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1.
J Nurs Adm ; 50(3): 165-173, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32068625

RESUMEN

Studies show sleep deprivation impacts patients' ability to perform physical activities and can lead to delirium, depression, and other psychiatric impairments. One of the Choosing Wisely® recommendations is "Do not wake the patient for routine care unless the patient's condition requires it." The authors discuss the development of an evidence-based toolkit to facilitate opportunities for patients to sleep during hospitalization, exemplifying the translation of a Choosing Wisely recommendation into clinical practice.


Asunto(s)
Toma de Decisiones Clínicas , Examen Físico/normas , Privación de Sueño/prevención & control , Hospitalización/estadística & datos numéricos , Humanos , Sueño
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 18-20, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914564

RESUMEN

With the acceleration of the population aging in China, the health problems and the demands of health services such as health check-up for rural residents should attract the attention of the whole society. The group standard entitled Health check-up guide for rural residents (T/CHAA 005-2019), was written by experienced researchers from Chinese Center for Disease Control and Prevention and other professional institutes coordinated by Chinese Health Association. The standard aims to establish a service model that takes health information collection as a means, health risk assessment, health risk intervention and information services as the core, improving the health of rural residents as the target.


Asunto(s)
Examen Físico/normas , Guías de Práctica Clínica como Asunto/normas , Población Rural , China , Humanos
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 37-38, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914566

RESUMEN

This standard stipulates the principles, institutional requirements, inspection items, service modes, data management and utilization requirements for carrying out the health check-up for rural residents. It is applicable to the standardized management of the health check-up for rural residents aged 15 years old and above under the relevant national laws and regulations.


Asunto(s)
Examen Físico/normas , Guías de Práctica Clínica como Asunto/normas , Población Rural , Adolescente , Adulto , China , Humanos , Pautas de la Práctica en Medicina/legislación & jurisprudencia
5.
Acta otorrinolaringol. esp ; 70(6): 364-372, nov.-dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-184882

RESUMEN

En noviembre 2014 la Sociedad Española de Otorrinolaringología, la Sociedad Española de Sueño y la Sociedad Española de Cirugía Maxilofacial propusieron y avalaron la elaboración de una Guía de Práctica Clínica sobre la exploración física de la vía aérea superior en pacientes con apnea obstructiva del sueño. La Guía ha seguido de forma estricta en toda su elaboración las recomendaciones del manual de elaboración de guías de práctica clínica del Sistema Nacional de Salud 2007 y 2009 y el manual de la Scottish Intercollegiate Guidelines Network (SIGN) 2015. El documento final puede ser altamente útil para los fines que se propuso inicialmente: ser un referente para unificar las regiones que deben ser exploradas en los pacientes con síndrome de apnea-hipoapnea obstructiva del sueño, mediante qué tipo de exploración y cómo gradarla, y expresada para todos los ámbitos asistenciales a los que estos pacientes pueden acudir. Las conclusiones y recomendaciones están basadas en una revisión exhaustiva y actualizada de la bibliografía con alto nivel de evidencia, además de la experiencia y conocimientos demostrados de todos los integrantes del grupo de elaboración. Dicho grupo se constituyó pensando siempre en la transversalidad del proyecto, y, por tanto, han participado especialistas de todos los ámbitos implicados (cirugía maxilofacial, medicina de familia, neumología, neurofisiología clínica, odontología y otorrinolaringología). Con la misma idea se seleccionaron los revisores externos del texto final


In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with obstructive sleep apnoea. The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015. The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with obstructive sleep apnoea-hypopnoea syndrome, the type of examination and how to grade it, and specific to all the care areas to which these patients have access. The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group. This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines


Asunto(s)
Humanos , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/terapia , Manejo de la Vía Aérea/normas , Examen Físico/métodos , Sociedades Médicas/normas , Examen Físico/normas
6.
J Autism Dev Disord ; 49(12): 4807-4819, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31448383

RESUMEN

Adolescence is a time of remarkable biopsychosocial change, which may be particularly challenging for youth with autism spectrum disorder (ASD), necessitating enhanced understanding and accurate assessment of pubertal maturation. The study compared physical examination to parent- and self-report measures in 200 participants (134 males and 66 females) ages 10.0-13.5 years. Both participants with typical development (TD, n = 78) and ASD (n = 122) were included. Concordance ranged from slight-to-fair for self-assessments (κ = .17-.32) and slight-to-moderate for parent-report (κ = .21-.44). Concordance of physical exam with self- and parent-report of the ASD group was somewhat lower than for the TD group. Findings indicate pubertal assessments by parent or child are not reliable indices of precise pubertal staging.


