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Isogai K, Noda A, Matsuzawa A, Okamoto S. Effectiveness of palpation technique training and practice using a muscle-nodule-palpation simulator. J Phys Ther Sci 2024; 36:195-201. [PMID: 38562532 PMCID: PMC10981955 DOI: 10.1589/jpts.36.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/16/2024] [Indexed: 04/04/2024] Open
Abstract
[Purpose] Extant techniques for palpating nodules, a diagnostic criterion of myofascial trigger points, lack high reliability. Therefore, this study aimed to investigate the effects of training and practice using a novel muscle-nodule-palpation simulator. [Participants and Methods] Sixteen university students (age range: 19-22 years) were randomly assigned to the training (n=8) and control (n=8) groups and used the muscle-nodule-palpation simulator to determine the position and orientation of the muscle nodule embedded in the model. During the experiment, only the participants in the training group were allowed to practice nodule detection while viewing the model through its transparent material. Subsequently, both groups underwent a performance evaluation. [Results] The training group exhibited greater improvement in performance than the control group. The means and standard errors of the improvement in the proportion of successful localization of the muscle nodule were 0.14 ± 0.06 for the control group and 0.42 ± 0.09 for the training group. [Conclusion] Training using the muscle-nodule-palpation simulator improved palpation technique for nodule localization.
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Affiliation(s)
- Kaoru Isogai
- Department of Physical Therapy, Faculty of Health and
Medical Sciences, Tokoha University: 1230 Miyakoda-cho, Kita-ku, Hamamatsu-shi, Shizuoka
431-2102, Japan
| | - Asuka Noda
- Department of Rehabilitation, Suzukake Central Hospital,
Japan
| | | | - Shogo Okamoto
- Department of Computer Science, Graduated School of Systems
Design, Tokyo Metropolitan University, Japan
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2
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Hiemstra LA, Kerslake S, Sasyniuk TM, Lafave MR. Palpation and fluoroscopy are valid but unreliable for the assessment of femoral tunnel position after medial patellofemoral ligament reconstruction. J ISAKOS 2024:S2059-7754(24)00050-6. [PMID: 38492848 DOI: 10.1016/j.jisako.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the validity and reliability of two techniques, palpation and fluoroscopy, for assessing medial patellofemoral ligament (MPFL) reconstruction femoral tunnel position accuracy. METHODS Twenty-one fresh frozen cadaveric knees had an MPFL femoral tunnel drilled and filled with a metal screw. Tunnels were created in a nonstandard fashion to ensure the sample included a range of tunnel positions from poor to ideal. Six experienced sport medicine and arthroscopy surgeons evaluated the placement of the femoral tunnel by palpating the screw in relation to anatomic landmarks and by fluoroscopy related to Schöttle's Point. They evaluated 1) the accuracy of femoral tunnel placement, 2) the direction of tunnel error, and 3) the clinical acceptability of the tunnel position. Validity measures included sensitivity, specificity, and correlation to clinical acceptability, which were calculated for the palpation and fluoroscopic assessments. Reliability measures included interrater reliability (ICC 2,k) for femoral tunnel accuracy and percent agreement of the raters' tunnel direction assessment. RESULTS The palpation method demonstrated a sensitivity of 0.79 and specificity of 0.84 for assessing the accuracy of femoral tunnel placement, while the fluoroscopic method showed a sensitivity of 0.83 and specificity of 0.92. Pearson correlation coefficients for clinical acceptability of tunnel position were high, with both techniques ranging from .589 to .854. Interrater reliability for the palpation and fluoroscopic techniques for assessment of tunnel accuracy were 0.31 and 0.55 (ICC 2,k), respectively. Assessment of the direction of tunnel error was good with the fluoroscopic technique slightly more accurate than palpation. CONCLUSION This study demonstrated that both palpation and fluoroscopy are valid techniques for assessing femoral tunnel position after MPFL reconstruction. Despite demonstrating good validity, the accuracy of assessing tunnel position was unreliable in a group of six experienced knee surgeons. Further research into MPFL reconstruction femoral tunnel assessment techniques, including patient-specific reference standards, is warranted. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Laurie A Hiemstra
- Banff Sport Medicine Foundation, PO Box 1300, Banff, Alberta, T1L 1B3, Canada; Department of Surgery, University of Calgary, North Tower Foothills Medicine Centre, 1403 29th St. NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Sarah Kerslake
- Banff Sport Medicine Foundation, PO Box 1300, Banff, Alberta, T1L 1B3, Canada.
| | - Treny M Sasyniuk
- Banff Sport Medicine Foundation, PO Box 1300, Banff, Alberta, T1L 1B3, Canada.
| | - Mark R Lafave
- Department of Health & Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada.
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Boisselier Q, Pinar U, Durand X, Tabourin T, Salin A, Baboudjian M, Murez T, Roupret M, Pradère B. Patients and general practitioner knowledge and perception of testicular self-examination for cancer. World J Urol 2024; 42:58. [PMID: 38279983 DOI: 10.1007/s00345-023-04707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/22/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE Testicular cancer (TC) predominantly affects young men and early detection enhances survival. However, uncertainty surrounds the impact of population-wide screening. Testicular self-examination (TSE) is a simple detection method but there is a gap in current practices that needs to be assessed. Our goal was to assess the perceptions and knowledge of male subjects in the general population (MP) and general practitioners (GPs) regarding TSE for TC. METHODS Two distinct surveys evaluating knowledge and perceptions of TSE for TC were administered to GPs and MP, aged 15‒45-years. Factors that could favour the realisation of TSE or improve the knowledge of TC were evaluated by multivariable logistic regression. RESULTS Overall, 1048 GPs (mean (SD) age: 35.1 ± 10.3 years) and 1032 MP (mean (SD) age: 27 ± 8.2 years) answered the survey. Among the GPs, only 93 (8.9%) performed scrotal examination for TC screening. Although the majority (n = 993, 94.8%) were aware of the age of onset of TC, most (n = 768, 73.3%) did not know the overall survival rate from TC. GPs familiar with the guidelines were more likely to explain TSE to their patients (OR = 2.5 [95% CI 1.5‒4.1]; p < 0.01). Among the MP, 800 (77.5%) admitted that they did not know how to perform TSE and 486 (47.1%) did not know the main symptoms associated with TC. MP who had already undergone TC screening were more likely to be familiar with the main symptoms (OR = 2.1 [95% CI 1.6‒2.7]; p < 0.001) and MP who knew someone with TC or who had already undergone TC screening were more likely to be aware of the correct prevalence of TC (OR = 1.9 [95% CI 1.3‒2.7], p < 0.01; and OR = 1.6 [95% CI 1.2‒2.1], p < 0.01; respectively). CONCLUSION The knowledge of both GPs and MP regarding TC could be improved. TSE screening and knowing someone close with TC improved the awareness of our subjects.
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Affiliation(s)
| | - Ugo Pinar
- GRC n°5, Predictive Onco-Urology, APHP, Sorbonne University, Hôpital Pitié-Salpêtrière, Urology, 75013, Paris, France
| | - Xavier Durand
- Urology Department, Hôpital Saint-Joseph, Paris, France
| | - Thomas Tabourin
- GRC n°5, Predictive Onco-Urology, APHP, Sorbonne University, Hôpital Pitié-Salpêtrière, Urology, 75013, Paris, France
| | - Ambroise Salin
- Department of Urology, La Croix du Sud Hospital, 31130, Quint Fonsegrives, France
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Thibaut Murez
- Urology and Renal Transplantation Department, CHU Lapeyronie, Montpellier, France
| | - Morgan Roupret
- GRC n°5, Predictive Onco-Urology, APHP, Sorbonne University, Hôpital Pitié-Salpêtrière, Urology, 75013, Paris, France
| | - Benjamin Pradère
- Department of Urology, La Croix du Sud Hospital, 31130, Quint Fonsegrives, France.
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4
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Lavoue V, Favier A, Franck S, Boutet G, Azuar AS, Brousse S, Golfier F, Uzan C, Vaysse C, Molière S, Boisserie-Lacroix M, Kermarrec E, Seror JY, Delpech Y, Luporsi É, Maugard CM, Taris N, Chabbert-Buffet N, Sabah J, Alghamdi K, Fritel X, Mathelin C. French college of gynecologists and obstetricians (CNGOF) recommendations for clinical practice: Place of breast self-examination in screening strategies. Breast 2024; 75:103619. [PMID: 38547580 PMCID: PMC10990735 DOI: 10.1016/j.breast.2023.103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 04/07/2024] Open
Abstract
Breast cancer is the most common female cancer in the world. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of formal breast self-examination (BSE) as opposed to breast awareness has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN The Commission of Senology (CS) of the Collège National de Gynécologie et Obstétrique Français (CNGOF) respected and followed the Grading of Recommendations Assessment, Development and Evaluation method to assess the quality of the evidence on which the recommendations were based. METHODS The CS studied 16 questions individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE versus abstention from this examination led to detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS BSE should not be recommended for women in the general population, who otherwise benefit from clinical breast examination by practitioners from the age of 25, and from organized screening from 50 to 74 (strong recommendation). In the absence of data on the benefits of BSE in patients aged over 75, for those at high risk and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these categories wish to undergo BSE, information on the benefits and risks observed in the general population must be given, notably that BSE is associated with a higher number of referrals, biopsies, and a reduced quality of life.
