田口 智博

Neonicotinoid is a new class of systemic insecticides that are selectively toxic to insects. However, cases of human toxicity have been reported. A man in his 60s, who worked as a pest control operator (which required the use of thiamethoxam), presented with fever and headache. We investigated the levels of thiamethoxam and clothianidin in the blood and urine. Our results suggested that chronic thiamethoxam intoxication was caused by occupational inhalation exposure and environmental pollution. After cessation of insecticide use, the patient remained asymptomatic but had persistent oral dysesthesia and postural finger tremor, even at undetectable levels of thiamethoxam and clothianidin. This case report is the first to describe human thiamethoxam intoxication after occupational inhalation exposure. When similar symptoms are encountered and a history of insecticide use is confirmed, clinicians should consider the diagnosis of neonicotinoid intoxication.

PURPOSE: Research suggests that daily previsit team huddling leads to improved teamwork, however there are no reports on the effect and mechanism of daily team reflection in primary care practice. To help healthcare professionals to integrate fragmented information and to enhance continuity, we previously developed and implemented a daily multidisciplinary team reflection (DMDTR) approach. The present study aimed to construct a conceptual diagram illustrating how participation in DMDTR influence medical care in an ambulatory clinic. PARTICIPANTS AND METHODS: In this qualitative study, we analyzed data from semi-structured interviews (n = 12) conducted with physicians, nurses, and medical assistants who regularly participated in DMDTR. Modified grounded theory approach (M-GTA) was adopted as the analysis method, and structure-construction qualitative research method (SCQRM) was used as a meta-theory to determine the number of cases correlatively with the research objectives. RESULTS: Our conceptual diagram demonstrated that, through DMDTR, team members shared fragmented information to gain a more holistic view of the patient and discuss diverse points of view, a process that resulted in real-time problem solving through collaboration. This team approach showed benefit to each discipline and improves the care attributes of contextuality, coordination, accessibility, accountability, continuity, and comprehensiveness of care. CONCLUSION: We generated a conceptual diagram showing that DMDTR embodies a team approach that leads to improved care attributes, which results in enhanced quality of primary care.

This manuscript presents a case report of transient global amnesia with bilateral hippocampal lesions which might be triggered by the fear of getting infected by coronavirus disease 2019 (COVID-19). The purpose of this article is to facilitate the clinicians in understanding that an increasing number of patients with transient global amnesia have been reported during the COVID-19 global outbreak.