Asunto(s)
Trastorno del Espectro Autista/psicología , Padres/psicología , Examen Físico/normas , Pubertad/psicología , Autoinforme/normas , Adolescente , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/fisiopatología , Niño , Recolección de Datos/métodos , Recolección de Datos/normas , Femenino , Humanos , Estudios Longitudinales , Masculino , Examen Físico/métodos , Estudios Prospectivos , Pubertad/fisiología , Autoevaluación
7.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31267902

RESUMEN

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Asunto(s)
Grupos Diagnósticos Relacionados/tendencias , Documentación/tendencias , Alta del Paciente/tendencias , Mejoramiento de la Calidad , Centros Traumatológicos/organización & administración , Heridas y Traumatismos/diagnóstico , Centros Médicos Académicos/organización & administración , Arizona , Intervalos de Confianza , Bases de Datos Factuales , Grupos Diagnósticos Relacionados/normas , Documentación/métodos , Femenino , Humanos , Masculino , Medicare/economía , Admisión del Paciente/normas , Admisión del Paciente/tendencias , Alta del Paciente/normas , Alta del Paciente/estadística & datos numéricos , Examen Físico/normas , Examen Físico/tendencias , Sistema de Pago Prospectivo/normas , Sistema de Pago Prospectivo/tendencias , Análisis de Regresión , Estudios Retrospectivos , Estados Unidos , Heridas y Traumatismos/clasificación
9.
Work ; 63(4): 635-642, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282454

RESUMEN

OBJECTIVE: The purpose of this study was to examine the impact of applying six commonly-used and two proposed resting blood pressure (BP) cut-points to clear individuals for maximal exercise in non-clinical health, wellness, commercial fitness agencies and physically demanding occupation test sites. METHODS: Participants (n = 1670) completed the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and had their resting BP measured. Individuals with a BP >160/90 mmHg were further screened for contraindications to exercise using the ePARMed-X+ (www.eparmedx.com), all 1670 were cleared. There were no adverse events during or post exercise. RESULTS: The percentages of participants cleared for each BP cut-point were: <130/80 mmHg (85.3%), <140/90 mmHg (93.4%), <144/90 mmHg (94.6%), <144/94 mmHg (96.3%), <150/100 mmHg (98.6%), <160/90 mmHg (95.6%), <160/94 mmHg (97.8%) and <160/100 mmHg (99.5%). Individuals who would not have been cleared without further screening were significantly older, had a higher BMI, or had a lower maximal oxygen consumption. CONCLUSIONS: Conservative or lower resting BP cut-points currently applied to clear individuals for maximal exercise provide an unnecessary barrier. For individuals categorized as low-to- moderate risk by evidence-based screening tools such as the PAR-Q+ and ePARmed-X+, we recommend a resting BP cut-point of <160/94 mmHg to clear for maximal exercise until sufficient evidence is amassed to support the increase to <160/100 mmHg.


Asunto(s)
Determinación de la Presión Sanguínea/normas , Evaluación del Rendimiento de Empleados/normas , Ejercicio/fisiología , Salud Laboral/normas , Examen Físico/normas , Adulto , Factores de Edad , Presión Sanguínea/fisiología , Índice de Masa Corporal , Evaluación del Rendimiento de Empleados/métodos , Femenino , Centros de Acondicionamiento/normas , Humanos , Masculino , Consumo de Oxígeno/fisiología , Examen Físico/métodos , Estándares de Referencia , Descanso/fisiología , Adulto Joven
10.
Work ; 63(4): 603-613, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282457

