Liquid-liquid equilibria (LLE) for (ethanol + water + K 2 HPO 4 ), (ethanol + water + NaH 2 PO 4 ), and (methanol + water + K 2 HPO 4 ) were measured at temperatures of (288.15, 298.15, and 308.15) K. A nonlinear equation was used to describe the binodal curves, in terms of the mass fraction of phosphate versus that of ethanol, and the tie lines were successfully correlated with the Othmer-Tobias and Bancroft equations. LLE results were predicted using the binodal and Othmer-Tobias equations as well as by the binodal and Bancroft equations. Both predictions showed close agreement with experimental values, and the average deviations of the former pair of equations were 0.41, 0.24, and 0.19 for (ethanol +water + K 2 HPO 4 ), (ethanol + water + NaH 2 PO 4 ), and (methanol + water + K 2 HPO 4 ), respectively.
Doctor shopping decreased significantly after patients consulted our department, with 'confirmation of the diagnosis' and 'satisfaction with consultation' being identified as contributing factors.
Key Clinical MessagePostherpetic pseudohernia must be suspected when a patient develops motor dysfunction coincident with or following a herpes zoster eruption.
We report a 38-year-old mestizo man with the sudden onset of left upper abdominal pain while climbing Mt. Fuji, which is the highest mountain in Japan. Enhanced computed tomography showed splenic infarction. Although his peripheral blood smear was normal, a hemoglobin S level of 40% established the diagnosis of sickle cell trait (SCT). This trait is common worldwide, but is not well recognized by doctors in Japan because no Japanese patients with SCT have been reported. However, in Japan it is important to consider SCT when assessing foreign patients with splenic infarction.
BackgroundThis study aimed to clarify the influence of predicting a correct diagnosis from the history on physical examination by comparing the diagnostic accuracy of auscultation with and without clinical information.MethodsThe participants were 102 medical students from the 2013 clinical clerkship course. Auscultation was performed with a cardiology patient simulator. Participants were randomly assigned to two groups. Each group listened to a different simulated heart murmur and then made a diagnosis without clinical information. Next, a history suggesting a different murmur was provided to each group and they predicted the diagnosis. Finally, the students listened to a murmur corresponding to the history provided and again made a diagnosis. Correct and incorrect diagnosis rates of auscultation were compared between students with and without clinical information, between students predicting a correct or incorrect diagnosis from the history (correct and incorrect prediction groups, respectively), and between students without clinical information and those making an incorrect prediction.ResultsFor auscultation with or without clinical information, the correct diagnosis rate was 62.7% (128/204 participants) versus 54.4% (111/204 participants), showing no significant difference (P=0.09). After receiving clinical information, a correct diagnosis was made by 102/117 students (87.2%) in the correct prediction group versus 26/87 students (29.9%) in the incorrect prediction group, showing a significant difference (P=0.006). The correct diagnosis rate was also significantly lower in the incorrect prediction group than when the students performed auscultation without clinical information (54.4% versus 29.9%, P<0.001).ConclusionObtaining a history alone does not improve the diagnostic accuracy of physical examination. However, accurately predicting the diagnosis from the history is associated with higher diagnostic accuracy of physical examination, while incorrect prediction is associated with lower diagnostic accuracy of examination.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.