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IEEE Transactions on Bio-medical... Sep 2018Motivated by the fact that palpation skills are challenging to learn and teach, particularly during Digital Rectal Examinations (DRE), and the lack of understanding of...
OBJECTIVE
Motivated by the fact that palpation skills are challenging to learn and teach, particularly during Digital Rectal Examinations (DRE), and the lack of understanding of what constitutes adequate performance, we present a visualisation and analysis system that uses small position and pressure sensors located on the examining finger, allowing the quantitative analysis of duration, steps and pressure applied.
METHODS
The system is first described, followed by an experimental study of twenty experts from four clinical specialties performing ten DREs each on a benchtop model using the proposed system. Analysis of the constitutive steps was conducted to improve understanding of the examination. A Markov model representing executed tasks and analysis of pressure applied is also introduced.
RESULTS
The proposed system successfully allowed the visualisation and analysis during the experimental study. General Practitioners and Nurses were found to execute more tasks compared to Urologists and Colorectal Surgeons. Urologists executed the least number of tasks and were the most consistent group compared to others.
CONCLUSION
The ability to "see through" allowed us to better characterise the performance of experts when conducting a DRE on a benchtop model, comparing the performance of relevant specialties, and studying executed tasks and the pressure applied. The Markov model presented summarises task execution of experts and could be used to compare performance of novices against that of experts.
SIGNIFICANCE
This approach allows for the analysis of performance based on continuous sensor data recording that can be easily extended to real subjects and other types of physical examinations.
Topics: Biomedical Engineering; Clinical Competence; Digital Rectal Examination; Education, Medical; Educational Measurement; Equipment Design; Humans; Models, Biological; Pressure
PubMed: 29993465
DOI: 10.1109/TBME.2017.2780982 -
Journal of Feline Medicine and Surgery Aug 2019Present-day diagnosis of hyperthyroidism is often established in the early stages where clinical signs and physical examination findings typically associated with the...
OBJECTIVES
Present-day diagnosis of hyperthyroidism is often established in the early stages where clinical signs and physical examination findings typically associated with the disease may not yet be present. The purpose of this study was to investigate thyroid palpation score (TPS), total thyroxine (T4), body weight, body condition score and a clinical scoring index, which assesses severity of illness and quality of life, in untreated hyperthyroid cats, healthy cats and cats with non-thyroidal illness.
METHODS
Fifty-five cats with hyperthyroidism, 45 healthy cats and 327 euthyroid cats with non-thyroidal disease were prospectively enrolled. A Kruskal-Wallis test was used to determine any differences between metric data. A χ test was applied to compare nominal data between the three subgroups. Correlation between two variables was analysed using Spearman's correlation coefficient.
RESULTS
Almost 80% of the hyperthyroid cats and up to 20% of the healthy cats and cats with non-thyroidal illness had a palpable thyroid gland. Median TPS in hyperthyroid cats was 2, which was significantly higher compared with the other groups. Although there was a significant correlation between TPS and T4 when evaluating all cats, this could not be demonstrated in the three subgroups. Hyperthyroid cats with larger thyroid glands (TPS >3) did not have higher T4 levels. Hyperthyroid cats with lower clinical scores had significantly higher T4 levels compared with hyperthyroid cats with higher scores. Hyperthyroid cats were older and had lower body weights and body condition scores than other cats.
CONCLUSIONS AND RELEVANCE
Hyperthyroid cats were commonly found to have palpable thyroid glands, but they were smaller than previously reported.
Topics: Animals; Cat Diseases; Cats; Hyperthyroidism; Palpation; Prospective Studies; Quality of Life; Severity of Illness Index; Thyroid Gland; Thyroxine
PubMed: 30328752
DOI: 10.1177/1098612X18799462 -
Poultry Science Feb 2019Damage to the keel bone is a major issue in the laying hen industry. The goal of this study was to compare palpation results of live laying hens to digital computed...