RESUMEN

BACKGROUND: Physical employment standards (PES) ensure that candidates can demonstrate the physical capacity required to perform duties of work. However, movement competency, or an individual's movement strategy, can relate to injury risk and safety, and therefore should be considered in PES. OBJECTIVE: Demonstrate the utility of using artificial intelligence (AI) to detect risk-potential of different movement strategies within PES. METHODS: Biomechanical analysis was used to calculate peak flexion angles and peak extensor moment about the lumbar spine during participants' performance of a backboard lifting task. Lifts performed with relatively lower and higher exposure to postural and moment loading on the spine were characterized as "low" or "high" exposure, respectively. An AI model including principal component and linear discriminant analyses was then trained to detect and classify backboard lifts as "low" or "high". RESULTS: The AI model accurately classified over 85% of lifts as "low" or "high" exposure using only motion data as an input. CONCLUSIONS: This proof-of-principle demonstrates that movement competency can be assessed in PES using AI. Similar classification approaches could be used to improve the utility of PES as a musculoskeletal disorders (MSD) prevention tool by proactively identifying candidates at higher risk of MSD based on movement competency.


Asunto(s)
Empleo/normas , Movimiento/fisiología , Traumatismos Ocupacionales/prevención & control , Examen Físico/métodos , Aptitud Física/fisiología , Adulto , Técnicos Medios en Salud/normas , Inteligencia Artificial , Fenómenos Biomecánicos/fisiología , Evaluación del Rendimiento de Empleados/métodos , Evaluación del Rendimiento de Empleados/normas , Estudios de Factibilidad , Femenino , Humanos , Vértebras Lumbares/fisiología , Masculino , Examen Físico/normas , Prueba de Estudio Conceptual , Rango del Movimiento Articular/fisiología , Medición de Riesgo/métodos , Adulto Joven
11.
Work ; 63(4): 591-601, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282458

RESUMEN

BACKGROUND: Hesitation to employ females for physically demanding jobs is often due to sex related physical abilities. A physical employment standard (PES) identifies individuals who are physically capable for work. OBJECTIVE: A database containing 300 + sources of physical performance tests (PFTs) will inform potential sex bias for PES development. METHODS: Weighted means and probability density curves illustrate the percentage overlap between male and female performance on PFT data from the armed forces of 11 countries and the open literature. Where female training data were available, the change in percentage overlap illustrates the potential for reduction in sex-related differences. RESULTS: PFTs demonstrating the extremes of sex disparity were bench press (11 sources) and sit-ups (14 sources) with 9% and 93% overlap in performance, respectively. Training for bench press; pull ups; VO2max; and upright pull improved female performance by 12%, 22%, 35%, and 23% respectively. This translated into narrowing the gap between male and female mean performance by 1%, 4%, 5%, and 10% respectively. CONCLUSIONS: The ability of PFT to predict performance is essential; however, PFTs with more overlap will facilitate development of PES with reduced sex bias. PFTs with the greatest potential for improvement in females are identified here.


Asunto(s)
Bases de Datos Factuales , Evaluación del Rendimiento de Empleados/normas , Empleo/normas , Disparidades en el Estado de Salud , Sexismo/prevención & control , Evaluación del Rendimiento de Empleados/estadística & datos numéricos , Prueba de Esfuerzo/normas , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Humanos , Masculino , Personal Militar , Acondicionamiento Físico Humano/fisiología , Acondicionamiento Físico Humano/estadística & datos numéricos , Examen Físico/normas , Examen Físico/estadística & datos numéricos , Aptitud Física/fisiología , Factores Sexuales
12.
Work ; 63(4): 581-589, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282459

RESUMEN

BACKGROUND: To assess the post-implementation impact of the Canadian Type 1 Wildland Fire Fighter (WFF) Fitness Test Circuit (WFX-FIT), a retrospective descriptive analysis of anonymized aggregate data collected between 2012-2016 was conducted. OBJECTIVES: The objectives were to examine the pass rates of Type 1 WFF in each fire jurisdiction and on the standard for exchanging Type 1 WFF between agencies, the interagency exchange standard, by age group and sex and to propose what other information could be of value in assessing the effectiveness of implementing a physical employment standard. METHODS: Frequencies and pass rate percentages were compared by sex and age groups (<40 years, ≥40 years). RESULTS: Between 2012-2016, pass rates for all participants on the jurisdictional and interagency exchange performance standards improved from 93.2% to 95.6% and 79.1% to 87.6%, respectively. CONCLUSIONS: We conclude that since the WFX-FIT was implemented, there has been an increase in the number of exchange-eligible Type 1 WFF for suppression of wildfires in Canada.


