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1.
Int J Oral Maxillofac Implants ; 36(6): e167-e173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34919615

RESUMO

PURPOSE: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis. MATERIALS AND METHODS: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample. RESULTS: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%. CONCLUSION: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing.


Assuntos
Peri-Implantite , Estudos Transversais , Humanos , Palpação , Peri-Implantite/diagnóstico por imagem , Periodontia , Supuração
2.
Sensors (Basel) ; 21(22)2021 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-34833626

RESUMO

Heart rate (HR) is an essential indicator of health in the human body. It measures the number of times per minute that the heart contracts or beats. An irregular heartbeat can signify a severe health condition, so monitoring heart rate periodically can help prevent heart complications. This paper presents a novel wearable sensing approach for remote HR measurement by a compact resistance-to-microcontroller interface circuit. A heartbeat's signal can be detected by a Force Sensing Resistor (FSR) attached to the body near large arteries (such as the carotid or radial), which expand their area each time the heart expels blood to the body. Depending on how the sensor interfaces with the subject, the FSR changes its electrical resistance every time a pulse is detected. By placing the FSR in a direct interface circuit, those resistance variations can be measured directly by a microcontroller without using either analog processing stages or an analog-to-digital converter. In this kind of interface, the self-heating of the sensor is avoided, since the FSR does not require any voltage or bias current. The proposed system has a sampling rate of 50 Sa/s, and an effective resolution of 10 bits (200 mΩ), enough for obtaining well-shaped cardiac signals and heart rate estimations in real time by the microcontroller. With this approach, the implementation of wearable systems in health monitoring applications is more feasible.


Assuntos
Dispositivos Eletrônicos Vestíveis , Impedância Elétrica , Frequência Cardíaca , Humanos , Monitorização Fisiológica , Palpação
3.
Emerg Med Clin North Am ; 39(4): 689-702, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600631

RESUMO

The physical examination of the patient is the cornerstone of the practice of medicine, and the skills to complete a thorough abdominal examination are critical in the care of patients. When performed correctly, the abdominal examination can be revealing when it comes to the overall health of the patient as well as acute pathology. The examination of the abdomen has the potential to minimize further testing or radiation and serves as a key diagnostic tool. In this article, we will discuss each portion of the abdominal examination in detail as well as pathologic findings, abdomen-specific signs, special patient populations, and clinical pearls.


Assuntos
Abdome , Exame Físico/métodos , Auscultação , Exame Retal Digital , Medicina de Emergência , Genitália/anatomia & histologia , Humanos , Palpação , Percussão
4.
Anesth Analg ; 133(5): 1288-1295, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517392

RESUMO

BACKGROUND: Accurate identification of the cricothyroid membrane is crucial for successful cricothyroidotomy. The aim of this study was to compare the conventional downward and modified upward laryngeal handshake techniques in terms of accuracy to identify the cricothyroid membrane in nonobese female patients. METHODS: In 198 anesthetized female patients, the cricothyroid membrane was identified by either the conventional downward laryngeal handshake technique (n = 99) or the modified upward laryngeal handshake technique (n = 99). According to the conventional downward laryngeal handshake technique, the cricothyroid membrane was identified by palpating the neck downward from the greater cornu of the hyoid bone, thyroid laminae, and cricoid cartilage. According to the modified upward laryngeal handshake technique, the cricothyroid membrane was located by moving up from the sternal notch. The primary outcome was the accuracy of identifying the cricothyroid membrane. Secondary outcomes included the accuracy of midline identification and time taken to locate what participants believed to be the cricothyroid membrane. The primary and secondary outcomes according to the technique were analyzed using generalized estimating equations. RESULTS: The cricothyroid membrane could be identified more accurately by the modified upward laryngeal handshake technique than by the conventional downward technique (84% vs 56%, respectively; odds ratio [OR], 4.36; 95% confidence interval [CI], 2.13-8.93; P < .001). Identification of the midline was also more accurate by the modified laryngeal handshake than by the conventional technique (96% vs 83%, respectively; OR, 4.98; 95% CI, 1.65-15.01; P = .004). The time taken to identify the cricothyroid membrane was not different between the conventional and modified techniques (20.2 [16.2-26.6] seconds vs 19.0 [14.5-26.4] seconds, respectively; P = .83). CONCLUSIONS: The modified upward laryngeal handshake technique that involved tracing the trachea and laryngeal structures upward from the sternal notch was more accurate in identifying the cricothyroid membrane than the conventional downward technique in anesthetized female patients.


