Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “STETHOSCOPE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources
PubMed1986

Prediction of streptococcal pharyngitis: an option for school nurses?

In this article the authors address the dilemma confronting school nurses in determining whether or not to counsel parents about seeking medical care for a child with a sore throat. The use of a clinical scorecard in the school setting as an aid in predicting streptococcal pharyngitis is investigated. The authors conclude that the only valid solution to the dilemma is the availability of the throat culture to schools. Using the culture as an additional assessment tool augments those already proven over time--the stethoscope, scoliosis and vision screening, and the otoscope.

Adolescent↗
PubMed2001

Survey on small animal anaesthesia.

OBJECTIVE: To ascertain anaesthetic practices currently for dogs and cats in Australia. METHODS: A questionnaire was distributed to 4,800 veterinarians throughout Australia, seeking data on numbers of dogs and cats anaesthetised per week; drug preferences for anaesthetic premedication, induction and maintenance; use of tracheal intubation, supplemental nitrous oxide and anaesthetic antagonists; and types of vaporisers, breathing systems and anaesthetic monitoring devices used or available. Additional questions concerned proportions of different animal types seen in the practice, and the respondent's university and year of graduation. RESULTS: The response rate was 19%; 95% of respondents graduated from Australian universities, about half since 1985. Most responses (79%) came from mainly small animal practices. On average 16 dogs and 12 cats were anaesthetised each week. Premedication was used more often in dogs than cats, with acepromazine and atropine most favoured in both species. For anaesthetic induction, thiopentone was most preferred in dogs and alphaxalone/alphadolone in cats. Inhaled agents, especially halothane, were preferred for maintenance in both species. Most respondents usually employed tracheal intubation when using inhalational anaesthetic maintenance, but intubation rates were lower during injectable anaesthetic maintenance and a minority of respondents provided supplemental O2. Nitrous oxide was administered regularly by 13% of respondents. The agents most frequently used to speed recovery from anaesthesia were doxapram and yohimbine. The most widely used vaporisers were the Fluotec Mark III and the Stephens machine. Most (95%) respondents used a rebreathing circuit for large dogs and a non-rebreathing system was used for small dogs by 68% of respondents. Most respondents (93%) indicated some form of aid was available to monitor general anaesthesia: the three most mentioned were an apnoea alarm, oesophageal stethoscope and electrocardiogram. CONCLUSION: Diverse approaches were evident, but there appeared to be less variation in anaesthetising dogs: premedication was more frequent and less varied in type, while thiobarbituates dominated for induction and inhalants for maintenance. Injectable maintenance techniques had substantial use in cats, but little in dogs. Evident disparity between vaporisers available and circuits used suggested either confusion in terminology or incorrect use of some vaporisers in-circuit. While most respondents used monitoring equipment or a dedicated observer to invigilate anaesthesia, the common reliance on apnoea alarms is of concern, because of unproven reliability and accuracy.

Anesthesia↗
PubMed1984

Factors influencing quantitative isolation of varicella-zoster virus.

Optimal conditions are described for the recovery of cell culture-derived varicella-zoster virus (VZV). Of the cells tested, human embryonic lung fibroblasts were the most sensitive. Storage and handling procedures were examined to determine the stability of VZV in viral transport medium. When the initial VZV titer was high (2 X 10(4) PFU/ml) 40% of the VZV survived room temperature for 24 h and 75% of the VZV remained viable for this long at 4 degrees C. Recovery was 5- to 10-fold less at lower initial VZV titers (less than 2 X 10(3) PFU/ml). Other factors which influenced VZV recovery included freezing at -20 degrees C, the use of cotton or calcium alginate swabs, and filtration to remove bacterial contaminants. The tissue culture methods described were used in a reconstruction experiment to demonstrate that VZV could be recovered from a laboratory coat or human skin (0.1 to 0.3% of input VZV) or from a stethoscope (19% of input VZV) as late as 30 min after inoculation. During a clinical trial using optimal VZV recovery procedures, 76% of the patients with herpes zoster yielded VZV when first cultured, and 60% remained culture positive for an additional 48 h.

Alginates↗
PubMed2004

Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-8, a novel metallo-beta-lactamase, in a tertiary care center in Cali, Colombia.