Asunto(s)
Evaluación del Rendimiento de Empleados/estadística & datos numéricos , Empleo/normas , Bomberos/estadística & datos numéricos , Examen Físico/estadística & datos numéricos , Aptitud Física , Adulto , Factores de Edad , Canadá , Evaluación del Rendimiento de Empleados/normas , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Examen Físico/normas , Estudios Retrospectivos , Factores Sexuales , Incendios Forestales
13.
Work ; 63(4): 571-579, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282460

RESUMEN

BACKGROUND: Beginning in 2017, successfully passing the four-part pre-enlistment Occupational Physical Assessment Test (OPAT) became a requirement for all U.S. Army recruits. To ensure the test accurately identifies individuals who are qualified for their job, it was necessary to examine classification errors. OBJECTIVE: The objectives were to 1) determine the accuracy of OPAT cut-scores for combat arms Soldiers, and 2) determine which events contribute to the individuals that are misclassified as passing or failing the OPATMETHODS:A total of 741 trainees were tested on the OPAT within two weeks of entering their initial entry training. At the end of their training, trainees were tested on simulations of the most physically demanding tasks of their job. RESULTS: There was a high classification concordance (76.5%) between success on the OPAT and job task simulations. False positives (6.7%) were misclassified because they did not perform as well on the strength-dominant task simulations. While the interval aerobic run was the greatest contributor to false negatives (16.8%), previous studies indicated high performance on this event as a potential key indicator of injury and attrition risk. CONCLUSIONS: The findings provide insight on how the accuracy of the OPAT, and similar pre-employment tests, could be improved.


Asunto(s)
Evaluación del Rendimiento de Empleados/métodos , Personal Militar , Examen Físico/métodos , Aptitud Física , Adolescente , Evaluación del Rendimiento de Empleados/normas , Reacciones Falso Negativas , Reacciones Falso Positivas , Estudios de Factibilidad , Femenino , Humanos , Masculino , Examen Físico/normas , Valor Predictivo de las Pruebas , Estados Unidos , Guerra , Adulto Joven
14.
Work ; 63(4): 559-569, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282461

RESUMEN

BACKGROUND: Given the physical demands of mining and rescue operations, a physical employment standard was warranted to ensure capable workers are selected. While evaluations of muscular strength and muscular and cardiorespiratory endurance domains are common, assessment of a worker's ability to meet the physically demanding postural requirements is often neglected. OBJECTIVE: The aim of this investigation was to develop a valid assessment for NSW Mines Rescue Brigadesmen that replicated the combined muscular and cardiorespiratory endurance and postural demands of constructing a timber pillar. METHODS: Oxygen consumption () V̇O2) was measured and dominant postures identified when incumbent Brigadesmen constructed a timber pillar. A shelf-stacking assessment was designed and validated. RESULTS: When Brigadesmen performed the block placement role, the task elicited a mean V̇O2 of 1.6 L.min-1, and required repeated placement of ∼8.7 kg blocks from 0 to 3.0 m. A shelf stacking assessment (5 min, mean V̇O2 1.7 L.min-1) replicating dominant postures and requiring repeated block placement at 0, 0.65, 1.10, 1.64 and 2.20 m was developed. The demand of the test, performed within a discontinuous circuit, was subsequently verified (1.6 L.min-1). CONCLUSIONS: A valid, physiological aptitude test that considered the job-related movement patterns, in addition to cardiorespiratory and muscular endurance requirements, was developed for Brigadesmen.