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Affiliation(s)
- Vincent Lavoue
- CHU Service de Gynécologie, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Amélia Favier
- Gynécologie-obstétrique et Médecine de La Reproduction, Maternité Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Sophie Franck
- Institut Curie, 26 Rue D'Ulm, 75248, Paris Cedex 05, France
| | - Gérard Boutet
- AGREGA, Service de Chirurgie Gynécologique et Médecine de La Reproduction, Centre Aliénor D'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33000, Bordeaux, France
| | - Anne-Sophie Azuar
- Centre Hospitalier Clavary, Chemin de Clavary, 06130, Grasse, France
| | - Susie Brousse
- Service D'oncologie Chirurgicale, Centre Eugène Marquis, Unicancer, Rennes, France
| | - François Golfier
- Service de Chirurgie Gynécologique et Cancérologique - Obstétrique, Hospices Civils de Lyon, CHU Lyon Sud, Lyon, France
| | - Catherine Uzan
- Hôpital Pitié Salpetrière, 47 Bld de L'Hôpital, 75013, Paris, France
| | - Charlotte Vaysse
- Service de Chirurgie Oncologique, CHU Toulouse, Institut Universitaire Du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot Curie, 31059, Toulouse, France
| | | | | | - Edith Kermarrec
- Hôpital Tenon Service de Radiologie, 4 Rue de La Chine, 75020, Paris, France
| | - Jean-Yves Seror
- Imagerie Duroc, 9 Ter Boulevard Montparnasse 75006 Paris, France
| | - Yann Delpech
- Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, Nice, France
| | - Élisabeth Luporsi
- Oncologie Médicale et Oncogénétique, CHR Metz-Thionville, Hôpital de Mercy, 1 Allée Du Château, 57085, Metz, France
| | - Christine M Maugard
- Service de Génétique Oncologique Clinique et Unité de Génétique Oncologique Moléculaire, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Nicolas Taris
- Service de Génétique Oncologique, ICANS, 17 Rue Calmette, 67200, Strasbourg, France, France
| | | | - Jonathan Sabah
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Khalid Alghamdi
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Xavier Fritel
- Centre Hospitalo-universitaire de Poitiers, 2 Rue de La Milétrie, 86021, Poitiers, France
| | - Carole Mathelin
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France.
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5
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Khair AM, McIlvain G, McGarry MDJ, Kandula V, Yue X, Kaur G, Averill LW, Choudhary AK, Johnson CL, Nikam RM. Clinical application of magnetic resonance elastography in pediatric neurological disorders. Pediatr Radiol 2023; 53:2712-2722. [PMID: 37794174 PMCID: PMC11086054 DOI: 10.1007/s00247-023-05779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Magnetic resonance elastography is a relatively new, rapidly evolving quantitative magnetic resonance imaging technique which can be used for mapping the viscoelastic mechanical properties of soft tissues. MR elastography measurements are akin to manual palpation but with the advantages of both being quantitative and being useful for regions which are not available for palpation, such as the human brain. MR elastography is noninvasive, well tolerated, and complements standard radiological and histopathological studies by providing in vivo measurements that reflect tissue microstructural integrity. While brain MR elastography studies in adults are becoming frequent, published studies on the utility of MR elastography in children are sparse. In this review, we have summarized the major scientific principles and recent clinical applications of brain MR elastography in diagnostic neuroscience and discuss avenues for impact in assessing the pediatric brain.
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Affiliation(s)
| | - Grace McIlvain
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | | | - Vinay Kandula
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
| | - Xuyi Yue
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Gurcharanjeet Kaur
- Department of Neurology, New York-Presbyterian / Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren W Averill
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
| | - Arabinda K Choudhary
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Rahul M Nikam
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA.
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6
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Scogin WM, Sanford D, Greenway MB, Ledbetter M, Washmuth NB. The influence of body painting on L4 spinous process palpation accuracy in novice palpators. J Man Manip Ther 2023:1-6. [PMID: 37930272 DOI: 10.1080/10669817.2023.2278264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Current literature remains inconclusive regarding the best methodology to accurately palpate lumbar spinous processes (SP). Body painting (BP) uses markers to draw anatomical structures on the skin's surface. While BP can be a useful tool for engaging learners, it is unknown whether it improves palpation accuracy. The purpose of this study was to investigate whether the addition of body painting to palpation education improves lumbar spinous process palpation accuracy in first-year Doctor of Physical Therapy (DPT) students. METHODS Thirty-eight DPT students were randomized into a traditional palpation group and a body painting (BP) group. Each group received identical instruction on palpating the lumbar spine, with the BP group additionally drawing lumbar SPs on their laboratory partner with a marker. Students were then assessed on their ability to accurately palpate the L4 SP on randomly assigned subjects. Two Certified Registered Nurse Anesthetists (CRNAs) used ultrasound imaging to confirm the location of each student's palpation. Palpation time was also recorded. The BP group also completed a survey on the learning experience. RESULTS Forty-five percent of students were able to accurately palpate the L4 SP. There was no significant difference (p = 0.78) in palpation accuracy between the traditional and BP group, although students in the BP group were randomly assigned subjects with a significantly (p = 0.005) higher BMI. Ninety-five percent of students were able to palpate within one spinal level of the L4 SP. Students in the BP group reported that the BP activity facilitated learning and active participation. There was no significant difference in palpation time (p = 0.98) between groups. There was a fair correlation (r=-0.41) between palpation accuracy and subject BMI. DISCUSSION/CONCLUSION While body painting was an enjoyable activity to incorporate into palpation laboratory, it is unclear whether it enhanced lumbar SP palpation accuracy in first-year DPT students.
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Affiliation(s)
- William M Scogin
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | - David Sanford
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | | | - Maria Ledbetter
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
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7
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Lavoué V, Favier A, Frank S, Boutet G, Azuar AS, Brousse S, Golfier F, Uzan C, Vaysse C, Molière S, Boisserie-Lacroix M, Kermarrec E, Seror JY, Delpech Y, Luporsi É, Maugard CM, Taris N, Chabbert-Buffet N, Sabah J, Alghamdi K, Fritel X, Mathelin C. [Place of breast self-examination in screening strategies. French College of Gynecologists and Obstetricians (CNGOF) recommendations for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:437-447. [PMID: 37652173 DOI: 10.1016/j.gofs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Breast cancer is the most common female cancer in the world. In France, over 60,000 new cases are currently diagnosed, and 12,000 deaths are attributed to it annually. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of breast self-examination (BSE) has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN the CNGOF's Commission de Sénologie (CS), composed by 17 experts and 3 invited members, drew up these recommendations. No funding was provided for the development of these recommendations. The CS respected and followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the quality of the evidence on which the recommendations were based. METHODS The CS studied 16 questions concerning BSE, individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE compared with abstention from this examination led to the detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS BSE should not be recommended for women in the general population, who otherwise benefit from a clinical breast examination (by the attending physician or gynecologist) from the age of 25, and from organized screening from 50 to 74 (strong recommendation). However, in the absence of data on the role of BSE in patients aged over 75, those at high risk of breast cancer and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these latter categories wish to undergo BSE, they must be given rigorous training in the technique, and information on the benefits and risks observed in the general population. Finally, the CS invites all women who detect a change or abnormality in their breasts to consult a healthcare professional without delay. CONCLUSION BSE is not recommended for women in the general population. No recommendation can be established for women aged over 75, those at high risk of breast cancer and those previously treated for breast cancer.
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Affiliation(s)
- Vincent Lavoué
- Service de gynécologie, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Amélia Favier
- Gynécologie-obstétrique et médecine de la reproduction - maternité, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Sophie Frank
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - Susie Brousse
- Service d'oncologie chirurgicale, centre Eugène-Marquis, Unicancer, Rennes, France
| | - François Golfier
- Service de chirurgie gynécologique et cancérologique - obstétrique, hospices civils de Lyon, CHU Lyon Sud, Lyon, France
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Charlotte Vaysse
- Service de chirurgie oncologique, institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Sébastien Molière
- Imagerie du sein, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France
| | | | - Edith Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Jean-Yves Seror
- Imagerie Duroc, 9 ter, boulevard Montparnasse, 75006 Paris, France
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Taris
- Service de génétique oncologique, ICANS, 17, rue Calmette, 67200 Strasbourg, France
| | | | - Jonathan Sabah
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France
| | - Khalid Alghamdi
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Carole Mathelin
- CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
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Takeshita J, Nakayama Y, Tachibana K, Nakajima Y, Shime N. Ultrasound-guided short-axis out-of-plane approach with or without dynamic needle tip positioning for arterial line insertion in children: A systematic review with network meta-analysis. Anaesth Crit Care Pain Med 2023; 42:101206. [PMID: 36858256 DOI: 10.1016/j.accpm.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
The efficacy of the short-axis out-of-plane (SA-OOP) approach with and without dynamic needle tip positioning (DNTP) remains unclear. This systematic review with network meta-analysis aimed to compare the success rate of arterial line insertion in children using the SA-OOP approach with and without DNTP and the palpation technique. We searched MEDLINE (via PubMed) and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials that compared two of the following techniques for arterial line insertion in children: (1) the ultrasound-guided SA-OOP approach with DNTP; (2) the ultrasound-guided SA-OOP approach without DNTP; and (3) the palpation technique. A network meta-analysis was performed. The outcomes were first-attempt and overall success rates. Eight studies were finally included in this network meta-analysis. The ultrasound-guided SA-OOP approach with DNTP was associated with increased first-attempt (relative risk RR = 3.45 [95% confidence interval (CI) 2.51-4.74]) and overall success rates (RR = 1.81 [1.41-2.32]) when compared with palpation. The same approach performed without DNTP was also associated with increased first-attempt (RR = 1.96 [1.59-2.42]) and overall success rates (RR = 1.25 [1.05-1.49]) when compared with palpation. The ultrasound-guided SA-OOP approach with DNTP was associated with increased first-attempt (RR = 1.76 [1.26-2.44]) and overall success rates (RR = 1.45 [1.10-1.91]) when compared with the same approach performed without DNTP. DNTP should be performed during the ultrasound-guided SA-OOP approach for arterial line insertion in children, as this can help increase first attempt and overall success rates.
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Affiliation(s)
- Jun Takeshita
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Yoshinobu Nakayama
- Department of Molecular, Cellular and Biomedical Sciences CUNY School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, USA.
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Yasufumi Nakajima
- Department of Anesthesiology and Intensive Care, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Sayama, Osaka 589-8511, Japan; Outcomes Research Consortium, 9500 Euclid Avenue, P77, Cleveland, OH 44195, USA.
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-3-2 Kagamiyama, Higashihiroshima, Hiroshima 739-8511, Japan.
