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At least 631 records · Page 35Linked to original sources
PubMed2004

A simple computer-based measurement and analysis system of pulmonary auscultation sounds.

Listening to various lung sounds has proven to be an important diagnostic tool for detecting and monitoring certain types of lung diseases. In this study a computer-based system has been designed for easy measurement and analysis of lung sound using the software package DasyLAB. The designed system presents the following features: it is able to digitally record the lung sounds which are captured with an electronic stethoscope plugged to a sound card on a portable computer, display the lung sound waveform for auscultation sites, record the lung sound into the ASCII format, acoustically reproduce the lung sound, edit and print the sound waveforms, display its time-expanded waveform, compute the Fast Fourier Transform (FFT), and display the power spectrum and spectrogram.

Algorithms↗
PubMed1999

Differences in blood pressure values by simultaneous auscultation of Korotkoff sounds inside the cuff and in the antecubital fossa.

To elucidate whether auscultation of the Korotkoff sounds inside the cuff and in the antecubital fossa leads to different blood pressure (BP) values we measured BP at both sites simultaneously with identical flat stethoscopes in a same-arm test design (part A) in 64 normotensive (N: 32 men, 32 women; mean age: 38.7 +/- 15.1 years) and 67 hypertensive subjects (H: 36 men, 31 women; mean age: 44.6 +/- 12.9 years), and additionally in a same- and opposite-arm test design (part B) in 20 normotensive young women. While in part A systolic BP measured inside the cuff was only slightly higher (N: +1. 6 +/- 3.2 mm Hg; H: +1.0 +/- 1.4 mm Hg), diastolic BP was considerably lower (N: -10.6 +/- 5.6 mm Hg; H: -8.4 +/- 4.9 mm Hg). This result was corroborated by part B with differences in systolic/diastolic BP of +0.8 +/- 1.0/-8.5 +/- 2.2 mm Hg in the same-arm test and +0.4 +/- 4.8/-10.6 +/- 5.2 mm Hg in the opposite-arm test. Subject's age was the main variable determining differences in diastolic BP with significantly higher differences in younger than in older subjects, indicating that the elastic properties of arteries may be responsible for these differences. Our results demonstrate that a modification in the auscultatory technique of BP measurement produces significantly different diastolic BP values, the magnitude of which is important for our conceptions of threshold and target values in diagnosing and treating hypertension.

Adolescent↗
PubMed2002

Do general practitioners use what's in their doctor's bag?

OBJECTIVE: To find out what general practitioners (GPs) take with them on house calls and how frequently they use it? DESIGN: A questionnaire about the drugs and medical equipment used during house calls. SETTING: Two peer review groups of GPs in Overijse and Hoeilaart (Belgium). SUBJECTS: 29 GPs. MEAN OUTCOME MEASURES: Availability and use of drugs and medical equipment on house calls. RESULTS: All GPs had a stethoscope, a sphygmomanometer, an otoscope and sterile injection syringes at their disposal on house calls and they used them frequently. Only 57% took a blood glucose sensor with them and 25% took the medical records on home visits. Though only 50% always carried all of the most common emergency drugs with them, almost 100% of GPs had administered all of them in the previous 12 months. Only epinephrine and atropine were not frequently administered. CONCLUSION: Most of the GPs were sufficiently equipped to meet most situations that can occur during house visits and emergency calls. Most of the available drugs and equipment were used during the 12 months preceding the registration. Only the medical records and a blood glucose sensor were insufficiently available.

Belgium↗
PubMed2006

Monitoring of vital signs during dental care.

