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  • 1
    Online Resource
    Online Resource
    The learning curve in diagnosing acute appendicitis with emergency sonography among novice emergency medicine residents
    Wiley ; 2018
    In:  Journal of Clinical Ultrasound Vol. 46, No. 5 ( 2018-06), p. 305-310
    Details
    In: Journal of Clinical Ultrasound, Wiley, Vol. 46, No. 5 ( 2018-06), p. 305-310
    Abstract: Ultrasonography (US) has good accuracy for diagnosing appendicitis when it is performed by emergency physicians. This study aimed to determine the amount of experience that is required to achieve competency in this field. Methods Three novice emergency medicine residents completed a 1‐day training course regarding the US diagnosis of appendicitis. Then, they performed appendix US in the emergency department on patients complaining of right lower quadrant pain. All included patients also underwent computed tomography or US performed by a board‐certified radiologist, to confirm the emergency US diagnosis. The agreement between the diagnoses of novices and experts was evaluated. Results A total of 266 patients were included, and the overall Cohen's kappa coefficient was 0.77 (95% confidence interval [CI]: 0.69‐0.84). The kappa value of first 20 cases was 0.49 (95% CI: 0.27‐0.71). It increased rapidly during evaluation of the first 20 cases. After the first 20 cases, the kappa coefficient was 0.84 (95% CI: 0.77‐0.92). The sensitivity and specificity values for the first 20 cases were 64.3% (95% CI: 77.6%‐90.7%) and 84.4% (95% CI: 85.4%‐95.4%), respectively. After the first 20 cases, the sensitivity and specificity values increased to 90.9% (95% CI: 83.4%‐95.8%) and 93.5% (95% CI: 87.0%‐97.3%), respectively. Conclusions A minimum of 20 cases are needed to achieve competency in emergency US diagnosis of acute appendicitis.
    Type of Medium: Online Resource
    ISSN: 0091-2751 , 1097-0096
    URL: Issue
    URL: Article
    DOI: 10.1002/jcu.v46.5
    DOI: 10.1002/jcu.22577
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1492376-2
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  • 2
    Online Resource
    Online Resource
    COWAT Performance of Persons with Alzheimer Dementia, Vascular Dementia, and Parkinson Disease Dementia According to Stage of Cognitive Impairment
    Wiley ; 2019
    In:  PM&R Vol. 11, No. 7 ( 2019-07), p. 737-744
    Details
    In: PM&R, Wiley, Vol. 11, No. 7 ( 2019-07), p. 737-744
    Abstract: The Controlled Oral Word Association Test (COWAT) evaluates frontal lobe and executive function. Therefore, it can be helpful in differentiating cognitive deficits. However, there are no studies comparing the COWAT performance according to the type and stage of cognitive impairment. Objective To compare performance among persons with Alzheimer dementia (AD), vascular dementia (VaD), and Parkinson disease dementia (PDD) on the COWAT according to stage of cognitive impairment. Design Retrospective chart review. Settings University hospital rehabilitation psychology center. Patients We reviewed the medical records of 246 persons diagnosed with mild cognitive impairment (MCI) or dementia using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) and the Korean‐Instrumental Activities of Daily Living (K‐IADL). Patients were divided into a control group, Alzheimer groups (amnestic mild cognitive impairment [aMCI] + AD), Vascular groups (vascular mild cognitive impairment [VaMCI]  + VaD), and Parkinson groups (Parkinson disease‐mild cognitive impairment [PD‐MCI] + PDD). Methods Total scores (ie, total number of words produced in 60 seconds on the semantic and phonemic fluency tests of the COWAT) were analyzed. Secondary analysis included calculating percentage scores of words produced during each of the four, 15‐second segments from the total number of words produced in each trial. Results All MCI groups scored significantly lower than the control group on both semantic and phonemic fluency tests. Among the dementia groups, the VaD (mean ± SD, 5.6 ± 5.1) and PDD (5.5 ± 5.5) groups' scores were significantly lower and worse than that of the AD (11.0 ± 8.8) group on the phonemic test ( P   〈  .001). The difference in percentage scores was most marked between the PD‐MCI (17.0 ± 2.2) and PDD (1.2 ± 3.1) groups, followed by the VaMCI (13.3 ± 1.9) and VaD (5.6 ± 1.8) groups on the latter phonemic test ( P  = .007). Conclusions The COWAT is a sensitive test of frontal‐lobe and executive function impairment in persons with MCI. Decreased verbal output in the last 15 seconds of phonemic fluency test is significantly decreased and impaired in persons with VaMCI and PD‐MCI compared to persons with aMCI as they progress to dementia. Level of Evidence III.
