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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

 68
  • Yasutaka Yanagita, Daiki Yokokawa, Kosuke Ishizuka, Rurika Sato, Jumpei Kojima, Yu Li, Shiho Yamashita, Kiyoshi Shikino, Tomoko Tsukamoto, Takanori Uehara, Masatomi Ikusaka
    Diagnosis (Berlin, Germany) 2025年4月4日  
  • Jumpei Kojima, Takanori Uehara, Yoshiyuki Ohira, Tomoko Tsukamoto, Kiyoshi Shikino, Daiki Yokokawa, Yu Li, Yasutaka Yanagita, Rurika Sato, Masatomi Ikusaka
    BMC medical education 25(1) 310-310 2025年2月26日  
    OBJECTIVES: The "5-microskills" instructional method for clinical reasoning does not incorporate a step for learners' critical reflection on their predicted hypotheses. This study aimed to correct this shortcoming by inserting a third step in which learners conduct critical self-examinations and furnish evidence that contradicts their predicted hypotheses, resulting in the "6-microskills" method. METHODS: In this cross-sectional study, changes in learners' confidence in their predicted hypotheses were measured and examined to modify confirmation bias and diagnoses. A total of 108 medical students were presented with one randomly assigned clinical vignette from a set of eight, having to: (1) describe their first impression; (2) provide evidence for it; and (3) finally identify inconsistencies/state evidence against it. Participants rated their confidence in their diagnosis at each of the three steps on a 10 point scale, and results were analyzed using a two-way ANOVA with repeated measures for two between-participant levels (correct or incorrect diagnosis) and three within-participant factors (diagnostic steps). The Bonferroni method was used for multiple comparison tests. RESULTS: Mean confidence scores were 5.01 (Step 1), 5.20 (Step 2), and 4.98 (Step 3); multiple comparisons showed a significant difference between Steps 1-2 (P =.04) and 2-3 (P =.01). Verbalization of evidence in favor of the predicted hypothesis (Step 2) and against it (Step 3) prompted changes in diagnosis in four cases of misdiagnosis (three at Step 2, one at Step 3). CONCLUSIONS: The 6-microskills method, which added a part encouraging learners to verbalize why something "does not fit" with a predicted diagnosis, may effectively correct the confirmation bias associated with diagnostic predictions.
  • Daiki Yokokawa, Takanori Uehara, Rurika Sato, Kosuke Ishizuka, Yu Li, Kiyoshi Shikino, Tomoko Tsukamoto, Hiroki Tamura, Yasutaka Yanagita, Jumpei Kojima, Shiho Yamashita, Masatomi Ikusaka
    Cureus 17(1) e77208 2025年1月  
    Background In the United States (US), most physicians who commit sexual misconduct are male, and such misconduct is associated with the absence of chaperones. Several organizations recommend a chaperone during all intimate examinations (breast, genital, and rectal exams). However, in Japan, guidelines are not clearly defined, and hospitals and medical societies have not established standardized protocols. At Chiba University Hospital's Department of General Medicine, female nurses are requested to act as chaperones during female patients' physical examinations. However, limited medical resources make this challenging. Thus, it is necessary to investigate the necessity of female chaperones for the examination area to prioritize their presence. This study surveyed physicians to determine which examination areas require the presence of female chaperones during the examination of female patients by male physicians. The necessity was stratified and compared by the physician's sex and age. Methods This pilot cross-sectional study surveyed physicians in the Department of General Medicine at Chiba University Hospital. The study content was explained via email, and only those who consented to participate were asked to complete the questionnaire. Only physicians who had passed the Japanese medical licensing examination and had completed two years of residency were included. The primary factors were the physician's sex and age. The necessity for female chaperones was measured using a five-point Likert scale for different examination areas and patient age groups. The Mann-Whitney U and Kruskal-Wallis tests were also employed. Results Responses were obtained from 17 of the 19 physicians (89%; 10 male and seven female). Regardless of sex, there was consensus on the necessity of female chaperones when examining intimate parts (chest, thighs (disrobed), breasts, inguinal region, perineum, and buttocks). Female physicians were more likely to consider chaperones necessary for additional areas, including the head/face (p=0.014), chest (clothed) (p=0.019), abdomen (clothed/disrobed) (p=0.003, 0.033), back (clothed) (p=0.001), buttocks (clothed) (p=0.023), shoulder-upper arm (clothed) (p=0.005), and thighs (clothed) (p=0.033). The necessity for chaperones decreased as the patient's age increased. Conclusion Female physicians presented more cautious opinions, considering chaperones necessary for a broader range of examination areas beyond the traditionally defined intimate parts.
