PHYSICAL EXAMINATION AND DIAGNOSIS OF DEMENTIA FOR VIDEO CONSULTATION

2008 ◽  
Vol 56 (5) ◽  
pp. 947-949 ◽  
Author(s):  
Melinda Martin-Khan ◽  
Paul Varghese ◽  
Richard Wootton ◽  
Len Gray
Keyword(s):  
Physical Examination ◽  
Video Consultation ◽  
Diagnosis Of Dementia

Dementia and Cognition

2019 ◽  
pp. 370-384
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Alzheimer’S Disease ◽  
Head Injury ◽  
Physical Examination ◽  
Frontotemporal Dementia ◽  
Temporal Pattern ◽  
Superficial Siderosis ◽  
Brain Hemorrhage ◽  
Provisional Diagnosis ◽  
Diagnosis Of Dementia ◽  
Structural Lesion

This chapter emphasizes the value of preliminary observations in making a provisional diagnosis of dementia. Significant aspects of the history are detailed, such as head injury or brain hemorrhage that could lead to hydrocephalus or superficial siderosis. Handles are given that facilitate identification of Alzheimer’s disease and its mimics, such as the posterior cortical variant. The importance of temporal pattern of disease is emphasized. Further Handles are outlined for frontotemporal dementia variants. The value of physical examination is stressed as it may disclose an underlying structural lesion.

A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint

2020 ◽  
Author(s):  
Sebastian Scheidt ◽  
Michael Kehrer ◽  
Max Jaenisch ◽  
Hans Goost ◽  
Dieter Christian Wirtz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Physical Examination ◽  
National Level ◽  
Treatment Modalities ◽  
Medical Background ◽  
Leg Axis ◽  
Number Of Patients ◽  
Video Consultation ◽  
The Mean ◽  
Self Examination

Abstract Background In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints. Material and Method 21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality. Results With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p < 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points. Conclusion The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.

Dementia

2016 ◽  
pp. 347-358
Author(s):  
Christopher H. Hawkes ◽  
Kapil D. Sethi ◽  
Thomas R. Swift
Keyword(s):  
Head Injury ◽  
Physical Examination ◽  
Temporal Pattern ◽  
Superficial Siderosis ◽  
Brain Hemorrhage ◽  
Progressive Decline ◽  
Nonfluent Aphasia ◽  
Diagnosis Of Dementia ◽  
Logopenic Aphasia ◽  
Structural Lesion

This chapter emphasizes the value of preliminary observations in making a provisional diagnosis of dementia. Significant aspects of the history are detailed, such as head injury or brain hemorrhage that could lead to hydrocephalus or superficial siderosis. Diagnostic clues are given that facilitate identification of the posterior cortical variant of Alzheimer’s disease, characterized by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. Emphasized is the importance of temporal pattern of disease, manifesting as episodic confusion and dementia progressing over a period of months. Further clues are outlined to facilitate identification of frontotemporal dementia variants, including semantic dementia, the behavioral variant, progressive nonfluent aphasia, and logopenic aphasia. The value of physical examination is stressed as it may disclose an underlying structural lesion.

Practicability of a Virtual Consultation to Evaluate the Shoulder Joint

2021 ◽  
Author(s):  
Martin Gathen ◽  
Davide Cucchi ◽  
Tom Jansen ◽  
Hans Goost ◽  
Frank Alexander Schildberg ◽  
...  
Keyword(s):  
Physical Examination ◽  
Shoulder Joint ◽  
Trauma Surgery ◽  
Provocation Test ◽  
Resource Conservation ◽  
Stability Criteria ◽  
Mobility Function ◽  
Video Consultation ◽  
Shoulder Disorders ◽  
Long Head

Abstract Objective In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. Methods Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. Results 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 – 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. Conclusion Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.

Tools and Resources: Web Sites of Interest

2001 ◽  
Vol 6 (2) ◽  
pp. 6-8
Author(s):  
Christopher R. Brigham
Keyword(s):  
Informed Consent ◽  
Physical Examination ◽  
Functional Status ◽  
Web Sites ◽  
Satisfaction Survey ◽  
High Quality ◽  
Diagnostic Studies ◽  
Physician Relationship ◽  
Complete History

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, explains that independent medical evaluations (IMEs) are not the same as impairment evaluations, and the evaluation must be designed to provide the data to answer the questions asked by the requesting client. This article continues discussions from the September/October issue of The Guides Newsletter and examines what occurs after the examinee arrives in the physician's office. First are orientation and obtaining informed consent, and the examinee must understand that there is no patient–physician relationship and the physician will not provide treatment bur rather will send a report to the client who requested the IME. Many physicians ask the examinee to complete a questionnaire and a series of pain inventories before the interview. Typical elements of a complete history are shown in a table. An equally detailed physical examination follows a meticulous history, and standardized forms for reporting these findings are useful. Pain and functional status inventories may supplement the evaluation, and the examining physician examines radiographic and diagnostic studies. The physician informs the interviewee when the evaluation is complete and, without discussing the findings, asks the examinee to complete a satisfaction survey and reviews the latter to identify and rectify any issues before the examinee leaves. A future article will discuss high-quality IME reports.

Effects of Observer Variation on Performance in Probabilistic Diagnosis of Jaundice

1981 ◽  
Vol 20 (03) ◽  
pp. 163-168 ◽  
Author(s):  
G. Llndberg
Keyword(s):  
Physical Examination ◽  
System Performance ◽  
Transition Matrix ◽  
Bayes Theorem ◽  
Observer Variation ◽  
Kappa Statistics ◽  
Diagnostic Categories ◽  
Number Of Patients ◽  
Probability Transition Matrix ◽  
Probabilistic Diagnosis

A system for probabilistic diagnosis of jaundice has been used for studying the effects of taking into account the unreliability of diagnostic data caused by observer variation. Fourteen features from history and physical examination were studied. Bayes’ theorem was used for calculating the probabilities of a patient’s belonging to each of four diagnostic categories.The construction sample consisted of 61 patients. An equal number of patients were tested in the evaluation sample. Observer variation on the fourteen features had been assessed in two previous studies. The use of kappa-statistics for measuring observer variation allowed the construction of a probability transition matrix for each feature. Diagnostic probabilities could then be calculated with and without the inclusion of weights for observer variation. Tests of system performance revealed that discriminatory power remained unchanged. However, the predictions rendered by the variation-weighted system were diffident. It is concluded that taking observer variation into account may weaken the sharpness of probabilistic diagnosis but it may also help to explain the value of probabilistic diagnosis in future applications.

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