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Fischetti C, Frisch E, Loesche M, Goldsmith A, Mormann B, Savage JS, Dias R, Duggan N. Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine. West J Emerg Med 2024; 25:275-281. [PMID: 38596930 PMCID: PMC11000543 DOI: 10.5811/westjem.18422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 04/11/2024] Open
Abstract
Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board. As technology continues to evolve, the assistance of other artificial intelligence and augmented reality systems are likely to facilitate training and dynamic real-time needs during space emergencies. Summary: As space tourism continues to evolve, an organized methodology for POCUS use is advised to best prepare astronauts for space.
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Affiliation(s)
- Chanel Fischetti
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Emily Frisch
- Cleveland Clinic, Department of Obstetrics and Gynecology, Cleveland, Ohio
| | - Michael Loesche
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Andrew Goldsmith
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Ben Mormann
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Joseph S. Savage
- Yale Bridgeport Hospital, Department of Emergency Medicine, Bridgeport, Connecticut
| | - Roger Dias
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Nicole Duggan
- Brigham and Women’s Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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2
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van Goor HMR, de Hond TAP, van Loon K, Breteler MJM, Kalkman CJ, Kaasjager KAH. Designing a Virtual Hospital-at-Home Intervention for Patients with Infectious Diseases: A Data-Driven Approach. J Clin Med 2024; 13:977. [PMID: 38398291 PMCID: PMC10889708 DOI: 10.3390/jcm13040977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Virtual hospital-at-home care might be an alternative to standard hospital care for patients with infectious diseases. In this study, we explore the potential for virtual hospital-at-home care and a potential design for this population. METHODS This was a retrospective cohort study of internal medicine patients suspected of infectious diseases, admitted between 1 January and 31 December 2019. We collected information on delivered care during emergency department visits, the first 24 h, between 24 and 72 h, and after 72 h of admission. Care components that could be delivered at home were combined into care packages, and the potential number of eligible patients per package was described. The most feasible package was described in detail. RESULTS 763 patients were included, mostly referred for general internal medicine (35%), and the most common diagnosis was lower respiratory tract infection (27%). The most frequently administered care components were laboratory tests, non-oral medication, and intercollegiate consultation. With a combination of telemonitoring, video consultation, non-oral medication administration, laboratory tests, oxygen therapy, and radiological diagnostics, 48% of patients were eligible for hospital-at-home care, with 35% already eligible directly after emergency department visits. CONCLUSION While the potential for virtual hospital-at-home care is high, it depends greatly on which care can be arranged.
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Affiliation(s)
- Harriët M. R. van Goor
- Department of Internal Medicine, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Anesthesiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Titus A. P. de Hond
- Department of Internal Medicine, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Kim van Loon
- Department of Internal Medicine, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Anesthesiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Martine J. M. Breteler
- Department of Internal Medicine, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Anesthesiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Digital Health, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Cor J. Kalkman
- Department of Anesthesiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Karin A. H. Kaasjager
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
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Piliuk K, Tomforde S. Artificial intelligence in emergency medicine. A systematic literature review. Int J Med Inform 2023; 180:105274. [PMID: 37944275 DOI: 10.1016/j.ijmedinf.2023.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Motivation and objective: Emergency medicine is becoming a popular application area for artificial intelligence methods but remains less investigated than other healthcare branches. The need for time-sensitive decision-making on the basis of high data volumes makes the use of quantitative technologies inevitable. However, the specifics of healthcare regulations impose strict requirements for such applications. Published contributions cover separate parts of emergency medicine and use disparate data and algorithms. This study aims to systematize the relevant contributions, investigate the main obstacles to artificial intelligence applications in emergency medicine, and propose directions for further studies. METHODS The contributions selection process was conducted with systematic electronic databases querying and filtering with respect to established exclusion criteria. Among the 380 papers gathered from IEEE Xplore, ACM Digital Library, Springer Library, ScienceDirect, and Nature databases 116 were considered to be a part of the survey. The main features of the selected papers are the focus on emergency medicine and the use of machine learning or deep learning algorithms. FINDINGS AND DISCUSSION The selected papers were classified into two branches: diagnostics-specific and triage-specific. The former ones are focused on either diagnosis prediction or decision support. The latter covers such applications as mortality, outcome, admission prediction, condition severity estimation, and urgent care prediction. The observed contributions are highly specialized within a single disease or medical operation and often use privately collected retrospective data, making them incomparable. These and other issues can be addressed by creating an end-to-end solution based on human-machine interaction. CONCLUSION Artificial intelligence applications are finding their place in emergency medicine, while most of the corresponding studies remain isolated and lack higher generalization and more sophisticated methodology, which can be a matter of forthcoming improvements.
