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Blume GG, Lechinewski LD, Vieira IP, Clausell N, Bertinato GP, Machado-Júnior PAB, Berro PG, Moura LAZ, Tsang T. Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports. J Cardiovasc Imaging 2022; 30:25-34. [PMID: 35086166 PMCID: PMC8792719 DOI: 10.4250/jcvi.2020.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the utility of a handheld device (HH) used during common daily practice and its agreement with the results of a standard echocardiography study (STD) performed by experienced sonographers and echocardiographer. METHODS A prospective follow-up was conducted in an adult outpatient echocardiography clinic. Experienced sonographers performed the STD and an experienced echocardiographer performed the HH. STD included 2-dimensional images, Doppler and hemodynamics analysis. Hemodynamic assessment was not performed with the HH device because the HH does not include such technology. The images were interpreted by blinded echocardiographers, and the agreement between the reports was analyzed. RESULTS A total of 108 patients were included; and the concordance for left ventricle (LV) ejection fraction (EF), wall motion score index, LV and right ventricle (RV) function, RV size, and mitral and aortic stenosis was excellent with κ values greater than 0.80. Wall motion abnormalities had good concordance (κ value 0.78). The agreement for LV hypertrophy, mitral and aortic regurgitation was moderate, and tricuspid and pulmonary regurgitation agreements were low (κ values of 0.26 and 0.25, respectively). CONCLUSIONS In a daily practice scenario with experienced hands, HH demonstrated good correlation for most echocardiography indications, such as ventricular size and function assessment and stenosis valve lesion analyses.
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Affiliation(s)
- Gustavo Gavazzoni Blume
- Division of Cardiovascular Diseases, Pontificial Catholic University of Paraná, Curitiba, Brazil
| | | | | | - Nadine Clausell
- Division of Cardiovascular Diseases, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovana Paludo Bertinato
- Division of Cardiovascular Diseases, Pontificial Catholic University of Paraná, Curitiba, Brazil
| | | | - Pedro Goulart Berro
- Division of Cardiovascular Diseases, Pontificial Catholic University of Paraná, Curitiba, Brazil
| | - Lidia Ana Zytynski Moura
- Division of Cardiovascular Diseases, Pontificial Catholic University of Paraná, Curitiba, Brazil
| | - Teresa Tsang
- Division of Cardiovascular Diseases, University of British Columbia, Vancouver, Canada
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Kimura BJ, Lou MM, Dahms EB, Han PJ, Waalen J. Prognostic Implications of a Point-of-Care Ultrasound Examination on Hospital Ward Admission. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:289-297. [PMID: 31378976 DOI: 10.1002/jum.15102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/02/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Few data exist regarding the use of ultrasound (US) to risk stratify ward admissions. Therefore, we evaluated associations between a cardiopulmonary limited ultrasound examination (CLUE) on admission and subsequent hospital outcomes. METHODS Over a 22-month period in a 300-bed hospital, CLUE data reviewed from a series of nonelective ward admissions were correlated with the composite outcome of a hospital stay of longer than 2 days, disposition to hospice, or death. The CLUE included 5 quick-look signs of left ventricular dysfunction, left atrial enlargement, lung B-lines, pleural effusions, and inferior vena cava plethora and had been performed as warranted by 1 of 31 US-trained admitting residents and then repeated by a cardiologist as the reference standard. The admitting condition, medical history, results of routine admission testing, and CLUE were assessed for an association with the outcome in univariate and multivariable models. RESULTS Of 547 patients, the mean age ± SD was 62.9 ± 15.5 years; 59% were male; and the mean stay was 5.6 ± 8.1 days, with 355 (65%) lasting longer than 2 days and 21 (4%) having hospice disposition or death. An abnormal CLUE exam was found in 368 (67%) of patients, was related to the outcome (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.23-2.68; P = .001) when obtained by a resident or cardiologist, and was included in a best-fit multivariable model with renal failure (OR, 2.44; 95% CI, 1.44-4.14; P < .001), infection/sepsis (OR, 2.25; 95% CI, 1.17-4.32; P = .02), and chest pain (OR, 0.36; 95% CI, 0.21-0.61; P < .001). CONCLUSIONS An abnormal admission point of care ultrasound exam was related to complex hospitalization, specifically a longer length of stay.
