Improving the Quality of Auscultation for Individuals with Cachexia
Notice bibliographique
Résumé
Physical examination of patients with cachexia, in particular auscultation of the heart and lungs, is challenging for clinicians. This is partly caused by the prominence of bones as muscle and fatty tissue are lost, creating an uneven surface for the diaphragm of the stethoscope. This makes it challenging to adequately discern heart and lung sounds, and introduces adventitious sounds. Faced with the necessity of listening to the heart and lungs of individuals with cachexia as optimally as possible, the authors have developed a novel way of transmitting sounds from the body to the stethoscope. This technique capitalizes on the fact that liquids are excellent acoustic transmitters and that bags of solute (e.g., normal saline) are malleable and can be easily apposed to irregular surfaces. As demonstrated in Figure 1, a 50-mL bag of solute can be interposed between the individual's chest and the stethoscope, offering greater contact between them. This technique provides an excellent yet simple means of transmitting the heart and lung sounds. Although this technique has not been formally studied, the authors have used it innumerable times and found it clinically useful. The bag serves as a surprisingly good acoustic window, provided that any air in the bag has been completely removed. Two limitations must be mentioned regarding this device. The first is that the size of the bag may prevent precise location of a particular sound, but with the use of a smaller bag (25 or 50 mL as opposed to 100 mL), discrete sounds can be readily located. The second limitation is that the bag constitutes another focus for potential transmission of nosocomial infections. This can be resolved by washing the bag itself with an antimicrobial agent, as one would with the stethoscope. The maker of a normal saline solution confirmed that repetitive washing of a bag with such solution posed no health threat (personal correspondence). In summary, the device described in this article may help clinicians in their assessment of individuals with cachexia, as it has helped the authors multiple times in the past. It is not only widely available, but also safe and inexpensive, making it a perfect adjunct to difficult auscultation in individuals with cachexia. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Chartier, Bonnycastle: first draft of manuscript, revision of manuscript. Both authors approved the final version. Sponsor's Role: N/A.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».