UNASSIGNED: Determine the reliability of three different methods of evaluating bone shortening in displaced midshaft clavicle fractures (DCMF).
UNASSIGNED: A cross-sectional analytical study evaluated bone shortening by metric tape (MT), radiography (X-ray), and computed tomography (CT). Twenty-six men had been evaluated and used clavícula not broken as control. The collection of data was of the blind type for three specialists. Differences and reliability were analyzed with the Friedman and Kappa tests and validated with the T-test (CI: 95%; significance index p<0.05; Software \"R\" version 3.2.2).
UNASSIGNED: The MT measurements (control) showed abnormal distribution and significant statistical difference concerning the imaging tests (p=0.000008). There was a similarity between X-ray and CT and Kappa agreement of 0.65. The fractured clavicles presented similar measurements between the three methods (p=0.059), and the T-tests proved that the similarity was caused by chance or possible measurement errors.
UNASSIGNED: Measurement by metric tape showed a tendency to overestimate bone shortening. The CT showed more reliable results for the diagnosis; however, the X-ray was sufficient for decision-making by surgeons, and therefore, it is not possible to rule out the importance of this resource for DCMF. Level of Evidence IV; Case-Control Study.
UNASSIGNED: Determinar a confiabilidade de três diferentes métodos de avaliação do encurtamento ósseo em fraturas deslocadas do eixo médio da clavícula (FDEMC).
UNASSIGNED: Estudo analítico transversal que avaliou o encurtamento ósseo por fita métrica (FM), radiografia (X-Ray) e tomografia computadorizada (TC). Foram avaliados 26 homens utilizando a clavícula não fraturada como controle. A coleta de dados foi do tipo cega por três especialistas. As diferenças e a confiabilidade foram analisadas com os testes de Friedman e Kappa e validados com o teste T (IC:95%; índice de significância p<0,05; Software \"R\" versão 3.2.2).
UNASSIGNED: As medidas de FM (controle), apresentaram distribuição anormal e diferença estatísfica significativa em relação aos exames de imagem (p=0,000008). Houve semelhança entre radiografia e TC, concordância Kappa 0,65. As clavículas fraturadas apresentaram medidas semelhantes entre os três métodos (p=0,059) e os testes-T comprovaram que a semelhança foi provocada casualmente ou possíveis erros de medição.
UNASSIGNED: A medição por fita métrica apresentou tendência em superestimação do encurtamento ósseo. A TC apresentou resultados mais confiáveis para o diagnóstico, contudo, a radiografia foi suficiente para tomada de decisão dos cirurgiões e por isso, não é possível descartar a importância deste recurso para FDEMC. Nível de Evidência IV; Estudo Caso Controle.

The evaluation and care of an injured scuba diver requires an understanding of the different types of underwater activities that may be deemed scuba diving. Such activities may range from the complex (eg, commercial or technical diving) all the way up to basic recreational scuba or snorkeling. A thorough physical examination should be completed as early as possible with a focus on specific areas at risk for injury and etiology, such as a detailed cardiopulmonary, skin, and neurologic examination. Serial reassessments and supportive care are as equally important as consultation with a dive medicine expert, especially one with hyperbaric capabilities.

BACKGROUND: Recent studies indicate that using combination of two or more clinical tests for detecting meniscal tear gets a higher sensitivity and specificity than any clinical test performed individually.
METHODS: The study involved 84 participants who were divided into two groups: the \"OP group\" consisting of participants diagnosed with a meniscal tear and who consequently underwent arthroscopic meniscectomy, and the \"CN group\" comprising of healthy participants with no history of knee injury. Two independent observers (orthopedic surgeons) recorded the results of six clinical tests: Thessaly Test, joint line tenderness, McMurray Test, Ege Test, Steinmann I Test, and atrophy of the thigh muscles. The tests were grouped into two combinations of three tests each. The first combination included Thessaly Test, joint line tenderness and McMurray Test, while the second combination comprised of remaining three tests. Cochran\'s Q Test was used to calculate interobserver variability for both combinations of clinical tests and for each test performed individually.
RESULTS: First combination of three clinical tests when considering the combination positive if two tests are positive had high sensitivity of 95%, specificity of 90.9%, and an overall accuracy of 92.9%. Furthermore, when compared to clinical tests performed individually, the combination demonstrated superior results.
CONCLUSIONS: This study shows that using a combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test), when considering the combination positive if two tests are positive, has greater accuracy than six clinical tests performed individually. There were no statistically significant differences between observers.

