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Mouawad YA, El Ters F, Mina C, Richa K, Salameh P, Nakhle R. Assessment of Point-of-Care Ultrasound (POCUS) Knowledge Among Lebanese Medical Residents. Cureus 2024; 16:e69205. [PMID: 39268028 PMCID: PMC11392010 DOI: 10.7759/cureus.69205] [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] [Accepted: 09/11/2024] [Indexed: 09/15/2024] Open
Abstract
Over the past few years, point-of-care ultrasound (POCUS) has emerged as a critical diagnostic tool in emergency medicine, providing real-time imaging at the bedside. This study aims to assess POCUS knowledge and competency among medical residents in Lebanon, identify possible gaps and deficiencies in their training, and recommend guidelines for further improvement of the curriculum in Lebanese medical schools and residency programs. Our study reveals that 58.3% (N=119) of resident doctors from multiple specialties in Lebanon have only basic knowledge about POCUS, 19.6% (N=40) have no knowledge, and only 21.6% (N=44) have sufficient knowledge to perform diagnostic studies on a routine basis. Lebanese medical residents currently possess suboptimal POCUS knowledge and proficiency due to disparities in training and educational obstacles. To address this, residency programs should focus on standardized POCUS training, simulation-based learning, and faculty development. This approach will help ensure residents gain the necessary skills to use POCUS effectively in clinical practice.
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Affiliation(s)
- Yara A Mouawad
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Fadi El Ters
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Christeen Mina
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Khalil Richa
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Pascale Salameh
- Primary Care and Population Health, University of Nicosia Medical School, Nicosia, CYP
- Public Health, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie (INSPECT-LB), Beirut, LBN
- Faculty of Pharmacy, Lebanese University, Beirut, LBN
- School of Medicine, Lebanese American University, Beirut, LBN
| | - Ramzi Nakhle
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
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Vega R, Kwok C, Rakkunedeth Hareendranathan A, Nagdev A, Jaremko JL. Assessment of an Artificial Intelligence Tool for Estimating Left Ventricular Ejection Fraction in Echocardiograms from Apical and Parasternal Long-Axis Views. Diagnostics (Basel) 2024; 14:1719. [PMID: 39202209 PMCID: PMC11353168 DOI: 10.3390/diagnostics14161719] [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: 07/23/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
This work aims to evaluate the performance of a new artificial intelligence tool (ExoAI) to compute the left ventricular ejection fraction (LVEF) in echocardiograms of the apical and parasternal long axis (PLAX) views. We retrospectively gathered echocardiograms from 441 individual patients (70% male, age: 67.3 ± 15.3, weight: 87.7 ± 25.4, BMI: 29.5 ± 7.4) and computed the ejection fraction in each echocardiogram using the ExoAI algorithm. We compared its performance against the ejection fraction from the clinical report. ExoAI achieved a root mean squared error of 7.58% in A2C, 7.45% in A4C, and 7.29% in PLAX, and correlations of 0.79, 0.75, and 0.89, respectively. As for the detection of low EF values (EF < 50%), ExoAI achieved an accuracy of 83% in A2C, 80% in A4C, and 91% in PLAX. Our results suggest that ExoAI effectively estimates the LVEF and it is an effective tool for estimating abnormal ejection fraction values (EF < 50%). Importantly, the PLAX view allows for the estimation of the ejection fraction when it is not feasible to acquire apical views (e.g., in ICU settings where it is not possible to move the patient to obtain an apical scan).
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Affiliation(s)
| | - Cherise Kwok
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
| | - Abhilash Rakkunedeth Hareendranathan
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
| | - Arun Nagdev
- Alameda Health System, Highland General Hospital, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (C.K.); (A.R.H.); (J.L.J.)
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Almulhim KN, Alabdulqader RA, Alghamd MK, Alqarni AA, Althikrallah FM, Alarfaj AA. Assessing Point-of-care Ultrasound Knowledge and Utilization among Emergency Physicians in Saudi Arabia: A Cross-sectional Survey. Indian J Crit Care Med 2024; 28:769-776. [PMID: 39239182 PMCID: PMC11372662 DOI: 10.5005/jp-journals-10071-24763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/25/2024] [Indexed: 09/07/2024] Open
Abstract
Background This study aims to assess the knowledge, perceptions, and utilization of point-of-care ultrasound (POCUS) among emergency physicians (EPs) in Saudi Arabia. Point-of-care ultrasound has emerged as a valuable tool in emergency medicine, providing real-time diagnostic information at the bedside. Understanding the current state of POCUS integration and the factors influencing its adoption is crucial for optimizing patient care in emergency settings. Materials and methods A cross-sectional study was conducted across various hospitals in Saudi Arabia over six months. The study included 100 EPs, encompassing residents and specialists. Data were collected through an online self-administered questionnaire, exploring demographic factors, POCUS training, equipment availability, and physicians' perceptions. Statistical analyses were performed using SPSS version 28.0, including descriptive statistics and Chi-square tests. Results The study revealed diverse demographic factors, with a majority of physicians working in regional emergency medical centers. While 84.0% of respondents had used an ultrasound device, varying levels of knowledge about POCUS were observed. Regional disparities and differences in training exposure were evident. The majority expressed positive perceptions of POCUS utility, with 67.0% recognizing its usefulness in primary care health centers. However, 31.0% only partially agreed on its daily practice utility, highlighting potential areas for intervention. Conclusion This study provides a comprehensive assessment of POCUS awareness, knowledge, and perceptions among EPs in Saudi Arabia. The findings underscore the need for targeted educational initiatives, resource allocation, and regional considerations to enhance POCUS integration. Addressing perceived barriers and regional variations can contribute to the widespread adoption of POCUS, ultimately optimizing patient care in emergency settings. How to cite this article Almulhim KN, Alabdulqader RA, Alghamd MK, Alqarni AA, Althikrallah FM, Alarfaj AA. Assessing Point-of-care Ultrasound Knowledge and Utilization among Emergency Physicians in Saudi Arabia: A Cross-sectional Survey. Indian J Crit Care Med 2024;28(8):769-776.
