Rectal Exam Meme

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  Recovering patients, they say, have continued to test positive through samples from the lower digestive tract days after nasal and throat swabs came back negative. Still, this method is only being used in certain situations, and primarily with...

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  Abstract Background Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination DRE plays a central role in the detection of abnormalities of the anus and rectum. However, studies in...

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  Despite this clinical evidence, studies in final year students as well as newly graduated doctors revealed that they are insufficiently prepared for performing DRE [ 4 - 9 ], and if they nevertheless do perform DRE in a clinical setting, doctors are not sufficiently supervised by senior physicians [ 8 , 10 ]. Furthermore, final year students complain of insufficient supervision as the most relevant hindrance for the acquisition of DRE skills [ 7 ].

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  This seems surprising given that there are a variety of methodological teaching approaches to deliver DRE skills, such as training on part-task trainers [ 11 ], finger movement simulators including video feedback [ 12 , 13 ], rectal and urological teaching associates RTA; UTA; specially trained laypersons to assist in DRE or even serve as a probands for practice [ 11 , 14 ] and standardized patients [ 15 - 17 ]. Although simulators show high validity [ 18 , 19 ] and lead to reduced inhibition and fear with regard to DRE [ 20 ], standardized patients are regarded as one of the most useful methods to deliver DRE skills [ 16 ]. Standardized patient SP is an umbrella term both for a simulated patient, trained to simulate a patient's illness, and an actual patient, trained to present their own illness, both in a standardized way [ 21 - 23 ]. SPs are classified as low-technology instruments, which provide a high degree of realism [ 24 ] and have strong potential for training general and specific communication [ 21 , 25 , 26 ] as well as physical examination skills [ 27 - 29 ], with professional feedback seen as the key to their educational success [ 30 - 33 ].

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  Besides the use of SPs for training general physical examination skills, there is long tradition of using standardized patients for the delivery of intimate examinations, particularly in the area of breast examination skills [ 34 - 46 ] and DRE [ 15 , 47 - 52 ]. Among the many advantages of deploying SPs is the observation that in their contact with an SP, students are less anxious, particularly within potentially embarrassing examination procedures such as pelvic exams [ 47 ]. However, surprisingly little is known about motives, attitudes and initial experiences of SPs who make themselves available to deliver DRE skills. Previous studies have shown that acting as an SP can cause stress and psychological burden [ 53 , 54 ], which is also reflected in psychophysiological measures [ 55 ].

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  Therefore, the aim of the presented pilot study was to learn more about the personal motives and attitudes of SPs as well as their initial training experiences when participating in the DRE for the first time. Methods Study design We conducted a descriptive study to investigate the personal background and motivation of SPs who agreed to act as patients upon whom DRE would be performed. All SPs were interviewed after their instructional training session. DRE Training for standardized patients The aim of the training session for SPs was to qualify them to conduct physical examination skills training sessions for medical students with the topic of examination of the abdomen including pain-free DRE [ 52 ].

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  Prior to the training session, the SPs received a detailed script to be studied in advance. It included information about the program, the role that they would play and the anatomic and technical fundamental principles of the DRE. The training encompassed 4 teaching units, amounting to a total of 3 hours. Table 1 shows topics, learning goals and the methodological realization of the SP training session. All SPs were carefully examined by an experienced physician in internal medicine prior to the training sessions and underwent two more examination during the training course. SPs were informed about the background, goals and course of the study, and participation in the study was voluntary. We decided against the implementation of group interviews as we wanted to provide a protected environment in which the SPs could talk freely about their personal motives, anxieties or topics that could be marked with shame.

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  The interview manual was constructed in a semi-standardized manner [ 60 - 63 ] and contained the main open-ended questions, followed by encouraging questions and clarifying questions. According to the main items of the COREQ checklist [ 64 ], in the following, we provide further information about the interview procedure. At the beginning of the interview, questionnaires regarding sociodemographic information and previous work experience were completed by the participants. The individual face-to-face interviews were conducted in person by one of the authors KD , and were digitally recorded, reviewed and summarized in detailed notes by the interviewer. The interviewer was a female doctoral candidate in her 6th year of medical education training, who had been trained and was supervised by an experienced colleague.

