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1.
Clin Sports Med ; 40(1): 53-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187613

RESUMO

The diagnosis of sport-related concussion is still based primarily on history and physical examination. Use of a standardized history and examination form is recommended. There have been many tests investigated, but none have been proven to be sensitive and specific for the diagnosis of concussion. Sideline management is based on recognition, diagnosis, and initial treatment. It is clear that symptoms of a concussion can worsen with continued play, and so, if a concussion is suspected based on observation, history, and physical examination, then the athlete should be removed from play.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Primeiros Socorros , Humanos , Anamnese , Exame Físico
2.
Clin Sports Med ; 40(1): 93-109, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33187616

RESUMO

This article provides a summary of clinical assessment methods and nonpharmacologic rehabilitation techniques used for concussed patients. It describes concussion-relevant physical examination methods to identify underlying symptom generators. This approach allows practitioners to prescribe targeted rehabilitation therapies to treat postconcussion symptoms. Evidence-based rehabilitation approaches include cervical rehabilitation, vestibulo-ocular rehabilitation, and sub-symptom threshold aerobic exercise.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Terapia por Exercício , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Terapia por Exercício/métodos , Tolerância ao Exercício , Humanos , Equipe de Assistência ao Paciente , Exame Físico , Síndrome Pós-Concussão/terapia
3.
Pediatr Rheumatol Online J ; 18(1): 85, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129319

RESUMO

BACKGROUND: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/métodos , Exame Físico/métodos , Pneumonia Viral , Reumatologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , Assistência à Saúde , Europa (Continente) , Humanos , Seleção de Pacientes , Pediatria/educação , Pediatria/organização & administração , Reumatologia/educação , Reumatologia/organização & administração , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Estados Unidos
4.
Acta Chir Orthop Traumatol Cech ; 87(5): 318-322, 2020.
Artigo em Eslovaco | MEDLINE | ID: mdl-33146598

RESUMO

Anterior cruciate ligament (ACL) rupture is one of the most common traumatic injuries of the knee joint. Acute knee injury is often characterized by pain and the typical accompanying rupture sound. The injured person often feels pain in the knee, with swelling, the movement is painful in the full range of motion. The most commonly used test procedures for rupture include Lachman test, pivot shift test, anterior drawer and lever sign test. This review includes a description of individual tests and the diagnostic value of examination after the ACL rupture. The sensitivity and specificity of the lever sign test was 0.92-1.00, the specificity was 0.94-1.00. The anterior drawer testing reported sensitivity values ranged from 0.18 to 0.92 and specificity values ranged from 0.78 to 0.98. The sensitivity and specificity of the pivot shift test ranged from 0.18 to 0.48 and the specificity from 0.90 to 0.99. The sensitivity and specificity of the Lachman test were 0.63-0.93 and the specificity was 0.55-0.99. The lever sign test, the pivot shift test, the anterior drawer test and the Lachman test are valid parts of the anterior cruciate ligament examination with respect to the prediction of anterior cruciate ligament rupture using Magnetic Resonance Imaging and arthroscopy. Key words: rupture ligamentum cruciatum anterius, test maneuvers, lever sign test, pivot shift test, anterior drawer, Lachman test.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho , Exame Físico , Ruptura
5.
Praxis (Bern 1994) ; 109(15): 1165-1176, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33234045

RESUMO

CME Sonography 95: Sonographic Differential Diagnosis of Anterior Shoulder Pain Abstract. Anterior shoulder pain is common, and, compared to high-resolution dynamic sonography, the clinical examination is usually not precise enough for the exact classification of the cause of the pain. In this review we discuss possible causes of anterior shoulder pain with special emphasis on the ultrasound diagnosis of causes of subcoracoidal impingement and of anterior snapping syndrome. We use high-resolution ultrasound images to illustrate various possible underlying pathologies in anterior shoulder pain.


Assuntos
Síndrome de Colisão do Ombro , Articulação do Ombro , Diagnóstico Diferencial , Humanos , Exame Físico , Síndrome de Colisão do Ombro/diagnóstico , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/etiologia , Ultrassonografia
6.
Curr Sports Med Rep ; 19(11): 498-503, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33156037

RESUMO

The American Medical Society for Sports Medicine (AMSSM) convened a writing group to address the current evidence and knowledge gaps regarding preparticipation evaluation of athletes during the SARS-CoV-2 pandemic. The writing group held a series of meetings beginning in April 2020. The task force reviewed the available literature and used an iterative process and expert consensus to finalize this guidance statement that is intended to provide clinicians with a clinical framework to return athletes of all levels to training and competition during the pandemic. The statement is not intended to address treatment, infection control principles, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.


Assuntos
Infecções por Coronavirus/epidemiologia , Exame Físico/normas , Pneumonia Viral/epidemiologia , Medicina Esportiva/métodos , Atletas , Betacoronavirus , Consenso , Humanos , Pandemias , Sociedades Médicas , Esportes
7.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33106340

RESUMO

OBJECTIVES: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS: Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS: In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]). CONCLUSIONS: PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an alternative to penile inversion vaginoplasty. These surgical implications should inform decision-making when initiating PS.


