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Crackles in asbestos workers: auscultation and lung sound analysis.

We surveyed 270 asbestos factory workers and 222 control subjects matched for age to assess the usefulness of listening for fine discontinuous adventitious lung sound (fine crackles) in detection of the early stages of interstitial fibrosis of asbestosis. Fine crackles at both bases were heard more frequently in asbestos workers (32.2%) than in controls (4.5%) (P less than 0.01). The presence of bilateral basal crackles was related to the duration of asbestos exposure and occurred before abnormalities could be detected by chest radiography. Two observers examined 74 workers randomly chosen from among 270 asbestos workers and found inter-observer agreement to be high (91.9%). There was close agreement between findings on chest auscultation and sound recordings.

Adolescent↗

Continuous passive motion in computer assisted auscultation of the knee.

A study of physiological patellofemoral crepitus (PPC) signal recorded from adolescent knees has yielded information which suggests that decay time of PPC amplitude due to continuous passive motion (CPM) activity is a consistent and useful signature variable for a given knee. The PPC vibrational signal was induced in each case by 1 min of static load on the patella and postural variables during the examination were carefully controlled. The speed of CPM has been noted as a factor directly influencing the rat of PPC amplitude decay; specifically, a higher CPM speed contributes to an increased decay constant at a cost of increased inter-subject variability. It is proposed that CPM might form an important basis for the ultimate development of a computer-based auscultation technique for diagnosis of patellofemoral joint disorders.

Acceleration↗

Neural network assisted cardiac auscultation.

Traditional cardiac auscultation involves a great deal of interpretive skill. Neural networks were trained as phonocardiographic classifiers to determine their viability in this rôle. All networks had three layers and were trained by backpropagation using only the heart sound amplitude envelope as input. The main aspect of the study was to determine what topologies, gain and momentum factors lead to efficient training for this application. Neural networks which are trained with heart sound classes of greater similarity were found to be less likely to converge to a solution. A prototype normal/abnormal classifier was also developed which provided excellent classification accuracy despite the sparse nature of the training data. Future directions for the development of a full-scale computer-assisted phonocardiographic classifier are also considered.

Cardiology↗

Intrapartum auscultation of the fetal heart rate.

A fetal heart rate recording containing a variable deceleration was played for 120 physicians and nurses. Although mean estimates for baseline and nadir of the fetal heart rate and duration of the deceleration were not significantly different from the actual values, individual estimates of the three parameters were widely distributed. Adjunctive techniques for intrapartum fetal heart rate auscultation are recommended.

Auscultation↗

Comparison of adenosine 5'-monophosphate and methacholine for the differentiation of asthma from chronic airway diseases with the use of the auscultative method in very young children.

Methacholine and adenosine 5'-monophosphate bronchial challenges were performed in 54 young children--39 with asthma and 15 with other chronic airway diseases (CADs), with the use of the auscultative method. Children with asthma were sensitive to both methacholine and adenosine; children with CAD responded only to methacholine. We conclude that bronchial challenge with adenosine can help differentiate asthma from CAD in young children.

Adenosine Monophosphate↗

Student nurses' knowledge in relation to blood pressure measurement by sphygmomanometry and auscultation.

A 20-item questionnaire was used to explore student nurses' knowledge in several areas of blood pressure measurement by sphygmomanometry and auscultation. Questions were asked about factors that might influence blood pressure; on resting the subject before BP measurement; which arm should be used; the interval between repeat readings; the markings of the mercury column; on the details of sphygmomanometry technique and recording of the result. The questionnaire was administered to a group of Project 2000 students nearing the end of their common foundation programme. Out of 93 students, 78 consented to take part, representing 84% of the cohort. Deficits were evident in students' background knowledge-90% had not heard of either Korotkoff sounds or auscultatory gap. Major deficits were also evident in the students' knowledge of correct measurement techniques. The results suggest that more attention is required in preparing students to carry out this basic nursing activity.

Auscultation↗

Computerized auscultation applied to irritable bowel syndrome.

