Why such complete physical examinations?
Explore the source record for details and available documents.
Humans↗
SEARCH · PubMed Health
Results for “PHYSICAL EXAMINATION”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Comparative study between scrotal physical examination and scrotal ultrasonography in the detection of varicocele in men with infertility.
From September 1989 to March 1991, we evaluated 110 men from our infertility clinic to determine the correlation between scrotal physical examination and scrotal ultrasonography in the detection of varicocele in men seeking clinical evaluation for infertility, depicting scrotal ultrasound as the gold standard. Of 110 men with infertility, clinically palpable varicocele was found in 40 patients (36.36%). Fifteen were of grade 1, nineteen of grade 2 and four of grade 3. Of these 40 patients, 32 (80%) had left sided varicocele 2 (5%) had right sided varicocele and the remaining 6 patients (15%) had bilateral varicoceles. Of the 40 patients with clinically palpable varicocele, 34 (85%) had the diagnosis confirmed by scrotal ultrasound. Of these 34 patients who had varicocele diagnosed by scrotal ultrasound, 17 (50%) had varicocele on the left side, 1 (2.94%) had varicocele on the right side and the remaining 16 patients (47.07%) had bilateral varicoceles. Seventy patients in whom initial scrotal physical examination failed to detect varicocele, 12 (17.14%) were found to have varicocele by scrotal ultrasound, all of which were on the left side. This group of patients was classified as subclinical varicocele. Statistical analysis revealed that scrotal physical examination in the detection of clinical varicocele has sensitivity of 73.90 per cent, specificity of 90.60 per cent and positive predictive value of 85.00 per cent with negative predictive value of 82.80 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Physical examinations in psychiatric practice in Ohio.
In 1974 members of the Ohio Psychiatric Association were surveyed to determine the extent to which psychiatrists performed physical examinations and their attitudes toward conducting such examinations. Responses from 222 psychiatrists showed that most believed psychiatric patients should have a physical examination, but that it should be conducted by a physician other than a psychiatrist. Those who felt more confident in their diagnostic skills tended to perform examinations more frequently than psychiatrists who were unsure of their skills. Regardless of whether they performed examinations, the respondents were almost universal in the belief that their medical training and experience added an important dimension to their skills.
Attitude of Health Personnel↗
Physical examination. Its role as a single screening modality in the Canadian National Breast Screening Study.
Although often recommended as an important component in screening for breast cancer, physical examination of the breasts (PE) by medical professionals has not been well evaluated. The Canadian National Breast Screening Study (NBSS) permits estimation of sensitivity, specificity, and positive predictive value (PPV) of PE alone as performed by screen-examiners because 50% of the 89,835 NBSS participants did not receive mammography. There were 19,965 women aged from 50 to 59 years who were eligible to receive four or five annual PEs from 77 nurse-examiners, in 12 screen centers outside Quebec province and 58 physician-examiners in three screen centers in Quebec. The gold standard was histologically proven breast cancer. When a test was positive the participant was referred to the study surgeon for review. For screens one to five, sensitivity was 83, 71, 57, 83, and 77; specificity was 88, 94, 96, 96, and 96; and PPV was 3, 3, 4, 3, and 4, respectively. For 25,620 women aged 40 to 49 years who were eligible to receive only one PE, sensitivity was 71, specificity 84, and PPV 1.5. Using a binomial regression model, X2 for heterogeneity suggested there was no difference between nurse and physician examiners (P = 0.6879). Similar estimates made for the surgeons who performed 8914 reviews showed that sensitivity and PPV were higher than for the screen examiners and specificity was lower. These results support the conclusion that physical examination of the breasts by trained nurses is a useful component in screening for breast cancer.
Adult↗
Interexaminer reliability in physical examination of patients with low back pain.
