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PeerJ 2024During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung...
OBJECTIVE
During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung auscultation, were done while patients were wearing surgical face masks. The aim of this study was to investigate whether mask wearing has an impact on pulmonologist assessment during auscultation of the lungs.
METHODS
This was a repeated measures crossover design study. Three pulmonologists were instructed to auscultate patients with previously verified prolonged expiration, wheezing, or crackles while patients were wearing or not wearing masks (physician and patients were separated by an opaque barrier). As a measure of pulmonologists' agreement in the assessment of lung sounds, we used Fleiss kappa (K).
RESULTS
There was no significant difference in agreement on physician assessment of lung sounds in all three categories (normal lung sound, duration of expiration, and adventitious lung sound) whether the patient was wearing a mask or not, but there were significant differences among pulmonologists when it came to agreement of lung sound assessment.
CONCLUSION
Clinicians and health professionals are safer from respiratory infections when they are wearing masks, and patients should be encouraged to wear masks because our research proved no significant difference in agreement on pulmonologists' assessment of auscultated lung sounds whether or not patients wore masks.
Topics: Humans; Masks; COVID-19; Cross-Over Studies; Auscultation; Male; Respiratory Sounds; Female; SARS-CoV-2; Middle Aged; Adult; Pandemics; Pulmonologists; Aged
PubMed: 38803582
DOI: 10.7717/peerj.17368 -
Nagoya Journal of Medical Science Aug 2022We developed a new interactive web-based teaching material to improve lung auscultation skills. Our objective was to investigate the effectiveness of the web-based... (Randomized Controlled Trial)
Randomized Controlled Trial
We developed a new interactive web-based teaching material to improve lung auscultation skills. Our objective was to investigate the effectiveness of the web-based teaching material on nurses with less than one-year work experience, using a prospective, open-label, stratified block randomized controlled trial. Of the 69 participants, 23, 22, and 24 participants were assigned to the web-based, paper-based, and control (with no intervention) groups, respectively. Using a simulator, a discrimination test on seven lung sounds, such as "normal," "wheeze," "rhonchi," "coarse crackles," "fine crackles," "left lung diminish," and "right lung absent," was conducted. Next, a post-test was conducted after one-week of training. Answers with formal names were considered "correct"; those with common names, misspellings, and without left and right parts were considered "insufficient"; and wrong answers were considered "incorrect." The control group showed no significant difference between the pre-test and post-test for any lung sounds. The paper-based group showed significant improvement in performance for "wheeze" (=0.004) and "coarse crackles" (=0.035). The web-based group showed a significant improvement in performance for "fine crackles" (=0.026). The number of correct answers in the post-test was higher in the paper- and web-based groups than the control group (=0.023). The web-based teaching materials that we had developed effectively improved the ability of new graduate nurses to auscultate lung sounds. Additionally, the results suggest that the combined use of web- and paper-based teaching materials may be more effective since the sounds that each method enhanced their ability to auscultate different lung sounds.
Topics: Auscultation; Humans; Lung; Prospective Studies; Respiratory Sounds; Teaching Materials
PubMed: 36237892
DOI: 10.18999/nagjms.84.3.526 -
Annual International Conference of the... Jul 2017There are several electronic stethoscopes available on the market today, with a very high potential for healthcare namely telemedicine, assisted decision and education.... (Comparative Study)
Comparative Study
There are several electronic stethoscopes available on the market today, with a very high potential for healthcare namely telemedicine, assisted decision and education. However, there are no recent comparatives studies published about the recording quality of auscultation sounds. In this study we aim to: a) define a ranking, according to experts opinion of 6 of the most relevant electronic stethoscopes on the market today; b) verify if there are any relations between a stethoscope's performance and the type of pathology present; c) analyze if some pathologies are more easily identified than others when using electronic auscultation. Our methodology consisted in creating two study groups: the first group included 18 cardiologists and cardiology house officers, acting as the gold standard of this work. The second included 30 medical students. Using a database of heart sounds recorded in real hospital environments, we applied questionnaires to observers from each group. The first group listened to 60 cardiac auscultations recorded by the 6 stethoscopes, and each one was asked to identify the pathological sound present: aortic stenosis, mitral regurgitation or normal. The second group was asked to choose, between two auscultation recordings, using as criteria the best sound quality for the identification of pathological sounds. Results include a total of 1080 evaluations, in which 72% of cases were correctly diagnosed. A detailed breakdown of these results is presented in this paper. As conclusions, results showed that the impact of the differences between stethoscopes is very small, given that we did not find statistically significant differences between all pairs of stethoscopes. Normal sounds showed to be easier to identify than pathological sounds, but we did not find differences between stethoscopes in this identification.
