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Clinical Medicine (London, England) 2005Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope,... (Review)
Review
Vertigo is an illusion of rotation due to a disorder of the vestibular system, almost always peripheral. In the history it must be distinguished from pre-syncope, seizures and panic attacks. A single attack of acute, isolated spontaneous vertigo lasting a day or more is due either to vestibular neuritis or cerebellar infarction; distinguishing between the two requires mastery of the head impulse test. Recurrent vertigo is mostly due to benign paroxysmal positioning vertigo (BPPV), Meniere's disease or migraine. With a good history, a positional test, an audiogram and a caloric test, it is usually possible to distinguish between these. BPPV is the single most common cause of recurrent vertigo and can usually be cured immediately with a particle repositioning manoeuvre. Posterior circulation ischaemia very rarely causes isolated vertigo attacks and when it does the attacks are brief and frequent and the history is short.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Palpation; Tomography, X-Ray Computed; Vertigo
PubMed: 15847010
DOI: 10.7861/clinmedicine.5-2-159 -
BMC Medical Education Nov 2023Abdominal palpation is an essential examination to diagnose various digestive system diseases. This study aimed to develop an objective and standardized test based on...
OBJECTIVES
Abdominal palpation is an essential examination to diagnose various digestive system diseases. This study aimed to develop an objective and standardized test based on abdominal palpation simulators, and establish a credible pass/fail standard of basic competency.
METHODS
Two tests were designed using the newly developed Jucheng abdominal palpation simulator (test 1) and the AbSim simulator (test 2), respectively. Validity evidence for both tests was gathered according to Messick's contemporary framework by using experts to define test content and then administering the tests in a highly standardized way to participants of different experience. Different simulator setups modified by the built-in software were selected from hepatomegaly, splenomegaly, positive McBurney's sign plus rebound tenderness, gallbladder tenderness (Murphy's sign), pancreas tenderness, and a normal setup without pathologies, with six sets used in test 1 and five sets used in test 2. Different novices and experienced were included in the tests, and test 1 was also administered to an intermediate group. Scores and test time were collected and analyzed statistically.
RESULTS
The internal consistency reliability of test 1 and test 2 showed low Cronbach's alphas of 0.35 and -0.41, respectively. Cronbach's alpha for palpation time across cases were 0.65 for test 1 and 0.76 for test 2. There was no statistical difference in total time spent and total scores among the three groups in test 1 (P-values (ANOVA) were 0.53 and 0.35 respectively), nor between novices and experienced groups in test 2 (P-values (t-test) were 0.13 and 1.0 respectively). It was not relevant to try to establish pass/fail standards due to the low reliability and lack of discriminatory ability of the tests.
CONCLUSIONS
It was not possible to measure abdominal palpation skills in a valid way using either of the two standardized, simulation-based tests in our study. Assessment of the patient's abdomen using palpation is a challenging clinical skill that is difficult to simulate as it highly relies on tactile sensations and adequate responsiveness from the patients.
Topics: Humans; Reproducibility of Results; Computer Simulation; Abdomen; Software; Clinical Competence; Palpation
PubMed: 37996904
DOI: 10.1186/s12909-023-04861-6 -
Anaesthesia Jun 2021The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with... (Comparative Study)
Comparative Study Meta-Analysis
Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics - a systematic review and meta-analysis with trial sequential analyses.
The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with the assistance of preprocedural ultrasound, in comparison with the landmark palpation method. The bibliographic databases Central, CINAHL, EMBASE, Global Health, MEDLINE, Scopus and Web of Science were searched from inception to 13 February 2020 for randomised controlled trials that included pregnant women having neuraxial procedures with preprocedural ultrasound as the intervention and conventional landmark palpation as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenszel method. In all, 22 trials with 2462 patients were included. Confirmed by trial sequential analysis, preprocedural ultrasound increased the first-pass success rate by a risk ratio (95%CI) of 1.46 (1.16-1.82), p = 0.001 in 13 trials with 1253 patients. No evidence of a difference was found in the total time taken between preprocedural ultrasound and landmark palpation, with a mean difference (95%CI) of 50.1 (-13.7 to 113.94) s, p = 0.12 in eight trials with 709 patients. The quality of evidence was graded as low and very low, respectively, for these co-primary outcomes. Sub-group analysis underlined the increased benefit of preprocedural ultrasound for those in whom the neuraxial procedure was predicted to be difficult. Complications, including postpartum back pain and headache, were decreased with preprocedural ultrasound. The adoption of preprocedural ultrasound for neuraxial procedures in obstetrics is recommended and, in the opinion of the authors, should be considered as a standard of care, in view of its potential to increase efficacy and reduce complications without significant prolongation of the total time required.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia, Epidural; Anesthesia, Obstetrical; Epidural Space; Female; Humans; Palpation; Pregnancy; Ultrasonography
PubMed: 32981051
DOI: 10.1111/anae.15255 -
Medicina (Kaunas, Lithuania) Feb 2020Palpation is an inherent and basic skill of health professionals-particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many...
