Standardized Physical Examination Research Articles

Leveraging Space-Flown Technologies to Deliver Healthcare with Holographic Physical Examinations.

INTRODUCTION: Musculoskeletal injuries are one of the more common injuries in spaceflight. Physical assessment of an injury is essential for diagnosis and treatment. Unfortunately, when musculoskeletal injuries occur in space, the flight surgeon is limited to two-dimensional videoconferencing and, potentially, observations made by the crew medical officer. To address these limitations, we investigated the feasibility of performing physical examinations on a three-dimensional augmented reality projection using a mixed-reality headset, specifically evaluating a standard shoulder examination.METHODS: A simulated patient interaction was set up between Western University in London, Ontario, Canada, and Huntsville, AL, United States. The exam was performed by a medical student, and a healthy adult man volunteered to enable the physical exam.RESULTS: All parts of the standard shoulder physical examination according to the Bates Guide to the Physical Exam were performed with holoportation. Adaptation was required for the palpation and some special tests.DISCUSSION: All parts of the physical exam were able to be completed. The true to anatomical size of the holograms permitted improved inspection of the anatomy compared to traditional videoconferencing. Palpation was completed by instructing the patient to palpate themselves and comment on relevant findings asked by the examiner. Range of motion and special tests for specific pathologies were also able to be completed with some modifications due to the examiner not being present to provide resistance. Future work should aim to improve the graphics, physician communication, and haptic feedback during holoportation.Levschuk A, Whittal J, Trejos AL, Sirek A. Leveraging space-flown technologies to deliver healthcare with holographic physical examinations. Aerosp Med Hum Perform. 2024; 95(4):214-218.

Ultrasound Elastography as a Diagnostic Tool for Peyronie's Disease: A State-of-the-Art Review.

Elastography is a noninvasive method that utilizes ultrasound imaging to assess the elasticity and stiffness of soft tissue. Peyronie's disease (PD) is a chronic inflammatory condition that affects the male penis, causing the formation of fibrous plaques. This alters the penis's elasticity and can lead to changes in its shape. Ultrasound elastography (UE) is an important advancement in the diagnosis of PD. It not only identifies plaques, but it also measures their rigidity, providing crucial information to monitor changes during and after treatment. We conducted a narrative review of the scientific literature to identify articles that discuss the use of elastography in the diagnostic study of PD. The purpose of this study was to describe the "state of the art" in the diagnostic use of ultrasound in combination with elastography to highlight any benefits in the diagnosis of PD. We found 12 relevant articles after searching PubMed, Embase, and Google Scholar using the keywords "ultrasound elastography" and "Peyronie's disease", including eight clinical studies, two case reports, and two review articles. The results of our review indicate that UE is a useful technique for identifying Peyronie-related plaques, particularly when they are not detectable using a standard ultrasound or physical examination. It is also helpful in monitoring improvements during and after conservative treatments. More research is required to confirm the effectiveness of ultrasound elastography in diagnosing Peyronie's disease and to determine whether it is better than traditional ultrasound.

Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study.

Traditional herbal medicine (THM) is frequently used in pediatric populations in many low-income countries as a form of healthcare and has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has not been thoroughly investigated. This study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS. This was a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS. A total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS. The incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.

Hydration status in patients hospitalized with acute decompensated heart failure depending on the severity of glucose metabolism disorder

Aim. To study the hydration status according to clinical parameters and laboratory and instrumental research findings at admission and discharge in patients hospitalized with acute decompensated heart failure (ADHF), depending on the severity of glucose metabolism disorder.Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF. 72.5% of patients had arterial hypertension in the medical history, 60% of patients had coronary artery disease. In all patients, the level of glycated hemoglobin (HbA1c) was determined to assess the glucose metabolism status. The patients were divided into groups depending on the results obtained: at HbA1c values < 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c of 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. The patients underwent a standard physical examination at admission and at discharge, as well as a clinical and comprehensive assessment of congestion (determination of N-terminal pro B-type natriuretic peptide (NT-proBNP), lung ultrasound, liver Fibroscan testing, including calculation of a controlled attenuation parameter, bioimpedance analysis of the body).Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% of patients (n = 48) and type 2 diabetes – in 40.4% (n = 113) of cases. Congestion at admission was detected in all patients. A significantly higher frequency of residual (61%) and a lower frequency of subclinical congestion (10%) were revealed in patients with ADHF and type 2 diabetes, compared to patients without glucose metabolism disorders (39% for residual congestion, 27% for subclinical congestion) and prediabetes (40% for residual congestion, 25% for subclinical congestion), respectively. There were no significant differences in the frequency of euvolemia at discharge, depending on the glucose metabolism disorder.Conclusion. Тo assess congestion phenomena at discharge, it is necessary to use clinical, laboratory, and instrumental assessments for patients with ADHF and glucose metabolism disorders. However, in patients with ADHF and prediabetes, it is preferable to focus on the laboratory and instrumental assessment of congestion, while in patients with ADHF and type 2 diabetes, both clinical and laboratory and instrumental assessment of congestion should be performed.

Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group

Background: Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. Purpose: To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification. Results: A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI (P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99). Conclusion: AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of “red flags” should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury.

Association Between Executive Dysfunction-Related Activities of Daily Living Disability and Clinical Dementia Rating Domain Patterns in Patients With Vascular Dementia and Age-Matched Patients With Alzheimer's Dementia.

Although the Clinical Dementia Rating (CDR) scale was originally developed to stage Alzheimer's dementia (AD), it is now used globally for various types of dementia. The aim of this study was to investigate the characteristic pattern of CDR domains and its association with neuropsychological findings and activities of daily living (ADL) in patients with vascular dementia (VaD) and patients with AD. We recruited very mild to mild VaD and AD patients who were age-matched among the first visitors to a dementia clinic. All subjects underwent a standardized clinical interview, physical and neurological examinations, and laboratory tests, including brain magnetic resonance imaging, according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease assessment battery. A total of 105 pairs of VaD and AD patients participated in this study. Although the adjusted scores on Korean version of the Mini-Mental State Examination were similar between the two groups, the VaD patients performed better on the Boston Naming Test, Word List Memory, Word List Recall, Word List Recognition, and Constructional Recall Test. However, the scores on global CDR, CDR sum of boxes, and ADL-related CDR domains were higher in VaD patients than in AD patients (p<0.001). The VaD patients also showed poor performances on the Disability Assessment for Dementia Scale, Frontal Assessment Battery, Executive Clock Drawing Task, and Stroop tests. Despite similar general cognitive function and better memory function, patients with VaD tend to be staged as severer dementia on the CDR scale than patients with AD because of more impaired ADL associated with executive dysfunction.

Transabdominal bowel ultrasound as a method of primary diagnosis in acute bowel pathology: literature review and demonstration of clinical cases

Currently, transabdominal ultrasound of the bowel is rarely used in daily routine practice to assess bowel condition due to the difficulty of its visualization, lack of awareness of specialists, and also due to the limited number of specialists who know the technique of bowel examination. Patients with acute bowel pathology seek emergency care in more than one third of cases. Gastrointestinal ultrasound is often used as the first imaging modality with good diagnostic accuracy in the setting of acute abdomen and may be the optimal diagnostic strategy in young women because of the radiation burden associated with X-ray and computer tomography scan. The clinician can examine the gastrointestinal tract in the area of greatest pain using ultrasound, thus obtaining more information and pathology data than standard physical examination. Intestinal ultrasound is mainly used for the diagnosis and monitoring of patients with inflammatory bowel disease, which helps to avoid the frequent use of invasive and expensive diagnostic procedures and leads to the early implementation of suitable treatment. This method can also serve to detect other pathological conditions present in the gastrointestinal tract. It is a promising method with high sensitivity and specificity, which has the advantage of being easily accessible, non-invasive, safe, due to the absence of ionising radiation and the need to use contrast agents. In addition, the advantage of this method is the reduction of diagnostic search, which allows the doctor to establish the diagnosis in a shorter time, as well as to reduce the patient’s expenses for expensive examinations.

THE FREQUENCY OF VSR (VENTRICULAR SEPTAL RUPTURE) AFTER ACUTE STEMI ST-ELEVATION MYOCARDIAL INFARCTION IN TERTIARY CARE HOSPITAL

The purpose of the study was to find out how frequently ventricular septal rupture occurred in patients who had an acute ST-elevation myocardial infarction and then visited the cardiology department of Lady Reading Hospital in Peshawar. The cross-sectional design was employed in the investigation, which took place between April 6, 2018, and April 12, 2018. A thorough history and standard physical examination were performed on 346 patients while under observation. Baseline tests such as transthoracic echocardiography and electrocardiography were carried out to evaluate ventricular septal rupture. Records included age, gender, type of STEMI, diabetes mellitus, smoking, history of CAD, and prodromal angina. The study's findings indicated that the patients' mean age was 53, with a standard deviation of ±11.23. Of the patients, 32% were female and 68% were male. Furthermore, ventricular septal rupture was present in 5% of the patients but not 95%. Thus, the study concludes that 5% of cases of ventricular septal rupture followed an acute ST-elevation myocardial infarction.

