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Tshibwabwa ET, Cannon J, Rice J, Kawooya MG, Sanii R, Mallin R. Integrating Ultrasound Teaching into Preclinical Problem-based Learning. J Clin Imaging Sci 2016; 6:38. [PMID: 27833780 PMCID: PMC5041377 DOI: 10.4103/2156-7514.190897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/01/2016] [Indexed: 11/04/2022] Open
Abstract
Objectives: The aim is to provide students in the preclinical with ultrasound image interpretation skills. Research question: Are students in smaller groups with access to a combination of lectures and hands-on patient contact most likely to have better ultrasound image interpretation skills, than students in larger groups with only interactive didactic lectures? Methodology: First-year students at the preclinical Program of the College of Medicine, participated in two 2-h introductory interactive ultrasound sessions. The study comprised two cohorts: 2012/2013 students, who were offered large group teaching (LGT) sessions (control group), and 2013/2014 students, who received the intervention in small group learning problem-based learning (PBL) sessions (experimental group). The overall learning objectives were identical for both groups. The success of the module was evaluated using pre- and post-tests as well as students’ feedback. Results: The students in the experimental group showed significantly higher scores in interpretations of images than those in the control group. The experimental group showed achievement of learning outcomes along with higher levels of satisfaction with the module compared to the latter. Conclusion: Posttest knowledge of the basics of ultrasound improved significantly over the pretest in the experimental group. In addition, students’ overall satisfaction of the ultrasound module was shown to be higher for the PBL compared to the LGT groups. Small groups in an interactive and PBL setting along with opportunities for hands-on practice and simultaneous visualization of findings on a high definition screen should enhance preclinical student learning of the basics of ultrasound. Despite the potential of ultrasound as a clinical, teaching and learning tool for students in the preclinical years, standardized recommendations have yet to be created regarding its integration into the curricula within academic institutions and clinical medicine. The interactive and PBL is here to stay at the college of medicine. Further research would be carried out to see if this trend persists in the upcoming vertical system-based curriculum of the college of medicine.
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Affiliation(s)
- Eli Tumba Tshibwabwa
- Department of Clinical Medicine, College of Medicine, American University of Antigua, Antigua and Barbuda; Department of Radiology, McMaster University Faculty of Health Sciences, HSC Building, Hamilton, Ontario, Canada
| | - Jenifer Cannon
- Department of Clinical Medicine, College of Medicine, American University of Antigua, Antigua and Barbuda
| | - James Rice
- Department of Behavioral Science and Neuroscience, College of Medicine, American University of Antigua, Antigua And Barbuda
| | - Michael G Kawooya
- Department of Radiology, Ernest Cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
| | - Reza Sanii
- Department of Physiology, College of Medicine, American University of Antigua, Antigua And Barbuda
| | - Robert Mallin
- Department of Clinical Medicine, College of Medicine, American University of Antigua, Antigua and Barbuda
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Wongwaisayawan S, Suwannanon R, Sawatmongkorngul S, Kaewlai R. Emergency Thoracic US: The Essentials. Radiographics 2016; 36:640-59. [PMID: 27035835 DOI: 10.1148/rg.2016150064] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute thoracic symptoms are common among adults visiting emergency departments in the United States. Adults with these symptoms constitute a large burden on the overall resources used in the emergency department. The wide range of possible causes can make a definitive diagnosis challenging, even after clinical evaluation and initial laboratory testing. In addition to radiography and computed tomography, thoracic ultrasonography (US) is an alternative imaging modality that can be readily performed in real time at the patient's bedside to help diagnose many thoracic diseases manifesting acutely and in the trauma setting. Advantages of US include availability, relatively low cost, and lack of ionizing radiation. Emergency thoracic US consists of two main parts, lung and pleura US and focused cardiac US, which are closely related. Acoustic mismatches among aerated lungs, pleura, chest wall, and pathologic conditions produce artifacts useful for diagnosis of pneumothorax and pulmonary edema and help in detection of subpleural, pleural, and chest wall pathologic conditions such as pneumonia, pleural effusion, and fractures. Visual assessment of cardiac contractility and detection of right ventricular dilatation and pericardial effusion at focused cardiac US are critical in patients presenting with acute dyspnea and trauma. Additional US examinations of the inferior vena cava for noninvasive volume assessment and of the groin areas for detection of deep venous thrombosis are often performed at the same time. This multiorgan US approach can provide valuable information for emergency treatment of both traumatic and nontraumatic thoracic diseases involving the lungs, pleura, chest wall, heart, and vascular system. Online supplemental material is available for this article. (©)RSNA, 2016.
