An Official Journal of the Japan Primary Care Association

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Abstract
Objective : To investigate the causes of fever of inpatients hospitalized in the Department of General Practice at Jichi Medical University Hospital.
Methods : We reviewed all medical records of the patients hospitalized in the Department of General Practice at this hospital between April 2003 and March 2004. Patients were selected as the “febrile group” by following criteria, 1) body temperature exceeded 37.5°C on admission, 2) fever and fever of unknown origin (FUO) were included in the clinical problems, and the causes of fever were described.
Results : A total of 464 patients were hospitalized and 221 patients (47.6%) were categorized as the “febrile group”. The most common cause of fever was infection (67.4%), followed by malignant disease (4.1%), collagen disease (3.2%), miscellaneous diseases (10.4%). 26 patients were classified as fever of unknown origin (FUO). Among FUO patients, collagen disease was the most common cause (34.6%), and undiagnosed cases was 26.9% that was similar to past reports. Although the rates of malignant disease and collagen disease were about sixteen percent in each generation from thirties to fifties as the cause of fever, only one patient met the criteria of classical FUO.
Conclusions : The most common cause of fever was infection. Systematic survey including hospitalization is needed early in case an outpatient doesn't cure fever unexpectedly. Noninfectious inflammatory diseases emerge as an important category of the causative disease of FUO.

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Abstract
Introduction : It is recommended that all negative rapid antigen tests for Group A streptococcus infection be conducted as back-up cultures.
Purpose : This study is intended to make a comparison of clinical manifestations and physical findings between patient and non-patient groups ; and to determine the effects on rapid strep test results if the same swab is used for both the culture and the rapid strep test.
Methods : We retrospectively studied the medical records of 480 cases where the rapid strep test was conducted in the outpatient pediatric department. The patient group consisted of those with positive laboratory cultures.
Results : The patient group was 124 cases. The patient group showed significantly high incidences of sore, or reddened throats, with a significantly small amount of tonsillar exudate.
The sensitivity of the strep tests was 87.9% and their specificity was 100% on a culture test.
Conclusion : It is difficult to rule in or rule out the Group A streptococcus infection on the basis of the clinical manifestations and physical findings. By using the same swab for both culture and rapid strep test, the results of the latter were less affected, and so this was considered as a simple and effective diagnostic method.

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Abstract
Introduction : For stable patients, we actively performed a reverse introduction into peripheral medical institutions, but “the interinstitutional relations in medical treatment which a hospital doctor hopes for” were not promoted or established.
Aim : Our primary aims were to understand “the interinstitutional relations in the field of medical treatment that outpatients demand” and to obtain materials to promote and establish such relations. Another major aim was to substantially investigate the backgrounds of the patients, the coordinated medical institutions, and general hospitals by using structural equation modeling, and to identify latent factors promoting interinstitutional relations in medical treatment.
Method : We enrolled 471 outpatients as subjects and conducted a questionnaire survey.
Results : Both the hopes and expectations of patients for coordinated medical institutions were related to a “strong connection with the general hospital and with the specialists”. On the other hand, the issuing of a “long-term prescription” with the purpose of reducing the burden on the outpatient department was a strong factor that disturbed such relations.
Conclusions : Our study suggested that the strong relationships that exist among these three elements--patients, peripheral medical institutions, and general hospitals--are latent factors that satisfy the medical demands of the patients and are promoted by smooth interinstitutional medical cooperation.

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Abstract
Sometimes experienced doctors and nurses have an intuitive sense of alarm about an apparently stable patient, a sense which may be expressed as, for instance, ‘He/she seems seriously ill.’ However, this intuitive sense of alarm remains a rule of thumb, even though it is recognized as an important “diagnostic” indicator in clinical decision-making. In this review, we have attempted to clarify the meaning of the phrase by proposing a pathophysiologic/symptomatologic model that suggests that the sense of alarm is a premonitory sign of a homeostatic crisis characterized by acute systemic autonomic symptoms and acute sickness behavior. The model proposed here may help novices to avoid missing potentially critical diseases.

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