Damage to the keel bone is a major issue in the laying hen industry. The goal of this study was to compare palpation results of live laying hens to digital computed tomography (CT) images, to assess changes in palpation reliability as training and familiarity increased, and to examine keel bone morphology over time. The longitudinal study consisted of 2 trials of 3 observation periods using 40 different (n = 120) W-36 hens housed in enriched colony cages. The first trial began when hens were 52 to 58 wk of age repeating the trial when the same birds were 74 to 81 wk of age. At 52 wk of age, each hen's keel bone was palpated by a single individual for keel bone caudal tip fractures (Tip), sagittal deviations (Evenness), and transverse deviations (Straightness). After palpation, each hen was placed in a motion limiting restraint and scanned using CT. The hens spent the next 21 d in their cages and on day 21, the hens were collected, palpated, and CT scanned again. The CT scans were imported into Mimics analysis software, 3D models of each keel bone were constructed and evaluated. Each bone and 3D model was scored (0, 1, 2) on the measurement of transverse deviation based on <0.5 cm, 0.51 to 1.0 cm, and >1.0 cm total deviation, respectively. Analysis of data using Proc Freq and Means in SAS 9.3 revealed minimal to moderate kappa values and moderate agreement percentages between palpators and digital analysis. The computer generated 3D models of individual keel bones were compared to palpation scores for Tip, Evenness, and Straightness at the beginning and end of each trial. The visual observations of the 3D models were qualitative, performed by a single individual. Overall, we found CT scanning to be a useful tool in observing changes to the keel bone, we observed changes in palpation accuracy as training/familiarity increased, and examined changes in keel morphology, specifically in the tip, after 52 wk of age.
Topics: Animal Welfare; Animals; Chickens; Female; Fractures, Bone; Longitudinal Studies; Palpation; Reproducibility of Results; Sternum
PubMed: 30165387
DOI: 10.3382/ps/pey373 -
BMC Women's Health Feb 2021Pelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pelvic floor muscles support the pelvic organs and control voiding. The first choice in the repair of pelvic floor function that is damaged during pregnancy and delivery is pelvic floor muscle training, which involves repeated muscle relaxation and contraction. However, as muscle contractions cannot be visualised, it is difficult to assess whether patients understand how to contract them. Therefore, we assessed patients' comprehension of pelvic floor muscle contraction by comparing two teaching methods, vaginal palpation and transabdominal ultrasound, following vaginal delivery. We hypothesised that vaginal palpation is better than transabdominal ultrasound in this regard.
METHODS
This randomised controlled trial conducted in facilities in Tokyo, Japan between July 2018 and January 2019 included women aged ≥ 20 years at 4-6 weeks after vaginal delivery. The randomisation involved website-based centralised allocation. The primary outcome was a change in bladder base displacement during pelvic floor muscle contraction before and after training, which was measured using transabdominal ultrasound. Participants performed three contractions for 3 s, and the mean value was used for statistical analysis. The secondary outcome was a change in understanding the contraction before and after training, which was measured using a five-point Likert scale questionnaire. Outcomes were analysed using Welch's t-test.
RESULTS
Sixty-five participants were randomly allocated to the vaginal palpation group (n = 32) and transabdominal ultrasound group (n = 33). Baseline characteristics were similar between the groups. Changes in bladder base displacement were not significantly different between the groups (p = 0.181). Within-group analyses showed that bladder base displacement was large in both groups after the respective intervention. There were no significant differences in any of the outcomes between the two groups before and after the intervention.
CONCLUSIONS
Vaginal palpation and transabdominal ultrasound might be useful for comprehending pelvic floor muscle contraction after vaginal delivery.
TRIAL REGISTRATION
UMIN 000032304. Registered 18 April 2018, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000036820 .
Topics: Comprehension; Delivery, Obstetric; Female; Humans; Japan; Muscle Contraction; Palpation; Pelvic Floor; Pregnancy
PubMed: 33549078
DOI: 10.1186/s12905-021-01203-w -
The Journal of the American Osteopathic... Oct 2015The palpation of motions is at the heart of the practice of foreign-trained osteopaths. When practicing osteopathic manual therapy (care provided by foreign-trained...