Assuntos
Cartilagem Cricoide/anatomia & histologia , Palpação , Cartilagem Tireóidea/anatomia & histologia , Adulto , Idoso , Pontos de Referência Anatômicos , Anestesia Geral , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Seul , Fatores Sexuais
5.
Acta Cytol ; 65(6): 483-493, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535580

RESUMO

BACKGROUND AND OBJECTIVE: The International Academy of Cytology (IAC) Yokohama system for reporting breast fine-needle aspiration biopsy (FNAB) cytopathology has been proposed to standardize breast FNAB reporting. The aim of this study was to categorize breast FNAB cases performed by palpation without radiological guidance according to the IAC system, establish the risk of malignancy (ROM) for the categories and assess the system's utility, pitfalls, and implications in low-resource/financial constraint settings. METHODS: A retrospective analysis of palpation-guided FNAB of breast lesions performed without radiological guidance between January 2016 and December 2019 was carried out and was correlated with follow-up biopsies wherever available. A total of 1,089 cases were recategorized using the IAC Yokohama system. Histopathology follow-up was available for 400 cases. The data were analysed for ROM, positive predictive value (PPV), and negative predictive value (NPV). RESULTS AND DISCUSSION: Out of 1,089 cases, 4.3% (n = 47) cases were categorized as insufficient, 82% (n = 893) as benign, 2.8% (n = 31) as atypical, 2.7% (n = 29) as suspicious of malignancy, and 8.2% (n = 89) as malignant. Some 400 cases had a follow-up biopsy, based on which, the ROM for the categories were 33.3%, 0.4%, 37.5%, 96%, and 100%. The NPV for the benign category was 99.6%. The PPV of the malignant category was 100%, that of combined suspicious of malignancy and malignant categories was 99%, and of combined atypical, suspicious of malignancy, and malignant was 90.6%. CONCLUSION: The IAC Yokohama system is useful in standardizing the reporting of cytopathology of breast lesions. FNAB with radiological guidance is ideal but in cases of finance/resource constraints, FNAB by palpation alone is satisfactory if the test result is in the benign, suspicious of malignancy, or malignant categories, which constitute 91.5% of the cases in this study. A repeat ultrasound-guided FNAB and/or core needle biopsy should be recommended for cases in the insufficient/inadequate or atypical categories.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Criança , Feminino , Humanos , Índia , Pessoa de Meia-Idade , Palpação , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
6.
Praxis (Bern 1994) ; 110(13): 721-722, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34583543

RESUMO

CME-Sonography 102/Answers: Acute Epigastric Pain Abstract. Acute upper abdominal pain is a common issue in emergency medicine. Next to the anamnesis and laboratory findings, sonography plays a leading role in differentiation. In addition to the direct representation of the respective pathologies (gallstones, duct dilatations, tumors), the clinical-sonographic examination, the so-called palpation under ultrasound view, is also important. In this article we aim to show the way of diagnosing acute epigastric pain.


Assuntos
Dor Abdominal , Cálculos Biliares , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Humanos , Palpação , Exame Físico , Ultrassonografia
7.
Codas ; 33(4): e20200035, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34346948

RESUMO

PURPOSE: To identify muscle tension dysphonia (MTD) signs and symptoms, as well as to analyze the results of vocal parameters, the physical clinical examination of muscle palpation, the self-perception of vocal symptoms, vocal pain, and fatigue of women with MTD and compare them with women with healthy voices. METHODS: a cross-sectional study with 45 women (23 with MTD and 22 controls), similar median age between groups. The speech-language and otorhinolaryngological evaluation determined the diagnosis of MTD. All participants responded to the Voice Symptoms Scale (VoiSS), Vocal Fatigue Index (VFI), and Nordic Musculoskeletal Questionnaire (NMQ) protocols. They were also assessed by a palpatory evaluation of the perilaryngeal musculature, auditory-perceptual evaluation, and acoustic analysis of the voice fundamental frequency. The speech sample included sustained vowels "a", "i" and "e" and connected speech, recorded in a silent environment, and submitted to auditory-perceptual evaluation by three judges. In the acoustic analysis, the fundamental frequency and maximum phonation times were extracted. RESULTS: The MTD group had worse results in VoiSS, VFI, and NMQ, in addition to greater resistance to palpation and a high vertical position of the larynx. The vocal parameters also showed greater deviation in the MTD group, except for the fundamental frequency. There was no relationship between vocal symptoms, fatigue, or pain with the general degree of dysphonia in the MTD group, indicating important symptoms in mild or moderate vocal deviations. CONCLUSION: women with MTD presented vocal symptoms, vocal fatigue, muscle pain, resistance to palpation and deviated vocal parameters when compared to vocally healthy women.


