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PubMedDate not supplied

Development and validation of assessment measures for a newly developed physical examination simulator.

OBJECTIVE: Define, extract and evaluate potential performance indicators from computer-generated data collected during simulated clinical female pelvic examinations. DESIGN: Qualitative and quantitative study analyzing computer generated simulator data and written clinical assessments collected from medical students who performed physical examinations on three clinically different pelvic simulators. SETTING: Introduction to patient care course at a major United States medical school. PARTICIPANTS: Seventy-three pre-clinical medical students performed 219 simulated pelvic examinations and generated 219 written clinical assessments. MEASUREMENTS: Cronbach's alpha for the newly defined performance indicators, Pearson's correlation of performance indicators with scored written clinical assessments of simulator findings. RESULTS: Four novel performance indicators were defined: time to perform a complete examination, number of critical areas touched during the exam, the maximum pressure used, and the frequency at which these areas were touched. The reliability coefficients (alpha) were time = 0.7240, critical areas = 0.6329, maximum pressure = 0.7701, and frequency = 0.5011. Of the four indicators, three correlated positively and significantly with the written clinical assessment scores: critical areas, p < 0.01; frequency, p < 0.05; and maximum pressure, p < 0.05. CONCLUSION: This study demonstrates a novel method of analyzing raw numerical data generated from a newly developed patient simulator; deriving performance indicators from computer generated simulator data; and assessing validity of those indicators by comparing them with written assessment scores. Results show the new assessment measures provide an objective, reliable, and valid method of assessing students' physical examination techniques on the pelvic exam simulator.

Clinical Competence↗
PubMed1976

The disparity of the size of the liver as determined by physical examination and by hepatic gammascanning in 504 patients.

The liver extended a minimum of 5 cm inferior to the right costal margin in 51% of the 504 patients studied. In 53% of these patients, experienced, mature physicians declared that the liver was not palpable on physical examination. In 3% of the cases, a mass was palpated which was believed to be liver by the examining physician but was found to be extrahepatic upon scanning and laparotomy. The unreliability of physical examination in determining whether or not the liver extends inferior to the costal margin in many instances is demonstrated.

Humans↗
PubMed1988

Relative usefulness of physical examination, urodynamics and roentgenography in the diagnosis of urinary stress incontinence.

Stress urinary incontinence is a common problem in women. Accurate diagnosis of this condition is necessary for successful surgical treatment. Currently, many tests are popular. The relative value of these tests, in terms of usefulness, accuracy and practicality, has not been tested in the past. With this aim, we have compared the results from three of the most commonly performed tests, namely physical examination, urodynamics and roentgenography. It is our opinion that physical examination in the standing position is the simplest and most accurate test. Cystometrogram is important, although the yield is small. We do not advise the routine use of urethral pressure profile. For accurate determination of anatomic deformity, roentgenographic examination is the most accurate test.

Adult↗
PubMed1997

Interexaminer reliability in physical examination of the neck.

BACKGROUND: There are numerous clinical tests used in the evaluation of patients with symptoms arising from the cervical spine. It is necessary to use clinical tests with high validity and reliability. Previous studies of reliability of clinical tests used in the evaluation of the cervical spine have come to various conclusions, most of which suggest low reliability. This might be explained by differences between examiners in performance and where the limit of normality is placed. OBJECTIVE: To evaluate the interexaminer reliability of clinical tests used in everyday clinical work, where the examiners base their evaluations on a comparison between left and right sides. STUDY DESIGN: A total of 50 volunteers were examined by two physiotherapists. The interexaminer reliability of clinical tests included in the physical examination of patients with symptoms from the cervical spine was evaluated. METHODS: Two physiotherapists independently examined volunteers. RESULTS: An acceptable reliability was found for two of 10 clinical tests. CONCLUSION: When it is possible to compare left and right sides, it is possible to show acceptable reliability for some clinical tests. Reliability studies most often find low reliability, perhaps because of bias; clinical tests are not standardized. In future studies, greater efforts should be taken to reduce bias.

