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Manual muscle strength testing is the primary method for testing muscle strength in clinical settings but is highly subjective. An objective measure of muscle strength can be obtained using a handheld dynamometer, but its cost inhibits its widespread usage. We hypothesized that a spring tensiometer (ST) could be an objective tool that can be used as a viable alternative to a dynamometer. Twenty-six outpatients were included, and the strengths of several muscle groups were measured using tensiometers and dynamometers. A paired t -test and Pearson's correlation coefficient and Bland–Altman plot analyses were used to estimate the reliability and measurement accuracy of both tools. Multiple regression analysis was performed to identify the factors contributing to the measurement gap between the two instruments. A total of 260 muscle force values were evaluated. Pearson's correlation coefficient and Bland–Altman analyses indicated that the measurements of the two instruments were strongly correlated and highly accurate. In the multiple regression analysis, the gap between the two instruments was significantly related to the original muscle strength and muscle part but was not significantly related to sex, age, body mass index, or laterality. For biceps and triceps muscle groups, the correlations were particularly strong and accurate, indicating that a tensiometer could be well substituted for a dynamometer. Our data show that a ST is similar to a dynamometer in terms of precision. A ST is an inexpensive alternative to a dynamometer and more accessible for clinical use than a dynamometer. [ABSTRACT FROM AUTHOR]

Objectives Studies have examined floor-to-stand performance in varied adult populations both quantitatively and qualitatively. Despite an elevated risk of falls and inability to independently return to stand after a fall, few have examined the ability to stand from the floor in patients recovering from stroke. There were 2 objectives of the study: to identify the relationships between floor-to-stand performance using a timed supine-to-stand test (TSS) and physical performance measures of gait, balance, and balance confidence among persons in the subacute phase after stroke; and to analyze descriptive strategies used in the completion of the TSS. Methods A cross-sectional design was implemented. Fifty-eight adults (mean age = 59.2 [standard deviation (SD) = 13.9] years; 34 [58.6%] men) who were in the subacute phase after ischemic or hemorrhagic stroke and who could stand from the floor with no more than supervision completed the TSS and physical performance assessments. Results The median time to complete the TSS in our sample was 13.0 (interquartile range = 15.5) seconds. TSS time was significantly correlated with physical performance tests, including the Timed "Up & Go" Test (ρ = 0.70), gait speed (ρ = −0.67), Dynamic Gait Index (ρ = −0.52), and Activities-Specific Balance Confidence Scale (ρ = −0.43). Thirty-two percent of the variance in TSS time was attributed to Timed "Up & Go" Test time and the use of the quadruped position to transition to standing. Participants who used a gait device were more likely to use a chair during rise to stand. Conclusion The TSS demonstrates concurrent validity with physical performance measures. Impact Findings serve to improve functional mobility examination after stroke and to formulate effective treatment interventions to improve floor-to-stand performance. [ABSTRACT FROM AUTHOR]

Background: Physical examination is a core medical skill and central to the clinical education of students. Peer-to-peer examination (PPE) in small groups with partial undressing is a well established didactic method. However, studies from various fields suggest that PPE impairs learning with subsequent deficits in physical examination. In this study, students were asked about their perceptions of PPE and preferences for course development. Methods: This web-based cross-sectional study surveyed medical students who had completed the examination course 2-4 semesters ago. The questionnaire addressed students' sociodemographic characteristics, their experiences with PPE, and their preferences for improving the course format. A logistic regression model analyzed the relationship between students' willingness to participate in PPE and preferences for enhancing the learning format. Results: The response rate was 39.5% (n= 156); 73.4% were female. The majority agreed that PPE is an important experience for future physicians (96.5%, n= 138), PPE is an appropriate teaching method (89.5%, n= 128), and they felt increasingly comfortable during the course (75.2%, n= 107). However, 13.3% (n= 19) of students were unwilling to be examined, and 22.4% (n= 32)were unwilling to be examined on ≥ 1 body part. In addition, 31.5% (n= 45) reported ≥ 1 issue with learning using PPE, and 12.2% (n= 17) felt forced to participate. Students chose on average 5.8 of 14 (standard deviation 1.9) suggestions to adapt the course format. Students who were unwilling to participate in PPE of ≥ 1 body region (23.8%, n= 34) were significantly more likely to indicate course modifications: training first on dummies (35.3% vs. 12%, p= 0.005) or actors trained as standardized patients (23.5%vs. 5.6%, p= 0.005), room separation by curtains (54.8% vs. 17.9%, p< 0.001), and same-sex tutors (24.2% vs. 1.9%, p< 0.001). Conclusion: Most students rated PPE positively, but about 30% indicated that they were not satisfied with the format. Options to further develop the teaching format were particularly preferred by students who were more uncomfortable with peer-topeer physical examinations. [ABSTRACT FROM AUTHOR]

Although the initial description of the distal biceps tendon (DBT) hook test (HT) reported 100% sensitivity (Sn) and specificity (Sp), subsequent retrospective series have demonstrated imperfect validity. The purpose of this investigation was to prospectively assess the validity and reliability of the HT for complete DBT ruptures. We aimed to determine the Sn/Sp and interrater reliability for the HT. A consecutive series of adult patients presenting to our outpatient clinics with an elbow complaint was prospectively examined. Patients were included if they had undergone advanced imaging (magnetic resonance imaging or ultrasound) that imaged the DBT and underwent DBT repair. There were four participating surgeons, all of whom were blinded to magnetic resonance imaging/ultrasound prior to performing the HT. To determine the Sn/Sp of the HT and advanced imaging, intraoperative findings served as the primary reference standard. The interrater reliability of the HT was calculated for cases in which a primary examiner (surgeon) and secondary examiner (physician assistant or resident) performed the HT. Of 64 patients who had undergone advanced imaging, 28 (44%) underwent DBT surgery and were included in the assessment of Sn/Sp. The mean age was 49 years, and all patients were men. The Sn and Sp of the HT were 96% and 67%, respectively. Advanced imaging demonstrated 100% Sn and Sp. Twenty-five patients were evaluated by a primary and secondary examiner. The interrater reliability was substantial (Cohen kappa, 0.71). The Sn and Sp of the HT were 96% and 67%, respectively, when assessed prospectively. Advanced imaging findings (magnetic resonance imaging/ultrasound) demonstrated 100% Sn and Sp. The HT can be performed reliably by examiners with varying experience levels. Considering the imperfect validity of the HT, we caution against the use of this examination alone to diagnose DBT ruptures. Diagnostic II. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of accurately detecting ulnar nerve subluxation in vulnerable athletes, few studies have compared the performance of physical examination and ultrasound in this population. Purpose/Hypothesis: The purpose of this study was to compare the diagnostic validity of physical examination versus ultrasound in detecting ulnar nerve subluxation at the cubital tunnel of the elbow in professional baseball pitchers. It was hypothesized that ultrasound would more sensitively detect ulnar nerve subluxation. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Physical and sonographic examinations for ulnar nerve subluxation were performed on 186 elbows of 95 consecutive male professional baseball pitchers (age, 17-30 years) as a routine part of their spring training assessments. Provocative maneuvers consisting of the Tinel and elbow flexion-compression tests were evaluated over the cubital tunnel. The validity of physical examination for detecting ulnar nerve subluxation at the elbow was determined using ultrasonographic examination for comparison. Results: Ulnar nerve subluxation was detected by physical examination in 58 (31.2%) elbows and by ultrasonography in 61 (32.8%) elbows. Of the 58 elbows with positive physical examination, 47 were positive on ultrasound. Using a positive ultrasound as a reference, the accuracy of the physical examination was 86.6%, with 77% sensitivity and 91.2% specificity. The positive and negative predictive values of physical examination were 81% and 89.1%, respectively. There was no relationship between nerve instability and positive provocative tests overall, in dominant versus nondominant arms, or in right versus left arms (P >.05 for all). Conclusion: Physical examination had moderate sensitivity and high specificity for detecting ulnar nerve subluxation at the cubital tunnel of the elbow when compared with ultrasound. These findings suggest that when detecting the presence of a subluxating ulnar nerve is most important, it may be advisable to obtain an ultrasound evaluation instead of relying on a physical examination; however, physical examination alone may be appropriate for ruling out subluxation. [ABSTRACT FROM AUTHOR]

