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1.
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
2.
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
3.
Acta otorrinolaringol. esp ; 70(6): 364-372, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184882

RESUMO

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


Assuntos
Humanos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Manuseio das Vias Aéreas/normas , Exame Físico/métodos , Sociedades Médicas/normas , Exame Físico/normas
4.
Aust Vet J ; 97(12): 490-498, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31565798

RESUMO

OBJECTIVE: The objective is to study the correlations between physical examination and stifle radiography findings and severity of arthroscopic cranial cruciate ligament (CrCL) fibre damage in dogs with cruciate rupture (CR). DESIGN: Design Prospective clinical study. METHODS: Twenty-nine client-owned dogs with CR underwent physical examination, stifle radiography and arthroscopy, and the findings were recorded. Initial examination was repeated after sedation and after general anaesthesia. The Spearman rank correlations of examination variables with diagnostic imaging were examined. RESULTS: Overall, cranial tibial translation assessed by the tibial compression test in extension showed correlation with arthroscopic CrCL fibre damage (P < 0.05). Correlations between severity of cranial drawer laxity and arthroscopic CrCL fibre damage were not significant. Under general anaesthesia, stifle laxity tests were positively correlated with lameness severity grade (SR ≥ 0.41, P < 0.05). Meniscal damage was correlated with pain on the internal rotation of the tibia (SR = 0.42, P < 0.05) and severity of radiographic osteophytosis (SR = 0.53, P = 0.01). CONCLUSION: Detection and estimation of severity of cranial tibial translation enable the diagnosis of CR and also the inference of the severity of CrCL fibre rupture, particularly with the tibial compression test in extension. Severity of joint laxity is best assessed under general anaesthesia. Such knowledge should reduce the risk of misdiagnosis and may enhance early diagnosis and treatment of dogs with CR over time.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Cães/lesões , Coxeadura Animal/diagnóstico por imagem , Exame Físico/veterinária , Animais , Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Artroscopia/veterinária , Feminino , Quadril/diagnóstico por imagem , Coxeadura Animal/etiologia , Masculino , Exame Físico/métodos , Índice de Gravidade de Doença , Coluna Vertebral/diagnóstico por imagem
7.
J Laparoendosc Adv Surg Tech A ; 29(10): 1349-1351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483186

RESUMO

Introduction: The diagnosis of indirect inguinal hernia is usually based on clinical grounds. Physical examination generally showed an inguinal bulge. However, when no bulge is seen, the silk glove sign (SGS) or palpating the processus vaginalis over the pubic tubercle can be useful. The aim of our study is to compare the accuracy of the presence of inguinal bulge with the presence of SGS. Materials and Methods: We conducted a retrospective of all patients undergoing laparoscopic inguinal hernia repair between January 2002 and November 2015. Preoperative diagnosis was obtained by physical examination. The presence of an inguinal bulge or SGS was considered diagnostic of indirect inguinal hernia. Intraoperative diagnosis was made to laparoscopic findings. The sample was divided into two groups: group 1 including the patient with inguinal bulge and group 2 including those with SGS. Results: A total of 1024 inguinal canals were evaluated. Inguinal bulge was observed in 379 inguinal canals (group 1), whereas SGS was detected in 196 (group 2). There were statistically significant differences between both groups regarding gestational age, birth weight, surgical age, and surgical weight. Prematurity and previous episodes of incarceration were statistically more common in group 1 (P < .001). The positive predictive value in group 1 was 98.7%, whereas in group 2 was 86.73% (P < .001). Conclusions: Although we have found that the success rate for accurate diagnosis is higher in patients with inguinal bulge, SGS can be useful in detecting indirect inguinal hernia.


Assuntos
Hérnia Inguinal/diagnóstico , Canal Inguinal/patologia , Exame Físico/métodos , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/patologia , Humanos , Laparoscopia , Masculino , Estudos Retrospectivos
9.
J Autism Dev Disord ; 49(12): 4807-4819, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448383

RESUMO

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.