The relationship between executive dysfunction‐associated activities of daily living (ADL) and the pattern of Clinical Dementia Rating (CDR) in patients with vascular dementia and age‐matched patients with Alzheimer’s disease

AbstractBackgroundClinical dementia rating (CDR) scale was originally developed to stage the severity of Alzheimer’s dementia (AD) but is now used globally regardless of types of dementia. This study aims to investigate the relationship between the characteristic pattern of CDR domains, neuropsychological findings, and activities of daily living (ADL) in patients with vascular dementia (VaD), compared with age‐matched patients with AD.MethodVery mild to mild VaD and AD patients matched for age were recruited among the first visitors to a dementia clinic. All subjects were administered a standardized clinical interview, physical and neurological examinations, and laboratory tests including the brain MRI according to the protocol of the Korean version of the CERAD assessment battery.ResultOne hundred and five pairs of VaD and AD patients participated in this study. Although the adjusted scores on MMSE were similar between two groups and the performances on Boston naming, word list memory, word list recall, word list recognition, constructional recall test were better in VaD patients, the scores on global CDR, CDR sum of box (SOB), and ADL‐related CDR domains were higher in VaD patients than in AD patients (p&lt;0.001). The poor performances on disability assessment for dementia scale, frontal assessment battery, executive clock drawing task, and Stroop tests were observed in VaD patients.ConclusionDespite similar general cognitive function and better memory function, patients with VaD tend to be staged as severer dementia on the CDR scale than patients with AD because of more impaired ADL associated with executive dysfunction.

Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS Study.

The role of Pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false positive rate. Focused Cardiac Ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. 2111 athletes (77.4% male, mean age 24.9±15,2years) underwent standardized family and medical history collection (MH), physical examination (PEX), resting ECG, FoCUS (10min/5views-protocol), comprehensive Echocardiography and exercise stress test(EST). We prospectively evaluated three PPS incremental models: Model-A = standardized MH and physical examination; Model-B = Model-A plus resting and stress-ECG; Model-C = Model-B plus FoCUS (10min/5views-protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model-A, 14 by Model-B, 13 athletes by Model-C. The introduction of FoCUS markedly increased the Sensitivity of PPS, compared with model-A and model-B (Sensitivity 94% vs. 19% vs. 58%, Specificity 93% vs. 93% vs. 92%). The total screening cost (TSC) were: Model-A 35.64Eur, Model-B 87.68Eur and Model-C 120.89Eur. Considering the sole conditions at risk of SCD, the Incremental Cost Effectiveness Ratio was 135.62Eur for model-B and 114.31 for model-C. The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.

Characteristics Associated With Noncompliance of Current Pitch Smart Guidelines in High School Baseball Pitchers Throughout the United States.

Although pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly 2 decades, compliance with guidelines remains poorly understood. The purpose of this study was to determine the frequency of compliance with Major League Baseball (MLB) Pitch Smart guidelines as well as the association between compliance and range of motion (ROM), strength, velocity, injury, and pitcher utilization. It was hypothesized that pitchers in violation of current recommendations would have increased strength, velocity, and injury. Case-control study; Level of evidence, 3. This was a prospective, multicenter study of 115 high school pitchers throughout the United States. Pitchers were surveyed about their compliance with current off-season, rest-related guidelines, and history of injury. During the preseason, pitchers underwent standardized physical examinations, and pitch velocity was measured. Pitch counts were collected during the baseball season that followed. Dynamometer strength testing of shoulder forward flexion, and external rotation as well as grip strength was recorded. We compared pitchers who were compliant with recommendations with those who were noncompliant using Student t and Mann-Whitney U tests. Based on preseason data, 84% of pitchers had violated current Pitch Smart guidelines. During the season, 14% had at least 1 violation of the Pitch Smart guidelines. Across both the preseason survey and in-season pitch counts, 89% of players had at least 1 violation of the Pitch Smart guidelines. While there were no significant differences in ROM or strength, the noncompliant group had higher maximum pitch velocity than the compliant group (74 ± 8 vs 69 ± 5 mph [119 ± 13 vs 111 ± 8 kph], respectively; P = .009). Players' self-reported velocity differed significantly from the direct measurement, for both peak velocity (80 ± 6 vs 73 ± 8 mph [129 ± 9 vs 117 ± 13 kph], respectively; P < .001) and mean velocity (73 ± 8 vs 53 ± 27 mph [117 ± 13 vs 85 ± 43 kph], respectively; P < .001). Most high school pitchers were not fully compliant with current Pitch Smart guidelines, and they tended to overestimate their peak velocity by 7 mph (11 kph). Pitchers who threw with greater velocity were at higher risk for violating Pitch Smart recommendations.