The prevalence of imipenem resistance among Pseudomonas aeruginosa isolates at a 195-bed tertiary care medical center in Cali, Colombia, rose from 2% in 1996 to 28% in 1997 and to over 40% in 2003. Many isolates showed high-level multiresistance, and phenotypic characterization suggested the spread of a predominant strain with minor variants. Sixty-six resistant isolates collected between February 1999 and July 2003 from hospitalized patients (n = 54) and environmental samples (n = 12) were subjected to a fuller analysis. Genetic fingerprints were compared by pulsed-field gel electrophoresis (PFGE) of SpeI-digested genomic DNA, and bla(IMP) and bla(VIM) genes were sought by PCR. PFGE and serotyping indicated that 52 of the 66 isolates belonged to a single strain, with 82% similarity; the PFGE pattern for this organism was designated pattern A. Two further pairs of isolates represented single strains; the remaining nine isolates were unique, and in the case of one isolate, no satisfactory PFGE profile could be obtained. The pattern A isolates were mostly of serotype O12 and were highly resistant to imipenem (MICs, 32 to >256 microg/ml), with this resistance decreased eightfold or more in the presence of EDTA. They yielded amplicons with bla(VIM)-specific primers, and sequencing of DNA from a representative isolate revealed bla(VIM-8), a novel allele with three polymorphisms compared with the sequence of bla(VIM-2). Two of these nucleotide changes were silent, but the third determined a Thr139Ala substitution. Only 4 of 13 resistant isolates (2 clinical isolates and 2 environmental isolates) assigned to other PFGE types carried bla(VIM) alleles, whereas the others were less multiresistant and mostly had lower levels of imipenem resistance (MICs, < or =32 microg/ml) which was not significantly reduced by EDTA. No bla(IMP) alleles were detected. During 2003, when the environmental study was undertaken, serotype O12 isolates with bla(VIM) were recovered from sinks and stethoscopes in the most-affected units, although not from the hands of staff; the problem declined once these reservoirs were disinfected and hygienic precautions were reinforced.

Adult↗
PubMed2004

Assessment and management of children aged 1-59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan.

BACKGROUND AND AIMS: Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap. METHODOLOGY: In a multicentre prospective study, children aged 1-59 months with auscultatory/audible wheeze and fast breathing and/or lower chest indrawing were screened. Response to up to three cycles of inhaled salbutamol was recorded. The responders were enrolled and sent home on inhaled bronchodilators, and followed up on days 3 and 5. RESULTS: A total of 1622 children with wheeze were screened from May 2001 to April 2002, of which 1004 (61.8%) had WHO defined non-severe and 618 (38.2%) severe pneumonia. Wheeze was audible in only 595 (36.7%) of children. Of 1004 non-severe pneumonia children, 621 (61.8%) responded to up to three cycles of bronchodilator. Of 618 severe pneumonia children, only 166 (26.8%) responded. Among responders, 93 (14.9%) in the non-severe and 63 (37.9%) children in the severe pneumonia group showed subsequent deterioration on follow ups. No family history of wheeze, temperature >100 degrees F, and lower chest indrawing were identified as predictors of subsequent deterioration. CONCLUSIONS: Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.

Bronchodilator Agents↗
PubMed2004

A novel multimedia tool to improve bedside teaching of cardiac auscultation.

Training in cardiac auscultation is a core element of undergraduate teaching but recent studies have documented a remarkable decline in auscultatory skills. Therefore there is an interest in new ways to teach cardiac auscultation. In analogy to phonocardiography, an electronic system for simultaneous auscultation and visualisation of murmurs was sought. For this purpose, an electronic stethoscope was linked to a laptop computer and software created to visualise auscultatory findings. In a preliminary trial in undergraduate students, this approach greatly facilitated teaching. Amalgamating traditional phonocardiography with a multimedia approach, this system represents a novel tool for bedside teaching of cardiac auscultation.

Education, Medical, Undergraduate↗
PubMed1979

Pierre Adolphe Piorry (1794-1879): pioneer of percussion and pleximetry.