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Affiliation(s)
- Khalid Nabeel Almulhim
- Department of Emergency Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Razan Anwar Alabdulqader
- Department of Emergency Medicine and Surgery, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Mohammed Khalid Alghamd
- Department of Emergency Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Alwaleed A Alqarni
- Department of Emergency Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Farah M Althikrallah
- Department of Emergency Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ahmed A Alarfaj
- Department of Emergency Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
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Kim S, Fischetti C, Guy M, Hsu E, Fox J, Young SD. Artificial Intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in Low-Resource Settings: A Scoping Review. Diagnostics (Basel) 2024; 14:1669. [PMID: 39125545 PMCID: PMC11312308 DOI: 10.3390/diagnostics14151669] [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: 07/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally, the lack of standardization in POCUS devices, protocols, and algorithms emerged as a significant barrier to AI implementation. The diversity of POCUS AI applications in different domains (e.g., lung, hip, heart, etc.) illustrates the challenges of having to tailor to the specific needs of each application. By separating out the analysis by application area, researchers will better understand the distinct impacts and limitations of AI, aligning research and development efforts with the unique characteristics of each clinical condition. Despite these challenges, POCUS AI systems show promise in bridging gaps in healthcare delivery by aiding clinicians in low-resource settings. Future research endeavors should prioritize addressing the gaps identified in this review to enhance the feasibility and effectiveness of POCUS AI applications to improve healthcare outcomes in resource-constrained environments.
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Affiliation(s)
- Seungjun Kim
- Department of Informatics, University of California, Irvine, CA 92697, USA;
| | - Chanel Fischetti
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Megan Guy
- Department of Emergency Medicine, University of California, Irvine, CA 92697, USA; (M.G.); (E.H.); (J.F.)
| | - Edmund Hsu
- Department of Emergency Medicine, University of California, Irvine, CA 92697, USA; (M.G.); (E.H.); (J.F.)
| | - John Fox
- Department of Emergency Medicine, University of California, Irvine, CA 92697, USA; (M.G.); (E.H.); (J.F.)
| | - Sean D. Young
- Department of Informatics, University of California, Irvine, CA 92697, USA;
- Department of Emergency Medicine, University of California, Irvine, CA 92697, USA; (M.G.); (E.H.); (J.F.)
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Baker DR, Glau CL, Himebauch AS, Arnoldi S, Rosenblatt S, Keim G, Loscalzo SM, Weber MD, Cohen M, Quartermain MD, Kaplan SL, Sutton RM, Nishisaki A, Conlon TW. Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU. Pediatr Crit Care Med 2024:00130478-990000000-00366. [PMID: 39023322 DOI: 10.1097/pcc.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVES To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development. DESIGN Retrospective observational study. SETTING Large academic, noncardiac PICU in the United States. SUBJECTS Patients in a PICU who had diagnostic POCUS performed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies (p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS (p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion. CONCLUSIONS Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.
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Affiliation(s)
- David R Baker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christie L Glau
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sara Arnoldi
- Department of Paediatric Anaesthesia, Evelina London Children's Hospital, London, United Kingdom
| | - Sam Rosenblatt
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Garrett Keim
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Steven M Loscalzo
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark D Weber
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Meryl Cohen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael D Quartermain
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, West FM. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. J Am Soc Echocardiogr 2024; 37:S0894-7317(24)00222-0. [PMID: 39230540 DOI: 10.1016/j.echo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Point-of-care ultrasound (POCUS) involves the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician. The current state of cardiac POCUS terminology is heterogeneous and ambiguous, in part because it evolved through siloed specialty practices. In particular, the medical literature and colloquial medical conversation contain a wide variety of terms that equate to cardiac POCUS. While diverse terminology aided in the development and dissemination of cardiac POCUS throughout multiple specialties, it also contributes to confusion and raises patient safety concerns. This statement is the product of a diverse and inclusive Writing Group from multiple specialties, including medical linguistics, that employed an iterative process to contextualize and standardize a nomenclature for cardiac POCUS. We sought to establish a deliberate vocabulary that is sufficiently unrelated to any specialty, ultrasound equipment, or clinical setting to enhance consistency throughout the academic literature and patient care settings. This statement (1) reviews the evolution of cardiac POCUS-related terms; (2) outlines specific recommendations, distinguishing between intrinsic and practical differences in terminology; (3) addresses the implications of these recommendations for current practice; and (4) discusses the implications for novel technologies and future research.
