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Results for “PHYSICAL EXAMINATION”

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PubMed1998

Impact of gowning on visit length and physical examinations.

We evaluated the effect of a randomized trial of gowning on length of visit and number of physical examinations performed in an outpatient clinic. Nineteen senior internal medicine trainees saw 110 patients without gowns and 113 patients with gowns. Patients without gowns were with the trainees 25.2 +/- 11.9 (mean +/- SD) minutes versus 24.2 +/- 10.3 minutes for gowned patients (p = .51). Ungowned patients were in the examination room a total of 38.5 +/- 15.9 minutes versus 42.9 +/- 17.6 minutes for gowned patients (p = .06). The number of patients that underwent physical examinations was the same (89) for gowned and ungowned groups, and the distribution of the number of examinations by patient group differed only slightly (p = .88). Gowning did not significantly decrease the length of visit or increase the number of physical examinations performed.

Bedding and Linens↗

PubMed1991

Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility.

High resolution color Doppler ultrasound is a noninvasive means of simultaneously imaging and evaluating the blood flow to the testes. To define the ability of color Doppler ultrasound to detect clinically evident as well as subclinical varicoceles men referred to our urology division with oligospermia and infertility underwent spermatic vein venography of the left testis if there was physical examination and/or color Doppler ultrasound evidence of a varicocele. The detection of valvular incompetence on venography was considered diagnostic for a varicocele. Of 17 study patients physical examination detected 10 of 14 venographically evident varicoceles (71%), whereas color Doppler ultrasound detected 13 of 14 (93%). Of 5 patients with a normal physical examination but with color Doppler ultrasound evidence of a varicocele 4 had a confirmatory venogram, and 1 of 2 patients with a varicocele on physical examination and a normal Doppler ultrasound had a positive venogram. These data suggest that color Doppler ultrasound of the testis may more appropriately direct further invasive testing and therapy of infertile men than physical examination alone.

Humans↗

PubMed1998

Physical examination and chronic lower-extremity ischemia: a critical review.

OBJECTIVE: To determine the clinical utility of physical examination in patients with suspected chronic ischemia of the lower extremities. DATA SOURCES: MEDLINE search (January 1966 to January 1997), personal files, and bibliographies of textbooks on physical diagnosis, surgery, and vascular surgery. STUDY SELECTION: Both authors independently graded the studies as level 1, 2, or 3, according to predetermined criteria. Criteria deemed essential for analysis of sensitivity, specificity, and likelihood ratios were (1) clear definition of study population, (2) clear definition of physical examination maneuver, and (3) use of an acceptable criterion standard test for comparison. RESULTS: The following positive findings help clinicians diagnose the presence of peripheral arterial disease: abnormal pedal pulses, a unilaterally cool extremity, a prolonged venous filling time, and a femoral bruit. Other physical signs help determine the extent and distribution of vascular disease, including an abnormal femoral pulse, lower-extremity bruits, warm knees, and the Buerger test. The capillary refill test and the findings of foot discoloration, atrophic skin, and hairless extremities are unhelpful in diagnostic decisions. Mathematical formulas, derived from 2 studies using multivariate analysis, allow clinicians to estimate the probability of peripheral arterial disease in their patients. CONCLUSION: Certain aspects of the physical examination help clinicians make accurate judgments about the presence of peripheral arterial disease and its distribution.

Aged↗

PubMed1981

Advantages and limitations of physical examination and mammography in breast cancer screening.

Among 167 breast cancers detected on screening by xeromammography and physical examination, the accuracy of each modality was found to depend not only on the size and stage of the tumor itself but also on the structure and composition of the surrounding breast tissue. Overall, 53% (89/167) of cancers were found on physical examination and 78% (131/167) on xeromammography. Mammographic accuracy was greatest for large breasts and fatty breasts but was reduced for small breasts, dense breasts, and retroareolar lesions. The proportion of tumors with negative findings on physical examination was equal among women above and below 50 years of age.

