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At least 541 records · Page 30Linked to original sources
PubMed1996

Microchips versus stethoscopes, part 2: Revisiting OSCAR at the Foothills Hospital.

Several years have passed since the Foothills Hospital in Calgary installed a multi-million-dollar computerized patient-information system. When it arrived, the computer system known as OSCAR created controversy, anxiety and arguments among clinical caregivers who found it tedious, time consuming and cumbersome. Gregory Powell looks at how OSCAR has since changed the clinical landscape at Foothills.

Alberta↗
PubMed2005

Bell or diaphragm in the measurement of blood pressure?

BACKGROUND: International guidelines have given diverse recommendations as to which side of the stethoscope should be used in the measurement of blood pressure. OBJECTIVE: To determine if there is any difference between the bell and the diaphragm sides of the ordinary acoustic stethoscope in the measurement of blood pressure. DESIGN AND METHODS: We compared, in random order, the bell and the diaphragm side of the ordinary acoustic stethoscope and also the effect of low- and high-frequency amplification with an electronic stethoscope in the measurement of blood pressure, in 250 adults. SETTING: Department of Medicine, Turku University Central Hospital. RESULTS: No statistically significant difference was seen between the bell side and the diaphragm side of the acoustic stethoscope, either in systolic blood pressure (SBP; mean +/- SD 129.5 +/- 21.7 and 129.4 +/- 20.8 mmHg, respectively) or diastolic blood pressure (DBP; 77.0 +/- 12.0 and 77.1 +/- 12.0 mmHg, respectively). Both the low-frequency (130.7 +/- 22.5 mmHg) and the high-frequency (131 +/- 22.2 mmHg) amplification of systolic Korotkoff sounds yielded significantly greater values of SBP than were measured either with the bell (P = 0.008 compared with low frequency, P = 0.0005 compared with high frequency) or the diaphragm (P = 0.004 compared with low frequency, P = 0.0001 compared with high frequency). Low-frequency amplification of DBP (76.4 +/- 12.3 mmHg) yielded values significantly lower than those measured with the bell (P = 0.04) or the diaphragm (P = 0.01). Values from high-frequency amplification of DBP (77.2 +/- 12.3 mmHg) did not differ significantly from those measured with the acoustic stethoscope. CONCLUSIONS: Both sides of the acoustic stethoscope give similar results in the measurement of office blood pressure and either side can be used in the reliable measurement of blood pressure.

Adult↗
PubMed2004

Validity and reliability of acoustic analysis of respiratory sounds in infants.

OBJECTIVE: To investigate the validity and reliability of computerised acoustic analysis in the detection of abnormal respiratory noises in infants. METHODS: Blinded, prospective comparison of acoustic analysis with stethoscope examination. Validity and reliability of acoustic analysis were assessed by calculating the degree of observer agreement using the kappa statistic with 95% confidence intervals (CI). RESULTS: 102 infants under 18 months were recruited. Convergent validity for agreement between stethoscope examination and acoustic analysis was poor for wheeze (kappa = 0.07 (95% CI, -0.13 to 0.26)) and rattles (kappa = 0.11 (-0.05 to 0.27)) and fair for crackles (kappa = 0.36 (0.18 to 0.54)). Both the stethoscope and acoustic analysis distinguished well between sounds (discriminant validity). Agreement between observers for the presence of wheeze was poor for both stethoscope examination and acoustic analysis. Agreement for rattles was moderate for the stethoscope but poor for acoustic analysis. Agreement for crackles was moderate using both techniques. Within-observer reliability for all sounds using acoustic analysis was moderate to good. CONCLUSIONS: The stethoscope is unreliable for assessing respiratory sounds in infants. This has important implications for its use as a diagnostic tool for lung disorders in infants, and confirms that it cannot be used as a gold standard. Because of the unreliability of the stethoscope, the validity of acoustic analysis could not be demonstrated, although it could discriminate between sounds well and showed good within-observer reliability. For acoustic analysis, targeted training and the development of computerised pattern recognition systems may improve reliability so that it can be used in clinical practice.

Acoustics↗
PubMed2007

Transmission of lung sounds through light clothing.