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Affiliation(s)
- James N Kirkpatrick
- Division of Cardiology and Department of Bioethics and Humanities, Department of Medicine, University of Washington, Seattle, Washington
| | - Nova Panebianco
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - José L Díaz-Gómez
- Critical Care Institute, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | | | - Yuriy S Bronshteyn
- Duke University School of Medicine, Durham Veterans Health Administrations, Durham, North Carolina
| | - Sara Damewood
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - Amer Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Bruce J Kimura
- Echocardiography and Vascular Ultrasound Lab, Scripps Mercy Hospital, San Diego, California
| | - Smadar Kort
- Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Arthur Labovitz
- Department of Cardiovascular Sciences, NCH Rooney Heart Institute, Naples, Florida
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Irene W Y Ma
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon L Mulvagh
- Dalhousie University, Women's Heart Health Clinic, Halifax, Nova Scotia, Canada
| | - Sara Nikravan
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington
| | - Sheela Pai Cole
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Michael H Picard
- Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Vincent L Sorrell
- University of Kentucky, Gill Heart and Vascular Institute, Lexington, Kentucky
| | | | - Ritu Thamman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Gabriele Via
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frances Mae West
- Division of Pulmonary & Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abuguyan F, Almasry NW, Alzahrani AA. Barriers to Point-of-Care Ultrasound Utilization Among Emergency Medicine Residents in Riyadh, Saudi Arabia. Cureus 2024; 16:e65765. [PMID: 39211663 PMCID: PMC11361400 DOI: 10.7759/cureus.65765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency medicine (EM). This study aimed to identify barriers to POCUS utilization among EM residents in the Riyadh region. MATERIALS AND METHODS An observational cross-sectional study was conducted among 116 EM residents from various training centers in Riyadh. Data were collected through self-administered questionnaires assessing demographics, ultrasound (US) training, perceived barriers, and facilitators to POCUS usage. Statistical analysis included descriptive statistics, multiple response dichotomy analysis, and multivariable linear regression. RESULTS The majority of residents had completed US training and recognized the importance of POCUS in emergency settings. However, significant barriers were identified, including time constraints and logistical challenges. Multivariable regression analysis revealed associations between residents' training status, beliefs in incentives, anticipated POCUS use, and perceived barriers. CONCLUSION This study highlights the importance of addressing barriers to POCUS integration into residency programs. Efforts should focus on optimizing training, addressing workflow challenges, and enhancing residents' confidence in POCUS utilization. Targeted interventions tailored to specific clinical contexts may facilitate greater acceptance and integration of POCUS into routine practice.
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Affiliation(s)
- Fahad Abuguyan
- Emergency Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | - Naief W Almasry
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
| | - Ali A Alzahrani
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
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Bouros GC, Popa TO, Nedelea PL, Manolescu E, Haisan A, Roca I, Morosanu P, Hauta A, Grigorasi G, Corlade-Andrei M, Cimpoesu D. A Modern Diagnostic Procedure-The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians' Daily Routine. Clin Pract 2024; 14:1137-1148. [PMID: 38921268 PMCID: PMC11203034 DOI: 10.3390/clinpract14030090] [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: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. METHODS Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. RESULTS The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. CONCLUSION The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.
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Affiliation(s)
- George-Catalin Bouros
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
| | - Tudor Ovidiu Popa
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Paul Lucian Nedelea
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Emilian Manolescu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Anca Haisan
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Iulia Roca
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Petruta Morosanu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Alexandra Hauta
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Gabriela Grigorasi
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
| | - Mihaela Corlade-Andrei
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Diana Cimpoesu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
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Ding K, Chen M, Li P, Xie Z, Zhang H, Kou R, Xu J, Zou T, Luo Z, Song H. The effect of simulation of sectional human anatomy using ultrasound on students' learning outcomes and satisfaction in echocardiography education: a pilot randomized controlled trial. BMC MEDICAL EDUCATION 2024; 24:494. [PMID: 38702655 PMCID: PMC11069238 DOI: 10.1186/s12909-024-05337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/21/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Effective teaching methods are needed to improve students' abilities in hand-eye coordination and understanding of cardiac anatomy in echocardiography education. Simulation devices have emerged as innovative teaching tools and exhibited distinctive advantages due to their ability to provide vivid and visual learning experiences. This study aimed to investigate the effect of simulation of sectional human anatomy using ultrasound on students' learning outcomes and satisfaction in echocardiography education. METHODS The study included 18 first-year clinical medical students with no prior echocardiography training. After randomization, they underwent a pre-test to assess basic knowledge. Following this, the students were divided into two groups: traditional teaching (traditional group) and simulation of sectional human anatomy using ultrasound (digital group). Each group received 60 min of instruction. Post-tests were assigned to students at two different time points: immediately after the lecture, and one week later (referred to as post-tests 1, and 2). In addition, anonymous questionnaires were distributed to students after class to investigate their satisfaction with teaching. RESULTS Both groups showed significant improvement in their scores on post-test 1 compared to pre-test (traditional group: from 33.1 ± 8.8 to 48.1 ± 13.1, P = 0.034 vs. digital group: from 35.0 ± 6.7 to 58.0 ± 13.2, P = 0.008). However, there were no significant differences between the two groups in several post-test comparisons. Student satisfaction ratings revealed that the digital group experienced significantly greater satisfaction in areas such as subject interest, teaching style, course alignment, and interaction compared to the traditional group. Additionally, 80% of the digital group strongly endorsed the use of simulation of sectional human anatomy using ultrasound for echocardiography teaching, highlighting its effectiveness. CONCLUSIONS Simulation of sectional human anatomy using ultrasound may improve students' understanding of echocardiography and satisfaction with the course. Our study provides evidence supporting the use of simulation teaching devices in medical education. Further research is needed to explore the long-term impact of this teaching method on students' learning outcomes and its integration into the medical curriculum. TRIAL REGISTRATION http://www.chictr.org.cn (registration number: ChiCTR2300074015, 27/07/2023).
