[Clinical findings of chronic obstructive pulmonary disease].

Patients with chronic obstructive pulmonary disease(COPD) can show various unique clinical findings. Whenever we examine smokers or ex-smokers, especially for those with chronic productive cough or dyspnea on effort, we have to pay attention to whether they would have clinical manifestations associated with COPD. Making physical diagnosis is quick and requires few costs. Rapid physical diagnosis of COPD in primary care practice can also lead to earlier actions of preventive measures and counseling for patients regarding smoking cessation. Furthermore, rapid physical diagnosis of COPD in an emergency department could be crucial for timely implementation of potentially lifesaving management specific for COPD patients. In this review, we will present an extensive list of clinical findings of COPD patients.

Questionnaire survey for challenging cases of medical professionalism in Japan.

BACKGROUND: Little information is available on evaluation of medical professionalism among Japanese physicians and on its education in Japanese medical schools. AIMS: To assess professionalism and its education in Japan. METHOD: We analysed the responses to challenges to professionalism for Japanese residents and physicians, using the Barry Questionnaire, and to survey the extent of education related to professionalism during medical school curricula. The survey was conducted at 14 teaching hospitals in Kyushu and Okinawa, using existing hospital conferences. RESULTS: We collected data from 175 participants (60 residents and 115 faculty physicians). The most challenging was the sexual harassment scenario, in which 51.4% provided the best or 2nd best answers, followed by the honesty scenario with 69.7% and the confidentiality scenario with 76.0%. Participants were more likely to provide the best or 2nd best responses to the scenarios involving physician impairment (87.4%), conflict of interest (81.1%), and acceptance of gifts (78.3%). Five (3%) participants reported learning experiences about professionalism during the curricula and the median hours for its course work were two hours. Only one resident reported that she was satisfied with these educational sessions. CONCLUSIONS: Many Japanese physicians were unable to provide an acceptable response to challenges to professionalism in several issues and few had received education in professionalism during school curricula. Greater teaching of professionalism is needed in medical education in Japan.

Physical diagnosis of chronic obstructive pulmonary disease.

Among the various diagnostic strategies of chronic obstructive pulmonary disease (COPD), physical diagnosis is the quickest and requires no extra cost. Rapid physical diagnosis of COPD in primary care practice can lead to earlier actions of preventive measures and counseling for patients. Further, rapid physical diagnosis of COPD in an emergency department is also crucial for timely use of potentially lifesaving therapy specific for COPD patients. In this review, we will present a broad scope of physical findings for rapid physical diagnosis of COPD.

Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis.

BACKGROUND: Randomized controlled trials have shown conflicting findings about the role of intrapleural fibrinolytic therapy for the treatment of empyema and complicated parapneumonic effusions in adult patients. OBJECTIVES: To assess the clinical efficacy and summarize the current evidence of intrapleural fibrinolytic use in patients with empyema and complicated parapneumonic effusions in adult patients. METHODS: We performed a meta-analysis of all properly randomized trials comparing intrapleural fibrinolytic agents with placebo in adult patients with empyema and complicated parapneumonic effusions. Outcome of primary interest was the reduction of death and surgical intervention. RESULTS: We included five trials totaling 575 patients. The number of enrolled patients for each trial was small, except for the recent trial by Multicenter Intrapleural Sepsis Trial (MIST1) group. Compared with placebo, intrapleural fibrinolytic therapy was associated with a nonsignificant reduction in death and need for surgery (27.6% of the treatment group vs 32.8% of the control group; random-effects pooled risk ratio, 0.55; 95% confidence interval, 0.28 to 1.07; heterogeneity, p = 0.023). A separate analysis for outcomes on either death or need for surgery also showed nonsignificant results. CONCLUSION: Our meta-analysis does not support the routine use of fibrinolytic therapy for all patients who require chest tube drainage for empyema or complicated parapneumonic effusions. However, there was significant heterogeneity of the treatment effects among the trials. Selected patients might benefit from the treatment.