Piorry was born in Poitiers on 31 December 1794. As a medical student he served in the Napoleonic war in Spain. His teachers in medicine included Corvisart, Bayle, Broussais, and Magendie; he qualified in 1816 with an MD thesis: "On the danger of reading medical text books by the laity"! Laënnec's invention of the stethoscope (1816) and De l' Auscultation Médiate (1819) inspired Piorry to make an analogous contribution to the technique of percussion (which had been originally described by Auenbrugger in his Inventum Novum in 1761 and translated from the Latin into French by Corvisart in 1808). This led to Piorry's invention in 1826 of the pleximeter (le plessimétre) to help outline the internal organs (l'organographisme), which he described inDe la Percussion Médiate (1828). Piorry became renowned as a professor of medicine in many of the great Parisian hospitals (Charité, Pitié, and Hôtel Dieux). In 1832 he was appointed to L'Hospice de la Salpétrière, where he held a famous course of clinical lectures. He wrote prolificly on many aspects of medicine and published more than twenty books. He was, in addition, a poet of some distinction, and wrote a remarkable long poem Dieu, L'Ame et la Nature (1853). Piorry held his neologisms-for example, toxin, toxaemia, septicaemia, etc.-are still in use. This, together with the mixed reception that his advocacy of pleximetry received from his medical contemporaries, made him a controversial figure. He died on 29 May 1879.

Auscultation↗
PubMed1981

R T H Laënnec 1781--1826 his life and work: a bicentenary appreciation.

René Théophile Hyacinthe Laënnec was born on 17 February 1781 in Quimper and spent much of his youth in Nantes, where his uncle Guillaume was Dean of the Faculty of Medicine. He was considerably influenced by his uncle and went to study medicine in Paris where he qualified in 1804. Among his teachers were Corvisart and Bayle who stimulated his interest in the clinical diagnosis of diseases of the chest and especially tuberculosis, from which Laënnec himself suffered. His clinical experience and morbid anatomical dissections at the Necker Hospital culminated in his invention of the stethoscope (1816) and the writing of his masterpiece De l'Auscultation Médiate (1819) which may be regarded as the pioneer treatise from which modern chest medicine has evolved. Despite his great success in Paris, laënnec always retained a great love for his native Brittany. When his health finally broke down, he returned to his home Kerlouarnec, near Quimper, and died there on 13 August 1826, aged 45 years. On the occasion of the bicentenary of his birth we pay homage to the memory of this great French physician.

Auscultation↗
PubMed2003

Use of acupressure to improve gastrointestinal motility in women after trans-abdominal hysterectomy.

The purpose of this study was to evaluate the effectiveness of acupressure on gastrointestinal (GI) motility in women after trans-abdominal hysterectomy (TAH). Patients were randomly assigned into two groups of 21 and 20 patients each. The experimental group received acupressure for 3 minutes at each of three meridian points: Neiguan (PC-6), Zusanli (ST-36) and Sanyinjiao (SP-6). The control group received 3 minutes of acupressure on sham points. Acupressure was performed twice a day. A questionnaire was used to determine patients' satisfaction prior to and after afternoon acupressure. GI contractions were measured with a multifunctional stethoscope before and after acupressure. Acupressure of these three meridian points significantly (p < 0.05) increased GI motility in the experimental group, but there was little change in the control group (p > 0.05). Our conclusions are that non-invasive acupressure of these meridian points can significantly improve GI motility and can be incorporated into the technical curriculum and clinical education program of nursing schools. Patients and their family members can be taught to continue this procedure at home to enhance GI motility in patients who have undergone TAH.

Abdominal Pain↗
PubMed2005

A centenary of auscultatory blood pressure measurement: a tribute to Nikolai Korotkoff.

In 1905, Dr. Nikolai Korotkoff (1874-1920), a Russian surgeon, discovered a simple and precise technique to measure arterial pressure. He was born on 26th February 1874 in the central Russian city of Kursk. Korotkoff graduated from the Medical Faculty of Moscow University in 1898, but he worked later in the Surgical Clinic at the Imperial Military Medical Academy in St. Petersburg (Russia). Korotkoff served as a military surgeon during the Russo-Japanese War (1904-1905) and his major efforts were to find reliable clinical signs that could predict whether limb flow would be viable after vascular surgery of traumatic aneurysm. He found that after complete compression, the aneurysm of the arm (i.e. distal pulse on a. brachialis) disappeared with Riva-Rocci cuff and then gradually decreasing the pressure, a series of sounds could be heard by stethoscope under the artery distal to the compression. Korotkoff described four distinct phases of sounds: first sound, then compression murmurs, second tone, and disappearance of sounds. Korotkoff was also able to demonstrate the same auscultatory finding in healthy persons. He failed to notice only the muffled second sound, which was demonstrated a little later. These classical observations are now well known as the five different phases of Korotkoff sounds. In November 1905, during a conference of the Imperial Military Medical Academy, he reported his discovery in a short presentation entitled 'On the issue of the methods for measuring blood pressure'. In 1939, the Joint Committee of the American Heart Association and the Cardiac Society of Great Britain and Ireland recognized officially and accepted worldwide Korotkoff's method for blood pressure determining.