BACKGROUND: Doctors are exhorted to always place the stethoscope directly on the skin and never to auscultate through clothing. Nevertheless, casual observation reveals that doctors and even pulmonologists often violate this principle. OBJECTIVES: This study was designed to evaluate the sensitivity of two common stethoscopes when used through clothing. METHODS: Littmann Classic and Littmann Master Cardiology stethoscopes were studied under conditions of light (60-100 g), medium (240 g) and heavy (555 g) force when placed on a lung sound test platform with one or two layers of cloth (T-shirt material and flannel) interposed between the stethoscope and the test surface. The test platform was designed to mimic the acoustic and mechanical properties of the chest wall and was driven by amplified white noise. The recorded amplitude spectra were compared over a range of 150-1,000 Hz. RESULTS: Compared to the sensitivity on a bare test platform surface, either fabric in single or double layers attenuated the sounds by a mean of 5-18 dB under light pressure. This attenuation was nearly abolished by the addition of either medium or heavy force on the stethoscope head. CONCLUSIONS: The deleterious effect of one or two layers of indoor clothing on lung sounds acquired through a stethoscope can be negated by force on the stethoscope head making effective auscultation possible. Nevertheless, auscultation through clothing remains problematic due to the hindrance to inspection and percussion and the risk of acoustic artifacts caused by clothing.

Auscultation↗
PubMed1998

Simultaneous transesophageal atrial pacing and transesophageal echocardiography in cardiac surgical patients.

OBJECTIVES: To measure the effect of inserting a transesophageal echocardiography (TEE) probe on the pacing threshold of a previously inserted transesophageal pacing stethoscope, and to examine whether an indwelling pacing stethoscope influences the feasibility and image quality of a TEE examination. DESIGN: Prospective, open study using each patient as his/her own control. SETTING: Cardiac operating room of an academic medical center. PARTICIPANTS: Twenty adult patients in sinus rhythm and anesthetized for cardiac surgery. INTERVENTIONS: After induction of anesthesia and endotracheal intubation, a pacing stethoscope was inserted into the esophagus. A 5-MHz TEE probe was inserted to the four-chamber-view position. A full echocardiographic examination was performed, noting image quality, ease of probe manipulation, and loss of pacing. The pacing stethoscope was removed, and image quality assessed again. MEASUREMENTS AND MAIN RESULTS: The initial mean pacing threshold +/- 1 standard deviation (SD) was 19 +/- 8 mA (range, 10 to 37 mA). After placement of the echocardiography probe, the mean threshold had increased to 24 +/- 8 mA (range, 11 to 40 mA; p < 0.01). Loss of pacing with probe manipulation was noted in 15 of 20 patients (transient in 10 patients, permanent in 5 patients). Problems manipulating the probe because of sticking to the pacing stethoscope were noted in 10 of 20 patients. Poor image quality, resolving after stethoscope removal, was seen in two patients. CONCLUSION: Placement of a TEE probe results in a modest increase of the transesophageal pacing threshold. An indwelling pacing stethoscope frequently interferes with the ability to perform a full echocardiographic examination, and probe manipulation commonly causes loss of pacing.

Adult↗
PubMed1991

Inability to assess breath sounds during air medical transport by helicopter.

This study assessed the capabilities of a traditional and an amplified stethoscope used by flight nurses to assess breath sound during air medical transport in an MBB BO-105 helicopter. We developed a normal breath sound model using a prerecorded tape of breath sounds interspersed with segments without breath sounds; the recorder had been placed in the chest wall of a resuscitation training manikin. Flight nurses completed control listening sessions in a quiet environment and experimental sessions during flight using a traditional stethoscope for half of the sessions and an amplified stethoscope for the remaining half. In the quiet environment, flight nurses accurately reported the presence or absence of breath sounds in 110 (92%) of 120 trials. During helicopter flight, none of the flight nurses heard breath sounds during any of the recorded segments with either the traditional stethoscope or the amplified stethoscope. We conclude that flight nurses are unable to hear normal breath sounds using a traditional or amplified stethoscope during flight in a medically configured MBB BO-105 helicopter. Improved stethoscopes, innovative methods of listening, and reduction of aircraft noise are potential solutions to the problems of breath sound assessment during air medical transport.

Aircraft↗
PubMed2005

The role of non-critical health-care tools in the transmission of nosocomial infections.

The authors performed the cultivation of swabs taken from membranes of 110 stethoscopes of physicians, medical students and shared stethoscopes from ward consultant rooms. In addition to that, 24 random samples from other non-invasive health-care tools and the hospital environment were taken. In order to find out about the disinfection habits and knowledge of medical students, 97 of them were addressed in an anonymous questionnaire. Out of 110 stethoscopes, microbial colonisation was not present only in nine cases (8 %). Staphylococcus sp. was present on 94 stethoscopes (85 %), out of which 19 (20 %) were methicillin-resistant staphylococci of various species. S. aureus was found in 16 cases (14 %), out of which MRSA made 12 % (two cases). Cultivation of 24 additional samples discovered methicillin-resistant staphylococci in four cases--two of them were MRSA present on the esmarch and a blood-presure cuff. The questionnaire revealed that only six (6 %) addressed medical students have ever disinfected their stethoscopes in the past. Disinfection of non-critical tools should become an integral part of under-graduate and postgraduate education (Tab. 1, Fig. 2, Ref. 7).

Cross Infection↗