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Affiliation(s)
- Kewen Ding
- West China School of Medicine, Sichuan University, 610041, Chengdu, Sichuan, P. R. China
| | - Mingjing Chen
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ping Li
- Department of Anesthesiology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Zichuan Xie
- West China School of Medicine, Sichuan University, 610041, Chengdu, Sichuan, P. R. China
| | - Haorong Zhang
- West China School of Medicine, Sichuan University, 610041, Chengdu, Sichuan, P. R. China
| | - Ruixing Kou
- West China School of Medicine, Sichuan University, 610041, Chengdu, Sichuan, P. R. China
| | - Jionghui Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Ting Zou
- Department of Anesthesiology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Zhen Luo
- Department of Anesthesiology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China
| | - Haibo Song
- Department of Anesthesiology, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan, China.
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10
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Naser JA, Lee E, Pislaru SV, Tsaban G, Malins JG, Jackson JI, Anisuzzaman DM, Rostami B, Lopez-Jimenez F, Friedman PA, Kane GC, Pellikka PA, Attia ZI. Artificial intelligence-based classification of echocardiographic views. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:260-269. [PMID: 38774376 PMCID: PMC11104471 DOI: 10.1093/ehjdh/ztae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 05/24/2024]
Abstract
Aims Augmenting echocardiography with artificial intelligence would allow for automated assessment of routine parameters and identification of disease patterns not easily recognized otherwise. View classification is an essential first step before deep learning can be applied to the echocardiogram. Methods and results We trained two- and three-dimensional convolutional neural networks (CNNs) using transthoracic echocardiographic (TTE) studies obtained from 909 patients to classify nine view categories (10 269 videos). Transthoracic echocardiographic studies from 229 patients were used in internal validation (2582 videos). Convolutional neural networks were tested on 100 patients with comprehensive TTE studies (where the two examples chosen by CNNs as most likely to represent a view were evaluated) and 408 patients with five view categories obtained via point-of-care ultrasound (POCUS). The overall accuracy of the two-dimensional CNN was 96.8%, and the averaged area under the curve (AUC) was 0.997 on the comprehensive TTE testing set; these numbers were 98.4% and 0.998, respectively, on the POCUS set. For the three-dimensional CNN, the accuracy and AUC were 96.3% and 0.998 for full TTE studies and 95.0% and 0.996 on POCUS videos, respectively. The positive predictive value, which defined correctly identified predicted views, was higher with two-dimensional rather than three-dimensional networks, exceeding 93% in apical, short-axis aortic valve, and parasternal long-axis left ventricle views. Conclusion An automated view classifier utilizing CNNs was able to classify cardiac views obtained using TTE and POCUS with high accuracy. The view classifier will facilitate the application of deep learning to echocardiography.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jeffrey G Malins
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - John I Jackson
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - D M Anisuzzaman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Behrouz Rostami
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Dadon Z, Rav Acha M, Orlev A, Carasso S, Glikson M, Gottlieb S, Alpert EA. Artificial Intelligence-Based Left Ventricular Ejection Fraction by Medical Students for Mortality and Readmission Prediction. Diagnostics (Basel) 2024; 14:767. [PMID: 38611680 PMCID: PMC11011323 DOI: 10.3390/diagnostics14070767] [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: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. AIM To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students using an artificial intelligence (AI) tool and 1-year primary composite outcome, including mortality and readmission for cardiovascular-related causes. METHODS Eight trained medical students used a hand-held ultrasound device (HUD) equipped with an AI-based tool for automatic evaluation of the LVEF of non-selected patients hospitalized in a cardiology department from March 2019 through March 2020. RESULTS The study included 82 patients (72 males aged 58.5 ± 16.8 years), of whom 34 (41.5%) were diagnosed with AI-based reduced LVEF. The rates of the composite outcome were higher among patients with reduced systolic function compared to those with preserved LVEF (41.2% vs. 16.7%, p = 0.014). Adjusting for pertinent variables, reduced LVEF independently predicted the composite outcome (HR 2.717, 95% CI 1.083-6.817, p = 0.033). As compared to those with LVEF ≥ 50%, patients with reduced LVEF had a longer length of stay and higher rates of the secondary composite outcome, including in-hospital death, advanced ventilatory support, shock, and acute decompensated heart failure. CONCLUSION AI-based assessment of reduced systolic function in the hands of medical students, independently predicted 1-year mortality and cardiovascular-related readmission and was associated with unfavorable in-hospital outcomes. AI utilization by novice users may be an important tool for risk stratification for hospitalized patients.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Hadassah Medical Center—Ein Kerem, Jerusalem 9112001, Israel
