Palpation Method Research Articles

Quality Improvement: Using Ultrasound-Guided Cannulation for Difficult IV Access in Medical-Surgical Patients: A Quality Improvement Project.

Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA. The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center. The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record. A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate. Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA.

Optical coherence tomography and elastography for the visualization of architecture and stiffness differences in gastric cancer and dysplasia.

382 Background: Individuals at high risk for gastric cancer may be recommended to undergo risk-reducing gastrectomy, which leads to life-long morbidity. Surveillance with endoscopy can be an appropriate and effective option for avoiding unnecessary surgery. Gastric cancer is commonly characterized by changes in tissue architecture and increased tissue stiffness, but visualization of these alterations is challenging for white light endoscopy methods. We utilized optical coherence tomography (OCT), a non-destructive imaging modality that uses reflected near-infrared light to generate cross-sectional images of tissue, to visualize microstructure and relative tissue stiffness. Methods: We utilized two modes of OCT for visualization of ex vivo tissue samples collected from patients undergoing gastrectomy for gastric cancer, endoscopic mucosal resection, or endoscopic biopsy. Images were collected with a benchtop OCT system (Thorlabs Telesto TEL221). Structural OCT was used to visualize changes in tissue architecture including thickened mucosa and irregular put structure of the mucosa. Optical coherence elastography (OCE) was used to extract relative measures of tissue stiffness using an optical palpation method. A phantom of known mechanical properties was placed on the tissue and an axial force was applied. The resulting deformation (strain) of the phantom provided relative measurements of tissue stiffness. Classification of normal and cancerous tissue was confirmed by histology. Results: Structural OCT imaged architectural features of tissue with high resolution (<10 um) and depth of imaging up to 1.5 mm. Strain maps generated with OCE data showed that normal gastric tissue had relatively consistent stiffness, whereas stomach cancer and dysplasia exhibited increased tissue stiffness compared to normal. Conclusions: Structural OCT and OCE captured changes in tissue architecture and increased stiffness in patient samples of gastric cancer and dysplasia. These tissue features are classic characteristics of cancer, making this technique a useful screening tool for several cancer types. Future work aims to implement endoscopic OCT and OCE to detect cancer at early stages in vivo .

Synergy-based motor therapy for post-stroke hemiparetic subjects: A randomized controlled trial

Objectives: Motor recovery is inclusively based on the severity of abnormal coupling or the abnormal synergistic actions among the post-stroke hemiparetic subjects. The normal synergistic pattern shall be incorporated to inhibit the abnormal synergistic behavior to attain motor control. Materials and Methods: A randomized controlled double blinded (assessor and subjects) trial was conducted in a rehabilitation institute. One hundred and thirty-six post-stroke (mean duration, 12.73 ± 9.52 months) hemiparetic subjects were conveniently selected and randomly allocated in two groups (experimental, 68 and control, 68). The experimental group received synergistic-based motor therapy (SBMT) protocol and the control group of the subjects received the conventional occupational therapy intervention. Both of the groups received dose-matched intervention for the period of 3 months, 48 sessions (4/week). Normal synergistic linkage was being exploited to encounter the abnormal synergistic patterns. The main outcome measures were Fugl-Meyer Assessment – upper extremity (FMA-UE), arm (FMA-A), wrist-hand (FMA-WH) for the motor recovery and Finger Breadth Palpation method (FBP) for the shoulder subluxation. Results: In comparison to the control group, the experimental group exhibited highly significant results. The mean score of FMA-UE was changed to 41.32 ± 11.50 from the pre-intervention score of 25.76 ± 15.26 (P < 0.001). Post-intervention, the mean score of FMA-A was increased to 26.89 ± 0.93 from 17.36 ± 1.21 (P < 0.001). The pre-assessment score of FMA-WH was 8.29 ± 0.96 and post-intervention, it was increased to 14.13 ± 0.88 (P < 0.001). The experimental group of subjects was recorded to have a reduction in the shoulder subluxation. The grade of FBP reduced to 0.39 ± 0.11 from the pre-intervention score of 1.23 ± 0.13 (P < 0.001). Conclusion: SBMT was concluded to be superior and highly significant than the conventional intervention for enhancing upper limb motor recovery among post-stroke hemiparetic subjects. Further, the grade of shoulder subluxation was also found to be significantly reduced among the SBMT group participants in comparison to the control subjects.

