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1.
Postgrad Med ; 132(1): 102-108, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31928276

RESUMEN

Background: Little is known about patient preference regarding the physical exam in non-urgent primary care settings.Objective: To determine the differences between a patient's expectations of the physical exam and the actual components of the physical examination performed during a non-urgent visit.Design: A total of 452 surveys administered in the waiting room of a VA primary care clinic in West Haven, CT.Key results: The response rate was 91.6% (n = 414). For 15 of 16 maneuvers on the survey, more respondents believed a reasonable provider should conduct it than received it at their annual physical exam; for 7 of them (breast, axillary, rectal, pelvic, total body skin exam, electrocardiogram, and stress test), over twice as many respondents believed they should be done than received them. There was an association between a patient's perception of their primary care provider and the number of maneuvers recalled at their annual exam (P < 0.001), and a gap in the number of maneuvers expected from a reasonable provider by nonwhite and white patients (P < 0.001).Limitations: Convenience sample, response bias (healthy patients are more likely to respond) and recall bias.Conclusion: Patient perception of their primary care provider is strongly associated with the number of maneuvers recalled during an annual physical. Furthermore, the number of maneuvers expected by a patient is influenced by race, with nonwhite patients desiring more. This suggests the need for further research on the role of race in the expectations of healthcare providers.


Asunto(s)
Prioridad del Paciente , Examen Físico , Atención Primaria de Salud/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico/métodos , Examen Físico/psicología , Encuestas y Cuestionarios , Adulto Joven
2.
Neonatal Netw ; 38(2): 107-108, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31470374

RESUMEN

Babies in the NICU should be managed in a neurodevelopment-friendly environment. Frequent handling by multiple examiners potentially increases the risk of cross infection. Interruption in kangaroo care is not advisable unless urgent. A minimum of three-point exam should be done (chest, heart, and abdomen) using a stethoscope and gentle palpation. However, the infant should not be wakened from sleep and all handling should be synchronized with the touch time.


Asunto(s)
Cuidado del Lactante , Enfermedades del Recién Nacido , Cuidado Intensivo Neonatal , Manejo de Atención al Paciente , Humanos , Cuidado del Lactante/ética , Cuidado del Lactante/métodos , Cuidado del Lactante/psicología , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/terapia , Unidades de Cuidado Intensivo Neonatal/organización & administración , Cuidado Intensivo Neonatal/ética , Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/psicología , Manejo de Atención al Paciente/ética , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/organización & administración , Comodidad del Paciente , Examen Físico/métodos , Examen Físico/psicología , Relaciones Profesional-Familia , Factores de Tiempo
4.
Sangyo Eiseigaku Zasshi ; 61(4): 123-132, 2019 Jul 25.
Artículo en Japonés | MEDLINE | ID: mdl-31155543

RESUMEN

BACKGROUND: Globally, health literacy is considered important for healthy ageing. However, to our knowledge, no study has investigated comprehensive health literacy in Japanese employees. OBJECTIVE: This study aimed to examine comprehensive health literacy in employees of company A, a Japanese railway company, and to determine the association between health literacy and behavior regarding health checkups and health counseling in the employees. METHODS: A representative sample of company A with 541 employees was selected through random sampling. We divided the sample into 20 groups based on gender, age, night shift work, and administrative position. These groups were compared with the employee distribution of company A. The self-administered Japanese version of the 47-item European Health Literacy Survey Questionnaire was distributed to the participants via mail from May 1, 2017, to May 30, 2017. This questionnaire consists of three domains, each with its own index: health care health literacy (health care health literacy index [HC-HL]), disease prevention health literacy (disease prevention health literacy index [DP-HL]), and health promotion health literacy (health promotion health literacy index [HP-HL]). Additionally, general health literacy (general health literacy index [GEN-HL]) was also assessed. Statistical analyses were performed to identify the association between health literacy and behavior regarding health checkups and health counseling in the employees in company A. Furthermore, we compared the health literacy of the present sample with that of samples in past studies by Nakayama et al. (2015) and Goto et al. (2018). RESULTS: A total of 417 questionnaires were returned. The health literacy scores were calculated based on the valid responses of 381 participants. The mean health literacy scores in company A for GEN-HL, HC-HL, DP-HL, and HP-HL were 25.1, 24.6, 27.9, and 22.8, respectively. The mean health literacy scores in the survey by Nakayama et al. for GEN-HL, HC-HL, DP-HL, and HP-HL were 25.3, 25.7, 22.7, and 25.5, respectively, and those in the survey by Goto et al. were 29.79, 29.23, 32.52, and 27.60, respectively. There was no significant difference between participant characteristics and GEN-HL scores. In contrast, there was a significant difference in the association between GEN-HL and health counseling in terms of the number of times health counseling was provided in the workplace. However, there was no significant difference between those who did not wish to receive health counseling and GEN -HL scores. CONCLUSION: The health literacy in railway company A was low. The results of this study and those of past studies did not demonstrate similar trends for health literacy. Additionally, GEN-HL scores were likely to increase if the number of people who wished to receive health counseling increased.