Prematurity, which occurs in about 12% of pregnancies worldwide, continues to be one of the leading causes of perinatal morbidity and mortality worldwide. Preterm birth (PTB) can still be considered a syndrome with a variety of causes and underlying factors, which results in mostly unnoticed contraction of the uterus and changes in the cervix. Despite considerable effort aimed at decreasing the incidence of spontaneous PTB, PTB remains the leading cause of perinatal morbidity and mortality. In light of the available data, screening strategies for PTB are deficient. Approaches used to identify women considered by historical factors to be low risk for preterm delivery, as well as those at high risk for PTB, continue to evolve. Ultrasound evaluation of the cervix during pregnancy has been the focus of much research during the past decades. Cervical measurement by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous PTB in high- and low-risk singleton pregnancy. Cervical shortening, which is often detected on ultrasound examination before it can be appreciated on physical examination, is one of the first steps in the processes leading to labor and can precede labor by several weeks. This is likewise true for funneling and loss of cervical gland area, which cannot be assessed with the physical examination. Therefore, all of these markers, especially if they are used together, can be useful to predict PTB and start adequate therapy as soon as possible to prevent spontaneous preterm delivery. [ABSTRACT FROM AUTHOR]

Background: Neglected partial subscapularis tears often cause functional impairment even after repair of the supraspinatus and infraspinatus tear is done. Numerous physical examinations for detecting partial subscapularis tears have been described in previous studies. Purpose: To analyze the relationship between the preoperative clinical features and the severity of a partial subscapularis tear and to provide diagnostic clues for patients requiring subscapularis repair. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study included 286 patients who underwent arthroscopic shoulder surgery between 2020 and 2022. Preoperative clinical features, including range of motion, functional scores, muscle strength ratio, modified belly-press test (measuring belly-press angle), and bear-hug test, were collected. Magnetic resonance imaging (MRI) evaluation was done according to the Yoo and Rhee classification. Types of subscapularis tear, supraspinatus lesion, and biceps lesion were recorded during arthroscopic surgery. A comparison of preoperative clinical features between the no-repair group (type 2A or less) and surgical repair group (type 2B or more) was done. The optimal cutoff value of the belly-press angle was determined and the diagnostic performance of the belly-press angle, bear-hug test, and MRI were evaluated using the receiver operating characteristic curve. Results: Among 286 patients, 189 (66.1%) had subscapularis tears with type 2A or more. There was a significant difference in muscle strength ratio of the belly-press (P <.001), belly-press angle (P <.001), and bear-hug test (P <.001) between the no-repair group (type 2A or less) and the surgical repair group (type 2B or more). With a belly-press angle of 15° as a new cutoff value, the modified belly-press test showed 67.6% sensitivity, 73.9% specificity, and 69.6% accuracy in detecting type 2B or higher subscapularis tear. Conclusion: Patients with type 2A and 2B subscapularis tears (according to the Yoo and Rhee classification) showed differences in belly-press strength ratio, belly-press angle, and bear-hug test. The cutoff value of the 15° belly-press angle showed an accuracy of 69.6% in detecting subscapularis tears with type 2B or higher. [ABSTRACT FROM AUTHOR]

Vertebrobasilar vascular pathology and upper cervical ligament instability may contraindicate the use of cervical manual therapy. We examined physical therapists' documentation of screening for these conditions and hypothesized screening would be more common with specific risk factors and when using manual therapy. This chart review included adults with neck pain presenting for outpatient physical therapy from 2015–2021. Exclusions were age<18 and history of cervical spine surgery. Demographics, vertebrobasilar and upper cervical ligament instability screening questions and examination tests, risk factors (i.e. hypertension, whiplash), and use of manual therapy were extracted. 260 patients were included (mean age ± standard deviation 59.6 ± 16.2 years, 70.8% female). Physical therapists infrequently administered vertebrobasilar and upper cervical ligament instability tests (each<14%). Screening questions were generally more common (e.g. headache, visual disturbances; each>13%). There was no significant difference in any frequency of screening method given the presence of hypertension, whiplash, or use of manual therapy (p >.05 for each). In the present study, physical therapists infrequently documented performance of vertebrobasilar or upper cervical ligament instability screening for adults with neck pain, even in the presence of risk factors or preceding manual therapy. Further research should corroborate these findings and explore reasons for use/avoidance of screening. [ABSTRACT FROM AUTHOR]

According to US Customs and Border Protection, over 473,000 family units and 76,000 unaccompanied children were apprehended in 2019, a multi-fold increase from previous years. Thus, the number of children who may be eligible for humanitarian relief has increased significantly. For those claiming humanitarian relief, forensic medical evaluations performed by health professionals can provide critical evidence to bolster claims. In this cross-sectional, nationwide survey-in which we sought to characterize specialties, forensic training, capacity, and scope of humanitarian relief evaluations for immigrant children under eighteen-years-old-only 28 providers, half of whom were Child Abuse Pediatricians, reported performing humanitarian relief evaluations. The most common reported type of humanitarian relief evaluation conducted was for asylum. We found that the current training for forensic medical evaluations for humanitarian relief in pediatrics is likely varied not well-defined, and not pediatric-specific. In order to protect the rights of children who are eligible for humanitarian relief, pediatric and family medicine forensic medical evaluation training standards and curricula need to be developed; validated humanitarian relief screening tools need to be tested and utilized; and residents and attending physicians, including specialists with expertise in forensic evaluations, need to be actively recruited to perform these evaluations in collaboration with legal aid organizations.