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Ricci V, Ricci C, Gervasoni F, Giulio C, Farì G, Andreoli A, Özçakar L. From physical to ultrasound examination in lymphedema: a novel dynamic approach. J Ultrasound 2022; 25:757-763. [PMID: 35000129 PMCID: PMC9402863 DOI: 10.1007/s40477-021-00633-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
In daily practice, medical history and physical examination are commonly coupled with anthropometric measurements for the diagnosis and management of patients with lymphatic diseases. Herein, considering the current progress of ultrasound imaging in accurately assessing the superficial soft tissues of the human body; it is noteworthy that ultrasound examination has the potential to augment the diagnostic process. In this sense/report, briefly revisiting the most common clinical maneuvers described in the pertinent literature, the authors try to match them with possible (static and dynamic) sonographic assessment techniques to exemplify/propose an 'ultrasound-guided' physical examination for different tissues in the evaluation of lymphedema.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Fabrizio Gervasoni
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cocco Giulio
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, G. d'Annunzio University, Chieti, Italy
| | - Giacomo Farì
- Section of Physical Medicine and Rehabilitation, Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Arnaldo Andreoli
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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10
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Tsuchida M, Shibata M, Iimura A, Oguchi T, Kim S, Nakao Y, Nakamura H. A macroscopic anatomical study of the appropriate palpation zone of the gluteus medius muscle. J Phys Ther Sci 2022; 34:554-560. [PMID: 35937621 PMCID: PMC9345755 DOI: 10.1589/jpts.34.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Few previous studies have delimitated the palpation zone of the gluteus medius
muscle with a focus on its fiber bundles. The purpose of this study was to clarify the
morphological characteristics of the gluteus medius muscle using an anatomical approach,
and to define its proper palpation zone. [Participants and Methods] In this study, we
evaluated thirteen halves of the pelvic region in seven formalin-fixed cadavers. We
identified the borders between the iliotibial band and gluteus medius muscle, and between
the gluteus medius and gluteus maximus muscles, on the iliac crest. Furthermore, we
quantified the border points of the gluteus medius’ fiber bundles and observed its
anatomical and morphological characteristics. [Results] We identified two fiber bundles in
the gluteus medius muscle, an anterior and a posterior fiber bundle, and detected that a
portion of the posterior fibers was located subcutaneously. [Conclusion] We propose that
the region where the posterior fibers of the gluteus medius muscle are located
subcutaneously is an appropriate zone for the palpation of this muscle.
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Affiliation(s)
- Masayuki Tsuchida
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Masakazu Shibata
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Akira Iimura
- Department of Anatomy, Kanagawa Dental University, Japan
| | - Takeshi Oguchi
- Department of Anatomy, Kanagawa Dental University, Japan
| | - SungHyek Kim
- Faculty of Health Science, Tokoha University, Japan
| | - Yoko Nakao
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Hisashi Nakamura
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
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11
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Passmore SR, Malone Q, MacNeil B, Sanli E, Gonzalez D. Differing Characteristics of Human-Shaped Visual Stimuli Affect Clinicians' Dosage of a Spinal Manipulative Thrust on a Low-Fidelity Model: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:171-178. [PMID: 35907658 DOI: 10.1016/j.jmpt.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether chiropractic clinicians modulate spinal manipulation (SM) thrust characteristics based on visual perception of simulated human silhouette attributes. METHODS We performed a cross-sectional within-participant design with 8 experienced chiropractors. During each trial, participants observed a human-shaped life-sized silhouette of a mock patient and delivered an SM thrust on a low-fidelity thoracic spine model based on their visual perception. Silhouettes varied on the following 3 factors: apparent sex (male or female silhouette), height (short, average, tall), and body mass index (BMI) (underweight, healthy, obese). Each combination was presented 6 times for a total of 108 trials in random order. Outcome measures included peak thrust force, thrust duration, peak preload force, peak acceleration, time to peak acceleration, and rate of force application. A 3-way repeated measures analysis of variance model was used to for each variable, followed by Tukey's honestly significant difference on significant interactions. RESULTS Peak thrust force was reduced when apparent sex of the presented silhouette was female (F1,7 = 5.70, P = .048). Thrust duration was largely invariant, except that a BMI by height interaction revealed a longer duration occurred for healthy tall participants than healthy short participants (F4,28 = 4.34, P = .007). Compared to an image depicting obese BMI, an image appearing underweight lead to reduced peak acceleration (F2,5 = 6.756, P = .009). Clinician time to peak acceleration was reduced in short compared to tall silhouettes (t7 = 2.20, P = .032). CONCLUSION Visual perception of simulated human silhouette attributes, including apparent sex, height, and BMI, influenced SM dose characteristics through both kinetic and kinematic measures. The results suggest that visual information from mock patients affects the decision-making of chiropractic clinicians delivering SM thrusts.
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Affiliation(s)
- Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Quinn Malone
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian MacNeil
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sanli
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - David Gonzalez
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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12
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Albuquerque PMNM, Da Silva EPC, Melo TMDS, Montenegro EJN, de Oliveira DA, Guerino MR, De Siqueira GR. Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques. J Manipulative Physiol Ther 2022; 45:227-234. [PMID: 35879125 DOI: 10.1016/j.jmpt.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation. METHODS Twenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ2 test were used to identify the factors associated with the error and inaccuracy of palpation. RESULTS Accuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = -0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region. CONCLUSION The palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.
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Affiliation(s)
| | | | - Thania M de S Melo
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Eduardo J N Montenegro
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Daniella A de Oliveira
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Marcelo R Guerino
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gisela R De Siqueira
- Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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13
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Ferreira APA, Zanier JFC, Santos EBG, Ferreira AS. Accuracy of Palpation Procedures for Locating the C1 Transverse Process and Masseter Muscle as Confirmed by Computed Tomography Images. J Manipulative Physiol Ther 2022; 45:337-345. [PMID: 36175313 DOI: 10.1016/j.jmpt.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy. METHODS This was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient. RESULTS The right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r = .219; 95% confidence interval, 0.018-0.403; P = .033). CONCLUSION Palpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles.
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Affiliation(s)
- Ana Paula A Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy; Visiting Fellow, ARCCIM, University of Technology Sydney, Sydney, Australia; Instituto Brasileiro de Osteopatia, Rio de Janeiro, Brazil.
| | - José Fernando C Zanier
- University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Brown G Santos
- University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arthur S Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, Brazil.
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Abstract
This qualitative and quantitative study offered students the opportunity to participate in engaging and inspiring activities "outside the classroom", to extend their experience and knowledge of surface anatomy. Medical and health science students benefit from studying surface anatomy as it is relevant to their future professions that deal with patients and clients. Surface anatomy is an essential part of the learning process that allows students an opportunity to identify anatomical structures on living people and to develop their palpation and tactile skills for physical examinations of patients. Body painting is a student-centred, engaging, and motivating approach to learn surface anatomy in anatomy practical classes. In this study, anatomy learning was extended "beyond the classroom" through extra-curricular body painting projects. These projects were run by student teams consisting of a student model, student artists (4-5), and a student photographer, under the direction of the chief investigator. A total of sixteen body painting projects were carried out from 2010 to show the skeletal system, the muscular system, pregnancy, respiratory and gastrointestinal systems, and the neurovascular systems of the entire body. A SurveyMonkey of 31/41 active participants suggested that participants enjoyed the projects (94-100%), found them relevant to their future profession (80-87%), and considered them to assist with deeper understanding (94%) and long-term memory (93%) of anatomy. Learning anatomy outside the classroom through extra-curricular body painting projects was a successful way to engage, motivate, and inspire participants and first year anatomy students to study surface anatomy and to develop their physical examination skills.
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Affiliation(s)
- Claudia M Diaz
- School of Dentistry and Medical Sciences, Charles Sturt University, Albury, NSW 2640 Australia
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15
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Ali AH, Qenawy OK, Saleh WR, Ali AM, Abdul Monem ES, Omar NN. Radio-carpal wrist MR arthrography: comparison of ultrasound with fluoroscopy and palpation-guided injections. Skeletal Radiol 2022; 51:765-75. [PMID: 34324016 DOI: 10.1007/s00256-021-03845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ultrasound- (US), fluoroscopy- (FL), and palpation-guided contrast injection techniques used for dorsal radio-carpal wrist MRA. MATERIALS AND METHODS Patients with chronic wrist pain were randomized as to which injection technique they underwent into three groups of 50 participants. Dorsal radio-carpal contrast injection was performed under US, FL guidance (one radiologist for each), or palpation guidance by an orthopedic surgeon. The three techniques were compared by procedure time, success rate, number of attempts needed, frequency and grade of extravasation, joint distension, and MRA image quality. Additionally, any change from baseline wrist pain was recorded using the visual analog scale (VAS) at five time points (immediately, 8 h, 24 h, 48 h, and 1 week) after injection. RESULTS One hundred and fifty patients (83 males and 67 females; mean age 29 ± 6.5 years) were included. Success rates for US- and FL-guided injections were 100%, while palpation-guided approach was significantly less successful (72%) (P = 0.02) with significantly more frequent extravasation (56%)(P < 0.001). US guidance was the least time-consuming (6.5 ± 1.6 min) compared to FL guidance (12.5 ± 1.9 min) and palpation guidance (8 ± 1.2 min) (all P < 0.001). The mean number of joint puncture attempts was significantly lower with imaging-guided techniques (1.1 ± 0.24 and 1.2 ± 0.4 for US and FL, P = 0.23) compared to palpation-guided one (1.6 ± 0.8) (P = 0.007). The largest increases in baseline-pain were 8-h post-injection, and US guidance was the least painful at all-time points (all P < 0.05). Joint distension and image quality were significantly better with imaging-guided techniques (P < 0.001 and P = 0.003). CONCLUSIONS US-guided radio-carpal injection is a less time-consuming, more tolerable, and successful radiation-free method when compared to FL guidance. Palpation-guided injections require multiple attempts to enter the joint with high failure rates and frequent extravasation.
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16
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Hamm RM, Kelley DM, Medina JA, Syed NS, Harris GA, Papa FJ. Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students. BMC Med Educ 2022; 22:63. [PMID: 35081956 PMCID: PMC8793257 DOI: 10.1186/s12909-022-03126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance. METHODS All third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student's manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation. RESULTS 119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p's < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students' confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training. CONCLUSIONS Guided abdominal simulator practice increased medical students' capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.
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Affiliation(s)
- Robert M Hamm
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA.
| | - David M Kelley
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Jose A Medina
- Physician Associate Program, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Noreen S Syed
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Geraint A Harris
- Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA
| | - Frank J Papa
- Texas College of Osteopathic Medicine, University of North Texas, Fort Worth, TX, USA
- ACDET, Inc., Fort Worth, TX, USA
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Abstract
Magnetic resonance elastography (MRE) is an emerging noninvasive technique, an alternative to palpation for quantitative assessment of biomechanical properties of tissue. In MRE, tissue stiffness information is obtained by a 3-step process, propagating mechanical waves in the tissues, measuring the wave propagation using modified magnetic resonance (MR) pulse sequences, and generating the quantitative stiffness maps from the MR images. MRE is clinically used in patients with liver diseases, whereas its applications in other organs are still being investigated. At present, the pediatric studies are in the initial stage and preliminary results promise to provide additional information about tissue characteristics.
