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1.
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
3.
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
4.
Hu Li Za Zhi ; 67(5): 82-88, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978769

RESUMO

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.


Assuntos
Cuidado do Lactente/métodos , Exame Físico/métodos , Retinopatia da Prematuridade/diagnóstico , Desenvolvimento Infantil , Humanos , Recém-Nascido , Recém-Nascido Prematuro
6.
Mayo Clin Proc ; 95(8): 1715-1731, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753146

RESUMO

Telemedicine uses modern telecommunication technology to exchange medical information and provide clinical care to individuals at a distance. Initially intended to improve health care for patients in remote settings, telemedicine now has a broad clinical scope with the general purpose of providing convenient, safe, and time- and cost-efficient care. The coronavirus disease 2019 pandemic has created marked nationwide changes in health care access and delivery. Elective appointments and procedures have been canceled or delayed, and multiple states still have some degree of shelter-in-place orders. Many institutions are now relying more heavily on telehealth services to continue to provide medical care to individuals while also preserving the safety of health care professionals and patients. Telemedicine can also help reduce the surge in health care needs and visits as restrictions are lifted. In recent weeks, there has been a significant amount of information and advice on how to best approach telemedicine visits. Given the frequent presentation of individuals with musculoskeletal complaints to the medical practitioner, it is important to have a framework for the virtual musculoskeletal physical examination. This will be of importance as telemedicine continues to evolve, even after coronavirus disease 2019 restrictions are lifted. This article will provide the medical practitioner performing a virtual musculoskeletal examination with a specific set of guidelines, both written and visual, to enhance the information obtained when evaluating the shoulder, hip, knee, ankle, and cervical and lumbar spine. In addition to photographs, accompanying videos are included to facilitate and demonstrate specific physical examination techniques that the patient can self-perform.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Doenças Musculoesqueléticas/diagnóstico , Pandemias , Exame Físico/métodos , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Doenças Musculoesqueléticas/complicações , Pneumonia Viral/epidemiologia
7.
Med Teach ; 42(11): 1310-1312, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32726155

RESUMO

Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.


Assuntos
Betacoronavirus , Competência Clínica , Infecções por Coronavirus/diagnóstico , Relações Médico-Paciente , Pneumonia Viral/diagnóstico , Testes Imediatos/organização & administração , Atitude do Pessoal de Saúde , Infecções por Coronavirus/terapia , Humanos , Capacitação em Serviço , Pandemias , Quartos de Pacientes/organização & administração , Exame Físico/métodos , Pneumonia Viral/terapia
8.
Foot Ankle Int ; 41(8): 1017-1026, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32639852

RESUMO

The COVID-19 pandemic has necessitated a rapid and drastic shift for clinicians and patients away from traditional in-person visits and toward internet-based virtual visits. The adoption of telehealth services is likely to persist in some capacity even as in-person visits resume, given the convenience and efficiency of telehealth consultations for patients and perhaps surgeons. A primary challenge of virtual visits, particularly in the field of orthopedic surgery, is the physical examination. However, for the foot and ankle, routine physical examination maneuvers can be completed virtually with little modification given proper patient instruction. We present a comprehensive virtual foot and ankle examination for telehealth visits, including instructions that can be provided to patients verbatim and a corresponding checklist for provider documentation.Level of Evidence: Level V, expert opinion.


Assuntos
Tornozelo , , Exame Físico/métodos , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Deformidades do Pé/diagnóstico , Doenças do Pé/diagnóstico , Humanos , Ortopedia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Amplitude de Movimento Articular
10.
Otolaryngol Head Neck Surg ; 163(5): 1061-1063, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32513060

RESUMO

SARS-CoV-2, the novel coronavirus resulting in the present COVID-19 pandemic, has increased the otolaryngologist's reliance on telemedicine to manage outpatient pathology. The nature of telemedicine, however, limits a provider's ability to obtain a comprehensive physical examination, specifically of the tympanic membrane. Various smartphone-based otoscopic attachments are now available that facilitate patient-obtained otoscopic image capture of the tympanic membrane. Here, we present 3 cases in which a patient-purchased, over-the-counter otoscope was utilized to alter otologic management during the time of social distancing. Further research is necessary to improve our understanding the safety and efficacy of patient-based "at-home" otoscopic examination and to optimize the use of these devices.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Transmissão de Doença Infecciosa/prevenção & controle , Otopatias/diagnóstico , Otoscopia/métodos , Exame Físico/métodos , Pneumonia Viral/diagnóstico , Telemedicina/métodos , Adolescente , Pré-Escolar , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Otopatias/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Smartphone
11.
Cochrane Database Syst Rev ; 6: CD012824, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32524581