Systematic and standardized evaluation of superficial venous disease, guided by knowledge of the various clinical presentations, venous anatomy, and pathophysiology of reflux, is essential for appropriate diagnosis and optimal treatment. Duplex ultrasonography is the standard for delineating venous anatomy, detecting anatomic variants, and identifying the origin of venous insufficiency. This article reviews tools and techniques essential for physical examination and ultrasound assessment of patients with superficial venous disease.

Background Clinicians vary markedly in their ability to detect murmurs during cardiac auscultation and identify the underlying pathological features. Deep learning approaches have shown promise in medicine by transforming collected data into clinically significant information. The objective of this research is to assess the performance of a deep learning algorithm to detect murmurs and clinically significant valvular heart disease using recordings from a commercial digital stethoscope platform. Methods and Results Using >34 hours of previously acquired and annotated heart sound recordings, we trained a deep neural network to detect murmurs. To test the algorithm, we enrolled 962 patients in a clinical study and collected recordings at the 4 primary auscultation locations. Ground truth was established using patient echocardiograms and annotations by 3 expert cardiologists. Algorithm performance for detecting murmurs has sensitivity and specificity of 76.3% and 91.4%, respectively. By omitting softer murmurs, those with grade 1 intensity, sensitivity increased to 90.0%. Application of the algorithm at the appropriate anatomic auscultation location detected moderate-to-severe or greater aortic stenosis, with sensitivity of 93.2% and specificity of 86.0%, and moderate-to-severe or greater mitral regurgitation, with sensitivity of 66.2% and specificity of 94.6%. Conclusions The deep learning algorithm's ability to detect murmurs and clinically significant aortic stenosis and mitral regurgitation is comparable to expert cardiologists based on the annotated subset of our database. The findings suggest that such algorithms would have utility as front-line clinical support tools to aid clinicians in screening for cardiac murmurs caused by valvular heart disease. Registration URL: https://clinicaltrials.gov; Unique Identifier: NCT03458806.

Telerehabilitation for pain management uses communication technology to minimize geographic barriers. Access to such technology has proven critically important during the coronavirus disease-2019 pandemic and has been useful for patients with chronic pain disorders unable to travel. The evaluation and treatment of such disorders requires a whole health approach that individualizes treatment options and delivers care through a biopsychosocial approach. The goals of care are unchanged from an in-person patient-provider experience. Telerehabilitation can be successfully implemented in pain management with appropriate consideration for staging an evaluation, a structured approach to the visit, and application of standard clinical metrics.

Advising patients before air travel is a frequently overlooked, but important, role of the physician, particularly primary care providers and pulmonary specialists. Although physiologic changes occur in all individuals during air travel, those with underlying pulmonary disease are at increased risk of serious complications and require a specific approach to risk stratification. We discuss the available tools for assessment of preflight risk and strategies to minimize potential harm. We also present a case discussion to illustrate our approach to assessing patients for air travel and discuss the specific conditions that should prompt a more thorough preflight workup.

Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%–99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%–30.0%) to 69.4% (95% CI, 57.3%–79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained. Level of evidence IV.

Abstract Aim We aim to develop and validate a nomogram including readily available clinical and laboratory indicators to predict the risk of metabolic-associated fatty liver disease (MAFLD) in the Chinese physical examination population. Methods The annual physical examination data of Chinese adults from 2016 to 2020 were retrospectively analyzed. We extracted the clinical data of 138 664 subjects and randomized participants to the development and validation groups (7:3). Significant predictors associated with MAFLD were identified by using univariate and random forest analyses, and a nomogram was constructed to predict the risk of MAFLD based on a Lasso logistic model. Receiver operating characteristic curve analysis, calibration curves, and decision curve analysis were used to verify the discrimination, calibration, and clinical practicability of the nomogram, respectively. Results Ten variables were selected to establish the nomogram for predicting MAFLD risk: sex, age, waist circumference (WC), uric acid (UA), body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure (SBP), fasting plasma glucose (FPG), triglycerides (TG), and alanine aminotransferase (ALT). The nomogram built on the nonoverfitting multivariable model showed good prediction of discrimination (AUC 0.914, 95% CI: 0.911–0.917), calibration, and clinical utility. Conclusions This nomogram can be used as a quick screening tool to assess MAFLD risk and identify individuals at high risk of MAFLD, thus contributing to the improved management of MAFLD.

Pseudomonas aeruginosa is a conditional pathogen, which is a common pathogen in nosocomial infections and relatively rare in community infections. At present, there are few reports on the clinical manifestations of Pseudomonas aeruginosa infection, especially regarding the lymphoid tissue infection caused by Pseudomonas aeruginosa. This paper reported a case of lymphoid tissue infection caused by Pseudomonas aeruginosa, summarized its clinical manifestations and treatment process, in order to improve the clinical understanding of the diagnosis and treatment of this disease.

Yimy F Medina,1,2,&ast; Alvaro J Ruiz,1,&ast; Martin A Rondon1 1PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia; 2Rheumatology Unit, Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia&ast;These authors contributed equally to this workCorrespondence: Yimy F Medina, Email yimy.medina@gmail.comIntroduction: Rheumatoid arthritis activity is evaluated based on a physical examination of each of the joints. However, the joint examination is not standardized, and the techniques are variable and difficult to reproduce due to disagreements among examiners.Objective: To recommend standardized joint examination techniques based on the modified RAND-UCLA appropriateness method.Methods: A review of the literature was conducted to determine the items to be included in the joint examination; subsequently, a consensus of rheumatologists was achieved with the modified RAND-UCLA methodology to issue the recommendations. The diagnosis of RA and differential diagnoses were excluded.Results: Two hundred fifteen rheumatologists were invited to participate. Five were included in the core group and 26 in the group of clinical experts. Clinical experience ranged between 2 and 25 years (mean 15.6 years; standard deviation 6.3 years). Most rheumatologists participated in all rounds (Round 1: 100%, Round 2: 61%, and Round 3: 61%). Of the 45 statements in the questionnaire assessing the examination techniques, 28 (62%) were retained. In addition, 6 other statements were included during the face-to-face meeting for a total of 34 final statements.Conclusion: Physical examination techniques for joints that determine RA activity are heterogeneous and differ markedly in terms of several characteristics. A list of recommendations is proposed as a guide to improve and standardize the method for the physical examination of the joints. This standardization will improve the diagnosis and results for patients with RA and help health caregivers provide better treatment.Keywords: rheumatoid arthritis, physical examination, joints, diagnosis, disease activity, consensus