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Affiliation(s)
- Manjunathan Nanjappa
- Department of Radiology, The Ohio State University Wexner Medical Center, 460 West 12th Avenue, Room No 333 3rd Floor, Columbus, OH 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State Wexner Medical Center, 395 West 12th Avenue, 4th Floor, Columbus, OH 43210, USA.
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Kyriakopoulos V, Xanthopoulos A, Papamichalis M, Skoularigkis S, Tzavara C, Papadakis E, Patsilinakos S, Triposkiadis F, Skoularigis J. Patent hemostasis of radial artery: Comparison of two methods. World J Cardiol 2021; 13:574-584. [PMID: 34754402 PMCID: PMC8554357 DOI: 10.4330/wjc.v13.i10.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radial artery obstruction is the most common complication of coronary angiography performed via transradial access. Patent hemostasis can significantly reduce the risk of radial artery occlusion. Previous studies utilized sophisticated methods to evaluate radial artery patency. Simplified and easily applicable methods for successful patent hemostasis are currently lacking.
AIM To determine which method (pulse oximeter vs the traditional radial artery palpation) is better to achieve patent hemostasis.
METHODS This prospective, single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019. Patients less than 18 years old, with a history of radial artery disease, or no palpable artery pulse were excluded from the study. Patients were randomly assigned to two groups. In the first group, radial artery flow was assessed by palpation of the artery during hemostasis (traditional method). In the second group, radial artery patency was estimated with the use of a pulse oximeter. Two different compression devices were used for hemostasis (air chamber and pressure valve). The primary study endpoint was the achievement of successful patent hemostasis.
RESULTS The two groups (pulse oximeter vs artery palpation) had no significant differences in age, sex, body mass index, risk factors, or comorbidities except for supraventricular arrhythmias. The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group (82.2% vs 68.1%, P = 0.005). A lower percentage of patients with spasm was recorded in the pulse oximeter group (9.9% vs 19.0%, P = 0.024). The incidence of local complications, edema, bleeding, hematoma, vagotonia, or pain did not differ between the two groups. In the multivariate analysis, the use of a pulse oximeter (OR: 2.35, 95%CI: 1.34-4.13, P = 0.003) and advanced age (OR: 1.04, 95%CI: 1.01-1.07, P = 0.006), were independently associated with an increased probability of successful patent hemostasis. The type of hemostatic device did not affect patent hemostasis (P = 0.450).
CONCLUSION Patent hemostasis with the use of pulse oximeter is a simple, efficient, and safe method that is worthy of further investigation. Larger randomized studies are required to consider its clinical implications.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | | | | | - Chara Tzavara
- Department of Health, Medical School, University of Athens, Athens 11527, Greece
| | - Emmanouil Papadakis
- Department of Cardiology, Konstantopoulio General Hospital, Athens 14233, Greece
| | | | | | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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Gaudreault N, Lebel K, Bédard S, Daigle F, Venne G, Balg F. Using ultrasound imaging to assess novice physiotherapy students' ability to locate musculoskeletal structures with palpation. Physiotherapy 2021; 113:53-60. [PMID: 34563915 DOI: 10.1016/j.physio.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Use ultrasound imaging to assess success rates of novice physiotherapy students attempting to locate two tendons and two joint spaces using palpation. DESIGN Cross-sectional study. SETTING Master of physiotherapy program at an academic institution. PARTICIPANTS Twenty-two end of first-year physiotherapy students. METHODS Participants were asked to palpate and locate the long head of the biceps (LHBT) and tibialis posterior (PTT) tendons as well as the acromioclavicular joint (ACJ) and medial tibiofemoral joint (TFJ) spaces on two human models. A truncated needle was taped onto the skin, parallel to the palpated structure. Ultrasound imaging was used to assess the position of the needle relative to the structures. MAIN OUTCOME MEASURES Success or failure was determined based on a judgment call on the needle position relative to the targeted structure on the ultrasound images. Inter-evaluator agreement for judgment criteria was investigated using Cohen's kappa tests and success rates subsequently calculated. RESULTS Kappa coefficients were 1.00 for all structures collectively, 1.00 for LHBT and PTT tendons, 1.006 for ACJ, and 0.79 for TFJ. Palpation success rates were: 9% for LHBT, 64% for PTT, 23% for ACJ, and 31% for medial TFJ. CONCLUSION These results highlight the fact that there is room for improvement in anatomy and palpation skill teaching methods and ultrasound imaging is valuable tool to assess this important skill.
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Affiliation(s)
- Nathaly Gaudreault
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada.
| | - Karina Lebel
- Department of Electrical and Computer Engineering, Faculty of Engineering, University of Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC J1K 2R1, Canada
| | - Sonia Bédard
- Orthopedic Surgery Division, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
| | - Frédériqu Daigle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
| | - Gabriel Venne
- Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, 845 Rue Sherbrooke Ouest, Montréal, H3A 0G4, Canada
| | - Frédéric Balg
- Orthopedic Surgery Division, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4, Canada
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Roytman GR, Selby S, Cantu J, Cramer GD. A Novel and Accurate Palpation Method for Identification of the L4 Spinous Process: A Preliminary Study of Accuracy. J Manipulative Physiol Ther 2021; 44:398-407. [PMID: 34429213 DOI: 10.1016/j.jmpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/19/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Gregory R Roytman
- Research Department, National University of Health Sciences, Lombard, Illinois
| | - Scott Selby
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Wheaton, Illinois
| | - Joe Cantu
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Charlottesville, Virginia
| | - Gregory D Cramer
- Research Department, National University of Health Sciences, Lombard, Illinois.
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Masuda M, Hayakawa H, Boudreau SA, Iida T, Svensson P, Komiyama O. Standardized palpation of the temporalis muscle evoke referred pain and sensations in individuals without TMD. Clin Oral Investig 2021. [PMID: 34342760 DOI: 10.1007/s00784-021-04096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to determine if standardized palpations of the temporalis muscle evoke referred pain and/or sensations in individuals without TMD. MATERIALS AND METHODS This was a randomized, single-blinded study. The mechanical sensitivity of the right temporalis muscle was assessed in 32 participants without TMD with nine different stimulations to 15 test sites using palpometers (different stimulus intensities (0.5, 1.0, and 2.0 kg) and durations (2, 5, and 10 s). After each stimulus, participants were asked to score perceived pain intensity and intensity of unpleasantness on a 0-100 numeric rating scale as an indicator of mechanical sensitivity in the temporalis muscle and to indicate any areas of referred pain/sensations on a body chart. RESULTS Pain intensity significantly differed between palpation durations, intensities, and test sites (P < 0.001). In contrast, unpleasantness significantly differed between palparation duration and intensities (P < 0.001), but not test sites. Participants more frequently reported referred pain/sensations evoked by the 10-s (34.4%) as opposed to the 2-s (6.3%) and 5-s (15.6%) palpation duration at the 2.0-kg stimulus intensity (P < 0.05). CONCLUSIONS Our present results indicate that referred pain/sensations in the orofacial region can be evoked by standardized palpation of the temporalis muscle and influenced by the palpation duration in individuals without TMD. CLINICAL RELEVANCE Referred pain/sensations from the temporalis muscle were duration- and intensity-dependent processes originating from local stimuli.
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Margelli M, Segat A, Raule M, Giacchetti C, Zanoli G, Pellicciari L. A reliability study of a novel visual ischemic palpation scale in an experimental setting. Musculoskelet Sci Pract 2021; 54:102384. [PMID: 33992885 DOI: 10.1016/j.msksp.2021.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Michele Margelli
- Faculty of Medicine and Surgery, Department of Clinical Ccience and Translation Medicine, University of Rome Tor Vergata, Roma, Italy; Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Studio Andreotti-Margelli Terapika, Ferrara, Italy.
| | | | - Maddalena Raule
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Caterina Giacchetti
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Gustavo Zanoli
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Casa di Cura SM Maddalena, Occhiobello, Italy.
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Shii F, Mang D, Kasubuchi M, Tsuneto K, Toyama T, Endo H, Sasaki K, Sato R. Ultrasensitive detection by maxillary palp neurons allows non-host recognition without consumption of harmful allelochemicals. J Insect Physiol 2021; 132:104263. [PMID: 34052304 DOI: 10.1016/j.jinsphys.2021.104263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
Most lepidopteran insect larvae exhibit stepwise feeding behaviors, such as palpation using the maxillary palps (MPs) followed by test biting and persistent biting. However, the purpose of palpation has been unclear. In particular, nothing is known about the neurons in the MP and their mode of recognition of undesired plants, although such neurons have been suggested to exist. In this study, we used larvae of the stenophagous insect Bombyx mori and compared the roles of palpation and test biting in the selection of feeding behavior. When the larvae were given non-host plant leaves, they did not initiate test biting, indicating that non-host plant leaves were recognized via palpation without biting, and that this behavior resulted in a lack of persistent biting, as the leaves were judged non-suitable for consumption. Surface extracts of inedible leaves significantly suppressed test biting of mulberry leaves, a host plant of B. mori, suggesting that secondary metabolites on the leaf surface of inedible leaves function as test biting suppressors, even when another conditions are suitable for test biting. The allelochemical coumarin, which is found in the inedible leaves of cherry, Cerasus speciosa, significantly suppressed test biting of mulberry leaves, suggesting that coumarin is a possible deterrent to the eating of cherry leaves. Using the electrophysiological method of tip recording and a leaf-surface extract as the test material, leaf-surface compound-responsive neurons were identified in the MP. In addition, several neurons that respond to coumarin in the attomolar range were identified, suggesting that the larvae use ultrasensitive neurons in the MP to recognize inedible leaves. In the HEK293T cell heterologous expression system, the B. mori gustatory receptors BmGr53 and BmGr19, which were previously found to be expressed in the MP and to respond to coumarin in the attomolar range, responded to a leaf-surface extract of C. speciosa, suggesting that these receptors may be present on the inedible-leaf-recognizing neurons of the MP. These findings suggest that ultrasensitive plant secondary metabolite-recognizing neurons in the MP allow for the recognition of non-host plants via palpation without risking damage caused by ingesting harmful allelochemicals.