Nitrous oxide is used medically as an anesthetic agent; in the food industry as a propellant for condiments; and recreationally for its euphoric and dissociative effects. We report three cases of nitrous oxide misuse causing severe, symptomatic cobalamin (vitamin B12) deficiency in which signs of nitrous oxide use per se, as well as signs of toxicity, were observed, including characteristic palmar calluses over the metacarpal heads, and frostbite. These signs may assist clinicians in the recognition of nitrous oxide use and the timely diagnosis of nitrous oxide toxicity.

BACKGROUND: Children with developmental coordination disorder (DCD) show deviations in motor development and motor skills in early childhood where the learning and execution of coordinated motor skills are below the level expected for their age. Early detection of DCD is critical to provide an opportunity for intervention and support, yet many cases remain undetected until school age. The study described aims to determine the warranty, feasibility and validity of a mobility screening in Tyrolean kindergartens and evaluate its potential benefit to enhance the motor development prospects of affected children.
METHODS: This research employs a two-stage cross-sectional approach with 6 months of follow-up assessments. The initial stage involves a playful mobility screening for all participating kindergarten children, followed by individual assessments for those displaying conspicuous motor skills. Motor skills will be evaluated using MobiScreen 4-6 and the Movement Assessment Battery for Children-2. Prior to the screening, informed consent is obtained from kindergarten bodies and authorities, parents and the children themselves. Parents are provided with information sheets and questionnaires to assess their attitudes and their child\'s eligibility. The study described aims to form a representative sample of kindergarten children, aged 4-6, in Tyrol. To target approximately 20-40 children with DCD for follow-up, the goal is to include 650 children, assuming an incidence of 3%-6%. For the follow-up, matching control groups will be formed and information about how identified motor deficits were addressed, including therapies or sports, will be gathered. Quantitative data will mainly be analysed descriptively, while feedback from kindergarten teachers regarding the practical implementation will be analysed using qualitative content analyses, according to Mayring.
BACKGROUND: The study has been approved by the Research Committee for Scientific Ethical Questions (RCSEQ 3369/24). Findings will be disseminated through contributions, peer-reviewed journals, and conferences.

BACKGROUND: Most Japanese medical schools likely continue to rely on peer physical examination (PPE) as a tool to for teaching physical examination skills to students. However, the attitudes of medical students in Japan toward PPEs have not be identified. Therefore, we evaluated students\' attitudes toward PPE in a Japanese medical school as a preparation for developing a PPE policy tailored to the context of Japanese culture.
METHODS: We conducted a mixed-methods study with an explanatory sequential approach, in which qualitative data were used to interpret the quantitative findings. Surveys and interviews were conducted with medical students and junior residents at a Japanese university. A total of 63 medical students and 50 junior residents responded to the questionnaire. We interviewed 16 participants to reach theoretical saturation and investigated the attitudes of medical students toward PPE and the themes emerging from the interview data, providing detailed descriptions of the quantitative findings.
RESULTS: Female participants were significantly more likely than male participants to report varying degrees of resistance to being a model patient during PPE (male: 59.7%, female: 87%, p < 0.001). Most of the participants who took on the role of patients that involved undressing were males. The participants expected improvements in issues related to the guarantee of freedom to refuse to be a model patient and measures to protect confidentiality. Approximately 22% of the participants reported that they witnessed incidental findings (including variations within the normal range) in front of other students during PPE.
CONCLUSIONS: The findings imply that medical students expect high levels of autonomy and confidentiality when volunteering as model patients during PPE. Thus, developing a PPE policy suitable for Japanese culture may be effective in establishing a student-centered PPE environment.

