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Results for “PHYSICAL EXAMINATION”

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At least 127 records · Page 7Linked to original sources

PubMed2003

Preoperative estimation of the pathological breast tumour size by physical examination, mammography and ultrasound: a prospective study on 105 invasive tumours.

OBJECTIVE: The clinical breast tumour size can be assessed preoperatively by physical examination, mammography and ultrasound. At present it is not clear which modality correlates best with the histological invasive breast tumour size. This prospective study aims to determine the most accurate clinical method (physical examination, mammography or ultrasound) to predict the histological invasive tumour size preoperatively. METHODS AND PATIENTS: Between October 1999 and August 2000, 96 women with 105 invasive malignant breast tumours were included in this study. All patients underwent excision and the tumour size was measured on histology. Tumour size was measured by all three modalities in 73 cases. Results were evaluated by calculating correlation coefficients. The examination modalities presenting the best estimation of the pathological tumour size were used in a stepwise linear regression analysis to construct a formula predicting the pathological tumour size from the result of the various diagnostic modalities. RESULTS: The correlation coefficient between ultrasound and pathological size (r=0.68) was significantly better than the correlations between physical examination and pathological size (r=0.42) and mammographic and pathological size (r=0.44). Physical examination overestimates and ultrasound underestimates breast tumour classification. The most accurate prediction formula was: Pathological tumour size (mm) equals sonographic tumour size (mm)+3 mm. CONCLUSION: When comparing physical examination, mammography and ultrasound for the prediction of the pathological size of a malignant breast tumour, ultrasound is the best predictor. The ensuing regression formula determines pathological size as tumour size by ultrasound+3 mm. However, with the wide 95% confidence interval of +/-11 mm, it remains difficult to predict the exact pathological size for an individual invasive breast tumour. A small deviation in millimetres of the tumour size could lead to a change in treatment and to another prognostic estimate.

Adult↗

PubMed2006

Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions.

Physical examination tests that place tension on the long head of the biceps may best reproduce symptoms in patients with type II superior labrum anterior-posterior (SLAP) lesions. The objective of this study is to compare the normalized electromyographic signal of the long head of the biceps for SLAP lesion physical examination tests. The active compression test, anterior-superior SLAP test, biceps load test II, biceps tension test, and pain provocation test were performed on 13 subjects while biceps electromyographic data were recorded. The active compression test and biceps tension test had significantly higher electromyographic signals than the other tests. We found no significant differences when comparing forearm supination and pronation within individual tests. Because the active compression and biceps tension tests maximize muscle activation on the long head of the biceps, they may be the best physical examination tests by which to identify type II SLAP lesions.

Adult↗

PubMedDate not supplied

Screening for dialysis access graft malfunction: comparison of physical examination with US.

PURPOSE: To test the reliability and performance of two physical diagnosis algorithms for use in physical examination of vascular access grafts. MATERIALS AND METHODS: Grafts were assessed in 39 patients by means of physical examination performed by four observers. Grafts were characterized as having a thrill, pulse, or indeterminate examination at three locations (arterial, midpoint, venous). Findings with this algorithm were compared with those from ultrasound (US) with volume flow measurements. RESULTS: Patients with a thrill at all three locations of the graft all had volume flows greater than 450 mL/min (negative predictive value = 100%). Of patients with a pulse at any of three locations, only 28% (positive predictive value) had a volume flow of 450 mL/min or less. CONCLUSION: Physical examination is a good screening test for ruling out the low flows associated with impending access graft failure, thereby eliminating the need for routine US for many patients.

Adult↗

PubMed1997

The physical examination in cancer pain assessment.

OBJECTIVES: To examine pain-related constructs, illness related constructs, and the particular importance of the physical examination as integrative steps in a comprehensive pain assessment. DATA SOURCES: Review articles and book chapters related to the physical examination and evaluation of cancer pain. CONCLUSIONS: The physical examination is a fundamental aspect of cancer pain assessment. It provides unique information that can be combined with the history, data from the medical record, and the results of additional studies to yield a comprehensive understanding of the patient. IMPLICATIONS FOR NURSING PRACTICE: The nurse's understanding of pain-related constructs, illness-related constructs, and the importance of the physical examination will help provide strategies for pain management that are most likely to offer both pain relief and improved quality of life.