Assuntos
Puberdade/efeitos dos fármacos , Caracteres Sexuais , Pessoas Transgênero , Adolescente , Mama/efeitos dos fármacos , Mama/crescimento & desenvolvimento , Estudos de Casos e Controles , Feminino , Disforia de Gênero , Identidade de Gênero , Procedimentos Cirúrgicos em Ginecologia , Humanos , Masculino , Mastectomia/métodos , Pênis/anatomia & histologia , Pênis/efeitos dos fármacos , Pênis/cirurgia , Exame Físico , Fatores Sexuais , Cirurgia de Readequação Sexual , Vagina/efeitos dos fármacos , Vagina/cirurgia , Adulto Jovem
8.
Ther Umsch ; 77(8): 349-356, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054648

RESUMO

A heart murmur - a frequent incidental finding Abstract. Heart murmurs are very common and are present in up to 80 % of school children and 52 % of adults. They originate from the transition from laminar to turbulent blood flow in patients with a structural cardiomyopathy (so-called "organic" murmurs) or in patients with normal hearts (so-called "innocent" murmurs). A detailed history and physical examination help to discriminate innocent from organic murmurs. With the wide availability of transthoracic echocardiography (TTE) cardiac auscultation has lost a lot of its importance, although it remains an important skill for the initial evaluation and triage. An innocent murmur is a minor (1 / 6 - 2 / 6), crescendo-decrescendo, mostly position-dependent, mid-systolic murmur without radiation, which needs no further workup in asymptomatic patients with normal physical capacity. A TTE should be ordered if signs for a cardiac disease are present based on history, physical examination or other tests. Diastolic and continuous murmurs are mostly pathologic and warrant further workup.


Assuntos
Sopros Cardíacos , Achados Incidentais , Adulto , Criança , Ecocardiografia , Auscultação Cardíaca , Sopros Cardíacos/diagnóstico , Humanos , Exame Físico
9.
Ther Umsch ; 77(8): 361-370, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054650

RESUMO

Incidental Proteinuria - Interpretation and Diagnosis Abstract. The incidental finding of proteinuria is common in daily clinical practice. In most cases, this is the result of a urinary dipstick test. When proteinuria is discovered as a coincidental finding, there are basically two scenarios: The dipstick test can be false or true positive. If the test is a true positive, a distinction needs to be made as to whether the proteinuria incidentally discovered is the result of a benign cause or a cause that requires further examinations or specific therapy. Therefore, in order to avoid unnecessary examinations, false positive results and benign causes such as contamination or extrarenal causes, temporary proteinuria or orthostatic proteinuria should be excluded in a first step. If there is persistent proteinuria with no obvious benign cause, the next step is to distinguish common from rare causes. It should always be explored whether there is diabetes mellitus, arterial hypertension or other cardiovascular risk factors that can explain the appearance of proteinuria. Regardless, when diagnosing persistent proteinuria for the first time, a basic assessment should be carried out, that includes serum creatinine, urinary sediment and sonography of the urinary tract. If the cause remains unclear, a kidney biopsy should be done without hesitation.


Assuntos
Hipertensão , Proteinúria , Creatinina , Humanos , Exame Físico , Proteinúria/diagnóstico , Urinálise
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1840-1843, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018358

RESUMO

Chronic wound assessment and wound healing are important for diagnostic, follow up and wound treatment. However, this growing disease affecting nearly 2 thousand million and 5.7 million people in the USA and Europe, costing around $20 billion and $8 thousand million USD per year, still relies on subjective human assessment of wounds. A scoping review allowed us to identify 109 articles that map the literature on the topic of computer vision for chronic wound assessment and healing. These results were carefully analyzed and mapped into relevant clinical challenges associated with this field, identifying the maturity of each different computer vision challenge that needs addressing. Results show that wound size and tissue type classification already have interesting work, but various other clinical areas are in need of larger datasets and computer vision research efforts for achieving a relevant impact in today's clinical routine.


Assuntos
Computadores , Cicatrização , Administração Tópica , Europa (Continente) , Humanos , Exame Físico
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4256-4260, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018936

RESUMO

The work of nurses is often associated with elevated anxiety, negative affect, and fatigue, all of which may impact both the quality of patient care and their own well-being. It is critical to understand behavioral patterns, such as human movement, that may be associated with these workplace challenges of nurses. These movement behaviors include location-based movement patterns and dynamical changes of movement intensity. Particularly, we investigated these movement-related patterns for 75 nurses, using wearable sensor recordings, collected over a continuous period of ten weeks. We first discover the location of movement patterns from the Bluetooth proximity data using topic models. We then extract the heart rate zone features from PPG readings to infer the intensity of physical movement. Our results show that the location movement patterns and dynamical changes of movement intensity offer key insights into understanding the workplace behavior of the nursing population in a complex hospital setting.