Asunto(s)
Evaluación del Rendimiento de Empleados/métodos , Empleo/normas , Examen Físico/métodos , Aptitud Física/fisiología , Trabajo de Rescate/normas , Adulto , Aptitud/fisiología , Evaluación del Rendimiento de Empleados/normas , Humanos , Masculino , Persona de Mediana Edad , Minería , Fuerza Muscular , Nueva Gales del Sur , Consumo de Oxígeno , Examen Físico/normas
15.
Work ; 63(4): 509-519, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282464

RESUMEN

BACKGROUND: If current population and health trends continue, workplace demographics will look significantly different by the turn of the century. Organizations will no longer have a steady pipeline of younger workers and will likely need to rely on older workers to remain competitive in the global marketplace. The future multi-generational workforce will bring with it the challenge of maximizing contributions from each generation whilst at the same time addressing the health, safety and wellbeing needs of all workers. OBJECTIVE: This review provides an insight into aging and older workers, and presents recommendations to promote worker longevity. METHODS: This narrative review draws on evidence from 108 published sources. RESULTS: The relationship between age and work is not simple; factors including the physical nature of the job and worker's health and fitness interact with age to either increase or decrease the potential effect of age. Evidence suggests that the issues arising from an aging workforce can be managed through polices that focus on active aging through: attitude management; flexible working and the provision of occupational health. CONCLUSION: The integration of such interventions would require company and organizational commitment from the top down with educational programs at all levels to ensure understanding and participation.


Asunto(s)
Envejecimiento/fisiología , Empleo/normas , Salud Laboral , Examen Físico/normas , Recursos Humanos/normas , Ageísmo/legislación & jurisprudencia , Ageísmo/prevención & control , Actitud Frente a la Salud , Promoción de la Salud , Envejecimiento Saludable/fisiología , Humanos , Aptitud Física/fisiología , Políticas , Participación de los Interesados , Lugar de Trabajo/legislación & jurisprudencia , Lugar de Trabajo/normas
16.
Work ; 63(4): 495-508, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282465

RESUMEN

BACKGROUND: Physically demanding occupations such as the military, firefighting and law enforcement have adopted physical employment standards (PES). The intent of PES is to match the physical capacity of personnel with the physical demands of job tasks. Inadequate physical capacity can affect occupational task performance as well musculoskeletal injury (MSKI) risk. OBJECTIVE: To present contemporary evidence on the relationship(s) between PES, physical training, physical capacity and MSKI in physically demanding occupations, and provide recommendations regarding physical training for improved occupational performance and reduced MSKI risk. METHODS: This narrative review draws on evidence from 104 published sources. RESULTS: Physical training is central to the development and maintenance of occupationally-relevant physical capacity, as well as mitigating MSKI risk associated with job performance. In addition, given the prevalence of manual handling tasks, strength training needs to be emphasised in physical training regimen. CONCLUSIONS: PES development can inform both physical training and injury prevention strategies in physically demanding occupations. Furthermore, a physical performance continuum is essential to through-career maintenance of occupational performance and health, and the preservation of organisational capability. Finally, organisations should consider the potential to implement PES as maximal performance tests to better understand the relationship between occupational task performance and MSKI risk.


Asunto(s)
Empleo/normas , Enfermedades Musculoesqueléticas/prevención & control , Sistema Musculoesquelético/lesiones , Salud Laboral , Traumatismos Ocupacionales/prevención & control , Humanos , Examen Físico/normas , Aptitud Física , Entrenamiento de Resistencia/métodos
17.
Work ; 63(4): 481-494, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31282466

RESUMEN

BACKGROUND: When one thinks of jobs with physical employment standards, the first thoughts typically center around firefighting, law enforcement, and military jobs. However, there are 100s of arduous jobs that exist in the public and private sectors that range from moderately demanding to strenuous. The Bureau of Labor Statistics reported that 28% of the workforce in the United States performs physically demanding jobs that involve construction, machinery installation and repair, public safety, and other professions. OBJECTIVE: This paper provides a historical perspective of physical employment standards for hiring workers into these arduous jobs, how we arrived at our current knowledge base, and the challenges faced today when determining and implementing physical employment standards. METHOD: This narrative review draws on evidence from 62 published sources. RESULTS: This paper focuses on the need for a multidisciplinary approach to identifying job requirements, the professions (e.g., medical, psychology, physiology) that underpin the methodologies, and the knowledge used by current researchers. Descriptions of test and cut score development, legal issues, and challenges for the future also are highlighted.