STUDY DESIGN: Seventy-one patients with low back pain were examined by two physiotherapists (50 patients) and two physicians (21 patients). The two physiotherapists had worked together for many years, but the two physicians had not. The interexaminer reliability of the clinical tests included in the physical examination was evaluated. OBJECTIVES: To evaluate the interexaminer reliability of clinical tests used in the physical examination of patients with low back pain under ideal circumstances, which was the case for the physiotherapists. SUMMARY OF BACKGROUND DATA: Numerous clinical tests are used in the evaluation of patients with low back pain. To reach the correct diagnosis, only tests with an acceptable validity and reliability should be used. Previous studies have mainly shown low reliability. It is important that clinical tests not be rejected because of low reliability caused by differences between examiners in performance of the examination and in their definition of normal results. METHODS: Two examiners, either two physiotherapists or two physicians, independently examined patients with low back pain. RESULTS: In approximately half of the clinical tests studied, an acceptable reliability was demonstrated. CONCLUSION: On the basis of the physiotherapists series, the reliability was acceptable for a number of clinical tests that are used in the evaluation of patients with low back pain. The results suggest that clinical tests should be standardized to a much higher degree than they are today.
Adolescent↗
Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position.
We consecutively and prospectively studied 219 critically ill patients to evaluate the accuracy of the physical examination in assessing ETT position and the appropriateness of taking routine chest x-ray films after intubation in the ICU. As a result of x-ray findings, 14 percent of the patients required ETT repositioning, and 5 percent had main-stem intubations. Endobronchial intubation was more common in females than in males, and frequently occurred after emergency intubations. Sixty percent of the main-stem intubations occurred despite the presence of equal breath sounds on examination. Techniques to minimize the risk of tube malposition, such as cuff ballottement in the suprasternal notch and referencing the ETT centimeter markings, were not completely reliable. This study confirms the unreliability of the physical examination to assess ETT position. Chest x-ray films after intubation are indicated to verify tube position, particularly after emergency intubations. Other techniques such as use of a lighted stylet require evaluation to determine whether they are more cost-effective in verifying ETT placement in patients who have no other indication for postintubation x-ray films.
Cost-Benefit Analysis↗
The psychiatric physical examination - Part I: methodology.
The frequency of medical findings in psychiatric patients is quite high. Regardless, none of the responding psychiatrists in a recent survey do routine physical examinations. In response to this survey, the authors describe a method of rapid physical examination specifically designed for the psychiatric patient. The average duration of the examination in 75 patients was 16.9 minutes. There was no evidence of negative transference or countertransference. The level of competency required was that of a medical student, yet there were 8.2 physical findings per patient with 5.3 physical findings per patient being unknown previously.
Humans↗
Electrocardiography and the preparticipation physical examination: is it time for routine screening?
The preparticipation physical examination (PPE) is a screening tool endorsed by numerous organizations and used to evaluate young athletes prior to competition for both medical and musculoskeletal conditions that may predispose them to injury. The cardiac portion of the examination, as recommended by the American Heart Association, is detailed specifically to detect signs or symptoms consistent with certain congenital heart conditions that may increase a young athlete's risk of sudden cardiac death (SCD). Much controversy has erupted over the years as to whether this examination has the diagnostic sensitivity to detect these conditions and prevent SCD, and whether additional modalities, such as the 12-lead electrocardiograph (ECG), should be incorporated. Given the rarity of SCD events, the large population of young athletes that would qualify yearly for the examination, and the limitations that an ECG would present, it would not be efficient to add the ECG to the standard PPE on the symptomatic athlete. More efforts should be spent in standardizing the PPE on a national level to further improve its efficiency.
Adolescent↗
Physical examination of the shoulder in the primary care setting.
Shoulder problems are extremely common reasons for visiting a primary care physician. To make a correct diagnosis, an appropriate physical examination must be performed. This article describes a systematic approach to the physical examination, correlating the various maneuvers and tests with the anatomy and pathology of the shoulder. The steps in this examination are: inspection, observation, palpation, manual muscle testing, and special testing. With this type of systematic approach, the physician is more likely to arrive at an accurate diagnosis.
Humans↗
The ultrasound-assisted physical examination in the periodic health evaluation of the elderly.
BACKGROUND: Except for specific procedures such as blood pressure measurement, the conventional physical examination (PE) does not have sufficient sensitivity to be useful as part of the periodic health evaluation. Ultrasound has demonstrated greater sensitivity and specificity in numerous studies but has been too expensive to be widely employed in health screening. The purpose of our study was to determine whether an examination in which conventional and ultrasound techniques are blended and applied by a primary care physician might be feasible and useful in the periodic health evaluations of senior citizens. METHODS: Seventy-two patients presenting to a community-based family physician for periodic health evaluations received an ultrasound-assisted physical examination (USA-PE) from a second family physician. The results were reported to the primary physician, and the outcomes were tracked for periods of up to 2 years. RESULTS: Twenty-two of the 72 patients (31%) had abnormalities found by the USA-PE that were not apparent during the conventional PE. Five of these patients (7%) had serious conditions that received prompt treatment with apparent benefit. Findings included endometrial carcinoma, abdominal aortic aneurysm, carotid stenosis, hydronephrosis, and urinary retention. CONCLUSIONS: The USA-PE found more abnormalities in this group of patients than conventional PE. Whether it can improve outcomes for senior citizens undergoing periodic health evaluations in a cost-effective manner is yet to be determined.