    Type of Medium: Online Resource
    ISSN: 1934-1482 , 1934-1563
    URL: Issue
    URL: Article
    DOI: 10.1002/pmrj.2019.11.issue-7
    DOI: 10.1002/pmrj.12125
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2480906-8
    SSG: 31
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  • 3
    Online Resource
    Online Resource
    Concordance between needle electromyography and manual muscle test findings for muscles with motor grades 0 and 1
    Wiley ; 2023
    In:  PM&R
    Details
    In: PM&R, Wiley
    Abstract: When it is difficult to determine whether a muscle is grade 0 or 1, manual muscle test (MMT) accuracy can be further improved by using needle electromyography (EMG) as a supplementary and confirmatory examination tool. Objective To evaluate concordance between needle EMG and MMT findings for key muscles with motor grades 0 and 1 on the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, and to potentially improve the prognosis for grade 0 muscles with proven muscle activity based on needle EMG findings. Design A retrospective analysis. Setting Inpatient tertiary rehabilitation facility. Interventions Not applicable. Patients One hundred seven patients with spinal cord injury (SCI) admitted for rehabilitation ( n  = 1218 key muscles, grades 0 or 1). Main Outcome Measures Inter‐rater reliability between MMTs and needle EMG was analyzed using Cohen's kappa coefficient ( κ ). A Mantel Haenszel linear‐by‐linear association chi‐square test was used to determine whether the presence of motor unit action potentials (MUAPs) in muscles graded 0 on the initial MMT at admission was associated with MMT grades at discharge and readmission. Results Moderate‐to‐substantial agreement between needle EMG and MMT findings was observed ( κ  = 0.671, p   〈  .01). Concerning key upper and lower extremity muscles, moderate and substantial agreement was identified, respectively. The lowest agreement was noted for C6 muscles. During follow up, 68.8% of muscles with proven MUAPs showed improved motor grades. Conclusions At initial assessment, distinguishing between motor grades 0 and 1 is imperative because motor grade 1 muscles are more likely to have a better prognosis for improvement. Moderate‐to‐substantial agreement was observed between MMT and needle EMG findings. The MMT is a reliable method of muscle grading, yet needle EMG may be of value in certain clinical situations to evaluate for the presence of MUAPs when evaluating motor function.
    Type of Medium: Online Resource
    ISSN: 1934-1482 , 1934-1563
    URL: Article
    DOI: 10.1002/pmrj.13032
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2480906-8
    SSG: 31
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  • 4
    Online Resource
    Online Resource
    Comparison of Balance Ability Between Patients With Type 2 Diabetes and With and Without Peripheral Neuropathy
    Wiley ; 2014
    In:  PM&R Vol. 6, No. 3 ( 2014-03), p. 209-214
    Details
    In: PM&R, Wiley, Vol. 6, No. 3 ( 2014-03), p. 209-214
    Abstract: (1) To examine the effects of peripheral neuropathy on balance stability in patients with type 2 diabetes, and (2) to assess static and dynamic balance and functional limitations. Design A cross‐sectional study. Setting Outpatient clinic. Patients Subjects with type 2 diabetes and healthy subjects (n = 60) were divided into 3 groups: subjects with diabetes and with established peripheral neuropathy (diabetic peripheral neuropathy [DPN] group) (n = 17), subjects with diabetes and without peripheral neuropathy (diabetic control group) (n = 25), and subjects without diabetes (nondiabetic control [NDC] group) (n = 18). Methods Sensory impairment assessment, motor impairment assessment, and functional limitation assessment were assessed by using the Balance Master system. Results In motor impairment assessment, left‐to‐right directional control in the rhythmic weight shift was significantly poorer in the diabetic control group than in the NDC group during slow movement ( P = .027). During fast movement, it was poorer in the DPN group than in the NDC group ( P = .022). In the unilateral stance test of functional limitation assessment with both eyes open, the mean center of gravity sway velocity was significantly higher in the DPN group than in the NDC group ( P = .011 for the left leg standing, P = .008 for the right leg standing) and higher in the DPN group than in the diabetic control group ( P = .027 for the right leg standing). In the tandem walk test, walking speed was significantly lower in the DPN group than in the NDC group ( P = .033), and end sway was significantly greater in the DPN group than in the NDC group ( P = .020). Conclusions Analysis of the results of this study suggest that functional limitations may occur more in the patients with diabetes and with peripheral neuropathy, and dynamic balance stability may decrease more with the patients with diabetes than with the subjects without diabetes. Further studies on balance rehabilitation that concern dynamic balance stabilities and exercise abilities are needed in patients with diabetes.
    Type of Medium: Online Resource
    ISSN: 1934-1482 , 1934-1563
    URL: Article
    DOI: 10.1016/j.pmrj.2013.11.007
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2480906-8
    SSG: 31
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