Age Factors↗

PubMed1983

Intensive bedside teaching of physical examination to medical undergraduates: evaluation including the effect of group size.

The effectiveness of intensive bedside teaching of techniques of physical examination of the alimentary system to students commencing their clinical training was assessed. All students viewed a videotape demonstrating these techniques and then participated in a morning practice examination session but only half of the class received afternoon bedside teaching of physical examination in addition. Teaching in history taking was used as a 'placebo' for the control group, and half the students in each of the study and control groups were taught in units of four, the other half in units of eight. Thus the effect of group size could also be estimated. After 1 week, the students' performance of a physical examination was assessed using a standardized scoring chart which demonstrated good reliability. The study group performed significantly better than the control and within the study group there was a trend for the students taught in smaller units to perform better.

Australia↗

PubMed1994

Physical examination and arteriography in patients with penetrating zone II neck wounds.

OBJECTIVE: To review the management of patients with penetrating zone II neck wounds to discern the value of physical examination and proximity arteriography for predicting arterial injury. DESIGN: A retrospective chart review of 178 patients treated for penetrating wounds to the neck. SETTING: A level I trauma facility in Dallas, Tex. PATIENTS: All patients seen from 1987 to 1991 with platysma penetration in zone II of the neck. INTERVENTION: Physical examination, arteriography, and surgical exploration were used to identify patients with arterial injuries in the neck after penetrating trauma. MAIN OUTCOME MEASURES: To identify the presence or absence of an arterial injury. RESULTS: Negative findings on physical examination ruled out an arterial injury in 99% of all patients. Patients with any sign of arterial injury had a 26% incidence of arterial injury confirmed at operation. Of 71 arteriograms in patients without signs or symptoms of arterial injury, only one had an arterial injury requiring operative intervention. CONCLUSIONS: Findings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in over 99% of patients. Arteriography is a sensitive test but has a very low yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.

Adolescent↗

PubMed1988

Diagnostic arthroscopy of the knee joint: comparison of the accuracy of physical examination, contrast arthrography and arthroscopy.

A group of 474 patients was retrospectively studied to assess the value of physical examination, arthrography and arthroscopy in the diagnosis of knee pathology. In 54% of cases, the correct clinical diagnosis was made from the patient's history, physical examination and standard radiology. The diagnosis at arthrography, especially in chondropathy and synovitis, appeared to be unreliable (only 46% corresponded to the definitive diagnosis). Contrast-arthrography of the knee joint is an invasive technique which provides relatively little extra (reliable) information, and is therefore not suitable as a standard procedure. Diagnostic arthroscopy is a superior and safe technique. Apart from the essential clinical assessment of patients with acute or chronic knee complaints (patient history, physical examination and standard radiology), there is a wide range of indications for diagnostic arthroscopy.

Adolescent↗

PubMed1990

A new approach to the low-back physical examination. Behavioral assessment of mechanical signs.

UNLABELLED: A rationale for a new approach to the low-back physical examination was developed. A set of 21 tests, 17 assessing organic and four assessing nonorganic signs, were organized into an examination according to specified criteria, and the reliability of the patient-reported and examiner-observed measures within the examination assessed. Primary outcome measures included patient reports of their pain location, aggravation and examiner-observed pain behaviors resulting from the maneuvers. Two pain behavior composites, conceptualized as outcome measures, were developed, one based on the 17 organic tests and one based on the four nonorganic tests. DESIGN: The reliability of the physical examination was assessed using a short-term test-retest paradigm. Three raters, two experienced orthopaedic surgeons and an RN with no previous experience in administering physical examinations were trained in the examination methods. Patients were assigned to one of three rater pairs and examined twice within a single day. During each examination both raters evaluated each patient; however, rater role as examiner or observer was reversed across examination. RESULTS: Forty-two patients were examined. Average times of 13.9 and 11.6 minutes were required to complete examinations 1 and 2, respectively. In addition, the time required to complete the examination decreased as the examiners became more familiar with the procedure, suggesting that an experienced examiner would usually be able to complete the examination in approximately 10 minutes. Within-examination reliabilities for the patient-reported measures (pain location and aggravation) were universally high, as expected, since these rating required the rater only to correctly hear and code patient responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗

PubMed1992

Mammography in women with axillary lymphadenopathy and normal breasts on physical examination: value in detecting occult breast carcinoma.