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  The interviews were semi-structured and lasted approximately 15 minutes. The interviewer probed for more details and specific examples when necessary. Ethics The ethics review committee of the University of Heidelberg did not consider this study to require approval. Informed consent was obtained prior to the SP training. We confirm that participation was voluntary, the participants cannot be identified from the material presented and no plausible harm to participating individuals could arise from the study. The study was conducted in accordance with the Declaration of Helsinki revised form, Seoul All participants gave written informed consent. Data analysis For the sample description, descriptive statistics were computed mean, standard deviation.

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  After transcribing the audio files of the 4 interviews verbatim, a qualitative content analysis was performed following the principles of qualitative content analysis and inductive category application [ 65 ]. First, we conducted an open coding of all of the 4 interview transcriptions line by line. In detail, single or few sentences were identified as a code, representing the most elemental unit of meaning [ 66 ]. As themes were recurrent among different participants, they were then compared and adapted until a number of relevant themes for all participants could be defined. The assignment of respective codes to specific themes was conducted by two independent analysers KD, CN and subsequently discussed to reach consensus and, if required, adjusted.

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  In the final step, themes were consolidated into three relevant categories. Results Standardized patient sample Detailed characteristics of the interviewed SPs are shown in Table 2. From these quotations and codes, eleven themes resulting in three main categories were derived. Main categories were defined as follows: background to program participation themes A-C ; training expectations and experiences themes D-H ; and transfer themes I-K. One of the SPs was unable to name any concrete motive, but following the training he determined that he had learned a great deal from it. Another SP described his agreement to participate as very spontaneous, without exactly knowing at the time what it would ultimately mean. After receiving further information about the project, however, he stuck to his initial decision. However, the importance of having the option to withdraw from participation at any time was remarked upon.

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  The prospect of participating in the DRE training was met with curiosity and mixed feelings as well as the expectation of learning something new. One SP indicated having spoken to his partner about it, but without going into detail. Another SP stated that he had spoken openly about it and that most people had been bemused when they heard that he was participating in this project Table 3.

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  For one of the SPs, it was important to already know some of the participating team members from previous assignments and to be well prepared. They believed that this was primarily due to the professional implementation and pleasant atmosphere during the training or else they attributed it to their personal biographical experiences, which had led to the fact that they did not experience such a situation of exposure as embarrassing.

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  One SP found the DRE carried out on him by a lecturer during the training to be embarrassing, which he believed was mainly down to the fact that it was a very unfamiliar situation for him. Nevertheless, he also found that the training personnel did everything they could to limit the embarrassment. The SPs found that the lecturers dealt with the potentially embarrassing theme in a very empathetic and appropriate way. However, in part, the issue was raised that participation in the training is not an everyday activity and that it was a physically very demanding experience. When asked whether he had found anything to be stressful or unpleasant during the training, one SP responded that he had some doubts as to whether he could reconcile himself with the idea of earning money from the participation in the DRE training.

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  The other SPs stated that they did not find anything to be stressful or unpleasant. In part, however, it was pointed out that following the application in practice, other suggestions might emerge. Following more targeted questioning, it was mentioned on several occasions that in part, the SPs would have wished for more repetitions and implementations of the DRE. Otherwise, the SPs were of the opinion that it would be good to have been informed of clear action guidelines in case conflicts with the students emerged in the later teaching, and that a compact summary regarding the training contents which they could take away with them would be helpful. Moreover, it was mentioned that there should be clearly defined breaks and that it would be nice to be offered coffee or such like.

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  On one occasion it was mentioned that at times there were too many lecturers present during the DRE training Table 4. One SP responded that he was not currently feeling very relaxed, but that this would no longer be very relevant when he had looked through the given role play instructions at his leisure at home before the DRE teaching. One SP indicated being slightly afraid of forgetting something. The SPs were also asked whether they had any misgivings regarding their assignment in the student teaching. Mostly, no fears could be mentioned. One SP also hoped that the students would learn something from the teaching and then be in the position to transfer what they had learned to practice Table 5. Moreover, it examines impressions regarding an experienced training session as well as expectations related to the first DRE teaching session with medical students.

