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1.
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
3.
Internist (Berl) ; 61(8): 813-826, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32542492

RESUMO

Syncope is a frequent disorder, sometimes due to life-threatening causes. The uncertainty in its diagnosis requires a standardized approach. According to the 2018 European Society of Cardiology (ESC) guidelines, new aspects in evaluation and treatment include risk stratification and decision-making strategies during the initial evaluation in the emergency department, a reconsideration of diagnostic tests, algorithms for the treatment of reflex syncope, indications for an implantable cardioverter/defibrillator in high risk patients for sudden cardiac death, and organizational aspects such as interdisciplinary syncope units. The 2018 ESC guideline and the 2019 commentaries of the German Society of Cardiology (DGK) are an excellent and comprehensive instruction for safe, effective and efficient evaluation and therapy. However, some aspects require critical appraisal. The inadequate availability and reimbursement of pivotal diagnostic tests, such as tilt table testing and the implantable loop recorder is emphasized.


Assuntos
Estimulação Cardíaca Artificial/normas , Desfibriladores Implantáveis , Exame Físico/normas , Guias de Prática Clínica como Assunto , Síncope/diagnóstico , Síncope/terapia , Cardiologia/normas , Alemanha , Humanos , Sociedades Médicas , Teste da Mesa Inclinada
4.
J Pediatr ; 221: 207-214, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446483

RESUMO

OBJECTIVE: To determine the interobserver agreement of history and physical examination findings in children undergoing evaluation in the emergency department (ED) for headaches. STUDY DESIGN: We conducted a prospective, cross-sectional study of children aged 2-17 years evaluated at 3 tertiary-care pediatric EDs for non-traumatic headaches. Two clinicians independently completed a standardized assessment of each child and documented the presence or absence of history and physical examination variables. Unweighted κ statistics were determined for 68 history and 24 physical examination variables. RESULTS: We analyzed 191 paired observations; median age was 12 years, with 19 (9.9%) children younger than 7 years. Interrater reliability was at least moderate (κ ≥ 0.41) for 41 (60.3%) patient history variables. Eleven (61.1%) of 18 physical examination variables for which κ statistics could be calculated had a κ that was at least moderate. CONCLUSIONS: A substantial number of history and physical examination findings demonstrated at least moderate κ statistic values when assessed in children with headaches in the ED. These variables may be generalizable across different types of clinicians for evaluation of children with headaches. If also found to predict the presence or absence of emergent intracranial abnormalities, the more reliable clinical findings may be helpful in the development of clinical prediction rules or risk stratification models that could be used across settings for children with headaches.


Assuntos
Cefaleia/epidemiologia , Anamnese/normas , Variações Dependentes do Observador , Exame Físico/normas , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Medicina de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pediatria , Estudos Prospectivos , Reprodutibilidade dos Testes
5.
Head Neck ; 42(6): 1235-1239, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-66374

RESUMO

Head and neck examinations are commonly performed by all physicians. In the era of the COVID-19 pandemic caused by the SARS-CoV-2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Based on experience and evidence from SARS-CoV-1 and early experience with SARS-CoV-2, we provide our perspective and guidance on mitigating transmission risk during head and neck examination, upper airway endoscopy, and head and neck mucosal surgery including tracheostomy.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Testes Diagnósticos de Rotina/normas , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , Cabeça/fisiopatologia , Humanos , Masculino , Pescoço/fisiopatologia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Exame Físico/normas , Pneumonia Viral/epidemiologia
6.
Head Neck ; 42(6): 1235-1239, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298028

RESUMO

Head and neck examinations are commonly performed by all physicians. In the era of the COVID-19 pandemic caused by the SARS-CoV-2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Based on experience and evidence from SARS-CoV-1 and early experience with SARS-CoV-2, we provide our perspective and guidance on mitigating transmission risk during head and neck examination, upper airway endoscopy, and head and neck mucosal surgery including tracheostomy.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Testes Diagnósticos de Rotina/normas , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , Cabeça/fisiopatologia , Humanos , Masculino , Pescoço/fisiopatologia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Exame Físico/normas , Pneumonia Viral/epidemiologia
7.
Sports Med Arthrosc Rev ; 28(2): 36-40, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32345924