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Jalilvand A, Bhatt A, Kopanczyk R, Wahl W. Formal ultrasound curriculum for surgical critical care fellows leads to improvement in comfort and skills in the intensive care unit. Surgery 2024; 175:893-898. [PMID: 37926583 DOI: 10.1016/j.surg.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Despite its importance, there are no official guidelines for point of care ultrasound training during surgical critical care fellowship. The primary objective of this study was to evaluate the comfort and competency of fellows after implementation of a point of care ultrasound program. METHODS Surgical critical care fellows (n = 7) participated in an ultrasound rotation (2021-2022), including dedicated lectures and training with interventional and echocardiography technicians. Pre and post self-assessments were administered evaluating comfort in point of care ultrasound for focused assessment with sonography for trauma, vascular access, drainage procedures, volume status, cardiac activity during arrest, and global cardiac function. Technicians assessed fellow skill in probe orientation, location, image manipulation, machine adjustment, and image quality. All questions were answered on a 7-point Likert scale (1, not-at-all; 7, yes/very much). Pre and post cohorts were compared using Wilcoxon signed-rank tests. RESULTS After the rotation, fellows reported improvement in comfort level for ultrasound-guided technique for focused assessment with sonography for trauma, drainage procedures, volume status, and cardiac assessment. Technician evaluations demonstrated improvement in probe orientation (5 [4-6] vs 7 [7-7], P = .02) and location (5 [3-6] vs 7 [7-7], P = .02), image manipulation (5 [4-5] vs 7 [7-7], P = .02), machine adjustment (5 [4-5] vs 7 [7-7], P = .02), and overall image quality (4 [4-6] vs 7 [7-7], P = .02) after the rotation. All fellows reported the course significantly improved their skill, comfort level, and was worthwhile. CONCLUSION All fellows exhibited significant improvement in skill and comfort with point of care ultrasound after this rotation. This is the first study to describe a dedicated ultrasound curriculum for surgical critical care with significant skill acquisition.
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Affiliation(s)
- Anahita Jalilvand
- Department of General Surgery, Division of Trauma, Critical Care, and Burns, The Ohio State University, Columbus, OH.
| | - Amar Bhatt
- Department of Anesthesiology, Division of Critical Care, The Ohio State University, Columbus, OH
| | - Rafal Kopanczyk
- Department of Anesthesiology, Division of Critical Care, The Ohio State University, Columbus, OH
| | - Wendy Wahl
- Department of General Surgery, Division of Trauma, Critical Care, and Burns, The Ohio State University, Columbus, OH
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Maheshwari S, Dagor H. Evolving the Scope of Cardiac Point-of-Care Ultrasound in the Current Era. Cureus 2024; 16:e53985. [PMID: 38476776 PMCID: PMC10928454 DOI: 10.7759/cureus.53985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Point-of-care ultrasound (POCUS) has become a flexible and multifaceted diagnostic instrument in the realm of cardiac care, transforming the landscape of cardiovascular assessment. This review aims to explore the extensive scope of POCUS applications in cardiac care, highlighting its diverse utility across various medical specialties. POCUS, conducted at the patient's bedside, offers real-time insights into cardiac anatomy and function, providing a valuable adjunct to traditional diagnostic methods. In critically ill patients, POCUS has demonstrated its effectiveness in the rapid evaluation of the left and right ventricular function, identification of pericardial effusion and tamponade, assessment of volume status, and detection of valvular lesions. Its role as an adjunct to the physical examination has been particularly impactful, leading to early diagnoses and significantly influencing medical management decisions. The review also discusses the current limitations of POCUS technology. As the utilization of POCUS continues to expand across diverse medical disciplines, its ability to offer timely and accurate diagnostic information is poised to reshape the standard of care in cardiac medicine. This comprehensive review provides insights into the evolving role of POCUS in cardiac care and underscores its potential to enhance patient outcomes through rapid and informed decision-making at the point of care.
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Affiliation(s)
| | - Himansu Dagor
- Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, IND
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14
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Li C, Liu Y, Dong R, Zhang T, Song Y, Zhang Q. Deep learning radiomics on shear wave elastography and b-mode ultrasound videos of diaphragm for weaning outcome prediction. Med Eng Phys 2024; 123:104090. [PMID: 38365343 DOI: 10.1016/j.medengphy.2023.104090] [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: 09/26/2023] [Revised: 11/17/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024]
Abstract
PURPOSE We proposed an automatic method based on deep learning radiomics (DLR) on shear wave elastography (SWE) and B-mode ultrasound videos of diaphragm for two classification tasks, one for differentiation between the control and patient groups, and the other for weaning outcome prediction. MATERIALS AND METHODS We included a total of 581 SWE and B-mode ultrasound videos, of which 466 were from the control group of 179 normal subjects, and 115 were from the patient group of 35 mechanically ventilated subjects in the intensive care unit (ICU). Among the patient group, 17 subjects successfully weaned and 18 failed. The deep neural network of U-Net was utilized to automatically segment diaphragm regions in dual-modal videos of SWE and B-mode. High-throughput radiomics features were then extracted, the statistical test and least absolute shrinkage and selection operator (LASSO) were applied for feature dimension reduction. The optimal classification models for the two tasks were established using the support vector machine (SVM). RESULTS The automatic segmentation model achieved Dice score of 87.89 %. A total of 4524 radiomics features were extracted, 10 and 20 important features were left after feature dimension reduction for constructing the two classification models. The best areas under receiver operating characteristic curves of the two models reached 84.01 % and 94.37 %, respectively. CONCLUSIONS Our proposed DLR methods are innovative for automatic segmentation of diaphragm regions in SWE and B-mode videos and deep mining of high-throughput radiomics features from dual-modal images. The approaches have been proved to be effective for prediction of weaning outcomes.