  • Daiki Yokokawa, Kiyoshi Shikino, Yuji Nishizaki, Sho Fukui, Yasuharu Tokuda
    JMIR medical education 10 e52068 2024年12月5日  
    BACKGROUND: The General Medicine In-Training Examination (GM-ITE) tests clinical knowledge in a 2-year postgraduate residency program in Japan. In the academic year 2021, as a domain of medical safety, the GM-ITE included questions regarding the diagnosis from medical history and physical findings through video viewing and the skills in presenting a case. Examinees watched a video or audio recording of a patient examination and provided free-text responses. However, the human cost of scoring free-text answers may limit the implementation of GM-ITE. A simple morphological analysis and word-matching model, thus, can be used to score free-text responses. OBJECTIVE: This study aimed to compare human versus computer scoring of free-text responses and qualitatively evaluate the discrepancies between human- and machine-generated scores to assess the efficacy of machine scoring. METHODS: After obtaining consent for participation in the study, the authors used text data from residents who voluntarily answered the GM-ITE patient reproduction video-based questions involving simulated patients. The GM-ITE used video-based questions to simulate a patient's consultation in the emergency room with a diagnosis of pulmonary embolism following a fracture. Residents provided statements for the case presentation. We obtained human-generated scores by collating the results of 2 independent scorers and machine-generated scores by converting the free-text responses into a word sequence through segmentation and morphological analysis and matching them with a prepared list of correct answers in 2022. RESULTS: Of the 104 responses collected-63 for postgraduate year 1 and 41 for postgraduate year 2-39 cases remained for final analysis after excluding invalid responses. The authors found discrepancies between human and machine scoring in 14 questions (7.2%); some were due to shortcomings in machine scoring that could be resolved by maintaining a list of correct words and dictionaries, whereas others were due to human error. CONCLUSIONS: Machine scoring is comparable to human scoring. It requires a simple program and calibration but can potentially reduce the cost of scoring free-text responses.
  • Kiyoshi Shikino, Yuji Nishizaki, Koshi Kataoka, Sho Fukui, Daiki Yokokawa, Taro Shimizu, Yu Yamamoto, Kazuya Nagasaki, Hiroyuki Kobayashi, Yasuharu Tokuda
    BMC medical education 24(1) 1402-1402 2024年11月30日  
    BACKGROUND: The general medicine in-training examination (GM-ITE) assesses physicians' clinical knowledge. This study expanded on findings from a previous pilot study to assess the relationship between general medicine in-training examination (GM-ITE) scores and the diagnostic skills of resident physicians in Japan by employing an innovative clinical simulation video (CSV-IE). METHODS: This multicenter cross-sectional study included 4,677 resident physicians who took the GMITE between January 17 and 30, 2023. Participants watched the CSV-IE, depicting an emergency room scenario, and provided a diagnosis. The CSV-IE depicts an emergency case and provides a diagnosis. Discrimination indices were used to assess the CSV-IE's effectiveness across clinical competence domains, and multilevel logistic regression was used to analyze physician- and hospital-level factors associated with correct diagnoses. RESULTS: Correct diagnoses were provided by 470 participants (10.0%). The CSV-IE demonstrated high discriminatory power across all assessed domains, including basic clinical knowledge (DI = 0.44), symptomatology and clinical reasoning (DI = 0.31), physical examination and clinical procedure (DI = 0.35), and knowledge about the disease (DI = 0.25), supporting its utility as an effective assessment tool. In the multivariable analysis, factors associated with a higher likelihood of providing a correct CSV-IE diagnosis included a higher annual number of emergency outpatients (adjusted odds ratio: 1.025; 95% confidence interval [CI]: 1.003-1.047; P = .0230) and being in a higher postgraduate year (adjusted odds ratio: 1.387; 95% CI: 1.104-1.742; P = .005). Conversely, resident physicians at university hospitals were less likely to provide a correct CSV-IE response (adjusted odds ratio: 0.624; 95% CI: 0.435-0.896; P = .0107). CONCLUSIONS: CSV-IE modules may provide an integrative and realistic evaluation of clinical competence, addressing limitations of traditional MCQ-based assessments by offering contextualized, real-world scenarios that require dynamic decision-making and diagnostic reasoning.