CONTEXT
The palpation of motions is at the heart of the practice of foreign-trained osteopaths. When practicing osteopathic manual therapy (care provided by foreign-trained osteopaths) in the cranial field or osteopathic cranial manipulative medicine, the palpation of small motions (several tens of micrometers) is a key process. However, to the authors' knowledge, the smallest detectable motion has not been identified.
OBJECTIVE
To quantify motion detection capacity by passive palpation.
METHODS
Participants were instructed to hold a mechanical device containing a micrometric actuator between their hands and report when they felt motion while 6 series of 27 random motions were generated by the actuator. After each series, if a participant succeeded or failed to detect motion with a confidence level of greater than 98%, the motions in the next series were set to a smaller or larger magnitude, respectively. After 6 series, the individual motion detection capacity was recorded. Statistical significance was set at P=.02.
RESULTS
A total of 21 participants were selected, comprising 14 osteopaths and 7 nonosteopaths. The average performance of the sample was 148 μm. Thirteen participants (62%) perceived motions of 200 μm or less, and 7 participants (33%) detected motions of 50 μm or less with bare hands. Osteopathic training did not notably affect the performance. Osteopaths were twice as likely to claim detection of nonexisting motions than to miss existing ones, whereas nonosteopaths were equally subject to both types of errors.
CONCLUSION
The data show human passive palpatory sensitivity to be in the range of several tens of micrometers. This range is comparable to that reported for calvarial motion (10-50 μm).
Topics: Adult; Female; Humans; Male; Musculoskeletal Manipulations; Osteopathic Medicine; Palpation; United States; Young Adult
PubMed: 26414713
DOI: 10.7556/jaoa.2015.121 -
Yonsei Medical Journal Sep 2011To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity.
PURPOSE
To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity.
MATERIALS AND METHODS
A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples.
RESULTS
Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003).
CONCLUSION
Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.
Topics: Adult; Aged; Elastic Modulus; Elasticity Imaging Techniques; Equipment Design; Female; Humans; In Vitro Techniques; Kidney; Kidney Neoplasms; Male; Middle Aged; Palpation; Phantoms, Imaging; Pilot Projects; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 21786441
DOI: 10.3349/ymj.2011.52.5.768 -
Scientific Reports Apr 2023Intermediate (IM) band physiology in skin blood flow exhibits parallels with the primary respiratory mechanism (PRM) or cranial rhythmic impulse (CRI), controversial...
Intermediate (IM) band physiology in skin blood flow exhibits parallels with the primary respiratory mechanism (PRM) or cranial rhythmic impulse (CRI), controversial concepts of osteopathy in the cranial field (OCF). Owing to inconsistent manual palpation results, validity of evidence of PRM/CRI activity has been questionable. We therefore tried to validate manual palpation combining instrumented tracking and algorithmic objectivation of frequencies, amplitudes, and phases. Using a standard OCF intervention, cranial vault hold (CVH), two OCF experts palpated and digitally marked CRI frequencies in 25 healthy adults. Autonomic nervous system (ANS) activity in low frequency (LF) and IM band in photoplethysmographic (PPG) forehead skin recordings was probed with momentary frequency of highest amplitude (MFHA) and wavelet amplitude spectra (WAS) in examiners and participants. Palpation errors and frequency expectation bias during CVH were analyzed for phases of MFHA and CRI. Palpated CRI frequencies (0.05-0.08 Hz) correlated highly with mean MFHA frequencies with 1:1 ratio in 77% of participants (LF-responders; 0.072 Hz) and with 2:1 ratio in 23% of participants (IM-responders; 0.147 Hz). WAS analysis in both groups revealed integer number (harmonic) waves in (very) low and IM bands in > 98% of palpated intervals. Phase analyses in participants and examiners suggested synchronization between MFHA and CRI in a subset of LF-responders. IM band physiology in forehead PPG may offer a sensible physiological correlate of palpated CRI activity. Possible coordination or synchronization effects with additional physiological signals and between examiners and participants should be investigated in future studies.
