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1.
Cancer Invest ; 39(2): 124-132, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33410359

RESUMO

BACKGROUND: Prostate cancer incidence and mortality in the United States in African Americans (AA) are higher than in Caucasians. Eastern Cuyahoga County in Ohio is majority AA and is considered an underserved population particularly vulnerable to healthcare disparities. There is a paucity of data about shared decision making among high-risk AA men with regard to prostate cancer screening. This study aims to examine shared versus informed decision making (SDM versus IDM) in a randomized, control trial among a large, high-risk AA population. METHODS: Patients were included in annual one-day outreach events, each held over 3 years (2017-2019), and were randomized at each event into IDM (control) and SDM (investigational) groups and then were offered screening via prostate specific antigen (PSA) and digital rectal exam (DRE). The primary endpoints were proportion of participants over 40 who did not demonstrate decisional conflict about prostate cancer screening measured by the SURE score, as well as change of knowledge score about prostate cancer screening. RESULTS: Overall, 175 patients were enrolled in the trial; 79 in the SDM arm and 96 in the IDM arm. The investigational (SDM) arm had 3/79 (3.9%) conflict versus 6/96 (6.4%) in the control (IDM) arm (p = 0.74). With regard to knowledge improvement, the SDM cohort demonstrated improvement following educational tools for 66/79 (81%) of participants versus 76/96 (79%) in the IDM cohort (p = 0.85). There was no difference in the proportion (63%) of participants in either group who found the information very helpful (using a Likert scale). CONCLUSIONS: Our education-based study showed no significant difference between SDM and IDM with regard to decisional conflict about prostate cancer screening. The study also demonstrated significant improvement in knowledge about prostate cancer screening in a high-risk AA population in both groups. Our results should be interpreted with caution due to several limitations; however, the study can serve as a benchmark for future studies in this very important topic.


Assuntos
Afro-Americanos/estatística & dados numéricos , Exame Retal Digital/métodos , Calicreínas/metabolismo , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/diagnóstico , Tomada de Decisões , Tomada de Decisão Compartilhada , Detecção Precoce de Câncer , Estudos de Viabilidade , Humanos , Masculino , Educação de Pacientes como Assunto , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/metabolismo , Sensibilidade e Especificidade , Estados Unidos/etnologia
3.
IEEE Trans Haptics ; 13(1): 183-190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31985441

RESUMO

Sphincter tone examination, as part of digital rectal examination (DRE), can provide essential information to support the early detection of colorectal cancer. Mastering DRE skills for junior doctors is always challenging due to the lack of real training cases. In this article, we developed a soft pneumatic active actuator,made of a compound of silicone rubber materials, to mimic human sphincter muscles and simulate various anal sphincter tones for the purpose of training. Different pumping actuation (syringe and bellows) and driving mechanisms (linear, stepper, and servo motor) were implemented and compared for their effect on the rendered tones. A further comparison was made with a previous prototype based on a cable-driven mechanism. Both quantitative and qualitative assessments were conducted to evaluate the performance of each mechanism. A differential pressure sensor was used to measure applied pressure on a catheter balloon placed inside the sphincter, comparing the readings with anorectal manometry data obtained from real patients. Qualitative feedback was gathered through a user study with ten colorectal expert practitioners. Four questions were asked targeting reaction/response time, pressure level, pressure quality, and similarity to a real case. The results show the capacity and limitation of each mechanism, with the one based on a servo motor and a bellows being the most favourably rated.


Assuntos
Canal Anal , Exame Retal Digital/instrumentação , Exame Retal Digital/métodos , Retroalimentação Sensorial , Percepção do Tato , Desenho de Equipamento , Humanos , Profissionais de Enfermagem/educação
4.
BJU Int ; 124 Suppl 1: 14-18, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31318121

RESUMO

OBJECTIVES: To determine if using a digital rectal examination (DRE) human volunteer improves medical students' confidence in performing DRE in comparison to using a simulated model alone. PARTICIPANTS AND METHODS: Medical students underwent randomization into one of two groups: a control group who underwent standard teaching and an intervention group who underwent standard teaching plus further tuition involving a DRE volunteer. Standard teaching involved a 30-min lecture and a practice DRE on a simulation model. The intervention group additionally observed a tutor demonstrating DRE on a volunteer, then conducted a DRE themselves under supervision. Before and after teaching, both groups completed a survey comprised of three questions. The primary endpoint was confidence in performing a DRE, which was assessed according to the sum of the scores from the three questions. RESULTS: In total, 48 students were randomized, 22 to the control group and 26 to the intervention group. The groups were well matched prior to teaching DRE (P = 0.76) After the DRE tutorial, students in the intervention group were more confident in knowing the indications for DRE (P = 0.001), more confident in their technique for performing DRE (P < 0.001) and more confident in their ability to assess findings accurately at DRE (P < 0.001). The primary outcome measure, overall confidence (sum of the scores from all three questions) in performing DRE, was significantly better in the intervention group (score 10/15 vs 14/15; P < 0.001). CONCLUSION: This study showed that teaching DRE with the assistance of volunteer patients improves inexperienced students' confidence in performing DRE, and the incorporation of such training should be considered in the DRE education programme.