Humans↗

PubMed2000

[The clinical history and physical examination in patients with chronic lumbar pain. Patient classification by a decision tree].

AIM: To analyze the correlation between clinical symptoms and physical examination signs in diagnostic groups of low back pain patients; making a spanning tree. MATERIAL AND METHOD: A prospective longitudinal study of 485 low back pain patients was carried. We assess the type of pain and its irradiation, evolution in time, duration of the episodes, timetable, intensity and morning stiffness. A complete physical examination with specific tests for sacroiliac joints and neurologic examination was carried. We carried out a study of absolute and relative frequencies; calculating the rates with the chi 2 Pearson test and having a confidence of 95%. RESULTS: We found a significant relation (p < 0.0001) between the type of pain and the diagnosis groups. Proximal irradiation with functional disorders (p < 0.01) and metabolic bone diseases (p < 0.0001); the radicular irradiation and the disorders by physical agents (p < 0.001). The flare-up back pain with disorders by physical agents and metabolic bone diseases (p < 0.001). The morning stiffness was exclusive in the inflammatory diseases. In the physical examination, was found a significant relation (p < 0.0001) between the different tests with the diagnostic groups. CONCLUSION: The history and the physical examination provide us symptoms and signs which let us direct towards the above diagnostic. The type of pain with its characteristics and the referred pain as a main symptoms, give us some information, which complemented with the physical examination tests, providing the base on which we support our diagnostic hypothesis, allow us the first classification of the patients; at the same time we understand as a low back pain patients suffer its problem.

Chi-Square Distribution↗

PubMed2006

[Descriptive study about physical examination patterns of a Spanish physician's sample].

BACKGROUND AND OBJECTIVES: We describe the basic scheme of physical examination (PE) and the patterns of PE by specialties. We compare items explored by internists and family physicians. PATIENTS AND METHOD: A cross-sectional study on the routine physical examination made by a Spanish physician's sample. Seventy-six maneuvres were analysed by a table of frequencies obtaining physical examination patterns by specialties. RESULTS: A total of 131 physicians of 140 answered the questionnaire (93.5%). They corresponded to Internal Medicine (48.1%), Family and General Medicine (32.1%), other specialties (19.8%). Average age of responders was 37.8 years (Confidence Interval [CI] 95%: 36.3-39.4) and years of experience average were 11.9 (CI 95%: 10.4-13.5). The pattern of general examination used by more than 70% of the physicians surveyed includes maneuvres related to the general examination, respiratory, cardio-circulatory, gastro-intestinal and neurological systems examination. Internists explore weight, temperature, cardiac rate, arterial pressure, neck, jugular ingurgitation, respiratory, abdominal and lymphatic system more often than family physicians (p<0.05). Family physicians perform otoscopy and nose, conches and nasal septum inspection more often than internists (p<0.05). CONCLUSIONS: PE is a flexible tool physicians adapt to their needs based on the specialty they have. Internists are the specialists who make a more exhaustive physical examination compared with family physicians and other specialists.

Adult↗

PubMed1988

Effectiveness of varicocelectomy in varicoceles diagnosed by physical examination versus Doppler studies.

The purpose of this study is to compare the effectiveness of varicocelectomy for improving the spermogram in treating varicoceles diagnosed by physical examination and those diagnosed by Doppler but with a negative physical examination. The charts of 112 patients were retrospectively analyzed and the patients divided in two groups: group A, where the varicocele was detected by physical examination, and group B, where physical examination was negative but Doppler studies revealed the presence of stasis or backflow in the pampiniform plexus of the spermatic veins. In subjects complaining of infertility, the two groups were similar with regard to age distribution and duration of infertility. After varicocelectomy, 85% of patients in group A had improved spermogram, compared with only 27% in group B. This difference was statistically significant (P less than 0.0001).

Adult↗

PubMed1982

The accuracy of the physical examination in the diagnosis of suspected ascites.

Twenty-one patients referred for evaluation with a diagnosis of questionable ascites were examined independently by three investigators who performed five different physical examination maneuvers. With ultrasonography as the reference standard, six patients had ascites. The sensitivity and specificity of the physical examination maneuvers ranged from 50% to 94% and 29% to 82%, respectively. The overall accuracy of the maneuvers was only 58%. The results of this study indicate that routine physical examination has definite limitations in the precise diagnosis of equivocal ascites. The only conclusion that can be made by a physical maneuver with over 90% accuracy is that ascites is absent if no flank dullness is elicited. Ultrasonography is recommended in questionable cases.

