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American Family Physician Nov 2003Respiratory difficulty is a common presenting complaint in the outpatient primary care setting. Because patients may first seek care by calling their physician's office,... (Review)
Review
Respiratory difficulty is a common presenting complaint in the outpatient primary care setting. Because patients may first seek care by calling their physician's office, telephone triage plays a role in the early management of dyspnea. Once the patient is in the office, the initial goal of assessment is to determine the severity of the dyspnea with respect to the need for oxygenation and intubation. Unstable patients typically present with abnormal vital signs, altered mental status, hypoxia, or unstable arrhythmia, and require supplemental oxygen, intravenous access and, possibly, intubation. Subsequent management depends on the differential diagnosis established by a proper history, physical examination, and ancillary studies. Dyspnea is most commonly caused by respiratory and cardiac disorders. Other causes may be upper airway obstruction, metabolic acidosis, a psychogenic disorder, or a neuromuscular condition. Differential diagnoses in children include bronchiolitis, croup, epiglottitis, and foreign body aspiration. Pertinent history findings include cough, sore throat, chest pain, edema, and orthopnea. The physical examination should focus on vital signs and the heart, lungs, neck, and lower extremities. Significant physical signs are fever, rales, wheezing, cyanosis, stridor, or absent breath sounds. Diagnostic work-up includes pulse oximetry, complete blood count, electrocardiography, and chest radiography. If the patient is admitted to the emergency department or hospital, blood gases, ventilation-perfusion scan, D-dimer tests, and spiral computed tomography can help clarify the diagnosis. In a stable patient, management depends on the underlying etiology of the dyspnea.
Topics: Acute Disease; Diagnosis, Differential; Dyspnea; Family Practice; Humans; Medical History Taking; Physical Examination; Triage
PubMed: 14620600
DOI: No ID Found -
Stroke Sep 1998There is a need for better understanding of the structure of instruments for functional outcome assessment after discharge from rehabilitation. One purpose of the study...
BACKGROUND AND PURPOSE
There is a need for better understanding of the structure of instruments for functional outcome assessment after discharge from rehabilitation. One purpose of the study was to contribute to the analysis of instrumental dimensionality. Another purpose was to compare disability in stroke patients within the younger age range 2 years after onset of stroke with that at discharge with respect to both dependence and patients' perceived difficulty and to extend the assessments with instrumental activities.
METHODS
We studied 68 stroke survivors aged 18 to 71 years at onset (59% aged <55 years) by means of interviews in their home, using activities from the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) for ratings of dependence and perceived difficulty. Rasch analysis was used to construct calibrated linear measures and to evaluate the level of fit.
RESULTS
Acceptable models for comparison of dependence between discharge and follow-up were found for the physical and the social-cognitive items in FIM. However, personal care and social-cognitive items showed an increased level of dependence at follow-up compared with at discharge. A combination of physical activities from FIM and IAM also gave acceptable models for both dependence and perceived difficulty, and the hierarchical orders of activities are presented. In general, there was agreement between the ratings of dependence and perceived difficulty, but with some discrepancies. Men found it harder to be independent in such instrumental activities as cooking and cleaning than women; the opposite was true for small-scale shopping and locomotion outdoors. Subjects aged > or =55 years had slightly higher level of dependence and perceived difficulty in IAM activities than those below that age.
CONCLUSIONS
Changes in the hierarchical order of activities should be taken into account in follow-up studies. Differences in the environment between hospital and home, as well as differences in support and motivation, might explain the relatively larger degree of dependence at follow-up compared with at discharge and indicate the need for further rehabilitation efforts. Instrumental activities could be combined with FIM activities in a model. For individual items, ratings of both dependence and perceived difficulty may provide further insight into the disablement process.
