1) During clinical clerkships at an outpatient clinic, medical students recognized the importance of medical interviews for problem-solving and for the physician-patient relationship.
2) The clinical clerkships were well accepted by patients.
3) Students worked harmoniously as members of medical teams.

BACKGROUND : Because of its high incidence, sensitivity to specific antibiotics, and rare but severe complications, campylobacter enteritis needs to be confirmed or excluded accurately and rapidly. We investigated the validity of Gram staining of a stool sample as a quick and useful method of diagnosing campylobacter enteritis in patients with acute diarrhea presenting at primary healthcare centers.
MATERIALS AND METHODS : Stool samples obtained from 64 patients with acute diarrhea were sent to a laboratory for Gram staining and culture. To estimate the usefulness of Gram staining, we calculated the sensitivity, specificity and likelihood ratio (LR) of Gram staining. Subject profiles, symptoms and peripheral white cell counts were also examined to see if they could raise the pre-test probability prior to the Gram staining test.
RESULTS : Of 64 subjects with acute diarrhea, 38 had C. jejuni (n=37) or C. coli (n=1) (campylobacter group), and 26 had other causes (control group). Gram staining revealed campylobacter-like bacteria (Cb-like bacteria) in 22 samples from the campylobacter group and 3 from the control group, yielding a sensitivity and specificity of 0.58 and 0.88, respectively. The positive LR was 5.02 (95%CI : 1.67-15.05), and the negative LR was 0.48 (0.32-0.71). Other factors such as patient age, disease duration, fever, abdominal pain and leucocytosis failed to raise the pre-test probability prior to Gram staining test. Taking a thorough history of food intake can raise the pre-test probability, although this may be difficult and was not evaluated in this study.
CONCLUSION : Gram staining can assist in making the diagnosis of campylobacter enteritis in patients with acute diarrhea, but it cannot be used alone to make or exclude the diagnosis.

　　Many patients carried into the emergency room or intensive care unit are suspected to have risk factors for deep-seated mycosis. Using the Actions Bundle, which itemizes diagnosis and treatment of invasive candidiasis, we carried out investigations into facts about the use of antifungal drugs in the intensive care unit of our hospital. The subjects of this retrospective study were 11 ICU patients who were given antifungal drugs intravenously between April 2013 and March 2014. Their medication records revealed that micafungin was administered to five patients, fosfluconazole to another five patients and fulconazole to the remaining one patient. The ratio of the cases where the dugs were used in compliance with what the Actions Bundle suggested worked out at 71.4±15.9%. When it came to the collection rate of two sets of blood culture and the proper dosage, the compliance rates were the lowest with 36% each. As regards dosage, 18% was excessive, 36% proper and 45% insufficient. As pharmacists in charge of the ICU, we have to use the checklist more effectively and intervene in the care of patients with invasive candidiasis at an early stage.

Rectal irritative symptoms in cancer patients are often refractory to treat and exacerbate their quality of life. We experienced a peadiatric case of rectal irritative symptoms treated by Yokukansan. A 9 year-old boy developed rectal irritative symptoms as itching sensation in rectum caused by relapsed rhabdomyosarcoma in pelvis. Oral Yokukansan, which is common Japanese Kampo medicine for temper tantrum of children, was administered and relieved his symptoms. Yokukansan is known as adjuvant drug for neuropathic pain. It could be one of the adjuvant drugs for refractory symptoms in palliative care setting.