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British Journal of Anaesthesia Jan 2021
Topics: Humans; Palpation; Reference Standards; Ultrasonography; Ultrasonography, Interventional
PubMed: 33131758
DOI: 10.1016/j.bja.2020.10.004 -
BMJ Open Jun 2022To determine the diagnostic accuracy of three tests-radial pulse palpation, an electronic blood pressure monitor and a handheld single-lead ECG device-for opportunistic... (Randomized Controlled Trial)
Randomized Controlled Trial
Detection of atrial fibrillation in primary care with radial pulse palpation, electronic blood pressure measurement and handheld single-lead electrocardiography: a diagnostic accuracy study.
OBJECTIVE
To determine the diagnostic accuracy of three tests-radial pulse palpation, an electronic blood pressure monitor and a handheld single-lead ECG device-for opportunistic screening for unknown atrial fibrillation (AF).
DESIGN
We performed a diagnostic accuracy study in the intention-to-screen arm of a cluster randomised controlled trial aimed at opportunistic screening for AF in general practice. We performed radial pulse palpation, followed by electronic blood pressure measurement (WatchBP Home A) and handheld ECG (MyDiagnostick) in random order. If one or more index tests were positive, we performed a 12-lead ECG at shortest notice. Similarly, to limit verification bias, a random sample of patients with three negative index tests received this reference test. Additionally, we analysed the dataset using multiple imputation. We present pooled diagnostic parameters.
SETTING
47 general practices participated between September 2015 and August 2018.
PARTICIPANTS
In the electronic medical record system of the participating general practices (n=47), we randomly marked 200 patients of ≥65 years without AF. When they visited the practice for any reason, we invited them to participate. Exclusion criteria were terminal illness, inability to give informed consent or visit the practice or having a pacemaker or an implantable cardioverter-defibrillator.
OUTCOMES
Diagnostic accuracy of individual tests and test combinations to detect unknown AF.
RESULTS
We included 4339 patients; 0.8% showed new AF. Sensitivity and specificity were 62.8% (range 43.1%-69.7%) and 91.8% (91.7%-91.8%) for radial pulse palpation, 70.0% (49.0%-80.6%) and 96.5% (96.3%-96.7%) for electronic blood pressure measurement and 90.1% (60.8%-100%) and 97.9% (97.8%-97.9%) for handheld ECG, respectively. Positive predictive values were 5.8% (5.3%-6.1%), 13.8% (12.2%-14.8%) and 25.2% (24.2%-25.8%), respectively. All negative predictive values were ≥99.7%.
CONCLUSION
In detecting AF, electronic blood pressure measurement (WatchBP Home A), but especially handheld ECG (MyDiagnostick) showed better diagnostic accuracy than radial pulse palpation.
TRIAL REGISTRATION NUMBER
Netherlands Trial Register No. NL4776 (old NTR4914).
Topics: Atrial Fibrillation; Blood Pressure; Electrocardiography; Electronics; Humans; Mass Screening; Palpation; Primary Health Care
PubMed: 35768092
DOI: 10.1136/bmjopen-2021-059172 -
Sensors (Basel, Switzerland) Jun 2021Pulse palpation is an effective method for diagnosing arterial diseases. However, most pulse measurement devices use preconfigured pressures to collect pulse signals,...
Pulse palpation is an effective method for diagnosing arterial diseases. However, most pulse measurement devices use preconfigured pressures to collect pulse signals, and most pulse tactile simulators can only display standard or predefined pulse waveforms. Here, a portable interactive human pulse measurement and reproduction system was developed that allows users to take arbitrary pulses and experience realistic simulated pulse tactile feedback in real time by using their natural pulse-taking behaviors. The system includes a pulse tactile recorder and a pulse tactile player. Pulse palpation forces and vibrations can be recorded and realistically replayed for later tactile exploration and examination. To retain subtle but vital pulse information, empirical mode decomposition was used to decompose pulse waveforms into several intrinsic mode functions. Artificial neural networks were then trained based on intrinsic mode functions to determine the relationship between the driving signals of the pulse tactile player and the resulting vibration waveforms. Experimental results indicate that the average normalized root mean square error and the average -squared values between the reproduced and original pulses were 0.0654 and 0.958 respectively, which indicate that the system can reproduce high-fidelity pulse tactile vibrations.
Topics: Heart Rate; Humans; Neural Networks, Computer; Palpation; Pressure; Pulse; Touch
PubMed: 34201954
DOI: 10.3390/s21134339 -
Acta Otorrinolaringologica Espanola Apr 2004Lymphatic metastasis is an important prognostic factor in patients with head and neck squamous cell carcinomas. Diagnostic evaluation and treatment of this adenopathies... (Review)
Review
Lymphatic metastasis is an important prognostic factor in patients with head and neck squamous cell carcinomas. Diagnostic evaluation and treatment of this adenopathies is very important. We can use physical examination, computered tomography (CT), magnetic resonance, ultrasound... but none of these give us a 100% security. This study evaluates the accuracy of physical examination and CT in detecting cervical lymph nodes. 120 neck dissections were performed after palpation and CT of 72 patients with head and neck carcinoma. Sensitivity of palpation was 51.7 and specificity 96.7. CTs sensitivity was 65 and specificity 86.7. Both, physical examination and palpation have a high number of mistakes evaluating cervical nodes. N0 necks are still a problem for Head and Neck Surgeons.
Topics: Head and Neck Neoplasms; Humans; Lymphatic Diseases; Neck; Palpation; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 15359665
DOI: 10.1016/s0001-6519(04)78505-2 -
Brazilian Journal of Anesthesiology... 2013Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of...
BACKGROUND AND OBJECTIVES
Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using postoperative X-rays in obstetric patients.
METHODS
We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confirmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentification of interspinous level.