RESUMO

The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly, validated options. It is important to recognize that anatomic structures other than the ACL contribute to rotatory knee stability. Addressing the tibial slope, anterolateral structures of the knee, specifically the iliotibial band, and menisci during ACL surgery may decrease residual pivot shift in an attempt to improve clinical outcomes and prevent reinjury. This review article describes the pivot shift maneuver, objective measurement tools, and clinical applications of the pivot shift test.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico , Instabilidade Articular/diagnóstico , Exame Físico/normas , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Humanos , Instabilidade Articular/fisiopatologia , Exame Físico/instrumentação
8.
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
9.
Am J Phys Med Rehabil ; 99(10): 961-967, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32195736

RESUMO

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in physical medicine and rehabilitation residents in foot and ankle surface anatomy palpation and to determine whether senior residents had higher examination performance compared with more junior residents. Physical medicine and rehabilitation residents at different levels of training were tested cross-sectionally, and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (P < 0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1 cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%) and the second (13.3%) and fourth for the tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for physical medicine and rehabilitation resident training.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Articulações do Pé/diagnóstico por imagem , Exame Físico/normas , Medicina Física e Reabilitação/educação , Ultrassonografia/métodos , Pontos de Referência Anatômicos , Articulação do Tornozelo/anatomia & histologia , Competência Clínica , Estudos Transversais , Educação de Pós-Graduação em Medicina , Articulações do Pé/anatomia & histologia , Humanos , Internato e Residência
10.
J Nurs Adm ; 50(3): 165-173, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068625

RESUMO

Studies show sleep deprivation impacts patients' ability to perform physical activities and can lead to delirium, depression, and other psychiatric impairments. One of the Choosing Wisely® recommendations is "Do not wake the patient for routine care unless the patient's condition requires it." The authors discuss the development of an evidence-based toolkit to facilitate opportunities for patients to sleep during hospitalization, exemplifying the translation of a Choosing Wisely recommendation into clinical practice.


Assuntos
Tomada de Decisão Clínica , Exame Físico/normas , Privação do Sono/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Sono
11.
Crit Care ; 24(1): 14, 2020 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931844

RESUMO

BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. METHODS: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. RESULTS: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. CONCLUSION: The agreement between lung ultrasound and auscultation is poor. TRIAL REGISTRATION: NCT02912624. Registered on September 23, 2016.


Assuntos
Pulmão/diagnóstico por imagem , Estetoscópios/normas , Ultrassonografia/normas , APACHE , Idoso , Auscultação/normas , Distribuição de Qui-Quadrado , Estudos de Coortes , Estado Terminal/terapia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Exame Físico/métodos , Exame Físico/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Estudos Prospectivos , Estatísticas não Paramétricas , Estetoscópios/tendências , Ultrassonografia/tendências
12.
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
13.
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
15.
Ophthalmology ; 127(1): 38-44, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522900

RESUMO

PURPOSE: Ophthalmologic telemedicine has the ability to provide eye care for patients remotely, and many countries have used screening tele-ophthalmology programs for several years. One such initiative at the Veterans Affairs (VA) Healthcare System is Technology-based Eye Care Services (TECS). The TECS services are located in primary care clinics and provide basic screening eye care, including vision, refraction, and retinal photography. Eye care providers ("readers") review the clinical data and recommend appropriate follow-up. One of the most common referrals from TECS has been for glaucoma, and this study was powered for glaucoma/glaucoma suspect detection. The current study was undertaken to identify aspects of the protocol that could be refined to enhance accuracy. DESIGN: Prospective comparison between the standard TECS protocol versus a face-to-face (FTF) examination on 256 patients, all of whom had no known history of significant ocular disease. PARTICIPANTS: Patients with no known ocular disease who were scheduled for an in-person eye appointment at the Atlanta VA. Patients underwent screening through the TECS protocol and received an FTF examination on the same day (gold standard). The TECS readers were masked to the results of the FTF examination. MAIN OUTCOME MEASURES: Percent agreement, kappa, sensitivity, and specificity were calculated for the TECS readers' interpretations versus the FTF examination. RESULTS: The TECS readers showed substantial agreement for cataract (κ ≥ 0.71) and diabetic retinopathy (κ ≥ 0.61) and moderate to substantial agreement for glaucoma/glaucoma suspect (κ ≥ 0.52) compared with an FTF examination. Age-related macular degeneration (AMD) showed moderate agreement (κ ≥ 0.34). Percent agreement with the TECS protocol was high (84.3%-98.4%) for each of the disease categories. Overall sensitivity and specificity were ≥75% and ≥55%, respectively, for any diagnosis resulting in referral. Inter-reader and intra-reader agreement was substantial for most diagnoses (κ > 0.61) with percent agreements ranging from 66% to 99%. CONCLUSIONS: Our results indicate that the standard TECS protocol is accurate when compared with an FTF examination for the detection of common eye diseases. The inclusion of additional testing such as OCT could further enhance diagnostic capability.


