11, Web ワークショップ・セミナー 2016/08/08 第28回学生・研修医のための家庭医療学夏期セミナー, 日本プライマリ・ケア連合学会. 静岡 2017/11/25 日本医療情報学会医療情報技師育成部会 生涯研修セミナー「医療情報分野の最新動向−機械学習入門」, 東京都千代田区日本大学駿河台校舎 2018/02/04 第3回日常診療での診断プロセスを考えるワークショップ 日内会館 2018/11/10 日本プライマリ・ケア連合学会, 専門医部会フォーラム 2018, 東京都千代田区 2023/11/19 令和5年度プライマリ・ケア学術講演会, 千葉県医師会館
  • 2018/04/01-2019/03/31 千葉大学医学部附属病院 褥瘡委員会 委員 2019/04/01-2020/03/31 千葉大学医学部附属病院 ベッドマネージャーチーム会議 委員 2019/04/01-2020/03/31 千葉大学医学部附属病院 手術部検討委員会 委員 2020/04/01-2021/03/31 千葉大学医学部附属病院 臨床検査適正委員会 委員 2020/04/01-2021/03/31 千葉大学医学部附属病院 保健委員会 委員 2021/01/22- 千葉大学医学部附属病院 医療機器管理実務者 2021/04/01- 千葉大学医学部附属病院 診療情報管理ワーキンググループ 委員 2021/11/08- 千葉大学医学部附属病院 オンライン診療推進ワーキンググループ 委員 2023/04/01- 千葉大学医学部附属病院 臨床試験品質管理専門部会 2024/04/01- 千葉大学医学部附属病院 総合診療科 実務者 2024/04/01- 千葉大学医学部附属病院 総合診療科 労務管理担当者
  • 【2015年度】 千葉大学初期研修医1名に総合診療科外来研修, 2015年4月〜12月 千葉大学医学部の学生に総合診療科外来教育および模擬面接, 2015年6月～2016年1月 【2016年度】 学生4名に対して, レクチャー「体重減少」, 2016/08/30 後期研修医2名、初期研修医3名、学生1名に対して, レクチャー「眼底鏡検査」, 2016/09/06 後期研修医3名に対して, レクチャー「初めての確定申告」, 2017/01/20 千葉大学初期研修医1名に総合診療科外来研修, 2015年9月 【2017年度】 小児科医学部学生 5年生にベッドサイドで指導, 2017/05/01-05/19 診療所で高校1年生に医師体験・病院見学の案内, 2018/03/26 救急集中治療科で1年目研修医にベッドサイドで指導, 2017/07/03-09/29 診療所で2年目研修医2名に外来・在宅指導, 2017/10/02-10/31 診療所で2年目研修医1名に外来・在宅指導, 2017/11/1-2018/01/31 診療所で職場体験の中学生2名に指導, 2017/11/08-09 診療所で2年目研修医2名に外来・在宅指導, 2018/02/01-02/28 診療所で2年目研修医1名に外来・在宅指導, 2018/03/01-03/31 【2018年度】 医学部のローテート学生に外来・診断推論の指導, 2018/04/05- タイからの学生1名に外来・診断推論の指導, 2018/04/05-04/27 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2018/04/06 学生3名に、症候学「振戦」の指導, 2018/04/06 初期研修医4名、後期研修医2名に身体診察「甲状腺の診察」の指導, 2018/04/13 留学生3名（マレーシア2名、タイ2名）、初期研修医4名、専攻医3名に身体診察「膝の診察」の指導, 2018/04/20 学生5名に、症候学「痛みの種類」「慢性会陰部痛」の指導, 2018/05/08 学生4名に、症候学「手根管症候群」「閾値を下げる要因」の指導, 2018/05/15 学生6名に、症候学「曖昧な訴えの患者へのアプローチ」の指導, 2018/05/22 学生5名に、PBLチューター「パニック障害①」, 2018/06/05 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2018/06/06 学生5名に、PBLチューター「パニック障害②」, 2018/06/12 初期研修医2名に身体診察「甲状腺の診察」の指導, 2018/06/13 学生6名に、症候学「足の甲の痛み」の指導, 2018/06/25 学生6名に、症候学「BPSモデルを用いた診断推論」の指導, 2018/07/03 学生6名に、PBLチューター「睡眠時無呼吸症候群①」, 2018/08/28 学生4名に、「クインケ浮腫」の指導, 2018/08/29 学生6名に、PBLチューター「睡眠時無呼吸症候群②」, 2018/09/03 初期研修医1名に訪問診療指導, 千城台クリニック, 2018/09/03-09/24 初期研修医1名に訪問診療指導, 千城台クリニック, 2018/10/01-10/29 学生6名に、症候学「失調の鑑別診断」の指導, 2018/10/23 学生6名に、症候学「右下腹部痛」の指導, 2018/10/30 初期研修医1名に訪問診療指導, 千城台クリニック, 2018/11/05-11/26 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2018/11/28 初期研修医1名に訪問診療指導, 千城台クリニック, 2018/12/03-12/17 学生6名に、PBLチューター「パニック障害①」, 2019/01/09 学生6名に、PBLチューター「パニック障害②」, 2019/01/16 