IntroductionPhysicians' scope of practice (SoP) depends on clinical settings and is related to how motivated they feel. The clarification and differences in the SoP in each clinical setting are necessary for physicians' careers. This study aimed to investigate how coronavirus disease 2019 (COVID-19) affected physicians' SoP. MethodsThis serial cross-sectional study compares the differences in physicians' SoP among Japanese rural community hospitals between 2018 and 2020. The participants were admitted patients in the internal medicine wards of the two community hospitals in urban and rural districts in the rural prefecture (Shimane) of Japan from January 1, 2018, to December 31, 2020. We calculated the number of health problems among the highest 50% of all health problems for each physician (SoP-50%) and used it as an indicator of the comprehensiveness of clinical practice. ResultsThe study found that SoP-50% was significantly higher in rural districts in 2018 (p = 0.0209). This trend remained unchanged even during the COVID-19 in 2020 (p = 0.0441). While there was a significant regional difference in the SoP, pre and post-COVID-19 analysis of the SoP in each region did not show any significant change. ConclusionThis is the first study to indicate that greater comprehensiveness of clinical practice is required in the districts of rural Japan. The findings can be helpful for physicians' medical education and career choices.

The incidence of anaerobic bacteremia has been increasing over the past several decades. Further, antibiotic resistance in Bacteroides is a pertinent issue. A 76-year-old man was brought to our hospital with complaints of fever, chills, and abdominal pain. Empiric antibiotics induced minimal relief. The blood culture was positive for multi-drug resistant Bacteroides ovatus. Our patient developed a periaortic abscess in the abdominal aorta and a thoracic aortic aneurysm with ulcer-like projection (ULP), which rapidly increased in size. He was transferred to the tertiary medical institution for surgical drainage. This case suggests that bacteremia can exacerbate aneurysms with ulcerative lesions. Anaerobic bacteremia is a possible differential diagnosis when periaortic abscess formation is present. Early surgical consultation and appropriate antibiotic selection are crucial in anaerobic bacteremia treatment.

Yersinia pseudotuberculosis is a rare pathogen that causes yersiniosis, a foodborne disease that has become more prevalent in recent years. Yersiniosis commonly causes gastrointestinal symptoms; however, bacteremia can be the primary clinical finding. Here, we report the case of an 83-year-old man who presented with fever and fatigue and was diagnosed with Y. pseudotuberculosis bacteremia. Gastrointestinal findings were absent at the time of admission. His condition was complicated by rhabdomyolysis, which was self-limiting and resolved spontaneously. This case reveals that fever may be the only clinical sign of invasive yersiniosis and that it can be complicated by rhabdomyolysis. Clinicians should consider Y. pseudotuberculosis as a potential causative pathogen in patients with a fever of unknown origin and rhabdomyolysis.