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Affiliation(s)
- Fumika Shii
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Dingze Mang
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Mayu Kasubuchi
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Kana Tsuneto
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Tomoko Toyama
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Haruka Endo
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan
| | - Ken Sasaki
- Graduate School of Agriculture, Tamagawa University, Tamagawagakuen 6-1-1, Machida, Tokyo 194-8610, Japan
| | - Ryoichi Sato
- Graduate School of Bio-Application and Systems Engineering, Tokyo University of Agriculture and Technology, Naka-cho 2-24-16, Koganei, Tokyo 184-8588, Japan.
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Proios I, Kusenda M, Seiler C, Siewert C, Seifert H, Kaske M. Postoperative wound assessment in cattle: How reliable is the back hand palpation? Ir Vet J 2021; 74:16. [PMID: 34134768 PMCID: PMC8207616 DOI: 10.1186/s13620-021-00195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background As part of clinical wound assessment in bovine surgery, discrepancies in skin temperature are evaluated by placing the back of the hand on the area to be examined. Generally, an increased skin temperature at the wound site for a prolonged period is considered as an indicator of impaired wound healing. The aim of this study was to verify the reliability of palpation under bovine practice conditions using laparotomy as an example. Fourteen cows (German Holstein) with a left displacement of the abomasum (LDA) without other severe concurrent diseases were examined preoperatively and once daily for ten days after surgery. The skin temperature of the wound site in the right flank was assessed by palpation, followed by thermographic evaluation using an infrared camera after a 45-min acclimatisation period, under standardised conditions in a closed examination room daily for 10 days. Results All the incisions healed without clinical detectable perturbances. The ambient temperature range during the study period was 7.8 − 24.1 °C. Two groups were retrospectively defined according to the ambient temperature: high ambient temperature (HT group; median: 20.2 °C 25/75 quartile: 18.5 °C / 21.7 °C; n = 6) and low ambient temperature (LT group; 10.8 °C; 9.4 °C / 12.8 °C; n = 8). The temperature differences (Δϑ) between the mean skin temperature of the wound site and a defined reference area cranial to the wound were assessed. A significant negative correlation was found between the ambient temperature (ϑAmb) and Δϑ (r=-0.51; P < 0.001). The Δϑ was postoperatively higher in the cows in the LT group (median of the individual animals 0.8–2.5 °C) than in the HT group (0.1–0.5 °C; P < 0.05). In contrast to the thermographic findings, manual palpation rarely detected local hyperthermia (> 1 °C) at the wound site (sensitivity 0.20; specificity 0.96). Conclusions The infrared thermography provides a more reliable assessment of temperature changes at the wound site in comparison to manual palpation. The ambient temperature markedly affects the extent of local hyperthermia at the wound site.
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Affiliation(s)
- Ioannis Proios
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
| | - Marian Kusenda
- Nord-Ostsee Tierärzte, Veterinary Practice, Schafflund, Germany
| | - Christian Seiler
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Carsten Siewert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Hermann Seifert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Martin Kaske
- Department for Farm Animals, Vetsuisse Faculty, Zurich, Switzerland
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Lee Y, Kang E, Shin HC, Lee H, Yoon K, Kang B, Kim EK. The Effect of Body Mass Index on Initial Breast Cancer Stage Among Korean Women. Clin Breast Cancer 2021; 21:e631-e637. [PMID: 34024752 DOI: 10.1016/j.clbc.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between obesity and breast cancer stage is not well-known in the Korean population. This study aimed to identify the effect of body mass index (BMI) on initial breast cancer stage. PATIENTS AND METHODS Among patients who underwent surgery for breast cancer (stages 0-III) from June 2003 to December 2018, we analyzed 4510 patients for whom there were BMI data. RESULTS The average BMI of our patients was 23.5 (14.2-44.9). In total, 4.6% and 24.2% of the patients had a BMI of ≥30 and 25-29.9, respectively. In the patients with obesity, the proportion of T2 to T4 was 41.4%, which was higher than that in patients with a BMI of 25 to 29 (28.4%; P = .001) or a BMI of <25 (23.3%; P < .001). There was no difference in positive rates of estrogen receptor and progesterone receptor with BMI, but obese patients were less likely to be human epidermal growth factor receptor 2 positive. Patients with higher stages were more likely to have a higher BMI. The effect of BMI on stage was stronger in patients <50 years (odds ratio, 2.439; 95% CI, 1.783-3.335). Although there was no statistical significance, tumors >2 cm were less likely to be palpable in obese patients than in patients of normal weight (nonpalpable in 33.8% and 27.0%, respectively). CONCLUSION Our study suggests that obesity is associated with a more advanced breast cancer stage, which represents a poor prognosis, and large tumors tend to be less palpable in women with obesity.
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Affiliation(s)
- Yongwoong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Haemin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyunghwak Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byeongju Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Isogai K, Okamoto S, Yamada Y. Properties of muscle nodules recognized by manual physical therapy practitioners. J Phys Ther Sci 2021; 33:356-361. [PMID: 33935361 PMCID: PMC8079898 DOI: 10.1589/jpts.33.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to describe the properties of muscle nodules
(kinkoketsu) recognized by manual physical therapy practitioners.
[Participants and Methods] A total of one hundred and thirty-three physical therapists,
occupational therapists, judo therapists, and acupuncturists participated in this study.
The shape, size, direction, depth, and hardness of muscle nodules, often treated in the
buttocks, were investigated through the completion of a questionnaire. [Results] A total
of 124 answer sheets were completed; 112 of these described the shape of muscle nodules as
ellipsoidal. Of these 112 sheets, 97 effective sheets were analyzed. The results showed
that the mean long axis length, short axis length, and thickness of the muscle nodules
were 30.9 mm, 16.2 mm, and 9.3 mm, respectively. The most common responses on the long
axis direction, depth, and hardness of the muscle nodules were the craniocaudal
orientation, the second shallowest layer of 5 divisions, and the eraser level,
respectively. [Conclusion] The typical muscle nodule found in the buttocks by manual
physical therapy practitioners is roughly the shape of a large almond.
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Affiliation(s)
- Kaoru Isogai
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University: 1230 Miyakoda-cho, Kita-ku, Hamamatsu-shi, Shizuoka 431-2102, Japan
| | - Shogo Okamoto
- Department of Mechanical Systems Engineering, Graduated School of Engineering, Nagoya University, Japan
| | - Yoji Yamada
- Department of Mechanical Systems Engineering, Graduated School of Engineering, Nagoya University, Japan
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Torossian K, Ottenio M, Brulez AC, Lafon Y, Viste A, Attali P, Benayoun S. Biomechanical analysis of practitioner's gesture for peripheral venous catheter insertion. Med Eng Phys 2021; 90:92-99. [PMID: 33781485 DOI: 10.1016/j.medengphy.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/10/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Peripheral venous catheter insertion (PVCI) is one of the most common procedures performed by healthcare professionals but remains technically difficult. To develop new medical simulators with better representativeness of the human forearm, an experimental study was performed to collect data related to the puncturing of human skin and a vein in the antebrachial area. A total of 31 volunteers participated in this study. Force sensors and digital image correlation were used to measure the force during the palpation and puncturing of the vein and to retrieve the kinematics of the practitioner's gesture. The in vivo skin rupture load, vein rupture load, and friction loads for skin only and for both the skin and vein were (mean ± standard deviation) 0.85 ± 0.34 N, 1.25 ± 0.37 N, -0.49 ± 0.19 N, and -0.51 ± 0.16 N, respectively. The results of this study can be used to develop realistic skin and vein substitutes and mechanically assess them by reproducing the practitioner's gesture in a controlled fashion.
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Affiliation(s)
- K Torossian
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, 36 avenue Guy de Collongues, 69134 Ecully, France; Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France.
| | - M Ottenio
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - A-C Brulez
- Laboratoire de Génie de la Fonctionnalisation des Matériaux Polymères, Institut Textile et Chimique de Lyon, 87 chemin des Mouilles, 69134 Ecully cedex, France
| | - Y Lafon
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - A Viste
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France; Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique, 165 Chemin du Grand Revoyet, 69495 Pierre Benite Cedex, France
| | - P Attali
- Institut de Formation en Soins Infirmiers, 5 Avenue Esquirol, 69003 Lyon, France
| | - S Benayoun
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, 36 avenue Guy de Collongues, 69134 Ecully, France
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Owens EF, Hosek RS, Russell BS. Mechanical properties of a thoracic spine mannequin with variable stiffness control. J Chiropr Educ 2021; 35:1-7. [PMID: 32930327 PMCID: PMC7958670 DOI: 10.7899/jce-19-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/24/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To test the posterior-to-anterior stiffness (PAS) of a new thoracic spine training simulator under different conditions of "fixation." METHODS We constructed a thoracic spine model using plastic bones and ribs mounted in a wooden box, with skin and soft tissue simulated by layers of silicone and foam. The spine segment could be stiffened with tension applied to cords running through the vertebrae and ribs. We tested PAS at 2 tension levels using a custom-built device to apply repetitive loads at the T6 spinous process (SP) and over adjacent soft tissue (TP) while measuring load and displacement. Stiffness was the slope of the force-displacement curve from 55 to 75 N. RESULTS Stiffness in the unconstrained (zero tension) condition over the SP averaged 11.98 N/mm and 6.72 N/mm over the TP. With tension applied, SP stiffness increased to 14.56 N/mm, and TP decreased to 6.15 N/mm. CONCLUSION Thoracic model compliance was similar to that reported for humans. The tension control system increased stiffness by 21.3% only over the SP. Stiffness over the TP was dominated by the lower stiffness of the thicker foam layer and did not change. The mannequin with these properties may be suitable for use in manual training of adjusting or PAS testing skills.
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Nuessle S, Luebke J, Boehringer D, Reinhard T, Anton A. [Acute angle closure : An ophthalmological emergency in the emergency room]. Med Klin Intensivmed Notfmed 2021; 117:137-143. [PMID: 33580819 PMCID: PMC8897352 DOI: 10.1007/s00063-021-00790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen. Methode Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs. Ergebnisse Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde. Schlussfolgerung Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.
