ObjectivesThis study was designed to assess the accuracy of gastrointestinal symptoms, including abdominal pain, nausea, and vomiting, in the diagnosis of Group A streptococcal (GAS) pharyngitis in children and to determine differences in diagnostic accuracy in boys versus girls.MethodsThis retrospective cross-sectional study included 5,755 consecutive patients aged <15 years with fever in the electronic database at a primary care practice. Gastrointestinal symptoms were recorded in the database according to the International Classification of Primary Care codes, and the data were extracted electronically. The reference standard was GAS pharyngitis diagnosed with a rapid test. Patients with a clinical diagnosis of probable GAS pharyngitis were excluded from the primary analysis.ResultsAmong the 5,755 children with fever, 331 (5.8%) were coded as having GAS pharyngitis, including 218 (65.9%) diagnosed with rapid tests and 113 (34.1%) clinically diagnosed with probable GAS pharyngitis. Among patients with fever and abdominal pain, rapid-test-confirmed GAS pharyngitis was significantly more common in boys (11/120, 9.2%) than in girls (3/128, 2.3%; p=0.026). The positive likelihood ratio of abdominal pain was 1.49 (95% CI =0.88–2.51): 2.41 (95% CI =1.33–4.36) in boys and 0.63 (95% CI =0.20–1.94) in girls. The positive likelihood ratio of nausea was 2.05 (95% CI =1.06–4.00): 2.74 (95% CI =1.28–5.86) in boys and 1.09 (95% CI =0.27–4.42) in girls. The association between abdominal pain and GAS pharyngitis was stronger in boys aged <6 years than in boys aged 6–15 years.ConclusionAbdominal pain and nausea were associated with GAS pharyngitis in boys, but not in girls. Abdominal pain and nausea may help determine the suitability of rapid tests in younger boys with fever and other clinical findings consistent with GAS pharyngitis, even in the absence of sore throat.

BackgroundThe Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients’ reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients’ RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system.MethodsWe conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015.We employed population density as index of accessibility. We calculated Spearman’s rank correlation coefficient to examine the correlation between the proportion of “non-internal medicine-related” RFEs and health problems in each study area in consideration of the population density.ResultsWe found 17 studies with diverse designs and settings. Among these studies, “non-internal medicine-related” RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, “non-internal medicine-related” health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of “non-internal medicine-related” RFEs and health problems.ConclusionsThis is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with “non-internal-medicine-related” RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0658-5) contains supplementary material, which is available to authorized users.

Past clinical data are not currently used to calculate pretest probabilities, as they have not been put into a database in clinical settings. This observational study was designed to determine the initial reasons for utilizing home visits or visits to an outpatient urban clinic in Japan.All family medical clinic outpatients and patients visited by the clinic (total = 11,688) over 1460 days were enrolled.We used a Bayes theorem-based clinical decision support system to analyze codes for initial reason-for-encounter (examination and final diagnosis: pretest probability) and final diagnosis of patients with fever (conditional pretest probability).Total number of reasons-for-encounter: 96,653 (an average of 1.2 reasons per visit). Final diagnosis: 62,273 cases (an average of 0.75 cases per visit). The most common reasons for initial examination were immunizations, physical examinations, and upper respiratory conditions. Regarding the final diagnosis, the combination of physical examinations and acute upper respiratory infections comprised 73.4% of cases. In cases where fever developed, the bulk of the final diagnoses were infectious diseases such as influenza, strep throat, and gastroenteritis of presumed infectious origin. For the elderly, fever often occurred with other health issues such as pneumonia, dementia, constipation, and sleep disturbances, though the cause of the fever remained undetermined in 40% of the cases.The pretest probability changed significantly based on the reason or the combination of reasons for which patients requested a medical examination. Using accumulated data from past diagnoses to modify subsequent subjective diagnoses, individual diagnoses can be improved.

Background: The role of oxygen therapy in end-of-life care for patients with advanced cancer is incompletely understood. We aimed to evaluate the association between oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care. Methods: We conducted a retrospective cohort study at a primary care practice in suburban Tokyo. Adult patients in home care with advanced cancer demonstrating first low oxygen saturation (less than 90%) detected in home visits were consecutively included in the study. Cox proportional hazards regression was used to investigate the effect of oxygen use on overall survival and survival at home, adjusted for systolic blood pressure, decreased level of consciousness, dyspnea, oral intake, performance status, and cardiopulmonary comorbidity. Results: Of 433 identified patients with advanced cancer, we enrolled 137 patients (oxygen use, n = 35; no oxygen use, n = 102) who developed low oxygen saturation. In multivariable analysis, the adjusted hazard ratio (HR) of oxygen use was 0.68 (95% confidence interval 0.39-1.17) for death and 0.70 (0.38-1.27) for death at home. In patients with dyspnea, the HR was 0.35 (0.13-0.89) for death and 0.33 (0.11-0.96) for death at home; without dyspnea, it was 1.03 (0.49-2.17) for death and 0.84 (0.36-1.96) for death at home. Conclusions: Oxygen use was not significantly associated with survival in patients with advanced cancer and low oxygen saturation, after adjusting for potential confounders. It may not be necessary to use oxygen for prolongation of survival in such patients, particularly in those without dyspnea.

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