BACKGROUND AND OBJECTIVES
Palpation is an inherent and basic skill of health professionals-particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current studies that evaluate palpation concordance reliability for the SMT in this particular position. This study aimed to investigate the intra- and inter-rater reliabilities of supraspinatus muscle tendon (SMT) palpation.
MATERIALS AND METHODS
Thirty-six healthy participants (14 females; aged 22-35 years) were recruited. Musculoskeletal ultrasound was used to measure the SMT localization after two physiotherapists performed the SMT palpation at two different times. The distance between the two marked points was used to analyze the analysis of true agreement between examiners. Finally, we analyzed if the demographic variables influenced the palpation procedure.
RESULTS
The intra-examiner reliability showed a high percentage of concordance for examiner 1 (E.1) (first palpation procedure (P.1) = 91.7%: second palpation procedure (P.2) = 95.8%) and examiner 2 (E.2) (P.1 = 91.6%; P.2 = 97.2%) and high percentage of inter-palpation agreement for E.1 (87.5%) and E.2 (88.9%). The inter-examiner reliability showed a high total concordance for the right shoulder (E.1 = 94.4%; E.2 = 95.8%) and left shoulder (E.1 = 93.05%; E.2 = 95.05%). The agreement (%) according to both examiners was 93.05% for the right shoulder and 94.4% for the left shoulder. The agreement between both examiners and the ultrasound (% of true agreement) was 92.9% for the right shoulder and 92.8% for the left shoulder. A statistically significant association (p = 0.02) was found for weight regarding concordance reliability; this was not seen for dominant arm, age, gender, body mass index, height, and tendon depth (p > 0.05).
CONCLUSIONS
The SMT palpation technique showed a high level of concordance and reproducibility.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Observer Variation; Palpation; Physical Therapists; Reproducibility of Results; Rotator Cuff; Ultrasonography
PubMed: 32085506
DOI: 10.3390/medicina56020083 -
The Veterinary Clinics of North... Apr 1999A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to... (Review)
Review
A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to apply its techniques properly. Chiropractic provides additional diagnostic and therapeutic means that may help equine practitioners to identify and treat the primary cause of lameness or poor performance. Specialized training in the evaluation and treatment of vertebral joint dysfunction and neuromusculoskeletal disorders places chiropractic in the forefront of conservative treatment of spinal-related disorders. Nevertheless, limited research is currently available on equine chiropractic and other nontraditional modalities in veterinary medicine. In 1996, the American Veterinary Medicine Association's Committee on Alternative and Complementary Therapies suggested that the research community should be encouraged to prioritize avenues of research and to allocate research funds to projects that are designed to provide further scientific evaluation of these modalities. The future of equine chiropractic in veterinary medicine is dependent on future research into the clinical effects of chiropractic techniques and the basic pathophysiology of spinal-related disorders in horses.
Topics: Animals; Chiropractic; Disease Management; Horse Diseases; Horses; Manipulation, Spinal; Palpation; Spinal Diseases
PubMed: 10218250
DOI: 10.1016/s0749-0739(17)30172-4 -
British Journal of Anaesthesia Sep 2016Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review... (Review)
Review
Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review summarizes the current evidence for application of airway ultrasonography for identification of the cricothyroid membrane compared with the clinical techniques. We identified the best-documented techniques for bedside use, their success rates, and the necessary training for airway-ultrasound-naïve clinicians. After a short but structured training, the cricothyroid membrane can be identified using ultrasound in difficult patients by previously airway-ultrasound naïve anaesthetists with double the success rate of palpation. Based on the literature, we recommend identifying the cricothyroid membrane before induction of anaesthesia in all patients. Although inspection and palpation may suffice in most patients, the remaining patients will need ultrasonographic identification; a service that we should aim at making available in all locations where anaesthesia is undertaken and where patients with difficult airways could be encountered.
Topics: Airway Management; Anesthesiology; Clinical Competence; Cricoid Cartilage; Education, Medical, Continuing; Evidence-Based Medicine; Humans; Palpation; Patient Positioning; Thyroid Cartilage; Ultrasonography
PubMed: 27432055
DOI: 10.1093/bja/aew176 -
International Journal of Computer... Nov 2020We present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing...
PURPOSE
We present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing or segmentation of the volumetric medical data set.
METHODS
In a first experiment, we quantified the forces and torques present during the palpation of a pedicle screw tract in a real boar vertebra. We equipped a ball-tipped pedicle probe with a 6-axis force/torque sensor and a motion capture marker cluster. We simultaneously recorded the pose of the probe relative to the vertebra and measured the generated forces and torques during palpation. This allowed us replaying the recorded palpation movements in our simulator and to fine-tune the haptic rendering to approximate the measured forces and torques. In a second experiment, we asked two neurosurgeons to palpate a virtual version of the same vertebra in our simulator, while we logged the forces and torques sent to the haptic device.