OBJECTIVE: The purpose of this study was to determine the value of mammography in detecting occult carcinoma in patients with axillary adenopathy and normal breasts on physical examination. MATERIALS AND METHODS: We analyzed the results of mammography performed in 17 patients; all women had palpable axillary lymphadenopathy of unknown origin and all had normal breasts on physical examination. RESULTS: In 10 of the 17 patients, mammographic findings were abnormal. The mammographic finding of axillary adenopathy in seven patients was inconsequential because the nodes were evident on physical examination. Three patients had abnormal mammographic findings that were potentially significant, including one with a poorly defined mass suggestive of breast carcinoma, one with a subcutaneous nodule, and one with parenchymal breast edema. Two of 17 patients had an occult breast cancer. In only one of the patients was the cancer detected on mammography. The other patient had undergone prior left mastectomy and was thought to have metastases to the right axilla from the contralateral breast. Mammographic findings in this latter patient were normal. CONCLUSION: While occult breast carcinoma was relatively common in our series (two of 17 patients), the ability to detect the tumor with mammography was disappointing (one of two patients). This may be explained by the fact that one postmastectomy patient with occult carcinoma had metastatic disease to the contralateral axilla and a normal remaining breast, which was pathologically confirmed at mastectomy. Our experience suggests that mammography is valuable in patients with normal breasts on physical examination who have primary carcinoma involving ipsilateral axillary lymph nodes. The procedure should be included in the diagnostic evaluation of patients with axillary adenopathy in order to detect the unusual case of occult breast carcinoma.

Axilla↗

PubMed1997

The association between clinical findings on physical examination and self-reported severity in back pain. Results of a population-based study.

STUDY DESIGN: A cross-sectional population-based study of back pain. OBJECTIVE: To evaluate the association between clinical findings on physical examination and subjective severity in nonspecific back pain. SUMMARY OF BACKGROUND DATA: Assessment of severity of back pain always has been controversial. Most studies evaluating the role of clinical findings in back pain have been hospital- or clinic-based, often representing a highly select population. This selection is avoided in the population-based approach of the present study. METHODS: Approximately 4,000 German inhabitants of Lubeck, aged 25-74, were selected randomly from the local population registry and received a postal questionnaire. Those who reported "back pain today" (n = 1200) or "back pain within the past 12 months but no back pain before" (n = 75) were invited to come in for a clinical examination. Thirty-four physical measurements were taken. They were divided into four groups: static measurements, dynamic measurements, neurologic findings, and non-organic physical signs. Self-reported severity of back pain was measured by a pain questionnaire and a 12-item activities of daily living list to assess functional disability. RESULTS: Within each of the four groups of physical measurements, those that corresponded best with the subjective severity of back pain could be identified (e.g., rotation, lateral flexion, and fingertip-floor distance, scoliosis, the position of the side plumb line, and pain on percussion of the spine pseudo-Lasegue and hand muscle-strength). Those that corresponded best could be differentiated statistically from less correlative measurements such as kyphosis and lordosis; flexion of the lumbar, thoracic, or cervical spine, abdominal muscle strength, and axial loading. The agreement between the classification of back pain severity based on clinical findings and the classification based on self-reports was moderate (kappa = 0.47). CONCLUSIONS: Assessment of severity in back pain can only partly be based on the clinical findings of a physical examination. There is a relatively weak agreement between the results of physical examination and the subjective reporting of pain and disability.

Activities of Daily Living↗

PubMed1998

Comparing fourth-year medical students with faculty in the teaching of physical examination skills to first-year students.

