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.

We describe a 38-year-old, severely emaciated female with slowly progressive type 1 diabetes mellitus (SPIDDM), who had hypoglycemia due to fasting and an extremely low energy intake. After being diagnosed with diabetes mellitus (DM), she took in only 300-500 kcal per day and her weight had decreased to 30 kg, with a body mass index (BMI) of 11.4 kg/m². She was admitted with hypoglycemia, and SPIDDM was confirmed by nearly-completely ceased insulin secretion and seropositivity towards anti-GAD antibody. After appropriate dietary therapy and insulin administration, she recovered from a state of emaciation and her glucose metabolism was restored. With this patient it proved very effective for the general physician to coordinate treatment for both diabetes and an eating disorder.

Patients seeking primary care often have upper respiratory symptoms caused by viral infection. Most patients are diagnosed based on medical interviews and physical examinations ; however, such diagnoses are often based on experience, and education for younger physicians regarding such patients is often insufficient. This review addresses evidence related to history and physical findings of cough, sore throat, and nasal discharge. We reviewed differential diagnosis of cough, as well as select diagnosis, including the common cold, acute bacterial sinusitis, Bordetella pertussis infection, and gastroesophageal reflux disease. Sore throat is similarly reviewed through differential diagnosis and select diagnosis, including Streptococcal (group A) infection, infectious mononucleosis, and Mycoplasma and Chlamydia. Nasal discharge is reviewed in terms of differential diagnosis and allergic rhinitis. Many histories or physical findings of upper respiratory symptoms are not supported by evidence, and further study is warranted.

OBJECTIVE : This study was conducted in a Japanese population to better understand the association between insomnia and sleeping prone.
METHODS : A cross sectional questionnaire study was conducted with outpatients of St. Luke's International Hospital in August, 2007. Information on sleep position habits, symptoms, quality of life, and sleep quality was collected. The Athens Insomnia Scale (AIS) was used to measure sleep quality. Participants with an AIS score of 4 or higher were categorized as sub-threshold insomnia and as the insomnia group.
RESULTS : Of the 784 subjects who returned completed questionnaires (response rate=65%) 30.4% were men. About 13% of the respondents slept in the prone position at least three times a week. Based on multivariate adjusted logistic regression analysis, there was a significant association between sleeping prone and having no problem with insomnia (odds ratio, 0.61 ; 95% CI, 0.38-0.99).
CONCLUSION : These data suggest that sleeping in the prone position is associated with good quality sleep.

BACKGROUND : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.
METHODS : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.
RESULTS : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.
CONCLUSIONS : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.

BACKGROUND : Norm-referenced equations to predict the 6-minute walk distance (6MWD) in healthy Japanese subjects have not been established. The current study aimed to determine the reference values for 6MWD in healthy Japanese adults.
METHODS : Ninety-seven healthy Japanese men and women aged 40-79 years were recruited from Kyoto city using posters and flyers. Measurements of 6MWD were performed twice on an indoor 30 m track with 20 minutes rest between the two tests. Before performing the tests, age, gender, height, body weight, waist circumference, a questionnaire for health status, spirometry, and a 12-lead electrocardiogram were recorded. The 6MWD was measured following guidelines published in 2002 by the American Thoracic Society.
RESULTS : The mean age of the study subjects was 57.0±9.4, and 63 of the 97 subjects were female. The mean 6MWD for all subjects was 672±83 m, with a range of 483-903 m. The 6MWD is significantly correlated with age, height, waist circumference, forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁). A multiple linear model showed age, waist circumference, and FVC were significantly associated with 6MWD and the model explained 35% of the variability in 6MWD. When FVC was replaced by height, the regression model also explained 32% of the variation. The measured 6MWD of Japanese subjects was similar to the predicted 6MWD using the equations derived from Caucasian subjects.
CONCLUSIONS : The 6MWD was affected to a substantial degree by age, waist circumference, height, and FVC in healthy Japanese adults.