Assuntos
Disfonia , Estudos Transversais , Disfonia/diagnóstico , Feminino , Humanos , Tono Muscular , Músculos , Dor , Palpação , Autoimagem , Qualidade da Voz
8.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404666

RESUMO

Transcricothyroid membrane (CTM) injection of local anaesthesia is widely used during bronchoscopic procedures. It is an effective way of delivering topical anaesthesia, and has been shown to reduce patient discomfort, improve clinician satisfaction and reduce overall sedation requirements. Risks from this procedure are uncommon and usually minor. Localisation of the CTM is usually performed clinically by palpation of anatomical landmarks and can vary depending on clinician skillset and experience. Clinical identification may be less accurate compared with ultrasound guidance in identifying puncture site, however, ultrasound is not always readily available and seldom used for this purpose. This case describes a rare complication following attempted local anaesthetic infiltration into the cricothyroid space, after clinical identification of puncture site. An obstructive fluid-filled mass formed around the site of injection on the right vocal cord; resulting in airway compromise, abandonment of procedure and subsequent intubation.


Assuntos
Anestesia Local , Glândula Tireoide , Anestesia Local/efeitos adversos , Cartilagem Cricoide , Humanos , Palpação , Cartilagem Tireóidea
9.
J Manipulative Physiol Ther ; 44(5): 398-407, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34429213

RESUMO

OBJECTIVE: The purpose of this study was to assess a novel method of lumbar spinous process (SP) palpation by using magnetic resonance imaging (MRI) high-signal marker reference standards for verification. METHODS: Clinicians (doctors of chiropractic) in this study used either: (1) the standard/traditional method of identifying the L4 SP using the supracristal plane (n = 14) or (2) a novel method that manually induced sacral motion to identify the L5 and then the L4 SP (n = 54). The clinicians, blinded to the results of each other, used a grease pencil to mark the location identified as the L4 SP. An MRI high-signal marker then was taped across this location. The MRI scans were assessed by a radiologist, blinded to the palpation method, who extended a line posteriorly from the superior and inferior extent of the L4 SP and determined whether the high-signal marker was within the lines bordering the L4 SP (ie, "on-target"). RESULTS: Palpation using the traditional method showed a 35.7% accuracy, with 5 of 14 "on target" and all "off target" being too superior. Palpation using the novel method showed 77.8% accuracy, with 42 of 54 "on target" and 3 "off target" being too superior and 9 "off target" too inferior. CONCLUSIONS: The novel method performed better than the traditional method. The novel method shows promise. Additional prospective research should be conducted to fully assess the accuracy of the novel method compared with traditional methods of palpation.


Assuntos
Quiroprática , Manipulação da Coluna , Humanos , Vértebras Lombares/diagnóstico por imagem , Palpação , Estudos Prospectivos
10.
Med J Aust ; 215(10): 460-464, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34420218

