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.

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.

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.

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.

Abstract
 Medical doctors are subject to a range of emotions in their daily practices, but their emotional experiences have been neglected in medical literature in Japan. This article introduces the concept of “emotional labor” which has not been accorded proper recognition in the medical field. Then, the importance of focussing attention on “emotional labor” among medical doctors is discussed in relation to both their occupational stress and their patient-doctor relationships.

Abstract
Objective : The purpose of this study was to verify characteristics, including changes in emotional state and finger motor function, in elderly subjects over the course of piano lessons.
Methods : Fifty-five healthy elderly subjects took part in this study. Subjects were assigned to either a “piano group” (total no. 32) or a “control group” (total no. 22), respectively. Piano group subjects participated in piano lessons for 3 months (total of 6 sessions). Characteristics of the elderly piano-learning subjects were analysed by noting the frequency and length of practice, by a tapping speed test and an emotion scale (the Mood Check List-Short Form 1 : MCL-S1 and the Face Scale).
Results : A significant difference was found when comparing the pre-score and post-score results of the piano group with those of control group in both the MCL-S1 “anxiety” test (p=0.04) and the rapid finger tapping test (p<0.01), with the latter test results being significantly better in the piano group, with four kinds of assessment. Comparing the difference between the pre-score and post-score results for Face Scale in the piano group with that of the control group, revealed no statistically significant difference (p=0.16).
Conclusion : In elderly subjects, learning piano is effective for relieving anxiety and improving finger motor tapping speed.

Abstract
 The aim of this report is to understand the characteristics of medical care for Japanese people particularly following the recent earthquake disaster. In view of this, Japanese culture has now attached much greater importance on interpersonal relationships than ever before. Unfortunately, Japanese culture has not fully accepted the concept of professionalism from the Western cultures of Europe and the United States, but instead has put more stress on actions concerning law and humanity. Japan needs to create its own professionalism based on its unique culture.

Abstract
Introduction : There are few reports of long-term medical support activities in disaster areas. We analyzed drug-related data using medical records and prescriptions obtained during the long-term medical support of patients impacted by the Great East Japan Earthquake, which occurred on March 11, 2011.
Methods : Using medical records and prescriptions, the dispensing frequency of each drug was calculated and usage trends of the top three most frequently dispensed drugs are described here. All data was collected from March 26, 2011 onwards after the medical support activity commenced.
Results : In the first week of data acquisition, a total of 166 patients visited the medical support team (median 48.5, range 14-166). Following that, the number of patients decreased with a median of 24 people per day (range 0-47). The number of prescriptions for common cold medication was the highest, followed by antihypertensive and anti-allergic medications, respectively. The usage of antihypertensive drugs and common cold medications decreased over time, whereas anti-allergic medications were prescribed on a continuous basis.
Conclusion : Disaster medical support teams should not only be prepared to support the acute phase but also long-term phase, which depends heavily on the restoration of local medical services. The earlier the intervention to provide support, the greater the likelihood that the disaster medical support team will require to provide treatment for both acute and chronic illness.

Abstract
Objective : We investigated the usefulness of providing medical students with demonstrations and education for commonly used medical devices focusing on medical and nursing care for the elderly. Educational materials were also distributed, in addition to the input from the participation of paramedic assistants as various strategies for providing instruction, prior to formal on-site practical training at our clinic.
Methods : Forty-two 5th year medical students undertook a questionnaire survey regarding the education provided prior to on-site practical training, and which was performed after training was completed at our clinic.
Results : All students responded that demonstrations of medical devices were “easy to understand”, while 81% responded that the distribution of materials was “necessary” and 97.6% responded that explanations from paramedics were either “important” or “necessary”. In addition, 95.2% reported that the explanations given prior to training “enhanced” their understanding of nursing care insurance facilities. In respect of medical procedures such as percutaneous endoscopic gastrostomy (PEG) tube management, while 97.6% of students reported that “the explanations given prior to practical training were adequate”, nevertheless 50% reported that “they still did not feel comfortable in actual practice even though the explanations given prior to training were adequate” .
Conclusion : The approaches used at our clinic for education given prior to on-site practical training, were considered beneficial for medical students. However, some of them did not feel comfortable performing medical procedures even though adequate explanations had been provided, indicating the need to create a program that promotes greater confidence in performing practical procedures among medical students in the future.