Supplementary Contribution of Eastern Cooperative Oncology Group-Performance Status to Quick Sequential Organ Failure Assessment in the Detection of Bacteremia Among Older Patients With Suspected Infections.

Background The Quick Sequential Organ Failure Assessment (qSOFA) is a simple method for identifying patients with bacteremia; however, it is not accurate for predicting it. Performance status assessment involves the evaluation of daily activities and could be beneficial in predicting bacteremia. We aimed to evaluate whether adding Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) to qSOFA could improve the prediction of bacteremia diagnosis in older patients admitted with suspected infections.

The epidemiology of minor surgical problems during specialists' absence: Single center, descriptive study.

Background: In Japan, even if physicians have not experienced surgical training, they face many instances in which they must provide initial surgical treatment, especially during off-hours. This study aimed to identify the frequency and fields of commonly encountered problems in a Japanese emergency department.

Methods: A retrospective review was performed to identify walk-in outpatients with exogenous problems visiting during off-hours in the Japanese educational hospital providing primary to tertiary emergency care between January 1 and December 31, 2014.

Molecular analysis of virulence factors of hypermucoviscous Klebsiella pneumoniae in a diabetes patient with multifocal intramuscular and musculoskeletal abscesses.

Unusual community-acquired invasive Klebsiella pneumoniae infection has been reported worldwide, particularly in Asia. Recently, several virulence-associated genes of the isolates have been investigated. We report a case of multifocal intramuscular and musculoskeletal abscesses caused by K.

Disseminated nocardiosis with Nocardia brasiliensis bacteremia in a patient with rheumatoid arthritis using tocilizumab.

Here, we present a case of disseminated nocardiosis, involving pneumonia, percutaneous abscess, and bacteremia, in a 67-year-old Japanese woman. She had also been treated for rheumatoid arthritis with prednisolone, methotrexate, and tocilizumab (interleukin-6 receptor inhibitor). Based on the 16S rRNA sequence analysis and a blast search, we identified the isolate as Nocardia brasiliensis.

Postherpetic abdominal pseudohernia: A diagnostic pitfall.

The accurate diagnosis of postherpetic abdominal pseudohernia, the rare complication of herpes zoster, is essential to avoid unnecessary imaging studies or surgery. Close observation and waiting for complete recovery are warranted considering the disease's self-resolving nature and favorable prognosis.

Cost of physician-led home visit care (Zaitaku care) compared with hospital care at the end of life in Japan.

Background: Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied.

[Collaboration with specialists and regional primary care physicians in emergency care at acute hospitals provided by generalists].

A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals.

A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.

Background: Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests.

Objective: To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students.

Participants And Methods: Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities.

Acute pancreatitis occurring in the early postpartum period: a case report.

We report a case of acute pancreatitis, which occurred after delivery in a woman who had an uneventful course of pregnancy and parturition. A 17-year-old Japanese woman was referred to our department because of nausea and vomiting two hours after delivery, followed by severe abdominal and back pain. On admission, in addition to elevated serum and urine amylase, plain computed tomography demonstrated a swollen pancreas and high density in the peripancreatic lesion with a large amount of ascites, suggesting the presence of an inflammation of the pancreas as well as peripancreatic lesion.

Quantitative evaluation of the diagnostic thinking process in medical students.

Objective: To explore the diagnostic thinking process of medical students.

Subjects And Methods: Two hundred twenty-four medical students were presented with 3 clinical scenarios corresponding to high, low, and intermediate pre-test probability of coronary artery disease. Estimates of test characteristics of the exercise stress test, and pre-test and post-test probability for each scenario were elicited from the students (intuitive estimates) and from the literature (reference estimates).

Interpretation of and preference for probability expressions among Japanese patients and physicians.

Background: Patients and physicians often communicate using qualitative probability expressions that describe expected outcomes or risks of a medical intervention without knowing whether or not they share the same understanding.

Objective: The aim of the present study was to determine interpretations of qualitative probability expressions in clinical settings by Japanese patients and physicians as well as their assessments and preferences about physicians' use of such expressions.

Methods: One hundred and sixty-eight consecutive patients aged 16 years or older, who attended a university hospital during a 2-week period in 1999, and 156 physicians recruited through the Japanese General Medicine Research Network participated in this cross-sectional survey, using a self-administered questionnaire.