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1.
Instr Course Lect ; 69: 255-272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017732

RESUMO

Compared with other joints in the body, examination of the shoulder continues to be a challenge for practitioners, whether they be trainers, physical therapists, primary care physicians, or orthopedic surgeons. There are many reasons for this challenge, the primary being the highly complex architecture of bony and soft-tissue anatomy which allows for the greatest range of motion of any joint of the body. As a result, the clinical examination as Ralph Hertel, MD, has commented "perhaps it is just not easy." His comment reflects that one cannot just expect to understand how to interpret the examination unless the observer has some knowledge of how the shoulder complex works, how to perform the basics of the examination, how to interpret radiographs, and how to integrate these variables into a diagnosis. This chapter will attempt to delineate the principles which make the shoulder examination more attainable, plus highlight the areas where a combination of factors is necessary to arrive at a diagnosis.


Assuntos
Articulação do Ombro , Ombro , Humanos , Exame Físico , Radiografia , Amplitude de Movimento Articular
2.
Instr Course Lect ; 69: 349-362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017737

RESUMO

Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.


Assuntos
Exame Físico , Doenças da Coluna Vertebral , Coluna Vertebral , Adolescente , Criança , Humanos
3.
Instr Course Lect ; 69: 509-522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017749

RESUMO

Numerous nerve disorders affect the foot and ankle, and specificity is essential for diagnosis. We review a systematic process to conduct a history and physical examination for nerve disorders and how to categorize these pathologies. Several common nerve-related pathologies of the foot and ankle are then described. Finally, we discuss systemic neurologic conditions which can cause symptoms in the foot and ankle. A vast array of treatment options exist for painful nerve lesions of the foot: both nonsurgical and surgical. Treatment options depend on the affected nerve's function and location within the foot. Essential nerves will be managed much differently than nonessential nerves. Also important to consider is whether this is the initial treatment, treatment following one recurrence, or treatment following multiple recurrences. After the proper diagnosis is made, consideration of these principles should allow for early and effective interventions to be made. Recalcitrant nerve conditions of the foot and ankle can represent a management challenge. As with primary nerve disorders, surgical management is warranted in cases where conservative management fails. Furthermore, patients may continue to experience neurologic complications or recurrence of symptoms even after surgical intervention, at which point further surgical procedures may be undertaken. Neurolysis, transection with or without containment, barrier procedures, and peripheral nerve stimulation are viable potential surgical options for patients with chronic or recurrent nerve pain, depending upon patient-specific underlying pathology.


Assuntos
Tornozelo , , Neuralgia/terapia , Articulação do Tornozelo , Humanos , Exame Físico
4.
Instr Course Lect ; 69: 597-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017754

RESUMO

Low back pain is one of the most common reasons for physician visits, leading to high heath care costs and disability. Patients may present to primary care physicians, pain management physicians, chiropractors, physical therapists, or surgeons with these complaints. A thorough history and physical examination coupled with judicious use of advanced imaging studies will aid in determining the etiology of the pain. As most cases of low back pain are self-limited and will not develop into chronic pain, nonsurgical treatment is the mainstay. First-line treatment includes exercise, superficial heat, massage, acupuncture, or spinal manipulation. Pharmacologic treatment should be reserved for patients unresponsive to nonpharmacologic treatment and may include NSAIDs or muscle relaxants. Surgery is reserved for patients with pain nonresponsive to a full trial of nonsurgical interventions and with imaging studies which are concordant with physical examination findings.


Assuntos
Dor Lombar , Vértebras Lombares , Cirurgiões Ortopédicos , Adulto , Humanos , Exame Físico , Guias de Prática Clínica como Assunto , Cirurgiões
5.
Instr Course Lect ; 69: 607-624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017755

RESUMO

Symptomatic lumbar disk herniation is abundantly common in adult patients and can cause significant pain and disability in those affected. Both surgical and nonsurgical treatment options exist for the management of this heterogeneous condition; thus, it is important that surgeons and other healthcare providers understand the appropriate indications for surgical treatment of patients with lumbar disk herniation. Though there is still lack of consensus regarding the optimal treatment of lumbar disk herniation in all situations, many principles and preferred techniques are agreed upon in the literature. In this chapter, we provide an in-depth overview of the anatomy and pathophysiology, natural history, physical examination, treatment decision making, surgical treatment options, and postoperative complications pertaining to lumbar disk herniation.


