Purpose: To assess problems of a system for evaluating educational methods which cause interevaluator variability at the pulse and blood pressure measurement station of the objective structured clinical examination. Subjects: 186 evaluations for 93 fourth-year medical students. Method: The vital-sign station consists of pulse examination, blood pressure measurement, and a 1-minute oral examination. To assess interevaluator reliability, the differences between two evaluations of each of 15 evaluation steps were calculated and divided into three categories: “greater than 95% agreement, ” “unidirectional disagreement, ” and “bidirectional disagreement.” Results: The steps of “consent to examination, ” “proper verbal instructions, ” “valve release, ” “estimation by palpation”, a question about “normal systolic blood pressure, ” and a question about “the interval and the number of repetitions” showed greater than 95% agreement. The steps of “manner of speaking, ” “palpation of peripheral pulse, ” “stethoscope placement, ” “cuff deflation, ” “presentation of blood pressure, ” and a question about “absolute arrhythmia” showed unidirectional disagreement. The steps of “presentation of pulse measurement, ” “cuff wrapping, ” and “cuff inflation” showed bidirectional disagreement. Discussion: Suggestions to improve intervaluator reliability include:(1) decreasing the evaluation steps to two with a single checkpoint, (2) presenting blood pressure with the palpation method, (3) deleting the oral examination, (4) providing adequate instruction about the differences in the types of cuffs and bladders, and (5) clarifying evaluation criteria and the training of evaluators.

We reported four cases of agricultural chemicals poisoning treated in our hospital during the past two years. These comprised two Paraquat poisoning and two Sumition poisoning cases. One Paraquat poisoned patient and one Sumition poisoned patient died of respiratory failure. The survivor of Paraquat poisoning had drank more Paraquat solutions than the dead case. However, the patient vomitted many times, and received medical treatment promptly, including gastric lavage, hemodialysis, and hemoperfusion.
While on the other hand, it took a long time before starting of hemodialysis and hemoper-fusion on the dead case of Sumition poisoning. Because the poison was unknown when the patient was sent to our hospital. Our experience suggesuted that every time we examine a case of agricultural chemical poisoning, we have to treat a patient intensively from the beginning.

BACKGROUND/AIMS: Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects. METHODS: Forty-two healthy volunteers (25 men and 17 women) with a mean ± standard deviation age of 33.3 ± 12.4 years (range: 22–72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized. RESULTS: Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus. CONCLUSIONS: Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24-hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.
Asian Continental Ancestry Group* ; Electric Impedance* ; Esophagus ; Gastroesophageal Reflux ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration* ; Male ; Reference Values*