Topics: Activities of Daily Living; Adolescent; Adult; Age Factors; Aged; Cerebrovascular Disorders; Dependency, Psychological; Disability Evaluation; Female; Humans; Male; Middle Aged; Sex Factors; Treatment Outcome
PubMed: 9731606
DOI: 10.1161/01.str.29.9.1843 -
Acta Physiologica Scandinavica Nov 1954
Topics: Action Potentials; Humans; Muscles; Physical Examination
PubMed: 13228109
DOI: 10.1111/j.1748-1716.1954.tb01167.x -
Physical Medicine and Rehabilitation... May 2006Treating pain patients is difficult. The usual problems encountered in providing coherent and effective treatment for any chronic medical illness are compounded in... (Review)
Review
Treating pain patients is difficult. The usual problems encountered in providing coherent and effective treatment for any chronic medical illness are compounded in painful conditions by time, society's choices, and the cultural role of the patient. Effective treatment of these patients depends on the persistence of the clinician. We must persist in requiring a complete history to understand the patient and his or her problem. We must persist in performing a thorough physical examination to uncover sufficient under-standing of the patient's physiology. We must persist in developing a comprehensive treatment plan to cover all of the intervening concerns. We must persist in following the patient in the clinic to make sure that the plan is completed and that complications that arise are dealt with efficiently. This can lead to considerable satisfaction and frustration. There remain many unanswered questions in the evaluation of pain patients and of pain itself. How accurate is physical examination in providing information about a given patient that is relevant to treating pain? Can physical examination reliably elicit a nociceptive focus for a specific individual's chronic pain experience? Is all long-term pain a smorgasbord of nociceptive, central sensitization, and neuromodulatory mechanisms? Can acute pain be more consistently aborted to minimize the development of chronic pain? Over the next few years, as our expanding knowledge of neuropharmacology, neurophysiology, and pain modulation in the CNS combines with better understanding of pain psychology and sociology, we clinicians will expect to have happier and more productive patients.
Topics: Adult; Aged; Analgesia; Disability Evaluation; Female; Humans; Male; Medical History Taking; Middle Aged; Pain Clinics; Pain Measurement; Pain, Intractable; Patient Care; Patient Care Team; Physical Examination; Physical Therapy Modalities; Practice Patterns, Physicians'; Prognosis; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 16616269
DOI: 10.1016/j.pmr.2005.12.008 -
Journal of the American Geriatrics... Sep 2009To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization.
The epidemiology of dependence in older people in Nigeria: prevalence, determinants, informal care, and health service utilization. A 10/66 dementia research group cross-sectional survey.
OBJECTIVES
To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization.
DESIGN
A single-phase cross-sectional catchment area survey.
SETTING
Dunukofia, a rural community in southeastern Nigeria.
PARTICIPANTS
One thousand two hundred thirty-eight adults aged 65 and older, for whom full data were available on 914.
MEASUREMENTS
The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, cognitive impairment, physical impairments, and self-reported diagnoses. The interviewer rated dependence as not needing care, needing some care, or needing much care. The prevalence of dependence and the independent contribution of underlying health conditions were estimated. Sources of income, care arrangements, caregiver strain, and health service use are described according to level of dependence.
RESULTS
The prevalence of dependence was 24.3% (95% confidence interval=22.1-26.5%), with a concentration in participants aged 80 and older. Only 1% of participants received a pension, and fewer than 7% had paid work. Those who were dependent were less likely than others to receive income from their family. Cognitive impairment, physical impairments, stroke, and depression were each independently associated with dependence. Depression made the largest contribution. Dependence was strongly associated with health service use (particularly private doctor and traditional healer services) and with high levels of out-of-pocket expenditure.