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  The results show that there are no obviously predominant motives for DRE program participation. SPs participate in the DRE training sessions with relatively little prejudice and anticipate no distinct vulnerability within teaching sessions with undergraduate medical students. Surprisingly to us, there do not seem to be any predominant personal motives, e.

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  SPs participate without prejudice, without anticipating risks or burden, and mainly without broaching a controversial issue within their own social environment. Accordingly, participation is mainly not discussed with friends or relatives, although if it is discussed, the social environment reacts with bemusement.

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  On the one hand, this laid-back behaviour of the SPs could be interpreted as sign of the professionalism and in-depth experience of the SPs examined in our study [ 56 ]. On the other hand, however, our findings show that detailed educational advertising on the program and the training is needed, which addresses potential personal psychological reactions before, during or after participation in DRE training or teaching sessions, as well as possible reactions of bemusement within the social environment. Indeed, adolescent standardized patients portraying adolescent roles reported discomfort but no long-term adverse effects of participation, especially when questioned about their sexual history [ 67 ]. In a qualitative focus group study, all of the 16 examined SPs described psychophysiological effects when portraying emotionally intense roles, sometimes lasting for several days [ 54 ]. Recent literature revealed that SPs show psychophysiological reactions in terms of a diminished heart rate variability during history-taking encounters, indicating emotional stress [ 55 ].

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  These psychophysiological reactions may even be much more pronounced when delivering intimate physical examination skills. Within our SP program, SP selection processes encompass comprehensive information talks [ 56 ]. Hanson et al.

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  A coronavirus nasal swab. Doctors claim the invasive procedure can be more effective in detecting the virus than nasal swabs. China, where coronavirus first emerged just over a year ago, is currently experiencing its worst surge in cases since March. Outbreaks have seen multiple cities in northern parts of the country sealed off — after two cases of the UK variant were reportedly discovered. International arrivals in Beijing and Qingdao are required to undergo anal swab testing before completing quarantine periods. The tests are only being used in a few cities on high-risk groups, according to Chinese state media. Up until now, people have been tested with the more traditional throat and nasal swab method, as well as antibody tests.

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  But residents are now understood to have been given rectal nucleic acid swabs, Chinese media reported. An infographic, from a widely circulated Chinese video, showing how to do it. A student called Douyacai, who underwent an anal swab after returning from South Korea, said two medical personnel carried out the test. No other feelings. People also reacted on Weibo with both mirth and horror.

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  They claim traces of the virus can survive longer in the anus than in the respiratory tract. The tests apparently work by inserting the swab about three to five centimetres into the rectum and rotated several times. Similarly to the nasal method, the swab is removed and securely placed into a sample container. Li Tongzeng, deputy director in charge of infectious disease at Beijing You'an Hospital, told state broadcaster CCTV that the anal swabs would pick up more virus. More than students at his school in the southern district of Daxing and their close contacts were tested with the anal swab method, according to the Global Times. Until now, the swabs had mainly been used in key groups at quarantine centres because of its inconvenience. Users of China's popular Twitter-like Weibo social media platform reacted to the invasive method with a mix of mirth and horror.

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  Others who had undergone the procedure chimed in with dark humour. CCTV said on Sunday anal swabs would not be used as widely as other methods, as the technique was "not convenient". Nasal swabs have been the norm since the pandemic hit in December The country has also tightened restrictions domestically, with Beijing announcing that people from medium or high-risk areas will be barred from the city from Thursday to reduce the risk of virus transmission over the Lunar New Year period. Meanwhile, arrivals into the country must have multiple negative test results and quarantine for at least 14 days in a designated hotel on arrival, with many cities and regions imposing additional home observation requirements. As of Wednesday, China has reported a total of 89, confirmed coronavirus cases. This article originally appeared on The Sun and has been republished here with permission.