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Affiliation(s)
- Bruce J Kimura
- Departments of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
| | - May M Lou
- Departments of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
| | - Eric B Dahms
- Departments of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
| | - Paul J Han
- Departments of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
| | - Jill Waalen
- Scripps Research Translational Institute, San Diego, California, USA
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Elhassan M, Gandhi KD, Sandhu C, Hashmi M, Bahl S. Internal medicine residents' point-of-care ultrasound skills and need assessment and the role of medical school training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:379-386. [PMID: 31213943 PMCID: PMC6549795 DOI: 10.2147/amep.s198536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/10/2019] [Indexed: 05/02/2023]
Abstract
Introduction: Point-of-care-ultrasound (POCUS) as a useful bedside tool is growing. Few studies have examined residents' attitude towards POCUS or compared POCUS image interpretation skills between residents with and without POCUS training in medical school. Material and Methods: We distributed an anonymous survey and image interpretation test to assess residents' attitude towards POCUS, confidence, and skills in interpreting POCUS images and videos. Using independent samples t-tests, we compared mean confidence levels and test scores between residents with and without prior POCUS training. Results: Fifty-two residents responded to survey (response rate 68%) and 59 took the image interpretation test (77%). Most residents (90%) reported being interested in POCUS. Residents with prior POCUS training (n=13) were either PGY-1 (9) or PGY-2 (4). No PGY-3 resident had prior training. Most residents (83%) thought POCUS could be extremely useful in the inpatient setting compared to 29% for outpatient setting. PGY-1 residents with prior training had a higher mean confidence level than PGY-1 residents without prior training, but the difference was not statistically significant (3.26 vs 2.64; p=0.08). PGY-1 with prior training had a mean confidence level that was close to that of PGY-3 residents. PGY-1 residents with prior training scored significantly higher than PGY-1 residents without prior training in image interpretation test (10.25 vs 7; p=0.01). Residents felt most confident in interpreting inferior vena cava images (mean 3.7; max. 5), which also had the highest score in image interpretation test (correct response rate of 88%). Conclusion: Our residents seem very interested in POCUS. PGY-1 residents with prior POCUS training in medical school seem to have higher confidence in their POCUS skills than PGY-1 residents without prior training and outperformed them in image interpretation test. The study is very instructive in building our future POCUS curriculum for residents.
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Affiliation(s)
- Mohammed Elhassan
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Kevin D Gandhi
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Charnjeet Sandhu
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Mohammad Hashmi
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Sameer Bahl
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
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Barron KR, Wagner MS, Hunt PS, Rao VV, Bell FE, Abdel-Ghani S, Schrift D, Norton D, Bornemann PH, Haddad R, Hoppmann RA. A Primary Care Ultrasound Fellowship: Training for Clinical Practice and Future Educators. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1061-1068. [PMID: 30182369 DOI: 10.1002/jum.14772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As ultrasound devices become smaller, more portable, and more user friendly, there is now widespread use of this technology by physicians of all specialties, yet there are currently few structured opportunities for ultrasound education outside of emergency and critical care medicine. Anticipating the rising educational demand in the primary care specialties, the University of South Carolina School of Medicine created a primary care ultrasound fellowship in 2011, the first yearlong training program in point-of-care ultrasonography for graduates of internal medicine, medicine-pediatrics, pediatrics, and family medicine residencies. This paper reviews the history of point-of-care ultrasonography fellowships and then provides an overview of the primary care ultrasound fellowship.
