Dr. Paul Kwo, Director of Hepatology at Stanford Medicine, demonstrates the approach to examining the liver at the bedside. In this essential clinical skills video, Dr. Kwo guides you through proper percussion techniques to determine liver span and palpation methods to assess liver borders and consistency. He highlights key findings to watch for during the exam, including hepatomegaly, tenderness, nodularity, and associated signs of chronic liver disease. Dr. Kwo shares expert tips gathered from years of clinical practice to help you perfect this fundamental examination technique. This Stanford Medicine 25 video serves as an invaluable resource for medical students, residents, and practitioners seeking to refine their physical diagnosis skills in hepatology. These videos are always free. Thank you to https://www.youtube.com/c/PrerakJuthani Prerak Juthani, MD, Stanford Internal Medicine Resident for being our patient. Produced by Aaron Frank, MD, and Errol Ozdalga, MD. Thank you to CSRP for the funding of this project. 0:00 Inspection 0:23 Percussion 1:06 Palpation 1:44 Palpation Tips

Objective: Reduction in alcohol craving has often been specified as an outcome for alcohol use disorder (AUD) interventions. This study evaluated changes in multiple craving measures from a double-blind randomized clinical trial (RCT) evaluating the efficacy of intermittent theta burst stimulation (iTBS) to the left dorsolateral prefrontal cortex for the treatment of AUD. We predicted that veterans in AUD residential treatment, who received active iTBS (Active; n = 22), would show greater reductions than those who received sham iTBS (Sham; n = 22). Method: Twenty iTBS sessions (1,200 pulses/session) were delivered over 2 weeks. Craving measures were administered before iTBS sessions (Baseline) and following completion of sessions (Post-Assessment). Craving measures administered were the Alcohol Craving Questionnaire Short Form–Revised Total Score, Abstinence Self-Efficacy Scale (AASE) Tempted Cravings and Urges subscale, and Obsessive Compulsive Drinking Scale (OCDS). Results: All craving measures showed reductions in scores (time main effect), collapsed across Active and Sham groups; however, the absence of significant Group × Time interactions indicated that active iTBS did not produce statistically greater reductions than sham. Exploratory post hoc simple effects analyses were conducted to further examine the significant main effect of time. Active participants showed reductions on the AASE Tempted Cravings and Urges and all OCDS measures, whereas the Sham group showed no significant changes on any measure. Conclusions: Active iTBS did not produce a statistically greater reduction in craving symptomatology than sham, as indicated by the absence of significant Group × Time interactions. However, the exploratory post hoc results can guide future larger-scale transcranial magnetic stimulation RCTs for AUD on the utility of the acquired craving measures. Public health significance statement: This study assessed the effects of left dorsolateral prefrontal cortex intermittent theta burst, a type of transcranial magnetic stimulation, on measures of alcohol craving. Evaluation for changes in alcohol craving is important because higher levels of craving during and after treatment are linked to a return to heavy alcohol drinking. Twenty-two (22) participants received Active (real) and 22 received Sham (placebo) stimulation. Primary analyses indicated comparable decreases in the Active and Sham groups across craving measures; however, exploratory analyses indicated that only the Active group showed a significantly greater reduction on four of five measures after the treatment sessions.

Objective: Reduction in alcohol craving has often been specified as an outcome for alcohol use disorder (AUD) interventions. This study evaluated changes in multiple craving measures from a randomized double-blind clinical trial (RCT) evaluating the efficacy of intermittent theta burst stimulation (iTBS) to the left dorsolateral prefrontal cortex, for treatment of AUD. We predicted Veterans in AUD residential treatment, that received active iTBS (Active; n=22), show greater reductions than sham iTBS (Sham; n=22). Method: Twenty iTBS sessions (1200 pulses/session) were delivered over 2 weeks. Craving measures were administered prior to iTBS sessions (Baseline) and following completion of sessions (Post-Assessment). Craving measures administered were the Alcohol Craving Questionnaire Short Form-Revised Total Score, Abstinence Self-Efficacy Scale (AASE) Tempted Cravings and Urges subscale, and Obsessive Compulsive Drinking Scale (OCDS). Results: All craving measures showed reductions in scores (time main effect), collapsed across Active and Sham groups; however, the absence of significant group x time interactions indicated active iTBS did not produce statistically greater reductions than sham. Exploratory post-hoc simple effects analyses were conducted to further examine the significant main effect of time; Active participants showed reductions on the AASE Tempted Cravings-Urges and all OCDS measures; Sham group showed no significant changes on any measure. Conclusions: Active iTBS did not produce a statistically greater reduction in craving symptomatology than sham, given the absence of significant group by time interactions. However, the exploratory post-hoc results can guide future larger scale transcranial magnetic stimulation RCTs for AUD on the utility of the acquired craving measures.

The ability to assess the social interactions of a newborn is an important skill for anyone involved in neonatal care.  Abnormal responses may be the first signs of illness.  Normal social responsiveness includes eye opening, facial expression changes, and the ability to visually focus on a face at close range.  Within minutes of birth, alert newborns should be able to visually connect.  An open-eyed infant who seems to be staring blankly into space is concerning.  In this video, Dr. Bhutani demonstrates his technique for evaluating the social interactions of a newborn.

Explore physical exam resources from Stanford Medicine 25 to help diagnose Parkinson’s disease—a growing neurological condition affecting millions.

This video is brought to you by Stanford Medicine 25 to teach you the exam to diagnose Parkinson's Disease confidently as well as monitor response to treatment or progression of disease. New Parkinson's Videos With Dr. Poston Here: https://youtu.be/AK0r4_5WhUo and https://youtu.be/swa6eC1mhEw. The video is lead by Dr. Kathleen Poston. She is faculty at Stanford and a neurologist with an expertise in movement disorders. She is an active researcher in the field of Parkinson's Disease and an wonderful clinician. (The patient is this video, Larry, is a patient of Dr. Poston's.) * All exams are demonstrated with examples of real abnormalities thanks to our amazing patients! Special thank you to Larry for being the primary patient in this video. Larry is an amazing teacher and person! The four cardinal parts of the exam for Parkinson's Disease (covered in detail in this video) are: 1) Bradykinesia (required for diagnosis of 2) Rigidity 3) Tremor (usually rest tremor but also kinetic and intentional tremor) 4) Issues with gait and postural instability The Stanford Medicine 25 program for bedside medicine at the Stanford School of Medicine aims to promote the culture of bedside medicine to make current and future clinicians and other healthcare provides better at the art of physical diagnosis and more confident at the bedside of their patients. Visit us: Website: http://stanfordmedicine25.stanford.edu/ Blog: http://stanfordmedicine25.stanford.ed... Facebook: https://www.facebook.com/StanfordMedi... Twitter: https://twitter.com/StanfordMed25

Check out tips for patient-centered medical draping to enhance comfort, dignity, and exam quality during physical exams.

Human connection is at the heart of medicine. These podcasts explore a fresh take on meaningful clinical relationships.