学生6名に、PBLチューター「パニック障害①」, 2019/02/05 専攻医2名に、PBLチューターファカルティ・ディベロップメント, 2019/02/06 学生6名に、PBLチューター「パニック障害②」, 2019/02/12 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2019/02/22 フィンランドからの学生1名に外来・診断推論の指導, 2019/03/04-03/29 【2019年度】 学生6名に、症候学「精神疾患を疑う症候」の指導, 2019/05/08 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2019/05/22 初期研修医1名に訪問診療指導, 千城台クリニック, 2019/06/03-06/24 学生3名に、症候学「腰痛、増悪寛解因子による鑑別診断」の指導, 2019/06/19 初期研修医2名に訪問診療指導, 千城台クリニック, 2019/07/01-07/29 専攻医3名にCSA指導, 千葉大学医学部附属病院, 2019/07/04 専攻医2名にCSA指導, 千葉大学医学部附属病院, 2019/07/08 初期研修医1名に訪問診療指導, 千城台クリニック, 2019/09/02-09/30 学生6名に、症候学「発作性の症状となる疾患」の指導, 2019/10/10 初期研修医1名に訪問診療指導, 千城台クリニック, 2019/12/02-12/27 東千葉メディカルセンターの学生2名に遠隔システムを用いて外来・診断推論の指導, 2019/12/03 学生6名に、症候学「めまい、PPPDの病態」の指導, 2019/12/17 【2020年度】 初期研修医1名に訪問診療指導, 千城台クリニック, 2020/08/03-08/31 初期研修医1名に訪問診療指導, 千城台クリニック, 2020/09/07-09/28 初期研修医2名に訪問診療指導, 千城台クリニック, 2020/11/30-12/28 初期研修医1名に訪問診療指導, 千城台クリニック, 2021/01/04-01/25 学生6名に、PBLチューター「睡眠時無呼吸症候群①」, 2021/03/02 学生6名に、PBLチューター「睡眠時無呼吸症候群②」, 2021/03/09 初期研修医2年に研修報告会における発表指導. 原因不明の易転倒性で紹介となり、進行性核上性麻痺を疑い精査に繋げることができた１例, 臨床研修報告会, 千葉大学医学部附属病院, 2021/03/01 【2021年度】 学生5名に、PBLチューター「アミロイドーシス①」, 2021/05/11 学生5名に、PBLチューター「アミロイドーシス②」, 2021/05/18 学生6名に、PBLチューター「パニック障害①」, 2022/01/19 学生6名に、PBLチューター「パニック障害②」, 2022/01/25 【2022年度】 学生4名に、PBLチューター「亜急性連合性脊髄変性症①」, 2022/04/20 学生4名に、PBLチューター「亜急性連合性脊髄変性症②」, 2022/04/27 学生5名に、PBLチューター「Fitz-Hugh-Curtis症候群①」, 2022/09/14 学生5名に、PBLチューター「Fitz-Hugh-Curtis症候群②」, 2022/09/21 初期研修医2名に訪問診療指導, 千城台クリニック, 2023/01/16-01/30 初期研修医1名に訪問診療指導, 千城台クリニック, 2023/02/06-02/27 【2023年度】 初期研修医1名に訪問診療指導, 千城台クリニック, 2023/04/17-04/24 初期研修医1名に訪問診療指導, 千城台クリニック, 2023/10/01-10/31 【2024年度】 初期研修医1名に訪問診療指導, 千城台クリニック, 2024/04/01-04/30 初期研修医1名に訪問診療指導, 千城台クリニック, 2024/05/01-05/31 初期研修医1名に訪問診療指導, 千城台クリニック, 2024/06/01-06/30
  • ■国家資格 2007年06月 第一種普通自動車免許（福井県公安委員会） 2013年03月29日 医師免許（厚生労働省） 2019年04月12日 ITパスポート（経済産業省） ■民間資格 2011年 簿記検定2級（日本商工会議所） 2014年03月 ICLSコース修了（日本救急医学会） 2015年01月10日 ICLSコース アシスタント（日本救急学会） 2016年08月27日 緩和ケア研修会（千葉大学医学部附属病院） 2016年09月09日 認定内科医（日本内科学会） 2018年10月01日 家庭医療専門医（日本プライマリ・ケア連合学会） 2018年10月01日 プライマリ・ケア認定医（日本プライマリ・ケア連合学会） 2019年01月08日 日本プライマリ・ケア連合学会認定 指導医（日本プライマリ・ケア連合学会） 2019年10月22日 向精神薬の適正使用に係る研修受講（学研メディカルサポート） 2020年01月11日 総合診療領域特任指導医（一般社団法人 日本専門医機構） 2020年09月21日 厚生労働省指定 オンライン診療研修受講（厚生労働省医政局医事課） 2020年09月21日 厚生労働省指定 緊急避妊薬の処方にかかるオンライン診療研修趣向（厚生労働省医政局医事課） 2022年9月19日 JMECC修了（日本内科学会認定）・ICLSコース修了（日本救急医学会認定） 2022年12月22日 総合内科専門医（日本内科学会） 2023年04月07日 内科指導医（日本内科学会）
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