Assuntos
Deslocamento do Disco Intervertebral , Vértebras Lombares , Adulto , Aconselhamento , Humanos , Dor , Exame Físico , Resultado do Tratamento
6.
Postgrad Med ; 132(1): 102-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31928276

RESUMO

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.


Assuntos
Preferência do Paciente , Exame Físico , Atenção Primária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico/métodos , Exame Físico/psicologia , Inquéritos e Questionários , Adulto Jovem
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 18-20, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914564

RESUMO

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.


Assuntos
Exame Físico/normas , Guias de Prática Clínica como Assunto/normas , População Rural , China , Humanos
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 37-38, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914566

RESUMO

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.


Assuntos
Exame Físico/normas , Guias de Prática Clínica como Assunto/normas , População Rural , Adolescente , Adulto , China , Humanos , Padrões de Prática Médica/legislação & jurisprudência
9.
Nursing ; 50(2): 48-55, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31977806

RESUMO

Low back pain (LBP) is one of the most frequent patient complaints in primary care. This article discusses the assessment and treatment of patients with LBP, including nonpharmacologic and pharmacologic approaches.


Assuntos
Dor Lombar/enfermagem , Atenção Primária à Saúde , Adulto , Humanos , Anamnese , Avaliação em Enfermagem , Exame Físico/enfermagem , Fatores de Risco
10.
Einstein (Sao Paulo) ; 18: eGS4913, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31531556

RESUMO

OBJECTIVE: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. METHODS: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. RESULTS: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. CONCLUSION: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atenção Primária à Saúde/estatística & dados numéricos , Retina , Doenças Retinianas/diagnóstico , Idoso , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/economia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Exame Físico , Estudos Retrospectivos , Telemedicina , Acuidade Visual
11.
J Surg Res ; 245: 656-662, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31585352

RESUMO

BACKGROUND: Incisional hernia (IH) is one of the most frequent complications after abdominal surgery. Follow-up with regard to IH remains challenging. Physical examination and imaging to diagnose IH are time-consuming and costly, require devotion of both the physician and patient, and are often not prioritized. Therefore, a patient-reported diagnostic questionnaire for the diagnosis of IH was developed. Objective of this study was to validate this questionnaire in a consecutive sample of patients. METHODS: All patients above 18 y of age who underwent abdominal surgery with a midline incision at least 12 mo ago were eligible for inclusion. Included patients visited the outpatient clinic where they filled out the diagnostic questionnaire and underwent physical examination. The questionnaire answers were compared with the physical examination results. The diagnostic accuracy of the entire questionnaire was assessed by multivariable logistic regression. RESULTS: In total, 241 patients visited the outpatient clinic prospectively. 54 (22%) patients were diagnosed with IH during physical examination. The area under the receiver operating characteristic curve of the diagnostic questionnaire was 0.82. Sensitivity and specificity were respectively 81.5% and 77.5%. The positive and negative predictive values were 51.2% and 94%, respectively. Ten (19%) patients with IH were missed by the questionnaire. CONCLUSIONS: The patient-reported diagnostic questionnaire as currently proposed cannot be used to diagnose IH. However, given the high negative predictive value, the questionnaire might be used to rule out an IH. Long-term follow-up for the diagnosis of IH should be performed by clinical examination.


Assuntos
Assistência ao Convalescente/métodos , Hérnia Incisional/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Exame Físico , Ferida Cirúrgica/complicações , Idoso , Estudos de Viabilidade , Feminino , Humanos , Hérnia Incisional/etiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
12.
Emerg Med Clin North Am ; 38(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757244

RESUMO

Acute musculoskeletal injuries are commonly seen in our emergency departments, and are commonly missed. There are many reasons for more missed injures and a significant one is over-reliance on radiographs. An emergency department orthopedic assessment goes far beyond the radiographs. A focused, yet comprehensive history is vital to understand the forces and mechanism of injury. That injury must be understood in the context of the patient, because older and much younger patients have weaker bone. Finally, the physical examination is instrumental in localizing the pathology and is essential to put radiograph results in the proper clinical context.