Assuntos
Competência Clínica/normas , Exame Retal Digital , Simulação de Paciente , Exame Físico , Atitude do Pessoal de Saúde , Austrália , Análise Custo-Benefício , Testes Diagnósticos de Rotina , Exame Retal Digital/métodos , Exame Retal Digital/normas , Educação de Graduação em Medicina , Humanos , Estudantes de Medicina , Análise e Desempenho de Tarefas , Voluntários
5.
Expert Rev Anticancer Ther ; 19(8): 705-716, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31277551

RESUMO

Introduction: Prostate cancer (PCa) is the most common diagnosed malignancy among the male population in the United States. The incidence is increasing with an estimated amount of 175.000 cases in 2019. Areas covered: Primarily, PCa is generally detected by an elevated or rising serum prostate-specific antigen (PSA) and digital rectal examination (DRE) followed by pathological examination. Histopathology ultimately confirms the presence of PCa and determines a Gleason score. However, PSA and DRE have low specificity and sensitivity, respectively. Subsequently, accurate assessment of the aggressiveness of PCa is essential to prevent overdiagnosis and thus overtreatment of low-risk or indolent cancers. By visualizing PCa suspicious lesions and sampling them during the targeted biopsy, it is likely that the diagnostic accuracy of significant PCa improves. This article reviews the current imaging techniques used to secure biopsies in patients with a suspicion of PCa. The advantages and limitations of each technique are described. Expert opinion: Multiparametric magnetic resonance imaging (mpMRI) and subsequent-targeted biopsy have improved the diagnostic accuracy of PCa detection in men with an elevated or rising serum PSA. Prostate lesions visible on mpMRI are easily targeted during either in-bore MRI-guided biopsy, cognitive fusion biopsy or MRI-TRUS fusion biopsy.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico , Exame Retal Digital/métodos , Humanos , Masculino , Gradação de Tumores , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Sensibilidade e Especificidade
6.
BMJ Open ; 9(7): e027182, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31324681

RESUMO

OBJECTIVES: To develop and test a method for automatic assessment of a quality metric, provider-documented pretreatment digital rectal examination (DRE), using the outputs of a natural language processing (NLP) framework. SETTING: An electronic health records (EHR)-based prostate cancer data warehouse was used to identify patients and associated clinical notes from 1 January 2005 to 31 December 2017. Using a previously developed natural language processing pipeline, we classified DRE assessment as documented (currently or historically performed), deferred (or suggested as a future examination) and refused. PRIMARY AND SECONDARY OUTCOME MEASURES: We investigated the quality metric performance, documentation 6 months before treatment and identified patient and clinical factors associated with metric performance. RESULTS: The cohort included 7215 patients with prostate cancer and 426 227 unique clinical notes associated with pretreatment encounters. DREs of 5958 (82.6%) patients were documented and 1257 (17.4%) of patients did not have a DRE documented in the EHR. A total of 3742 (51.9%) patient DREs were documented within 6 months prior to treatment, meeting the quality metric. Patients with private insurance had a higher rate of DRE 6 months prior to starting treatment as compared with Medicaid-based or Medicare-based payors (77.3%vs69.5%, p=0.001). Patients undergoing chemotherapy, radiation therapy or surgery as the first line of treatment were more likely to have a documented DRE 6 months prior to treatment. CONCLUSION: EHRs contain valuable unstructured information and with NLP, it is feasible to accurately and efficiently identify quality metrics with current documentation clinician workflow.


Assuntos
Algoritmos , Exame Retal Digital/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Processamento de Linguagem Natural , Neoplasias da Próstata/diagnóstico , Adulto , Humanos , Masculino , Estudos Retrospectivos
7.
Arq Gastroenterol ; 56(1): 79-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141075

RESUMO

BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient's complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient's management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient's history was blinded for the examiner's knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.