Adolescent↗
PubMedDate not supplied

The preparticipation physical examination for athletics: a critical review of current recommendations.

The preparticipation physical examination (PPE) has become the standard of care for the millions of high school students in the United States as they prepare for athletic participation. These assessments are intended to identify medical conditions that may affect safe and effective participation in organized sports. The PPE has become an integral aspect of the athletic and sports medicine system during the last three decades. Over time, the PPE has been revised, largely based upon the recommendations of large medical organizations. Several primary and secondary goals have been presented to be accomplished through the PPE. One particular goal of these assessments is to identify individuals with underlying cardiovascular disease, a significant cause of acute sudden cardiac death in high school and college athletes. While current research continues to demonstrate that the PPE has no effect on the overall morbidity and mortality rates in athletes, other objectives may be fulfilled by these examinations. In order to improve the ability of these examinations in fulfilling their primary objectives, instruments that have better results in preventing the injuries and deaths associated with athletic participation should be developed and investigate.

Adolescent↗
PubMed1990

The low yield of physical examinations and laboratory investigations of patients with chronic fatigue.

Fatigue is a common symptom but guidelines for its appropriate evaluation are lacking. The authors prospectively studied 100 adults with a chief complaint of fatigue lasting at least 1 month in order to determine the diagnostic contribution of physical examinations and laboratory investigations. The evaluations were performed in the specialized clinic of a faculty practice. Physical examinations produced diagnostic information in 2% of patients, and laboratory investigations elucidated the cause of fatigue in 5% of patients. Structured follow-up evaluations after an average interval of 10 months failed to reveal any new organic causes for the fatigue symptom. Minor laboratory abnormalities were relatively common but did not contribute to the diagnostic process and did not seem to influence the clinical outcome. The authors conclude that the traditional medical evaluation of patients complaining of chronic fatigue has a low yield in discovering treatable physical disorders.

Adult↗
PubMed1998

Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain.

OBJECTIVE: To assess the value of plain abdominal radiographs and of data from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in particular. DESIGN: Prospective study. SETTING: 4 university and 2 community hospitals, Germany. SUBJECTS: 1254 patients with acute abdominal pain lasting less than 7 days, and with no history of abdominal injury including surgery. INTERVENTIONS: Standardised and structured medical history and physical examination, study of results of plain abdominal radiographs. MAIN OUTCOME MEASURES: Positive predictive value and sensitivity of clinical variables and abdominal film with respect to the diagnosis at discharge. RESULTS: 48 patients (3.8%) had bowel obstruction. 704 patients (56.1%) had plain abdominal films taken at the time of initial presentation. 111 studies (15.8%) showed important findings leading to diagnosis or immediate treatment, 455 (64.7%) showed unimportant or no findings. In 138 (19.6%) results of films were not reported. 16 of 45 single variables were of help in diagnosing bowel obstruction. The six with the highest sensitivity were distended abdomen, increased bowel sounds, history of constipation, previous abdominal surgery, age over 50, and vomiting. If only patients presenting with any two of these symptoms had had radiographs taken, 300 (42.6%) could have been avoided without loss in diagnostic accuracy. CONCLUSION: A considerable number of plain abdominal films taken for patients with acute abdominal pain could be avoided by focusing on clinical variables relevant to the diagnosis of bowel obstruction.

Abdominal Pain↗
PubMed2004

Can history and physical examination reliably diagnose pediatric obstructive sleep apnea/hypopnea syndrome? A systematic review of the literature.