Reliability of a Measurement Method for Upper Limb Raised Standing Spinal Alignment Using a Smartphone Inclinometer Application.

To evaluate the reliability and validity of spinal alignment measurements in the raised arm standing posture using a smartphone app. An inclinometer is a reliable tool for measuring spinal alignment. Measurement of static standing posturespinal curvature angles using smartphone inclinometer applications has been investigated in the lumbar spine but has not been reported for the thoracic spine. However, the sacral vertebrae were used as the reference point for the measurement of the lumbar spine, and the method of palpation of the sacral vertebrae was unclear. No measurement methods, including inclinometers, have been found for upper limb elevation. Thoracic kyphosis and lumbar lordosis angles were measured in 18 healthy young adults (mean age: 21.0 ± 3.5). Measurements were taken in the raised standing posture. The points of measurement included angle α at the thoracic spine (T)1/2, angle β at the T12/lumbar spine (L)1, and angle γ at the L4/L5 spinous processes. The thoracic kyphosis angle was calculated as the sum of α and β, while the lumbar lordosis angle was the sum of β and γ. Two raters measured these angles twice using the same smartphones. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC 2.1), and measurement precision was determined by calculating MDC95 from the ICC values.Validity was also carried out on 12 healthy young adults (age: 20.8 ± 4.0 years). The measurement points were the same as described above, and two types of measurements were taken with a smartphone and an inclinometer; the results of the two types of measurements were used to determine the relationship using Pearson's correlation coefficient. During upper limb raising, the smartphone's ICC (95% confidence interval) was 0.92 (0.81-0.97) for thoracic kyphosis and 0.90 (0.74-0.96) for lumbar lordosis. The MDC95 values indicated acceptable precision, with 7.00° for thoracic kyphosis and 9.95° for lumbar lordosis.All correlation coefficients between inclinometers and smartphones were above 0.9 for both the thoracic and lumbar spines. Measuring spinal alignment angles using a smartphone inclinometer app in the raised standing posture demonstrates good reliability for inter-rater comparisons.It was also good with regard to validity.

Gender variability in palpation performance for temporomandibular disorders with three different methods: An experimental study.

Gender differences in pain reporting and prevalence have been demonstrated. As gender of examiner also affects reporting of pain on palpation, the aim of this study was to evaluate the effects of examiner gender on palpation performance using three different palpation methods. Examiners of both genders were instructed on the correct technique for each palpation method by either a female or male instructor. The target was to achieve a pressure of 100kPa, corresponding tothe 1kg of force for muscle palpation described in the diagnostic criteria for temporomandibular disorders (DC/TMD). All examiners performed traditional palpation with the index finger, palpation with a palpometer, and a novel bimanual palpation with visual feedback, in a randomized order. The examiner's gender, and its interaction with the gender of the instructor did not significantly affect magnitude, accuracy, or precision of the pressure applied. The method of palpation was the only factor that significantly impacted all metrics. The palpometer achieved the lowest palpation magnitude (mean pressure applied=113.7kPa, 95% CI: 109.8-117.6), the highest accuracy (absolute difference=15.7kPa, 95% CI: 12.3-19.1), and the highest precision (mean coefficient of variation=6.8, 95% CI: 6.0-7.6), followed by bimanual palpation and traditional palpation. The results suggest that gender differences in pain reporting in patients are not likely to be a result of the technical aspects associated with the gender of the examiner. Instead, these differences may be attributed to other factors, such as sociocultural influences.

Is It Possible to Detect Return of Spontaneous Circulation during Chest Compression? Evaluation of a Novel Method: Carotid Artery Compression Ultrasound.