Assuntos
Transtornos de Ansiedade , Movimento , Humanos , Exame Físico , Local de Trabalho
13.
Muscle Nerve ; 62(5): 611-616, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33103253

RESUMO

We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25° and 65° of anterior elevation, or with shoulder internal rotation. VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.


Assuntos
Eletromiografia , Doenças Musculoesqueléticas/diagnóstico , Doenças Neuromusculares/diagnóstico , Exame Físico , Escápula/inervação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/fisiopatologia , Doenças Neuromusculares/diagnóstico por imagem , Doenças Neuromusculares/fisiopatologia , Adulto Jovem
14.
Rev Med Liege ; 75(10): 670-675, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33030844

RESUMO

In October 2018, the World Health Organization (WHO) has published a report condemning the practice of virginity testing, which are scientifically unfounded and turn out to be harmful for the women who are victims of these. In February 2019, the Belgian National Council of Physicians Order follows the WHO and has recalled that virginity testing is not justified, neither scientifically nor ethically. To complete these reports, the present article intends to provide to the clinician, whatever its speciality field, an up-to-date and practical guide explaining the nature of hymen, its clinical examination, the mechanism leading to the onset of the lesions, their description and their forensic interpretation. According to the legal and social aspects of forensic medicine, we also would like to recall the nature and the inherent dangers of virginity testing, as well as the legal framework of which the clinician must be aware of, in response to such a request from a patient.


Assuntos
Hímen , Médicos , Feminino , Humanos , Exame Físico , Abstinência Sexual
16.
PLoS One ; 15(9): e0238542, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886733

RESUMO

OBJECTIVES: Simulation-based training (SBT) is increasingly used to teach clinical patient-doctor communication skills (CS) to medical students. However, the long-lasting impact of this training has been poorly studied. METHODS: In this observational study we included all fourth-year undergraduate medical students from a French medical school who undertook a CS objective structured clinical examination (OSCE) and who answered a post-examination survey. OSCE scores and students' feedback were compared by whether students had received a specific CS-SBT or not 12 months prior to the OSCE. RESULTS: A total of 173 students were included in the study. Of them, 97 (56%) had followed the CS-SBT before the OSCE. Students who had undergone CS-SBT had significantly higher CS-OSCE scores in the multivariate analysis compared to untrained students (mean score 7.5/10 ±1.1 vs. 7.0/10 ±1.6, respectively, Cohen's d = 0.4, p<0.01). They also tended to experience less nervousness during the OSCE (p = 0.09) and increased motivation to further train in "real-life" internships (p = 0.08). However, they overall expressed a general lack of CS in therapeutic patient education, delivering bad news, and disclosing medical errors. CONCLUSIONS: Fourth-year medical students who benefited from a CS-SBT 12 months before examination displayed higher CS-OSCE scores than their counterparts. PRACTICE IMPLICATIONS: These results support the early introduction of practical training to improve communication skills in undergraduate medical curricula. Studies are required to assess the sustainability of this improvement over time and its effect on further real doctor-patient communication.


Assuntos
Relações Médico-Paciente , Treinamento por Simulação/métodos , Competência Clínica , Comunicação , Avaliação Educacional , Feminino , Humanos , Masculino , Simulação de Paciente , Exame Físico/métodos , Estudantes de Medicina
17.
Med Klin Intensivmed Notfmed ; 115(7): 530-538, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32885280

RESUMO

Medical history taking and the clinical examination are the traditional medical tools in making a diagnosis. Both the medical history taking and clinical examination have wrongly lost their practical value in modern emergency and intensive care medicine. When diagnosing an acutely or critically ill patient, the sequence, technique and focus of history taking and the clinical examination must be adapted to the individual situation and the condition of the patient. In this article the continuing central importance of both techniques in the diagnostics of emergency and intensive care patients is practically evaluated and discussed.


Assuntos
Cuidados Críticos , Medicina de Emergência , Estado Terminal/terapia , Serviço Hospitalar de Emergência , Humanos , Anamnese , Exame Físico
18.
Emerg Med Clin North Am ; 38(4): 771-782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981616

RESUMO

Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.


Assuntos
Parada Cardíaca/terapia , Prevenção Secundária , Temperatura Corporal , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Eletrocardiografia , Eletroencefalografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Humanos , Hipóxia-Isquemia Encefálica/prevenção & controle , Anamnese , Transferência de Pacientes , Intervenção Coronária Percutânea , Exame Físico , Prognóstico , Radiografia Torácica , Respiração Artificial , Convulsões/diagnóstico , Convulsões/etiologia , Tomografia Computadorizada por Raios X
19.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
20.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981623

RESUMO

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Assuntos
Hemorragia Gastrointestinal/terapia , Manuseio das Vias Aéreas , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Oclusão com Balão , Fatores de Coagulação Sanguínea/administração & dosagem , Transfusão de Sangue/métodos , Cateteres , Serviço Hospitalar de Emergência , Fator Xa/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Infusões Intraósseas , Infusões Intravenosas , Anamnese , Exame Físico , Inibidores da Bomba de Prótons/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Ressuscitação , Tromboelastografia , Vasoconstritores/uso terapêutico
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