RESULTS
In the experiments with the real vertebra, the maximum measured force along the longitudinal axis of the probe was 7.78 N and the maximum measured bending torque was 0.13 Nm. In an offline simulation of the motion of the pedicle probe recorded during the palpation of a real pedicle screw tract, our approach generated forces and torques that were similar in magnitude and progression to the measured ones. When surgeons tested our simulator, the distributions of the computed forces and torques were similar to the measured ones; however, higher forces and torques occurred more frequently.
CONCLUSIONS
We demonstrated the suitability of direct visual and haptic volume rendering to simulate a specific surgical procedure. Our approach of fine-tuning the simulation by measuring the forces and torques that are prevalent while palpating a real vertebra produced promising results.
Topics: Animals; Computer Simulation; Feasibility Studies; Male; Motion; Palpation; Pedicle Screws; Simulation Training; Spinal Fusion; Swine; Torque; User-Computer Interface; Virtual Reality
PubMed: 32959159
DOI: 10.1007/s11548-020-02258-0 -
PloS One 2022Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.
BACKGROUND
Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.
OBJECTIVE
We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.
METHODS
Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.
RESULTS
The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.
CONCLUSIONS
Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.
Topics: Adult; Aged; Ambulatory Care Facilities; Atrial Fibrillation; Cardiology; Electrocardiography; Heart Failure; Humans; Mass Screening; Middle Aged; Palpation; Pulse
PubMed: 35446875
DOI: 10.1371/journal.pone.0266955 -
The Cornell Veterinarian Jul 1980Ninety percent accuracy in pregnancy diagnosis by ultrasonic techniques during the last half of gestation in ewes and does has been reported. Rectal abdominal palpation... (Review)
Review
Ninety percent accuracy in pregnancy diagnosis by ultrasonic techniques during the last half of gestation in ewes and does has been reported. Rectal abdominal palpation is relatively inexpensive and easy to perform in field conditions with more than 90% accuracy after 60 days of gestation. Pregnancy diagnosis and fetal count is possible by radiographic technique after the 90th and 70th day of gestation in ewes and does, respectively. Vaginal biopsy techniques have yielded an accuracy of 97% after the 40th day of gestation in ewes and progesterone assays after the 20th day of gestation have yielded 90% accuracy both in ewes and does. Direct palpation of the pregnant uterus via laparotomy after the 28th day of gestation in ewes has demonstrated less than 3% error.
Topics: Abdomen; Animals; Biopsy; Female; Goats; Laparotomy; Palpation; Pregnancy; Pregnancy Tests; Progesterone; Rectum; Sheep; Ultrasonography; Vagina
PubMed: 7000436
DOI: No ID Found -
The Cochrane Database of Systematic... Sep 2015Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal... (Review)
Review
BACKGROUND
Symphysis fundal height (SFH) measurement is commonly practiced primarily to detect fetal intrauterine growth restriction (IUGR). Undiagnosed IUGR may lead to fetal death as well as increase perinatal mortality and morbidity.
OBJECTIVES
The objective of this review is to compare SFH measurement with serial ultrasound measurement of fetal parameters or clinical palpation to detect abnormal fetal growth (IUGR and large-for-gestational age), and improving perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 July 2015) and reference lists of retrieved articles.
SELECTION CRITERIA
Randomised controlled trials including quasi-randomised and cluster-randomised trials involving pregnant women with singleton fetuses at 20 weeks' gestation and above comparing tape measurement of SFH with serial ultrasound measurement of fetal parameters or clinical palpation using anatomical landmarks.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
One trial involving 1639 women was included. It compared SFH measurement with clinical abdominal palpation.There was no difference in the two reported primary outcomes of incidence of small-for-gestational age (risk ratio (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.90, low quality evidence) or perinatal death.(RR 1.25, 95% CI 0.38 to 4.07; participants = 1639, low quality evidence). There were no data on the neonatal detection of large-for-gestational age (variously defined by authors). There was no difference in the reported secondary outcomes of neonatal hypoglycaemia, admission to neonatal nursery, admission to the neonatal nursery for IUGR (low quality evidence), induction of labour and caesarean section (very low quality evidence). The trial did not address the other outcomes specified in the 'Summary of findings' table (intrauterine death; neurodevelopmental outcome in childhood). GRADEpro software was used to assess the quality of evidence, downgrading of evidence was based on including a small single study with unclear risk of bias and a wide confidence interval crossing the line of no effect.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether SFH measurement is effective in detecting IUGR. We cannot therefore recommended any change of current practice. Further trials are needed.
Topics: Abdomen; Female; Fetal Growth Retardation; Humans; Palpation; Pregnancy; Pubic Symphysis; Randomized Controlled Trials as Topic; Ultrasonography, Prenatal; Uterus
PubMed: 26346107
DOI: 10.1002/14651858.CD008136.pub3