Asunto(s)
Consejo , Conductas Relacionadas con la Salud , Alfabetización en Salud/estadística & datos numéricos , Salud Laboral , Examen Físico/psicología , Transportes , Adolescente , Adulto , Anciano , Femenino , Alfabetización en Salud/tendencias , Humanos , Japón , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
5.
Pediatrics ; 143(6)2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31147486

RESUMEN

BACKGROUND: The American Academy of Pediatrics recommends literacy promotion and developmental assessment during well-child visits. Emergent literacy skills are well defined, and the use of early screening has the potential to identify children at risk for reading difficulties and guide intervention before kindergarten. METHODS: The Reading House (TRH) is a children's book designed to screen emergent literacy skills. These are assessed by sharing the book with the child and using a 9-item, scripted scoring form. Get Ready to Read! (GRTR) is a validated measure shown to predict reading outcomes. TRH and GRTR were administered in random order to 278 children (mean: 43.1 ± 5.6 months; 125 boys, 153 girls) during well-child visits at 7 primary care sites. Parent, child, and provider impressions of TRH were also assessed. Analyses included Rasch methods, Spearman-ρ correlations, and logistic regression, including covariates age, sex, and clinic type. RESULTS: Psychometric properties were strong, including item difficulty and reliability. Internal consistency was good for new measures (rCo- α = 0.68). The mean TRH score was 4.2 (±2.9; range: 0-14), and mean GRTR was 11.1 (±4.4; range: 1-25). TRH scores were positively correlated with GRTR scores (r s = 0.66; high), female sex, private practice, and child age (P < .001). The relationship remained significant controlling for these covariates (P < .05). The mean TRH administration time was 5:25 minutes (±0:55; range: 3:34-8:32). Parent, child, and provider impressions of TRH were favorable. CONCLUSIONS: TRH is a feasible, valid, and enjoyable means by which emergent literacy skills in 3- and 4-year-old children can be directly assessed during primary care.


Asunto(s)
Libros , Alfabetización , Examen Físico/métodos , Atención Primaria de Salud/métodos , Lectura , Preescolar , Femenino , Humanos , Alfabetización/psicología , Masculino , Examen Físico/psicología , Reproducibilidad de los Resultados
8.
Nurs Forum ; 54(1): 111-120, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30380141

RESUMEN

AIM: To develop and test a scale that assesses the attitudes and practices of registered nurses toward physical examination (PE) in of (delete) the clinical settings. METHODS: A cross-sectional methodological design with a convenience sample of 277 registered nurses was used. A Likert-type scale was constructed using 55 Likert-type items that were extracted from the relevant literature. Exploratory factor analyses were conducted using varimax rotation. Factor loading, eigenvalues, and screeplots were used to determine the best fit model. RESULTS: The final version of the scale consisted of four factors. The determinant score was (0.001) and the total variance explained was 56.26%. All of those four factors had eigenvalue more than 1. The final version of the scale (the 20-item scale) was tested for reliability and was internally consistent (Cronbach's α = 0.833). The scale was supported for its validity. CONCLUSION: The final version of the scale can be used to determine nurses' perspective and use of PE, and assist in bridging the gap between what is taught and what is practices regarding PE.