Assuntos
Canal Anal/fisiopatologia , Exame Retal Digital/métodos , Manometria/instrumentação , Adulto , Competência Clínica , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tono Muscular , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Índice de Gravidade de Doença
8.
Pan Afr Med J ; 32: 15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143320

RESUMO

There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of PCa and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.


Assuntos
Exame Retal Digital/métodos , Sintomas do Trato Urinário Inferior/epidemiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Neoplasias da Próstata/patologia
9.
Urologe A ; 58(5): 511-517, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31016332

RESUMO

Prostate cancer remains among the most commonly diagnosed malignancies worldwide in men. In patients with low-risk prostate cancer, the risk of metastasis and mortality is very low; therefore, a tumor surveillance strategy can be used. In patients undergoing active surveillance, curative active therapy is postponed without compromising opportunities for cure until there is evidence of progression or the patient desires active therapy. The aim of active surveillance in prostate cancer patients is to minimize treatment-related toxicity without impairing patient survival. To maintain patients under active surveillance, the following criteria should be met: prostate-specific antigen (PSA) ≤10 ng/ml, Gleason score ≤6, cT1 or cT2a, ≤2 biopsy cores with <50% cancer involvement of every positive core. Follow-up in active surveillance patients is based on repeat biopsy, serial PSA measurements, and digital rectal examination.


Assuntos
Exame Retal Digital/métodos , Gradação de Tumores/métodos , Antígeno Prostático Específico/sangue , Próstata/patologia , Neoplasias da Próstata/terapia , Biópsia , Humanos , Masculino , Estadiamento de Neoplasias/métodos , Prostatectomia , Neoplasias da Próstata/patologia , Fatores de Risco
10.
Clin Teach ; 16(1): 36-40, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29436165

RESUMO

BACKGROUND: Digital rectal examination (DRE) is an important component of physical examination and an essential skill for medical graduates. DRE is often underutilised in clinical practice. The lack of confidence and expertise and also underutilization of DRE have been associated with inadequate training of medical students during their undergraduate studies. The training of Indian undergraduates in DRE has not been studied. METHODS: A questionnaire on undergraduate training in DRE was administered to students from various medical colleges joining specialty postgraduate courses in Jawaharlal Institute of Postgraduate Medical Education and Research. RESULTS: A total of 101 out of 131 students participated in the survey. Ninety-one percent of students were taught DRE as undergraduates but only three-quarters had performed DRE on patients. Among the respondents who had performed DRE, two-thirds had performed fewer than five DREs before the completion of their medical education. Respondents who had performed fewer DREs were less confident about performing DRE (p < 0.05). Only 8% had performed DRE with manikins. Patients declining DRE and the need to minimise DRE influenced the decisions to perform DRE during training. DRE was never taught in paediatrics. DREs were most often performed only in the final year of the Bachelor of Medicine and Bachelor of Surgery (MBBS) degree, and mostly without supervision (49.3%); 61.4% were unsatisfied with their training in DRE and would like to be trained better. A lack of confidence, expertise and use of DRE are associated with inadequate training of medical students CONCLUSION: The survey indicates a lack of importance given to DRE training of undergraduate students and huge gaps in imparting this clinical skill. Training may be improved by introducing manikins, changing attitudes to DRE by incorporating it in clinical problem solving, and with more frequent opportunities to practise under supervision.


Assuntos
Competência Clínica , Exame Retal Digital/métodos , Educação de Graduação em Medicina/organização & administração , Atitude do Pessoal de Saúde , Educação de Graduação em Medicina/normas , Humanos , Índia , Estudantes de Medicina/estatística & dados numéricos
11.
Neurogastroenterol Motil ; 31(1): e13510, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30426597

RESUMO

BACKGROUND: Balloon expulsion test (BET) and high-resolution anorectal manometry (HRM) are used in diagnosis of rectal evacuation disorders (REDs); their performance characteristics are suboptimal. METHODS: We audited records of 449 consecutive patients with chronic constipation (CC). We documented anal sphincter tone and contraction, puborectalis tenderness, and perineal descent on digital rectal exam (DRE); maximum resting and squeeze pressures, and rectoanal pressure gradient on HRM; weight or time to balloon expulsion; colonic transit, and area of rectal area on radiograph (RASF). We based the diagnosis of RED on ≥2 abnormalities on both DRE and HRM, excluding results of BET, as the performance of BET is being investigated. Results of RED vs non-RED and results obtained using tbBET vs wbBET groups were compared. We used multivariate logistic regressions to identify predictors of RED using different diagnostic modalities. KEY RESULTS: Among 449 individuals, 276 were included (74 RED and 202 non-RED). Predominant exclusions were for no HRM (n = 79) or use of low resolution anorectal manometry (n = 77). Logistic regression models for abnormal tbBET showed time >60 seconds, RASF and age-predicted RED. For tbBET, the current cutoff of 60 seconds had sensitivity of 39.0% and specificity 93.0% to diagnose RED; on the other hand, applying the cutoff at 22 seconds, the sensitivity was 77.8% and specificity 69.8%. CONCLUSIONS & INFERENCES: The clinical diagnosis of RED in patients with CC is achieved with combination of DRE, HRM and an optimized, time-based BET. Prospective studies are necessary to confirm the proposed 22 second cutoff for tbBET.