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Affiliation(s)
- S Nuessle
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - J Luebke
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - D Boehringer
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - A Anton
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- ADMEDICO Augenzentrum, Olten, Schweiz
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Maddaluno MLM, Ferreira APA, Tavares ACLC, Meziat-Filho N, Ferreira AS. Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study. J Manipulative Physiol Ther 2021; 44:196-204. [PMID: 33461748 DOI: 10.1016/j.jmpt.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/17/2019] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP). METHODS This cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined. RESULTS The accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = -1.1°, 95% CI, -1.6 to -0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = -0.088 and -0.099, respectively) and disability (ρ = -0.231 and -0.249, respectively). CONCLUSION Craniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.
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Affiliation(s)
- Maria Letizia M Maddaluno
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Ana Paula A Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Ana Carolina L C Tavares
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil
| | - Arthur S Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brazil.
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da Silva JB, de Godoi Fernandes JG, Caracciolo BR, Zanello SC, de Oliveira Sato T, Driusso P. Reliability of the PERFECT scheme assessed by unidigital and bidigital vaginal palpation. Int Urogynecol J 2021. [PMID: 33416969 DOI: 10.1007/s00192-020-04629-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was to evaluate the inter- and intra-rater reliability of the PERFECT scheme assessed by uni- and bidigital vaginal palpation in young nulligravid women. METHODS Forty healthy women [median age 22 (19-34) years] were evaluated by unidigital vaginal palpation by both Examiners A and C, while the other 40 participants [median age 23.5 (19-35) years] were assessed by Examiners B and C by bidigital vaginal palpation. Inter- and intra-rater reliability of all items of the PERFECT scheme were evaluated: P = power (Modified Oxford Scale); E = endurance; R = repetitions; F = fast contractions. Cohen's linear weighted kappa (κw) was used to assess the reliability of the power, while the intraclass correlation coefficient (ICC) was applied for the other items. A priori sample size calculation found that 40 participants would be adequate. RESULTS Inter-rater reliability of unidigital palpation was considered fair for power (κw = 0.34) and poor for other items (ICC < 0.50); bidigital inter-rater reliability was considered moderate (power: κw = 0.57; endurance: ICC = 0.53; fast contractions: ICC = 0.65, respectively) and low (repetitions: ICC = 0.27). Intra-rater reliability was substantial for power (κw = 0.73 and 0.62), moderate for fast contractions (ICC = 0.63 and 0.51) and poor for repetitions (ICC < 0.50), respectively, for uni- and bidigital palpation. Endurance showed poor (ICC < 0.50) and moderate (ICC = 0.61) reliability for uni- and bidigital palpation. CONCLUSIONS The PERFECT scheme carried out by bidigital vaginal palpation presents higher reliability when two examiners carry out the physical examination. When one examiner is responsible for PFM assessment, both types of palpation are recommended for evaluation of power and fast contraction; endurance should be evaluated using bidigital palpation. Examiners should be careful during the assessment of repetition of sustained contractions because inter- and intra-reliabilities for both types of palpation were classified as poor.
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Abstract
An abdominal physical examination is one of the most important tools in evaluating patients with acute abdominal pain. We focused on palpation, in which assessment is made according to the patient’s response and force feedback. Since palpation is performed manually by the examiner, the uniformity of force and location is difficult to achieve during examinations. We propose an integrated system to quantify palpation pressure and location. A force sensor continuously collects pressure data, while a camera locates the precise position of contact. The system recorded, displayed average and maximum pressure by creating a pressure/time curve for computer-aided diagnosis. Compared with previous work on pressure sensors of quantifying abdominal palpation, our proposed system is the integrated approach to measure palpation force and track the corresponding position at the same time, for further diagnosis. In addition, we only make use of a sensing device and a general web camera, rather than commercial algometry and infrared cameras used in the previous work. Based on our clinical trials, the statistics of palpation pressure values and the corresponding findings are also reported. We performed abdominal palpation with our system for twenty-three healthy participants, including fourteen males and nine females. We applied two grades of force on the abdomen (light and deep) by four-quadrant and nine-region schemes, record the value of pressure and location. In the four-quadrant scheme, the average pressures of abdominal palpation with light and deep force levels were 0.506(N) and 0.552(N), respectively. In the nine-region scheme, the average pressures were 0.496(N) and 0.577(N), respectively. Two episodes of contact dermal reaction were identified. According to our experiment statistics, there is no significant difference in the force level between the four-quadrant and nine-region scheme. Our results have the potential to be used as a reference guide while designing digital abdominal palpation devices.
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Affiliation(s)
- Jia-Lien Hsu
- Department of Computer Science and Information Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Hui Lee
- Department of Computer Science and Information Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chung-Ho Hsieh
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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McDevitt AW, Cleland JA, Strickland C, Mintken P, Leibold MB, Borg M, Altic R, Snodgrass S. Accuracy of long head of the biceps tendon palpation by physical therapists; an ultrasonographic study. J Phys Ther Sci 2020; 32:760-767. [PMID: 33281293 PMCID: PMC7708007 DOI: 10.1589/jpts.32.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/22/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Examination and treatment of the long head of the biceps tendon (LHBT)
requires accurate palpation. The purpose of this study was to determine physical
therapists’ reliability and ability to accurately palpate the LHBT in two arm positions
with ultrasound as the gold standard. [Participants and Methods] Examiners palpated the
LHBT within the intertubercular groove (ITG) of the humerus on the bilateral shoulders of
32 asymptomatic (21 female; 24.3 ± 1.9 years) participants in 2 arm positions. The
magnitude of distance between a marker and the border of the ITG was compared between 2
positions using an independent t-test. Percent accuracy was calculated. [Results]
Inter-rater reliability was poor (position 1, k=1.04; position 2,
k=0.016). Overall accuracy rate was 45.7% (117/256). Accuracy was 49.2%
(63/128) and 42.2% (54/128) for testing position 1 and position 2 respectively. Mean
distance palpated from the groove was M=2.58 mm (± 6.2 mm) for position 1
and M=3.77 mm (± 6.6 mm) for position 2. Inaccurate palpation occurred
medially 72.3% (47/65) and 93.2% (69/74) in position 1 and position 2 respectively.
[Conclusion] Results of this study did not support one arm position being more accurate
over another for LHBT palpation.
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Affiliation(s)
- Amy W McDevitt
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA.,Sports Medicine and Rehabilitation, University of Colorado Health, USA.,School of Health Sciences, The University of Newcastle, Australia
| | | | - Colin Strickland
- Sports Medicine and Rehabilitation, University of Colorado Health, USA
| | - Paul Mintken
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA
| | | | - Maria Borg
- Sports Medicine and Rehabilitation, University of Colorado Health, USA
| | - Rebecca Altic
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus: 13121 E. 17th Avenue, ED2S, Aurora, CO 80045, USA
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Takatalo J, Ylinen J, Pienimäki T, Häkkinen A. Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain. BMC Musculoskelet Disord 2020; 21:529. [PMID: 32778081 PMCID: PMC7418198 DOI: 10.1186/s12891-020-03551-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1
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Affiliation(s)
- Jani Takatalo
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Jari Ylinen
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Tuomo Pienimäki
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland.,Central Finland Central Hospital, Jyväskylä, Finland
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Bartsch KM, Schleip R, Zullo A, Hoppe K, Klingler W. The Stiffness Comparison Test: A pilot study to determine inter-individual differences in palpatory skill related to gender, age, and occupation-related experience. J Bodyw Mov Ther 2020; 24:1-6. [PMID: 33218495 DOI: 10.1016/j.jbmt.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Manual palpation is a core skill in physical examination. Assessing elastic properties such as tissue stiffness has the potential for being an important diagnostics tool in the detection of cancer and other diseases. OBJECTIVE The study describes the newly developed Stiffness Comparison Test (SCT). The aim of our study was to test the SCT as a tool to detect interindividual differences in palpation skill related to gender, age and occupational experience. METHODS We used eight pairs of polyuterhane gel pads with the stiffness difference decreasing from the first to the last pair. Test subjects were asked to palpate each pair and determine stiffness differences. PARTICIPANTS We recruited 25 osteopaths, 48 other manual therapists and 50 participants from other non-manual professions. RESULTS As hypothesized there was no significant difference in SCT performance between the sexes (t(121) = 0.288, p = .774). To investigate if an age-related decline would have an effect on palpation skill, we carried out a linear regression. As hypothesized, the model did not predict any significant associations (F(1, 121) = 2.733, b = -0.149, p = .101, R2 = 0.022). To compare the effect of occupational groups on SCT performance a one-way ANOVA was conducted. There were no statistically significant differences between group means (F(2, 120) = 0.598, p = .552). CONCLUSIONS The SCT can be used as simple and affordable tool for assessment, teaching and training in all disciplines of manual medicine. Further refinements of the tool are suggested to advance its discrimination power.
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Affiliation(s)
- Katja Martina Bartsch
- Verein zur Förderung der Faszienforschung e.V., Munich, Germany; Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, Germany.
| | - Robert Schleip
- Experimental Anaesthesiology, Ulm University, Ulm, Germany; Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany; Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany; Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, Germany.
| | - Alberto Zullo
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy.
| | - Kerstin Hoppe
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy, University of Frankfurt, Frankfurt, Germany.
| | - Werner Klingler
- Experimental Anaesthesiology, Ulm University, Ulm, Germany; SRH Hospital, Sigmaringen, Germany; Queensland University of Technology, Brisbane, Australia; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, Germany.
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Feng Q, Zhang L, Zhang M, Wen Y, Zhang P, Wang Y, Zeng Y, Wang J. Morphological parameters of fourth lumbar spinous process palpation: a three-dimensional reconstruction of computed tomography. J Orthop Surg Res 2020; 15:227. [PMID: 32571368 PMCID: PMC7309970 DOI: 10.1186/s13018-020-01750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background The localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases. Methods Five hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction. Results Five hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above. Conclusion The traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.
