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PubMed1999

Agreement between symptom surveys, physical examination procedures and electrodiagnostic findings for the carpal tunnel syndrome.

OBJECTIVES: The goal of this study was to evaluate the concordance between various clinical screening procedures for carpal tunnel syndrome. METHODS: The subject population consisted of 824 workers from 6 facilities. The evaluated procedures included bilateral sensory nerve conduction testing, physical examinations, and symptom surveys, including hand diagrams. The agreement between the outcomes of various combinations of these procedures was assessed by determining the kappa coefficient. RESULTS: There was relatively poor overlap between the reported symptoms, the physical examination findings, and the electrodiagnostic results consistent with carpal tunnel syndrome. Overall, only 23 out of 449 subjects (5%) with at least 1 positive finding met all 3 criteria (symptoms, physical examination findings, and electrophysiological results consistent with carpal tunnel syndrome) for the dominant hand. The screening procedures showed poor or no agreement with kappa values ranging between 0.00 and 0.18 for all the case definitions evaluated for carpal tunnel syndrome. CONCLUSIONS: The poor overlap between the various screening procedures warns against the use of electrodiagnostic findings alone without the symptom presentation being considered. The results of this study also point to a need for the further development and evaluation of methods for detecting carpal tunnel syndrome.

Adult↗
PubMed1978

The nurse practitioner as a teacher of physical examination skills.

The service role of nurse practitioners has been widely recognized (1). However, their potential as clinical instructors of physical examination skills has not been appreciated. This article details a new first-year medical school course in physical examination in which nurse practitioners are key members of the instructional team.

California↗
PubMed1999

Parental preparation of children for routine physical examinations.

Preparation of the child and parents/caretakers for health care events is expected to decrease a child's anxiety and uncooperative behaviors. The purpose of this study was to ascertain the methods of preparation (discussion, reading, play, other) and levels of discussion used by parents in readying their preschool and school-age children for six selected events during routine physical examinations. A phone survey was conducted to all parents of children, ages 2 to 12 years, who visited an academic nursing center or public school for a routine physical examination (n = 132). The events are "listen to heart," "look in ears," "take temperature," "feel the stomach," "look at the throat," and "give a shot." The most common method of preparation parents used was discussion that consisted largely of procedural information rather than a reciprocal dialogue with the child. Preschool children were told what the health care provider would do and what they should do during the physical examination more often than school-age children.

Child↗
PubMed1977

The nurse practitioner as a teacher of physical examination skills.

The service role of Nurse Practitioners has been widely recognized. (1) However, their potential as clinical instructors of physical examination skills has not been previously documented. This communication details a new first-year medical school course in physical examination in which Nurse Practitioners are key members of the instructional team.

Clinical Competence↗
PubMed2006

Comparing the frequency of physical examination techniques performed by associate and baccalaureate degree prepared nurses in clinical practice: does education make a difference?

Rapid changes in health care have underscored the need for reform in health professions education, including nursing education. One of many problems cited in the nursing and other health sciences education literature is overcrowded curricula; therefore, an evaluation of content is necessary. The purpose of this study was to determine whether differences exist in the frequency that physical examination techniques are performed by associate and baccalaureate degree prepared nurses. Participants completed a survey on performance of various physical examination techniques. A Mann-Whitney test showed no differences between the two groups in terms of frequency of techniques performed. A small negative correlation was found between frequency and years of experience with the nutrition assessment category. A comparison of physical examination content covered in baccalaureate and associate degree nursing programs is needed to further understand these findings.

Clinical Competence↗
PubMed2004

[Development of Web-based multimedia content for a physical examination and health assessment course].

PURPOSE: This study was to develop Web-based multimedia content for Physical Examination and Health Assessment. METHOD: The multimedia content was developed based on Jung's teaching and learning structure plan model, using the following 5 processes : 1) Analysis Stage, 2) Planning Stage, 3) Storyboard Framing and Production Stage, 4) Program Operation Stage, and 5) Final Evaluation Stage. RESULTS: The web based multimedia content consisted of an intro movie, main page and sub pages. On the main page, there were 6 menu bars that consisted of Announcement center, Information of professors, Lecture guide, Cyber lecture, Q&A, and Data centers, and a site map which introduced 15 week lectures. In the operation of web based multimedia content, HTML, JavaScript, Flash, and multimedia technology (Audio and Video) were utilized and the content consisted of text content, interactive content, animation, and audio & video. Consultation with the experts in context, computer engineering, and educational technology was utilized in the development of these processes. CONCLUSIONS: Web-based multimedia content is expected to offer individualized and tailored learning opportunities to maximize and facilitate the effectiveness of the teaching and learning process. Therefore, multimedia content should be utilized concurrently with the lecture in the Physical Examination and Health Assessment classes as a vital teaching aid to make up for the weakness of the face-to- face teaching-learning method.