RESUMO

BACKGROUND: Meningitis is inflammation of the meninges, the layers that protect the brain and spinal cord. Acute meningitis is an emergent disease that develops over the course of hours to several days. Delay in treatment can lead to serious outcomes. Inflammation of the meninges is assessed by analysing cerebrospinal fluid. Identifying the pathogen in cerebrospinal fluid is another way to diagnose meningitis. Cerebrospinal fluid is collected by doing a lumbar puncture, which is an invasive test, and can be avoided if a physical examination excludes the diagnosis of meningitis. However, most physical examinations, such as nuchal rigidity, Kernig's test, and Brudzinski's test, are not sufficiently sensitive to exclude meningitis completely. Jolt accentuation of headache is a new and less well-recognised physical examination, which assesses meningeal irritation. It is judged as positive if the headache is exacerbated by rotating the head horizontally two or three times per second. A 1991 observational study initially reported high sensitivity of this examination to predict pleocytosis. Pleocytosis, an abnormally high cerebrospinal fluid sample white cell count, is an accepted indicator of nervous system infection or inflammation. Jolt accentuation of headache may therefore accurately rule out meningitis without the use of lumbar puncture. However, more recent cross-sectional studies have reported variable diagnostic accuracy. OBJECTIVES: To estimate the diagnostic accuracy of jolt accentuation of headache for detecting acute meningitis in emergency settings. Secondary objectives: to investigate the sources of heterogeneity, including study population, patient condition, and types of meningitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), and Embase (Elsevier) to 27 April 2020. We searched ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and Ichushi-Web Version 5.0 to 28 April 2020. SELECTION CRITERIA: We included cross-sectional studies that assessed the diagnostic accuracy of jolt accentuation of headache for people with suspected meningitis in emergency settings. We included participants of any age and any severity of illness. Meningitis should be diagnosed with any reference standard, such as cerebrospinal fluid pleocytosis, proof of causative agents, or autopsy. DATA COLLECTION AND ANALYSIS: Two review authors independently collated study data. We assessed methodological quality of studies using QUADAS-2 criteria. We used a bivariate random-effects model to determine summary estimates of sensitivity and specificity where meta-analysis was possible. We performed sensitivity analyses to validate the robustness of outcomes. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included nine studies (1161 participants). Five studies included only adults. Four studies included both adults and children; however, the proportion was not reported in three of these studies. The youngest child reported in the studies was aged 13 years. There was no study including only children. The reference standard was pleocytosis in eight studies, and the combination of pleocytosis and increased protein in the cerebrospinal fluid in one study. Two studies also used smear or positive culture of cerebrospinal fluid. Risk of bias and concern about applicability was high in the participant selection domain for all included studies and the consciousness subgroup. Overall, pooled sensitivity was 65.3% (95% confidence interval (CI) 37.3 to 85.6), and pooled specificity was 70.4% (95% CI 47.7 to 86.1) (very low-certainty evidence). We established the possibility of heterogeneity from visual inspection of forest plots. However, we were unable to conduct further analysis for study population, types of meningitis, and participants' condition, other than disturbance of consciousness (a secondary outcome). Amongst participants whose consciousness was undisturbed (8 studies, 921 participants), pooled sensitivity and specificity were 75.2% (95% CI 54.3 to 88.6) and 60.8% (95% CI 43.4 to 75.9), respectively (very low-certainty evidence). AUTHORS' CONCLUSIONS: Jolt accentuation for headache may exclude diagnoses of meningitis in emergency settings, but high-quality evidence to support use of this test is lacking. Even where jolt accentuation of headache is negative, there is still the possibility of acute meningitis. This review identified the possibility of heterogeneity. However, factors that contribute to heterogeneity are incompletely understood, and should be considered in future research.


Assuntos
Movimentos da Cabeça/fisiologia , Cefaleia/etiologia , Meningite/diagnóstico , Exame Físico/métodos , Doença Aguda , Adolescente , Adulto , Viés , Intervalos de Confiança , Procedimentos Clínicos , Progressão da Doença , Emergências , Reações Falso-Negativas , Reações Falso-Positivas , Cefaleia/líquido cefalorraquidiano , Humanos , Leucocitose/líquido cefalorraquidiano , Meningite/líquido cefalorraquidiano , Meningite/complicações , Rotação , Sensibilidade e Especificidade
13.
Expert Rev Cardiovasc Ther ; 18(7): 435-442, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32594825

