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Category Archives: HIV-Seropositive Patients

Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Conclusion

First, the kappa coefficient is a measure of agreement independent of reference to the gold standard and therefore does not measure accuracy of the test. Secondly, ROC analysis examined accuracy based on a sum score that weighted equally positive results by any of the techniques, whereas the kappa calculation requires agreement on result for each technique among examiners. Finally, kappa coefficients are affected by prevalence as are positive and negative predictive values, so that even with a high percentage of observed agreement, the kappa coefficient can be low. We have shown that AusP adds to the sensitivity of the standard examination of the chest, especially when used in populations with a high prevalence of pulmonary abnormalities. The likelihood ratio also shows superiority of AusP over ConA and ConP. No abnormalities were detected by ConP that were not detected by AusP. Given this information, we can say that the ideal screening physical examination of the lung in this population would consist of ConA and AusP rather than ConA and ConP. canada health and care mall

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Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Discussion

Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: DiscussionIn 1980, Guarino published the results of a controlled blind study in which 30 patients with suspected lung disease were examined by one examiner using both ConP and AusP. Using the chest radiograph as the gold standard, the examiners found AusP to be more sensitive than ConP detecting 27 of 28 lung abnormalities.
Recent work has not confirmed initial observations of the usefulness of AusP. In 1989, Bourse et al attempted to determine the diagnostic value of ConA and ConP again using the chest radiograph as the gold standard. Fifty random patients who had a chest radiograph at the time of hospital admission were examined by two physicians alternating between AusP and ConP. Twenty-six of 100 lungs had radiographic abnormalities. No time frame was given as to when radiographs were taken in relation to when the examination was performed. These examiners found ConP to be 15.4 percent sensitive and 97.3 percent specific and AusP to be 19.2 percent sensitive and 85.1 percent specific. mycanadianpharmacy

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Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Results

The prevalence of radiologic lung abnormalities among the 126 lungs was 55.6 percent. Table 1 lists the prevalence of each radiographic abnormality. Table 2 gives patients demographic data, vital signs, and laboratory values prior to being examined.
Sixty-three hospitalized patients (126 lungs) were examined by 1 to 3 examiners yielding 308 single lung examinations (LEs) of a possible 378 LEs (ie, 63 patients X 2 lungs per patient X 3 examiners). Of these 308 LEs, results of 174 (56.5 percent) were abnormal by chest radiograph. Table 3 summarizes the abnormal results of radiographic examinations and the number of positive examination findings for each technique. Likelihood ratios for all examiners and techniques were greater than 1 which allowed us to pool likelihood ratios across examiners as described in the “Methods” section. Auscultatory percussion proved to be the most sensitive of all techniques for each examiner (range, 51.0 to 69.6 percent). The likelihood ratio was higher for two of the three examiners as well as the likelihood ratio pooled across examiners. Table 4 gives performance characteristics for each examiner as well as pooled likelihood ratios with 95 percent confidence intervals.
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Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Statistical Analysis

Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Statistical AnalysisDuring statistical analysis of the data, abnormal and equivocal findings were both treated as abnormal results. An analyzer (ROC Analyzer, version 5.2, Richmond, Va) and a system (Statistical Analysis System, PC-SAS version 6.04, SAS Institute Inc, Cary, NC) were used for statistical calculations. Separate estimates of sensitivity, specificity, and likelihood ratios were calculated for each examiner and for each technique. Likelihood ratios were calculated as follows: (probability of positive method result in a subject with radiographic lung abnormalities/probability of positive method result in subject without radiographic lung abnormalities) = (sensitivity/1—specificity). The 95 percent confidence intervals for likelihood ratios were calculated as described by Simel et al. Pooled estimates of likelihood ratios were made using the Mantel-Haenszel test (SAS Proc Frequency). canadianfamilypharmacy

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Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Methods

Prior to enrollment of the first subject, each examiner was taught the technique of AusP as described by Guarino (Fig 1). Briefly, the patient sat with the examiner behind or on either side of the patient. Before examination, the patient was told to cough to clear retained secretions and then breathe normally. The examiner then directly percussed over the manubrium by tapping lighdy with the distal phalanx of the index or middle finger of one hand while listening with the diaphragm piece applied by the other hand to the posterior chest wall. Percussion was applied with equal intensity over the same area of the manubrium while the stethoscope explored both lung fields to detect differences in sound transmission. It was applied alternately on one side of the chest and then the other in the same horizontal plane and at corresponding anatomic areas from apex to base, to provide comparison of sound transmission between the two sides. The stethoscope was then applied with the same technique over the paravertebralareas to detect possible mediastinal and hilar masses.
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Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: Methods

Rapid Clinical Diagnosis of Pulmonary Abnormalities in HIV-Seropositive Patients by Auscultatory Percussion: MethodsSince the onset of the AIDS pandemic, it has been shown that the lungs are one of the primary target organs of both infectious and noninfectious complications. In the most common HIV-related pneumonia in adults, Pneumocystis carinii pneumonia (PCP), results of the physical examination of the lung are often normal or with the occasional findings of fine rales, rhonchi, and wheezing. Tachypnea and exaggerated breath sounds are often found in advanced lung disease, but distinct signs of consolidation, such as rales, are unusual unless the lesion is of bacterial etiology.
The technique of auscultatory percussion (AusP) was originally described by Laennec2 and was adapted to outline various solid organs and fluid collections by Cammann and Clark. Gairdner s coin test for pneumothorax is a modification of auscultatory percussion. In 1974, Guarino described a modification that was used to detect pulmonary lesions. It was reported to have a high sensitivity in detecting pulmonary lesions, including viral and atypical pneumonias.
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