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Affiliation(s)
| | - Sven Tomforde
- Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany
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Saati A, Au A, Joshi AU, Davis R, West FM, Lewiss RE. Can Untrained Patients Perform Their Own Skin and Soft Tissue Ultrasound Examination by Teleguidance? POCUS JOURNAL 2023; 8:159-164. [PMID: 38099176 PMCID: PMC10721299 DOI: 10.24908/pocus.v8i2.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Objectives: This pilot study aims to determine if patients untrained in performing ultrasound can self-scan to obtain images under remote clinician teleguidance during a simulated telehealth encounter. This study also seeks to describe the patients' comfort level and barriers to performing an ultrasound examination on themselves using a handheld ultrasound device. Methods: This was a single center prospective observational cohort study conducted over a 4-month period in 2021. Patients were eligible if they had no prior training in the use of ultrasound and in the use of teleguidance. They voluntarily consented to participate at a single ambulatory internal medicine clinic. Results: 20 participants were enrolled and underwent teleguidance to ultrasound their own skin and soft tissues at the antecubital fossae. Six second video clips were evaluated by 2 subject matter experts using the Point of Care Ultrasound Image Quality scale. A score >7 was considered adequate for diagnostic interpretation. The average score was 10.15/14, with a minimum score of 5/14, and maximum score of 14/14 and a standard deviation (SD) of 2.39 using a two tailed Z-score. Setting alpha at 0.05 the 95% CI was (5.47-14.83). Conclusion: In a pilot study of 20 participants with no ultrasound experience, untrained healthy volunteers were able to perform technically acceptable and interpretable ultrasound scans using teleguidance by a trained clinician.
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Affiliation(s)
- Ammar Saati
- Department of Cardiovascular Medicine Section of Vascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic FoundationCleveland, OHUSA
| | - Arthur Au
- Department of Emergency Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Aditi U Joshi
- Digital Health Intelligence, MDisrupt, Founder, Nagamed LLC
| | - Rebecca Davis
- Department of Internal Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Frances Mae West
- Department of Internal Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, Thomas Jefferson UniversityPhiladelphia, PAUSA
| | - Resa E Lewiss
- Department of Emergency Medicine, University of Alabama at BirminghamBirmingham, ALUSA
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Zayed BA, Ali AN, Elgebaly AA, Talaia NM, Hamed M, Mansour FR. Smartphone-based point-of-care testing of the SARS-CoV-2: A systematic review. SCIENTIFIC AFRICAN 2023; 21:e01757. [PMID: 37351482 PMCID: PMC10256629 DOI: 10.1016/j.sciaf.2023.e01757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus's worldwide pandemic has highlighted the urgent need for reliable, quick, and affordable diagnostic tests for comprehending and controlling the epidemic by tracking the world population. Given how crucial it is to monitor and manage the pandemic, researchers have recently concentrated on creating quick detection techniques. Although PCR is still the preferred clinical diagnostic test, there is a pressing need for substitutes that are sufficiently rapid and cost-effective to provide a diagnosis at the time of use. The creation of a quick and simple POC equipment is necessary for home testing. Our review's goal is to provide an overview of the many methods utilized to identify SARS-CoV 2 in various samples utilizing portable devices, as well as any potential applications for smartphones in epidemiological research and detection. The point of care (POC) employs a range of microfluidic biosensors based on smartphones, including molecular sensors, immunological biosensors, hybrid biosensors, and imaging biosensors. For example, a number of tools have been created for the diagnosis of COVID-19, based on various theories. Integrated portable devices can be created using loop-mediated isothermal amplification, which combines isothermal amplification methods with colorimetric detection. Electrochemical approaches have been regarded as a potential substitute for optical sensing techniques that utilize fluorescence for detection and as being more beneficial to the Minimizing and simplicity of the tools used for detection, together with techniques that can amplify DNA or RNA under constant temperature conditions, without the need for repeated heating and cooling cycles. Many research have used smartphones for virus detection and data visualization, making these techniques more user-friendly and broadly distributed throughout nations. Overall, our research provides a review of different novel, non-invasive, affordable, and efficient methods for identifying COVID-19 contagious infected people and halting the disease's transmission.