Advances in medicine have greatly increased the survival of patients with severe health problems and have significantly prolonged life in elderly individuals with systemic disorders. Concomitant advances in dentistry and evolving societal expectations regarding dental health and function have likewise ensured that these patients are increasingly retaining their teeth and/or seeking dental care. The administration of local anaesthetics and the performance of extensive dental procedures may cause stress and systemic disturbances in such patients. In order to avoid potentially serious reactions, dentists are obligated to monitor continuously their medically challenged patients. Monitoring provides three important benefits. First, it helps the dentist detect acute medical emergencies that may require an immediate response. Second, monitoring may reveal gradual deleterious trends that can often be easily reversed before a true emergency occurs. Third, monitoring can assist the dentist in evaluating the efficacy of any emergency treatments or preventive measures that are rendered. The purposes of this article are to: briefly review monitoring techniques and devices, discuss their suitability for use in the dental office, and provide some tips for their application during dental care. In overall decreasing order of routine importance, monitoring resources include the following: responsible personnel, non-invasive blood pressure monitor, pulse oximeter, ECG, and the pretracheal stethoscope or capnograph.

Blood Pressure↗
PubMed2001

The health professional's role in preventing nosocomial infections.

Despite their best intentions, health professionals sometimes act as vectors of disease, disseminating new infections among their unsuspecting clients. Attention to simple preventive strategies may significantly reduce disease transmission rates. Frequent hand washing remains the single most important intervention in infection control. However, identifying mechanisms to ensure compliance by health professionals remains a perplexing problem. Gloves, gowns, and masks have a role in preventing infections, but are often used inappropriately, increasing service costs unnecessarily. While virulent microorganisms can be cultured from stethoscopes and white coats, their role in disease transmission remains undefined. There is greater consensus about sterile insertion techniques for intravascular catheters-a common source of infections-and their care. By following a few simple rules identified in this review, health professionals may prevent much unnecessary medical and financial distress to their patients.

Catheterization, Central Venous↗
PubMed2006

Cardiac auscultation: a glorious past--and it does have a future!

Cardiac auscultation remains an important part of clinical medicine. The standard acoustic stethoscope, which has been useful for more than a century, cannot process, store, and play back sounds or provide visual display, and teaching is hindered because there is no means to distribute the same sounds simultaneously to more than one listener. Modern portable and inexpensive tools are now available to provide, through digital electronic means, better sound quality with visual display and the ability to replay sounds of interest at either full or half speed with no loss of frequency representation or sound quality. Visual display is possible in both standard waveform and spectral formats. The latter format is readily available and provides certain advantages over the time-honored waveform (phonocardiographic) method. Both methods, however, can and should be used simultaneously. Sound signals obtained electronically may then be subjected to objective visual and numerical analysis, transmitted to distant sites, and stored in medical records. Signal analysis shows early promise for clinical application, such as in the assessment of severity of aortic stenosis and in the separation of innocent from organic murmurs. In addition to their clinical value, these methods provide a critical vehicle for the teaching of cardiac auscultation, a method that can and should be preserved for future generations.

Heart Auscultation↗
PubMed2005

The effect of noise in the emergency department.

BACKGROUND: It is hypothesized that high ambient noise in the emergency department (ED) adversely affects the ability of the examiner to hear heart and lung sounds. OBJECTIVE: To determine the ability of various examiners to hear heart tones and lung sounds at the high end of loudness typically found in the ED setting. METHODS: The study was divided into two parts. First, sound levels in the ED were measured over various times during the months of January through June 2001, using a sound level monitor. The second part of the study was the determination of the ability to hear heart and lung sounds on a young healthy volunteer using the same Littmann lightweight stethoscope at a predetermined ambient noise level of 90 dB. The results were entered into a database and analyzed using SPSS version 10 (Chicago, IL). Descriptive statistics, analysis of variance, frequencies, and correlation were calculated using this program. RESULTS: Two hundred five sound measurements were taken in the ED during the study period in three locations at various hours. The mean noise level at the nursing station was 57.60 dB, with a minimum of 45.00 dB and a maximum of 70.00 dB. Four of the 104 test subjects (3.8%) were unable to hear the heart tones, and nine of the 104 (8.7%) were unable to hear the lung sounds. Fifty percent (27 of 54) of the test subjects reported diminished lung sounds and eight of 15 (53.3%) reported diminished heart sounds. No significant difference was found between hearing heart sounds and years of experience, age, professional position, and quality of the sound. Significant differences were found between hearing lung sounds and years of experience and professional position, but not with age, gender, and sound quality. CONCLUSIONS: This study demonstrated that most of the tested examiners have the ability to hear heart and lung sounds at the extreme of loudness found in one ED.