Topics: Adult; Humans; Palpation; Manipulation, Osteopathic; Skull; Forehead; Skin
PubMed: 37095164
DOI: 10.1038/s41598-023-33644-8 -
Acta Obstetricia Et Gynecologica... Dec 2014To give an overview of the methods available for biomechanical testing of the non-pregnant and pregnant uterine cervix in vivo. (Review)
Review
OBJECTIVE
To give an overview of the methods available for biomechanical testing of the non-pregnant and pregnant uterine cervix in vivo.
METHODS
The following databases were searched. PubMed, Embase, and Cochrane Library. Additional studies were identified from reference lists. Only studies on in vivo biomechanical testing on both pregnant and non-pregnant women were included.
MAIN OUTCOME MEASURES
Estimation of distensibility, compressibility, and biochemical composition of the uterine cervix.
RESULTS
The distensibility methods evaluated a physiologic variable and might serve as a gold standard; however, they may never be clinically useful as they involve instrumentation of the cervical canal. The compression methods evaluated an unphysiological variable but despite that, they seemed to evaluate biologically relevant figures and were non-invasive. Of the methods evaluating the biomechanical properties indirectly, those based on ultrasound may be clinically useful. Other indirect methods only measured variables within the most superficial layer of the distal uterine cervix, so further studies are needed to evaluate whether these measurements reflect the entire organ. Both compression methods and indirect methods were similar or superior to the Bishop score and to cervical length measurements regarding prediction of spontaneous preterm delivery and successful induction of labor in small studies.
CONCLUSION
The methods may have the potential to detect the biomechanical changes in the uterine cervix before the cervical length has shortened. The most promising methods need large-scale clinical testing regarding induction of labor and preterm delivery before they can be used in the clinic.
Topics: Biomechanical Phenomena; Cervical Ripening; Cervix Uteri; Diagnostic Techniques, Obstetrical and Gynecological; Elasticity Imaging Techniques; Female; Humans; In Vitro Techniques; Obstetric Labor, Premature; Palpation; Pregnancy
PubMed: 25174701
DOI: 10.1111/aogs.12483 -
PloS One 2024Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points.
MATERIALS AND METHODS
In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement.
RESULTS
Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate.
CONCLUSIONS
Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.
Topics: Humans; Palpation; Lumbar Vertebrae; Female; Male; Lordosis; Adult; Low Back Pain; Prospective Studies; Middle Aged
PubMed: 38814967
DOI: 10.1371/journal.pone.0304571 -
Abdominal Physical Signs and Medical Eponyms: Part II. Physical Examination of Palpation, 1907-1926.Clinical Medicine & Research Jun 2019Abdominal palpation is an important clinical skill used by physicians to detect the cause of the underlying disease. Abdominal physical signs reported as medical eponyms...
BACKGROUND
Abdominal palpation is an important clinical skill used by physicians to detect the cause of the underlying disease. Abdominal physical signs reported as medical eponyms are sometimes helpful in supporting or confirming clinical suspicion of a diagnosis. With the advent of advanced and rapid imaging techniques physicians often know the diagnosis prior to setting their hands on patients. Nevertheless, knowledge of these signs may still remain important in settings where imaging may not be readily available and importantly provide deeper insights into the mechanism of disease. In this paper, described are medical eponyms associated with abdominal palpation from the period 1907-1926.
DATA SOURCES
PubMed, Medline, on-line Internet word searches, textbooks, and references from other source text were used as the data source. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.
CONCLUSION
We describe brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application and implication into today's medical practice.
Topics: Abdomen; Eponyms; History, 20th Century; Humans; Palpation
PubMed: 31160480
DOI: 10.3121/cmr.2018.1426