PURPOSE: Clinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients.METHODS: In this prospective, single-centre cohort study, we included all acutely ill patients admitted to the ICU and expected to stay > 24 h. We conducted a protocolised clinical examination of 19 clinical signs followed by critical care ultrasonography for cardiac index measurement. Clinical signs were associated with cardiac index and a low cardiac index (< 2.2 L min-1 m2) in multivariable analyses. Diagnostic test accuracies were also assessed.RESULTS: We included 1075 patients, of whom 783 (73%) had a validated cardiac index measurement. In multivariable regression, respiratory rate, heart rate and rhythm, systolic and diastolic blood pressure, central-to-peripheral temperature difference, and capillary refill time were statistically independently associated with cardiac index, with an overall R2 of 0.30 (98.5% CI 0.25-0.35). A low cardiac index was observed in 280 (36%) patients. Sensitivities and positive and negative predictive values were below 90% for all signs. Specificities above 90% were observed only for 110/280 patients, who had atrial fibrillation, systolic blood pressures < 90 mmHg, altered consciousness, capillary refill times > 4.5 s, or skin mottling over the knee.CONCLUSIONS: Seven out of 19 clinical examination findings were independently associated with cardiac index. For estimation of cardiac index, clinical examination was found to be insufficient in multivariable analyses and in diagnostic accuracy tests. Additional measurements such as critical care ultrasonography remain necessary.
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Description of a new hand/palm-held computerized 3D force measuring system. The system is built for interface (direct) measurement of 3D manual contact force with real-time data presentation. Static calibration was performed of the 3D force sensor with variable preloads to study their effect as well of the prototype system adapted for clinical manual examination and treatment. The new system enables, for the first time, recording and presenting of 3D manual contact forces at the patient-practitioner interface. 3D direct manual contact force measures have the potential to give a more complete and differentiated characterization of patient and practitioner forces than 1D forces. Clinical validity of the prototype system will have to be investigated, and for studying specific clinical manual handling techniques, obvious limitations require further development.
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Studies about clinical pain in schizophrenia are rare. Conclusions on pain sensitivity in people with schizophrenia are primarily based on experimental pain studies. This review attempts to assess clinical pain, that is, everyday pain without experimental manipulation, in people with schizophrenia. PubMed, PsycINFO, Embase.com, and Cochrane were searched with terms related to schizophrenia and pain. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Fourteen studies were included. Persons with schizophrenia appear to have a diminished prevalence of pain, as well as a lower intensity of pain when compared to persons with other psychiatric diseases. When compared to healthy controls, both prevalence and intensity of pain appear to be diminished for persons with schizophrenia. However, it was found that this effect only applies to pain with an apparent medical cause, such as headache after lumbar puncture. For less severe situations, prevalence and intensity of pain appears to be comparable between people with schizophrenia and controls. Possible underlying mechanisms are discussed. Knowledge about pain in schizophrenia is important for adequate pain treatment in clinical practice. Perspective This review presents a valuable insight into clinical pain in people with schizophrenia
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The relationship between race and biology is complex. In contemporary medical science, race is a social construct that is measured via self-identification of study participants. But even though race has no biological essence, it is often used as variable in medical guidelines (e.g., treatment recommendations specific for Black people with hypertension). Such recommendations are based on clinical trials in which there was a significant correlation between self-identified race and actual, but often unmeasured, health-related factors such as (pharmaco) genetics, diet, sun exposure, etc. Many teachers are insufficiently aware of this complexity. In their classes, they (unintentionally) portray self-reported race as having a biological essence. This may cause students to see people of shared race as biologically or genetically homogeneous, and believe that race-based recommendations are true for all individuals (rather than reflecting the average of a heterogeneous group). This medicalizes race and reinforces already existing healthcare disparities. Moreover, students may fail to learn that the relation between race and health is easily biased by factors such as socioeconomic status, racism, ancestry, and environment and that this limits the generalizability of race-based recommendations. We observed that the clinical case vignettes that we use in our teaching contain many stereotypes and biases, and do not generally reflect the diversity of actual patients. This guide, written by clinical pharmacology and therapeutics teachers, aims to help our colleagues and teachers in other health professions to reflect on and improve our teaching on race-based medical guidelines and to make our clinical case vignettes more inclusive and diverse.