Topics: Heart Auscultation; Heart Sounds; Stethoscopes
PubMed: 29060434
DOI: 10.1109/EMBC.2017.8037392 -
Clinical Pediatrics Sep 1982Auscultation of neonates by means of conventional techniques is subject to many errors. Consequently, pediatricians rely on radiographs for much of their information...
Auscultation of neonates by means of conventional techniques is subject to many errors. Consequently, pediatricians rely on radiographs for much of their information regarding ventilation abnormalities. We report a method of simultaneous differential auscultation, using a double-headed stethoscope, which allows better auscultatory evaluation of neonates. The technique is simple and easily learned. The equipment used is inexpensive and easily constructed. The technique is most useful in emergency and transport situations when radiographs are not readily available.
Topics: Auscultation; Diagnosis, Differential; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases
PubMed: 7105616
DOI: 10.1177/000992288202100909 -
Annual International Conference of the... Aug 2016Auscultation is a routine exam and the first line of screening in heart pathologies. The objective of this study was to assess if using a new data collection system, the... (Comparative Study)
Comparative Study
Auscultation is a routine exam and the first line of screening in heart pathologies. The objective of this study was to assess if using a new data collection system, the DigiScope Collector, with a guided and automatic annotation of heart auscultation, different levels of expertise/experience users could collect similar digital auscultations. Data were collected within the Heart Caravan Initiative (Paraíba, Brasil). Patients were divided into two study groups: Group 1 evaluated by a third year medical student (User 1), and an experienced nurse (User 2); Group 2 evaluated by User 2 and an Information Technology professional (User 3). Patients were auscultated sequentially by the two users, according to the randomization. Features extracted from each data set included the length (HR) of the audio files, the number of repetitions per auscultation area, heart rate, first (S1) and second (S2) heart sound amplitudes, S2/S1, and aortic (A2) and pulmonary (P2) components of the second heart sound and relative amplitudes (P2/A2). Features extracted were compared between users using paired-sample test Wilcoxon test, and Spearman correlations (P<;0.05 considered significant). Twenty-seven patients were included in the study (13 Group 1, and 14 Group 2). No statistical significant differences were found between groups, except in the time of auscultation (User 2 consistently presented longer auscultation time). Correlation analysis showed significant correlations between extracted features from both groups: S2/S1 in Group 1, and S1, S2, A2, P2, P2/A2 amplitudes, and HR in Group 2. Using the DigiScope Collector, we were able to collect similar digital auscultations, according to the features evaluated. This may indicate that in sites with limited access to specialized clinical care, auscultation files may be acquired and used in telemedicine for an expert evaluation.
Topics: Brazil; Heart Auscultation; Heart Rate; Heart Sounds; Humans; Phonocardiography; Telemedicine
PubMed: 28325025
DOI: 10.1109/EMBC.2016.7591945 -
International Orthopaedics Jul 2022The problems posed by trauma, fractures, and dislocations have not changed in human history. The traumas of prehistoric persons were similar to those observed by...
History of bone acoustic in fracture diagnosis: crepitus in antiquity; bone percussion with Auenbrugger; bone auscultation with Laennec and Lisfranc; monitoring cementless hip arthroplasty fixation with acoustic and sensor.
PURPOSE
The problems posed by trauma, fractures, and dislocations have not changed in human history. The traumas of prehistoric persons were similar to those observed by Imhotep, Hippocrates, and Galen or, more recently, by Ambroise Paré, Watson Jones, and Böhler. And the current road traumas are probably no more severe than those caused by mammoths, the construction of the pyramids, or middle age wars. Diagnostic methods have evolved, and the advent of radiography has revolutionized the diagnosis of traumatology. Before discovering radiography, another physical phenomenon made it possible to help in the diagnosis of fractures. This physical phenomenon is acoustic.
