Clinical factors associated with negative urinary antigen tests implemented for the diagnosis of community-acquired pneumococcal pneumonia in adult patients

This study investigated clinical factors associated with negative urinary antigen tests [UAT] implemented for the diagnosis of pneumococcal community-acquired pneumonia [CAP] in adult patients. We reviewed the medical records of 755 adult patients who completed the UAT in our hospital between 2009 and 2012. Of these, we evaluated 63 patients with bacteriologically confirmed definite pneumococcal CAP [33 were UAT-positive, and 30 were UAT-negative]. There was no significant difference between the UAT-positive and the UAT-negative patients regarding age, dehydration, respiratory failure, orientation, blood pressure [ADROP] score [the CAP severity score proposed by the Japanese Respiratory Society], gender, white blood cell counts, liver/kidney function tests, or urinalysis. However, serum C-reactive protein [CRP] concentrations were 31% lower in the UAT-negative patients than in the UAT-positive patients [p = 0.02]. Furthermore, the prothrombin time-international normalized ratio was 50% higher in the UAT-negative patients than in the UAT-positive patients, although the difference did not reach statistical significance [p = 0.06]. The prevalence of comorbidities was similar in both UAT-positive and UAT-negative patients. However, warfarin had been prescribed in 8 [27%] of the UAT-negative patients compared to only 1 [3%] of the UAT-positive patients [odds ratio = 11.6; p = 0.01]. These results suggested that low serum CRP concentrations and the use of warfarin increased the possibility with which false-negative UAT results occurred in these patients with pneumococcal CAP

Construction of Yanegawara-style skills training in our clinical skills laboratory for new residents / 医学教育

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.<br>2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.<br>3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.