Adult↗

PubMed1982

Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage.

The accuracy of initial physical examination and peritoneal lavage in detecting intra-abdominal injury was assessed in 221 consecutive blunt trauma victims. Of the patients, 121 had negative peritoneal lavages, with one false result, and 100 had positive peritoneal lavages, including six false results and two injuries not requiring surgical correction. Hemoperitoneum occurred in 32 of 71 patients with a depressed sensorium and in 29 of 54 patients with thoracic injury. Twenty-eight of 120 patients with absent bowel tones and 20 of 100 patients with abdominal guarding or rigidity had negative peritoneal lavages. Among the 150 conscious, responsive patients there was a high incidence of false-positive and false-negative abdominal findings on physical examination. Hemoperitoneum was detected in four clinically negative patients. Significant error accompanies the initial abdominal examination and clinical assessment in the blunt trauma victim. In contract, open diagnostic peritoneal lavage is a sensitive and highly accurate test for blunt intraperitoneal injury. We believe peritoneal lavage is the single best test for intra-abdominal injury and should be performed in th majority of patients with such injuries.

Abdominal Injuries↗

PubMed1987

Observation, history, and physical examination in diagnosis of serious illnesses in febrile children less than or equal to 24 months.

To determine if observational assessment performed in a systematic manner adds to the efficacy of the traditional history and physical examination in detecting serious illnesses in febrile children, and to determine the sensitivity of the combined evaluation, we studied consecutive patients less than or equal to 24 months of age seen for evaluation of fever at the Primary Care Center-Emergency Room (PCC-ER) of the Yale-New Haven Hospital (n = 143) and a suburban private practice (n = 207). An attending pediatrician performed the observation using the previously reported Acute Illness Observation Scales (AIOS). Subsequently, the history and physical examination were done by an attending pediatrician, and findings were scored as to whether they suggested the presence of a serious illness. Thirty-six patients, 28 in the PCC-ER and eight in the private practice, had a serious illness. The combined AIOS, history, and physical examination had a higher sensitivity and r correlation for serious illness than did the traditional history and physical examination. Three children with serious illnesses, all of whom had no abnormalities on history and physical examination, were identified only by use of AIOS. We conclude that assessment of appearance in a child with fever, when performed in a careful, integrated, stepwise fashion, improves the sensitivity of the history and physical examination in detecting serious illnesses in febrile children.

Evaluation Studies as Topic↗

PubMed1992

Physical examination of the breast.

Despite the increasing emphasis in physicians' use of screening mammography, primary care physicians continue to appropriately perform physical examination of the breast. Several screening programs have reported that mammography will miss at least 10% of breast cancers, physical examination can independently detect breast cancer, the combination of mammography and physical examination is superior to either modality alone, and biopsy of a palpable dominant mass should not be deferred because the results of the mammogram are normal. Optimal breast cancer screening should include both mammography and physical examination of the breast.

Breast Neoplasms↗

PubMed1994

Performance of the vascular physical examination by residents and medical students.

PURPOSE: This study uses an objective structured clinical examination to evaluate the performance and interpretation of the vascular physical examination by interns and medical students. METHODS: A patient with lower extremity arterial occlusive disease findings was examined by 20 third-year students (M3), 23 physicians entering surgical internship (PGY1), and 7 individuals completing internship (PGY2). The test consisted of two sections: part A evaluated the individuals' ability to perform a pulse examination (data gathering); part B evaluated the interpretation of the physical examination findings (data interpretation). National Board of Medical Examiners Part II examination results were obtained for 84% of participants. RESULTS: All groups performed poorly, with overall correct percent scores being 43% (M3), 39% (PGY1), and 62% (PGY2). PGY2s performed significantly better than M3s or PGY1s (p = 0.0002). No statistical difference was noted between M3 and PGY1 scores. Overall, data gathering skills were significantly better than data interpretation skills (51% vs 37%, p = 0.0001). National Board of Medical Examiners Part II scores did not vary substantially among groups. CONCLUSIONS: Interns and medical students demonstrated considerable inaccuracy in both data gathering and data interpretation. A modest improvement was observed in individuals tested at the end of the internship year. This study suggests that increased attention should be directed toward instructing surgical residents and students how to perform an accurate peripheral vascular physical examination and how to interpret its significance.