PURPOSE: To see whether fourth-year medical students can teach the physical examination to first-year students as effectively as can faculty preceptors. METHOD: Ninety-three first-year students studying the physical examination were randomly assigned to one of ten fourth-year student preceptors or one of 15 faculty preceptors. Test results and course evaluations were compared by type of preceptor. Fourth-year student preceptors were surveyed regarding their experience. RESULTS: The mean test scores did not differ between the first-year students with fourth-year student preceptors and those with faculty preceptors. The first-year students rated the fourth-year student preceptors higher than they did the faculty preceptors. The fourth-year students rated their experience favorably. CONCLUSION: A select group of fourth-year medical students provides a successful alternative to faculty in the teaching of the physical examination to first-year students.

Attitude↗

PubMed1981

The psychiatric physical examination - Part II: findings in 75 unselected psychiatric patients.

The psychiatric physical examination described in the previous paper was done on 75 new psychiatric inpatients. The examiners were one psychiatrist and two psychiatrist-internists. Results confirmed the high frequency of known and unsuspected medical illnesses previously reported in the literature. Additionally, the specific "psychiatric physical examination" confirmed the known psychiatric diagnoses in 76% of the patients and led to consideration of a second or other psychiatric diagnoses in 43% of the patients.

Adolescent↗

PubMed2006

Nursing experience of redesigning a schedule to consider gender identity disorder in recruits' physical examination.

The military service in Taiwan currently uses a recruiting system. With the duty of helping examinees get through their physical examination, we examiners have to consider their individual statements and privacy so as to adjust where necessary while undertaking the examination. The purpose of this case study is to explore the nursing experience of handling the gender identity disorder patient in the field of physical examination. Through their participation, and by considering their personal circumstances, we can execute a thorough examination effectively and smoothly but not influence other examinees, and avoid unexpected disputes. In particular, private items including chest X-ray, electrocardiogram, and gender organ examinations must be executed with care. The nursing designed alternative schedule may provide a reference for the participants involved in the field of recruits' physical examination.

Female↗

PubMedDate not supplied

Are yearly physical examinations in adolescents necessary?

BACKGROUND: Recommendations regarding the frequency of routine physical examinations for adolescents have varied from one examination every 2 to 3 years to yearly evaluations. Because none of these recommendations was based on studies regarding the usefulness of such examinations, it was pertinent to review the results of published studies. METHODS: All series of routine school and preathletic examinations of adolescents published in the English literature from 1943 to 1995 were reviewed. Only reviews of examinations by physicians with or without supervised health professionals were included. RESULTS: Findings included weight, blood pressure, visual acuity, innocent heart murmurs, scoliosis, referral for further testing, and serious abnormalities unknown before examination. A total of 20,047 examinations by 12 different groups of investigators was abstracted. Only 2 adolescents had major, previously unknown findings: 1 boy was blind in one eye and the other had mitral insufficiency. Elevated blood pressures were found in 0.1% to 1.6% of adolescents. Minor findings included acne, caries, myopia, and minor orthopedic problems, but they did not prevent participation in school or sports. CONCLUSIONS: Yearly physical examinations in adolescents are not cost-effective and have practically no value in finding important pathologic conditions. This conclusion would not apply to sexually active teenagers. The value of an examination for health education or detection of mental problems has never been tested in this population. For entrance to school and camps or for sports participation, the review of a questionnaire and screening examinations by allied health providers should be the method of choice unless future studies justify repeated yearly examination of adolescents.

Adolescent↗

PubMed2006

[Diagnostic value of patient history and physical examination in elderly patients with urinary incontinence; a literature review].