Asunto(s)
Empleo/normas , Selección de Personal/normas , Examen Físico/normas , Aptitud Física , Recursos Humanos/normas , Derechos Civiles/historia , Derechos Civiles/normas , Empleo/historia , Empleo/legislación & jurisprudencia , Guías como Asunto , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Selección de Personal/historia , Selección de Personal/legislación & jurisprudencia , Examen Físico/historia , Derecho al Trabajo , Discriminación Social/historia , Estados Unidos , Recursos Humanos/historia , Recursos Humanos/legislación & jurisprudencia
18.
BMC Palliat Care ; 18(1): 57, 2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31307441

RESUMEN

BACKGROUND: Constipation is a common symptom for patients receiving palliative care. Whilst international clinical guidelines are available on the clinical management of constipation for people with advanced cancer receiving specialist palliative care (SPC), the extent to which the guidelines are implemented in practice is unclear. This study aimed to examine clinical practices for the assessment and management of constipation for patients with advanced cancer within inpatient SPC settings. METHODS: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three inpatient SPC units across the United Kingdom between August 2016 and May 2017. The variables selected for review were determined by the recommendations within the clinical guidelines. Descriptive statistics, cross tabulation, chi square, and bivariate correlations were used to examine clinical practices compared to policy guidelines for the assessment and management of constipation. Reporting was structured by the STROBE checklist for observational research (Additional File 2). RESULTS: A comprehensive assessment, including a full history and performing a physical exam, was recorded for 109 patients (73%), however, no standardised documentation was utilised. Assessment was nurse led, with variable involvement across sites of other members of the multidisciplinary team (MDT). Education on prevention was documented in 30 (20%) case-notes, and 53% recorded evidence of non-pharmacological intervention. Age, gender, and reason for admission did not impact on the likelihood of receiving a comprehensive assessment, education, or non-pharmacological intervention, however, significant differences were evident between sites. Pharmacological management was well developed and aligned to the guidelines however, 33% of patient case-notes recorded no information on the titration of laxatives. Twelve percent of patients experienced partial or complete bowel obstruction, and management strategies were variable. CONCLUSIONS: Constipation management is driven by a pharmacological approach, with little evidence of the implementation of preventative and non-pharmacological strategies. The nurse plays a key coordinating role in assessment; however, involvement and roles of the wider MDT varies. Accurate recording of care is essential when examining clinical practice and identifying areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to ensure consistency in assessment and implementation of appropriate non-pharmacological/ preventative strategies.


Asunto(s)
Estreñimiento/etiología , Neoplasias/complicaciones , Cuidados Paliativos/métodos , Examen Físico/normas , Anciano , Anciano de 80 o más Años , Estreñimiento/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Examen Físico/métodos , Examen Físico/tendencias , Estudios Retrospectivos , Reino Unido
19.
Work ; 62(4): 647-656, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31104050