OBJECTIVE: To develop a statistical approach that provides a quantitative index measuring the magnitude of the irregularity of the breathing response to exercise for the diagnosis of dysfunctional breathing.
METHODS: Cross-sectional, retrospective, real-world study.
METHODS: Single-centre study.
METHODS: A population of 209 patients investigated with cardiopulmonary exercise testing in our institution for unexplained or disproportionate exertional dyspnoea between January and July 2022.
METHODS: A novel statistical approach providing a quantitative index-proportional tidal volume variation (PTVV)-was developed to measure the magnitude of the irregularity of the breathing response to exercise.
RESULTS: PTVV provided a reliable statistical readout for the objective assessment of DB with a prediction accuracy of 78% (95% CI: 72 to 83%). The prevalence of DB in the investigated population was high with more than half of the patients affected by moderate-to-severe DB.
CONCLUSIONS: PTVV can easily be implemented in the clinical routine. Our study suggests a possible further simplification for the diagnosis of DB with two objective criteria including PTVV and one single criterion for hyperventilation.

OBJECTIVE: This study investigates experiences of medical students across Canada related to consent for educational sensitive (i.e., pelvic, rectal) exams under anesthesia (EUAs).
METHODS: A bilingual online questionnaire was developed and distributed to medical students across Canada.
RESULTS: Of 134 respondents, 63% had performed a pelvic EUA, 35% a rectal EUA, and 11% another sensitive EUA during their training. For those who had performed pelvic EUA, 28% were unsure if consent had taken place, 26% reported no specific consent, 20% reported specific consent, and 25% had mixed experiences of consent. For rectal EUAs, 48% reported no specific consent, 37% were unsure if consent had taken place, 13% reported that there had been specific consent, and 2% reported mixed experiences. Most respondents were uncomfortable (36%) or not sure if they were comfortable (32%) with how the consent process was handled for student pelvic EUAs; 31% were comfortable. In open-ended responses, respondents described a variety of experiences related to variability, discomfort, and authority.
CONCLUSIONS: Non-consensual educational sensitive EUAs continue to take place in medical training across Canada, although practices of consent are highly variable. The majority of respondents reported being uncomfortable or unsure if they are comfortable with how consent for educational sensitive EUAs was practiced during their training, and some respondents struggled to express their discomfort given the power dynamics at play.

Physical examination data are used to indicate individual health status and organ health, and understanding which physical examination data are indicative of physiological aging is critical for health management and early intervention. There is a lack of research on physical examination data and telomere length. Therefore, the present study analyzed the association between blood telomere length and physical examination indices in healthy people of different ages to investigate the role and association of various organs/systems with physiological aging in the human body. The present study was a cross-sectional study. Sixteen physical examination indicators of different tissue and organ health status were selected and analyzed for trends in relation to actual age and telomere length (TL). The study included 632 individuals with a total of 11,766 data for 16 physical examination indicators. Age was linearly correlated with 11 indicators. Interestingly, telomere length was strongly correlated only with the renal indicators eGFR (P < .001), CYS-C (P < .001), and SCR (P < .001). The study established that renal aging or injury is a risk factor for Physical aging of the human body. Early identification and management are essential to healthcare.

Cardiac complications are a rare but potentially serious consequence of hyperbaric oxygen treatment (HBOT), resulting from increased blood pressure and decreased heart rate and cardiac output associated with treatment. These physiologic changes are generally well-tolerated by patients without preexisting cardiac conditions, although those with known or undetected cardiac disease may be more vulnerable to treatment complications. Currently, there are no universally accepted guidelines for pre-HBOT cardiac screening to identify these patients at heightened risk, leading to variability in practice patterns. In the absence of HBOT-specific evidence, screening protocols might be adapted from the diving medicine community; however, given the important differences in physiological stressors, these may not be entirely applicable to patients undergoing HBOT. Traditional cardiac investigations such as electro- and echo-cardiograms are limited in their ability to detect relevant risk modifying states in the pre-HBOT patient, stymieing their cost-effectiveness as routine tests. In the absence of strong evidence to support routine cardiac investigation, we argue that a comprehensive history and physical exam - tailored to identify high-risk patients based on clinical parameters - may serve as a more practical screening tool. While certain unique patient groups such as those undergoing dialysis or with implanted cardiac devices may warrant specialised assessment, thorough evaluation may be sufficient to identify many patients unlikely to benefit from cardiac investigation in the pre-HBOT setting. A clinical decision-making tool based on suggested low-risk and high-risk features is offered to guide the use of targeted cardiac investigation prior to HBOT.