Asunto(s)
Enfermeras y Enfermeros/psicología , Examen Físico/psicología , Psicometría/normas , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/normas , Examen Físico/normas , Psicometría/instrumentación , Psicometría/métodos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
9.
BMC Health Serv Res ; 18(1): 823, 2018 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-30376830

RESUMEN

BACKGROUND: The engagement of citizens in the development of evidence-based screening programs is internationally supported. The aim of our research was to explore the motivations and reasons of adult citizens in Austria for attending periodic health examinations (PHE) as well as their satisfaction with the way PHE are organized. METHODS: We conducted three focus groups with a random sample of previous attenders of PHE. Participants were stratified by age, gender, and education. The discussions were recorded, transcribed, and analyzed using a thematic analysis approach. RESULTS: Main motivations of attenders (n = 30) were to detect diseases early, to prevent suffering, and to live a long, healthy life. They believed that PHE work as an incentive of health behavior change. As possible reasons not to attend PHE, participants mentioned lack of awareness, time constraints, unpleasant prior experiences, and fear of harm or negative consequences. They wanted the range of examinations to be selected based on individual risks and to be more comprehensive. Some participants expressed frustration with the lack of time doctors dedicated to the examination or discussion of the results. Throughout the discussion, participants realized there is a great diversity among doctors in the quality of health examinations and how content is delivered. CONCLUSION: The study showed that attenders of PHE have high expectations concerning the beneficial outcomes of PHE. They requested a comprehensive and individualized program that does not reflect the scientific evidence from effectiveness studies of PHE. These findings indicate serious shortcomings in the communication of benefits and harms of screening interventions and highlight the need for a more proactive communication about aims and content of the program.


Asunto(s)
Diagnóstico Precoz , Promoción de la Salud , Motivación , Examen Físico/psicología , Adolescente , Adulto , Anciano , Austria , Comunicación , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Médicos , Investigación Cualitativa , Adulto Joven
10.
BMC Med Educ ; 18(1): 246, 2018 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-30373579

RESUMEN

BACKGROUND: Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students' motivation and willingness to participate in a physical examination course. METHODS: Students were asked to complete a questionnaire subdivided into five domains: anthropometric data, religiousness, motivation to take part in physical examination courses, willingness to be physically examined at 11 different body regions by peers or a professional tutor and a field for free text. RESULTS: The questionnaire was completed by 142 medical students. The importance of the examination course was rated 8.7 / 10 points, the score for students' motivation was 7.8 / 10 points. Willingness to be physically examined ranged from 6 to 100% depending on body part and examiner. Female students were significantly less willing to be examined at sensitive body parts (breast, upper body, groin and the hip joint; p = .003 to < .001), depending on group composition and / or examiner. Strictly religious students showed significantly less willingness to undergo examination of any part of the body except the hand (p = .02 to < .001). Considering BMI, willingness to be examined showed comparable rates for normal weight and under- / overweight students in general (80% vs. 77%). Concerning the composition of the group for physical examination skills courses, students preferred self-assembled over mixed gender and same gender groups. CONCLUSIONS: Peer physical examination is a method to improve students' skills. While motivation to participate in and acceptance of the physical examination course appears to be high, willingness to be examined is low for certain parts of the body, e.g. breast and groin, depending on religiousness, gender and examiner. Examination by a professional medical tutor did not lead to higher acceptance. Most students would prefer to choose their team for physical examination courses themselves rather than be assigned to a group.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Grupo Paritario , Examen Físico/psicología , Estudiantes de Medicina/psicología , Adulto , Actitud del Personal de Salud , Peso Corporal , Curriculum , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Examen Físico/estadística & datos numéricos , Psicometría , Religión , Factores Sexuales , Estudiantes de Medicina/estadística & datos numéricos , Compromiso Laboral , Adulto Joven
11.
Praxis (Bern 1994) ; 107(19): 1021-1030, 2018 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-30227797

RESUMEN

The Physical Examination of an 'Uncooperative' Elderly Patient Abstract. The physical examination of uncooperative elderly patients regularly presents physicians in the private practice, in the hospital or nursing home with great challenges. The lack of cooperation itself can be an important indication of an underlying medical problem. Important elements to improve the patient's cooperation include ensuring basic needs, sufficient time and patience, adequate communication and good cooperation with relatives and other healthcare professionals. Targeted clinical observation as well as thinking in geriatric syndromes and unmet needs can help to raise physical findings despite limited cooperation. Pathological findings are indicators of impaired organ and functional systems and must be supplemented by a detailed examination.