CONCLUSION
In Nigeria, dependence is an important outcome given rapid demographic aging and increases in chronic disease prevalence in all developing regions. Enhancing the social protection of dependent older adults should be a policy priority. Cognitive and mental disorders are important contributors to disability and dependence; more attention should be given to their prevention, detection, and treatment.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Caregivers; Chronic Disease; Cognition Disorders; Comorbidity; Cost of Illness; Cross-Sectional Studies; Dependency, Psychological; Depressive Disorder; Developing Countries; Disability Evaluation; Female; Health Services; Health Surveys; Humans; Incidence; Income; Male; Nigeria; Pensions; Pilot Projects; Rural Population; Socioeconomic Factors; Stroke; Utilization Review
PubMed: 19682135
DOI: 10.1111/j.1532-5415.2009.02397.x -
The Veterinary Clinics of North... May 2016Successful care of the critical pet bird patient is dependent on preparation and planning and begins with the veterinarian and hospital staff. An understanding of avian... (Review)
Review
Successful care of the critical pet bird patient is dependent on preparation and planning and begins with the veterinarian and hospital staff. An understanding of avian physiology and pathophysiology is key. Physical preparation of the hospital or clinic includes proper equipment and understanding of the procedures necessary to provide therapeutic and supportive care to the avian patient. An overview of patient intake and assessment, intensive care environment, and fluid therapy is included.
Topics: Animals; Animals, Exotic; Bird Diseases; Birds; Critical Care; Emergencies; Physical Examination; Veterinary Medicine
PubMed: 27131161
DOI: 10.1016/j.cvex.2016.01.014 -
Journal of Interpersonal Violence Dec 2011Individuals sometimes remain in dysfunctional, and even violent, relationships due to a perceived dependence on a partner. We examined the influence of dependence power...
Individuals sometimes remain in dysfunctional, and even violent, relationships due to a perceived dependence on a partner. We examined the influence of dependence power judgments (defined by a combined assessment of mother commitment, perceived father commitment, and perceived father alternatives) in a community sample of mothers potentially bound to a relationship with the father of her child. We also considered the influence of perceived father involvement in the child's life on judgments related to dependence power. Using a survey design with a sample of 100 mothers (age: 16-43, M = 29.16, SD = 7.17 years old) enrolled in a local Early Head Start/Head Start program, we observed that a mother's perceived father involvement was positively associated with judgments of her dependence power. Furthermore, we observed that her assessment of dependence power was negatively associated with her tolerance for both physical and psychological violence as well as the use of destructive child discipline tactics.
Topics: Adolescent; Adult; Battered Women; Dependency, Psychological; Domestic Violence; Fathers; Female; Forecasting; Health Surveys; Humans; Judgment; Male; Mothers; United States; Violence; Vulnerable Populations; Young Adult
PubMed: 21859752
DOI: 10.1177/0886260511403746 -
Injury Jan 2008Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely,... (Review)
Review
Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.
Topics: Diagnostic Errors; Emergency Service, Hospital; Epidemiologic Methods; Humans; Multiple Trauma; Outcome Assessment, Health Care; Physical Examination; Time Factors
PubMed: 18164007
DOI: 10.1016/j.injury.2007.07.030 -
Sportverletzung Sportschaden : Organ... Jun 2015Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are... (Review)
Review
Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.
Topics: Athletic Injuries; Combined Modality Therapy; Humans; Laparoscopy; Leg Injuries; Lower Extremity; Physical Examination; Physical Therapy Modalities; Tendinopathy; Ultrasonography
PubMed: 26076301
DOI: 10.1055/s-0034-1399668 -
IEEE ... International Conference on... Sep 2023Assisting persons during physical therapy or augmenting their performance often requires precise delivery of an intervention. Robotic devices are perfectly placed to do...
Assisting persons during physical therapy or augmenting their performance often requires precise delivery of an intervention. Robotic devices are perfectly placed to do so, but their intervention highly depends on the physical human-robot connection. The inherent compliance in the connection leads to delays and losses in bi-directional power transmission and can lead to human-robot joint axes misalignment. This is often neglected in the literature by assuming a rigid connection and has a negative impact on the intervention's effectiveness and robustness. This paper presents the preliminary results of a study that aims to close that gap. The study investigates what model forms and parameters best capture human-robot connection dynamics across different persons, connection designs (cuffs), and cuff strapping pressures. The results show that the linear spring-damper model is the best compromise, but its parameters must be adjusted for each individual and different conditions separately.
Topics: Humans; Robotics; Pressure; Physical Examination
PubMed: 37941249
DOI: 10.1109/ICORR58425.2023.10304754