Objectives: To evaluate the diagnostic accuracy of carotid artery compression using a point-of-care ultrasound probe (POCUS-CAC) in reducing pulse check times and facilitating the detection of the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) compared to manual palpation (MP). The secondary aim of the study is to assess the ability of POCUS-CAC to detect ROSC during ongoing chest compressions. Methods: This prospective study was conducted in a tertiary emergency department between January and June 2023. During CPR, POCUS-CAC was performed by placing a linear ultrasound probe transversely on the lateral neck to assess the compressibility of the carotid artery. Complete compression of the artery without any visible pulsation indicated no ROSC, while resistance to compression or partial compression suggested the presence of ROSC. Simultaneously, another clinician performed manual palpation of the femoral artery. The primary outcome assessed in this study was comparing ROSC detection between POCUS-CAC and traditional methods, and the secondary outcome was comparing the time taken to detect ROSC with each method, and the ability to detect ROSC during ongoing chest compressions. Results: The study included 41 cardiac arrest patients and analyzed 496 MP pulse and 1984 POCUS-CAC checks. The mean time to identify a pulse using POCUS-CAC was significantly shorter, at 2.3 (0.5-7.8, SD ± 1.2, 95% CI [2.25, 2.35]) s, compared to 4.7 (2.0-10.5, SD ± 1.8, 95% CI [4.54, 4.86]) s with MP (p = 0.004). Additionally, 52.9% of ROSC cases were detected earlier using POCUS-CAC, even during ongoing chest compressions. The sensitivity of POCUS-CAC was 100% (95% CI [80.5-100%]) and the specificity was 87.5% (95% CI [67.6-97.3%]). The POCUS-CAC method required less than 5 s in 99.996% of cases. Conclusions: POCUS-CAC significantly reduces pulse check times and enhances the early detection of ROSC during CPR, offering a reliable and rapid alternative to traditional manual palpation methods in emergency settings.

Embryonic and Fetal Mortality in Dairy Cows: Incidence, Relevance, and Diagnosis Approach in Field Conditions

Pregnancy loss (PL) in dairy cattle results in animal health and welfare disruption and has a great economic impact on farms, with decreases in fertility and increased culling. It can occur at any stage of embryonic or fetal development. Abortion occurring from the second half of pregnancy has a more negative impact on dairy farms. There are several infectious and non-infectious factors that can lead to PL and vary according embryonic or fetal stages. As this is a multifactorial or multi-etiological occurrence, it is important to identify the risk factors and the best diagnostic tools to approach these reproductive losses that can occur sporadically or by outbreaks. Reaching a final diagnosis can be challenging, especially when it occurs at a very early stage of pregnancy, where losses may not be detected and neonatal deaths may be related to alterations in the fetus in utero. Also, laboratorial results from animal samples should be interpreted according to the full clinical approach. This review aimed to highlight all these essential aspects, identifying the main infectious and non-infectious causes leading to PL, as well as the best veterinary practices for diagnosing it, mainly through transrectal palpation, ultrasound, and laboratory methods, in bovine dairy farms.

Clinical Utility of Ultrasonographic Guidance for Arterial Catheterization in Patients with Obesity: A Randomized Controlled Trial

ObjectivesWe aimed to compare the success and complication rates of radial artery catheterizations between ultrasound guidance and conventional palpation technique in obese patients by anesthesia residents with similar levels of experience in both methods. Another objective was to measure the skin-to-artery distance of radial, brachial, and dorsalis pedis arteries using ultrasound with standardized anatomical landmarks. DesignProspective, randomized controlled trial SettingSingle tertiary center ParticipantsEighty adults with a body mass index (BMI) ≥ 30 kg·m-2 InterventionsUltrasound guidance or conventional palpation method Measurements and Main ResultsThe primary outcome was the first-attempt success rate of arterial catheterizations. The skin-to-artery distance of the radial artery in the BMI groups of 40–49 and ≥ 50 kg/m2 was significantly greater than that of the BMI group of 30–39 kg·m-2, mean difference: 1.0 mm [95% confidence interval (CI): 0.4 – 1.7, p=0.0029] for BMI 40–49 vs. 30–39 kg/m2 and 1.5 mm (95% CI: 0.6 – 2.4, p=0.0015) for ≥ 50 vs. 30–39 kg·m-2. Similar findings were observed for the brachial artery. BMI was inversely associated with first-attempt success rates (p=0.0145) and positively with time to successful catheterization (p=0.0271). The first-attempt success and vascular complication rates of catheterization did not significantly differ between the ultrasound guidance group (65.0%; 52.5%) and the conventional palpation group (70.0%, p=0.6331; 57.5%, p=0.6531). ConclusionOur results do not support routine uses of ultrasonography during radial arterial catheterizations for obese adults when junior practitioners performed the procedure.

Reliable Stenosis Detection Based on Thrill Waveform Analysis Using Non-Contact Arteriovenous Fistula Imaging.