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Affiliation(s)
- Changchun Li
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Yan Liu
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rui Dong
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Tianjie Zhang
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ye Song
- Department of Ultrasonography, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China.
| | - Qi Zhang
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China.
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15
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Liu J, Guo YL, Ren XL. No Critical Ultrasound, No Life: The Value of Point-of Care Critical Ultrasound in the Rescue of Critically Ill Infants. Diagnostics (Basel) 2023; 13:3624. [PMID: 38132208 PMCID: PMC10743008 DOI: 10.3390/diagnostics13243624] [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: 11/08/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by fungal sepsis was treated and nursed under the guidance of POC-CUS monitoring, and the infant was ultimately cured. This premature infant had systemic multiple organ system dysfunction and disseminated intravascular coagulation (DIC) caused by fungal sepsis. In the hypercoagulable state of early-stage DIC, cardiac thrombosis could be found using ultrasound screening. For this case, right renal artery thrombosis was found via renal artery Doppler ultrasound examination. Due to the severity of this disease, ultrasound-guided peripherally inserted central catheter (PICC) insertion and ultrasound checks of the PICC tip's position were performed, which ensured the success of this one-time catheterization and shortened the catheterization time. Lung ultrasound is used for the diagnosis and differential diagnosis of pulmonary diseases, and to guide the application of mechanical ventilation. Because the abdominal circumference of the patient's markedly enlarged abdominal circumference, bloody stool, and absence of bowel sounds, abdominal ultrasonography was performed, which revealed a markedly enlarged liver, significant peritoneal effusion, and necrotizing enterocolitis. Guided by POC-CUS monitoring, we had the opportunity to implement timely and effective treatment that ultimately saved this critically ill patient's life. The successful treatment of this newborn infant fully reflects the importance of carrying out POC-CUS screening.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing 100021, China
| | - Ya-Li Guo
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing 100021, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing 100021, China
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Calderon Martinez E, Diarte E, Othon Martinez D, Rodriguez Reyes L, Aguirre Cano DA, Cantu Navarro C, Ycaza Zurita MG, Arriaga Escamilla D, Choudhari J, Michel G. Point-of-Care Ultrasound for the Diagnosis of Frequent Cardiovascular Diseases: A Review. Cureus 2023; 15:e51032. [PMID: 38264374 PMCID: PMC10805123 DOI: 10.7759/cureus.51032] [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] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Point-of-care ultrasound (POCUS) has emerged as an indispensable diagnostic tool in cardiology, particularly within the emergency department. This narrative synthesis provides a comprehensive exploration of POCUS applications in cardiovascular diseases, elucidating its multifaceted roles and addressing challenges. The review delves into the technical attributes of POCUS, emphasizing its non-invasive nature, radiation-free qualities, and suitability for non-radiologists. It navigates through educational strategies, stressing the importance of structured programs for the seamless integration of POCUS into clinical practice. Highlighting its efficacy, the synthesis discusses POCUS applications in various scenarios such as dyspnea, chest pain, cardiac arrest, aortic dissection, pericardial effusion, and pulmonary embolism. Beyond acute care, the review explores the role of POCUS in outpatient and inpatient settings, focusing on chronic and acute heart failure, valvular heart diseases, and more. Acknowledging operator-dependent challenges and the need for continuous education, the review underscores the transformative potential of POCUS across diverse healthcare settings. This narrative synthesis accentuates POCUS as a valuable and versatile diagnostic tool in cardiology, offering efficiency, safety, and cost-effectiveness. Despite challenges, POCUS stands out as a transformative addition to clinical practices, poised to enhance patient outcomes and reshape the landscape of cardiovascular diagnostics.
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Affiliation(s)
| | - Edna Diarte
- Medicine, Universidad Autónoma de Sinaloa, Culiacán, MEX
| | | | | | | | | | | | | | - Jinal Choudhari
- Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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Sultan LR, Haertter A, Al-Hasani M, Demiris G, Cary TW, Tung-Chen Y, Sehgal CM. Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound. AI 2023; 4:875-887. [PMID: 37929255 PMCID: PMC10623579 DOI: 10.3390/ai4040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.