Adult↗
PubMed2004

Accuracy of detecting irregular cardiac rhythms via telemedicine.

We evaluated the accuracy of an electronic stethoscope in the detection of irregular cardiac rhythms. Ten patients with either normal sinus rhythm or atrial fibrillation previously documented by electrocardiogram (ECG) were recruited from a local retirement community. Six senior family medicine resident physicians were asked to assess the cardiac rhythms of the subjects as either regular or irregular, in both a telemedical and an in-person examination. An ECG was obtained simultaneously as the gold standard. Forty-five of the 60 in-person assessments were correct, as were 49 of the 60 telemedicine assessments. The difference was not significant. Physician confidence in telemedical examination did not affect the accuracy of examination. The results of this study suggest that telemedicine-directed auscultation of patients may be just as successful as inperson examination for the detection of cardiac arrhythmias.

Aged↗
PubMed2003

Assessment of severity of aortic stenosis through time-frequency analysis of murmur.

STUDY OBJECTIVE: The accurate and inexpensive noninvasive assessment of the presence and severity of aortic stenosis remains a challenge. In this study, we performed spectral analysis on the murmurs of a group of patients with this disease in order to assess its severity. DESIGN: An electronic stethoscope was used to generate a spectral analysis of murmurs in patients with aortic stenosis. The durations of the spectra at different frequencies (ie, 200, 250, and 300 Hz) were correlated to the Doppler echocardiogram-derived mean and peak pressure gradients. Heart murmurs from the patients were recorded, and the spectra of the recordings were produced via fast-Fourier transformation. The duration of the spectra above the three given frequencies was then measured. PATIENTS: Forty-one patients (age range, 45 to 94 years; mean age, 68 years) met the inclusion criteria, which included a minimum ejection fraction of 40% and no other significant systolic murmur or coexistent valve disease. RESULTS: The peak pressure gradient measured via Doppler echocardiogram ranged from 15.3 to 185 mm Hg with the mean of 63 mm Hg. The duration of the spectra of > 300 Hz correlated best with the peak pressure gradient measured using the Doppler echocardiogram. An exponential regression model was created showing a significant correlation coefficient of r = 0.86 (p < 0.0001). CONCLUSIONS: This study demonstrated a good correlation between the duration of spectra at 300 Hz and the Doppler derived peak pressure gradient. This simple and inexpensive technique may prove to be valuable in the evaluation and monitoring of patients with suspected and proven aortic stenosis.

Aged↗
PubMed2006

Assessing children's heart sounds at a distance with digital recordings.

OBJECTIVE: The objective of this study was to assess whether computer-stored digital sound recordings can be used to distinguish innocent from pathologic systolic murmurs. METHODS: Recordings of 55 children aged 1 month to 19 years were made remotely with the use of a digital stethoscope and were e-mailed to a computer in our center for later assessment. Eight-second recordings were made by a physician in 2 to 4 locations on the chest. Three cardiologists who were blinded to the diagnosis reviewed the recordings independently using stethophones to assess the splitting of the second heart sound and whether murmurs were innocent or pathologic. Diagnoses were confirmed with echocardiography. RESULTS: Seventeen children had innocent murmurs and 38 had pathologic murmurs. For the 3 cardiologists, sensitivity was 0.87 to 1.0, specificity was 0.82 to 0.88, negative predictive value was 0.75 to 1.0, and positive predictive value was 0.93 to 0.95. Assessment of splitting of second heart sound was highly accurate. CONCLUSIONS: Digital recordings of children's heart sounds allow reliable differentiation between innocent and pathologic murmurs. Use of this technology may allow remote diagnosis of childhood murmurs and avoid the expense and stress of travel to pediatric cardiology centers for some children. Cardiologists who use recordings should assess their diagnostic accuracy before clinical application.