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Objective: To determine the construct validity, criterion validity, and responsiveness of measurement instruments evaluating scapular function. Design: Systematic review of measurement properties. Literature Search: The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception until March 2019. Study Selection Criteria: Studies published in Dutch, English, or German were included when they evaluated at least 1 of the measurement properties of interest. No restrictions were made regarding participants' health status. Data Synthesis: Two reviewers independently evaluated study quality using the COSMIN checklist and extracted and analyzed data. Quality of evidence was graded by measurement property for each distinctive type of measurement. Results: Thirty-one measurement instruments in 14 studies were categorized into instruments to measure scapular posture and movement, and to assess scapular dyskinesis. Quality of evidence was at most moderate for 4 instruments with respect to criterion validity. Of these, criterion validity for instruments measuring scapular protraction/retraction posture and rotation angles up to 120° of thoracohumeral elevation was sufficient. Criterion validity for instruments measuring asymmetrical scapular posture, range of motion, and the lateral scapular slide test was insufficient. Quality of evidence for measurement properties of all other instruments was graded lower. Conclusion: There is currently insufficient evidence to recommend any instrument for the clinical examination of scapular function. Measurement instruments to assess scapular dyskinesis are prone to misinterpretation and should therefore not be used as such.
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As the population ages, more people will have comorbid disorders and polypharmacy. Medication should be reviewed regularly in order to avoid adverse drug reactions and medication-related hospital visits, but this is often not done. As part of our student-run clinic project, we investigated whether an interprofessional student-run medication review program (ISP) added to standard care at a geriatric outpatient clinic leads to better prescribing. In this controlled clinical trial, patients visiting a memory outpatient clinic were allocated to standard care (control group) or standard care plus the ISP team (intervention group). The medications of all patients were reviewed by a review panel (“gold standard”), resident, and in the intervention arm also by an ISP team consisting of a group of students from the medicine and pharmacy faculties and students from the higher education school of nursing for advanced nursing practice. For both groups, the number of STOPP/START-based medication changes mentioned in general practitioner (GP) correspondence and the implementation of these changes about 6 weeks after the outpatient visit were investigated. The data of 216 patients were analyzed (control group = 100, intervention group = 116). More recommendations for STOPP/STARTbased medication changes were made in the GP correspondence in the intervention group than in the control group (43% vs. 24%, P = < 0.001). After 6 weeks, a significantly higher proportion of these changes were implemented in the intervention group (19% vs. 9%, P = 0.001). The ISP team, in addition to standard care, is an effective intervention for optimizing pharmacotherapy and medication safety in a geriatric outpatient clinic.
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BACKGROUND: Non-use of and dissatisfaction with ankle foot orthoses (AFOs) occurs frequently. The objective of this study is to gain insight in the conversation during the intake and examination phase, from the clients’ perspective, at two levels: 1) the attention for the activities and the context in which these activities take place, and 2) the quality of the conversation. METHODOLOGY: Semi-structured interviews were performed with 12 AFO users within a two-week period following intake and examination. In these interviews, and subsequent data analysis, extra attention was paid to the needs and wishes of the user, the desired activities and the environments in which these activities take place. RESULTS AND CONCLUSION: Activities and environments were seldom inquired about or discussed during the intake and examination phase. Also, activities were not placed in the context of their specific environment. As a result, profundity lacks. Consequently, orthotists based their designs on a ‘reduced reality’ because important and valuable contextual information that might benefit prescription and design of assistive devices was missed. A model is presented for mapping user activities and user environments in a systematic way. The term ‘user practices’ is introduced to emphasise the concept of activities within a specific environment.
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Purpose: The aim of this study was to assess physiotherapists’ clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Methods: Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the “buy a feature” method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Results: Participating physiotherapists (N = 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists’ acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Conclusions: Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care.
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Background and objective: Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. Materials and Methods: An online cross-sectional survey. Results: 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms’ indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). Conclusions: a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.
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