Assuntos
Transtorno do Espectro Autista/psicologia , Pais/psicologia , Exame Físico/normas , Puberdade/psicologia , Autorrelato/normas , Adolescente , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/fisiopatologia , Criança , Coleta de Dados/métodos , Coleta de Dados/normas , Feminino , Humanos , Estudos Longitudinais , Masculino , Exame Físico/métodos , Estudos Prospectivos , Puberdade/fisiologia , Autoavaliação
10.
Aerosp Med Hum Perform ; 90(9): 813-818, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31426898

RESUMO

INTRODUCTION: Body composition (BC) measurements are used to determine qualification for enlistment and to ensure active members are meeting standards. Although there is extensive research on BC in active-duty military, very few have examined ROTC cadets. The purpose of this study was to identify and quantify differences in BC between freshman/sophomore [underclass (UND)] and junior/senior [upperclass (UPP)] ROTC cadets by using bioelectrical impedance spectroscopy (BIS).METHODS: UND (N = 21) and UPP (N = 15) Air Force ROTC cadets volunteered for this study. BIS was used to measure fat mass percentage (FM%), fat free mass percentage (FFM%), total body water percentage (TBW%), extracellular fluid percentage (ECF%), and intracellular fluid percentage (ICF%). Separate one-way ANOVAs were run between UND and UPP for all dependent variables with a Bonferroni correction factor. Additionally, a Pearson correlation between abdominal circumference (AC) and FM% was conducted.RESULTS: No significant differences were observed between the UND and UPP groups' BMI. However, significant differences were observed for ECF%, ICF%, TBW%, FFM%, and FM% in which the UPP had a higher TBW%, ICF%, FFM%, and a lower ECF% and FM% compared to the UND.CONCLUSIONS: This study observed significant differences in BC across class ranks in ROTC cadets. Findings from this study suggest that due to an increased exposure to ROTC training, UPP cadets have a more ideal body composition (FFM% and FM%) when compared to UND cadets.Johnson QR, Mackey CS, Muddle TD, Smith DB, DeFreitas JM. Body composition comparison of upper- and underclass Reserve Officers Training Corps cadets. Aerosp Med Hum Perform. 2019; 90(9):813-818.


Assuntos
Medicina Aeroespacial/normas , Composição Corporal/fisiologia , Militares , Exame Físico/métodos , Aptidão Física/fisiologia , Adolescente , Impedância Elétrica , Feminino , Humanos , Masculino , Adulto Jovem
11.
J Hand Surg Asian Pac Vol ; 24(3): 311-316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438792

RESUMO

Background: Chronic exertional compartment syndrome (CECS) is a rare condition, which generally occurs in athletes. Few tools are available for diagnosis and treatment evaluation. We examined pre- and post- exertional forearm magnetic resonance imaging (MRI) before and after fasciotomy since 2013. The purpose of this study was to evaluate the efficacy of pre- and post-exertional MRI before and after fasciotomy. Methods: We treated 8 forearms of 5 patients diagnosed with CECS of the forearms since 2013, including 6 forearms of 3 motocross racers, 1 forearm of 1 baseball pitcher, 1 forearm of 1 manual laborer with a history of muscle contusion. We obtained pre- and post-exertional MRI before and after fasciotomy in all cases. Pre-exertional MRI was obtained when the patient was at rest without any symptom. Post-exertional MRI was obtained after the patients repeated "grip and release" using a hand gripper with maximum effort for approximately 10 minutes until symptoms occurred. We compared MRI findings before and after fasciotomy and evaluated the correlation with clinical outcome. Results: Symptoms disappeared completely in all 3 motocross racers after fasciotomy. MRI at rest showed no abnormal high signals in all cases both before and after fasciotomy. On post-exertional MRI, T2 high area presented mainly in flexor digitorum profundus (FDP) and brachioradialis (BR) and disappeared completely after surgery. Symptoms persisted in the pitcher and the laborer after fasciotomy. T2 high area presented mainly in FDP on post-exertional MRI before fasciotomy and remained on post-exertional MRI after fasciotomy in these two patients. These intensity changes correlated strongly with their symptoms. Conclusions: We performed pre- and post-exertional MRI before and after fasciotomy. The intensity change in T2-weighted images on post-exertional MRI correlated strongly with their symptoms. Post-exertional MRI is useful for diagnosis and treatment evaluation in CECS.