Adolescent↗
PubMed2000

The history of thoracic surgical instruments and instrumentation.

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

Endoscopes↗
PubMed2000

[Validation of electronic automatic-measurement arterial blood pressure devices].

Validation of automatic devices for self blood pressure measurement is a necessity, as the mercury columns are no longer available. The European consensus meeting organized by the Group for blood pressure measurement and evaluation (GEM), from French Society of Hypertension held last June 1999 has defined a new international protocol for clinical validation of these devices. The main parts of this protocol are the following: the blood pressure is measured at the same arm with two observers simultaneously and then with the automatic device sequentially seven times among 38 patients. The evaluation is interrupted after the 15th patient if the pre-analysis fails defined criteria. Technical supports are available: A CD-rom from French society of HTA for the training and certification of observers, a special kit for the evaluation (2 mercury column's and a double stethoscope) and a specific software for data analysis created by the GEM.

Automation↗
PubMedDate not supplied

Conscious sedation experiences in graduate pediatric dentistry programs.

PURPOSE: Conscious sedation is a behavior modification adjunct taught in all postgraduate pediatric dental residency programs. It has been a decade since the last survey was done specifically related to didactic and clinical aspects of conscious sedation in postgraduate pediatric dental programs. The aim of the study was to determine the clinical and didactic experiences associated with conscious sedation in these programs and to compare some of the findings to those collected a decade ago. METHODS: A 31-item survey similar to that of a decade ago was constructed and sent to all pediatric dentistry program directors of accredited postgraduate and residency programs in the United States. The items covered several didactics including didactic topics, sedative agents, monitoring, and emergency policy among others. A follow-up mailing was done involving those who had not responded 6 weeks following the initial mailing. RESULTS: Fifty-four of 58 (93%) program directors returned the 31-item survey. The following are highlighted findings. Conscious sedation among residency programs was achieved most commonly with a combination of sedative agents used with N2O. Midazolam was more popular than chloral hydrate. The oral route was the predominant route of administration. More lecture hours were spent on conscious sedation than 10 years ago. The pre-cordial stethoscope, pulse oximeter, and blood pressure cuff were the most commonly used monitors. Sedative agent and anticipated depth of sedation were the factors most often considered in choosing monitors used during the sedation of a patient. The capnograph was being used more frequently than it was 10 years ago. Programs did not report an increase in sedation emergencies but practiced emergency drills more often and had increased numbers of individuals certified in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS). The percent of the total patient population which required sedation is about 1-20%, with most directors reporting an increase in the numbers of sedations done in the past few years. CONCLUSIONS: While many factors remained unchanged or slightly modified when compared to the survey done a decade ago, the results of this study suggest that there has been significant changes in several key factors including the most frequently used sedative (i.e., midazolam) and increased preparation in the area of emergency preparedness.

Administration, Oral↗
PubMed1964

BIOPHYSICS OF HEART SOUNDS AND ITS APPLICATION TO CLINICAL AUSCULTATION.

Much research has been carried out recently into the means by which heart sounds and murmurs reach the stethoscope from their point of origin. Heart sounds originate as vibrations of the cardiac valves and travel as transverse vibrations with low velocity over the walls of the ventricles and great vessels. Where these structures are in contact with the thoracic surface they emerge, at the ;auscultatory areas', and spread like ripples over the chest surface. Murmurs originate in the cavities receiving the blood stream, and are loudest in the cavity that is less distensible. Frequency, damping in transit and the possible misinterpretation of apparent ;splitting' seen in phonocardiographic records are discussed. This basic knowledge of modes of transmission allows the interpretation of unusual locations of auscultatory areas in disease states, and explains some puzzling findings obtained with microphones mounted on cardiac catheters.