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Affiliation(s)
- Sirote Wongwaisayawan
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Ruedeekorn Suwannanon
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Sorravit Sawatmongkorngul
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
| | - Rathachai Kaewlai
- From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.)
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Advancing clinician-performed sonography in the twenty-first century: building on the rich legacy of the twentieth century pioneers. Eur J Trauma Emerg Surg 2016; 42:115-8. [DOI: 10.1007/s00068-016-0652-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/11/2016] [Indexed: 12/21/2022]
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 PMCID: PMC5023223 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V. Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C. F. Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R. Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S. Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H. Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E. Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D. Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A. L. Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P. S. Sidhu
- Department of Radiology, King’s College Hospital, London, UK
| | - M. Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F. Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M. Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C. Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A. Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O. H. Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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Heron N. Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP. BMJ QUALITY IMPROVEMENT REPORTS 2016; 4:bmjquality_uu207172.w2905. [PMID: 26733320 PMCID: PMC4645797 DOI: 10.1136/bmjquality.u207172.w2905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/23/2015] [Indexed: 12/17/2022]
Abstract
Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice's performance to the same time period in the previous year as well as patient satisfaction questionnaires.
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56
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Fakoya FA, du Plessis M, Gbenimacho IB. Ultrasound and stethoscope as tools in medical education and practice: considerations for the archives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:381-7. [PMID: 27471420 PMCID: PMC4948728 DOI: 10.2147/amep.s99740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES In recent years, the use and portability of ultrasound has threatened the utility of the stethoscope, with many debating and even advocating its replacement. The authors set out to assess opinions in this regard among faculty within a medical school and specifically within an anatomy department where ultrasound is incorporated into the curriculum from the first term. METHODS A debate was elicited during a biweekly Anatomy Journal Club session and was centered on three published papers presented. Several questions were raised regarding the possible replacement of stethoscope - the value of early exposure to students as well as how ultrasound and stethoscope should be considered by physicians, students, and teachers. RESULTS The general consensus was that the stethoscope should not be replaced but should be used in conjunction with emerging portable ultrasound. Caution was given that technology could "overcomplicate" diagnosis and lead to increased tests resulting in increased cost of care. In terms of exposing students to ultrasound, just as the stethoscope requires practice to use effectively, so does the ultrasound and should be introduced as early on as possible. As is the case with the stethoscope, students may not initially appreciate all the finer details on ultrasound; however, continual use would improve skill. CONCLUSION The stethoscope should always remain part of the physical examination and ultrasound should be used in addition to, not replacement of. As technology advances the need for apprenticeship, training increases and students of the medical profession should be exposed to these technologies as early as possible. Hence, it is not yet time to archive the stethoscope. Perhaps never.
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Affiliation(s)
- Francis A Fakoya
- Department of Anatomical Sciences, St George’s University School of Medicine, St George’s University, Grenada, West Indies
- Correspondence: Francis A Fakoya, Department of Anatomical Sciences, St George’s University School of Medicine, St George’s University, PO Box 7, True Blue Campus, St George’s, Grenada, West Indies, Tel +1 473 444 4175 (extension 3817), Email
| | - Maira du Plessis
- Department of Anatomical Sciences, St George’s University School of Medicine, St George’s University, Grenada, West Indies
| | - Ikechi B Gbenimacho
- Department of Anatomical Sciences, St George’s University School of Medicine, St George’s University, Grenada, West Indies
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Testa A, Francesconi A, Giannuzzi R, Berardi S, Sbraccia P. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department. Intern Emerg Med 2015; 10:1015-24. [PMID: 26450846 DOI: 10.1007/s11739-015-1320-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets), other than evident medical benefits.
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Affiliation(s)
- Americo Testa
- Internal Medicine Unit, "Madonna delle Grazie" Clinic, viale S. D'Acquisto 67, 00040, Velletri (Rome), Italy.