Aged↗
Methods for teaching physical examination skills to medical students.
BACKGROUND AND OBJECTIVES: Teaching physical examination (PE) skills is a fundamental component of medical education. However, there is little information available about how medical school faculty teach PE skills. This study surveyed PE course directors to determine how they presently teach PE skills, the methods that are perceived to be the best, and how standardized patients (SPs) are recruited and paid. METHODS: A written survey was mailed to PE course directors at US allopathic and osteopathic medical schools. RESULTS: PE course directors at 83 (58%) schools responded. Results indicate that the top three methods presently used for teaching (demonstration on an SP, practice on an SP, and practice on patients) and those perceived to be the best methods are the same but in different rank order. A significant difference was observed in the overall mean scores of the present methods versus the best methods in 8 of the 10 teaching methods; thus, instructors are not always using the best methods to teach PE. There were also differences in methods used to teach "sensitive areas" (ie, genital or breast exam). CONCLUSIONS: The highest-ranked methods for teaching PE are demonstrations and practice with SPs and practice on real patients. However, PE instructors are not always using the teaching methods they deem best.
Education, Medical, Undergraduate↗
Physical examination of the liver: is it still worth it?
OBJECTIVES: The aim of this study was to evaluate the actual role of physical examination of the liver in normal subjects and in cirrhotic patients. METHODS: One hundred healthy subjects and 100 patients with liver cirrhosis underwent a physical and an ultrasonographic evaluation of the liver by independent operators. Physical examination was performed by means of percussion and palpation to determine total liver span, liver span below the costal margin, and liver consistency. Total liver span, liver span below the costal margin, and liver volume were also determined by means of ultrasonography. RESULTS: The agreement between physical and ultrasonographic assessment of the liver span below the costal margin was poor in controls (chance corrected agreement index = 0.13) and excellent in patients (chance corrected agreement index = 0.93). Physical and ultrasonographic total liver span were correlated in patients with cirrhosis (r = 0.592) but not in controls (r = 0.205). Echo-measured liver span significantly correlated with the actual volume of the organ in both groups, whereas physical liver span significantly correlated with liver volume in cirrhosis but not in controls. The difference between actual liver volume and the value predicted by liver span was large. The cirrhotic liver was slightly reduced in size in comparison with that of healthy subjects and differed by an increase in consistency and a thickened edge. CONCLUSIONS: The bedside examination of the liver does not provide any accurate information regarding the actual volume of the organ. Its major role remains to define the characteristics of lower edge, mainly consistency, which may help in clinical diagnosis. Liver volume proved to predict prognosis in patients with cirrhosis, but its measurement needs quantitative, reproducible methods, which can be obtained only by imaging techniques.
Case-Control Studies↗
Prospective evaluation of the sensitivity of physical examination in chest trauma.
BACKGROUND: Chest radiographs are routine for patients presenting with blunt and penetrating chest trauma. The accuracy of physical examination in the diagnosis of hemopneumothorax in these patients is unclear. A prospective study was performed to define the utility of routine portable chest radiographs in 676 trauma patients. METHODS: Over 19 months (January 2000-July 2001), 676 patients who presented with penetrating or blunt chest trauma were interviewed and examined for signs and symptoms of hemopneumothorax. The incidence of chest pain or tenderness and tachypnea was noted and both lung fields were auscultated. A portable chest radiograph was then performed on all the patients. RESULTS: All the patients were hemodynamically stable. Five hundred twenty-three patients sustained blunt trauma, with seven hemopneumothoraces (1.3%). The negative predictive values of auscultation, pain or tenderness, and tachypnea were 99& to 100%. One hundred fifty-three patients sustained penetrating chest trauma. Of these injuries, 68 were gunshot wounds and 85 were stab wounds. Twenty-four (16%) of these patients had hemopneumothoraces. The sensitivities of auscultation, pain or tenderness, and tachypnea were 50%, 25%, and 32%, respectively. The negative predictive values of these tests were < 91%. CONCLUSION: Blunt chest trauma patients who are hemodynamically stable with a normal physical examination do not require a routine chest radiograph. In contrast, all victims of penetrating trauma require chest radiographs because many will have hemopneumothorax in the absence of clinical findings.