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Affiliation(s)
- Laith R. Sultan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Allison Haertter
- Radiation Oncology Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - George Demiris
- Informatics Division of the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore W. Cary
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Yale Tung-Chen
- Emergency Medicine Department, La Madrida Hospital, 28006 Madrid, Spain
| | - Chandra M. Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
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Levy BE, Castle JT, Virodov A, Wilt WS, Bumgardner C, Brim T, McAtee E, Schellenberg M, Inaba K, Warriner ZD. Artificial intelligence evaluation of focused assessment with sonography in trauma. J Trauma Acute Care Surg 2023; 95:706-712. [PMID: 37165477 DOI: 10.1097/ta.0000000000004021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The focused assessment with sonography in trauma (FAST) is a widely used imaging modality to identify the location of life-threatening hemorrhage in a hemodynamically unstable trauma patient. This study evaluates the role of artificial intelligence in interpretation of the FAST examination abdominal views, as it pertains to adequacy of the view and accuracy of fluid survey positivity. METHODS Focused assessment with sonography for trauma examination images from 2015 to 2022, from trauma activations, were acquired from a quaternary care level 1 trauma center with more than 3,500 adult trauma evaluations, annually. Images pertaining to the right upper quadrant and left upper quadrant views were obtained and read by a surgeon or radiologist. Positivity was defined as fluid present in the hepatorenal or splenorenal fossa, while adequacy was defined by the presence of both the liver and kidney or the spleen and kidney for the right upper quadrant or left upper quadrant views, respectively. Four convolutional neural network architecture models (DenseNet121, InceptionV3, ResNet50, Vgg11bn) were evaluated. RESULTS A total of 6,608 images, representing 109 cases were included for analysis within the "adequate" and "positive" data sets. The models relayed 88.7% accuracy, 83.3% sensitivity, and 93.6% specificity for the adequate test cohort, while the positive cohort conferred 98.0% accuracy, 89.6% sensitivity, and 100.0% specificity against similar models. Augmentation improved the accuracy and sensitivity of the positive models to 95.1% accurate and 94.0% sensitive. DenseNet121 demonstrated the best accuracy across tasks. CONCLUSION Artificial intelligence can detect positivity and adequacy of FAST examinations with 94% and 97% accuracy, aiding in the standardization of care delivery with minimal expert clinician input. Artificial intelligence is a feasible modality to improve patient care imaging interpretation accuracy and should be pursued as a point-of-care clinical decision-making tool. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level III.
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Affiliation(s)
- Brittany E Levy
- From the Department of Surgery (B.E.L., J.T.C., W.S.W., E.M.), Institute for Biomedical Informatics (A.V.), Department of Pathology (C.B.), and Department of Radiology (T.B.), University of Kentucky, Lexington, Kentucky; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (M.S., K.I.), University of Southern California, Los Angeles, California; and Division of Trauma Critical Care and Acute Care Surgery, Department of Surgery (Z.D.W.), University of Kentucky, Lexington, Kentucky
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Corroenne R, Chesnais M, Khawand C, Attali I, Boucherie AS, Defrance M, Morgan R, Maurey L, Ville Y, Salomon LJ. Physicians' perceptions of the daily use of a handheld ultrasound device in the labor room. J Gynecol Obstet Hum Reprod 2023; 52:102618. [PMID: 37290728 DOI: 10.1016/j.jogoh.2023.102618] [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: 03/20/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of our study was to describe the perception of physicians who use a handheld ultrasound (US) device in an intensive perinatal care unit. METHODS We conducted a prospective observational study in the labor ward of an intensive perinatal care unit between November 2021 and May 2022. Obstetrics & Gynecology residents in rotation in our department during this time were recruited as participants in this study. All the participants were provided with a handheld US device Vscan Air™ (GE Healthcare, Zipf, Austria) to use during their normal days and nights practice in labor ward. At the end of their 6 months rotation, participants completed an anonymous surveys about their perceptions of the handheld US device. The survey included questions about the ease of use in clinical situations, the amount of time of initial diagnosis, performances of the device, feasibility to use, and patient's satisfaction with the use of the device. RESULTS 6 residents in their last year of residency were included. All the participants were satisfied with the device and would like to use it in their future practice. They all agreed that the probe was easy to handle and that the mobile application was easy to use. Image quality was always considered good by the participants and 5/6 of them declared that the handheld US device was always sufficient and did not require any confirmation with a conventional US machine. 5/6 of the participants considered that the handheld US device allowed them to gain time for clinical decision but half of them did not estimate that the use of the handheld US device improved their ability to make a clinical diagnosis. CONCLUSION Our study suggests that the Vscan Air™ is easy to use, with a good quality image and reduces the amount of time to make a clinical diagnosis. Handheld US device could be useful in the daily practice in maternity hospital.
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Affiliation(s)
- Romain Corroenne
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Marion Chesnais
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Chelsea Khawand
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Isabelle Attali
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Anne Sophie Boucherie
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Manon Defrance
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Rosemary Morgan
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Louise Maurey
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Yves Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker Enfants Malades Hospital, Paris, France; EA fetus 7328 and LUMIERE Platform, University of Paris, Paris, France.
