جستجوی مقالات مرتبط با کلیدواژه « Physical examination » در نشریات گروه « پزشکی »

The heel-rise test is a measurement method that can evaluate the muscle endurance and muscle fatigue of the plantar flexor. On the other hand, there is a limit to quantifying the criteria because the evaluation method and criteria differ according to the measurement conditions.

The purpose of this study is to compare the validity and reliability of the smartphone-based measurement application compared to the standardized surface electromyography (sEMG) for measuring muscle fatigue during the heel-rise test.

Fifty-seven adults in their 20s participated in the heel-rise test twice a week apart. The concurrent validity for muscle fatigue during the heel-rise test was measured using surface sEMG and 'Calf raise' application, and analyzed through correlation analysis. The intra-rater reliability and inter-rater reliability of the ‘Calf raise’ application were analyzed using ICC.

The Pearson correlation coefficient between the 'Calf raise' application and sEMG showed a statistically significant correlation of r=0.509 for both loss (%) and slope value (p<0.01). The ‘Calf raise’ application showed high intra-rater reliability for loss (%) and slope value with ICC (2,1) = 0.986 and 0.987 respectively. It also showed high inter-rater reliability for loss (%) and slope value with ICC (2,1) =0.946 and 0.926.

The smartphone-based 'Calf rise' application can be usefully used in clinical practice as an evaluation tool capable of not only quantitative evaluation of counting the number of heel-rise tests but also qualitative evaluation of muscle fatigue.

Bedside teaching is a concentrated form of small-group teaching that takes place in the presence of the patient. Improvement in communication skills in a sympathetic manner with the patient and the ability to provide a purposeful history description and earning skills in clinical examinations is a goal that can only be achieved at the patient’s bedside. Bedside teaching has declined in recent years despite all its benefits; however, there are strong recommendations to continue this teaching modality for its valued benefits. In this context, we aimed to deal with the importance of bedside teaching and the challenges ahead in the covid epidemic as well as its alternatives for teaching medical students. 

Evidence acquisition: 

This study was conducted through a literature search on articles in English with the relevant keywords (((((((“students, medical”[Mesh]) AND (“COVID-19”[Mesh])) AND (“education”[Mesh])) AND (“patient-centered care”[Mesh])) AND (“patient care team”[Mesh])) OR (“teaching rounds”[Mesh])) OR (“education, distance”[Mesh])) AND (“Physical examination”[Mesh]) using PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases from 2001 to 2022.

In our search, 22 related articles were found, 3 of which were clinical trials) and 4 were review articles. This study summarized the following important issues related to bedside teaching: 1- We discussed the definition, importance, benefits, and difficulties of bedside teaching on the way to education; 2- We deliberated the causes of reluctance to carry out education at the bedside and the ways to deal with the reduction of its implementation; 3-we also noticed alternative methods for medical education in periods of special contact restrictions with patients such as the COVID-19 epidemic in this review.

Bedside teaching has a fundamental role in medical education. In particular circumstances, such as covid 19 epidemy, in which the bedside teaching courses were suspended, it is necessary to allocate other educational arrangements and design a distance learning curriculum, including virtual teaching, uploading videos to view clinical procedures on social media platforms, interview with a virtual patient, and simulation.

Cervical cancer is prevalent cancer among women that correct diagnosis has very important role in its treatment.

The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in comparison with surgical staging. Also, we compared the accuracy of physical examination with surgical pathology.

This retrospective cross-sectional study was performed on women who had cervical cancer from the start of 2017 to the end of 2021. Age, tumor pathology report (squamous cell carcinoma, clear cell carcinoma, adenocarcinoma, and small cell carcinoma), stage of the tumor, involvement of vagina, uterine, and parametrium, cervical stroma invasion, mass size, pelvic and abductor lymph node metastasis were extracted from the patient’s data and all were evaluated. The pathology report was considered as the gold standard.

Eighty women with cervical cancer were evaluated and the mean age was 47.3 years. There was a statistically significant difference between the different prevalence of disease stages (P-value = 0.035) and also stage diagnosis between the three methods (P-value = 0.0004). The diagnostic accuracy of physical examination and MRI in terms of vaginal involvement, parametrium involvement, and uterine involvement were 97.5% and 98.7%; 98.7% and 96.2%; 94.9% and 93.6%; respectively.