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Affiliation(s)
- Keith R Barron
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Michael S Wagner
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Patrick S Hunt
- Department of Emergency Medicine, Palmetto Health Richland, Columbia, South Carolina
| | - Victor V Rao
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Floyd E Bell
- Department of Radiology, University of South Carolina School of Medicine, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Saaid Abdel-Ghani
- Department of Hospital Medicine, Medical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - David Schrift
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Duncan Norton
- Department of Pediatrics, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Paul H Bornemann
- Department of Family Medicine, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Robert Haddad
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
| | - Richard A Hoppmann
- Department of Internal Medicine, Palmetto Health-USC Medical Group, Palmetto Health-USC Medical Group, Columbia, South Carolina
- Ultrasound Institute, Palmetto Health-USC Medical Group, Columbia, South Carolina
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Phillips CT, Manning WJ. Advantages and pitfalls of pocket ultrasound vs daily chest radiography in the coronary care unit: A single-user experience. Echocardiography 2017; 34:656-661. [PMID: 28295525 DOI: 10.1111/echo.13509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pocket ultrasonography may enhance patient diagnosis and care. We sought to assess pocket ultrasound in detecting common conditions in the coronary care unit (CCU) compared to portable daily chest radiography (CXR) and conventional transthoracic echocardiography (TTE). METHODS An experienced pocket ultrasound user performed a pocket ultrasound examination for interstitial edema, pneumonia, central line seen in the right ventricle, pleural and pericardial effusions, left atrial enlargement, and cardiomegaly. Data were blindly compared to the radiologist CXR interpretation and cardiologist TTE interpretation. RESULTS A total of 102 CXR and pocket ultrasound examinations were performed in 66 patients. The most common CXR indication was "interval change" (37%) and finding central line (65%). Pocket ultrasound demonstrated overall good concordance with CXR ranging from 77% for pleural effusion to 92% for pneumonia. Additionally, the pocket ultrasound examination appeared to anticipate resolution of pulmonary edema prior to the CXR. Compared to TTE, pocket ultrasound had excellent sensitivity for cardiac findings with values ranging from 85% for left atrial enlargement to 100% for cardiomegaly, but limited specificity of cardiomegaly at just 51%. CONCLUSION In the CCU, bedside pocket ultrasound reliably diagnoses common conditions identified by CXR with the advantage of lack of ionizing radiation and the suggestion of detecting the resolution of pulmonary edema prior to CXR. Pitfalls include only modest concordance for pleural effusions and limited specificity for cardiomegaly. Larger, multicenter studies are needed to determine whether pocket ultrasound can reduce routine daily CXR in the CCU and other intensive care settings.
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Affiliation(s)
- Colin T Phillips
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Tsai BT, Dahms EB, Waalen J, Kimura BJ. Actual use of pocket-sized ultrasound devices for cardiovascular examination by trained physicians during a hospitalist rotation. J Community Hosp Intern Med Perspect 2016; 6:33358. [PMID: 27987287 PMCID: PMC5161791 DOI: 10.3402/jchimp.v6.33358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022] Open
Abstract
Background In actual clinical practice as opposed to published studies, the application of bedside ultrasound requires a perception of need, confidence in one's skills, and convenience. Objective As the frequency of ultrasound usage is evidence to its perceived value in patient care, we observed the pattern of autonomous use of a pocket-sized device (PSD) by ultrasound-trained residents during a night hospitalist rotation. Methods Consecutive internal medicine residents (n=24), trained in a cardiac limited ultrasound examination (CLUE) as a mandatory part of their curriculum, were sampled on their PSD use after their admitting nights, regarding perceived necessity, deterring factors, detected abnormalities, and imaging difficulties. A detailed analysis was performed with one resident who used a PSD on every admission to compare the proportion of abnormal CLUEs and utility in patients with and without a perceived need. Results Residents admitted 542 patients (mean age: 55±17 years, range: 17–95 years) during 101 shifts and performed CLUE on 230 patients (42%, range: 17–85%). Residents elected not to scan 312 (58%) patients due to 1) lack of perceived necessity (231, 74%), 2) time constraints (44, 14%), and 3) patient barriers (37, 12%). In the detailed analysis (n=71), the resident felt CLUE was necessary in 32 (45%) patients versus unnecessary in 39 (55%) patients, with abnormality rates of 50% versus 20.5% (p=0.01) and utility rates of 28.1% versus 15.4% (p=0.25), respectively. Conclusion When unbiased residents acting as hospitalists are provided with a PSD to augment initial cardiac examination, usage is frequent and suggests clinical value in hospital medicine.