Assuntos
Catarata/diagnóstico , Assistência à Saúde/normas , Retinopatia Diabética/diagnóstico , Glaucoma/diagnóstico , Degeneração Macular/diagnóstico , Telemedicina/normas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/diagnóstico , Exame Físico/normas , Estudos Prospectivos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Veteranos , Acuidade Visual/fisiologia
16.
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
17.
Simul Healthc ; 14(6): 378-383, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31743310

RESUMO

OBJECTIVE: The aim of the study was to evaluate patterns of skill acquisition in the labor cervical examination in novice providers, such as the change in accuracy and overestimation and underestimation over time and the impact of dilation and effacement on accuracy. METHODS: In this descriptive longitudinal study, medical students each performed 120 simulated cervical examinations. Accuracy and how often students overestimated and underestimated dilation and effacement during was determined for each set of 10 repetitions. Accuracy data were grouped and compared by dilation (1-3, 4-6, and 7-10 cm) and effacement (90%, 75%, 50%, and 25%). RESULTS: Student accuracy in dilation significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated dilation, but this decreased over time (P < 0.001). In addition, the accuracy of the students' estimations was 84%, 62%, and 52% for dilations of 1-3, 4-6, and 7-10 cm, respectively (P < 0.001). Student accuracy in effacement significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated effacement, but as training progressed, more students tended to overestimate and underestimate equally often (P < 0.001). In addition, accuracy of the students' estimations was 93%, 88%, 81%, and 35% for effacements of 90%, 75%, 50%, and 25%, respectively (P < 0.001). CONCLUSIONS: Knowing that students tend to overestimate cervical dilation and effacement early in training and that cervices of high dilation and low effacement are more difficult to assess will be helpful in designing more efficient cervical examination training regimens.


Assuntos
Colo do Útero , Competência Clínica , Trabalho de Parto , Aprendizagem , Obstetrícia/educação , Exame Físico/normas , Feminino , Humanos , Estudos Longitudinais , Gravidez , Treinamento por Simulação , Estudantes de Medicina
18.
Artigo em Inglês | MEDLINE | ID: mdl-31614408

RESUMO

PURPOSE: To determine if an objective structured clinical examination (OSCE) could be used to evaluate and monitor hand hygiene and personal protective equipment (PPE) proficiency for medical interns in the United States. METHODS: Interns in July 2015 (N=123, Cohort 1) without OSCE-based contact precaution evaluation and teaching were evaluated early 2016 by OSCE for hand hygiene and PPE proficiency. They performed poorly. Therefore, the new interns entering July 2016 (N=151, Cohort 2) were immediately tested in the same OSCE station as Cohort 1 and provided feedback and teaching. Cohort 2 was then retested in the OSCE station early 2017. The Mann Whitney U test was used to compare Cohort 1 vs. Cohort 2 performances on checklist items. Cohort 2 performance differences at the beginning and end of the intern year were compared using McNemar's X2 test for paired nominal data. RESULTS: Checklist items were scored, summed and reported as percent correct. In Cohort 2, the mean percent correct was higher in posttest than pretest, 92% vs. 77% )(P <0 .0001). The passing rate (100% correct) was significantly higher, 55% vs. 16%. Comparing Cohort 1 and Cohort 2 at the end of intern year, the mean percent correct was higher for Cohort 2 compared to Cohort 1, 95% vs 90% (P < 0.0001). 55% of the Cohort 2 passed (a perfect score) compared to 24% in Cohort 1 (P < 0.0001). CONCLUSION: An OSCE can be utilized to evaluate and monitor hand hygiene and PPE proficiency for interns in the United States.