Computer-Assisted Instruction↗
PubMed2001

A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis.

BACKGROUND: We conducted a review of the diagnostic accuracy of clinical examination for the diagnosis of cirrhosis. The objectives were: to identify studies assessing the accuracy of clinical examination in the detection of cirrhosis; to summarize the diagnostic accuracy of reported physical examination findings; and to define the effects of study characteristics on estimates of diagnostic accuracy. METHODS: Studies were identified through electronic literature search of MEDLINE (1966 to 2000), search of bibliographic references, and contact with authors. Studies that evaluated indicants from physical examination of patients with known or suspected liver disease undergoing liver biopsy were included. Qualitative data on study characteristics were extracted. Two-by-two tables of presence or absence of physical findings for patients with and without cirrhosis were created from study data. Data for physical findings reported in each study were combined using Summary Receiver Operating Characteristic (SROC) curves or random effects modeling, as appropriate. RESULTS: Twelve studies met inclusion criteria, including a total of 1895 patients, ranging in age from 3 to 90 years. Most studies were conducted in referral populations with elevated aminotransferase levels. Ten physical signs were reported in three or more studies and ten signs in only a single study. Signs for which there was more study data were associated with high specificity (range 75-98%), but low sensitivity (range 15-68%) for histologically-proven cirrhosis. CONCLUSIONS: Physical findings are generally of low sensitivity for the diagnosis of cirrhosis, and signs with higher specificity represent decompensated disease. Most studies have been undertaken in highly selected populations.

Fibrosis↗
PubMed1995

Compartment-directed physical examination of the knee can predict articular cartilage abnormalities disclosed by needle arthroscopy.

OBJECTIVE: To determine whether physical examination maneuvers that focus on each knee compartment and assess crepitus at several distinct sites can specifically disclose articular cartilage abnormalities in the compartment being assessed. METHODS: Twenty patients with knee pain were examined before needle arthroscopy. Crepitus was sought from the patellofemoral compartment, medial tibiofemoral compartment, and lateral tibiofemoral compartment. Any crepitus felt in the distal tibia during a tibiofemoral stress maneuver was recorded as transmitted bony crepitus (TBC). Needle arthroscopy assessed articular cartilage (5 sites) and both menisci in each knee. RESULTS: Crepitus by conventional assessment revealed patellar cartilage disruption (69% sensitive, 50% specific) and abnormalities of tibiofemoral cartilage (67% sensitive, 40% specific) but could not indicate their location. Tibiofemoral crepitus found cartilage disruption in the compartment at a sensitivity of 22% and a specificity of 100%, and with added tibiofemoral stress, a sensitivity of 65% and a specificity of 94% (the one "false positive" had bare bone in the other compartment). TBC was detected in 7 compartments, all of which had focal bare bone on tibial and femoral surfaces; 6 other compartments had tibial bare bone without TBC. Thus, TBC was 54% sensitive and 100% specific for tibial bare bone, and 88% sensitive and 100% specific for bone-on-bone. CONCLUSION: Compartment-directed physical examination of the painful knee can locate and assess the severity of certain articular cartilage abnormalities that are not reliably found by conventional methods. Transmitted bony crepitus is a specific finding for bone-on-bone in the compartment being assessed.

Adult↗
PubMed1995

MR imaging of Achilles tendon in patients with familial hyperlipidemia: comparison with plain films, physical examination, and patients with traumatic tendon lesions.