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Affiliation(s)
- Benjamin T Tsai
- Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, CA, USA
| | - Eric B Dahms
- Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, CA, USA
| | - Jill Waalen
- Scripps Translational Science Institute, San Diego, CA, USA
| | - Bruce J Kimura
- Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, CA, USA;
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Skalski JH, Elrashidi M, Reed DA, McDonald FS, Bhagra A. Using Standardized Patients to Teach Point-of-Care Ultrasound-Guided Physical Examination Skills to Internal Medicine Residents. J Grad Med Educ 2015. [PMID: 26217431 PMCID: PMC4507938 DOI: 10.4300/jgme-d-14-00178.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care (POC) ultrasound has been shown to improve procedural outcomes and physical examination accuracy in multiple settings. There are limited data regarding the optimal way to train nonradiologists in POC ultrasound. This is a primary barrier to more widespread use of ultrasound in the physical examination. OBJECTIVE We created a workshop to instruct postgraduate year (PGY)-2 and PGY-3 internal medicine residents in POC ultrasound imaging of the abdominal aorta and kidneys. METHODS A half-day simulation center workshop was created to review ultrasound operations and teach residents to independently obtain ultrasound images of the abdominal aorta and kidneys on standardized patients with normal anatomy. The workshop incorporated didactic instruction and hands-on ultrasound practice in small groups. Each resident's ability to independently obtain ultrasound images was assessed using a preworkshop and postworkshop skills examination with a standardized patient. Resident knowledge and attitudes toward POC ultrasound were also assessed using a preworkshop and postworkshop test and survey. RESULTS A total of 58 residents completed the workshop, and 84% were able to independently obtain high-quality images of the abdominal aorta and kidney after workshop completion, compared with 16% on the preworkshop test. Residents demonstrated a statistically significant increase in their self-reported confidence with ultrasound operation and image acquisition. CONCLUSIONS Training using standardized patients can prepare residents to independently obtain POC ultrasound images of the aorta and kidneys. Training resulted in increased resident confidence with POC ultrasound and self-reported likelihood of future use.
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Andersen GN, Viset A, Mjølstad OC, Salvesen Ø, Dalen H, Haugen BO. Feasibility and accuracy of point-of-care pocket-size ultrasonography performed by medical students. BMC MEDICAL EDUCATION 2014; 14:156. [PMID: 25070529 PMCID: PMC4131775 DOI: 10.1186/1472-6920-14-156] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 07/17/2014] [Indexed: 05/10/2023]
Abstract
BACKGROUND Point-of-care ultrasound performed by clinicians is a useful supplement in the treatment and assessment of patients. We aimed to investigate whether medical students with minimal training were able to successfully acquire and interpret ultrasound images using a pocket-size imaging device (PSID) as a supplement to their clinical practice. METHODS Thirty 5th year (of six) medical students volunteered to participate. They were each given a personal PSID device to use as a supplement to their physical examination during their allocated hospital terms. Prior to clinical placement the students were given three evenings of hands-on training with PSID by a board certified radiologist/cardiologist, including three short lectures (<20 min). The students were shown basic ultrasound techniques and taught to assess for basic, clinically relevant pathology. They were specifically instructed to assess for the presence or absence of reduced left ventricular function (assessed as mitral annular excursion < 10 mm), pericardial effusion, pleural effusion, lung comets, hydronephrosis, bladder distension, gallstones, abdominal free-fluid, cholecystitis, and estimate the diameter of abdominal aorta and inferior vena cava. RESULTS A total of 211 patients were examined creating 1151 ultrasound recordings. Acceptable organ presentation was 73.8% (95% CI 63.1-82.6) for cardiovascular and 88.4% (95% CI: 80.6-93.6) for radiological structures. Diagnostic accuracy was 93.5% (95% CI: 89.0-96.2) and 93.2% (95% CI: 87.4-96.5) respectively. CONCLUSION Medical students with minimal training were able to use PSID as a supplement to standard physical examination and successfully acquire acceptable relevant organ recordings for presentation and correctly interpret these with great accuracy.