OBJECTIVE: To assess the validity of patient history and physical examination in elderly patients in the diagnosis ofvarious types of urinary incontinence. DESIGN: Literature review. METHOD: Articles on the diagnosis of urinary incontinence in elderly patients (patient history and/or physical examination versus urodynamic testing) were identified using PubMed, Picarta (a Dutch database) and the reference lists of the articles found. Articles were published between January 1970 and August 2005. The applicability and quality of the articles were assessed using the relevant Cochrane criteria. 'Sufficient diagnostic evidence' was defined as a positive likelihood ratio > 5 and a negative likelihood ratio < 0.02. RESULTS: 5 studies met the eligibility criteria; 4 were performed in the second-line setting and 1 in a general population. All 5 studies involved women aged 55 years or older. None of the 5 studies found a positive or negative likelihood ratio for providing sufficient diagnostic evidence for various types of urinary incontinence. In the study conducted in a general population, the positive and negative likelihood ratios for the presence of stress incontinence according to patient history and physical examination were 3.23 and 0.40, respectively. CONCLUSION: Few adequate studies have been reported on the validity of clinical evaluation in the diagnosis of urinary incontinence in older women, and no studies have been conducted in men. The validity of clinical evaluation has been demonstrated only in the diagnosis of stress incontinence in older women.

Aged↗

PubMedDate not supplied

[Clinical techniques for use in neurological physical examinations. III. Sensory functions].

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the neurological physical examination of the sensory functions and to present an approach for the practice of this study. DEVELOPMENT: Despite the difficulty often involved in interpreting its results, today the formal examination of sensation is still an important part of a complete neurological evaluation and remains valid in the search for a correct diagnosis and suitable treatment. We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for abnormalities in the sensory functions. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. We present a detailed review of the practical aspects of the main techniques used in the physical examination of this neurological category. In addition to the tests used to examine the peripheral and cortical sensory systems, we also describe other techniques designed to trigger pain or other sensory symptoms due to radicular lesions or injury to the median nerve. CONCLUSIONS: We present a detailed description of the main clinical techniques used in the neurological physical examination of the sensory functions, as well as an approach that allows them to be performed on adult patients. In addition, we underline the importance of physically examining the sensory functions in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Adult↗

PubMed1994

The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography.

The association between male subfertility and varicocele has long been recognized. Physical examination is the most widely used method for detecting varicoceles but other techniques may be more sensitive. Color Doppler sonography has the theoretical advantage of allowing direct demonstration of reversed flow in the testicular veins. The frequency of detection of reversed flow by color Doppler ultrasound in a normal population is, however, unknown. We evaluated 34 asymptomatic young men with physical examination, standard scrotal sonography and color Doppler evaluation of the scrotal veins. Findings were correlated with semen analysis. Of the subjects 15% had varicoceles by physical examination and 18% by scrotal sonography, while 35% had retrograde flow by color Doppler evaluation. The majority of men in this population did not exhibit retrograde flow within the gonadal veins when evaluated by color Doppler sonography. The physiological significance of retrograde flow, however, remains to be defined.

Adolescent↗

PubMed1994

Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma.

BACKGROUND: Optimal management of patients with Zone II penetrating neck trauma for vascular injury remains controversial. Retrospective studies have demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. This study was undertaken to evaluate prospectively the safety and accuracy of physical examination in determining the management of patients with penetrating Zone II neck trauma. STUDY DESIGN: During a 22 month period, 66 consecutive patients presented to our Level I trauma center with penetrating neck trauma. Determination of the vascular status of these patients was based on physical examination alone if the injury was located in Zone II and there was no definite sign of vascular injury. Patients were observed for at least 23 hours. Patients admitted during the first year of the study underwent ultrasound examination of the carotid artery within 48 hours to assess for injuries. RESULTS: Thirty-six patients met admission criteria. Two patients had large lacerations requiring operative debridement and closure. Six patients underwent arteriography because of the proximity of the vertebral arteries to the injury tract, the trajectory also included Zone I or III, or there were equivocal signs of vascular injury. Each arteriogram was negative. Of the remaining 28 patients, none had any evidence of a vascular injury during hospitalization or follow-up period (mean of 1.8 months). Eighteen of the 28 patients had carotid ultrasounds, none of which showed injuries requiring operative intervention. CONCLUSIONS: Patients with Zone II penetrating neck injuries and no definite signs of vascular injury can be safely and accurately managed on the basis of physical examination alone. Arteriography or ultrasonography are not needed to identify vascular injuries.

Adult↗