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  Procedure[ edit ] Many articles of contraband are concealable in the body's cavities, via means such as insertion into the rectum. Illegal drugs are often found in condoms and temporarily stowed in the colon , and cylinders such as cigar tubes are used to hide money, intravenous syringes, and knives. Duplicate handcuff keys could be concealed in many body orifices , such as in the nasal passages or underneath the tongue. In a thorough visual body cavity search, a flashlight is used to illuminate common bodily areas, including the nostrils , ears , mouth , navel , penis urethra and foreskin or vulva , and buttocks. Generally, the detainee is required to cooperate with manipulating these body parts as they are examined.

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  Squatting is sometimes instructed during the visual search, and prolonged holding of a squat can be demanded; squats are sometimes demanded while standing over a mirror so that the observer has an improved view. The circumstances in which these inspections may be done are often restricted, such as on individuals refusing to offer to consent to a visual body cavity search for reasons other than anxiety or in situations where there is a strong evidence to suspect the presence of contraband, and require a court order. Legal standing[ edit ] Some inmates and human rights activists argue that body cavity searches are done not so much to stop the flow of contraband but rather to harass and humiliate detainees. A visual inspection of the rectum will not reveal objects concealed deeply inside.

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  Likewise, it is possible to circumvent detection during manual body cavity searches. In some instances, suspects swallow packages of drugs protected by condoms and allow them to pass through their digestive tract. Only diagnostic imaging will reveal the concealed contraband, invalidating the body cavity search. X-ray diagnostic images can reveal concealed contraband that could not otherwise be detected. The yellow marks show capsules of illegal drugs swallowed by the suspect. Such smugglers are often called drug packers or mules.

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  Wolfish is the benchmark case on this issue. In its judgment of the case, the U. Supreme Court established a standard of reasonable grounds for performing cavity searches. Among these are security concerns at prisons. Such searches are generally governed by the Fourth Amendment to the United States Constitution , which prohibits searches without probable cause. Though said prisoners may be visually searched, prison staff do not have the power to carry out cavity searches.

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  Any officer who conducts a cavity search or strip search can be sentenced up to 4 years in prison and given a Rs. Generally, it adds to the suffering of a comedic foil. It is generally not depicted explicitly, but implied by the donning of a lubricated glove by a searcher. It is similar to the use of the rectal examination in this regard.

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  Outlook Prostate cancer is the second leading cause of cancer among adult males in the United States, after skin cancer. However, it is highly treatable, especially in the early stages. Prostate cancer starts in the prostate gland , which is part of the male reproductive system. The gland produces a fluid that, together with sperm from the testicles, makes up semen. Muscle cells inside the prostate play a role in ejaculation. The ACS also note that 1 in 9 men will receive a diagnosis of prostate cancer during their lifetimes, and around 1 in 41 men will die from the disease. With treatment, there is a good chance of surviving prostate cancer. Prostate cancer often produces no symptoms in the early stages. After a certain age, the doctor may recommend regular screening. A prostate exam can help detect cancer while it is still highly treatable, even if symptoms are not present.

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  Share on Pinterest A doctor can advise on the main methods of screening for prostate cancer. Screening involves looking for early signs of a disease in people who do not have any symptoms. Cancer screening aims to detect telltale changes at an early stage, when treatment is more likely to be effective. Doctors commonly use two main tests to screen for prostate cancer: the digital rectal exam DRE the prostate-specific antigen PSA test Neither test can confirm that prostate cancer is present, as various other factors may influence results. However, these tests can indicate whether further steps are necessary. A prostate biopsy is the only way to confirm that a person has prostate cancer. Before undergoing either of these tests, the person will need to give consent, which involves confirming that they understand the potential benefits and risks.

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  The DRE is a physical examination for changes in the prostate that could indicate a tumor. How long will it take? Will it be painful? How accurate is a DRE, in terms of finding cancer? What will happen next? The individual should also: Inform their healthcare team if they have hemorrhoids or anal fissures, as a DRE may exacerbate these. Ask their insurance provider about coverage and whether there will be additional costs. During the DRE The procedure usually requires the person to undress from the waist down. The specialist may instruct the person to lie on their left side and pull their knees up to their chest or to stand and lean against a table. The specialist will: put on some gloves and put lubricant on one finger assess the area around the rectum for anything unusual gently insert a lubricated, gloved finger into the rectum feel the prostate to assess the size and check for bumps, soft or hard spots, and other abnormalities A DRE is not usually painful, but it may be slightly uncomfortable.