Auscultation↗
PubMed1990

Comparative effects of ibopamine and captopril in mild congestive heart failure. Focus on the long-term effects of inodilation on ventricular arrhythmias.

Twenty-three patients with mild heart failure (I-II NYHA classes) on digitalis and diuretics were assigned to the following treatment in a random and double-blind fashion: ibopamine-captopril, ibopamine-placebo, captopril-placebo, and placebo-placebo. The doses of captopril and ibopamine were respectively 25 mg t.i.d. and 100 mg t.i.d. The incremental exercise time (until exhaustion) and the peak VO2 (oxygen consumption), the indexes of left ventricular function (by echo and nuclear stethoscope) and ventricular arrhythmias (evaluated by prolonged Holter monitoring) were assessed before randomization, at 45 days and at 3 months. Ejection fraction, exercise time, peak VO2, ventricular arrhythmias and heart rate (at rest and during exercise) appeared to be equally unaffected by each treatment. Our results show that ibopamine exerts no significant effects on either heart rate or ventricular arrhythmias and that indexes of left ventricular function are not modified by any treatment in mild congestive heart failure.

Adult↗
PubMedDate not supplied

A new cardiology patient simulator.

We report a new cardiology patient simulator developed through the application of new digital computer technology, capable of playing back selected physical findings (jugular-venous waves, arterial pulses of carotid, brachial, radial and femoral arteries, and cardiac impulses), as well as cardiac sounds, murmurs and respiratory sounds that have been prerecorded from actual patients. The examining physician uses an ordinary type of stethoscope. Four built-in speakers are located in the human-sized mannequin at the classic auscultatory sites (aortic, pulmonic, tricuspid and mitral). This compact and portable educational apparatus should facilitate medical training in the bedside cardiac examination, of physicians, medical students, nurses and paramedics throughout the world.

Cardiology↗
PubMed1986

Detection of lung abnormalities by auscultatory percussion: a comparative study with conventional percussion.

Auscultatory percussion is a new method of physical examination developed by Guarino [Lancet i: 1332-1334, 1980]. It consists in tapping lightly the manubrium sterni with the distal phalanx of the middle finger while listening over the chest wall posteriorly with a stethoscope; a decrease in sound intensity is usually attributed to lung abnormalities. The aim of our study was to assess the validity of the method as compared to classical percussion, a point not entirely clear in the original study. Two observers independently examined 281 unselected patients (170 men; 111 women) referred for chest X-ray studies. Roentgenographic analysis, carried out by a third observer, revealed 12 categories of abnormalities in 96 patients. The validity of auscultatory and conventional percussion was calculated by taking the product of sensitivity and specificity of each method. For both observers and both methods, the values of this index were always found to be below 0.25, indicating that the results can be explained entirely by chance. When the roentgenographic category was taken into account, both methods of percussion were valid only to detect large pleural effusions. Auscultatory percussion failed completely to detect many other abnormalities including solitary nodules less than 6 cm in diameter. There is no single hypothesis to explain these results. Various possibilities are discussed.

Adult↗
PubMed1993

American monitoring: standard and state of the art.

Monitoring of the anesthetized patient, the anesthesia machine, and the patient-machine interface is an essential component of anesthetic practice in order to prevent anesthetic-related injuries resulting from equipment failure or human error. While the optimal monitor to detect anesthetic problems (hypoxia, esophageal intubation, hemodynamic compromise, for example) is unclear at present, American standards require continuous presence of qualified personnel who evaluate patient oxygenation, ventilation, circulation, and temperature. A common monitoring array includes electrocardiogram, autosphygmomanometer, pulse plethysmography/oximetry, stethoscope, anesthetic gas analyzer, thermistor, and nerve stimulator. The role of emerging technologies, including transesophageal echocardiography, automated electrocardiographic analysis of ST segments, transcranial Doppler, and transcranial near infrared spectroscopy are discussed.