- , Via dei Laghi, 32, 00040, Rocca di Papa, Rome, Italy.
| | - Andrea Francesconi
- Department of Economics and Management, University of Trento, via Calepina, 14, 38122, Trento, Italy
- Public Policy and Management Department, SDA Bocconi University, via Roberto Sarfatti 25, 20100, Milan, Italy
| | - Rosangela Giannuzzi
- Emergency Medicine Department, "A. Gemelli" University Hospital, l.go A. Gemelli 8, 00168, Rome, Italy
| | - Silvia Berardi
- Internal Medicine Unit, "A. Fiorini" Hospital, via Firenze 1, 04019, Terracina (LT), Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
- Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Foss KT, Subhi Y, Aagaard R, Bessmann EL, Bøtker MT, Graumann O, Laursen CB, Weile J, Todsen T. Developing an emergency ultrasound app - a collaborative project between clinicians from different universities. Scand J Trauma Resusc Emerg Med 2015; 23:47. [PMID: 26092581 PMCID: PMC4473832 DOI: 10.1186/s13049-015-0130-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022] Open
Abstract
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
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Affiliation(s)
- Kim Thestrup Foss
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark. .,Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark.
| | - Yousif Subhi
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Clinical Eye Research Unit, Copenhagen University Hospital Roskilde, Roskilde, Denmark
| | - Rasmus Aagaard
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Department of Anesthesia, Randers Regional Hospital, Randers, Denmark
| | - Ebbe Lahn Bessmann
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesia, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Morten Thingemann Bøtker
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Research Department, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Ole Graumann
- Center of Clinical Ultrasound, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Research, Aarhus University, Aarhus, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper Weile
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Department of Emergency Medicine, Regional Hospital Herning, Herning, Denmark
| | - Tobias Todsen
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
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Fox JC, Marino H, Fischetti C. Differential diagnosis of cardiovascular symptoms: setting the expectations for the ultrasound examination and medical education. Glob Heart 2015; 8:289-92. [PMID: 25690628 DOI: 10.1016/j.gheart.2013.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Within the past several decades, dramatic changes have been made in the field of diagnostic imaging. Many of these changes have been with ultrasound, which has been transformative in the efficiency and accuracy of diagnostics. Emergency physicians, intensivists, and other acute care clinicians are using and relying on critical care ultrasound imaging to better triage and diagnose patients at the point of care. As this new frontier of medicine continues to forge forward using this new and improving technology, we strongly believe in integrating ultrasound training earlier into the medical education curriculum. This paper reviews and discusses the transformation of medical diagnostics within the last few decades and describes changes that should be expected as point-of-care cardiac ultrasound evolves within medical education.
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Affiliation(s)
- J Christian Fox
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, USA.
| | - Heather Marino
- Department of Emergency Medicine, University of California, Irvine, Orange, CA, USA
| | - Chanel Fischetti
- School of Medicine, University of California, Irvine, Orange, CA, USA
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Performance of bedside diagnostic ultrasound in an Ebola isolation unit: the Emory University Hospital experience. AJR Am J Roentgenol 2015; 204:1157-9. [PMID: 25730332 DOI: 10.2214/ajr.15.14344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with Ebola virus disease, a contagious and potentially lethal infection, are now being treated in specialized units in the United States. We describe Emory University's initial experience, current operating procedures, and ongoing planning with diagnostic ultrasound in the isolation unit. CONCLUSION Ultrasound use has been limited to date. Future planning considerations include deciding what types of ultrasound studies will be performed, which personnel will acquire the images, and which ultrasound machine will be used.
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Abstract
Ultrasound (US) is an extremely useful diagnostic imaging modality because of its real-time capability, noninvasiveness, portability, and relatively low cost. It carries none of the potential risks of ionizing radiation exposure or intravenous contrast administration. For these reasons, numerous medical specialties now rely on US not only for diagnosis and guidance for procedures, but also as an extension of the physical examination. In addition, many medical school educators recognize the usefulness of this technique as an aid to teaching anatomy, physiology, pathology, and physical diagnosis. Radiologists are especially interested in teaching medical students the appropriate use of US in clinical practice. Educators who recognize the power of this tool have sought to incorporate it into the medical school curriculum. The basic question that educators should ask themselves is: "What should a student graduating from medical school know about US?" To aid them in answering this question, US specialists from the Society of Radiologists in Ultrasound and the Alliance of Medical School Educators in Radiology have collaborated in the design of a US curriculum for medical students. The implementation of such a curriculum will vary from institution to institution, depending on the resources of the medical school and space in the overall curriculum. Two different examples of how US can be incorporated vertically or horizontally into a curriculum are described, along with an explanation as to how this curriculum satisfies the Accreditation Council for Graduate Medical Education competencies, modified for the education of our future physicians.