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Affiliation(s)
- Garrett Newton Andersen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Health Trust, 7600 Levanger, Norway
| | - Annja Viset
- Clinic of Radiology and Nuclear Medicine, St. Olav Trondheim University Hospital, Trondheim, Norway
| | - Ole Christian Mjølstad
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway
- Clinic of Cardiology, St. Olav Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Health Trust, 7600 Levanger, Norway
| | - Bjørn Olav Haugen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway
- Clinic of Cardiology, St. Olav Trondheim University Hospital, Trondheim, Norway
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Cullen MW, Blauwet LA, Vatury OM, Mulvagh SL, Behrenbeck TR, Scott CG, Pellikka PA. Diagnostic capability of comprehensive handheld vs transthoracic echocardiography. Mayo Clin Proc 2014; 89:790-8. [PMID: 24684783 PMCID: PMC4082693 DOI: 10.1016/j.mayocp.2013.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers. PATIENTS AND METHODS We conducted a prospective study of adult outpatients undergoing comprehensive TTE between July 9, 2012, and April 3, 2013. Experienced sonographers performed a detailed, standardized examination using a handheld ultrasound device that included 2-dimensional and color Doppler images from standard imaging windows. Images from TTE and HHE were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed. RESULTS The study group contained 190 patients (mean ± SD age, 62 ± 17 years; 49% male [n=93]). The κ values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings. CONCLUSION In experienced hands, HHE shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. Even when performed and interpreted by experienced operators, HHE should not be used as a surrogate for standard TTE. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01558518.
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Affiliation(s)
| | - Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ori M Vatury
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Noriega O, Ho H, Wright J. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10009-1340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, this reliable diagnostic instrument has started showing its age with the arrival of a newer diagnostic instrument: the hand-held ultrasound.
Hand-held ultrasound is rapidly expanding in many specialties but not yet in obstetrics and gynecology. There is a paucity of literature on the application of hand-held ultrasound in obstetrics and gynecology, in contrast to a large volume of literature published by other specialties. Several studies demonstrated that medical students and residents can improve the accuracy of their physical examinations with the use of hand-held ultrasound. Similarly, physical examinations performed by hospitalists with hand-carried ultrasound are more accurate than those performed without the instrument. Advances in technology have contributed to the improvement of image quality and portability. As a result, these devices become increasingly available in many clinical settings such as point of care, telemedicine and rural medicine. The quality of ultrasound images of the hand-held scanner is inferior to those of standard laptop ultrasound. However, the hand-held ultrasound requires much less time for setup.
Although there have been recommendations for training guidelines for operators of hand-held ultrasound, standards for optimal training to achieve level of competency have not been determined.
How to cite this article
Wright J, Noriega O, Ho H. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. Donald School J Ultrasound Obstet Gynecol 2014;8(1):87-91.
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Kimura BJ, Amundson SA, Phan JN, Agan DL, Shaw DJ. Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination. J Hosp Med 2012; 7:537-42. [PMID: 22592969 DOI: 10.1002/jhm.1944] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 03/05/2012] [Accepted: 03/23/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite the future potential of using ultrasound stethoscopes to augment the bedside cardiac physical, few data exist on a general cardiovascular imaging protocol that can be taught to physicians on a perpetual basis as a curriculum in graduate medical education. METHODS During the past decade, we developed and integrated a cardiovascular limited ultrasound training program within the confines of an internal medicine residency. The evidence-based rationale for the exam, the teaching methods, and curriculum are delineated, and subsequent observations regarding program requirements, proficiency, and academic outcomes are explored. Analysis of variance and linear regression assessed for relationships between academic scores, chief resident selection, and gender to proficiency in ultrasound. RESULTS A brief, 5-minute cardiovascular limited ultrasound exam (CLUE) was taught using both didactic and bedside methods, and practiced primarily within the cardiology consult, outpatient clinic, and intensive care rotations. Program costs were minimized by employing readily available institutional resources. After a 2-year lead-in training phase, the subsequent 4 years of senior resident performance (n = 41 residents) showed an 81% pass rate in CLUE competency. Resident ultrasound performance did not relate to academic scores (r = 0.05, P = 0.75), chief resident selection, nor gender. Observations regarding resident pitfalls in CLUE practice and increased participation in extracurricular research are described. CONCLUSIONS We report our initial experience in developing and implementing a training program for bedside cardiovascular ultrasound examination that employed evidence-based techniques, set proficiency goals, and assessed resident performance. It may be feasible to teach future internist-hospitalists the technique of bedside ultrasound during residency.