RESUMO

INTRODUCTION: Pre-participation cardiovascular screening (PPCS) in athletes is recommended by numerous medical and sporting societies. While there is consensus that young athletes should be screened prior to participation in competitive sports, there are on-going debates regarding the true incidence of sudden cardiac death (SCD), the most frequent causes of SCD, and the optimal methods for PPCS. AREAS COVERED: This review focuses on the current evidence for the incidence of SCD, causes of SCD, and the pros and cons of a history and physical exam (H&P) and electrocardiogram (ECG) in PPCS of young competitive athletes. EXPERT OPINION: With significant controversy surrounding PPCS in athletes, a large-randomized trial powered for mortality is needed to assess the utility of PPCS and to define the optimal screening methods to detect cardiovascular diseases that may lead to SCD in competitive athletes. Until a trial of this caliber is created, controversy will remain and heterogeneity in care will exist. Future research should also define the optimal timing and frequency of PPCS given age-related penetrance of certain diseases, create evidence-based history questionnaires, continue to optimize ECG screening criteria, and create more learning modules for ECG interpretation in athletes.


Assuntos
Atletas , Morte Súbita Cardíaca/prevenção & controle , Programas de Rastreamento/métodos , Sistema Cardiovascular , Eletrocardiografia/métodos , Humanos , Incidência , Exame Físico/efeitos adversos , Exame Físico/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Esportes , Medicina Esportiva/métodos
14.
PLoS One ; 15(4): e0231547, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298328

RESUMO

BACKGROUND: The Victorian legislation prohibits sex workers from working when they have visible anogenital herpes or warts. The aim of this study was to determine the proportion of asymptomatic female sex workers (FSW) diagnosed with anogenital herpes or warts by genital examination. METHODS: We analysed all computerised medical records of consultations with FSW at the Melbourne Sexual Health Centre (MSHC) in 2018. All asymptomatic sex workers were offered screening sexually transmitted infections (STIs) and a genital examination to identify visible anogenital herpes or warts at MSHC. FSW consultations were categorised into either 'asymptomatic' or 'symptomatic' based on the presence of symptoms reported by the FSW to the triage nurse. The proportion of asymptomatic FSW diagnosed with visible anogenital herpes or warts during a routine screening examination was calculated. RESULTS: In 2018, 4055 consultations were provided to 1979 FSW. 3406 of these consultations were asymptomatic and all were examined by an experienced clinician for signs of STIs. Of these 3406 asymptomatic consultations, seven FSW (0.21%, 95% CI: 0.08% to 0.42%) were diagnosed with visible anogenital herpes and/or warts following a genital examination. Four were diagnosed with warts (0.12%, 95% CI: 0.03% to 0.30%), two with herpes (0.06%, 95% CI: 0.01% to 0.21%) and one with both herpes and warts (0.03%, 95% CI: 0.001% to 0.16%). CONCLUSION: Based on these data, approximately 500 asymptomatic FSW would need to be examined to identify one case of anogenital herpes or warts. Genital examinations consume considerable clinical resources, increase the duration of consultations and provide essentially no significant benefit to the mandated testing for gonorrhoea, chlamydia, HIV and syphilis. Our clinic will use self-collected samples and no longer examine FSW who are asymptomatic.


Assuntos
Condiloma Acuminado/diagnóstico , Genitália Feminina/patologia , Herpes Genital/diagnóstico , Programas de Rastreamento/métodos , Exame Físico/métodos , Profissionais do Sexo , Adulto , Doenças Assintomáticas , Condiloma Acuminado/patologia , Feminino , Herpes Genital/patologia , Humanos , Exame Físico/estatística & dados numéricos , Estudos Retrospectivos , Profissionais do Sexo/legislação & jurisprudência , Fatores de Tempo , Vitória
15.
Med Clin North Am ; 104(3): 439-454, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312408

RESUMO

Anorexia and cachexia, nausea and vomiting, and constipation are gastrointestinal symptoms that commonly accompany serious illness. Basic science and clinical research continue to improve the understanding of their pathophysiology. Thorough assessment necessitates history, physical examination, and laboratory and diagnostic testing. Pharmacologic management attempts to counteract or reverse the underlying pathophysiologic mechanisms that accompany each symptom, which may benefit from a multimodal approach to achieve adequate control. Future improvements in management require investments in clinical research to determine the efficacy of novel agents along with comparator studies to better understand which treatments should be used in what sequence or combination.