OBJECTIVE: Using an evidence-based technique, systematically review the literature to evaluate the accuracy of routine clinical history and physical examination in the diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the pediatric patient. STUDY DESIGN AND SETTING: The biomedical literature was systematically reviewed. Articles comparing the results of clinical evaluation to polysomnography (PSG) were selected. The level of evidence was assessed using established evidence-based medicine (EBM) guidelines. RESULTS: Twelve articles were identified using the search criteria. Eleven of 12 articles concluded that clinical evaluation is inaccurate in the diagnosis of OSAHS. The level of evidence was good to very good (Grade B/B+). CONCLUSION/SIGNIFICANCE: Clinical history and physical examination are not reliable for diagnosing OSAHS compared with overnight PSG. Complicating the interpretation of this work is the lack of a validated PSG threshold of clinically significant disease. There is an urgent need for the development of adequate screening tests with validated clinical outcomes. EBM RATING: B-3.

Adolescent↗
PubMed2003

Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests.

Family physicians frequently encounter patients with knee pain. Accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination skills. The history should include characteristics of the patient's pain, mechanical symptoms (locking, popping, giving way), joint effusion (timing, amount, recurrence), and mechanism of injury. The physical examination should include careful inspection of the knee, palpation for point tenderness, assessment of joint effusion, range-of-motion testing, evaluation of ligaments for injury or laxity, and assessment of the menisci. Radiographs should be obtained in patients with isolated patellar tenderness or tenderness at the head of the fibula, inability to bear weight or flex the knee to 90 degrees, or age greater than 55 years.

Arthralgia↗
PubMed2002

Teaching and testing physical examination skills without the use of patients.

OBJECTIVE: To design a cardiopulmonary physical exam curriculum that does not involve the use of patients. Bedside teaching is becoming a lost art, and the use of alternative methods of instruction such as simulation has become increasingly important. Simulators have been shown to enhance physical examination skills of students and physicians in training.(1) DESCRIPTION: In 1995, a program was started to improve cardiopulmonary physical diagnosis and the teaching of auscultation at the University of Texas Medical Branch at Galveston (UTMB). The teaching manikin "Harvey" played a vital role in the development of the new curriculum. In 1997, UTMB adopted an organ-based approach to the basic science curriculum. The cardiopulmonary module in the basic science curriculum was a ten-week course taught in the second year of medical school. The physical diagnosis section of that course involved six instructional hours; four of the six hours were dedicated to cardiac auscultation and two hours to pulmonary auscultation. Only simulators and CD-ROMs were used for instruction. The 184 second-year medical students at UTMB were formed into small groups for instruction and practice. Although "Harvey" was an effective teaching tool, other simulators had to be developed for testing students' skills after instruction. It would be very difficult to administer a skills OSCE for 184 students without the development of several smaller transportable simulators. A commercially available blood pressure simulator from the Medical Plastics Laboratory, Inc., Gatesville, TX, was used to test the accuracy of students' blood pressure readings. Small auscultation transducers combined with a palpable pulse simulator, developed by one of the authors (WT) in collaboration with Andries Acoustics, Spicewood, TX, were used to efficiently test students' proficiency in cardiopulmonary auscultation. Digital simulated cardiopulmonary sounds were recorded onto a standard CD-ROM mini-disc and transmitted to the small transducers. Students used their own stethoscopes for auscultation. The targeted skills were efficiently tested in one hour of testing time per student. DISCUSSION: This cardiopulmonary instructional module was well received by the second-year medical students. In the skills OSCE, 80% of the students accurately measured systolic and diastolic blood pressure to within 5 mm Hg. Cardiopulmonary auscultation proficiency results showed average recognition of 60% for cardiac abnormalities and 88% for pulmonary sounds. Developing auscultation transducers with pulse simulation capability ensured that students could identify systole. Therefore, heart murmurs and sounds could be timed with the cardiac cycle. We found the results from the skills OSCE encouraging. Most students demonstrated reasonable competency in the skills taught, and the new transportable simulators performed well. The six-hour instructional module was meant to prepare students for their bedside teaching during the third year of medical school. The significant cost of the "Harvey" simulator may be a barrier to its widespread use for teaching. Therefore, continued development of smaller transportable simulators for teaching and testing purposes is important.