Assuntos
Higiene das Mãos/métodos , Equipamento de Proteção Individual/ética , Exame Físico/normas , Lista de Checagem , Estudos de Coortes , Higiene das Mãos/normas , Humanos , Internato e Residência/ética , Atenção Plena , Equipamento de Proteção Individual/normas , Exame Físico/estatística & dados numéricos , Análise e Desempenho de Tarefas , Estados Unidos/epidemiologia , Precauções Universais/métodos
19.
J Wound Ostomy Continence Nurs ; 46(6): 485-490, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633610

RESUMO

PURPOSE: To test the fidelity and feasibility of using augmented reality glass (ARG) telehealth technology for comprehensive wound, ostomy, and continence (WOC) service delivery to underserved rural practice settings. DESIGN: Intrarater reliability design focusing on treatment integrity. SAMPLE AND SETTING: Adult patients in a tertiary care hospital and a rural long-term care setting who were scheduled for routine wound care consults. METHODS: Intra- and interrater reliability were assessed using a documentation-based wound assessment tool comprising 6 discrete assessment points. The wound teleassessment was first conducted by the telehealth "hub" WOC nurse remotely in collaboration with a bedside nurse wearing the ARG. The same hub WOC nurse then conducted an assessment at the bedside. Initial assessment points and treatment plans were compared to establish assessment and treatment intrarater reliability. A different WOC nurse, blinded to the first assessment, also conducted a bedside assessment and provided treatment recommendations, which were then compared to the hub WOC nurse's initial remotely ARG-generated treatment plan to establish treatment interrater reliability. RESULTS: Sixteen patients with 21 wounds were assessed. Six wound assessment components were included, yielding a total of 126 total observation points. Intrarater assessment reliability was 98%. Treatment plan interrater reliability was 100%. CONCLUSIONS: Results support further evaluation of ARG technology as a tool to enhance the delivery of wound care services in remote underserved settings. Implementation and evaluation of this technology on clinical and financial outcomes in multiple wound care delivery environments should be determined moving forward. Successful implementation should serve as a template to expand evidence-based WOC nursing care across the globe.


Assuntos
Realidade Aumentada , Óculos/normas , Telemedicina/instrumentação , Telemedicina/normas , Cicatrização , Óculos/estatística & dados numéricos , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/estatística & dados numéricos , Exame Físico/instrumentação , Exame Físico/métodos , Exame Físico/normas , Reprodutibilidade dos Testes , Sudeste dos Estados Unidos , Telemedicina/métodos
20.
Obstet Gynecol ; 134 Suppl 1: 1S-8S, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568034

RESUMO

INTRODUCTION: To assess how skill in the digital cervical examination is acquired in medical students. METHODS: In a longitudinal study, medical students completed 200 simulated cervical examinations. We performed regressions of each student's cumulative accuracy using the linear, power, and sigmoidal models to determine best fit. We also constructed multilevel models to determine the influence of dilation and effacement on accuracy and to determine whether the starting level and rate of learning varied between individuals. To assess skill decay, we assessed accuracy at 1, 2, and 5 months after training. We defined the amount of sustained accuracy needed to achieve competence using cumulative summation analyses and determined the amount of practice needed to reach this level of skill. RESULTS: Twenty-five medical students participated. The median (interquartile range) of cumulative accuracy at the end of the study was 69% (65-78) for dilation and 80% (76-91) for effacement. The sigmoidal model had the best fit. All students achieved competence during the study. The multilevel models showed that accuracy decreased with higher dilation and lower effacement and found that starting level and rate of learning varied between individuals. Maximal accuracy in both dilation and effacement was seen after 150 repetitions. Accuracy of the medical students persisted for 1 month for dilation and 2 months for effacement. The average±SD number of repetitions needed to achieve competence was 89±46 (range 35-195) for dilation and 48±38 (range 11-174) for effacement. DISCUSSION: Based on the variability in skill between individuals and the rate of skill acquisition and decay, we feel that a competence-based rather than time-based approach is most appropriate, that trainee performance should be monitored both during and after training, and that 150 repetitions, or more, should be included in any digital cervical examination simulation regimen.


Assuntos
Colo do Útero , Curva de Aprendizado , Modelos Anatômicos , Obstetrícia/educação , Exame Físico/normas , Treinamento por Simulação/métodos , Adulto , Colo do Útero/fisiologia , Competência Clínica , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Primeira Fase do Trabalho de Parto/fisiologia , Estudos Longitudinais , Masculino , Exame Físico/métodos , Gravidez , Estudantes de Medicina , Adulto Jovem
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