Hemodialysis therapy is an extracorporeal circulation treatment that serves as a substitute for renal function. In Japan, patients receive this efficient four-hour treatment, three times per week, allowing them to maintain a social life nearly equivalent to that of healthy individuals. Before the treatment, two punctures are performed to establish extracorporeal circulation, and a high blood flow rate is essential to ensure efficient therapy. Specialized blood vessels created through arteriovenous fistula (AVF) surgery are utilized to achieve high blood flow rates. Although the AVF allows safe and efficient dialysis treatment, AVF stenosis leads to a serious problem in dialysis. To early detect this abnormal blood flow, auscultation and palpation methods are widely used in hospitals. However, these methods can only provide qualitative judgment of the AVF condition, so the results cannot be shared among other doctors and staff. Additionally, since the conventional methods require contact with the skin, some issues require consideration regarding infection and low reproducibility. In our previous study, we proposed an alternative method for auscultation using non-contact optical imaging technology. This study aims to construct a reliable AVF stenosis detection method using Thrill waveform analysis based on the developed non-contact device to solve the problem with the contact palpation method. This paper demonstrates the performance validation of the non-contact imaging in the normal AVF group (206 total data, 75 patients, mean age: 69.1 years) and in the treatable stenosis group (107 total data, 17 patients, mean age: 70.1 years). The experimental results of the Mann-Whitney U test showed a significant difference (p=0.0002) between the normal and abnormal groups, which indicated the effectiveness of the proposed method as a new possible alternative to palpation.

Educational Intervention Can Improve the Pilot Balloon Palpation Method of Tracheal Tube Cuff Pressure Monitoring: An Experimental Study.

Considerable morbidity is attributable to inappropriate tracheal cuff pressure. An earlier study undertaken in our hospital revealed that a normal cuff pressure of 20-30 cm H2O was achieved in only 6% of intubated patients using subjective estimation methods. To determine whether a training intervention could improve the accuracy of the subjective estimation method in our tracheal cuff monitoring. A 1-day training session was conducted in April 2022 for our anaesthesia providers. The cuffs of different sizes of endotracheal tubes were inflated to 25 cm H2O, and each staff was requested to feel the turgor of the pilot balloon. Subsequently, anaesthesia providers used pilot balloon palpation for the regulation of the tracheal cuff pressure in consecutive patients undergoing general anaesthesia with endotracheal intubation. During each intubation, a manometer was used to crosscheck the inflated cuff pressure objectively. The incidence of post-operative sore throat was also evaluated. The obtained outcomes were compared with pre-intervention data obtained from an earlier study conducted in the health facility from October 2020 to September 2021. Significant differences were considered when P < 0.05. The mean tracheal cuff pressure was improved post-intervention (49.2 ± 24.1 cm H2O versus 77.1 ± 31.1 cm H2O; P < 0.001). A significantly higher proportion of tracheal cuffs (20%; 31/156) were inflated within the normal range compared to 6% (9/141) prior to the intervention (P = 0.003). Fewer patients developed post-operative sore throat following the educational intervention (32.8%; 41/125) versus pre-intervention (47.7%; 53/111; P = 0.019). The educational intervention improved the safety of tracheal cuff management, which could positively impact airway management, especially in poor resource settings without cuff manometers.

Radial artery catheterization using a novel T-type ultrasound probe: a single-center randomized study.

Ultrasound guidance has been reported to facilitate radial artery catheterization compared with the palpation method. However, a recent meta-analysis showed that there was not significant differences in the first attempt success rate between the long-axis in-plane (LA-IP) method and the short-axis out-of-plane method. In 2023, we started using a novel T-type probe. We can recognize the needle first during the radial artery access with the short-axis view and then dose it with the long-axis view using the T-type probe. Therefore, we hypothesized that the T-type probe-guided method might heighten the first attempt success rate in radial artery catheterization, even for non-expert practitioners, compared with the LA-IP technique. One hundred and fifty adult patients, older than 20years, ASA I to III, were randomly assigned to the T-type probe-guided group (Group T: n = 75) or the LA-IP group (Group L: n = 75). The primary outcome was the first attempt success rate. The first attempt success rate in Group T (49/71, 69%) was significantly higher than that in Group L (31/68, 46%) (p = 0.0062). The present study showed that the T-type probe might facilitate the radial artery catheterization rather than the LA-IP method.