RESULTS
Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological deficits. No variables evaluated were significantly associated with misidentification of interspinous level by the anesthesiologists.
CONCLUSIONS
There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.
Topics: Adult; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Lumbar Vertebrae; Middle Aged; Palpation; Pregnancy; Radiography; Reproducibility of Results; Retrospective Studies; Young Adult
PubMed: 23683445
DOI: 10.1016/S0034-7094(13)70224-1 -
Medical Science Monitor : International... Jul 2016BACKGROUND This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. MATERIAL AND METHODS A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. RESULTS (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (P<0.05). (2) The cannulation duration in the ultrasound group and the palpation group was 8.77±6.33 s and 28.7±26.33 s, respectively (P<0.01). (3) Incidence of hematoma and staxis around stoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). CONCLUSIONS Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics.
Topics: Aged; Catheterization, Peripheral; Critical Care; Female; Humans; Intensive Care Units; Male; Middle Aged; Palpation; Prospective Studies; Punctures; Radial Artery; Shock; Ultrasonography, Interventional
PubMed: 27397118
DOI: 10.12659/msm.896805 -
The European Respiratory Journal Sep 1995Inspection of the thorax identifies the breathing position adopted by the patient, the shape of the thorax, the dynamics of respiration (breathing pattern, symmetry of... (Review)
Review
Inspection of the thorax identifies the breathing position adopted by the patient, the shape of the thorax, the dynamics of respiration (breathing pattern, symmetry of expansion, mechanics and synchrony of rib cage and abdominal movements). Inspection of the neck adds useful information, particularly with respect to the dynamics of breathing. Palpation ascertains the signs suggested by inspection with respect to the mechanics of breathing. It also assesses the state of the pleura and pulmonary parenchyma by studying the tactile fremitus. It integrates extrarespiratory signs, such as enlarged lymph nodes or breast abnormalities. Extrathoracic respiratory signs should also be systematically looked for, including cyanosis, finger deformation, pulsus paradoxus, and pursed lips breathing. Interobserver agreement about respiratory signs has repeatedly been studied, and generally found to be low, as are clinical-functional correlations. However, some data on chronic obstructive pulmonary disease (COPD), asthma or pulmonary embolism are available. From the description of some signs and the current knowledge about their operative values, it appears that much clinical research remains necessary to better define the precise diagnostic value of a given sign. The impact of training on diagnostic performance also has to be defined. Both of these aspects should allow clinicians to optimize the way in which they use their hands and eyes to conduct respiratory diagnosis, as well as the way they teach respiratory symptomatology.
Topics: Adult; Humans; Palpation; Physical Examination; Respiratory Tract Diseases
PubMed: 8575588
DOI: No ID Found -
Sensors (Basel, Switzerland) Nov 2022The implementation of robotic systems for minimally invasive surgery and medical procedures is an active topic of research in recent years. One of the most common...
The implementation of robotic systems for minimally invasive surgery and medical procedures is an active topic of research in recent years. One of the most common procedures is the palpation of soft tissues to identify their mechanical characteristics. In particular, it is very useful to identify the tissue's stiffness or equivalently its elasticity coefficient. However, this identification relies on the existence of a force sensor or a tactile sensor mounted at the tip of the robot, as well as on measuring the robot velocity. For some applications it would be desirable to identify the biomechanical characteristics of soft tissues without the need for a force/tactile nor velocity sensors. An estimation of such quantities can be obtained by a model-based state observer for which the inputs are only the robot joint positions and its commanded joint torques. The estimated velocities and forces can then be employed for closed-loop force control, force reflection, and mechanical parameters estimation. In this work, a closed-loop force control is proposed based on the estimated contact forces to avoid any tissue damage. Then, the information from the estimated forces and velocities is used in a least squares estimator of the mechanical parameters. Moreover, the estimated biomechanical parameters are employed in a Bayesian classifier to provide further help for the physician to make a diagnosis. We have found that a combination of the parameters of both linear and nonlinear viscoelastic models provide better classification results: 0% misclassifications against 50% when using a linear model, and 3.12% when using only a nonlinear model, for the case in which the samples have very similar mechanical properties.
Topics: Robotics; Bayes Theorem; Palpation; Touch; Minimally Invasive Surgical Procedures
PubMed: 36433266
DOI: 10.3390/s22228670 -
Chiropractic & Manual Therapies Jun 2021The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess...
OBJECTIVE
The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine.
MATERIALS
Reliability study that used a convenience sample of 51 patients between the ages of 16-70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other's findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure.
RESULTS
When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88-0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53-0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45-0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test.
CONCLUSIONS
Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Neck Pain; Palpation; Physical Examination; Reproducibility of Results; Young Adult
PubMed: 34127016
DOI: 10.1186/s12998-021-00377-2 -
Clinical Medicine & Research Dec 2019This paper describes medical eponyms associated with abdominal palpation from the period 1926-1976. Despite opposition by some, eponyms are a long standing tradition and...
BACKGROUND
This paper describes medical eponyms associated with abdominal palpation from the period 1926-1976. Despite opposition by some, eponyms are a long standing tradition and widely used in medicine. The techniques may still be useful in some cases, assisting in the selection of an appropriate and cost-effective approach to patient care. In this piece, we cover signs named in honor of physicians who contributed to medicine by developing new palpatory techniques in an attempt to better diagnose disease of the abdominal wall, umbilicus, gallbladder, pancreas, and appendix.
DATA SOURCES
PubMed, Medline, online Internet word searches, textbooks, and references from other source texts. 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, Acute; Eponyms; History, 19th Century; History, 20th Century; Humans; Palpation; Physical Examination; Physicians; United States
PubMed: 31308023
DOI: 10.3121/cmr.2018.1427