Assuntos
Constipação Intestinal/diagnóstico , Exame Retal Digital/métodos , Manometria/métodos , Doenças Retais/diagnóstico , Adulto , Feminino , Humanos , Masculino
12.
Urology ; 121: 112-117, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30171925

RESUMO

OBJECTIVE: To develop a novel scoring system for the prediction of prostate cancer (PCa). METHODS: We assessed 127 patients who underwent a prostate biopsy. Prior to biopsy, we performed shear wave elastography (SWE), transrectal ultrasound, digital rectal exam, total prostatic specific antigen, PSA density (PSAD), and free PSA/total PSA ratio (F/T). We developed an 11-point scoring system based on SWE and these clinical parameters. RESULTS: PCa was diagnosed in 51 (40.2%) of 127 patients and 192 (25.2%) of 762 sextants on initial biopsy. ROC curve analyses showed that the cutoff value (COV) for SWE was 40.8 kpa at the sextant level. The AUC of score system based on the SWE and clinical parameters (0.911) was significantly different from scoring systems based on SWE alone (0.842) or clinical parameters alone (0.868). For this 11-point scoring system, the optimal COV, Youden index, sensitivity, specificity, PPV, NPV, and AUC were 3 points, 0.66, 76.5% 89.5%, 82.98%, 85.00%, and 0.911, respectively. There were 68 negative biopsy results in patients with 0-3 points, and the detection rate of PCa was 100% in patients with scores exceeding 6 points. CONCLUSION: This 11-point scoring system based on SWE and clinical parameters has the good diagnostic performance for predicting PCa. It may be useful in selecting patients for biopsy, substantially reducing the number of unnecessary biopsies while ensuring that few cancers are missed.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Próstata , Neoplasias da Próstata , Idoso , Biópsia/métodos , China , Exame Retal Digital/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Projetos de Pesquisa , Ultrassonografia/métodos
15.
BMC Fam Pract ; 19(1): 79, 2018 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-29859531

RESUMO

BACKGROUND: Prostate cancer is the most common cancer in men in the UK. NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant. However, this is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer. METHODS: The aim of this review is to ascertain the sensitivity, specificity, positive and negative predictive value of DRE for the detection of prostate cancer in symptomatic patients in primary care. CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched in august 2015 for studies in which a DRE was performed in primary care on symptomatic patients and compared against a reference diagnostic procedure. RESULTS: Four studies were included with a total of 3225 patients. The sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively. CONCLUSION: This review found that DRE performed in general practice is accurate, and supports the UK NICE guidelines that patients with a malignant prostate on examination are referred urgently for suspected prostate cancer. Abnormal DRE carried a 42.3% chance of malignancy, above the 3% risk threshold which NICE guidance suggests warrants an urgent referral. However this review questions the benefit of performing a DRE in primary care in the first instance, suggesting that a patient's risk of prostate cancer based on symptoms alone would warrant urgent referral even if the DRE feels normal.


Assuntos
Exame Retal Digital/métodos , Neoplasias da Próstata/diagnóstico , Avaliação de Sintomas/métodos , Humanos , Masculino , Atenção Primária à Saúde/métodos , Sensibilidade e Especificidade
17.
Asia Pac J Clin Oncol ; 14(5): e412-e419, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29700974