RESUMO

OBJECTIVE: To assess the sensitivity and specificity of clinical breast examination for detecting breast cancer in asymptomatic women with predisposing germline mutations enrolled in a cancer risk management program that includes radiologic screening. DESIGN, SETTING: Retrospective, longitudinal cohort study of women with BRCA1/2 mutations who attended the Breast and Ovarian Cancer Risk Management Clinic at the Peter MacCallum Cancer Centre, a tertiary referral centre in Melbourne, during 1 September 2001 - 31 December 2019. PARTICIPANTS: Consecutive women with BRCA1/2 mutations who did not have personal histories of cancer and had not undergone bilateral risk-reducing mastectomy, and who had visited the clinic at least twice during the study period. Participants had generally undergone breast examination at 6- or 12-month intervals, and annual breast imaging (mammography; and magnetic resonance imaging [MRI] for women aged 50 years or younger). MAIN OUTCOME MEASURES: Sensitivity (proportion of all biopsy-confirmed breast cancers detected by breast examination alone) and specificity of breast examination for detecting breast cancer. RESULTS: Of 414 eligible women (mean age, 35.5 years; SD, 11.2 years), 35 were diagnosed with breast cancer during 1761 woman-years of follow-up. Only two were diagnosed based on breast examination alone (ie, without radiologic evidence), neither of whom was undergoing MRI screening. The sensitivity of breast examination was 6% (95% CI, 1-19%), the specificity 97% (95% CI, 95-98%); the positive predictive value was 14% (95% CI, 2-43%), the negative predictive value 92% (95% CI, 89-94%). CONCLUSION: Clinical breast examination did not increase the number of breast cancers detected in MRI-screened women with BRCA1/2 mutations. Removing breast examination from surveillance programs that include MRI may be reasonable for these women.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Detecção Precoce de Câncer/métodos , Genes BRCA1 , Genes BRCA2 , Mutação em Linhagem Germinativa , Palpação , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Feminino , Predisposição Genética para Doença , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
11.
Chiropr Man Therap ; 29(1): 33, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446040

RESUMO

BACKGROUND: Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults. METHOD: We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes. RESULTS: We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy. CONCLUSION: Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.


Assuntos
Dor Lombar , Radiculopatia , Adulto , Humanos , Dor Lombar/diagnóstico , Palpação , Amplitude de Movimento Articular , Reprodutibilidade dos Testes
12.
Pediatr Pulmonol ; 56(9): 2893-2902, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34265176

RESUMO

BACKGROUND: To evaluate digital tracheal intubation (DTI) when compared to laryngoscope-assisted TI; finger palpation of endotracheal tube (ETT) tip position when compared to any standard method. DESIGN: A systematic review of Medline, Embase, CENTRAL, and CINAHL with synthesis of data using meta-analysis was performed. MAIN OUTCOME MEASURE: The proportion of successful TI and correct ETT tip positioning were the main outcome measures. RESULTS: Five studies (one observational study and four RCTs) enrolling 310 neonates were included. 94% (81%-98%) of the DTI were successful on the first attempt (certainty of evidence [CoE]: low). The proportion of successful intubation on the first attempt was higher with DTI when compared to laryngoscope-assisted TI (RR 95% CI: 1.81 [1.18; 2.76]) (CoE: very low). Time to successful TI with DTI was 7.4 (95% CI: 6.3, 8.5) s (CoE: low). Time to successful TI was significantly shorter with DTI when compared to laryngoscope assisted TI (MD [95% CI]: -4.9 [-7.3, -2.4] s) (CoE: very low). There was a trend towards a higher proportion of correct ETT tip positions with finger palpation when compared to weight-based formulae alone (RR 95% CI: 1.12 [0.96; 1.31]) (CoE: very low). CONCLUSIONS: DTI and finger palpation to ascertain ETT tip position in neonates are promising strategies. Future studies with emphasis on their learning trajectory and generalizability are needed.


Assuntos
Intubação Intratraqueal , Palpação , Humanos , Recém-Nascido , Estudos Observacionais como Assunto
13.
Sensors (Basel) ; 21(13)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34201954

RESUMO

Pulse palpation is an effective method for diagnosing arterial diseases. However, most pulse measurement devices use preconfigured pressures to collect pulse signals, and most pulse tactile simulators can only display standard or predefined pulse waveforms. Here, a portable interactive human pulse measurement and reproduction system was developed that allows users to take arbitrary pulses and experience realistic simulated pulse tactile feedback in real time by using their natural pulse-taking behaviors. The system includes a pulse tactile recorder and a pulse tactile player. Pulse palpation forces and vibrations can be recorded and realistically replayed for later tactile exploration and examination. To retain subtle but vital pulse information, empirical mode decomposition was used to decompose pulse waveforms into several intrinsic mode functions. Artificial neural networks were then trained based on intrinsic mode functions to determine the relationship between the driving signals of the pulse tactile player and the resulting vibration waveforms. Experimental results indicate that the average normalized root mean square error and the average R-squared values between the reproduced and original pulses were 0.0654 and 0.958 respectively, which indicate that the system can reproduce high-fidelity pulse tactile vibrations.