OBJECTIVE: The purpose of this study was to evaluate the MR imaging characteristics of Achilles tendons in patients at risk for tendon xanthomas because of familial hyperlipidemia and to compare these findings with those seen on plain radiographs and physical examination. We also wished to determine if MR imaging could be used to differentiate xanthomas from traumatic tendinopathy in a second group of patients who had no history of hyperlipidemia but who had a history of trauma to the Achilles tendon. SUBJECTS AND METHODS: We evaluated the MR imaging studies of 26 Achilles tendons in 13 patients with heterozygous familial hypercholesterolemia (n = 11) and type III dysbetalipoproteinemia (n = 2). The size, shape, and signal characteristics of the Achilles tendon were recorded. A tendon was considered abnormal by MR if there was high signal, a convex anterior border, or an anteroposterior measurement greater than 7 mm. Findings on plain radiographs and physical examination of the Achilles tendons were evaluated in the same group of patients. In the group of patients with hyperlipidemia, palpable abnormalities of the Achilles tendon were present in 14 of 26 tendons. Plain radiographs were interpreted as showing abnormalities in 18 of the 26 tendons. In a second group of 21 tendons in patients with no history of hyperlipidemia but with traumatic tendinopathy, studies were evaluated for the size, shape, and signal characteristics of the Achilles tendon. RESULTS: On MR images, 24 of 26 tendons showed signal abnormalities, and 19 of 26 were enlarged. Abnormal signal was a diffuse stippled pattern with many low-signal round structures of equal size surrounded by high-signal material on all pulse sequences. Abnormal signal was seen in tendons of both normal and abnormal size. Bilateral and symmetric changes were found in all but one patient. Tendinopathy in patients without known hyperlipidemia appeared indistinguishable from tendon xanthomas in six (29%) of 21 tendons. The other tendons (71%) were distinctly different from xanthomas without a uniform stippled signal pattern. CONCLUSION: MR imaging of patients with familial hyperlipidemia showed an abnormal stippled signal pattern with or without enlargement or abnormal configuration of the tendon. MR imaging is a more sensitive method than physical examination and plain films for detecting abnormalities in Achilles tendons of patients with hyperlipidemia. Although the MR signal pattern of xanthomas is often different from that of partial tendon tears, tendon degeneration, or tendinitis, a significant overlap in appearance can be observed and the MR appearance of a xanthoma is not pathognomonic.

Achilles Tendon↗
PubMed2005

[The effect of web-based multimedia contents for a course of physical examination and health assessment].

PURPOSE: This study was to test the effectiveness of Web-based multimedia contents for Physical Examination and Health Assessment on learning achievement. METHOD: Multimedia contents based on Jung's teaching and learning structure model were used to enhance learning achievement. Learning achievement was measured by the knowledge of Physical Examination and Health Assessment. The participants of this study were students in a BSN and RN-BSN program in a university located in Seoul. 59 students in the experimental group received lectures using web-based multimedia contents and 75 students in the control group received regular lectures. RESULTS: The mean score of the degree of educational achievement in the experimental group(mean=31.09) was significantly higher than in the control group(mean=25.55)(t=-3.883, p=.000). CONCLUSION: These web-based multimedia contents were found to maximizethe effectiveness of the teaching process when used as a teaching aid, and yet kept the strength of a face to face teaching learning method. This program is recommended as part of a main text, vital teaching aid or cyber lecture materials in nursing schools and in health care educational institutions.

Adult↗
PubMed1988

Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.

Abdominal aortic aneurysm (AAA) is an important cause of preventable death in older persons. Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA. In an effort to develop an effective and efficient program of AAA detection, we selectively screened a high-risk population. Men aged 60 to 75 years with hypertension and/or coronary artery disease were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected aneurysms, 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 patients, for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these aneurysms, but missed none in patients with an abdominal girth less than 100 cm (n = 6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward AAA detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin patients. We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.

Abdomen↗
PubMed2000

Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

OBJECTIVES: To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). DESIGN: Retrospective chart review SETTING: Orthopedic practice limited to disorders of the shoulder PARTICIPANTS: 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period MAIN OUTCOME MEASURE: Presence of partial or complete RCT on arthrogram RESULTS: 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P < .001), weakness with either elevation (P < .001) or external rotation (P < .001), arc of pain (P = .004), and impingement sign (P = .01). Stepwise logistic regression based on a derivation dataset (n = 191) showed that weakness with external rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age > or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. CONCLUSIONS: The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

Aged↗
PubMed2005

Physical examination of the knee.