Clinical Competence↗
PubMed1999

Practical considerations in the performance of physical examinations on women with disabilities.

There are over 28 million women with disabilities in the United States (1). This includes women with mobility and self-care limitations of varying degrees. Many of these women have difficulty obtaining comprehensive, accessible, and dignified physical examinations. Additionally, patients and clinicians are often misinformed about issues pertaining to healthcare needs of women with disabilities (2). This article outlines strategies to overcome physical barriers and gaps in knowledge, and proposes creative solutions for common problems encountered during the performance of the basic physical examination of a woman who has disabilities. It discusses the reality of sexually transmitted disease, promotes awareness of abuse in the population of women with disabilities, and offers guidelines physicians can follow in assisting their patients in resolving this abuse.

Battered Women↗
PubMed1988

The value of the physical examination in the diagnosis of anemia. Correlation of the physical findings and the hemoglobin concentration.

Certain clinical findings, such as pallor of the conjunctivae, nail beds, lips, oral mucosa, and palmar creases have traditionally been used by physicians in the diagnosis of anemia. We prospectively examined 50 patients to determine whether there was any correlation between these clinical findings and hemoglobin concentration. We noted a statistically significant correlation between hemoglobin concentration and the following: color tint of the lower eyelid conjunctiva, nail-bed rubor, nail-bed blanching, and palmar crease rubor. Results from our study support the contention that the presence and degree of anemia can be estimated clinically by careful physical examination.

Anemia↗
PubMed2007

The Colorado Haemophilia Paediatric Joint Physical Examination Scale: normal values and interrater reliability.

Persons with haemophilia often experience their first joint haemorrhage in early childhood. Recurrent bleeding into a joint may lead to significant morbidity, specifically haemophilic arthropathy. Early identification of the onset and progression of joint damage is critical to preserving joint structure and function. Physical examination is the most feasible approach to monitor joint health. Our group developed the Colorado Haemophilia Paediatric Joint Physical Examination Scale to identify earlier signs of joint degeneration and incorporate developmentally appropriate tasks for assessing joint function in young children. This study's objectives were to establish normal ranges for this scale and assess interrater reliability. The ankles, knees and elbows of 72 healthy boys aged 1 through 7 years were evaluated by a physical therapist to establish normal ranges. Exactly 10 boys in each age category from 2 to 7 years were evaluated by a second physical therapist to determine interrater reliability. The original scale was modified to account for the finding that mild angulation in the weight-bearing joints is developmentally normal. The interrater reliability of the scale ranged from fair to good, underscoring the need for physical therapists to have specific training in the orthopaedic assessment of very young children and the measurement error inherent in the goniometer. Modifications to axial alignment scoring will allow the scale to distinguish healthy joints from those suffering frequent haemarthroses.

Ankle Joint↗
PubMed1981

Pathologic discriminants of breast cancers detected on screening by mammography and physical examination.

Pathologic discriminants such as lesion size, ratio of infiltrating to intraductal growth, histologic type, histologic grade, percentage tubule formation, lymph vessel invasion, and axillary lymph node metastases were used to analyze 183 breast cancers detected on screening by mammography and physical examination. In general, cancers detected only on mammography should be associated with favorable long-term survival because of their early stage. These lesions had histologic features indicating significant potential for subsequent metastatic spread, which would have occurred had screening been performed by physical examination alone.

Breast Neoplasms↗
PubMed2005

The use of a standardized pre-participation physical examination form in Turkish adolescent athletes.

