Improving the Quality of Auscultation for Individuals with Cachexia
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".