Assuntos
Síndromes Compartimentais/diagnóstico , Antebraço/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Exame Físico/métodos , Esforço Físico , Adulto , Síndromes Compartimentais/cirurgia , Fasciotomia , Humanos , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
12.
Eur J Radiol ; 118: 239-244, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439248

RESUMO

PURPOSE: to review the role of the radiologist in reporting pre-signing medical imaging prior to athlete transfer between clubs. METHOD: When a professional athlete transfers from one club to another they may undergo a transfer or "pre-signing" medical examination, of which imaging forms a major component. The purpose of imaging is to enable the overseeing sports physician to make a risk assessment on the athlete that may influence decisions such as the duration of contract offered. Imaging studies have to be performed and reported often within limited time constraints, usually by MSK radiologists specialised in sports imaging. This article describes the role of the sports radiologist in reporting pre-signing medical imaging studies, and discusses some of the common pathology identified, as well as some of the ethical and medicolegal issues encountered. RESULTS: Not applicable. This is a review article. CONCLUSION: the sports radiologists report of the pre-signing medical is an important component of the decision making process to sign an athlete, and is closely linked to the physical examination.


Assuntos
Atletas , Exame Físico/métodos , Papel do Médico , Radiologistas , Futebol/lesões , Medicina Esportiva/métodos , Traumatismos do Tornozelo/diagnóstico , Traumatismos em Atletas/diagnóstico , Tomada de Decisão Clínica/métodos , Humanos , Traumatismos do Joelho/diagnóstico , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Pelve/lesões , Lesões do Ombro/diagnóstico
13.
Neonatal Netw ; 38(2): 98-106, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470372

RESUMO

BACKGROUND: VACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT. IMPLICATIONS FOR PRACTICE: Respiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.


Assuntos
Canal Anal/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas , Rim/anormalidades , Deformidades Congênitas dos Membros , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Situs Inversus , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Assistência ao Convalescente/métodos , Canal Anal/fisiopatologia , Diagnóstico Diferencial , Esôfago/fisiopatologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Recém-Nascido , Rim/fisiopatologia , Deformidades Congênitas dos Membros/complicações , Deformidades Congênitas dos Membros/diagnóstico , Deformidades Congênitas dos Membros/fisiopatologia , Deformidades Congênitas dos Membros/terapia , Triagem Neonatal/métodos , Administração dos Cuidados ao Paciente/métodos , Exame Físico/métodos , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Situs Inversus/complicações , Situs Inversus/diagnóstico , Situs Inversus/fisiopatologia , Situs Inversus/terapia , Coluna Vertebral/fisiopatologia , Traqueia/fisiopatologia , Doenças do Nervo Vestibulococlear/congênito , Doenças do Nervo Vestibulococlear/diagnóstico
14.
Neonatal Netw ; 38(2): 107-108, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470374

RESUMO

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.


Assuntos
Cuidado do Lactente , Doenças do Recém-Nascido , Terapia Intensiva Neonatal , Administração dos Cuidados ao Paciente , Humanos , Cuidado do Lactente/ética , Cuidado do Lactente/métodos , Cuidado do Lactente/psicologia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Unidades de Terapia Intensiva Neonatal/organização & administração , Terapia Intensiva Neonatal/ética , Terapia Intensiva Neonatal/métodos , Terapia Intensiva Neonatal/psicologia , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Conforto do Paciente , Exame Físico/métodos , Exame Físico/psicologia , Relações Profissional-Família , Fatores de Tempo
15.
BMJ ; 366: l4225, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340932

RESUMO

OBJECTIVES: To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018. STUDY SELECTION CRITERIA: English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP. DATA EXTRACTION: Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model. RESULTS: 40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72). CONCLUSIONS: Absence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests. REGISTRATION: PROSPERO CRD42018105642.