RESUMEN

BACKGROUND: Clinical Breast Examination (CBE) is the examination of a women's breasts by a healthcare professional, such as a breast surgeon, family physician or breast-care nurse who is trained to recognise many different types of abnormalities and warning signs in the breast [1]. CBE is particularly important in rural areas and developing countries who have limited access to technology such as mammography. CBE needs to be taught to health professionals like any other clinical skill used by medical professionals in the workplace. CBE in part involves palpation of the breast, that is, determining by touch which breast lumps are normal and which are suspicious in feeling. The gold standard for assessing tactile skills in CBE is seeing whether students can accurately identify and discriminate between different breast lumps also known as masses (IDBM) on actual patients in a clinical setting. However, this is not practical in a medical education setting. Usually the testing methods 'go through the motions' of feeling the breast as part of CBE. So the students' technique is examined either using unrealistic simulation models or using an intimate examination associate (IEA), an actor/volunteer who permits students to examine their intimate body parts such as breast or genitals for teaching purposes. These volunteers do not have any abnormalities so this teaching does not include the actual detection of suspicious lumps. We undertook a study of clinical skill with 10 medical students to examine different methods of assessing novice student clinical skills after a brief training in CBE. OBJECTIVES: This study aims to evaluate the effectiveness of current training and assessment of novice students in CBE and their capacity to identify and discriminate breast masses (IDBM) on actual patients. METHODS: We assessed each student's IDBM ability in an actual clinical situation, a breast clinic with a mixture of eight IEAs and one real patient with a large, easily palpable, putative breast cancer. We recruited 10 clinically inexperienced medical students, who were trained for 30 minutes by two breast surgeons using an IEA. Students were tested in a simulated clinical setting, a breast clinic where each examined 4 IEAs and one patient. The students were blind to who was the real patient and who was an IEA. Patients were examined by a breast surgeon in private prior to the commencement in the study. The breast surgeon recorded any clinical finding on the patients during the initial examination. The surgeon coached each patient on how to mark the students and showed the patient their results so the patients had a benchmark. After each examination was finished the students had four different assessments: 1) patients marked each student, 2) students were independently proctored - that is, marked by an expert, 3) students recorded their clinical findings and 4) students recorded how confident they were that they had the correct findings. Results from different kinds of student assessments were compared.RESULTSA chi-square test for independence between true positive or negative masses versus student-assessed positive or negative masses was not significant at alpha = .05. This means that there was no statistical association in the indication of positive or negative presence of masses versus whether such masses were actually present or absent. By comparison, experts (breast surgeons) were able to detect normal and abnormal breast masses by palpation alone 100% of the time and rate their confidence level as 'certain'. Unlike the experts, student self-reported confidence was unrelated to their competence score (CS). Proctoring was inversely related to the students' CS.CONCLUSIONSThe main conclusion is that novice students do not seem to be able to accurately detect breast masses in a clinical setting even after training. On the basis of these results, we believe that a comprehension component in the current CBE testing is needed in addition to the current methods of testing.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Mama/anomalías , Examen Físico/normas , Adulto , Mama/fisiopatología , Distribución de Chi-Cuadrado , Competencia Clínica/normas , Educación de Pregrado en Medicina/métodos , Evaluación Educacional/métodos , Femenino , Humanos , Palpación/métodos , Palpación/normas , Examen Físico/métodos , Estudiantes de Medicina/estadística & datos numéricos
20.
Taiwan J Obstet Gynecol ; 58(3): 345-348, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31122522

RESUMEN

OBJECTIVE: This study aimed to compare the diagnostic value of VIA with Pap smear in screening for cervical cancer. MATERIALS AND METHODS: In this cross-sectional study, 440 women who had eligibility criteria, in Kashan city were assessed. All women underwent Pap smear test and then a visual inspection with acetic acid and colposcopy-biopsy (Gold Standard). Then, the diagnostic value indices including the specificity, sensitivity, positive and negative predictive values for the results of VIA and Pap smear were analyzed by SPSS V16 software. RESULTS: Finding showed that 29.9% of women had abnormal Pap smear. The false positive rate of Pap smear was 40.2%, and its false negative rate was 37.4%. For VIA, the false positive and false negative rates were 21.2% and 4.6%. The sensitivity, specificity, NPV and PPV of Pap smear was 29.7%, 85.5%, 59.8%, 62.6%, and these values for VIA was 94.6%, 81.6%, 78.8%, 95.4% respectively. Combination of Pap smear and VIA showed the sensitivity of 97.3% and 100% in low grade and high grade cervical lesions. CONCLUSION: VIA has a higher sensitivity than Pap smear in detection of low and high grade cervical lesions, however, its specificity is less than Pap smears. Therefore it is recommended to use of VIA along with Pap smear to reach a higher sensitivity.


Asunto(s)
Neoplasia Intraepitelial Cervical/diagnóstico , Prueba de Papanicolaou/normas , Examen Físico/normas , Neoplasias del Cuello Uterino/diagnóstico , Ácido Acético/administración & dosificación , Ácido Acético/normas , Adulto , Anciano , Colposcopía/normas , Estudios Transversales , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Irán , Persona de Mediana Edad , Prueba de Papanicolaou/métodos , Examen Físico/métodos , Sensibilidad y Especificidad , Adulto Joven
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