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  It takes only a few minutes to complete. After the DRE After the exam, the doctor will explain the results. The person can usually go back to their regular activities immediately after a DRE. However, there may be some bleeding from the rectum afterward, particularly if the person has hemorrhoids or anal fissures. If bleeding persists or is significant, the person should contact their healthcare provider. The person may also undergo a PSA test on the same day.

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  If the doctor believes that further steps may be necessary, they will base this on the results of both the PSA and DRE. It is worth noting that a DRE often produces a false-positive result. If the doctor detects changes in the prostate gland, this does not necessarily indicate cancer. Prostate nodules can develop because of prostate cancer or other prostate-related conditions. Learn more about prostate nodules here. Some of this antigen leaks into the blood and will show up during testing. High levels of PSA in the blood can indicate prostate cancer, but various other conditions and factors can raise PSA levels. High levels do not necessarily mean that cancer is present. What does the PSA test involve? The PSA test involves taking a blood sample and sending it to a laboratory for analysis.

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  There is a 1 in 4 chance that cancer is present. The specialist will likely recommend more testing, including a prostate biopsy. It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. Prostate cancer is not the only cause of high PSA levels. Find out more about the other causes here. What do the results mean? PSA levels may be above the baseline for various reasons other than prostate cancer. Other factors that can raise PSA levels include: older age.

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  Even better, the funniest lines lead to some super-important facts about the procedure. A doctor inserts a gloved, lubricated finger into your rectum to reach the prostate. Yup, you heard that right. A doctor sticks their finger up your butt. What do doctors feel for during a prostate exam? To check the walnut-sized gland , aka the prostate, for abnormal lumps or hard areas and screen for early signs of prostate cancer. This is a necessary medical procedure for guys at about age 50, usually done in addition to a PSA test , with 1 in 9 Canadian men developing prostate cancer during their lifetime. Exercise is great for your health, and so is a prostate exam. When caught early, the survival rate for prostate cancer is close to percent. A muppet has a whole hand up its backside for its entire existence.

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  A prostate exam, on the other hand ha! Probably not. Oh, and doctors always remove their rings while performing the exams. Because the early stages of prostate cancer often show no symptoms , detecting it ASAP is the only reason you need to get checked. And if the doctor finds your keys, consider it a bonus. As you can tell, prostate exams are, ahem, the butts of some pretty good one-liners.

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  Here are some more: After my prostate exam, the doctor left. I went to see my doctor for a prostate exam. There was nothing to worry about — he gave me the thumbs up! What funny moments have you had with your doctor? Share your experience in the comments below. This article was originally published on September 5,

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  Anatomical considerations[ 1 ] The rectum is the curved lower, terminal segment of large bowel. It is about 12 cm long and runs along the concavity of the sacrum. In women, the anterior rectal peritoneum forms the rectouterine pouch the pouch of Douglas. The pouch of Douglas is filled with loops of bowel. At the tip of the examining finger it may be possible to feel cervix and even a retroverted uterus. The anus is cm long and joins the rectum to the perineum. The wall of the anus and anal canal is supported by powerful sphincter muscles. These muscles are made up of: Voluntary external sphincter muscles. These muscles are essential in the mechanism of defecation and the maintainance of continence.

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  Indications for rectal examination This is an intimate and sometimes uncomfortable examination which is most often done when disease usually gastrointestinal or genitourinary disease is suspected or already identified. It is important in all cases to explain the reasons for the examination see 'Preparing for the examination', below and to obtain verbal consent. Examples of indications for examination include: Assessment of the prostate particularly symptoms of outflow obstruction. When there has been rectal bleeding prior to proctoscopy, sigmoidoscopy and colonoscopy. Problems with urinary or faecal continence. In exceptional circumstances, to detect uterus and cervix when vaginal examination is not possible. Preparing for the examination The reasons for performing the procedure should be explained to the patient.

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  The procedure itself should be explained to the patient. A chaperone should be offered. Warn patients that: The examination may be uncomfortable but should not be painful. They may experience a feeling of rectal fullness and the desire to defecate.

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