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Affiliation(s)
- Qi Feng
- School of Clinical Medicine, Southwest Medical University, Luzhou, China.,Academician Workstation in Luzhou, Luzhou, China
| | - Lei Zhang
- Academician Workstation in Luzhou, Luzhou, China. .,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China. .,National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Mengyao Zhang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China.,Academician Workstation in Luzhou, Luzhou, China
| | - Youliang Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Ping Zhang
- Operating Room, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yi Wang
- Academician Workstation in Luzhou, Luzhou, China.,School of Chinese and Western Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Yan Zeng
- Department of Nephropathy, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Junqiu Wang
- Academician Workstation in Luzhou, Luzhou, China.,School of Chinese and Western Clinical Medicine, Southwest Medical University, Luzhou, China
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Zhang W, Li K, Xu H, Luo D, Ji C, Yang K, Zhao Q. Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2020; 24:197. [PMID: 32375841 PMCID: PMC7201726 DOI: 10.1186/s13054-020-02920-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
Background The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations. Method A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms “ultrasonography,” “ultrasonics,” “ultrasound-guided,” “ultrasound,” “radial artery,” “radial arterial,” “catheter,” “cannula,” and “catheterization.” The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5. Results From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41). Conclusions The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
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Affiliation(s)
- Wen Zhang
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng City, Shandong Province, China
| | - Kunpeng Li
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Hui Xu
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China.
| | - Dawei Luo
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Changbin Ji
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Keshi Yang
- Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China
| | - Qinghua Zhao
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng City, Shandong Province, China
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Kim WW, Lee J, Jung JH, Park HY, Kim WH, Kim HJ, Park JY, Tufano RP. Usefulness of intraoperative determination of central lymph node metastasis by palpation in papillary thyroid cancer. Yeungnam Univ J Med 2020; 37:302-307. [PMID: 32316082 PMCID: PMC7606959 DOI: 10.12701/yujm.2020.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon’s palpation in papillary thyroid cancer. Methods This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness. Results Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively. Conclusion Determination of central LN metastasis by a surgeon’s palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.
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Affiliation(s)
- Wan Wook Kim
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji-Young Park
- Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Polk AJ, Nguyen V, Jarstad J. Is Palpation Sufficient for Estimation of IOP Immediately Following Cataract Surgery? Med Hypothesis Discov Innov Ophthalmol 2020; 9:143-148. [PMID: 32490021 PMCID: PMC7134245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to evaluate the accuracy of standard palpation techniques and Barraquer tonometry relative to Tono-Pen for measurement of postoperative intraocular pressure (IOP) immediately following routine micro-incision cataract surgery (MICS). We conducted a prospective comparative analysis of postoperative IOP immediately after MICS in a single academic outpatient surgery center. A random block of 166 eyes that underwent MICS at our institution was selected for inclusion. Exclusion criteria consisted of any complications including posterior capsule rupture. IOP was measured immediately postoperatively, first with palpation or a Barraquer tonometer, then with a Tono-Pen handheld applanation tonometer. Measurements obtained by each method were compared. The mean difference between IOP measurements obtained by palpation and Tono-Pen was 10 mmHg, 95% confidence interval (CI; 8, 12); whereas the mean difference between IOP measurements obtained by Barraquer tonometer and Tono-Pen was 2 mmHg, 95% CI (1, 3). IOP measurements acquired via palpation differed from their corresponding Tono-Pen measurements by > 5 mmHg in 48.0% of cases compared to only 5.9% of measurements acquired using a Barraquer tonometer. Spearman correlation coefficient for measurements obtained by standard palpation and Tono-Pen was r = 0.397 (p < 0.01) compared to r = 0.774 (p < 0.01) for those obtained by Barraquer tonometer and Tono-Pen. In conclusion, palpation is not an accurate method for estimating IOP immediately after cataract surgery compared to Tono-Pen. Appropriate measurement and adjustment of IOP at the end of cataract surgery may decrease complications such as cystoid macular edema. In settings where a Tono-Pen is not readily available, Barraquer tonometry may serve as a reasonable and cost-effective alternative.
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Affiliation(s)
- Andrew J Polk
- University of Missouri School of Medicine, Department of Ophthalmology
| | - Van Nguyen
- University of Missouri School of Medicine, Department of Ophthalmology
| | - John Jarstad
- University of Missouri School of Medicine, Department of Ophthalmology
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40
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Stein R, Reschke F, Ludwikowski B. ["Uncomplicated" inguinal testis : How practicable are the guidelines?]. Urologe A 2020; 59:300-6. [PMID: 32072199 DOI: 10.1007/s00120-020-01129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It has been known for more than 20 years that early treatment of maldescended testicles can have a positive effect on fertility and a negative effect on the development of tumors. In certain circumstances, hormone therapy is still recommended in German-speaking countries. However, its benefit is still controversially discussed. Therapy is usually initiated by the pediatrician, who is usually the first to detect undescended testicles. Since therapy may involve early hormone therapy as well as surgery, acceptance among pediatricians and also the parents may be reduced. The question also arises as to how far the implementation is practicable. In patients with nonpalpable testis, there are many controversies concerning the value of ultrasound investigations. In the following two case studies, the treatment decisions for undescended testes in infancy are exemplified. Furthermore, the available evidence from the literature and guidelines is presented to provide assistance for daily routine care and to critically discuss potential fields of application and limitations of existing guidelines.
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Holm-Jensen A, Kjaer P, Schiøttz-Christensen B, Ziegler DS, Andersen S, Myburgh C. The Interexaminer Reproducibility and Prevalence of Lumbar and Gluteal Myofascial Trigger Points in Patients With Radiating Low Back Pain. Arch Rehabil Res Clin Transl 2020; 2:100044. [PMID: 33543073 PMCID: PMC7853331 DOI: 10.1016/j.arrct.2020.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To determine the interexaminer reproducibility for judging the presence, number, and location of leg-pain referring myofascial trigger points, and their prevalence in patients with low back pain with and without concomitant leg pain referral. Design An interexaminer reproducibility study. Setting An outpatient public Hospital Spine Centre in Southern Denmark. Participants Examiners: experienced examiners (N=2), a chiropractor and a physiotherapist, respectively. Subjects: a case mix of patients with low back pain (N=32) with and without leg pain referral. Interventions A standardized palpation examination protocol of 4 bilateral lumbosacral muscles performed by each examiner. Main Outcome Measures Reproducibility on presence (measured in Cohen’s κ), number (difference and limits of agreement), location (distance between matching marks placed by examiners), and prevalence of myofascial trigger points. Results Kappa values of the examined muscles were as follows: quadratus lumborum (κ=0.42), gluteus medius (κ=0.83), gluteus minimus (κ=0.74), and piriformis (κ=0.62), with a mean of all examined muscles of kappa=0.66, assessed as substantial agreement. The mean difference in number of trigger points was 0.8, with limits of agreement ranging from −6.4 to 4.9. Mean distance between trigger point locations was 12.9 mm, with 57% only being identified by a single examiner. The prevalence of trigger points was 82.7%, highest in the gluteal region of the painful side. Conclusions Inadequate standardization and multiple trigger point sites complicate interexaminer reproducibility on location and number of patients with low back pain and leg pain referral. Nevertheless, substantial interexaminer reproducibility for the trigger point presence appears achievable. Implemented routinely, this relatively simple clinical evaluation procedure could meaningfully enhance diagnostic triage and eventual management.
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Affiliation(s)
- Aske Holm-Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Schøler Ziegler
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark.,Spine Surgery and Research, Spine Center of Southern Denmark-part of Lillebaelt Hospital, Middelfart, Denmark
| | - Stina Andersen
- Medical Research Department, Spine Centre of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs and Medical Eponyms: Part III. Physical Examination of Palpation, 1926-1976. Clin Med Res 2019; 17:107-114. [PMID: 31308023 PMCID: PMC6886893 DOI: 10.3121/cmr.2018.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 10/14/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This paper describes medical eponyms associated with abdominal palpation from the period 1926-1976. Despite opposition by some, eponyms are a long standing tradition and widely used in medicine. The techniques may still be useful in some cases, assisting in the selection of an appropriate and cost-effective approach to patient care. In this piece, we cover signs named in honor of physicians who contributed to medicine by developing new palpatory techniques in an attempt to better diagnose disease of the abdominal wall, umbilicus, gallbladder, pancreas, and appendix. DATA SOURCES PubMed, Medline, online Internet word searches, textbooks, and references from other source texts. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. CONCLUSION We describe brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication into today's medical practice.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida College of Medicine, Department of Graduate Medical Education, 6850 Lake Nona Blvd, Orlando, FL 32827 USA
| | - Devina Singh
- University of Florida, Department of Medicine, 2000 SW Archer Rd, Gainesville, FL 32610 USA
| | - Halil Tekiner
- Erciyes University School of Pharmacy, Department of the History of Pharmacy and Ethics, Talas, Kayseri 38280 Turkey
| | - Fan Ye
- University of Central Florida College of Medicine, Department of Graduate Medical Education, 6850 Lake Nona Blvd, Orlando, FL 32827 USA
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI 54449 USA
| | - Steven H Yale
- University of Central Florida College of Medicine, Department of Internal Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827
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El-Haieg DO, Madkour NM, Basha MAA, Ahmad RA, Sadek SM, Al-Molla RM, Tantwy EF, Almassry HN, Altaher KM, Mahmoud NEM, Aly SA. Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study. Ultrasonography 2019; 38:355-364. [PMID: 31466142 PMCID: PMC6769195 DOI: 10.14366/usg.19007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. Methods This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. Results The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). Conclusion MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
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Affiliation(s)
- Dahlia O El-Haieg
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Nadia M Madkour
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | | | - Reda A Ahmad
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Somayya M Sadek
- Department of Obstetrics and Gynecology, Zagazig University, Zagazig, Egypt
| | - Rania M Al-Molla
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
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Passmore SR, Gelley GM, Malone Q, MacNeil BJ. Tactile Perception of Pressure and Volitional Thrust Intensity Modulate Spinal Manipulation Dose Characteristics. J Manipulative Physiol Ther 2019; 42:335-342. [PMID: 31272711 DOI: 10.1016/j.jmpt.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine clinicians' ability to modulate spinal manipulation (SM) thrust characteristics based on their tactile perception of pressure and volitional intensity. METHODS In a cross-sectional, within-participants design, 13 doctors of chiropractic delivered SM thrusts of perceived least, appropriate, or greatest intensity of their perceived safe output level for an SM thrust on low-fidelity thoracic spine models of 4 different pressure levels. The participants performed SM over the course of 96 trials in a randomized order on combinations of thrust intensity and pressure. Dependent variables included normalized preload force, thrust force, thrust duration, peak acceleration, time to peak acceleration, and displacement. For all dependent measures, 2-factor within-participants analysis of variance models with repeated measures on both factors were performed. RESULTS Preload force increased with intensity (F2,24 = 9.72; P < .001) and model pressure (F3,36 = 4.27; P = .011). Participants modulated thrust force and displacement as each also increased with intensity escalation (F2,24 = 22.53, P < .001; F2,18 = 45.20, P < .001). The highest accelerations were observed during the greatest intensity. Increased thrust force was delivered at higher model pressures (F3,36 = 6.43; P < .001). A significant interaction demonstrated that as volitional thrust intensity increased, greater displacement was attained, particularly on low pressure models (F6,54 = 11.06; P < .001). Thrust duration and time to peak acceleration yielded no significant differences. CONCLUSION Spinal manipulation thrust dosage was modulated by the chiropractors' tactile perception of pressure and volitional intensity.