Objective To explore the risk factors of non-alcoholic fatty liver disease (NAFLD) in young adults and to establish a model for prediction, in order to provide reference for the early prevention of the disease in young people. Methods A retrospective analysis was performed on the young adults who underwent routine physical examination in the Department of Physical Examination from January 2018 to June 2022. Totally 365 adults with NAFLD were divided into the NAFLD group(observation group), and 273 healthy adults were divided into the Healthy group (control group). The differences in general information and blood drawing results between the two groups were analyzed. Results The proportion of male, smoking and hypertension in the NAFLD group was significantly higher than that in the Healthy group; The mean values of BMI and low density lipoprotein-cholesterol in the NAFLD group were significantly higher than those in the Healthy group; The median values of triglyceride, total cholesterol, uric acid, alanine aminotransferase, aspartate aminotransferase and glycosylated hemoglobin in the NAFLD group were higher than those in the Healthy group, with significant difference(P＜0. 05). Multivariate regression analysis showed that BMI increased (OR=1. 429; 95%CI=1. 306～1. 563; P=0. 001), triglyceride (OR=1. 524; 95%CI=1. 086～2. 137; P=0. 015), serum uric acid (OR=1. 005; 95%CI=1. 001~1. 008; P=0. 019), alanine aminotransferase (OR=1. 049; 95%CI=1. 026~1. 071; P=0. 001), aspartate aminotransferase (OR=0. 986; 95%CI = 0. 972～0. 999; P=0. 038), glycosylated hemoglobin (OR=7. 800; 95%CI=3. 666～16. 597; P=0. 001) were independent risk factors for NAFLD(P

Background Stroke is one of the major public health problems affecting human health in current. Longitudinal check up data has accumulated a large amount of health information. However, the utilization rate of the longitudinal check up data is low and important information has not been fully extracted due to many problems such as missing data and small sample size, which brings difficulties to the effective prevention and control of common chronic diseases. Objective To explore the risk factors of stroke in check-up population based on Bayesian multivariate joint model, so as to provide a new approach for the analysis of risk factors for chronic diseases. Methods In this study, the data were collected from the Center for Health and Medicine, Xijing Hospital, Air Force Military Medical University from 2008 to 2015. Follow-up status: the follow up was conducted with the first occurrence of stroke as the outcome event and stopped at the occurrence of outcome event or ended when the collection of medical examination information was completed by 2015 if the outcome event did not occur. The interval between physical examinations was 1 year. The participants were divided into the stroke group and the non-stroke group according to whether stroke occurred during follow-up. Longitudinal variables observed in this study included total cholesterol (TC) , triglyceride (TG) , low density lipoprotein cholesterol (LDL-C) , high density lipoprotein cholesterol (HDL-C) , body mass index (BMI) and systolic blood pressure (SBP) . Multivariate Cox regression model was used to analyze the influence of baseline conditions on stroke outcome events. Bayesian multivariate joint model was used for analyzing the effect of longitudinal trajectory of TC, TG, LDL-C, HDL-C, BMI and SBP on the incidence of stroke during follow-up. Results A total of 234 subjects with 1 581 longitudinal follow-up records were included in this study, with the mean follow-up time of (7.4±1.2) years, of which 70 cases (29.9%) developed stroke during the follow-up. The results of multivariate Cox proportional hazards model showed that there was no effect of baseline values including TC, TG, LDL-C, HDL-C, BMI and SBP on the incidence of stroke (P>0.05) . The results of Bayesian multivariate joint model showed that the risk of stroke was 1.863 times higher for per longitudinal increase of 1 mmol/L TG level 〔95%CI (1.018, 3.294) , P=0.042〕 and 1.347 times higher for per longitudinal increase of 1 mmol/L LDL-C level〔95%CI (1.045, 1.863) , P=0.046〕. Conclusion The longitudinal increase of TG and LDL-C levels over time is a risk factor for stroke in check-up population. Bayesian multivariate joint model can be used to explore the risk factors of chronic diseases in check-up population.

Background As with other chronic diseases, cancer presents a multidimensional state. And many chronic diseases share common risk factors with cancers. The association between a single chronic disease indicator and the risk of cancer is weak, so it is significant to construct a risk score composed of multiple chronic disease indicators and analyze its association with the risk of cancer. Objective To investigate the association between chronic disease risk score and cancer risk. Methods This study selected a total of 18 009 eligible individuals who had participated in Tianjin Chronic Disease Risk and Health Management Cohort Study and undergone physical examination in Health Management Center, Tianjin Medical University General Hospital from January 2015 to December 2019. All subjects completed the health risk assessment questionnaire, physical examination, and laboratory examination. Follow-up ended on the day of cancer occurrence or the day of follow-up termination (December 31, 2019) . Multivariate Cox regression model was used to evaluate the relationship of the risk of cancer (used as the dependent variable) with each of the chronic disease related indicators〔consisting of BMI, waist circumference, blood pressure, blood glucose, total cholesterol, triglyceride, uric acid, total bilirubin, heart rate, and estimated glomerular filtration rate (used as independent variables) 〕. And then the comprehensive score of chronic disease risk was calculated, and the cancer risk in tertile groups of the score 〔low-score group (

Background: Bedside teaching is a concentrated form of small-group teaching that takes place in the presence of the patient. Improvement in communication skills in a sympathetic manner with the patient and the ability to provide a purposeful history description and earning skills in clinical examinations is a goal that can only be achieved at the patient’s bedside. Bedside teaching has declined in recent years despite all its benefits; however, there are strong recommendations to continue this teaching modality for its valued benefits. In this context, we aimed to deal with the importance of bedside teaching and the challenges ahead in the covid epidemic as well as its alternatives for teaching medical students. Evidence acquisition: This study was conducted through a literature search on articles in English with the relevant keywords (((((((“students, medical”[Mesh]) AND (“COVID-19”[Mesh])) AND (“education”[Mesh])) AND (“patient-centered care”[Mesh])) AND (“patient care team”[Mesh])) OR (“teaching rounds”[Mesh])) OR (“education, distance”[Mesh])) AND (“Physical examination”[Mesh]) using PubMed, Scopus, Web of Sciences, Cochrane, and Embase databases from 2001 to 2022. Results: In our search, 22 related articles were found, 3 of which were clinical trials) and 4 were review articles. This study summarized the following important issues related to bedside teaching: 1- We discussed the definition, importance, benefits, and difficulties of bedside teaching on the way to education; 2- We deliberated the causes of reluctance to carry out education at the bedside and the ways to deal with the reduction of its implementation; 3-we also noticed alternative methods for medical education in periods of special contact restrictions with patients such as the COVID-19 epidemic in this review. Conclusions: Bedside teaching has a fundamental role in medical education. In particular circumstances, such as covid 19 epidemy, in which the bedside teaching courses were suspended, it is necessary to allocate other educational arrangements and design a distance learning curriculum, including virtual teaching, uploading videos to view clinical procedures on social media platforms, interview with a virtual patient, and simulation.