Biophysics↗
PubMed2003

[May heart murmurs be assessed by telemedicine?].

BACKGROUND: Children often have heart murmurs; referral to a specialist is common. A service for remote auscultation of heart murmurs was established in which heart sounds and short texts were sent as attachment to e-mails. Our aim was to assess the quality of this method. MATERIAL AND METHODS: Heart sounds from 47 patients with no murmur (n = 7), innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor-based stethoscope and e-mailed to a computer. The sounds were repeated giving 100 cases, randomly distributed on a CD. Four specialists categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded assessment time, degree of certainty, and need for referral. RESULTS: On average 2.1 minutes were spent on each case. Mean sensitivity and specificity were 90% and 98%, respectively. Inter- and intra-observer variability were low (kappa 0.81 and 0.87). 93% of cases with a pathological murmur and 13% with an innocent murmur were recommended for referral. INTERPRETATION: Telemedical referral of children with heart murmurs to a cardiologist is safe, reduces travelling, and saves time. Skilled auscultation is adequate to detect those with innocent murmurs.

Electronic Mail↗
PubMed2005

[Hand-held echocardiography in clinical practice].

In the last years the industry has created echocardiographic portable machines of reduced size, available for a growing number of operators. After the first experiences of the '70s, hand-held echocardiography (HHE) is earned interesting commercial positions. The transportability of these machines allows to perform examinations outside the echo-lab and provides diagnostic information in heterogeneous locations such as intensive care unit, emergency room and outpatient structures, at the bedside and even in ambulance. HHE can be useful for detection of several pathologies including aortic aneurysms and left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusion. To date, four main kinds of HHE can be distinguished: a first, high-cost variety, including miniaturized machines, equipped with instrumentations of standard echocardiography and even new softwares for tissue Doppler and myocardial contrast echocardiography; a second kind of machines of high level but not miniaturized; a third (intermediate level and low cost), and a fourth one (basic level and very low cost), including "cardioscopes" corresponding to the ultrasound stethoscope, able to complete efficaciously the clinical examination. The introduction of HHE opens controversy about its diagnostic accuracy, the opportunity to establish the clinical scenario where it should be utilized and the identification of the potential users and the needed competence level. Preliminary experiences show the possibility of improving and anticipating the diagnosis of several cardiac diseases but also the need to plan specific ultrasound training to avoid inappropriate use of HHE.

Echocardiography↗
PubMed2005

The optimal method for recording prosthetic heart valve sounds in clinical situations.

BACKGROUND: Valve sounds are thought to be useful in evaluating the functioning of prosthetic heart valves. In previous reports, two recording instruments have mainly been used, a condenser microphone (instrument A) and an accelerometer (instrument B), respectively. This study aimed to investigate the applicability of these conventional devices in recording mechanical heart valve sounds in daily clinical situations. In addition, two other instruments, namely, a stethoscope including a small microphone in its tube (instrument C) and an electrostethoscope (instrument D), were proposed and examined. METHODS: Mechanical valve sounds were recorded from postoperative patients using each-device and the signal to noise ratio (SNR) of each was calculated. Frequency characteristics of the two newly proposed instruments were also investigated by recording a sweep signal in an anechoic chamber. RESULTS: The SNR values of the new instruments were significantly superior to those of conventional ones (A, sound signals were not defined from noises; B, 0.97 +/- 0.59 dB; C, 11.5 +/- 4.7 dB; and D, 9.4 +/- 3.5 dB, respectively p<0.05). The frequency characteristics of the two newly proposed instruments were also shown to be acceptable (under 10 kHz), though resonance frequency peaks were observed. CONCLUSIONS: Two newly proposed instruments can record mechanical heart valve sounds more noiselessly and with more ease than previous ones, and their frequency characteristics are acceptable.

Acoustics↗