Clinical Validation of an Adult-acquired Buried Penis Classification System Based on Standardized Evaluation of the Penis, Abdomen, and Scrotum

To clinically validate a previously developed adult-acquired buried penis (AABP) classification system that is based on a standardized preoperative physical examination that subtypes patients by their penile skin/escutcheon complex (P), abdominal pannus (A), and scrotal skin (S). The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database was used to create an AABP cohort. Patients were retrospectively classified using the previously described PAS classification system. The frequency of subtypes, surgical methods utilized for AABP repair, and correlations between PAS classification and surgery subtypes were analyzed. The final cohort consisted of 101 patients from 10 institutions. Interrater reliability between two reviewers was excellent (κ = 0.95). The most common subtypes were P2c (contributory escutcheon+insufficient penile skin; 27%) and P2a (contributory escutcheon+sufficient penile skin; 21%) for penile subtypes, A0 (no pannus; 41%) and A1 (noncontributory pannus; 39%) for abdominal subtypes, and S0 (normal scrotal skin with preserved scrotal sulcus; 71%) for scrotal subtypes. AABP repair procedures included escutcheonectomy (n = 59, 55%), scrotoplasty (n = 51, 48%), split-thickness skin grafting (n = 50, 47%), penile skin excision (n = 47, 44%) and panniculectomy (n = 7, 7%). P, A, and S subtypes were strongly associated with specific AABP surgical techniques. The PAS classification schema adequately describes AABP heterogeneity, is reproducible amongobservers, and correlates well with AABP surgery types. Future work will focus on how PAS subtypes affect both surgical and patient-centered outcomes.

Renal venous Doppler ultrasound – a new parameter for predicting outcomes in patients with decompensated heart failure

Aim. To assess the frequency, dynamics, and prognostic value of renal venous congestion using Doppler ultrasound in patients with decompensated heart failure (DHF).Materials and methods. A prospective, single-center study included 124 patients with DHF (mean age 70 ± 12 years, 51.6% were males), left ventricular ejection fraction (LVEF) 44 [34; 55] %, N-terminal pro B-type natriuretic peptide (NT-proBNP) 1,609 [591; 2,700] pg / ml. All patients underwent a standard physical examination and laboratory and instrumental tests, including the assessment of the NT-proBNP level. Renal venous blood flow was assessed using pulsed-wave Doppler ultrasound. The presence of continuous renal blood flow was considered as the absence of venous congestion, while intermittent blood flow (two-phase and single-phase flow) indicated venous congestion. Rehospitalization for DHF and reaching a composite endpoint (rehospitalization for DHF and cardiovascular mortality) within 12 months after discharge were selected as endpoints.Results. At admission, continuous renal venous blood flow was observed in 34 (27.4%) patients, intermittent renal venous blood flow was found in 90 (72.6%) patients: two-phase flow in 62 (50%) and single-phase flow in 28 (22.6%) patients with DHF. At discharge, 66 (53.2%) patients had intermittent renal venous blood flow: two-phase flow in 50 (40.3%) and single-phase flow in 16 (12.9%) patients. Correlations of renal venous congestion with the levels of NT-proBNP, serum iron, uric acid, creatinine, LVEF, systolic pressure in the pulmonary artery (SPPA), and the development of acute kidney injury (AKI) were revealed. Persistent renal venous congestion at discharge was significantly associated with a higher probability of rehospitalization for DHF (hazard ratio (HR) 1.93 95% confidence interval (CI) (1.017–3.67); p = 0.044) and a composite endpoint (HR 2.66, 95% CI (1.43–4.96); p = 0.002).Conclusion. In patients with DHF, it is necessary to evaluate renal venous blood flow using pulsed-wave Doppler ultrasound to stratify patients with development of cardiovascular complications within 12 months.