Aims: Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. Methods: A five-year prospective registry study investigating every live birth in the study’s catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). Results: The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. Conclusion: The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance. Cite this article: Bone Jt Open 2023;4(4):234–240.

BackgroundTrauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified.ObjectiveThe object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools.MethodsThe PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively.FindingsSurgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures.ConclusionsSurgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India.

High-flow priapism (HFP) during childhood is a very rare condition. Low-flow priapism (LFP) is an urological emergency, but HFP is not. Thus, it is important to make a differential diagnosis between LFP and HFP. The Piesis Maneuver can be used as a physical examination for differential diagnosis between LFP and HFP, as well as to roughly locate the arteriocavernosal fistula in childhood HFPs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their impacts on students’ learning. METHODS: This cross-sectional study, based on a self-designed questionnaire was conducted at two Pakistani medical colleges which included final year students, and post graduate trainees. RESULTS: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative impact on IAE learning. A high percentage of respondents reported that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed. CONCLUSION: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

ABSTRACT BACKGROUND: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION: Concentrated laboratory practice resulted in positive improvements in students’ physical examination skills.

Background: Superior labrum anterior to posterior (SLAP) lesions are targeted on physical examination using a variety of provocative maneuvers. Purpose/Hypothesis: The purpose was to conduct a systematic review on the performance of physical examination maneuvers in diagnosing SLAP lesions and to perform a meta-analysis comparing the sensitivity and specificity of these examinations both individually and in combination. The null hypothesis stated that there would be no significant difference in the sensitivity or specificity of the included physical examination tests, neither individually nor in combination. Study Design: Meta-analysis and systematic review; Level of evidence, 4. Methods: A systematic review was performed with the inclusion criteria of studies that reported either the sensitivities and specificities or the number of true-positive, true-negative, false-positive, or false-negative results for at least 1 maneuver for identifying SLAP lesions. A meta-analysis was performed to determine the sensitivity and specificity of individual maneuvers. Additional analysis determined the performance of these maneuvers when combined in series and parallel. In series, all must be present to be considered positive. In parallel, any single positive test forces the overall combination to be considered positive. Only tests that were included in ≥3 studies were considered in the meta-analysis and those included in ≥4 studies were considered in the combination analysis. Results: Overall, 862 studies were identified, 18 of which were included in the systematic review and meta-analysis. The physical examinations included were the O'Brien (n = 16), speed (n = 8), Yergason (n = 6), anterior slide (n = 8), crank (n = 7), Jobe (n = 5), dynamic labral shear (n = 3), Kim 2 (n = 3), and biceps groove tenderness tests (n = 3). All combinations of 2 to 5 maneuvers in both series and parallel were considered. The O'Brien and crank test combination was the most sensitive 2-test combination in both parallel and series. The Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series. Conclusion: This systematic review and meta-analysis reports an updated meta-analysis considering the sensitivity and specificity of common physical examination maneuvers used in the diagnosis of SLAP lesions and considers these values for tests in both series and parallel combinations. The present analysis demonstrates improved specificities when tests are considered in series and improved sensitivities when considered in parallel combination. [ABSTRACT FROM AUTHOR]

Insufficient physical function is strongly associated with decreased activity of daily living and health-related quality of life in middle-aged and older women. YOSAKOI Soran is one of the traditional Japanese dances to have naruko (wooden hand clappers) in their hands as they dance and incorporate the phrase from the Soran Bushi in their song. YOSAKOI Soran festivals can be seen being held in various places across the country, proving its growing popularity with residents as a celebration regardless of age or occupation. The purpose of this study was to examine the cross-sectional associations between YOSAKOI Soran and the physical functions of middle-aged and older women. A total of 30 middle-aged and older women practicing YOSAKOI Soran (YOSAKOI group) and 163 middle-aged and older women who had not practiced YOSAKOI Soran (control group) participated in this cross-sectional study. Handgrip strength, 30-second chair stand performance, and flexibility were used to measure physical functions. Handgrip strength was not significantly differed between the YOSAKOI group and the control group (P = 0.79). 30-second chair stand performance and flexibility were significantly higher in the YOSAKOI group than in the control group (both P < 0.05). These results remained significant after adjusting for age and body mass index (both P < 0.05). The present results suggest that practicing YOSAKOI Soran may increase lower extremity function and flexibility in middle-aged and older women. [ABSTRACT FROM AUTHOR]

Few studies have analyzed the acceptance of home/community-based medical and elderly care services in China. Therefore, we conducted a cross-sectional study to describe the acceptance of five services among people aged ≥ 45 years in the China mainland, and their influencing factors. The data were obtained from the database China Health and Retirement Longitudinal Study 2018. For each service, a binary logistics regression was adopted. A total of 9719 people were included, of whom 20.12% received services. The numbers of recipients (acceptance rates) of the five services, namely, comprehensive aged care services, regular physical examinations, onsite visits, health management, and entertainment, were 107 (1.10%), 1640 (16.87%), 323 (3.32%), 156 (1.61%), and 245 (2.52%), respectively. About 4% of people had received two or more services. The elderly aged 65–74 and those who were satisfied with the local medical services had higher acceptance of services. Urban hukou having health insurance, two or more chronic diseases, provincial economic welfare, and social welfare were positively associated with the acceptance of regular physical examination services. It is suggested that the government should gradually improve satisfaction with local medical services, and pay more attention to the needs of elderly people aged 65–74 for all kinds of home/community-based medical and elderly care services. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Archives of Lung is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Child abuse and neglect is a common, underreported, and worldwide problem. Health care providers play an important role in detecting and reporting this problem. This study examined the knowledge on the clinical signs and mimickers of child abuse among Belgian trainees in family medicine and pediatrics. Participants filled out an anonymous online survey of 15 fictional but realistic cases with either suspicious or non-suspicious signs of abuse or neglect in the context of primary or emergency care. The overall score on all cases, the number of correct answers per case, and the median score were calculated, and the association of the participant's demographic characteristics with their score was examined using regression analysis. A total of 70 participants completed the survey. The overall median score was 73.3% (IQR 20.0%). The suspicious cases were solved more correctly than the non-suspicious cases (median: 85.7% versus 62.5%, p < 0.001). Regression analysis could not reveal a significant association of type and level of education with the performance on the survey. Knowledge of the clinical signs of child maltreatment among pediatricians and general practitioners in training is good, but there is still room for improvement. [ABSTRACT FROM AUTHOR]