The purpose of this study was to investigate the potential of a computerized auscultation method for providing an objective, quantitative measure characteristic of irritable bowel syndrome. Bowel sounds from irritable bowel patients and normal controls were digitized using an electronic stethoscope. Computerized analysis indicated that the character of the bowel sounds did not differ significantly between groups. However, the fasting sound-to-sound interval was significantly different between groups (1931 +/- 365 msec for normals and 452 +/- 35 msec for the irritable bowel group; P = 0.0001). Using the sound-to-sound interval as a test for irritable bowel syndrome, the cutoff value of 640 msec resulted in a sensitivity of 89%, and a specificity of 100%. We conclude that computerized analysis of bowel sounds has the potential to be a noninvasive, quantitative, and objective test providing positive criteria in the diagnosis of irritable bowel syndrome.

Auscultation↗

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↗

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↗

Airway auscultation. A new method of confirming tracheal intubation.

Unrecognised accidental oesophageal intubation remains an important cause of morbidity and mortality in anaesthetic practice. We have evaluated a new method of distinguishing tracheal from oesophageal intubation using a simple adaptation of an ordinary stethoscope which is inserted into the patient end of the breathing system. We call this technique 'airway auscultation'. Characteristic sounds are heard with the stethoscope during inflation and deflation which allow the observer to diagnose the position of the tube. When the tube is in the trachea loud breath sounds are heard. In contrast, when the tube is in the oesophagus either squeaks or a flatus-like noise is heard or else there is no sound. In 100 healthy adults two observers rapidly identified 99 intubations correctly in a randomised single-blind trial. We recommend further widespread evaluation of this device as it appears to be an effective, simple and rapid method of detecting oesophageal intubation and confirming tracheal intubation which may be of particular use in situations where capnography is not available.

Adolescent↗

Inspection-palpation-percussion-auscultation and an outcome-oriented alternative approach to the musculoskeletal examination.

Thirty-two university-based doctors and sixty-seven medical students used a visual analogue scale (VAS) to estimate the usefulness of the inspection-palpation-percussion-auscultation (IPPA) approach. Doctors considered IPPA less useful in the examination of the musculoskeletal system than in other systems, both in clinical practice (P less than 0.01) and as an aid in teaching (P less than 0.01). Students rated IPPA less useful in the musculoskeletal examination than in other systems as a learning aid (P less than 0.001). Based on these findings, an alternative model for physical examination of the musculoskeletal system was devised, using inspection, palpation and other clinical methods only when required to reach a diagnosis. The model focused on the outcome of the diagnostic process (aetiological, anatomical/pathophysiological and functional diagnoses) rather than on the process itself. Thirteen students taught this method found it a useful learning aid. Those familiar with both methods preferred the outcome-oriented to the IPPA method (P less than 0.001).

Auscultation↗

Correlation of cervical auscultation with physiological recording during suckle-feeding in newborn infants.

Pharyngeal swallows during infant suckle-feeding are associated with a characteristic sequence of sounds audible by stethoscope or by an accelerometer or microphone held over the larynx. In rhythmically feeding term-born neonates, the delineating acoustic elements are discrete sounds which precede and succeed pharyngeal swallows. Digital signal processing shows similarities in morphological detail between the discrete sounds preceding swallows and between those succeeding swallows; those succeeding swallows are more variable in temporal relation to swallows, amplitude and morphological detail. Variations in the pattern of interswallow respiration, including apnea, are correlated with variations in the discrete sounds. Specification of physiological correlates of these internal feeding sounds increases the utility of cervical auscultation as a method of investigation and of clinical observation of feeding.

Auscultation↗

Fetal heart rate auscultation: current and future practice.

Intermittent auscultation (IA) has been reported as equivalent to electronic fetal monitoring (EFM) as a fetal surveillance method in terms of neonatal outcomes based on randomized controlled trials and meta-analyses. Despite recommendations to include IA as a primary method for fetal evaluation, EFM use predominates. Understanding the equipment, method, benefits and limitations, and strategies for implementing IA may assist nurses in providing informed choices for low-risk pregnant women.

Algorithms↗

An adaptive noise reduction stethoscope for auscultation in high noise environments.

Auscultation of lung sounds in patient transport vehicles such as an ambulance or aircraft is unachievable because of high ambient noise levels. Aircraft noise levels of 90-100 dB SPL are common, while lung sounds have been measured in the 22-30 dB SPL range in free space and 65-70 dB SPL within a stethoscope coupler. Also, the bandwidth of lung sounds and vehicle noise typically has significant overlap, limiting the utility of traditional band-pass filtering. In this study, a passively shielded stethoscope coupler that contains one microphone to measure the (noise-corrupted) lung sound and another to measure the ambient noise was constructed. Lung sound measurements were made on a healthy subject in a simulated USAF C-130 aircraft environment within an acoustic chamber at noise levels ranging from 80 to 100 dB SPL. Adaptive filtering schemes using a least-mean-squares (LMS) and a normalized least-mean-squares (NLMS) approach were employed to extract the lung sounds from the noise-corrupted signal. Approximately 15 dB of noise reduction over the 100-600 Hz frequency range was achieved with the LMS algorithm, with the more complex NLMS algorithm providing faster convergence and up to 5 dB of additional noise reduction. These findings indicate that a combination of active and passive noise reduction can be used to measure lung sounds in high noise environments.