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Affiliation(s)
- Bruce J Kimura
- Department of Medical Education, Scripps Mercy Hospital, San Diego, CA, USA.
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Geriatricians’ Interest to Learn Bedside Portable Ultrasound (GEBUS) for Application in the Clinical Practice and in Education. J Am Med Dir Assoc 2012; 13:308.e7-10. [DOI: 10.1016/j.jamda.2011.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/01/2011] [Indexed: 11/21/2022]
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:463-5. [DOI: 10.1097/aco.0b013e3283499d5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lucas BP, Candotti C, Margeta B, Mba B, Kumapley R, Asmar A, Franco-Sadud R, Baru J, Acob C, Borkowsky S, Evans AT. Hand-carried echocardiography by hospitalists: a randomized trial. Am J Med 2011; 124:766-74. [PMID: 21663885 DOI: 10.1016/j.amjmed.2011.03.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/03/2011] [Accepted: 03/09/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospitalists can use hand-carried echocardiography for accurate point-of-care information, but patient outcome data for its application are sparse. METHODS We performed an unblinded, parallel-group randomized trial between July 2008 and March 2009 at one teaching hospital in Chicago, Illinois. We randomly assigned adult general medicine inpatients referred for standard echocardiography with indications investigatable by hand-carried echocardiography to care guided by hand-carried echocardiography or usual care. The main outcome measure was length of stay on the referring hospitalist's service. Secondary outcomes included a before-after analysis of reported changes in management due to hand-carried echocardiography and the diagnostic accuracy of hand-carried echocardiography. RESULTS The difference in length of stay between 226 participants randomized to care guided by hand-carried echocardiography (geometric mean 46.1 hours, interquartile range 29.0-70.9 hours) and 227 participants randomized to usual care (46.9 hours, interquartile range 34.1-68.3 hours) corresponded to a 1.7% reduction in length of stay that was not statistically significant (95% confidence interval, -12.1 to 9.8%). In post hoc subgroup analyses, care guided by hand-carried echocardiography reduced length of stay in participants who were referred for heart failure (P=.0008). Among participants who underwent both hand-carried and standard echocardiography, hospitalists changed management due to hand-carried echocardiography in 37%. Despite the favorable diagnostic accuracy of hand-carried echocardiography, most changes to the timing of hospital discharge occurred after standard echocardiography. CONCLUSION Hospitalist care guided by hand-carried echocardiography for unselected general medicine patients does not meaningfully affect length of stay. Whether or not it affects care quality remains unstudied.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, IL, USA.
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Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, Paulman LE, Wells JR, Richeson NA, Catalana PV, Thomas LK, Britt Wilson L, Cook T, Riffle S, Neuffer FH, McCallum JB, Keisler BD, Brown RS, Gregg AR, Sims KM, Powell CK, Garber MD, Morrison JE, Owens WB, Carnevale KA, Jennings WR, Fletcher S. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011; 3:1-12. [PMID: 21516137 PMCID: PMC3064888 DOI: 10.1007/s13089-011-0052-9] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/15/2010] [Indexed: 12/02/2022] Open
Abstract
A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.
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Affiliation(s)
| | - Victor V. Rao
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Mary Beth Poston
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Duncan B. Howe
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Patrick S. Hunt
- School of Medicine, University of South Carolina, Columbia SC, USA
| | | | - Lance E. Paulman
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - James R. Wells
- School of Medicine, University of South Carolina, Columbia SC, USA
| | | | - Paul V. Catalana
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Lynn K. Thomas
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - L. Britt Wilson
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Thomas Cook
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Shaun Riffle
- School of Medicine, University of South Carolina, Columbia SC, USA
| | | | | | - Brian D. Keisler
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Rachel S. Brown
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Anthony R. Gregg
- School of Medicine, University of South Carolina, Columbia SC, USA
| | - Kerry M. Sims
- School of Medicine, University of South Carolina, Columbia SC, USA
| | | | | | | | - William B. Owens
- School of Medicine, University of South Carolina, Columbia SC, USA
| | | | | | - Sarah Fletcher
- School of Medicine, University of South Carolina, Columbia SC, USA
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