Knowledge of reference values for cervical muscle strength is a key tool for clinicians to use as a clinical reference measure and to establish goals during rehabilitation. The objective was to establish reference values for the maximal strength of cervical muscles in healthy women using a handheld dynamometer and verify the association of cervical muscle strength with age and anthropometric measurements. A hundred women were classified into four groups (n = 25) according to age: 18–29 years, 30–39 years, 40–49 years, and 50–60 years. Maximal muscle strength of the cervical spine was measured using a Lafayette® handheld dynamometer for flexion, extension, and bilateral lateral flexion. No differences in cervical muscle strength were observed among the groups (p > 0.05). However, the 18–29-year-old group took less time to reach the peak of force for flexion than the 50–60-year-old group. Moderate correlations were observed between cervical flexor strength and weight, body mass index, and neck circumference, and between cervical extensor strength and weight and body mass index (r = 0.43–0.55; p < 0.05). Reference values for cervical muscle strength in healthy women were established using a handheld dynamometer, and the association between muscle strength and anthropometric data was moderate. [ABSTRACT FROM AUTHOR]

Physical examination (PE) of donors is essential to identify potential risks to the safety and efficacy of donated organs and tissues and is mandatory in the EU. However, no detailed guidance is available as to how PE should be performed. Health authorities (HA) and health professionals (HP) inmember states of the European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) and observer countries completed surveys relating to the regulatory requirements for PE and the professional practice of PE in their countries for organ and tissue donors. The HA survey addressed regulatory aspects, and the HP survey addressed professional practices, training, and respondents' opinions on the value of PE. These surveys revealed significant inter-country variation in the regulatory approach to PE and the performance of PE by professionals. Most respondents opined that PE was important and yielded valuable information in identifying contraindications to donation. There is no consensus at a regulatory or professional level as to how PE should be performed on organ and tissue donors. There is a requirement for agreed best practice guidelines in this area. [ABSTRACT FROM AUTHOR]

Aims: To describe the perceived barriers to nurses performing physical assessments of patients in rehabilitation wards. Secondarily, to investigate how sociodemographic and professional characteristics influence the use and frequency of physical assessments by nurses and their perceptions of barriers to their practice. Design: A multicentre, cross‐sectional, observational study. Methods: Data were collected from September to November 2020 among nurses working with inpatients in eight rehabilitation care institutions in French‐speaking Switzerland. Instruments included the Barriers to Nurses' use of Physical Assessment Scale. Results: Almost half of the 112 nurses who responded reported performing physical assessments regularly. The predominant perceived barriers to performing physical assessments were 'specialty area', 'lack of nursing role models' and 'lack of time and interruptions'. Greater clinical nursing experience in rehabilitation wards and more senior nurse specialist positions were associated with significantly lower use of physical assessment procedures by nurses. Conclusion: The present study revealed heterogeneity in the use of physical assessment by nurses practicing in rehabilitation units and highlighted their perceived barriers to this. Impact statement Most nurses working in rehabilitation care units did not routinely perform physical assessments as part of their daily clinical practice. These results should raise stakeholders' awareness of this fact. Effective interventions to increase the use of physical assessments in nursing practice are to be recommended, including continuing education or hiring enough highly qualified nurses as role models in wards. This will promote quality of care and patient safety in rehabilitation care units. Public and patient engagement and involvement: There was no patient or public involvement in the present study. [ABSTRACT FROM AUTHOR]

Objective To investigate the detection situation and characteristics of abnormal ECGs of on-post staff and workers in enterprises and institutions during physical examination, and to provide references for their preventive health care. Methods We selected ECG data of 15 225 on-post staff and workers from Xiangcheng District, Suzhou who had undergone routine physical examination in 2022. Descriptive statistical analysis was performed on the population distribution characteristics and clinical features of abnormal ECGs by different sexes and ages. Results The overall detection rate of abnormal ECGs is 31. 55%, mainly including sinus bradycardia (9. 07% ), ST-T changes (5. 96% ), right axis deviation (4. 43% ), left ventricular high voltage (2. 58% ), sinus tachycardia ( 2. 40% ), left axis deviation ( 1. 89% ), complete right bundle branch block ( CRBBB, 1. 66% ), and nonspecific intraventricular block (1. 25% ). The detection rate of abnormal ECGs in males is higher than that in females, with statistically significant difference (P < 0. 05). The detection rate of abnormal ECGs in the 51 - 60 age group is higher than that in other age groups of the same sex (P < 0. 05); there is no statistically significant difference of detection rate of abnormal ECGs between males and females of the 51 - 60 age group (P > 0. 05). The detection rate of single abnormal ECG index shows significant difference between ages or sexes. Right axis deviation, sinus tachycardia, and short PR interval are more common in the 21 - 30 age group while sinus bradycardia, ST-T changes, left ventricular high voltage,left axis deviation, CRBBB, premature beats, first degree atrioventricular block, and left anterior fascicular block are more common in the 51 - 60 age group. In the females, the detection rates of ST-T changes, sinus tachycardia, and accelerated atrial escape rhythm are significantly higher than those in the males while in the males, the detection rates of sinus bradycardia, left ventricular high voltage, left axis deviation, CRBBB, nonspecific intraventricular block,first degree atrioventricular block, and prolonged P-wave duration are significantly higher than those in the females (P <0. 05). Conclusion The detection rate of abnormal ECGs is relatively high among on-post staff and workers in enterprises and institutions, which is closely related to age and sex. Regular physical examination and targeted health management help to prevent cardiovascular diseases among this kind of population. [ABSTRACT FROM AUTHOR]