Assuntos
Estado Terminal , Hipertensão Intracraniana/diagnóstico , Humanos , Exame Físico/métodos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana/métodos
16.
Mayo Clin Proc ; 94(8): 1427-1435, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31303427

RESUMO

OBJECTIVE: To measure McArdle sign (rapidly reversible weakness induced by neck flexion) both qualitatively and quantitatively and to evaluate its specificity and clinical utility for diagnosis of multiple sclerosis (MS). PATIENTS AND METHODS: In this prospective study, McArdle sign was evaluated by a technician blinded to diagnosis by measuring changes in finger extensor strength in successive trials of neck extension and flexion, first clinically and then with a torque measurement device. We studied 25 healthy controls and 81 patients with finger extensor weakness. Patients were not selected for having McArdle sign. Fifty-two patients had MS, 24 had other myelopathies, and 5 had peripheral nerve lesions accounting for their weakness. The study was conducted between February 1, 2016, and June 30, 2017. RESULTS: The median clinical McArdle sign and the 2 quantitative measures of neck flexion-induced strength reduction were greater in patients with MS than in the other groups (P<.001). Baseline strength did not confound the difference. The area under the receiver operating characteristic curve was 0.84 (95% CI, 0.75-0.93) comparing patients with MS vs healthy controls and 0.84 (95% CI, 0.75-0.93) comparing MS vs patients with other myelopathies. The 2 quantitative and 1 clinical measurement of McArdle sign by the technician who performed the quantitative testing were correlated (r=.57 and r=.58; P<.001), and in turn, the technician's and unblinded referring physician's clinical assessments were correlated (r=.58; P<.001). McArdle sign was evident in some patients who had minor disability and who were in early phases of MS. CONCLUSION: McArdle sign, when defined as greater than 10% neck flexion-induced reduction in strength, is entirely specific and 65% sensitive for a diagnosis of MS when compared with other conditions that mimic MS-associated myelopathy. It may facilitate diagnosis in certain clinical situations. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03122873.


Assuntos
Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico , Debilidade Muscular/diagnóstico , Exame Neurológico/métodos , Exame Físico/métodos , Adulto , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/classificação , Análise Multivariada , Debilidade Muscular/classificação , Projetos Piloto , Curva ROC , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença
17.
Folia Med (Plovdiv) ; 61(2): 289-295, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301660

RESUMO

BACKGROUND: Cervical cancer is the tenth most frequent cancer in Egyptian women. The Papanicolaou screening test is not suitable for rural area as most follow-up consultations never take place. AIM: To evaluate visual inspection of the cervix with acetic acid as a screening test. MATERIALS AND METHODS: According to the inclusion criteria, women aged 25-60 years commuting to a gynecological out-patient clinic at the University Hospital went through a visual inspection of the cervix with acetic acid (VIA). Exclusion criteria were women below 25 years, unmarried, pregnant, menstruating, known to have cancer, having a precancerous lesion or a cervical operation. Multiple punch biopsies were done for all VIA positive cases and a subsample of the VIA negative cases underwent the same. Cervical intraepithelial neoplasia (CIN) was evaluated. In addition, the site of the lesion was assessed. SPSS was used for the statistical analysis. RESULTS: Of the 379 screened women, 17.1% were found to be VIA positive. The sensitivity was found to be 91.3% (79.6%-96.5%) and the specificity 68.5% (57.1%-77.9%). Significantly more women with positive punch biopsies complained of contact bleeding than those with negative punch biopsies. CIN2 and CIN3 were mostly found (77.8%) in the right quadrant, while 74% of CIN1 was found in the lower right and left quadrant. CONCLUSION: VIA is weak as a test to stand alone but may need a combination with other indicators such as the location of the lesion on the right side of the cervix or contact bleeding. A combined indicator may detect precancerous cervix.