Asunto(s)
Anciano Frágil/psicología , Cooperación del Paciente , Examen Físico/métodos , Actividades Cotidianas/clasificación , Anciano de 80 o más Años , Cuidadores/psicología , Terapia Combinada , Comunicación , Comorbilidad , Conducta Cooperativa , Delirio/complicaciones , Delirio/psicología , Diagnóstico Diferencial , Evaluación de la Discapacidad , Disnea/etiología , Disnea/terapia , Femenino , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Examen Físico/psicología , Relaciones Médico-Paciente , Agitación Psicomotora/complicaciones , Agitación Psicomotora/psicología
14.
Med Clin North Am ; 102(3): 425-431, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29650064

RESUMEN

The privilege of examining a patient is a skill of value beyond its diagnostic utility. A thorough physical examination is an important ritual that benefits patients and physicians. The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic status. Understanding ritual in medicine, including the placebo effects of such rituals, reaffirms the centrality of the physical examination to the process of building strong physician-patient relationships.


Asunto(s)
Conducta Ceremonial , Examen Físico , Relaciones Médico-Paciente , Agotamiento Profesional/prevención & control , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/normas , Humanos , Examen Físico/psicología , Examen Físico/normas , Efecto Placebo , Ciencias Sociales
15.
Med Clin North Am ; 102(3): 521-532, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29650073

RESUMEN

Data from the United States show that persons from low socioeconomic backgrounds, those who are socially isolated, belong to racial or ethnic minority groups, or identify as lesbian, gay, bisexual, or transgender experience health disparities at a higher rate. Clinicians must transition from a biomedical to a biopsychosocial framework within the clinical examination to better address social determinants of health that contribute to health disparities. We review the characteristics of successful patient-clinician interactions. We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery.


Asunto(s)
Competencia Cultural , Disparidades en Atención de Salud , Atención Dirigida al Paciente/normas , Examen Físico/normas , Relaciones Médico-Paciente , Toma de Decisiones , Prestación de Atención de Salud/métodos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Humanos , Grupos Minoritarios , Examen Físico/psicología , Factores de Riesgo , Estados Unidos
16.
Chiropr Man Therap ; 26: 6, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29507714

RESUMEN

Background: Peer physical examination (PPE) is a teaching and learning strategy utilised in most health profession education programs. Perceptions of participating in PPE have been described in the literature, focusing on areas of the body students are willing, or unwilling, to examine. A small number of questionnaires exist to evaluate these perceptions, however none have described the measurement properties that may allow them to be used longitudinally. The present study undertook a Mokken scale analysis of the Peer Physical Examination Questionnaire (PPEQ) to evaluate its dimensionality and structure when used with Australian osteopathy students. Methods: Students enrolled in Year 1 of the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia) were invited to complete the PPEQ prior to their first practical skills examination class. R, an open-source statistics program, was used to generate the descriptive statistics and perform a Mokken scale analysis. Mokken scale analysis is a non-parametric item response theory approach that is used to cluster items measuring a latent construct. Results: Initial analysis suggested the PPEQ did not form a single scale. Further analysis identified three subscales: 'comfort', 'concern', and 'professionalism and education'. The properties of each subscale suggested they were unidimensional with variable internal structures. The 'comfort' subscale was the strongest of the three identified. All subscales demonstrated acceptable reliability estimation statistics (McDonald's omega > 0.75) supporting the calculation of a sum score for each subscale. Conclusion: The subscales identified are consistent with the literature. The 'comfort' subscale may be useful to longitudinally evaluate student perceptions of PPE. Further research is required to evaluate changes with PPE and the utility of the questionnaire with other health profession education programs.


Asunto(s)
Enfermedades Musculoesqueléticas/diagnóstico , Medicina Osteopática/educación , Examen Físico/normas , Estudiantes de Medicina/psicología , Actitud del Personal de Salud , Australia , Competencia Clínica , Curriculum , Encuestas Epidemiológicas , Humanos , Medicina Osteopática/normas , Grupo Paritario , Examen Físico/psicología , Reproducibilidad de los Resultados , Estadísticas no Paramétricas
18.
Emerg Med J ; 35(7): 406-411, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29431142