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Rudolph SS, Sørensen MK, Svane C, Hesselfeldt R, Steinmetz J. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients--a systematic review. Resuscitation 2013; 85:21-30. [PMID: 24056394 DOI: 10.1016/j.resuscitation.2013.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/18/2013] [Accepted: 09/15/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Advances in technology have made prehospital ultrasound (US) examination available. Whether US in the prehospital setting can lead to improvement in clinical outcomes is yet unclear. OBJECTIVE The aim of this systematic review was to assess whether prehospital US improves clinical outcomes for non-trauma patients. METHOD We conducted a systematic review on non-trauma patients who had an US examination performed in the prehospital setting. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the ISI Web of Science and the references of the included studies for additional relevant studies. We then performed a risk of bias analysis and descriptive data analysis. RESULTS We identified 1707 unique citations and included ten studies with a total of 1068 patients undergoing prehospital US examination. Included publications ranged from case series to non-randomized, descriptive studies, and all showed a high risk of bias. The large heterogeneity between the different studies made further statistical analysis impossible. CONCLUSION There are currently no randomized, controlled studies on the use of US for non-trauma patients in the prehospital setting. The included studies were of large heterogeneity and all showed a high risk of bias. We were thus unable to assess the effect of prehospital US on clinical outcomes. However, consistent reports suggested that US may improve patient management with respect to diagnosis, treatment, and hospital referral.
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Affiliation(s)
- Søren Steemann Rudolph
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark.
| | | | - Christian Svane
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Rasmus Hesselfeldt
- Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Jacob Steinmetz
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
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Wimalasena Y, Windsor J, Edsell M. Using Ultrasound Lung Comets in the Diagnosis of High Altitude Pulmonary Edema: Fact or Fiction? Wilderness Environ Med 2013; 24:159-64. [DOI: 10.1016/j.wem.2012.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/17/2012] [Accepted: 10/19/2012] [Indexed: 12/17/2022]
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Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings. Emerg Med Int 2013; 2013:986160. [PMID: 23431455 PMCID: PMC3568862 DOI: 10.1155/2013/986160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 12/03/2022] Open
Abstract
Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, “nontraditional” providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.
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Chak Wah K, Wai Man C, Janet Yuen Ha W, Lai V, Kit Shing John W. Evolving frontiers in severe polytrauma management - refining the essential principles. Malays J Med Sci 2013; 20:1-12. [PMID: 23785252 PMCID: PMC3685221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 09/11/2012] [Indexed: 06/02/2023] Open
Abstract
This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma-Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.
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Affiliation(s)
- Kam Chak Wah
- Department of Accident & Emergency, Tuen Mun Hospital, Hong Kong
| | - Choi Wai Man
- Department of Social Work & Public Admin, The University of Hong Kong, Hong Kong
| | - Wong Janet Yuen Ha
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Vincent Lai
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Heron N, Malliaropoulos NG. International differences in sport medicine access and clinical management. Muscles Ligaments Tendons J 2012; 2:248-252. [PMID: 23738305 PMCID: PMC3666540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
I undertook the 2012 ECOSEP travelling fellowship, sponsored by Bauerfeind, between May and August 2012, which involved visiting 5 European sport medicine centres and spending approximately one week in each centre. The 5 centres included: National Track and Field Centre, SEGAS, Thessaloniki, Greece; Professional School in Sport & Exercise Medicine, University of Barcelona, Spain; Sport Medicine Frankfurt Institute, Germany; Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy, and Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, England. Throughout the fellowship, the clinical cases which were routinely encountered were documented. The following sections detail my experiences throughout the fellowship, the sports of the athletes and the injuries which were treated at each of the sport medicine centres during the fellowship visit and the different forms of management employed.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen’s University, Belfast, UK
- Centre for Public Health Research, Queen’s University, Belfast, UK
| | - Nikolaos G. Malliaropoulos
- National Track & Field Centre, Sports Injury Clinic, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece
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