Using Thermography Infrared to Detect Diabetic Foot Ulcers in Asia Pacific Countries: Scoping Review

Introduction: Diabetes Mellitus (DM) is a growing global health concern, particularly in Indonesia, where the prevalence is projected to rise significantly. Diabetic Foot Ulcer (DFU) is a severe complication of DM that escalates the risk of amputations. Early detection of DFUs plays a crucial role in preventing associated complications Objective: This review aimed to assess the efficacy of infrared thermography in detecting DFUs in the Asia-Pacific region. Methods: A scoping review methodology adhering to PRISMA guidelines was employed. Databases were searched from 2011-2021. PICO strategy used keyword Diabetic foot ulcer, Skin ulcer, Leg ulcer, Foot ulcer, Diabetic neuropathic, Thermography, Temperature mapping, and Detection from PubMed, Scopus, Google Scholar, and Science Direct. Quality of article assessed by JBI. Results: Four (4) studies meeting the inclusion criteria were identified, primarily cross-sectional in design. The results indicated promising sensitivity and specificity of infrared thermography in detecting DFUs among DM patients. The technology's ability to capture thermal images revealing temperature variations associated with tissue inflammation, a common DFU indicator, underscores its efficacy. This non-invasive technique allows for early detection and monitoring of DFUs, facilitating timely interventions and improving patient outcomes. Additionally, infrared thermography provides a quantitative and objective assessment of tissue health, complementing traditional visual inspection and palpation methods. Its effectiveness lies in detecting subtle skin temperature changes, aiding in early identification and management of DFUs before they progress to more severe stages. Conclusion: Infrared thermography shows significant potential in detecting DFUs early, which is vital for effective management and prevention of severe complications. Despite the promising results, broader and more rigorous studies are necessary to validate these findings across different populations and healthcare settings. Further research across diverse settings and study designs is essential to reinforce these findings.

The Relationship of Mitochondrial-derived Peptide (MOTS-c) and Brain Mitochondrial Carrier Protein 1 (BMCP1) Response in Sheep with Some Physiological Parameters

Background: Mitochondria are organelles called power plants of the cell, which are found in eukaryotic cells and are responsible for the production of energy needed by the cells through aerobic respiration. Mitochondrial dysfunction causes endocrinological, cardiovascular, metabolic and neurodegenerative diseases. The aim of this study was to examine the effects of body condition score (BCS), lactation, pregnancy, age and gender on Mitochondrial-Derived Peptide (MOTS-c) and Brain Mitochondrial Transporter Protein 1 (BMCP1) levels in Akkaraman sheep. Methods: Sheep are classified into 3 categories according to BCS (BCS less than 2, BCS=3-3.5, BCS≥4). In creating groups in terms of BCS, it was determined by the palpation method applied to the waist area. The sheep included in the study were divided into 4 groups: early lactation, early pregnancy, late pregnancy (dry period) and age (female and male sheep).1st group, ewes in the first period of pregnancy (on the 100th day of the first pregnancy) (n = 30), 2nd group, ewes in the early lactation period (n = 30), 3rd group, ewes in the dry period (the last two months of pregnancy) (n = 30) and in the 4th group, less than 2 (young) (n=30), 2-8 (adult) (n=30), 8 greater than (old) (n=30), male and female sheep (n=30) of different ages. =180) total of 270 animals. Blood samples were taken from the jugular vein of the sheep before the morning feeding. MOTSc and BMCP1 levels were determined in blood serum samples by ELISA method. Result: In the study, serum MOTS-c and BMCP1 levels in sheep during lactation and pregnancy were determined to be lowest in the VKS less than 2 group and highest in the VKS≥4 groups. Likewise, in age and gender groups, the highest level was detected in young lambs and yearlings in the VKS less than 2 group, while the highest level was detected in old sheep and rams in the VKS≥4 group. As a result, it was determined that different age, gender, pregnancy and lactation periods affected serum MOTS-c and BMCP1 levels depending on the change in BCS (P less than 0.05). It was concluded that MOTS-c and BMCP1 may be useful parameters in the evaluation of mitochondrial function, energy metabolism and metabolic profile.