Arterial Occlusive Diseases↗

PubMed2006

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics.

BACKGROUND: Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research. The aim of this project was to explore whether a previously developed generic (i.e. content independent) SDE application to support the structured documentation of narrative data (called OpenSDE) can be used to model data obtained at history taking and physical examination of a broad specialty. METHODS: OpenSDE was customized for the broad domain of general pediatrics: medical concepts and its descriptors from history taking and physical examination were modeled into a tree structure. RESULTS: An EMR system allowing structured recording (OpenSDE) of pediatric narrative data was developed. Patient history is described by 20 main concepts and physical examination by 11. In total, the thesaurus consists of about 1800 items, used in 8648 nodes in the tree with a maximum depth of 9 levels. Patient history contained 6312 nodes, and physical examination 2336. User-defined entry forms can be composed according to individual needs, without affecting the underlying data representation. The content of the tree can be adjusted easily and sharing records among different disciplines is possible. Data that are relevant in more than one context can be accessed from multiple branches of the tree without duplication or ambiguity of data entry via "shortcuts". CONCLUSION: An expandable EMR system with structured data entry (OpenSDE) for pediatrics was developed, allowing structured documentation of patient history and physical examination. For further evaluation in other environments, the tree structure for general pediatrics is available at the Erasmus MC Web site (in Dutch, translation into English in progress) 1. The generic OpenSDE application is available at the OpenSDE Web site 2.

Child↗

PubMed2000

[Diagnostic value of physical examination and electrocardiogram in the initial evaluation of heart murmurs in children].

OBJECTIVE: To investigate the diagnostic value of the physical examination and electrocardiogram in the evaluation of heart murmur in new patients referred to the pediatric cardiologist. METHOD: From 1 April to 30 September 1998, all consecutive patients referred to the pediatric cardiology clinic for evaluation of heart murmur were included. They were prospectively categorized with no heart disease, possible heart disease or definite heart disease based on history and physical examination. They then underwent electrocardiogram with which the diagnosis was reevaluated by the pediatric cardiologist. Lastly, a doppler-echocardiography was systematically performed. RESULTS: In 120 children aged four days to 14 years (median: ten months), 72 (60%) showed abnormalities on doppler-echocardiography and 48 (40%) no heart disease. After physical examination, 52 patients were categorized with no heart disease: 45 patients had a normal doppler-echocardiography; in three of them, the diagnosis was incorrectly modified to possible heart disease on the basis of the electrocardiogram. In the other seven children, the electrocardiogram was normal and the doppler-echocardiography revealed minor (n = 5) or moderate (n = 2) heart defects. Nineteen patients were suspected of having possible heart disease, no diagnosis was modified after analysis of the electrocardiogram and six had normal doppler-echocardiography; 49 patients were correctly diagnosed as having definite heart disease. The sensibility of the physical examination was 90.3%, the specificity was 93.8%, the positive predictive value 95.6% and the negative predictive value 86.5%. CONCLUSION: The electrocardiogram is of no help in the discrimination between heart disease and no heart disease in children referred to the pediatric cardiologist for a cardiac murmur. The physical examination is able to differentiate children with or without heart disease in most of the cases.

Adolescent↗

PubMed2002

Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up.

OBJECTIVES: To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up. DESIGN: Prospective cohort study. SETTING: County hospital, Sweden. PATIENTS: Prospective data were retrieved from the Swedish Hernia Register for patients aged 15-80 years at the time of groin hernia repair, operated on during 1994. INTERVENTIONS: Three years after operation patients were mailed a three-item questionnaire and invited to have a physical examination. Those examined answered a detailed questionnaire about pain and functional impairment. When appropriate an extended physical examination was undertaken to find out the probable cause of the pain. MAIN OUTCOME MEASURES: Recurrence, pain, and functional impairment. RESULTS: 272 hernias were repaired in 264 patients. 24 patients had died and 16 had a recurrence before the follow-up examination. After a median observation time of 44 months, 218 patients with 223 repairs (96%) were examined. Depending on the definition of recurrence and completeness of physical examination (selective or all patients) the recurrence rate varied between 10% (25/239) and 15% (35/239) including recurrences diagnosed before follow-up. 40 patients (18%) reported groin pain at follow-up, which was considered to be caused by a previous hernia repair in 34 (15%), 12 of whom (5%) had moderate or severe pain. Postoperative complications were associated with an increased risk of chronic pain, whereas type of hernia and use of mesh had no influence. CONCLUSIONS: The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.