Assuntos
Gerenciamento Clínico , Medicina de Emergência/métodos , Procedimentos Ortopédicos/métodos , Exame Físico/métodos , Radiografia/métodos , Ferimentos e Lesões/terapia , Humanos , Ferimentos e Lesões/diagnóstico
15.
S D Med ; 72(10): 451-453, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31816205

RESUMO

The Objective Structured Clinical Examination (OSCE) was introduced in the mid-1970s as a method of testing students' clinical skills with more objectivity. The University of South Dakota Sanford School of Medicine (USD SSOM) administered its first OSCE to third year students in 1996. At a national level, the U.S. Medical Licensing Examination (USMLE) incorporated clinical skills testing for all medical students in the form of Step 2 Clinical Skills (CS) in 2004. The USMLE Step 2 CS exam has both proponents and opponents, but at this time will continue to be used. The USD SSOM OSCE has evolved over the years to include standardized patients, simulations, and note writing in an effort to better assess students and prepare them for Step 2 CS. Currently, the USD SSOM OSCE administered at the end of Pillar 2 is a requirement for graduation. The formal OSCE committee works diligently throughout the year to provide students with ample opportunity to prepare them for success. A significant ongoing part of student preparation is the clinical training that they receive in the offices of dedicated community preceptors.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Avaliação Educacional , Estudantes de Medicina , Humanos , Exame Físico
16.
Laryngorhinootologie ; 98(12): 898-899, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31810106
18.
JAMA ; 322(23): 2323-2333, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846019

RESUMO

Importance: Hip osteoarthritis (OA) is a common cause of pain and disability. Objective: To identify the clinical findings that are most strongly associated with hip OA. Data Sources: Systematic search of MEDLINE, PubMed, EMBASE, and CINAHL from inception until November 2019. Study Selection: Included studies (1) quantified the accuracy of clinical findings (history, physical examination, or simple tests) and (2) used plain radiographs as the reference standard for diagnosing hip OA. Data Extraction and Synthesis: Studies were assigned levels of evidence using the Rational Clinical Examination scale and assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. Data were extracted using individual hips as the unit of analysis and only pooled when findings were reported in 3 or more studies. Main Outcomes and Measures: Sensitivity, specificity, and likelihood ratios (LRs). Results: Six studies were included, with data from 1110 patients and 1324 hips, of which 509 (38%) showed radiographic evidence of OA. Among patients presenting to primary care physicians with hip or groin pain, the affected hip showed radiographic evidence of OA in 34% of cases. A family history of OA, personal history of knee OA, or pain on climbing stairs or walking up slopes all had LRs of 2.1 (sensitivity range, 33%-68%; specificity range, 68%-84%; broadest LR range: 95% CI, 1.1-3.8). To identify patients most likely to have OA, the most useful findings were squat causing posterior pain (sensitivity, 24%; specificity, 96%; LR, 6.1 [95% CI, 1.3-29]), groin pain on passive abduction or adduction (sensitivity, 33%; specificity, 94%; LR, 5.7 [95% CI, 1.6-20]), abductor weakness (sensitivity, 44%; specificity, 90%; LR, 4.5 [95% CI, 2.4-8.4]), and decreased passive hip adduction (sensitivity, 80%; specificity, 81%; LR, 4.2 [95% CI, 3.0-6.0]) or internal rotation (sensitivity, 66%; specificity, 79%; LR, 3.2 [95% CI, 1.7-6.0]) as measured by a goniometer or compared with the contralateral leg. The presence of normal passive hip adduction was most useful for suggesting the absence of OA (negative LR, 0.25 [95% CI, 0.11-0.54]). Conclusions and Relevance: Simple tests of hip motion and observing for pain during that motion were helpful in distinguishing patients most likely to have OA on plain radiography from those who will not. A combination of findings efficiently detects those most likely to have severe hip OA.


Assuntos
Articulação do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico , Exame Físico , Radiografia , Diagnóstico Diferencial , Feminino , Articulação do Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Dor/etiologia , Amplitude de Movimento Articular , Sensibilidade e Especificidade
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(6): 1085-1090, 2019 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-31848509

RESUMO

OBJECTIVE: To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population. METHODS: We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined. RESULTS: A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was -1. CONCLUSION: The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.


Assuntos
Osteoporose , Autoavaliação , Absorciometria de Fóton , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Medição de Risco , Sensibilidade e Especificidade
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