Adult↗
PubMed2001

Artificial neural network-based method of screening heart murmurs in children.

BACKGROUND: Early recognition of heart disease is an important goal in pediatrics. Efforts in developing an inexpensive screening device that can assist in the differentiation between innocent and pathological heart murmurs have met with limited success. Artificial neural networks (ANNs) are valuable tools used in complex pattern recognition and classification tasks. The aim of the present study was to train an ANN to distinguish between innocent and pathological murmurs effectively. METHODS AND RESULTS: Using an electronic stethoscope, heart sounds were recorded from 69 patients (37 pathological and 32 innocent murmurs). Sound samples were processed using digital signal analysis and fed into a custom ANN. With optimal settings, sensitivities and specificities of 100% were obtained on the data collected with the ANN classification system developed. For future unknowns, our results suggest the generalization would improve with better representation of all classes in the training data. CONCLUSION: We demonstrated that ANNs show significant potential in their use as an accurate diagnostic tool for the classification of heart sound data into innocent and pathological classes. This technology offers great promise for the development of a device for high-volume screening of children for heart disease.

Adolescent↗
PubMed2006

Performance of subclinical arterial disease detection as a screening test for coronary heart disease.

Traditional risk factors are poor screening tests for coronary heart disease, whereas clinical arterial disease represents its strongest predictor. This raises the question whether subclinical arterial disease may also predict coronary disease. Using published data of prospective studies of subclinical arterial disease, we calculated the incidence of coronary event associated with the absence or presence of atherosclerosis as defined by dichotomous characterization of the following markers: low or high intima-media thickness or the absence or presence of plaque, assessed by carotid ultrasound; zero or high total coronary artery calcium score assessed by computed tomography; normal or decreased ankle-arm index pressure assessed by Doppler stethoscope; and low or high aortic pulse wave velocity assessed by mecanography. A dose-response relationship was found between the absence and presence of atherosclerosis and coronary event incidence. Yearly incidence was <1% in the absence of atherosclerosis regardless of the marker used. Coronary event incidence was >1% in the presence of atherosclerosis and increased in a gradual way, depending on the marker tested, to reach 3% maximum with massive coronary calcifications. The relation between clinically overt arterial disease, such as angina, transient ischemic attack, stroke, or myocardial infarct, and yearly incidence of subsequent events reported in the literature prolonged the dose-response curve of subclinical disease. Therefore, detection of arterial disease, not only clinically overt but also subclinical asymptomatic, is a worthwhile screening test for future coronary event.

Adult↗
PubMed1988

A comparison of the random-zero and standard mercury sphygmomanometers.

Both the standard mercury sphygmomanometer and the random-zero sphygmomanometer have been used in epidemiological studies and clinical trials. Problems arise in comparing studies since, in addition to other methodological differences, the readings obtained with the random-zero sphygmomanometer have been found to be lower than those obtained with the standard mercury sphygmomanometer. In the present study, blood pressures were measured in 66 subjects to examine the comparability of findings with the two instruments. Trained observers measured blood pressures simultaneously using a double-headed stethoscope and one cuff connected to the two sphygmomanometers. Use of instrument was randomly assigned for each blood pressure measurement; each observer was unaware of the other's blood pressure reading. Readings were lower with the random-zero sphygmomanometer; mean difference ranged from 2.5 to 3.3 mm Hg for systolic pressure and 1.9 to 2.7 mm Hg for diastolic pressure. Digit distributions recorded by the two observers for the standard mercury sphygmomanometer and the random-zero sphygmomanometer were not significantly different for either systolic or diastolic blood pressure. Intraindividual variation was greater with the random-zero sphygmomanometer than with the standard mercury sphygmomanometer. These data do not indicate that one instrument is clearly superior to the other, although in studies where the observer seeks to reduce the bias of multiple readings per person, the random-zero sphygmomanometer may be the more appropriate instrument. Critical to the use of either instrument are careful training, standardization, certification, and periodic recertification of observers.

Adult↗