Magnetic resonance imaging is a good method for the assessment of the clinical staging of cervical cancer and its accuracy is more than 94% in the diagnosis of different parts of cervical cancer involvement.

The evidence has shown that specific exercises effectively treat acute low back pain. This study aimed to investigate the effects of lumbar spinal loading in both directions in the sagittal plane in patients with acute lumbosacral radiculopathy.

A total of 20 patients with unilateral acute lumbosacral radiculopathy voluntarily participated in the study. The patients randomly performed flexion or extension back exercise ten times in three sets with 1-min rest between each set. Pain intensity, range of forward bending and straight leg raising (SLR), time of sit to stand, and soleus H-reflex were measured before and after the exercise.

This study showed that flexion compared to extension loading exercises significantly improved pain intensity, SLR degree of freedom, forward bending range of motion, time of sit to stand, and H-reflex latency (P˂0.05). There was no significant improvement in the H-reflex amplitude of the patients doing either of the exercises (P=0.07).

Flexion loading exercises are recommended for reducing pain intensity and improving spinal mobility and neurophysiological function of the nerve root functional status in patients with acute lumbosacral radiculopathy. It seems that flexion exercises with the flatting of lumbar lordosis and opening intervertebral space reduce disk pressure and neural tissue tension.

Cognitive impairment is an unpleasant and progressive mental disorder characterized by learning and memory disabilities. Stress and alcohol are two known environmental factors that increase cognitive impairment. This study was designed to evaluate the relative role of cyclooxygenase 2 in alcohol or stress‑induced cognitive impairment.

Male Wistar rats were randomly divided into groups with six rats in each. The groups included sham, control, alcohol (15% ethanol in drinking water), and restraint stress (restraint 6 h per day). Three separated groups received celecoxib at a dose of 20 mg/kg in addition to those listed above. The treatments continued daily for 28 days. The object recognition task (ORT) and Morris water maze (MWM) are used to evaluate the learning and memory.

Alcohol or restrain stress significantly increased the time and distance needed to find the hidden platform in MWM. Furthermore, they decreased the recognition index in ORT compared to the control group. Administration of celecoxib significantly decreased the required time and traveled distance to reach the platform in alcohol‑treated animals but not in the stress‑exposed rats. Celecoxib also significantly increased the recognition index both in alcohol‑ or restraint stress‑exposed animals.

We found that either alcohol or restraint stress impairs memory in rats. In MWM, celecoxib improved the alcohol‑induced memory impairment but could not show a reduction in memory deterioration due to restraint stress. In ORT, celecoxib reversed memory impairment due to both alcohol and restraint stress.

The pre-participation physical evaluation (PPE), which includes a musculoskeletal system evaluation, identifies factors that may be a risk for athletes while practicing sport. Thus, the Sport Readiness Questionnaire Focused on Musculoskeletal Injuries (MIR-Q) was developed to screen athletes at risk of future injuries or worsening pre-existing injuries during training or competition. However, the criterion-related validity and reliability of the MIR-Q have not yet been analyzed.

To test the criterion-related validity and reliability (internal consistency and test-retest) of the MIR-Q.

One hundred and twenty adult athletes from different sports (17 women) completed the MIR-Q and underwent a physical orthopedic examination (POE) performed by an orthopedic physician. At least one affirmative answer on the MIR-Q, as well as one positive finding on the POE, was considered “a risk factor for sport injury”. The validity was assessed from sensitivity, specificity, and accuracy measurements. Internal consistency was obtained through the KR-20 test. Reliability was measured using the test-retest method in a 7-14 day interval with a sub-sample (n = 41) and verified by the Kappa index.

Eighty-one (67.5%) questionnaires contained positive responses. The sensitivity of the MIR-Q against POE was high (84.4%), while specificity and accuracy were considered moderate, with values of 42.7% and 58.0%, respectively. Internal consistency was moderate (KR-20 = 0.57), and test-retest was weak (K = 0.30; P = 0.02).

The MIR-Q was associated with high values of validity and low values of reliability. The questionnaire may be an alternative tool for musculoskeletal screening during PPE in limited medical settings (sports OR orthopedic physician) conditions. Future studies should investigate the predictive validity of the MIR-Q, and psychometric properties of the questionnaire with younger athletes.

Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. 

We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. 

We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. 

Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. 

Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting.

Medical students and residents rely increasingly on web-based education. Online videos provide uniqueopportunities to share knowledge. The objective of this study was to investigate the accuracy and quality of instructionalvideos on the physical examination of the elbow and identify factors influencing educational usefulness. On October 7, 2018, a search on YouTube, VuMedi, Orthobullets, and G9MD was performed. Videos wererated for accuracy and quality by two independent authors using a modified version of a validated scoring system forthe nervous and cardiopulmonary system. Inter-rater reliability was analysed. The 126 included videos were uploaded between June 2007 and February 2018. Twenty-three videos wereindicated as useful for educational purposes. Accuracy, quality and overall scores were significantly higher for videosfrom specialized platforms (VuMedi, Orthobullets, G6MD) compared to YouTube. Video accuracy and quality variedwidely and were not correlated. Number of days online, views, and likes showed no or weak correlation with accuracyand quality. For the overall score, our assessment tool showed excellent inter-rater reliability. There is considerable variation in accuracy and quality of currently available online videos on the physicalexamination of the elbow. We identified 23 educationally useful videos and provided an assessment method for thequality of educational videos. In educational settings, this method may help students to assess video reliability and aideducators in the development of high-quality instructional online content.Level of evidence: III

To evaluate the diagnostic accuracy of history taking and physical examination in the patients with traumatic rib fractures. In a cross-sectional study, all patients with multiple traumas who referred to the emergency department were evaluated for the mechanism of injury, chief complaints, vital signs and oxygen saturation. History taking and physical examination were performed according to Barbara Bates reference. Fracture was diagnosed based on chest x-ray results and CT scan, if needed. The results were analyzed by receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis. Isolated rib fractures of thoracic bones were found in 8 out of 99 subjects with mean age of 33.4±19.43 years. In the sensitivity analysis of history taking and physical exam tests, the highest sensitivity was chest tenderness and deformity with 100% sensitivity for each one and the lowest was for the dyspnea with 28.10%; however, the highest sensitivity was for dyspnea with 62.50% sensitivity; and pulmonary hearing aid and chest deformity were not specific (0%). For heart rate, AUC analysis was significant. Heart rate above 80/min was associated with 87.5% sensitivity and 62.5% specificity for rib fractures. Proper and physical examination and history taking can help to detect rib fractures with high sensitivity and specificity denoting to the importance of the issue; while, radiographic or surgical approval is required to diagnose rib fractures.

Labial adhesion (LA) is a rare clinical entity in postmenopausal women. Estrogen deficiency and lack of sexual activity are probable contributing causes. Voiding dysfunction due to LA is even rarer in postmenopausal women, and only a few studies have previously reported such occurrence. A 62-year-old virgin postmenopausal woman presented to the Al-Zahra Hospital (Isfahan, Iran) with a 5-year history of voiding dysfunction and recurrent urinary tract infection. Despite multiple medical visits, no genital examination was ever performed by a medical practitioner, mainly due to the patient’s refusal to be examined by a male physician. On physical examination, we observed extensive LA with only a small opening. Surgical separation of the labia was performed and subsequently, the urinary tract symptoms were completely resolved. Herein, we present a case of LA causing urinary problems in a virgin postmenopausal woman. The case underlines the importance of the genital examination of female patients with urinary tract symptoms.

A post-natal baby check is a comprehensive, head-to-toe clinical examination performed routinely within 72 hours of birth in the hospital and by a general practitioner (GP) in the community 6-8 weeks following delivery. It serves as an opportunity for continuity of care and coincides with the time of the baby’s first set of vaccinations at eight weeks, which is often when babies are seen by a GP. The aim of this review is to describe the important elements of infant baby check and physical examination at 6-8 weeks in the context of evidence-based guidelines. Some abnormalities that are not visible at 72 hours after birth can become apparent at the 6-8-week post-natal baby check, and this is a valuable opportunity for further care through establishing an effective and efficient partnership with the baby and the mother. A satisfactory and skillful physical examination of an infant is reassuring and valued by the parents.

