Heckerling’s criteria to distinguish community-acquired pneumonia in a Japanese primary care setting: observational Study

Naoto Ishimaru — 2020-09-14

Background: Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. Chest radiographs are the gold standard method of confirmation of pneumonia but could unnecessarily expose patients to radiation. Heckerling’s criteria (HC) scoring is a useful substitute for chest radiographs and can be used to rule out CAP. HC score ≥ 4 is strongly indicative of pneumonia, while ≤ 1 indicates the patient is pneumonia-free. HC scoring is well validated in Western populations, but has not been validated in an Asian population. Racial differences in symptoms and differences in the method of measuring body temperature might affect the validity of HC scoring in this population. We evaluate the use of HC scoring in a Japanese primary care setting.

Methods: We conducted a prospective observational study of patients aged ≥ 16 years who had fever and respiratory symptoms in one of two community hospitals between December 2016 and October 2018. We evaluated the accuracy of HC in discrimination of patients with and without CAP.

Pneumonia was defined as when patients suffered from respiratory symptoms and had new infiltration recognized on chest X-ray or chest computed tomography.

Results: Analyzable data from 296 of 341 patients was available (37.2% were female, mean age: 41.1 years). CAP was diagnosed in 58 patients (19.6%). HC discriminated CAP with ROC area of 0.69 (95% CI 0.62-0.76). Sensitivity was 0.66 (95% CI 0.52-0.78) (HC score ≤ 1) and specificity was 0.68 (95% CI 0.61-0.74) (HC score >1).

Conclusions: HC failed to detect CAP in approximately 30% of our Japanese cases presenting acute respiratory illness. HC scoring should be used cautiously in non-Western populations.

Do family medicine clerkships complement clerkships at teaching hospitals in Japanese undergraduate medical education?: An observational study

Koki Nakamura — 2020-09-14

Background: Despite recognition of the importance of primary health care, the opportunities for medical students to participate in family medicine clerkships (FMCs) are still inadequate around the world. In order for FMCs to be accepted in the undergraduate curriculum, it is necessary to clarify whether FMCs complement clerkships at teaching hospitals.
Methods: Throughout the academic year 2018–2019, a total of 125 fifth-year students in Fukushima Medical University participated in an FMC. The students evaluated themselves at the beginning and end of their FMC whilst the family doctors evaluated students at the end of the FMC. The evaluations were a 5-point scale on 31 items in the following seven areas; objectives in general practice, practical skills and patient care, communication skills, patient-physician relationship, practice of team-based health care, medical practice in society and medical knowledge and problem-solving ability. A multiple regression analysis was conducted to assess whether self-evaluation was increased by clerkships at teaching hospitals where students rotated before the start of FMC. A Wilcoxon signed-rank sum test was used to assess self-evaluation changes before and after the FMC.
Results: All 125 students completed the study. Pre-FMC self-evaluation scores for 19 items tended to be higher depending on when the FMC was conducted; the later the semester, the higher the score (e.g. diagnostic reasoning: first semester, 2.23; second semester, 2.48 [p = 0.11]; third semester, 2.61 [p = 0.02]). However, this tendency was not observed in the remaining 12 items: psychological and social background, home medical care, interprofessional work, healthcare system, team-based health care, participate as a member of the team, role of the physician in team collaboration, current medical situation in the community, community-based integrated care system, necessity of primary care, discover necessary tasks, and rank the tasks. In post-FMC evaluation, six of the 12 items were higher than four point in both the self-evaluations and family doctor evaluations. A significant increase was observed between the pre-and post-FMC self-evaluation scores in all 31 items (e.g. diagnostic reasoning: pre 2.2 and post 3.9 [p <0.0001]).
Conclusion: The results of the present study suggest that FMCs complement clerkships at teaching hospitals.

Asia Pacific Family Medicine

Heckerling’s criteria to distinguish community-acquired pneumonia in a Japanese primary care setting: observational Study

Do family medicine clerkships complement clerkships at teaching hospitals in Japanese undergraduate medical education?: An observational study