RESUMEN

OBJECTIVES: Our aim was to determine whether emergency physicians (EPs) felt their standard patient evaluation practice was modified by two non-private clinical encounters: hallway encounters and encounters during which a companion was present. METHODS: We administered an iteratively developed cross-sectional survey at an annual national professional meeting. We used logistic regression to compare relationships among non-private clinical encounters and predictors of interest. RESULTS: 409 EPs completed the survey. EPs deviated from standard history-taking when practising in a hallway location (78%) and when patients had a companion (84%). EPs altered their standard physical exam when practising in a hallway location (90%) and when patients had a companion (77%). EPs with at least a decade of experience were less likely to alter history-taking in the hallway (OR 0.55, 95% CI 0.31 to 0.99). Clinicians who frequently evaluated patients in the hallway reported delays or diagnostic error-related to altered history-taking (OR 2.34, 95% CI 1.33 to 4.11). The genitourinary system was the most common organ system linked to a delay or diagnostic error. Modifications in history-taking were linked to delays or failure to diagnose suicidal ideation or self-harm (25%), intimate partner violence (40%), child abuse (12%), human trafficking (8%), substance abuse (47%) and elder abuse (17%). CONCLUSIONS: Our study suggests that alterations in EP usual practice occurs when the doctor-patient dyad is disrupted by evaluation in a hallway or presence of a companion. Furthermore, these disruptions are associated with delays in care and failure to diagnosis medical, social and psychiatric conditions.


Asunto(s)
Medicina de Emergencia , Examen Físico/métodos , Médicos/psicología , Pautas de la Práctica en Medicina/tendencias , Adulto , Anciano , Boston , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Examen Físico/psicología , Examen Físico/normas , Encuestas y Cuestionarios
19.
Int Health ; 10(3): 191-196, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29474639

RESUMEN

Background: A voluntary health examination is offered to asylum seekers in Sweden with the purpose of detecting infectious diseases and identifying other health needs. This study aimed to explore the organization, content and perceived value of the health examination from the perspective of asylum seekers. Methods: Semi-structured interviews were conducted with 18 migrants recruited from different settings in Stockholm. Data were transcribed verbatim and analysed using thematic analysis in relation to the availability, accessibility, acceptability and quality framework. Results: Participants reported positive aspects of the health examination while raising important concerns, categorized into the following themes: availability-despite being available, the service was considered to be delayed with perceived implication for infection control; accessibility-migrants experienced no physical or economic barrier to access the health examination, especially when it was performed through a mobile clinic, however, they had limited access to information; acceptability and quality-migrants trusted the health staff, however, the examination lacked important aspects related to mental health and dental care needs, among other health needs. Conclusion: Health examinations are valued by participants but failed to identify and address many perceived health needs. Mobile clinics seem a practical strategy to improve accessibility.


Asunto(s)
Actitud Frente a la Salud , Examen Físico/psicología , Migrantes/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Suecia , Migrantes/estadística & datos numéricos , Adulto Joven
20.
Rheumatology (Oxford) ; 57(2): 283-290, 2018 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-28541484

RESUMEN

Objective: To assess how many PsA patients with an acceptable disease state according to the treating rheumatologist have quiescent disease defined as minimal disease activity (MDA). Methods: This cross-sectional study included 250 PsA patients. To assess current clinical practice as closely as possible, acceptable disease state was not determined by predefined activity measures, but instead was defined by asking rheumatologists to refer those patients whom they considered sufficiently treated. Patients were evaluated for current disease activity including clinical assessments and patient reported outcomes (PROs). Results: One-third (88/250) of the patients with acceptable disease state according to the rheumatologist did not fulfil MDA (MDA-). The presence of tender joints and patient pain and global disease activity scores most frequently contributed to not fulfilling MDA (not achieved in 83, 82 and 80%, respectively). However, also objective signs of disease activity were higher in the MDA- than MDA+ patient group: a swollen joint count >1 occurred in 35% vs 7% (P < 0.001), enthesitis >1 in 14% vs 3% (P = 0.002) and Psoriasis Area and Severity Index >1 in 43% vs 26% (P = 0.002). Residual disease was more frequent in females, elder patients and those with a raised BMI, independent of the treatment schedule, and negatively influenced PROs of function and quality of life. Conclusion: One-third of the PsA patients with acceptable disease state according to the treating rheumatologist did not fulfil the MDA criteria and had residual disease activity on both subjective and objective disease activity measurements. As residual disease activity was associated with worse PROs, future strategy trials should evaluate if treatment adjustments are beneficial for this patient group.


Asunto(s)
Artritis Psoriásica/psicología , Disentimientos y Disputas , Medición de Resultados Informados por el Paciente , Reumatólogos/psicología , Evaluación de Síntomas/psicología , Anciano , Artritis Psoriásica/patología , Artritis Psoriásica/terapia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico/métodos , Examen Físico/psicología , Inducción de Remisión , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Resultado del Tratamiento
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