FITNESS LEVEL OF SECONDARY SCHOOL STUDENTS ENGAGED IN SPORTS

School physical education is effective means of providing children with the knowledge for lifelong physical activity. The research was aimed to examine the influence of different sports activities (badminton, basketball, football) on fitness level of boys aged 10-11. 72 boys aged 10-11 were engaged in the research. Evaluation of children’s fitness level involved anthropometric parameters of body length (cm); body mass (kg); hand dynamometry (kg). Cardiovascular and respiratory systems were also assessed: heart rate (HR, bpm) – method of palpation; blood pressure – systolic (SBP, mm Hg) and diastolic (DBP, mm Hg) – method of Korotkoff sounds; vital capacity of lungs (VC, L) – spirometer measuring. The Ruffier index, life index, strength index, the Robinson index and the Quetelet index were considered as well. Summing the points of five parameters, fitness levels were defined as low, below average, average, above average, and high. Comparative analysis of ball games influence on children’s fitness level revealed the highest growth rate among badminton players, though their initial and final parameters were the lowest ones. Research findings made it possible to conclude that extramural engagement in ball games throughout school year had beneficial effect on fitness levels of boys aged 10-11.

Reliability of an intraoral extension for intraoral palpation and assessment of mechanical sensitivity of the temporal tendon.

The temporal tendon is a structure often compromised in patients suffering from temporomandibular disorders (TMD), yet its intraoral location makes a standardised assessment difficult. To evaluate the variability and accuracy to target force of a newly designed intraoral extension for a palpometer device (Palpeter, Sunstar Suisse) when compared to manual palpation, in addition to clinically assessing the mechanical sensitivity and referred sensations of the temporal tendon in healthy individuals. Experiment 1: 12 individuals were asked to target on a scale 0.5, 1 and 2 kg, for 2 and 5 s by using five different methods (Palpeter, Palpeter with three different extension shapes and manual palpation). Experiment 2: 10 healthy participants were recruited for a randomised double-blinded assessment by applying pressure of 0.5, 1 and 2 kg to the right temporal tendon with the three extensions and manual palpation. Participants rated the intensity of their sensation/pain on a 0-50-100 numeric rating scale (NRS), unpleasantness on a 0-100 NRS, and if present, they rated and drew the location of referred sensations. Repeated measures analysis of variance (ANOVA) was used in both experiments to compare differences between palpation methods. Tukey's HSD tests were used for the post hoc comparisons, and p values below .05 were considered significant. Experiment 1: The extensions showed no significant differences between them regarding reliability and accuracy for all forces and durations (p > .05). The manual method was significantly less reliable and accurate when compared to the other methods (p < .05). Experiment 2: There were no significant differences between the Palpeter extensions regarding pain intensity or unpleasantness NRS scores (p > .05), but all the extensions had significantly increased pain intensity and unpleasantness when compared to manual palpation (p < .05). Similarly, the frequency of referred sensations was similar between extensions but increased when compared to manual palpation. The new Palpeter extensions proved to be significantly more accurate and have lower test-retest variability than the manual method in a non-clinical setting. Clinically, they showed no significant differences in NRS scores for pain intensity nor unpleasantness, with no major differences in referred sensations, making any of the extensions suitable for clinical testing of the temporal tendon in future studies.

Low Inter-Rater Reliability and Reproducibility of Neck Reflex/“Adler-Langer” Points in Neural Therapy Diagnostics but Increased Pressure Pain Threshold after Therapy: Results of a Randomized Controlled Observer-Blind Trial

Background: Neck reflex points or Adler-Langer points are commonly used in neural therapy to detect so-called interference fields. Chronic irritations or inflammations in the sinuses, teeth, tonsils, or ears are supposed to induce tension and tenderness of the soft tissues and short muscles in the upper cervical spine. The individual treatment strategy is based on the results of diagnostic Adler-Langer point palpation. This study investigated the inter- and intra-rater reliability and explored treatment effects. Methods: We performed a randomized controlled trial with 104 inpatients (80.8% female, 51.8 ± 12.74 years) of a German department for internal and integrative medicine. Patients were randomized to individual neural therapy according to the pathological findings (n = 48) or no treatment (n = 56). In each patient, three experienced raters (20–45 years of experience in neural therapy) and two novice raters (medical students) rated Adler-Langer points rigidity on a standardized rating scale (“strong,” “weak,” “none”). The patients independently evaluated the tenderness on palpation of the eight points using the same scale. Pressure pain thresholds were assessed at the eight Adler-Langer points. All patients were retested after 30 min. The five raters were blinded to treatment allocation and assessments of the other raters. Video recordings were obtained to assess the consistency of the areas tested by the different raters. Results: Agreement between patients and raters (Cohen’s kappa = 0.161–0.400) and inter-rater reliability were low (Fleiss kappa = 0.132–0.150). Moreover, the individual agreement (pre-post comparisons in untreated patients) was similarly low even in experienced raters (Cohen’s kappa = 0.099–0.173). Video documentation suggests that raters do not place their fingers in the correct segments (percentage of correct position: 42.0–60.6%). Pressure pain thresholds at five of the eight Adler-Langer points showed significant changes after treatment compared to none in the control group. Conclusion: Under this artificial experimental setting, this method of Adler-Langer point palpation has not proven to be a reliable diagnostic tool. But it could be shown that, as claimed by the method, the tenderness in five of eight Adler-Langer points decreased after neural therapy.