Assuntos
Anorexia/tratamento farmacológico , Caquexia/tratamento farmacológico , Constipação Intestinal/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Anorexia/epidemiologia , Anorexia/fisiopatologia , Biomarcadores/metabolismo , Caquexia/epidemiologia , Caquexia/fisiopatologia , Terapia Combinada/métodos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Estado Terminal , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Humanos , Inflamação/metabolismo , Inflamação/prevenção & controle , Náusea/epidemiologia , Náusea/fisiopatologia , Cuidados Paliativos/métodos , Exame Físico/métodos , Exame Físico/normas , Qualidade de Vida/psicologia , Receptores de Neurotransmissores/efeitos dos fármacos , Vômito/epidemiologia
16.
Curr Opin Anaesthesiol ; 33(3): 343-353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32324662

RESUMO

PURPOSE OF REVIEW: To review the perioperative applications of point-of-care ultrasound (POCUS). RECENT FINDINGS: The role of point-of-care ultrasonography for perioperative care is expanding with respect to perioperative application. The imaging approach can complement the physical exam and provide additional information for decision-making in pediatric perioperative medicine. This review will focus on applications in the following organ systems: airway, cardiac, pulmonary and gastric. Specifically, POCUS of the airway has been used to optimize endotracheal tube depth, aid in tube size selection and predict difficulty with laryngoscopy and intubation. Lung POCUS has been used to assess for causes hypoxemia as well as to optimize ventilatory mechanics. Cardiac POCUS has been used for assessment of hemodynamics, valvular and ventricular function. Gastric ultrasound has emerged as an evaluative mechanism of gastric content in the setting of fasting as well as to confirm placement of gastric tubes. The applications of POCUS in the perioperative setting continue to evolve as a reliable diagnostic tool that can assist in timely diagnosis, improve procedural safety and has the potential to improve patient outcomes. SUMMARY: The utility of perioperative POCUS has been well demonstrated, specifically for examination of the airway, stomach and cardiopulmonary system. It is advisable for the novice sonographer to perform POCUS within the guidelines set by the American Society of Echocardiography regarding basic POCUS. As with all diagnostic modalities, understanding the limitations of ultrasound and POCUS as well as continuous self-assessment is crucial.


Assuntos
Anestesia/métodos , Exame Físico/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Criança , Ecocardiografia , Humanos , Assistência Perioperatória , Período Perioperatório
19.
Pediatr Emerg Med Pract ; 17(3): 1-12, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32115935

RESUMO

Although failure to thrive (FTT) is a relatively common presentation in the emergency department, many emergency clinicians are unsure of how to properly work up a pediatric patient with this condition. Obtaining a thorough history and physical examination will likely reveal the cause of FTT. Although most laboratory testing has low diagnostic yield, they may be indicated in certain circumstances. Radiologic testing is normally not indicated unless the history or physical examination point to a specific etiology. This issue reviews the etiology, pathophysiology, and management of patients with FTT, with the goal of improving outcomes while minimizing unnecessary testing, decreasing cost, and expediting emergency department care.


Assuntos
Insuficiência de Crescimento/diagnóstico , Exame Físico/métodos , Avaliação de Sintomas/métodos , Emergências , Serviço Hospitalar de Emergência , Insuficiência de Crescimento/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
20.
Neurologist ; 25(2): 19-23, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132494

RESUMO

OBJECTIVE: To determine the feasibility of nonmydriatic fundus photography in the neurology outpatient setting and to record frequency of clinically relevant fundus findings. METHODS: Over 5 weeks, fundus photographs were obtained using a nonmydriatic fundus camera in both eyes of adult patients attending our general neurology and headache clinics. A neurologist, who had received 15 minutes of training on the use of the camera, took the photographs. Quality of photographs was graded. Photographs were reviewed by 2 neuro-ophthalmologists. Treating neurologists completed a survey on the use of this technology in the neurology clinic. Feasibility parameters including ease, comfort, speed, quality, and clinical relevance of nonmydriatic fundus photography was assessed. RESULTS: We obtained 505 fundus photographs of 206 patients. Median time to completion of photographs per patient was 2.12 minutes. Mean rating for ease, comfort, and speed was 9.7 out of 10. Among these, 160 had normal and 44 had abnormal findings. In 114 of 206 patients, neurologists relied on photographs for ocular fundus assessment. In the remaining 92 patients, 18 patients had abnormal photographs, of which neurologists missed the abnormality in 14 (78%). All neurologists preferred nonmydriatic fundus photography over direct ophthalmoscopy. CONCLUSIONS: Using nonmydriatic fundus photography in an outpatient neurology clinic is feasible without disrupting patient flow or causing patient discomfort. Findings of optic nerve pallor, optic nerve swelling, or normal optic nerves were particularly relevant to these patients seen for headaches or demyelinating disease and helped inform immediate diagnosis and management.


Assuntos
Oftalmopatias/diagnóstico , Cefaleia/diagnóstico , Pacientes Ambulatoriais , Adulto , Oftalmopatias/terapia , Estudos de Viabilidade , Feminino , Fundo de Olho , Cefaleia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia , Exame Físico/métodos
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