Differences in type 2 diabetes risk between East, South, and Southeast Asians living in Singapore: the multi-ethnic cohort

IntroductionProspective data on differences in type two diabetes (T2D) risk between Asian ethnic groups are sparse. We, therefore, compared T2D risk for East (Chinese), South (Indian), and Southeast (Malay) Asians...

Poster 167: Increased Throwing Velocity is Correlated with a Higher Likelihood of Violating Current Pitch Count Recommendations in High School Baseball Pitchers.

Objectives: While pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly two decades, compliance with guidelines remains poorly understood. The purpose of this study was to determine the frequency of compliance with Pitch Smart guidelines, as well as the association between compliance and range of motion, strength, velocity, injury, and pitcher utilization. Methods: This study was a prospective, multi-center study of high school pitchers, encompassing each region of the United States. Pre-season pitchers were surveyed about their compliance with current off- season rest-related guidelines and history of injury. Pre-season, pitchers underwent standardized physical examinations and pitch velocity was measured. During the high school season that followed, both pitch counts and injury incidence were collected. Results: One hundred and fifteen pitchers participated. Based upon pre-season data, 84% of pitchers had previously violated current pitch recommendation guidelines. During the season, 14% had at least one instance of a violation of the current pitch counts guidelines. Across both the pre-season survey and in-season pitch counts, 89% of players had at least one violation of the current Pitch Smart guidelines. While there were no significant differences in range of motion or strength, those pitchers who were non-compliant with guidelines in the pre-season had higher max pitch velocity (mean±standard deviation 74±8 miles per hour vs. 69±5 miles per hour, p=0.009). Pitchers self-reported their peak velocity at 7 MPH greater than the actual measured velocity. Only a single injury occurred during the season, precluding a comparison between groups. There were no significant differences in the incidence of a history of injury between those pitchers who were noncompliant with between-season rest guidelines (p=0.285). Conclusions: Most high school pitchers are non-compliant with current Pitch Smart guidelines, and they tend to overestimate their peak velocity by 7 MPH. Pitchers with greater velocity were at the highest risk for violating current pitch count recommendations. Since both increased throwing volume and pitch velocity are known risk factors for injury, these athletes may be at particular risk for subsequent injury. research is necessary to understand whether taking three consecutive month rest between seasons prevents pitching-related injury.

Comparison of Endocrinologists' Physical Examination Documentation for In-person vs Video Telehealth Diabetes Visits.

Outpatient diabetes mellitus (DM) care over video telehealth (TH) requires modifications to how endocrinologists complete physical examinations (PEs). But there is little guidance on what PE components to include, which may incur wide variation in practice. We compared endocrinologists' documentation of DM PE components for in-person (IP) vs TH visits. Retrospective chart review of 200 notes for new patients with DM from 10 endocrinologists (10 IP and 10 TH visits each) in the Veterans Health Administration between April 1, 2020, and April 1, 2022. Notes were scored from 0 to 10 based on documentation of 10 standard PE components. We compared mean PE scores for IP vs TH across all clinicians using mixed effects models. Independent samples t-tests were used to compare both mean PE scores within clinician and mean scores for each PE component across clinicians for IP vs TH. We described virtual care-specific and foot assessment techniques. The overall mean (SE) PE score was higher for IP vs TH (8.3 [0.5] vs 2.2 [0.5]; P < .001). Every endocrinologist had higher PE scores for IP vs TH. Every PE component was more commonly documented for IP vs TH. Virtual care-specific techniques and foot assessment were rare. Our study quantifies the degree to which Pes for TH were attenuated among a sample of endocrinologists, raising a flag that process improvements and research are needed for virtual Pes. Organizational support and training could help increase PE completion via TH. Research should examine reliability and accuracy of virtual PE, its value to clinical decision-making, and its impact on clinical outcomes.