Agreement in the Postural Assessment of Older Adults by Physical Therapists Using Clinical and Imaging Methods.

Postural assessment is one of the indicators of health status in older adults. Since the number of older adults is on the rise, it is essential to assess simpler methods and automated ones in the future. Therefore, we focused on a visual method (imaging method). The purpose of this study is to determine the degree of agreement between the imaging method and the palpation and visual methods (clinical method). In addition, the influence of differences in the information content of the sagittal plane images on the assessment was also investigated. In this experiment, 28 sagittal photographs of older adults whose posture had already been assessed using the clinical method were used. Furthermore, based on these photographs, 28 gray and silhouette images (G and S images) were generated, respectively. The G and S images were assessed by 28 physical therapists (PTs) using the imaging method. The assessment was based on the Kendall classification, with one of four categories selected for each image: ideal, kyphosis lordosis, sway back, and flat back. Cross-tabulation matrices of the assessments using the clinical method and imaging method were created. In this table, four categories and two categories of ideal and non-ideal (KL, SB, and FB) were created. The agreement was evaluated using the prevalence-adjusted bias-adjusted kappa (PABAK). In addition, sensitivity and specificity were calculated to confirm the reliability. When comparing the clinical and imaging methods in the four posture categories, the PABAK values were -0.14 and -0.29 for the S and G images, respectively. In the case of the two categories, the PABAK values were 0.57 and 0.5 for the S and G images, respectively. The sensitivity and specificity were 86% and 57% for the S images and 76% and 71% for the G images, respectively. The four categories show that the imaging method is difficult to assess regardless of the image processing. However, in the case of the two categories, the same assessment of the clinical method applied to the imaging method for both the S and G images. Therefore, no differences in image processing were observed, suggesting that PTs can identify posture using the visual method.

Surveillance of echinococcosis in Bayingolin Mongol Autonomous Prefecture, Xinjiang Uygur Autonomous Region from 2017 to 2022

To analyze the echinococcosis surveillance results in Bayingolin Mongol Autonomous Prefecture, Xinjiang Uygur Autonomous Region from 2017 to 2022, so as to provide insights into formulation of echinococcosis control measures in the prefecture. Villagers were randomly sampled using a multistage sampling method from class I and II echinococcosis endemic counties in Bayingolin Mongolian Autonomous Prefecture from 2017 to 2022 for detection of human echinococcosis, while all patients undergoing ultrasound examinations in medical institutions in class III endemic counties received active echinococcosis screening. In addition, livestock in centralized slaughterhouses or slaughtering sites were screened for echinococcosis using the palpation and necropsy method, and fresh domestic dog feces samples were collected from randomly selected dog owners in each administrative village for detection of Echinococcus copro-antigen in domestic dogs. The trends in detection of human and livestock echinococcosis, detection of newly diagnosed human echinococcosis cases and detection of Echinococcus coproantigen in domestic dogs were analyzed in Bayingolin Mongol Autonomous Prefecture from 2017 to 2022. The mean detection rate of human echinococcosis was 0.13% (540/407 803) in Bayingolin Mongol Autonomous Prefecture from 2017 to 2022, which appeared a tendency towards a decline over years (χ2trend = 1 217.21, P < 0.001), and the highest detection of newly diagnosed echinococcosis cases was seen in Hejing County (0.28%, 191/67 865). The detection of livestock echinococcosis appeared a tendency towards a decline over years from 2017 to 2022 (χ2trend = 147.02, P < 0.001), with the highest detection rate seen in Hejing County (3.44%, 86/2 500), and the detection of Echinococcus copro-antigen in domestic dogs appeared a tendency towards a decline over years from 2017 to 2022 (χ2trend = 302.46, P < 0.001), with the highest detection rate in Qiemo County (2.74%, 118/4 313). The detection of human and livestock echinococcosis and dog feces antigens Echinococcus copro-antigen in domestic dogs all appeared a tendency towards a decline in Bayingolin Mongol Autonomous Prefecture, Xinjiang Uygur Autonomous Region from 2017 to 2022; however, there is still a high echinococcosis transmission risk in local areas. Sustainable integrated echinococcosis control is required in Bayingolin Mongol Autonomous Prefecture.