Assuntos
Redes Neurais de Computação , Tato , Frequência Cardíaca , Humanos , Palpação , Pressão , Pulso Arterial
14.
Cochrane Database Syst Rev ; 6: CD014546, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34124773

RESUMO

BACKGROUND: The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES: To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults). SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS: We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS: We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi2(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi2(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results. AUTHORS' CONCLUSIONS: Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.


Assuntos
Cárie Dentária/diagnóstico , Esmalte Dentário , Diagnóstico Precoce , Palpação/métodos , Exame Físico/métodos , Adulto , Viés , Criança , Intervalos de Confiança , Humanos , Sensibilidade e Especificidade
15.
J Community Health Nurs ; 38(3): 193-199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34148433

RESUMO

The purpose of this evidence-based education initiative was to increase A Fib detection in a cardiovascular diseased population in which participants were taught radial pulse palpation and signs/symptoms of A Fib. Participants were evaluated after initial education on performance of radial pulse palpation and teach back of signs/symptoms of the arrhythmia and again at three weeks on adherence to daily self-screening and recall of signs/symptoms of A Fib. Post initial education, 88% of eligible participants learned pulse-palpation and 93% could verbalize at minimum one sign/symptom. After three weeks, 94.7% reported daily self-screening, but only 44.7% could verbalize at minimum one sign/symptom. This indicated that participants were continuing to self-screen, but in need of booster education sessions. Educating individuals on self-screening and signs/symptoms of A Fib is clinically feasible.


Assuntos
Fibrilação Atrial/diagnóstico , Frequência Cardíaca/fisiologia , Autoavaliação (Psicologia) , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Palpação/métodos , Educação de Pacientes como Assunto/métodos
16.
Breast J ; 27(8): 651-656, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34120393

RESUMO

Intraoperative nodal palpation in the axilla is a mandatory part of sentinel lymph node biopsy. However, there is no consensus regarding the definition of suspicious palpable node. The sampling rate and involvement rate of suspicious palpable nodes are inconsistent. We hypothesized that axillary reverse mapping is helpful to select suspicious palpable sentinel lymph nodes more accurately. Patients with clinically negative nodes underwent sentinel lymph node biopsy with intraoperative nodal palpation and axillary reverse mapping. Blue and hot nodes were removed as sentinel lymph nodes. Suspicious palpable nodes that were neither blue nor hot were removed as palpable sentinel lymph nodes. Nodes around blue and hot sentinel lymph node were incidentally removed as para-sentinel lymph nodes. Fluorescent nodes were considered axillary reverse mapping nodes. Patients with positive sentinel lymph node underwent axillary lymph node dissection. Palpable sentinel lymph nodes and para-sentinel lymph nodes were removed in 130 (15%) of 850 patients with clinically negative nodes. Although palpable sentinel lymph nodes and para-sentinel lymph nodes were involved in 19 (15%) of 130 patients, fluorescent palpable sentinel lymph nodes were involved only in 2 patients and fluorescent para-sentinel lymph nodes were not involved. When excluding fluorescent palpable sentinel lymph nodes and para-sentinel lymph nodes, the sampling rate of suspicious palpable nodes significantly decreased (15% vs. 5%, p < 0.01) and the involvement rate of palpable sentinel lymph nodes significantly increased (15% vs. 31%, p < 0.05). Axillary reverse mapping is helpful to avoid an unnecessary removal of palpable nodes without metastases.


Assuntos
Neoplasias da Mama , Biópsia de Linfonodo Sentinela , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática/diagnóstico por imagem , Palpação
17.
Chiropr Man Therap ; 29(1): 20, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127016

RESUMO

OBJECTIVE: The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. MATERIALS: Reliability study that used a convenience sample of 51 patients between the ages of 16-70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other's findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. RESULTS: When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88-0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53-0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45-0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. CONCLUSIONS: Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.