Assuntos
Ácido Acético , Biópsia/métodos , Neoplasia Intraepitelial Cervical/patologia , Indicadores e Reagentes , Exame Físico/métodos , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Detecção Precoce de Câncer , Egito , Feminino , Humanos , Pessoa de Meia-Idade , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico
18.
BMC Palliat Care ; 18(1): 57, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307441

RESUMO

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.


Assuntos
Constipação Intestinal/etiologia , Neoplasias/complicações , Cuidados Paliativos/métodos , Exame Físico/normas , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Exame Físico/métodos , Exame Físico/tendências , Estudos Retrospectivos , Reino Unido
19.
Internist (Berl) ; 60(8): 799-804, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31278434

RESUMO

The skin is one of the organs most commonly affected by vasculitis and the only one that is open to direct inspection. Cutaneous vasculitis can be part of a systemic vasculitis, a variant restricted to the skin (e.g. systemic and cutaneous IgA1 vasculitis) or an independent cutaneous form (recurrent macular vasculitis in hypergammaglobulinemia, nodular vasculitis). For the nomenclature and classification of cutaneous vasculitides the scheme of the Chapel Hill Consensus Conference can be used and the vessels mainly affected determine the clinical picture of individual forms of vasculitis. Some cutaneous efflorescences and their distribution are so characteristic for certain forms of vasculitis that they provide diagnostic indications or even diagnostic criteria. A palpable purpura on the legs is typical for involvement of postcapillary venules in the context of immune complex vasculitis. If arterioles or venules in the dermis are additionally affected, the clinical presentation is that of plaques with marginal offshoots and central hemorrhagic blisters or necrosis (retiform purpura). In contrast to the purpura in occluding vasculopathies, which shows no or little surrounding erythema, the purpura in vasculitis is accompanied by an inflammatory erythema. In vasculitides of the arterioles and small-caliber arteries in the subcutaneous tissue, visible or only palpable nodules exist surrounded by an irregular livedo or also retiform purpura. Understanding how vasculitis-induced efflorescence arises and the histological manifestations helps their recognition during physical examinations in daily practice and is an important guide in the diagnosis and classification of vasculitides.


Assuntos
Exame Físico/métodos , Dermatopatias Vasculares/diagnóstico , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Pele/patologia , Vasculite/classificação , Vasculite/diagnóstico , Eritema , Humanos , Púrpura , Púrpura de Schoenlein-Henoch , Terminologia como Assunto , Vasculite/complicações , Vasculite/imunologia
20.
Int J Rehabil Res ; 42(3): 240-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283550

RESUMO

The objective of this study was to develop an extensive assessment list for individuals with knee osteoarthritis based on the International Classification of Functioning, Disability and Health (ICF) osteoarthritis comprehensive Core Set. Ten experienced physical therapists including five lecturers and five clinicians were purposively nominated to form an expert panel. Consensus among the experts was obtained through a four-iteration Delphi technique. A list of ICF categories and their third- and fourth-level categories were selected and matched with outcome measures associated with knee osteoarthritis. The expert panel agreed that 26 out of 38 second-level categories of the comprehensive ICF core set for osteoarthritis were relevant to identify problems related to knee osteoarthritis. The information relevant to the specific categories for knee osteoarthritis was obtained from self-reported, subjective observation and physical examination. The extensive assessment list for knee osteoarthritis based on the comprehensive ICF core set for osteoarthritis was assembled. This assessment tool can be used to expansively identify the multidimensional disabilities of impairment, activity limitation and participation restriction in individuals with knee osteoarthritis.


Assuntos
Avaliação da Deficiência , Osteoartrite do Joelho/fisiopatologia , Exame Físico/métodos , Técnica Delfos , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Fisioterapeutas , Tailândia
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