METHODS
Curiously, no history of acoustics in fracture diagnosis has been published so far. This article proposes briefly reviewing the history and evolution of acoustics in orthopaedic surgery from antiquity to the present day.
RESULTS
Before the invention of radiography by Conrad Roentgen in 1895, the surgeons described crepitus as the most critical sign of fractures in antiquity. Surgeons remarked during the eighteenth and nineteenth century that bone was a good sound-conductor. Physicians improved first the diagnosis of fractures by using percussion established by Auenbrugger in 1755. The principle of chest mediate auscultation with a stethoscope was described by Laennec in 1818. Lisfranc used the stethoscope to amplify the crepitus sound of fractures. Surgeons also developed association of percussion and auscultation with a stethoscope to diagnose and reduce fracture. Recently, acoustic emission technology has seen a recent increase in applications to prevent femur fractures during cementless fixation.
CONCLUSION
The acoustic properties of bones were known to a prehistoric person who knew how to make flutes from animal or human bones. Surgeons used them for the diagnosis of fractures before radiography. Acoustic properties of bones currently remain a subject of research for the prevention of fractures.
Topics: Acoustics; Arthroplasty, Replacement, Hip; Auscultation; Fractures, Bone; Humans; Percussion
PubMed: 35451635
DOI: 10.1007/s00264-022-05397-y -
Chest Oct 2003To survey the teaching time and importance given to cardiopulmonary auscultation during internal medicine (IM) and family practice (FP) residencies, and to compare... (Comparative Study)
Comparative Study
OBJECTIVE
To survey the teaching time and importance given to cardiopulmonary auscultation during internal medicine (IM) and family practice (FP) residencies, and to compare current practices to those of the early 1990s.
DESIGN
A nationwide mail survey of IM and FP program directors (PDs).
SETTING
All Accreditation Council for Graduate Medical Education-accredited IM and FP residencies.
PARTICIPANTS
A total of 538 of 939 PDs (57.5%).
MEASUREMENTS AND MAIN RESULTS
In contrast to the early 1990s, when there had been no significant difference in teaching practices between IM and FP programs, more IM than FP residencies taught cardiopulmonary auscultation in 1999 (cardiac auscultation: IM residencies, 48%; FP residencies, 29.2% [p < 0.001]; pulmonary auscultation: IM residencies, 23.7%; FP residencies, 12.2% [p < 0.001]). Across the decade there also had been a significant increase in the percentage of IM programs offering structured education in chest auscultation (cardiac auscultation increase, 27.1 to 48% [p < 0.001]; pulmonary auscultation increase, 14.1 to 23.7% [p < 0.02]), but no significant changes for FP residencies. IM PDs gave more clinical importance to auscultation and expressed a greater desire for expanded teaching than did their counterparts in FP programs.
CONCLUSIONS
This study indicates a significant gain over the last decade in the percentage of IM residencies offering structured teaching of cardiopulmonary auscultation. This same gain did not occur for FP programs. Whether these differences in attitudes and teaching practices will translate into improved auscultatory proficiency of IM trainees will need to be determined.
Topics: Auscultation; Heart Auscultation; Humans; Internship and Residency; Lung; Primary Health Care; Surveys and Questionnaires; United States
PubMed: 14555576
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... Feb 2018Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the... (Review)
Review
INTRODUCTION
Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers.
OBJECTIVE
To describe a new way to diagnose subcutaneous emphysema.
METHOD
Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound.
RESULTS
This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency.
CONCLUSION
Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.
Topics: Auscultation; Diagnosis, Differential; Humans; Noise; Subcutaneous Emphysema
PubMed: 29641666
DOI: 10.1590/1806-9282.64.02.159 -
British Medical Journal Nov 1967
Clinical Trial
Topics: Audiometry; Auditory Threshold; Auscultation; Humans
PubMed: 6054915
DOI: 10.1136/bmj.4.5576.388 -
Clinical Cardiology Nov 1995
Topics: Auscultation; Cardiology; History, 19th Century; Humans; Massachusetts
PubMed: 8590541
DOI: 10.1002/clc.4960181118