Early single sport specialization does not improve pitching velocity, motion, strength, or utilization in high school baseball pitchers

The impact of single-sport specialization on performance and injury risk in youth and adolescent athletes remains debated. The purpose of this study was to determine the incidence of single-sport specialization and its association with pitch velocity, pitcher utilization, range of motion, strength, and injury history. High school pitchers in the Northeastern, Southeastern, Midwestern, and Western Regions of the United States were prospectively recruited. Prior to the season, pitchers were surveyed about their basic demographics, sport participation history, and injury history. At this timepoint, a standardized physical examination was performed and max pitch velocity was measured. They were then prospectively followed over the ensuing high school season, where pitch utilization and counts were followed and injuries were tracked. Across the study, 115 pitchers were recruited, of whom 53% played baseball as their only sport and 47% played other sports. Single- position specialization within baseball was uncommon as 90% of athletes played positions other than pitcher. There were no differences in range of motion, strength, or pitch velocity between multisport athletes and single-sport specialists. Within the multisport group, 26% reported a history of injury, while 38% of the single-sport specialists reported a history of injury (P= .179). There were no significant differences in pitcher utilization between multisport athletes and single-sport specialists. Only a single prospective injury occurred in the 115 players. Although single-sport specialization is common, nearly half of all high school pitchers in this study were multisport athletes. While injury history was generally similar between the two groups, single-sport baseball players did not have the following: improved motion, increased strength, higher ball velocity, or greater pitching volumes during the high school baseball season compared to multisport athletes. Accordingly, single-sport specialization did not have a competitive advantage for these high school pitchers based on the performance factors studied. Further prospective studies are necessary to understand the association between single-sport specialization and injury risk in high school baseball players.

Standardized Photography of Female Genitalia and Anatomical Evaluations.

Standardized photographic recording and anatomic evaluation are crucial to refined and comprehensive preoperative design and enhanced aesthetic effect of female genital cosmetic surgery. The authors aim to propose a standard photographic scheme and physical examination form for the anatomical assessment of patients undergoing female genital surgery. The scheme containing 2 positions (standing and lithotomy positions) and 11 views (1 frontal and 2 oblique views from standing position; 6 frontal views with labia minora open and closed, pulled to the opposite side, clitoral hood pushed up, posterior fourchette stretched; 2 oblique views from lithotomy position) (2P11V) is applied to record pre- and postoperative appearance of the vulva. The evaluation form is utilized to record characteristics of different anatomical subunits during photography. Two hundred forty-five patients who underwent female genital surgery were enrolled in the research from October 2018 to October 2022. All the patients received preoperative and postoperative 2P11V photography with about 5-minutes' shooting time. Various anatomical variations containing hypertrophy and prolapse of mons pubis, redundant types of labia minora and clitoral hood, incremental exposure of clitoral glans, hypo- to hypertrophy of labia majora, disappearance of interlabial groove, hypertrophy of posterior fourchette, and relation of subunits were accurately documented. 2P11V photographic scheme displays the isolated features of each organ and proportion relation among different parts of vulva. The standard photographic record and physical examination form offer detailed anatomical structure to surgeons and facilitate surgeons to carry out an accurate surgical design, which deserve to be promoted and applied.

Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension—A Pilot Prospective Cohort Study

Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.

Higher vegetable consumption is related to a lower risk of cardiometabolic risk cluster among children and adolescents: A national cross-sectional study in China

Background and aimsEvidence about the association between vegetable consumption and cardiometabolic risk factors (CMRFs) cluster among children and adolescents was inconsistent. We aimed to investigate the prevalence of CMRFs and CMRFs cluster, and to evaluate their associations with vegetable consumption. Methods and resultsA total of 14,061 participants aged 6–19 years were recruited from 7 provinces of China. A standard physical examination, including height, weight and blood pressure, was conducted. Information regarding CMRFs was obtained through anthropometric measurements and blood sample testing, while weekly frequency and daily servings of vegetable consumption data collected by questionnaires. Logistic regression models were used to analyze the odds ratios (OR) for associations between CMRFs, CMRFs cluster and vegetable consumption. The prevalence of no CMRFs cluster among children and adolescents was 26.4%. Participants whose daily vegetable consumption was 0.75–1.5 and ≥1.5 servings showed a lower risk of high blood pressure (HBP), high total cholesterol (TC), high triglyceride (TG), and high low-density lipoprotein cholesterol (LDL-C) compared to those with daily vegetable consumption of <0.75 servings. Besides, higher average daily vegetable consumption was strongly associated with lower risks of CMRFs cluster. Stratified analyses showed that the protective effects of more vegetable intake on CMRFs cluster were profounder in boys and young adolescents. ConclusionMore vegetable intake was associated with lower risks of CMRFs cluster in Chinese children and adolescents aged 6–19 years, which further highlighted the significance of vegetable consumption to improve the cardiometabolic risk status.