Background: New onset fever is a common symptom among hospitalized patients and it may be a manifestation of fatal illnesses such as infection. However, its epidemiology and predictors for mortality have not been fully determined in a Japanese teaching hospital.
Methods: We investigated adult patients with new onset elevated temperature of 37.5 degrees Celsius or greater the 3^rd day after admission during a 4-month study period. Only the first, single episode per patient was analyzed. We determined the causes of fever among these patients with new onset fever. We also analyzed predictors for in-hospital mortality among these patients. These predictors were based on multivariable adjusted logistic regression using demographics, vital signs at the time of fever onset, baseline diseases, and basic laboratory data.
Results: From a total of 2,271 admitted patients, 126 patients (5.6%) developed fever. Among these febrile patients, 98 (78%) had infectious diseases with a prevalence of 4.3% in all admitted patients. The most common cause of infection among those patients was respiratory tract infection, followed by urinary tract infection. Causes for non-infectious fever included neoplastic diseases, inflammatory diseases, and drug fever. In-hospital mortality was associated with lower mean blood pressure <60 mmHg with odds ratio (OR) of 12.7 (95% CI, 1.3–121), tachycardia >90/min with OR 4.1 (95% CI, 1.2–13.5), tachypnea >20/min with OR 10.0 (95% CI, 2.8–35.2), and neoplastic disease with OR 4.1 (95% CI, 1.3–13.1). Infection as a cause of fever was not associated with mortality.
Conclusion: The majority of inpatients with new onset fever had infectious diseases, however fever was also caused by neoplastic diseases, inflammatory diseases and drug fever. Abnormality of vital signs and neoplastic disease were related to in-hospital mortality.

Objective: The purpose of this study is to clarify the characteristics of cases where decision-making is difficult and how the medical staff can deal with them in the medical field. Method: Seven oncology physicians were interviewed. The survey items include cases where decision-making is difficult, how to deal with them, and decision support. Category analysis was performed based on verbatim records. Results: First, the cases where decision-making is difficult were divided into two categories: patient factors and environmental factors. The former is further divided into two subcategories: “personal factors” include personality and, intellectual ability and “factors due to diseases and aging” that included flailing of body parts and dementia. Further, there were three categories of medical staff’s strategies: assessment, response skills, and environmental approach. Discussion: In providing information to patients, it is necessary to respond according to the patient’s intellectual state environmental factors to promote understanding. Specifically, it is effective to use patient-specific explanations, target planning, and nudges.

Purpose: In today’s medical field, it is an essential quality competency for staff to not only recognize the importance of patient decision-making and the skills to support it, but also implement it. This study aimed to establish a training program on decision support for healthcare professionals and examine its effectiveness. Method: We conducted the training at a medical institution and conducted a questionnaire survey at two points before and after the training. A total of 88 nurses and doctors participated in the survey. Result: We developed a two-hour training on the knowledge and skills needed for decision support. Questionnaire results showed improvements in literacy and efficacy before and after the training. Discussion: It was confirmed that the training led to an in-depth understanding of the participants’ decision support, and increased the sense of efficacy in their daily work, particularly through responding to patients according to patients’ cognitive and physical assessments, and in actively supporting those who have difficulty in making decisions. There were references to the significance of re-learning and the possibility of applying the training to difficult situations in participants comments. In the future, it is necessary to study decision support with reference toco-operation in the medical field where collaboration among multiple professions is indispensable.