To identify the extent and quality of fine motor skill alteration in patients with Dupuytren disease (DD) using an instrumented device measuring grip forces, beyond the commonly used measurement of contracture. Case–control study. University outpatient clinic. Patients with DD (N=27) and a contracture >45° (Tubiana stage II, III, and IV) were included and compared with age-matched healthy control patients (N=27). Not applicable. All individuals were subjected to a set of specific tests using a new instrumented device ("manipulandum"). These included lifting, grasping, and then holding the "manipulandum" with 4 different object characteristics (light and heavy weight, rough and smooth surface) along with a measurement of the precision grip strength. Standard measurements including the Nine-Hole Peg Test, a two-point discrimination, and the Disability of Arm, Shoulder and Hand score were evaluated in comparison. Although the measurements of precision grip, two-point discrimination, Nine-Hole Peg Test, and Disability of Arm, Shoulder and Hand score showed no statistically significant differences between both groups, patients with DD applied significantly greater forces when tested with the different subtests using the "manipulandum." Analysis of the 2-phase movement (lifting and holding the "manipulandum") revealed highly significant differences between the groups. Patients with DD use excessive grip forces when lifting and holding the "manipulandum" when compared with healthy control patients, independent of the degree of contracture. As no differences in precision grip strength were seen, the presented approach is useful to obtain additional important information about fine motor function in diseased hands. [ABSTRACT FROM AUTHOR]

BACKGROUND: A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking. OBJECTIVE: We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees. METHODS: We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al. RESULTS: We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees. CONCLUSION: The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predictive ability of symptom self‐localization to distinguish obstructive eustachian tube dysfunction from non‐obstructive salpingitis. Methods: Adult (age ≥18 years) patients with a primary complaint of aural discomfort who underwent diagnostic nasal endoscopy and tympanometry at a tertiary academic center were enrolled. Symptoms were self‐localized by using a single finger on the affected side. All patients completed the 7‐item Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) and underwent scoring of eustachian tube inflammation using the Endoscopic Evaluation of the Eustachian Tube (3ET) system. Results: Seventy‐three patients were included in the study. Symptoms were localized to the external auditory canal (EAC) in 28 (38.4%), to the infratemporal fossa (ITF) below the lobule in 37 (50.7%), and to the preauricular region in 8 (11.0%). Demographics and medical history were similar between groups. The EAC group had significantly more negative tympanometric peak pressure (TPP) (median, −92.0 daPa; IQR, 95.5) and higher 3ET scores. In contrast, the ITF group had normal TPP (median, −2.0 daPa; IQR, 7.0) and higher 3ET scores. The preauricular group was more likely to have temporomandibular joint or pterygoid muscle pain. ETDQ‐7 scores did not differ significantly between groups. Conclusion: Symptom localization is associated with specific objective findings in the evaluation of aural discomfort. Patients with pain localizing to the ITF are more likely to have findings of eustachian tube salpingitis without obstruction whereas patients with symptoms deep in the EAC are more likely to have findings consistent with obstructive eustachian tube dysfunction. Level of Evidence: 3 Laryngoscope, 133:1818–1823, 2023 [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of metabolic associated fatty liver disease (MAFLD) in 7 421 employees of a company in Shiyan, Hubei Province, and the influencing factors of MAFLD. Methods According to the diagnostic criteria of MAFLD, 7 421 employees of Dongfeng Company who underwent physical examination were divided into the MAFLD group of 2 839 cases and non-MAFLD group of 4 582 cases. The gender, age and other data were collected, and we calculated the prevalence rate of MAFLD of different genders and ages. General data and blood biochemical indicators of the two groups were collected, including age, BMI, alanine aminotransferase (ALT), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), platelet count （PLT）, fasting blood glucose, uric acid, etc. With the presence or absence of MAFLD as the dependent variable and the indicators with statistical significance in the univariate analysis as independent variables and assigned values, mul⁃ tivariate Logistic regression analysis was conducted to analyze the influencing factors of MAFLD in 7 421 cases of physical examination. Results The prevalence of MAFLD among 7 421 subjects was 38. 3%, with 43. 8% in males and 17. 1% in females. The prevalence of MAFLD in males was significantly higher than that in females （P<0. 05）. The prevalence of male MAFLD patients <30 years old, 30-39 years old, 40-49 years old, and ≥50 years old was higher than that of female patients （P<0. 05）. Significant differences were found in the age, ALT, TG, TC, HDL-C, LDL-C, PLT, the detection rate of overweight/obesity, the detection rate of impaired fasting glucose, and the detection rate of hyperuricemia between 3 309 male physical examination subjects of the non-MAFLD group and 2 576 male subjects in the MAFLD group （all P< 0. 05）. Significant differences were found in the age, ALT, TG, TC, HDL-C, LDL-C, and PLT, the detection rate of overweight/obesity, the detection rate of impaired fasting glucose, and the detection rate of hyperuricemia between 1 273 non-MAFLD female subjects of the non-MAFLD group and 263 female subjects in the MAFLD group （all P<0. 05）. Logis⁃ tic regression analysis showed that age, ALT, TG, HDL-C, PLT, overweight/obesity, impaired fasting glucose and hyper⁃ uricemia were the influencing factors for MAFLD in 5 885 male physical examination subjects. ALT, TG, HDL-C, over⁃ weight/obesity, and hyperuricemia were the influencing factors for MAFLD in 1 536 female subjects. Conclusions Among 7 421 employees of a company in Shiyan, Hubei Province, the prevalence of MAFLD was higher in males than in females. Age, ALT, TG, HDL-C, PLT, overweight/obesity, impaired fasting blood glucose and hyperuricemia were the influencing factors for MAFLD in male physical examination subjects. ALT, TG HDL-C, overweight/obesity, and hyper⁃uricemia were the influencing factors for MAFLD in female physical examination subjects. [ABSTRACT FROM AUTHOR]

Background. Palpitations are one of the most prevalent general practice presentations and a concerning aetiology for cardiac causes. Since many physiological and pathological causes induce palpitations, doctors tend to conduct long-term, expensive evaluations, laboratory tests and specialised examinations. In addition to increasing medical expenses, more evaluations can lead to distress for patients and their families. While palpitations tend to be benign, on the other hand, they may sometimes have lifethreatening implications. Objectives. To summarise the current study on rapid assessment of patients with palpitations; therefore, patients will receive adequate management and treatment effectively. Material and methods. A comprehensive electronic search was conducted using PubMed, Google Scholar, SAGE and ScienceDirect. The following search keywords were used: palpitation, assessments, ECG, emergency and diagnostic testing. The search was limited to English-language publications from 1990 to 2021. Manual searching of relevant journals and reference lists was also performed. Results. Palpitations are a common clinical sign caused by various factors. Palpitations are a frequent clinical symptom with a wide range of causes. A systematic rapid assessment can initially identify palpitations. Conclusions. If the patient is examined during palpitations, the earliest echocardiogram (ECG) record is important in the diagnostic approach while waiting for further workup. A detailed history taking is then necessary to narrow the cause of palpitations. A comprehensive history helps determine which testing and monitoring will be needed. [ABSTRACT FROM AUTHOR]