Shoulder pain (SP) is one of the most common complaints encountered in patients attending rehabilitation settings. Rotator cuff (RC) tendinopathies and subacromial impingement syndrome (SIS) are the most common disorders involved in SP. Physical examination (PE) is essential to perform the correct diagnosis and treatment. In fact, in the rehabilitation settings, patients are treated based on clinical symptoms and PE as well as clinical evolution. There are 184 maneuvers to evaluate the shoulder complex. PE is extremely important to evaluate the presence, location, and extent of RC tear or shoulder pathology. Unfortunately, PE is neither sensitive nor specific enough to diagnose a unique disorder. The current study aimed at reviewing the main features of clinical and physical evaluation and diagnostic accuracies of the most common PE tests performed in the rehabilitation settings

The diagnostic value of clinical signs in early diagnosis of meningitis has been evaluated but the existing results are contradicting. The present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard. In this diagnostic accuracy study, patients with suspected meningitis who were referred to the emergency department were examined regarding presence or absence of the mentioned clinical signs and screening performance characteristics of the signs were calculated. Cerebrospinal fluid analysis was used as the reference test. 120 cases with mean age of 48.79 ± 21.68 years (18 – 93) were studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases. Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH (p < 0.001) had significantly higher frequency among patients with meningitis. The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI: 0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839), respectively. It seems that diagnostic value of JAH is higher than other clinical signs but the accuracy of all signs is in poor to fair range. JAH had the highest sensitivity and Kernig and Brudzinski had the highest specificity.

Otitis media (OM) is a major health problem that usually results from adenoid hypertrophy. The diagnosis is given based on symptoms and imaging studies, such as mouth breathing and lateral neck radiography (LNR), respectively. However, there are huge controversies regarding the LNR role in the management of patients with OM. This study aimed to evaluate adenoid nasopharyngeal ratio (AN ratio) in children suffering from OM with effusion (OME) and related factors. This cross-sectional study was conducted on 27OME-suspected children referring to the Ear, Nose and Throat clinics (ENT) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, in 2016. All the children underwent standard LNRs and indirect laryngoscopy in order to have adenoidal and nasopharyngeal length assessment before surgery. After adenoidectomy, pathologic data were analyzed in SPSS software (version 21) using Pearson correlation, independent sample t-test, and Mann-Whitney U test. The p-value less than 0.05 was considered statistically significant. According to the results, 70.4% of the participants were male. The mean age of the participants was 7.81±2.52 years. All the patients in the study were symptomatic, and the most frequent symptom was mouth breathing (100%). The mean values of AN ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm, respectively. The AN ratio was significantly correlated with laryngoscopic and pathologic adenoid sizes (r=+0.46, P=0.01, and r=+0.44, P=0.02, respectively). The findings indicated a significant correlation between AN ratio and adenoid real measurement. Therefore, researchers are recommended to use this procedure in the assessment of patients with OME due to its availability, inexpensiveness, and negligible sid effects.

Ultrasound has emerged as a valuable complimentary tool for assessment of pelvic organ prolapse (POP). The present study aimed to evaluate the correlation between ultrasound measures and clinical staging in patients with suspected POP. Patients and Methods: Forty women with clinical suspicion of POP were enrolled in this cross-sectional study between November 2011 and April 2012. Pelvic organ prolapse quantification (POP-Q) system was used for clinical staging. Perineal ultrasound was performed both at rest and during Valsalva maneuver after proper preparation. On mid sagittal view, two reference lines were drawn; midpelvic line (MPL) was defined as the inferior horizontal tangent of symphysis pubis and H line was drawn from the most inferior part of symphysis pubis to the anorectal junction. Spearman’s correlation coefficient and Kappa coefficient of agreements were used for statistical analysis. Forty women with the mean age of 49.9 ± 10.07 years were enrolled. Excellent correlation was seen between MPL and H line (rho = 0.91, 0.93 and 0.88 in anterior, apical and posterior compartments, respectively). POP-Q had good-to-excellent correlation with ultrasound (rho = 0.84, 0.78 and 0.63 for H line and rho = 0.89, 0.82, 0.71 for MPL in anterior, apical and posterior compartments respectively). In anterior and apical compartments, high agreement was seen between clinical and ultrasound staging methods when grouping patients to no prolapse/mild vs. moderate/severe. In the posterior compartment, this agreement was significant when grouping was done based on the presence or absence of POP. Ultrasound has high correlation with POP-Q staging in all compartments for staging of pelvic organ prolapse. Ultrasound might be useful in the diagnosis of pop in those with negative clinical examination.