PubMed · 12073729
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Manon Paquette, Geza T Terezhalmy, William S Moore. 2002. Subcutaneous emphysema.. https://pubmed.ncbi.nlm.nih.gov/12073729/
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Structured teaching of pulmonary auscultation is greatly underrepresented during internal medicine (IM) or family practice (FP) training. It is not known, however, whether this underrepresentation applies to the other major field of primary care, pediatrics. To answer this question, we surveyed all accredited U.S. residencies in pediatrics by mailing a 1-page questionnaire to 174 pediatrics program directors, and by comparing results to those previously gathered from internal medicine and family practice residencies. Pediatrics directors' response rate was 62%. More pediatrics than family practice residencies offered structured teaching of pulmonary auscultation (21.5% vs. 9.7%, P < 0.004). When compared to internal medicine programs, this difference showed a trend toward significance (21.5% for pediatrics and 14.1%, for internal medicine, P = 0.08). Teaching modalities included: lectures (91.2%); audiotapes (13%); seminars (8.3%); and miscellaneous (21.7%). University-affiliated residencies taught auscultation significantly more frequently than nonuniversity-affiliated programs (25.4% vs.10.5%, P = 0.07). Pediatrics directors gave great importance to pulmonary auscultation, and wished for more time devoted to its teaching (5.52 +/- 0.84 and 5.01 +/- 1.07, respectively, on a 1-6 scale, with 6 indicating the highest value). They also attributed great clinical importance to 13 commonly encountered pulmonary auscultatory events (all rated, on average, between 4-5.8 on a 1-6 scale, with 6 indicating highest importance). In summary, training programs in pediatrics offered significantly more structured teaching of pulmonary auscultation than IM or FP residencies. Whether this difference in teaching may have a beneficial impact on the auscultatory proficiency of pediatric residents, as compared to internal medicine and family practice trainees, needs to be determined.
The paper evaluates the performance of an automatic discrimination analysis (DA) method used to discriminate efficiently the types of discontinuous breath sound (DBS), i.e. fine crackles (FCs), coarse crackles (CCs) and squawks (SQs); this may lead to more accurate characterisation of the pulmonary acoustical changes due to the related pathology. Based on higher-order crossings (HOCs), the proposed method, HOC-DA, captured the differences in the oscillatory patterns of FCs, CCs and SQs, which are only exposed when higher (> 1) crossings are employed. Prior to HOC-DA, wavelet-based de-noising of DBSs was employed to eliminate the effects of the vesicular sound (background noise) from their oscillatory pattern. The HOC-DA was applied to 157 discontinuous breath sounds corresponding to 16 cases included in three lung sound databases. Results showed that the HOC-DA efficiently separated FCs from CCs, SQs from CCs (both with an accuracy of 100%), and SQs from FCs (accuracy of 80%), with the optimum order ranging from 9 to 11. When compared with other classification tools, the HOC-DA resulted in high discrimination accuracy without involving high computational complexity. Owing to its simplicity, it could be implemented in a real-time context and be used in clinical medicine as a module of an integrated intelligent patient evaluation system.
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