Even with the rapid advancement in technology and medical imaging, there is still no substitute for the history and physical examination that can be obtained from a patient. With a well-performed history and physical, the majority of pathology can be determined prior to any expensive imaging or surgical procedures. The knee is one of the most commonly injured joints, and its function is critical to basic ambulation and participation in sports, work, and activities of daily living. This article reviews the key concepts to a complete evaluation of the knee and highlights aspects of the physical examination and radiographic imaging that best aid in diagnosing knee pathology.

Arthralgia↗
PubMed2004

Physical examination may miss the diagnosis of bilateral varicocele: a comparative study of 4 diagnostic modalities.

PURPOSE: We evaluated the sensitivity of 3 noninvasive methods for detecting left and right varicoceles. MATERIALS AND METHODS: Three noninvasive methods for the detection of varicocele in the left and right internal spermatic veins were evaluated in 214 infertile men, namely, physical examination, scrotal contact thermography and ultrasound Doppler. Venography was used as the reference diagnosis. RESULTS: Varicocele was detected in 195 patients (91.1%), on the left side in 37 (19%), on the right side in 3 (1.5%) and bilaterally in 155 (79.5%). Scrotal contact thermography using varicoscreen proved to be the most accurate method. Sensitivity, specificity, accuracy and positive predictive value were 98.9%, 66.6%, 98.5% and 100%, respectively, for left varicocele, and 95.6%, 91.6%, 94.9% and 98%, respectively, for right varicocele. Doppler sonography was associated with the highest number of false-positive results. Accuracy in evaluating retrograde flow was lowest for both sides for physical examination and highest for the combination of Doppler sonography and contact thermography, with a sensitivity, specificity, accuracy and positive predictive value of 100%, 33.3%, 99.0% and 98.9%, respectively, for the left side, and 97.4%, 58.3%, 90.3% and 91.1%, respectively, for the right side. In 165 (85%) of the 195 patients who underwent internal spermatic vein embolization sperm parameters were improved. CONCLUSIONS: The present study yielded 2 major findings. Thermography is more sensitive and accurate for the detection of varicocele than Doppler ultrasound and physical examination, and it can be used for screening as a single modality in infertile men. Doppler ultrasound and thermography are complementary and their combined use yields the highest sensitivity and accuracy.

Adult↗
PubMed2001

Is physical examination useful in predicting epididymal obstruction?

OBJECTIVES: To evaluate the independent predictive value of subjective epididymal fullness in predicting obstruction in azoospermic men (group 1) and determining preoperatively the need for vasoepididymostomy (VE) in men presenting for vasectomy reversal (group 2). METHODS: All men were evaluated with a medical history and physical examination. During the physical examination, the epididymis was classified as full, if any portion was palpably distended, or normal. Obstruction was confirmed at surgical exploration for group 1 after a biopsy that revealed sufficient spermatogenesis. In group 2, the indications for VE were either no fluid seen from the testicular end of the vas or thick, pasty fluid devoid of sperm. In cases in which VE was required, these units were classified as obstructed. RESULTS: The predictive value of epididymal fullness was evaluated in 51 units (12 in group 1 and 39 in group 2). The sensitivity, specificity, and positive and negative predictive values were 67%, 100%, 100%, and 83%, respectively, in group 1 and 33%, 89%, 20%, and 94%, respectively, in group 2. CONCLUSIONS: Epididymal fullness in azoospermic men is predictive of obstruction, although a normal epididymal examination cannot rule out obstruction. In men presenting for vasectomy reversal, the absence of epididymal fullness is predictive of vasal fluid that allows for vasovasostomy. Epididymal fullness may suggest, but cannot predict, unfavorable vasal fluid that requires VE.

Epididymis↗
PubMed2002

A pilot project to study the use of ultrasonography for teaching physical examination to medical students.

The purpose of this study was to study the use of ultrasound as an aid to teaching physical examination. Five medical students were given a 1-week course in ultrasound, and were then assigned to clinical rotations to perform ultrasound and physical examinations on patients. Basic ultrasound skills were assessed by having each student scan the same normal model at the conclusion of the first week and at the conclusion of the project. Clinical cases were presented to a preceptor, and the ultrasound images were graded on a five-point scale. At the end of the first week, the mean grade of ultrasound examinations performed on the control model was 3.2, improving to 4.4 at the end of the project. Grading of ultrasound exams performed during the first clinical week averaged 4.1, improving to 4.5 at the end of the project. An exit survey indicated a favorable response to using ultrasound as an educational tool.

Adult↗