  • 田村 弘樹, 上原 孝紀, 柳田 育孝, 横川 大樹, 生坂 政臣
    日本医事新報 (5245) 1-2 2024年11月  
  • Yasutaka Yanagita, Mutsuka Kurihara, Daiki Yokokawa, Takanori Uehara, Masatomi Ikusaka
    Annals of Internal Medicine: Clinical Cases 3(11) 2024年11月1日  
  • Kiyoshi Shikino, Yuji Nishizaki, Koshi Kataoka, Masanori Nojima, Taro Shimizu, Yu Yamamoto, Sho Fukui, Kazuya Nagasaki, Daiki Yokokawa, Hiroyuki Kobayashi, Yasuharu Tokuda
    BMJ Open 14 e083184 2024年10月18日  査読有り
  • 上原 孝紀, 横川 大樹, 李 宇, 柳田 育孝, 小島 淳平, 佐藤 瑠璃香, 鋪野 紀好, 塚本 知子, 大平 善之, 太田 光泰
    医学教育 55(Suppl.) 133-133 2024年7月  
  • Daiki Yokokawa, Takanori Uehara, Yoshiyuki Ohira, Kazutaka Noda, Naofumi Higuchi, Eigo Kikuchi, Kazuaki Enatsu, Masatomi Ikusaka
    Cureus 16(6) e61641 2024年6月  
    This study tests whether comprehensively gathering information from medical records is useful for developing clinical decision support systems using Bayes' theorem. Using a single-center cross-sectional study, we retrospectively extracted medical records of 270 patients aged ≥16 years who visited the emergency room at the Tokyo Metropolitan Tama Medical Center with a chief complaint of experiencing headaches. The medical records of cases were analyzed in this study. We manually extracted diagnoses, unique keywords, and annotated keywords, classifying them as either positive or negative. Cross tables were created, and the proportion of combinations for which the likelihood ratios could be calculated was evaluated. Probability functions for the appearance of new unique keywords were modeled, and theoretical values were calculated. We extracted 623 unique keywords, 26 diagnoses, and 6,904 annotated keywords. Likelihood ratios could be calculated only for 276 combinations (1.70%), of which 24 (0.15%) exhibited significant differences. The power function+constant was the best fit for new unique keywords. The increase in the number of combinations after increasing the number of cases indicated that while it is theoretically possible to comprehensively gather information from medical records in this way, doing so presents difficulties related to human costs. It also does not necessarily solve the fundamental issues with medical informatics or with developing clinical decision support systems. Therefore, we recommend using methods other than comprehensive information gathering with Bayes' theorem as the classifier to develop such systems.
  • 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  
  • 坂本 悠加, 横川 大樹, 小林 浩, 上原 孝紀, 塚本 知子, 鋪野 紀好, 李 宇, 柳田 育孝, 小島 淳平, 生坂 政臣
    日本内科学会関東地方会 694回 np104-np104 2024年3月  
  • 坂本 悠加, 横川 大樹, 小林 浩, 上原 孝紀, 塚本 知子, 鋪野 紀好, 李 宇, 柳田 育孝, 小島 淳平, 生坂 政臣
    日本内科学会関東地方会 694回 np104-np104 2024年3月  
  • 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  
  • Mutsuka Kurihara, Yasutaka Yanagita, Daiki Yokokawa, Yu Li, Masatomi Ikusaka
    European journal of case reports in internal medicine 11(2) 004258-004258 2024年  
    UNLABELLED: Kikuchi-Fujimoto disease (KFD), also called histiocytic necrotizing lymphadenitis, is more common in young women and typically presents with small, painful, localized cervical lymphadenopathy that resolves spontaneously within a few weeks. Laboratory findings are variable. As many as 40% of KFD cases are reported to be painless, and up to 22% to be generalized lymphadenopathy. Therefore, malignant lymphoma could be a differential diagnosis of KFD. A histopathologic diagnosis is needed when it is difficult to distinguish KFD from lymphoma. KFD typically shows small, highly accumulated cervical lymph nodes on fluorodeoxyglucose positron emission tomography (FDG-PET). This contrasts with malignant lymphoma, which tends to be associated with massive lymphadenopathy. In our case, a 40-year-old Japanese male presented with painless lumps in the right neck, accompanied by fever, night sweats, and loss of appetite. His symptoms and laboratory results worsened over a month. FDG-PET revealed highly accumulated uptake in cervical, mediastinal, and axillary lymph nodes. The PET imaging showed a small, high FDG uptake and contributed to the correct diagnosis of KFD. This case report highlights the importance of FDG-PET, which is a valuable diagnostic tool for KFD as it typically differentiates large clusters of small lymph nodes typical of KFD from normal lymph nodes. LEARNING POINTS: Kikuchi-Fujimoto disease (KFD) typically presents with small, painful, localised cervical lymphadenopathy.KFD has atypical patterns showing painless and generalised lymphadenopathy.Fluorodeoxyglucose positron emission tomography (FDG-PET) could be useful for diagnosing not only malignant lymphoma but also KFD.
  • 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.
  • 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, 塚本 知子, 久富 隆之介, 小林 浩, 山内 陽介, 生坂 政臣
    日本病院総合診療医学会雑誌 19(臨増1) 127-127 2023年2月  
  • 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

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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） 2024年04月01日 総合診療専門医（一般社団法人 日本専門医機構）
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