Chronic Disease↗

PubMed1995

A Comparison of Mass Screening for Breast Cancer Using Mammography and Physical Examination Alone in Japan.

To compare the sensivity of breast cancer screening methods by conventional physical examination and film mammography, a trial of mass screening for breast cancer using mammography was principally carried out in asymptomatic women over 50 years of age in Tokushima Prefecture. In this trial craniocaudal and mediolateral oblique imagings of the breast using two-view film mammography and physical examination, using inspection and palpation of the breasts were performed independently. Breast cancer was detected in 8 of a total of 950 examinees by mammography alone, and no cases of breast cancer were detected by physical examination. The detection rate of breast cancer was 0.84%, that is 7 times higher than that(0.12%) obtained by conventional mass screening using physical examination alone. The detection rate of increased especially in the sixth and seventh decades of life. The stage of the detected breast cancer was stage 0 (Tis) in 5 cases and stage T, with a tumor size of 1.0 cm or less, in 3 cases. All 8 cases were in the early stage, and they underwent breast conservation therapy. Based on these results, it is recommended to employ mammography in breast cancer screening for asymptomatic women aged over 50 years. We consider mammography alone may be sufficient for mass screening for breast cancer in these subjects.

Journal Article↗

PubMed1999

Interexaminer reliability in physical examination of the cervical spine.

BACKGROUND: Most of the studies of physical examinations of the cervical spine have shown poor reliability. PURPOSE: To assess the interexaminer reliability in physical examinations of the cervical spine. SUBJECTS: Forty-eight subjects, age range 18 to 63 years. METHODS: Two physiotherapists independently evaluated a number of clinical tests of passive general and intersegmental movement. RESULTS: Acceptable kappa/kappa (w) values were obtained in several of the clinical tests of passive general motion range but in few of the clinical tests of passive intersegmental movement. More clinical tests had acceptable reliability and less bias in symptomatic subjects than asymptomatic subjects. CONCLUSION: Many of the clinical tests of passive general motion range were shown to be reliable. The increased number of acceptable kappa (w) values obtained in the symptomatic subjects indicates that further studies of the reliability of the clinical tests of passive intersegmental movement should be performed on patients.

Adolescent↗

PubMed2003

Role of history and physical examination in preoperative evaluation.

BACKGROUND AND OBJECTIVE: Since reports have shown that outpatient preoperative evaluation increases the quality of care and cost-effectiveness, an increasing number of patients are being evaluated purely on an outpatient basis. To improve cost-effectiveness, it would be appealing if those patients who are healthy and ready for surgery without additional testing could be easily distinguished from those who require more extensive evaluation. This paper examines whether published studies provide sufficient data to determine how detailed preoperative history taking and physical examination need to be in order to assess the health of surgical patients and to meet the objective of easy and early distinction. METHODS: A MEDLINE search was conducted from 1991 to 2000 with respect to preoperative patient history and physical examination. Altogether, 213 articles were found, of which 29 were selected. Additionally, 38 cross-references, 7 articles on additional testing and 4 recently published papers were used. RESULTS: It is questionable to what extent an extensive history is relevant for anaesthesia and long-term prognosis. With respect to physical examination, it seems unreasonable to diagnose valvular heart disease based on cardiac auscultation only, and it is unclear which method should be used to predict the difficulty of endotracheal intubation. The benefits of routine testing for all surgical patients before operation are extremely limited and are not advocated. CONCLUSIONS: The amount of detail of preoperative patient history and the value of physical examination to obtain a reasonable estimate of perioperative risk remains unclear. Although not evidence based, a thorough history taking and physical examination of all patients before surgery seems important until more evidence-based guidelines become available. Diagnostic and prognostic prediction studies may provide this necessary evidence.

Diagnostic Tests, Routine↗