Adolescent↗
The utility of the physical examination and investigations in the pediatricneurology consultation.
For most consultations the diagnosis is established by a thorough clinical history. We prospectively assessed the impact of each component of the pediatric neurologic consultation in 500 consecutive referrals to a tertiary care pediatric neurology clinic. Diagnosis and management decisions were declared for each patient by the consultant after each stage of the consultation process (1: receipt of consultation letter, 2: history, 3: physical examination and 4: receipt of investigation results). We found that the physical examination and investigations influenced management decisions for less than 6%. Specifically the examination was never influential for children with headaches, Tourette syndrome, developmental delay or attention-deficit-hyperactivity disorder (ADHD). Investigations never influenced management for those with Tourette syndrome, ADHD, or cerebral palsy. Therefore for the majority of children the critical component of the pediatric neurology consultation is a detailed clinical history.
Attention Deficit Disorder with Hyperactivity↗
Physical examination and selective conservative management in patients with penetrating injuries of the neck.
This prospective study of 335 patients with penetrating injuries of the neck examined the decision whether to operate or observe according to a protocol based mainly on physical examination. Emergency angiography was performed in only three patients. Sixty-six patients (20 per cent) were subjected to emergency operation because of signs and symptoms suggestive of significant injury (60 patients) or because of positive investigations (six). The remaining 269 patients (80 per cent) were selected for non-operative management. Two of these patients (0.7 per cent) required elective operation during the initial hospital stay. No deaths occurred in patients treated conservatively. Some 192 (72 per cent) of observed patients were available for early follow-up and 111 (42 per cent) for late follow-up. No significant complications were found. Physical examination is a reliable method for detecting significant injuries following penetrating neck trauma. Emergency angiography is rarely necessary.
Adolescent↗
Why perform a routine history and physical examination?
Science uses two types of data--one for generating hypotheses and a second for testing hypotheses. In clinical medicine the history and physical examination generate the data used for making hypotheses about what could possibly be wrong with the patient; but the various laboratory and imaging procedures are used for hypothesis-testing, ie, deciding which of the possible problems is actually the one bothering the patient. Although comparisons between physical examination maneuvers and imaging procedures may tell something about the precision of the former, in general such comparisons can tell little about the intrinsic worth of one versus the other, because these two different types of procedures generate data with two completely different types of usage.
Decision Theory↗
[Efficacy of smoking cessation instruction for general smokers at an annual physical examination].
A randomized controlled trial was conducted to evaluate the efficacy of smoking cessation instruction given to general smokers at an annual physical examination. Four hundred and twenty-six male and 42 female clients were randomly assigned to an intervention group (I), and 413 males and 76 females were assigned to a control (C) group. The I group was given an approximately 2-minute smoking cessation instruction by physicians, answered a quiz concerning tobacco, chose their own behavioral goals and were handed a leaflet on how to quit smoking. Subjects in both groups responded to a self-administered questionnaire and a 6-month and 12-month follow-up was performed by post card or telephone. The I group received an encouragement card one month after instruction and abstainers of the I group were awarded a telephone card at the 6-month follow-up. The results were as follows: 1) The male I group exhibited 7.3% (6 months), 10.1% (12 months) abstinence rates and the male C group 4.4% (6 months), 5.3% (12 months), respectively. The difference in 12-month abstinence rates was statistically significant. 2) The female I group exhibited abstinence rates of 16.7% (6 months), 23.8% (12 months) and the female C group 14.5% (6 months), 17.1% (12 months), respectively. 3) A multivariate analysis of smoking cessation showed that lower nicotine dependency, strong determination for smoking cessation, and being female were significant factors for abstinence at the 6-month follow-up. At 12 months, the smoking cessation instruction also became a significant factor. These data suggest that a simple smoking cessation instruction at an annual physical examination was effective for general smokers.
Adult↗