RESUMO

AIM: This study aims to assess characteristics of patients with prostate cancer for whom clinical T stage category (cT) was not documented in the medical record and assess whether specialists had concordant conclusions regarding cT based on digital rectal examination (DRE) notes. METHODS: Data from the Prostate Cancer Outcome Registry - Victoria (PCOR-Vic) were interrogated. Four specialists independently assigned cT to DRE notes. Words, or part thereof, associated with agreement between clinicians were identified. RESULTS: Of the 10 587 men, cT was documented in 8758 (82.7%) cases. Multivariate analysis indicated that poor cT documentation was associated with older patient age (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.66-0.99 if 75.1-85 years; OR 0.50, 95%CI 0.36-0.72 if >85 years); diagnosis via transperineal compared to transrectal ultrasound-guided biopsy (TRUS) (OR 0.68, 95%CI 0.51-0.91); diagnosed in a private hospital (OR 0.85, 95%CI 0.75-0.96); and a diagnostic Gleason score of >8 compared to ≤6 (OR 0.59, 95%CI = 0.48-0.73). cT was more likely documented in men diagnosed via transurethral resection of prostate (OR 2.06, 95%CI 1.64-2.58) compared to TRUS and/or if receiving treatment in a radiotherapy center (OR 3.44, 95%CI 2.80-4.23 for external beam radiotherapy; OR 3.57 95%CI 2.44-5.23 for brachytherapy and OR 1.34, 95%CI 1.06-1.69 for combination surgery and radiotherapy) compared to those undergoing radical prostatectomy. Agreement in cT assignment ranged from kappa of 0.158 to 0.582. Stem word components in DRE notes associated with poorest level of agreement were "abnorm," "hard," "nodul" and those with highest level of agreement were terms "benign" and "smooth." CONCLUSIONS: Mode of diagnosis/subsequent treatment, and cancer characteristics were associated with cT documentation. Third party interpretation of clinical notes is problematic.


Assuntos
Exame Retal Digital/métodos , Antígeno Prostático Específico/sangue , Prostatectomia , Neoplasias da Próstata/patologia , Ressecção Transuretral da Próstata , Idoso , Idoso de 80 Anos ou mais , Humanos , Biópsia Guiada por Imagem , Masculino , Gradação de Tumores , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Ultrassonografia
18.
Eur. J. Ost. Clin. Rel. Res ; 13(1): 18-28, ene.-abr. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189507

RESUMO

Introducción: La coccidinia o coccigodinia fue descrita como un dolor que surge alrededor del coxis que puede irradiarse al ano, genitales y piernas, agravándose con la defecación y las relaciones sexuales. El dolor crónico en el ano, recto u otros órganos pélvicos, se presenta entre el 7% y el 24% de la población, asociándose con problemas de calidad de vida. La coccigodinia constituye menos del 1% de las consultas no traumáticas de dolencias vertebrales. Objetivo: Realizar una revisión sistemática sobre el tratamiento a través de la terapia manual en pacientes con coccigodinia. Material y Métodos: Se utilizan las bases de datos Pubmed, PEDro, Biblioteca Cochrane Plus, Scielo, LILACS, ENFISPO y ScienceDirect, empleando las palabras clave Coccyx; Coccydynia; Coccygodynia, "Physical Therapy Modalities"; "Manual Therapy"; Osteopath; Manipulati; Physiotherap y Treatment. Se incluyen ensayos clínicos publicados entre enero de 2000 y mayo de 2017, escritos en castellano, inglés, francés, italiano y portugués. Se excluyen artículos que no utilicen la terapia manual como tratamiento para la coccigodinia y los estudios sobre pacientes menores de 18 años. Resultados: Se seleccionan, siguiendo los criterios de inclusión/exclusión, 6 artículos para la presente revisión. Incluyen documentación sobre los tratamientos de terapia manual para abordar la coccigodinia, así como distintas maniobras de tratamiento. Conclusiones: La terapia manual como método para abordar la coccigodinia puede ser un tratamiento sencillo y efectivo para disminuir la sensación de dolor en estos pacientes. Las técnicas de tratamiento más empleadas son las manipulaciones intrarectales. Se necesita más cantidad de estudios de alta calidad metodológica para estudiar la efectividad de estas técnicas


No disponible


Assuntos
Humanos , Cóccix/fisiopatologia , Manipulações Musculoesqueléticas/métodos , Dor Crônica/reabilitação , Modalidades de Fisioterapia , Manipulação Osteopática/tendências , Manejo da Dor/métodos , Exame Retal Digital/métodos
19.
Ann Fam Med ; 16(2): 149-154, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29531107

RESUMO

PURPOSE: Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings. METHODS: We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality. RESULTS: Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36-0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41-0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31-0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58-0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low. CONCLUSION: Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.


Assuntos
Exame Retal Digital/métodos , Detecção Precoce de Câncer/métodos , Neoplasias da Próstata/diagnóstico , Humanos , Masculino , Atenção Primária à Saúde/organização & administração
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