Assuntos
Cervicalgia/fisiopatologia , Palpação/normas , Exame Físico/normas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
18.
J Bodyw Mov Ther ; 26: 7-11, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33992299

RESUMO

INTRODUCTION: Dry needling of the periscapular musculature is a procedure commonly performed by physical therapists. Needling of the deep musculature may be challenging, and use of a thoracic rib as a "backstop" is often applied to prevent inadvertent puncture of the pleura. The aim of this study was to: 1) To examine the accuracy rate of experienced physical therapists in identifying a mid-scapular thoracic rib using palpation, 2) to understand patient characteristics that affect the accuracy rate, and 3) to examine if therapist confidence levels were associated with palpatory accuracy. METHODS: Two experienced physical therapists attempted to palpate a thoracic rib in the mid-scapular region of healthy participants (n = 101 subjects, 202 ribs), and self-reported their level of confidence in an accurate palpation. Their accuracy was verified with ultrasonography. RESULTS: The two physical therapists were accurate on 73.3% of palpations and did not differ in accuracy (72.0% vs. 75.0%, p = 0.747). The only ultrasonographic or subject characteristic measurement that correlated with improved accuracy was a reduced muscle thickness (p = 0.032). Therapists' self-reported confidence levels did not correlate to actual accuracy (p = 0.153). DISCUSSION: Physical therapists should be aware that palpation of a thoracic rib may not be as accurate as it may seem. The greater thickness of muscle in the area reduces the accuracy of accurate palpation. CONCLUSION: Dry needling of the periscapular muscles should be done with caution if using a rib as a "blocking" technique.


Assuntos
Agulhamento Seco , Voluntários Saudáveis , Humanos , Palpação , Costelas/diagnóstico por imagem , Ultrassonografia
19.
Musculoskelet Sci Pract ; 54: 102384, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33992885

RESUMO

BACKGROUND: Manual palpation is an important part of the clinical examination and generally it has low reliability. The aim of this study was to assess the reliability of a novel method for discriminating 3 different levels of palpation force. METHODS: This reliability study included 96 healthy physiotherapists and physiotherapy students, who have been taught a new palpation graduated procedure called Visual Ischemic Palpatory Scale (VIPS), aimed to classify the applied pressure based on the finger's ischemia. Force was recorded by a force measurement system putting sensor over a rigid surface. To study the characteristic of VIPS the analysis of variance (ANOVA), Spearman rank correlation coefficient, Intraclass Correlation Coefficient (ICC), Standard Error of Measurements (SEM), and Minimal Detectable Change (MDC) were calculated. RESULTS: Three distinct degrees were found with distinct forces expression: 1st degree 76.04 g (95% CI 65.86-86.22), 2nd degree 307.87 g (95% CI 263.29-352.44) and 3rd degree 1319.48 g (CI 1204.73-1434.23). Male participants significantly recorded a greater force than females. Good to excellent reliability across degrees were found (0.89 [95% CI: 0.82-0.97]), and final agreement found that more than 65.6% of sample recorded a force in the cut-offs identified. SEM values became bigger as the recorded force increased and MDC were equal to 48.94 g, 188.73 g, and 379.24 g for 1st, 2nd, and 3rd degree, respectively. CONCLUSIONS: VIPS would appear to have three distinct degrees, sex dependent, with specific force expression for each degree and a good to excellent intra-rater reliability, but a poor agreement between raters.


Assuntos
Isquemia , Palpação , Exame Físico , Feminino , Humanos , Isquemia/diagnóstico , Masculino , Modalidades de Fisioterapia , Reprodutibilidade dos Testes
20.
IEEE Trans Haptics ; 14(2): 285-290, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33939613

RESUMO

Contractures are generally assessed by a physician or physical therapist through palpation. However, contracture palpation requires skill and experience. The frictional vibration, which has a pulse-like vibration due to sliding disturbances around the affected area during palpation, is important in assessing the degree of contracture progression. This paper aims to enhance the perceptual sensitivity of frictional vibration for contracture palpation using a vibrotactile feedback system. We previously proposed an evaluation system for palpation with a wearable skin vibration sensor that detects skin-propagated vibration, allowing touch with a bare fingertip. In this paper, we propose the vibrotactile feedback system that presents the tactile information of the fingertip detected by the wearable tactile sensor to the temples with a vibrotactile display. A stimulator that gives vibrations similar to those during the palpation, which include pulse-like vibration and small vibration, was assembled. Then, psychophysical experiments on the vibrotactile feedback system were conducted using this stimulator. The results showed that the detection sensitivity of the pulse-like vibration was significantly enhanced with the feedback.


Assuntos
Contratura , Percepção do Tato , Retroalimentação , Humanos , Palpação , Tato , Vibração
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