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Affiliation(s)
- Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Health, Leisure, and Human Performance Research Institute, University of Manitoba, Winnipeg, Canada; College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada; Research Department, New York Chiropractic College, Seneca Falls, New York.
| | - Geoffrey M Gelley
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Quinn Malone
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada
| | - Brian J MacNeil
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
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Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs and Medical Eponyms: Part II. Physical Examination of Palpation, 1907-1926. Clin Med Res 2019; 17:47-54. [PMID: 31160480 PMCID: PMC6546280 DOI: 10.3121/cmr.2018.1426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 10/13/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Abdominal palpation is an important clinical skill used by physicians to detect the cause of the underlying disease. Abdominal physical signs reported as medical eponyms are sometimes helpful in supporting or confirming clinical suspicion of a diagnosis. With the advent of advanced and rapid imaging techniques physicians often know the diagnosis prior to setting their hands on patients. Nevertheless, knowledge of these signs may still remain important in settings where imaging may not be readily available and importantly provide deeper insights into the mechanism of disease. In this paper, described are medical eponyms associated with abdominal palpation from the period 1907-1926. DATA SOURCES PubMed, Medline, on-line Internet word searches, textbooks, and references from other source text were used as the data source. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. CONCLUSION We describe brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication into today's medical practice.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
| | - Devina Singh
- University of Florida, Department of Medicine, Gainesville, Florida, USA
| | - Halil Tekiner
- Department of the History of Pharmacy and Ethics, Erciyes University School of Pharmacy, Talas, Kayseri, Turkey
| | - Fan Ye
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, Florida, USA
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Steven H Yale
- University of Central Florida College of Medicine, Department of Internal Medicine, Orlando, Florida, USA
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Ichinose J, Mun M, Matsuura Y, Nakao M, Okumura S. Efficiency of thoracoscopic palpation in localizing small pulmonary nodules. Surg Today 2019; 49:921-6. [PMID: 31129722 DOI: 10.1007/s00595-019-01826-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The thoracoscopic localization of small and deep pulmonary nodules can be challenging. We conducted this study to evaluate the efficiency of thoracoscopic palpation in tumor detection. METHODS The subjects of this study were 229 patients with a collective 267 indeterminate pulmonary nodules ≤ 15 mm in diameter, in the outer third of the lung field. The nodules were localized by palpation using the forefinger or a metal suction probe. Based on the distance from the pleura-to-tumor size ratio (D/S), the nodules were classified into group A (D/S = 0), group B (0 < D/S ≤ 1), and group C (D/S > 1). RESULTS The median tumor diameter was 10 mm. All 267 nodules were palpable and resected with negative margins via thoracoscopic wedge resection. The majority of the deep nodules had no pleural change (11%, 86%, and 100% in groups A, B, and C, respectively; P < 0.01). The median margins were 15, 16, and 14 mm in groups A, B, and C, respectively. In four patients (1.5%) with relatively short margins (2-7 mm), an additional intraoperative wedge resection was performed. CONCLUSION Thoracoscopic palpation was effective for tumor detection when the nodules were located in the outer third of the lung.
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Badra K, Coutin A, Simard R, Pinto R, Lee JS, Chenkin J. The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation 2019; 139:17-23. [PMID: 30902687 DOI: 10.1016/j.resuscitation.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/16/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Manual pulse checks (MP) are an unreliable skill even in the hands of healthcare providers (HCPs). In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the use of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study was to assess the time required to detect a carotid pulse in live subjects using US compared to the traditional palpation method. METHODS We conducted a prospective randomized controlled crossover non-inferiority trial. HCPs attended a 15 minute focused US workshop on identification of the carotid pulse. Both pulse check methods were timed for each participant on two different subjects in random order. The primary outcome was time to carotid pulse detection in seconds (s). Secondary outcomes included confidence levels of pulse detection measured on a 100 mm visual analog scale (VAS) and rates of prolonged pulse checks (> 5 s or >10 s). The study was powered to determine whether US pulse checks were not slower than MP by greater than two seconds. The results are presented as the difference in means with a 90% two-sided confidence interval (CI). RESULTS 111 participants completed the study. Mean pulse detection times were 4.22 s (SD 3.26) by US compared to 4.71 s (SD 6.45) by MP with a mean difference in times of -0.49 s (90% CI: -1.77 to 0.39). There were no significant differences between US and MP in the rates of prolonged pulse checks of greater than 5 s (23% vs 19%, p = 0.45) or 10 s (9% vs 8%, p = 0.81). First attempt at detection of pulse checks was more successful in the US group (99.1% vs 85.6%, p = 0.0001). Prior to training, participants reported higher confidence using MP compared to US; 68 (IQR 48-83) vs 15 (IQR 8-42) mm (p < 0.001). Following the study, participants reported higher confidence levels using US than MP; 91 (IQR 82-97) vs 83 (IQR 72-94) mm (p < 0.001). CONCLUSIONS Carotid pulse detection in live subjects was not slower using US as compared to palpation, and demonstrated higher first attempt success rate and less variability in measurement times. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in cardiac arrest.
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Affiliation(s)
- Karine Badra
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | | | - Robert Simard
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jacques S Lee
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Chenkin
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Koike T, Irie Y, Ebine R, Fujishiro T, Kanzaki S, Keat CS, Higo T, Ohoyama K, Hayashi M, Ikegami H. Development of intra-operative assessment system for ossicular mobility and middle ear transfer function. Hear Res 2018; 378:139-148. [PMID: 30503297 DOI: 10.1016/j.heares.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/01/2018] [Indexed: 12/28/2022]
Abstract
Objective measurements of the ossicular mobility have not been commonly performed during the surgery, and the assessment of ossicular mobility is made by palpation in most cases. Palpation is inherently subjective and may not always be reliable, especially in milder degrees of ossicular fixation and in the case of multiple fixation. Although several devices have been developed to quantitatively measure the ossicular mobility during surgery, they have not been widely used. In this study, a new system with a hand-held probe which enables intraoperative quantitative measurements of ossicular mobility has been developed. This system not only measures the ossicular mobility, but also investigates "local" transmission characteristics of the middle ear by directly applying vibration to the ossicles and measuring cochlear microphonic. The basic performance of this system was confirmed by measuring the mobility of artificial ossicles and cochlear microphonics in an animal experiment. Our system may contribute to selection of a better surgical method and reducing the risks of revision surgery.
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Affiliation(s)
- Takuji Koike
- The University of Electro-Communications, Japan.
| | - Yuuka Irie
- The University of Electro-Communications, Japan
| | - Ryo Ebine
- The University of Electro-Communications, Japan
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Lemeunier N, Jeoun EB, Suri M, Tuff T, Shearer H, Mior S, Wong JJ, da Silva-Oolup S, Torres P, D'Silva C, Stern P, Yu H, Millan M, Sutton D, Murnaghan K, Cȏté P. Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration. Musculoskelet Sci Pract 2018; 38:128-147. [PMID: 30455032 DOI: 10.1016/j.msksp.2018.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). METHODS We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. RESULTS We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. CONCLUSIONS We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.
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Affiliation(s)
- N Lemeunier
- Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère, 31300, Toulouse, France; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada.
| | - E B Jeoun
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - M Suri
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - T Tuff
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - J J Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - S da Silva-Oolup
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Torres
- Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile
| | - C D'Silva
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
| | - P Stern
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - H Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - M Millan
- Cabinet d'expertise médicale, Castres, France
| | - D Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada
| | - K Murnaghan
- Librarian, Canadian Memorial Chiropractic College (CMCC), 6100, Leslie Street, Toronto, Ontario, Canada
| | - P Cȏté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000, Simcoe St. N., Oshawa, Ontario, L1H 7K4, Canada
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Rastogi V, Singh D, Tekiner H, Ye F, Kirchenko N, Mazza JJ, Yale SH. Abdominal Physical Signs and Medical Eponyms: Physical Examination of Palpation Part 1, 1876-1907. Clin Med Res 2018; 16:83-91. [PMID: 30166497 PMCID: PMC6306141 DOI: 10.3121/cmr.2018.1423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/02/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abdominal palpation is a difficult skill to master in the physical examination. It is through the tactile sensation of touch that abdominal tenderness is detected and expressed through pain. Its findings can be used to detect peritonitis and other acute and subtle abnormalities of the abdomen. Some techniques, recognized as signs or medical eponyms, assist clinicians in detecting disease and differentiating other conditions based on location and response to palpation. Described in this paper are medical eponyms associated with abdominal palpation from the period 1876 to 1907. DATA SOURCES PubMed, Medline, on-line Internet word searches, textbooks and references from other source text were used as the data source. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. CONCLUSION We present brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication in today's medical practice.
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Affiliation(s)
- Vaibhav Rastogi
- University of Central Florida, College of Medicine, Orlando, Florida, USA
| | - Devina Singh
- University of Florida, Department of Medicine, Gainesville, Florida, USA
| | - Halil Tekiner
- Department of the History of Pharmacy and Ethics, Erciyes University School of Pharmacy, Talas, Kayseri, Turkey
| | - Fan Ye
- University of Central Florida, College of Medicine, Orlando, Florida, USA
| | - Nataliya Kirchenko
- North Florida/South Florida Georgia Veterans Health System, Gainesville, Florida, USA
| | - Joseph J Mazza
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Steven H Yale
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
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