Palpation and fluoroscopy are valid but unreliable for the assessment of femoral tunnel position after medial patellofemoral ligament reconstruction

ObjectivesThe purpose of this study was to evaluate the validity and reliability of two techniques, palpation and fluoroscopy, for assessing medial patellofemoral ligament (MPFL) reconstruction femoral tunnel position accuracy. MethodsTwenty-one fresh frozen cadaveric knees had an MPFL femoral tunnel drilled and filled with a metal screw. Tunnels were created in a nonstandard fashion to ensure the sample included a range of tunnel positions from poor to ideal. Six experienced sport medicine and arthroscopy surgeons evaluated the placement of the femoral tunnel by palpating the screw in relation to anatomic landmarks and by fluoroscopy related to Schöttle's Point. They evaluated 1) the accuracy of femoral tunnel placement, 2) the direction of tunnel error, and 3) the clinical acceptability of the tunnel position. Validity measures included sensitivity, specificity, and correlation to clinical acceptability, which were calculated for the palpation and fluoroscopic assessments. Reliability measures included interrater reliability (ICC 2,k) for femoral tunnel accuracy and percent agreement of the raters' tunnel direction assessment. ResultsThe palpation method demonstrated a sensitivity of 0.79 and specificity of 0.84 for assessing the accuracy of femoral tunnel placement, while the fluoroscopic method showed a sensitivity of 0.83 and specificity of 0.92. Pearson correlation coefficients for clinical acceptability of tunnel position were high, with both techniques ranging from .589 to .854. Interrater reliability for the palpation and fluoroscopic techniques for assessment of tunnel accuracy were 0.31 and 0.55 (ICC 2,k), respectively. Assessment of the direction of tunnel error was good with the fluoroscopic technique slightly more accurate than palpation. ConclusionThis study demonstrated that both palpation and fluoroscopy are valid techniques for assessing femoral tunnel position after MPFL reconstruction. Despite demonstrating good validity, the accuracy of assessing tunnel position was unreliable in a group of six experienced knee surgeons. Further research into MPFL reconstruction femoral tunnel assessment techniques, including patient-specific reference standards, is warranted. Level of EvidenceLevel 2.

COMPARISON OF METHODS OF NON-MECHANICAL PRESSURE MEASUREMENT IN THE CUFF OF AN ENDOTRACHEAL TUBE

Background: Tracheal injuries are uncommon but pose significant risks in anesthesiology and critical care. These injuries primarily occur due to the direct mechanical impact, often linked to the excessive pressure from the intubation tube's cuff. This study aims to assess the actual cuff pressure in intubated patients during surgeries, examine how these measurements correlate with anesthesiologists' subjective evaluations, and compare various cuff inflation techniques. Methods: The study included 90 patients, divided into two groups of 45 each. For the experimental group, the cuff was inflated using the «minimum leakage» method, while the control group used palpation to gauge the required pressure. The actual cuff pressure for both groups was determined using a mechanical manometer connected to the cuff. Results: The mean pressure in the experimental group was 30.4 ± 4.9 cm H2 O (2.98 ± 0.48 kPa), significantly lower than the control group's 68.9 ± 23.3 cm H2 O (6.75 ± 2.28 kPa). In the control group, only 2 patients were within the safe pressure range, compared to 23 in the experimental group. Conclusion: The palpation method for estimating cuff pressure in intubated patients often does not reflect the actual pressure values. The study highlights the effectiveness of the minimal occlusion volume technique as a non-mechanical method for more accurately measuring and controlling cuff pressure.