Acute abdominal pain is the most frequent complaint evaluated by the emergency surgeon. The frequency of this presentation and the multitude of diagnoses and severity of cases reinforce the importance of a methodic clinical approach and knowledge of the causes of acute abdomen. In this article, we intend to review the process of diagnosing an acute abdomen and remind the medical community the importance of an accurate history and physical examination in this process. [ABSTRACT FROM AUTHOR]

There is a growing interest in diagnosis and treatment through telemedicine because of its convenience, accessibility, and lower costs. There are clinician and patient barriers to wider adoption of telemedicine. To support the effective and equitable use of telemedicine, we investigated the patient, illness, and surgeon factors associated with the specialist level of comfort in providing upper limb care via telemedicine. Seventy-five upper-extremity musculoskeletal specialists completed an online survey-based experiment in which they viewed 12 patient scenarios with randomized patient age, gender, diagnosis, pain intensity, and patient preference for surgical treatment (yes or no) and rated their comfort with telemedicine from 0, no comfort, to 10, complete comfort. The participants were able to provide a rationale for their stance in open text boxes. We recorded the following specialist factors: gender, location of practice, years in practice, subspecialty, the supervision of trainees, and surgeon-rated importance of a physical examination. In a multivariable analysis, greater surgeon comfort using telemedicine was associated with nontrauma conditions, four specific diagnoses, and patients who did not have severe pain. Lower surgeon comfort with telemedicine was associated with the higher clinician-rated importance of a hands-on physical examination and supervising trainees. Text-based reasons provided for relative comfort with telemedicine included nonsurgical treatment and facility of diagnosis based on interviews alone. Text-based reasons for relative discomfort with telemedicine included a perceived need for a hands-on physical examination and a preference for an in-person conversation for specific discussions, including scheduling surgery. Greater specialist enthusiasm for telemedicine is associated with personal preferences regarding the upper-extremity condition, patients with less severe pain, and a willingness to forego a hands-on examination. Utilization of telemedicine for upper-extremity specialty care may be facilitated by diagnosis-specific care strategies and strategies for video examination, with a focus on tactics that are effective for people with more intense symptoms. [ABSTRACT FROM AUTHOR]

Objective Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists' documentation of DM PE components for in-person (IP) vs TH visits. Methods Retrospective chart review of 200 notes for new patients with DM from 10 endocrinologists (10 IP and 10 TH visits each) in the Veterans Health Administration between April 1, 2020, and April 1, 2022. Notes were scored from 0 to 10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs TH across all clinicians using mixed effects models. Independent samples t -tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs TH. We described virtual care-specific and foot assessment techniques. Results The overall mean (SE) PE score was higher for IP vs TH (8.3 [0.5] vs 2.2 [0.5]; P <.001). Every endocrinologist had higher PE scores for IP vs TH. Every PE component was more commonly documented for IP vs TH. Virtual care-specific techniques and foot assessment were rare. Conclusions Our study quantifies the degree to which Pes for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual Pes. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Medical Rehabilitation / Rehabilitacja Medyczna is the property of Medical Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and hypothesisWe describe the responsiveness and minimally important difference (MID) of the Accidental Bowel Leakage Evaluation (ABLE) questionnaire.MethodsWomen with bowel leakage completed ABLE, Patient Global Impression of Improvement, Colo-Rectal Anal Distress Inventory, and Vaizey questionnaires pretreatment and again at 24 weeks post-treatment. Change scores were correlated between questionnaires. Student's t tests compared ABLE change scores for improved versus not improved based on other measures. The MID was determined by anchor- and distribution-based approaches.ResultsIn 266 women, the mean age was 63.75 (SD = 11.14) and 79% were white. Mean baseline ABLE scores were 2.32 ± 0.56 (possible range 1-5) with a reduction of 0.62 (SD = 0.79) by 24 weeks. ABLE change scores correlated with related measures change scores (r = 0.24 to 0.53) and differed between women who improved and did not improve (all p

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19.ObjectiveInvestigators sought to update the San Diego County sexual assault guidelines, created in collaboration with health care professionals, forensic specialists, and law enforcement, through a consensus iterative review process. An additional objective was to create a SAFET-I Tool for use by frontline providers during the COVID-19 pandemic.DiscussionThe authors present a novel SAFET-I Tool that outlines the following five components of effective sexual assault patient care: stabilization, alert system activation, forensic evidence consideration, expedited post-assault treatment, and trauma-informed care. This framework can be used as an educational tool and template for agencies interested in developing or adapting existing sexual assault policies.ConclusionsThere is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV.

ObjectivesComputed tomography (CT), the reference standard for diagnosis of intraabdominal injury (IAI), carries risk including ionizing radiation. CT-sparing clinical decision rules for children have relied heavily on physical examination, but they did not include focused assessment with sonography for trauma (FAST), which has emerged into widespread use during the past decade. We sought to determine the independent associations of physical examination, laboratory studies, and FAST with identification of IAI in children and to compare the test characteristics of these diagnostic variables. We hypothesized that FAST may add incremental utility to a physical examination alone to more accurately identify children who could forgo CT scan.MethodsWe reviewed a large trauma database of all children with blunt torso trauma presenting to a freestanding pediatric emergency department during a 20-month period. We used logistic regression to evaluate the association of FAST, physical examination, and selected laboratory data with IAI in children, and we compared the test characteristics of these variables.ResultsAmong 354 children, 50 (14%) had IAI. Positive FAST (odds ratio [OR] = 14.8, 95% confidence interval [CI] = 7.5 to 30.8) and positive physical examination (OR = 15.2, 95% CI = 7.7 to 31.7) were identified as independent predictors for IAI. Physical examination and FAST each had sensitivities of 74% (95% CI = 60% to 85%). Combining FAST and physical examination as FAST-enhanced physical examination (exFAST) improved sensitivity and negative predictive value (NPV) over either test alone (sensitivity = 88%, 95% CI = 76% to 96%) and NPV of 97.3% (95% CI = 94.5% to 98.7%).ConclusionsIn children, FAST and physical examinations each predicted the identification of IAI. However, the combination of the two (exFAST) had greater sensitivity and NPV than either physical examination or FAST alone. This supports the use of exFAST in refining clinical predication rules in children with blunt torso trauma.

Head and neck examinations are commonly performed by all physicians. In the era of the COVID-19 pandemic caused by the SARS-CoV-2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Based on experience and evidence from SARS-CoV-1 and early experience with SARS-CoV-2, we provide our perspective and guidance on mitigating transmission risk during head and neck examination, upper airway endoscopy, and head and neck mucosal surgery including tracheostomy.