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Affiliation(s)
- Berlanty A Zayed
- Tanta Student Research Academy, Faculty of Medicine, Tanta University, Tanta 31111, Egypt
| | - Ahmed N Ali
- Tanta Student Research Academy, Faculty of Medicine, Tanta University, Tanta 31111, Egypt
| | - Alaa A Elgebaly
- Tanta Student Research Academy, Faculty of Medicine, Tanta University, Tanta 31111, Egypt
| | - Nourhan M Talaia
- Tanta Student Research Academy, Faculty of Medicine, Tanta University, Tanta 31111, Egypt
| | - Mahmoud Hamed
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Tanta University, Elgeish Street, The Medical Campus of Tanta University, Tanta 31111, Egypt
| | - Fotouh R Mansour
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Tanta University, Elgeish Street, The Medical Campus of Tanta University, Tanta 31111, Egypt
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Kirkpatrick AW, McKee JL, Breeck K. Comments on Tien and Beckett’s ‘Medical support for future large-scale combat operations’. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Andrew W. Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions Research Group, Calgary, Alberta, Canada
| | - Jessica L. McKee
- TeleMentored Ultrasound Supported Medical Interventions Research Group, Calgary, Alberta, Canada
| | - Karen Breeck
- Women Veterans Research and Engagement Network, Ottawa, Ontario, Canada
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Kirkpatrick AW, McKee JL, Couperus K, Colombo CJ. Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care. Diagnostics (Basel) 2022; 12:2884. [PMID: 36428945 PMCID: PMC9689087 DOI: 10.3390/diagnostics12112884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.
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Affiliation(s)
- Andrew W. Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
- Departments of Critical Care Medicine and Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jessica L. McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
| | - Kyle Couperus
- Ready Medic One (RMO) Research Group, Tacoma, WA 98431, USA
| | - Christopher J. Colombo
- Department of Medicine, Uniformed Services University of Health Sciences Bethesda Maryland, Bethesda, MD 20814, USA
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Flemons K, Baylis B, Khan AZ, Kirkpatrick AW, Whitehead K, Moeini S, Schreiber A, Lapointe S, Ashoori S, Arif M, Berenger B, Conly J, Hawkins W. The use of drones for the delivery of diagnostic test kits and medical supplies to remote First Nations communities during Covid-19. Am J Infect Control 2022; 50:849-856. [PMID: 35908822 PMCID: PMC9329072 DOI: 10.1016/j.ajic.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 02/06/2023]
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Kirkpatrick AW, McKee JL, Ball CG, Ma IWY, Melniker LA. Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health. Ultrasound J 2022; 14:2. [PMID: 34978611 PMCID: PMC9417136 DOI: 10.1186/s13089-021-00250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background SARS-CoV-2 infection, manifesting as COVID-19 pneumonia, constitutes
a global pandemic that is disrupting health-care systems. Most patients who are
infected are asymptomatic/pauci-symptomatic can safely self-isolate at home.
However, even previously healthy individuals can deteriorate rapidly with
life-threatening respiratory failure characterized by disproportionate hypoxemic
failure compared to symptoms. Ultrasound findings have been proposed as an early
indicator of progression to severe disease. Furthermore, ultrasound is a safe
imaging modality that can be performed by novice users remotely guided by experts.
We thus examined the feasibility of utilizing common household
informatic-technologies to facilitate self-performed lung ultrasound. Methods A lung ultrasound expert remotely mentored and guided participants
to image their own chests with a hand-held ultrasound transducer. The results were
evaluated in real time by the mentor, and independently scored by three
independent experts [planned a priori]. The primary outcomes were feasibility in
obtaining good-quality interpretable images from each anatomic location
recommended for COVID-19 diagnosis. Results Twenty-seven adults volunteered. All could be guided to obtain
images of the pleura of the 8 anterior and lateral lung zones (216/216 attempts).
These images were rated as interpretable by the 3 experts in 99.8% (647/648) of
reviews. Fully imaging one’s posterior region was harder; only 108/162 (66%) of
image acquisitions was possible. Of these, 99.3% of images were interpretable in
blinded evaluations. However, 52/54 (96%) of participants could image their lower
posterior lung bases, where COVID-19 is most common, with 99.3% rated as
interpretable. Conclusions Ultrasound-novice adults at risk for COVID-19 deterioration can be
successfully mentored using freely available software and low-cost ultrasound
devices to provide meaningful lung ultrasound surveillance of themselves that
could potentially stratify asymptomatic/paucisymptomatic patients with early risk
factors for serious disease. Further studies examining practical logistics should
be conducted. Trial Registration: ID
ISRCTN/77929274 on 07/03/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00250-6.
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Affiliation(s)
- Andrew W Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB, Canada. .,Departments of Surgery, University of Calgary, Calgary, AB, Canada. .,Departments of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. .,Regional Trauma Services, EG 23, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada. .,Canadian Forces Medical Services, University of Calgary, Calgary, AB, Canada.
| | - Jessica L McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB, Canada
| | - Chad G Ball
- Departments of Surgery, University of Calgary, Calgary, AB, Canada.,Regional Trauma Services, EG 23, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Irene W Y Ma
- W21C, University of Calgary, Calgary, AB, Canada.,John A. Buchanan Chair, Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence A Melniker
- Department of Emergency Medicine, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
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