OBJECTIVE: The pre-participation physical examination (PPE) has become the standard of care for athletes of all ages. The PPE is generally intended to identify medical conditions that may affect safe and effective participation in organized sports. The aim of this study is to validate and to implement a standardized questionnaire in Turkish language, which might aid Turkish physicians during the PPE. METHODS: A total of 1350 athletes visiting the yearly PPE of the Directorate of Sports and Youth in Isparta, Turkey were asked to participate in this study between October 2001 and November 2001. Eight hundred and ten (60%) students accepted to fill out the questionnaire. A self-reported questionnaire that includes 2 parts has been administered. The first part included questions on socio-demographics. Second part is a translated PPE evaluation form. The questionnaire has been piloted in 15 adolescent students. Athletes have been examined afterwards by one of the medical practitioner and he used the questionnaire (PPE Evaluation Form) to identify additional problems in each athlete. RESULTS: Participants were predominantly male, with higher family income and social security, active at an amateur level, participated in team, and in contact sports. Internal consistency of the PPE form was Cronbach alpha=0.69. Thirty-one (3.8%) athletes had significant findings that needed further evaluation. No one was disqualified after follow-up. Eight items, which asked for certain cardiovascular risk factors, had significant relation to cardiovascular findings of PPE [Chi-Square (1) = 7.4-99.6, p<0.01]. An additional 132 (16.3%) athletes had significant problems that never had been adequately evaluated or treated but which were not likely to affect safe sports participation. CONCLUSION: The Turkish PPE form seems to be promising tool to support the physician during PPE. Using a standardized and valid PPE tool might diminish the dependency of primary care physicians to technological equipment, which are mostly not available in developing countries' primary health care settings and would also reduce the costs of PPE, which might not be affordable for athletes without social security.

Adolescent↗
PubMed1995

On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature.

STUDY DESIGN: A criteria-based review of the literature was conducted regarding the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain. OBJECTIVES: To perform meta-analysis of the literature regarding signs and symptoms in diagnosing radiculopathy, ankylosing spondylitis, and vertebral cancer. SUMMARY OF BACKGROUND DATA: Diagnosing low back pain, especially in general practice, depends largely on history taking, physical examination, and the erythrocyte sedimentation rate. No previous review has assessed the diagnostic accuracy of signs and symptoms in a systematic way, taking into account the methodological quality of studies. METHODS: The literature was reviewed for relevant studies. Retrieved studies were independently rated for methodological quality by two reviewers. The reported sensitivity and specificity in the rated studies were reviewed. RESULTS: Thirty-six eligible studies were retrieved. Major methodological shortcomings were observed, and only 19 studies scored > or = 55 points (maximal score 100). Not one single test appeared to have high sensitivity and high specificity in radiculopathy. The combined history and the erythrocyte sedimentation rate had relatively high diagnostic accuracy in vertebral cancer. Getting out of bed at night and reduced lateral mobility seemed to be the only moderately accurate items in ankylosing spondylitis. CONCLUSIONS: Additional studies that take into account the shortcomings identified would be needed to produce definite conclusions. Few of the studied signs and symptoms seemed to be valuable diagnostics for radiculopathy, ankylosing spondylitis, and vertebral cancer. Reproducibility of signs and symptoms over time might be a valuable diagnostic criterion. However, this was neglected in almost all studies.

Blood Sedimentation↗
PubMed1990

Prospective study of the yield of physical examination compared with chest radiography in penetrating thoracic trauma.

A prospective study was conducted on 102 patients (84 male), with a median age of 27 years, who had sustained a penetrating chest wound to evaluate the ability of physical examination in comparison with chest radiography to determine management of these injuries. Knife wounds accounted for 92% of the injuries. Fifty three patients had a small collection of air or fluid in their pleural cavity that was not drained. Fifty six hemithoraces had a large collection of fluid or air and were treated by tube thoracostomy. Physical examination at presentation detected large collections of air and fluid correctly and predicted appropriate management (sensitivity 96%, specificity 94%). Residual collections of air or fluid or both were also predicted correctly by clinical examination. Seven small collections increased in size and required intubation. Routine pre-extubation radiographs were found to be of little value in management and their routine use is not recommended. Four patients required late thoracotomy for decortication. By using a policy of selective intubation, frequent clinical reassessment, and chest radiography when relevant, experienced trauma surgeons can manage most penetrating pleural injuries with an acceptably low complication rate.

Adolescent↗