Auscultation↗

Auscultation of foetal heart rate: an assessment of its error and significance.

AUSCULTATION OF FOETAL HEART RATE WAS SHOWN TO BE SUBJECT TO THREE TYPES OF ERROR: a random error, an error biased towards normality when the heart rate is fast or slow, and an error based on the inability to count the heart rate during contractions. In spite of these limitations a clinically observed foetal heart rate of more than 160 beats per minute was shown to be associated with significantly lower Apgar scores at birth. In contrast, a steady foetal heart rate of 100-120 beats per minute was not.

Electrocardiography↗

Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children.

BACKGROUND: It can be difficult to assess bronchial responsiveness in children because of their inability to perform spirometric tests reliably. In bronchial challenges lung sounds could be used to detect the required 20% fall in the forced expiratory volume in one second (FEV1). A study was undertaken to determine whether a change in lung sounds corresponded with a 20% fall in FEV1 after methacholine challenge, and whether the occurrence of wheeze was the most important change. METHODS: Fifteen children with asthma (eight boys) of mean age 10.8 years (range 8-15) were studied. All had normal chest auscultation before the methacholine challenge test. Lung sounds were recorded over the trachea for one minute and stored on tape. They were analysed directly and also scored blindly from the tape recording by a second investigator. Wheeze, cough, increase in respiratory rate, and prolonged expiration were assessed. RESULTS: The total cumulative methacholine dose causing a fall in FEV1 of 20% or more (PD20) was detected in 12 children by a change in lung sounds - in four by wheeze and in eight by cough, increased respiratory rate, and/or prolonged expiration. In two subjects altered lung sounds were detectable one dose step before PD20 was reached. In three cases in whom no fall in FEV1 occurred, no change in lung sounds could be detected at the highest methacholine dose. CONCLUSION: Changes in lung sounds correspond well with a 20% fall in FEV1 after methacholine challenge. Wheeze is an insensitive indicator for assessing bronchial responsiveness. Cough, increase in respiratory rate, and prolonged expiration occurs more frequently.

Adolescent↗

Auscultation of bowel sounds in patients with suspected acute appendicitis--an aid in the diagnosis? Preliminary results.

In 12 patients with suspected acute appendicitis undergoing appendectomy the bowel sounds were registrated pre- and postoperatively with a microphone placed on the abdominal wall. The results show that auscultation and registration of bowel sounds may aid in the diagnosis of acute appendicitis. However, these results cannot be applied to the clinical situation. Further evaluation of this method is essential.

Acute Disease↗

A comparative study of the measurement of mean arterial blood pressure using automatic oscillometers, arterial cannulation and auscultation.

Mean brachial artery pressures determined by five different non-invasive automatic oscillometric and one auscultatory preferred (oscillometric back-up) blood pressure (BP) monitors were compared with mean arterial pressures (MAP) obtained by cannulation of the radial artery of the same arm. The devices tested all performed similarly, showing a wide range of variation (+40% to -29%) compared with the directly measured MAP, and all tended to over-read at low values and under-read at high values. Trend information was generally acceptable, but occasionally was misleading. In addition, using one of the devices, systolic and diastolic blood pressure measurements were compared with those obtained by auscultation. This gives a range of differences from +22 to -25 mmHg for systolic and +20 to -12 mmHg for diastolic BP measurements. (The average fell within 1.0 mmHg of the auscultatory measurement, with a standard deviation of 10 mmHg.) Thus, the automatic oscillometric BP monitors tested were comparable in accuracy to auscultatory BP measurement, and are satisfactory for routine use in the appropriate clinical context. However, in settings where significance is to be attached to individual BP readings rather than to trends, or where a high degree of accuracy is required, automatic oscillometric machines cannot be regarded as satisfactory alternatives to arterial cannulation.

Analysis of Variance↗