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Is Pulmonary Auscultation Alone Sufficient for Clinical Practice?

open journal of Respiratory Diseases 2020年第3期10卷 49-58页

作者： Waldo Luis Leite Dias de Mattos joão vitor pinotti dallasen Ana Gabriela Goularte Juchem Douglas da Silva Pinos3, Fabiana Jaeger Federal University of Health Sciences of Porto Alegre (UFCSPA) Porto Alegre Brazil Santa Casa de Misericórdia Hospital Porto Alegre Brazil Nossa Senhora da Conceiç ã o Hospital Porto Alegre Brazil

objective: The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease... 详细信息

ong>objective:ong> The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. ong>Methods:ong> Patients with CoPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. ong>Results:ong> 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI;1.16 to 2.01) and negative LR of 0.33 (95% CI;0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI;1.02 to 4.9) and a negative LR of 0.3 (95% CI;0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p ong>Conclusions:ong> Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.

关键词： Physical Examination Pulmonary Auscultation Clinical Diagnosis

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Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis

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World journal of Nephrology 2015年第2期4卷 287-294页

作者： Pasqual Barretti joo vitor Pereira Doles Douglas Gonalves pinotti Regina Paolucci El Dib Department of Internal Medicine Botucatu Medical SchoolUNESP Botucatu Medical School UNESP Department of Anesthesiology Botucatu Medical SchoolUNESP

Peritonitis continues to be a major complication of peritoneal dialysis(PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional metaanalysis published by our group. Results from systematic reviews of randomized control trials(RCT) and quasiRCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate(86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides(66%) and glycopeptides plus aminoglycosides(75%). other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gramnegative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.

关键词：腹膜炎并发症治疗方法临床分析

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