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20
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Kim JJ, Li JJ, Nguyen Q, Neilson E. The Effectiveness of Student-Led Musculoskeletal and Vascular Ultrasound Workshops at a Single Institution: A Retrospective Survey Analysis. Cureus 2023; 15:e41902. [PMID: 37583741 PMCID: PMC10423848 DOI: 10.7759/cureus.41902] [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] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) is a rapidly evolving field of diagnostic medicine as its low cost, portability, and versatility have made handheld ultrasound (US) probes an invaluable tool for many modern physicians. Despite US's benefits as a bedside evaluative tool, many medical schools have not integrated POCUS into their pre-clerkship medical education due to a lack of equipment and faculty. The first objective of our study was to determine whether student tutors (STs) would be effective resources to teach musculoskeletal (MSK) and vascular US to preclinical medical students. The second objective of our study was to determine whether students who previously attended ST-run MSK US workshops perform better in vascular US than those who did not. Methods Six POCUS workshops were led by STs after approval from experienced US faculty. These included US workshops on gastrointestinal structures, forearm structures, joint structures, basic echocardiography, and US-guided IV access. We collected data from two of our six workshops. We developed surveys to gauge the confidence and ability of students to perform US after an MSK workshop and US-guided IV access workshop led by STs. We also measured students' US abilities and collected student feedback after our US-guided IV access workshop. We evaluated students' US competency in US-guided IV access via their ability to correctly position the US probe, angle the needle of insertion, move the probe with the needle, and access the vein based on the accuracy of the movements. We divided student results into two groups: students who previously attended the MSK workshop before attending the US-guided IV access workshop and students who did not attend the MSK workshop before attending the US-guided IV access workshop. We used averages, frequencies, and two-tailed t-tests to analyze the survey responses and US-guided IV access skill assessments. Results Fifty percent of first- and second-year surveyed students "agreed," and 32.4% "strongly agreed" that they felt confident using US after an ST-run MSK workshop. About 29.4% of surveyed students "agreed" and 41.2% "strongly agreed" that they felt comfortable explaining basic US concepts, such as proper probe positioning and echogenicity. The group of students who attended the MSK workshop prior to the peripheral IV workshop scored similarly to the students who did not attend the MSK workshop (14.33±1.03 versus 14.20±0.84 points). Both groups of students had an average of over 94% accuracy in technique, positioning, angling, moving the US probe, and achieving US-guided venous access after being taught by STs. Qualitative surveying noted positive student feedback, such as "Teacher was great at guiding us through the procedure." Survey responses also included suggestions on adding and diversifying equipment, such as "[It would be useful to have a] different type of needle to see the difference on ultrasound." Conclusion Based on the high percentages of accuracy and confidence, we found that STs were effective resources to teach MSK and vascular POCUS and that students who attended previous MSK ST-run US workshops had stronger vascular US ability over time compared to those who did not. Our data support the use of STs as US educational resources, especially in institutions without an existing pre-clerkship US curriculum and limited US resources.
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Affiliation(s)
- Jane J Kim
- Education, California University of Science and Medicine, Colton, USA
| | - Jeffrey J Li
- Education, California University of Science and Medicine, Colton, USA
| | - Quang Nguyen
- Education, California University of Science and Medicine, Colton, USA
| | - Eric Neilson
- Family Medicine, California University of Science and Medicine, Colton, USA
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21
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Smith M, Krishnan SV, Leamon A, Galwankar S, Sinha TP, Kumar VA, Laere JV, Gallien J, Bhoi S. Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India. J Emerg Trauma Shock 2023; 16:116-126. [PMID: 38025509 PMCID: PMC10661575 DOI: 10.4103/jets.jets_50_23] [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: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 12/01/2023] Open
Abstract
Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India's 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations.
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Affiliation(s)
- Mike Smith
- School of Health Sciences, Cardiff University, Cardiff, Wales, UK
| | - S. Vimal Krishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Andrew Leamon
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Sagar Galwankar
- Department of Emergency Medicine, Florida State University, Tallahassee, Florida, USA
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jeffrey V. Laere
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - John Gallien
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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22
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Hafner C, Scharner V, Hermann M, Metelka P, Hurch B, Klaus DA, Schaubmayr W, Wagner M, Gleiss A, Willschke H, Hamp T. Eye-tracking during simulation-based echocardiography: a feasibility study. BMC MEDICAL EDUCATION 2023; 23:490. [PMID: 37393288 DOI: 10.1186/s12909-023-04458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Due to the technical progress point-of-care ultrasound (POCUS) is increasingly used in critical care medicine. However, optimal training strategies and support for novices have not been thoroughly researched so far. Eye-tracking, which offers insights into the gaze behavior of experts may be a useful tool for better understanding. The aim of this study was to investigate the technical feasibility and usability of eye-tracking during echocardiography as well as to analyze differences of gaze patterns between experts and non-experts. METHODS Nine experts in echocardiography and six non-experts were equipped with eye-tracking glasses (Tobii, Stockholm, Sweden), while performing six medical cases on a simulator. For each view case specific areas of interests (AOI) were defined by the first three experts depending on the underlying pathology. Technical feasibility, participants' subjective experience on the usability of the eye-tracking glasses as well as the differences of relative dwell time (focus) inside the areas of interest (AOI) between six experts and six non-experts were evaluated. RESULTS Technical feasibility of eye-tracking during echocardiography was achieved with an accordance of 96% between the visual area orally described by participants and the area marked by the glasses. Experts had longer relative dwell time in the case specific AOI (50.6% versus 38.4%, p = 0.072) and performed ultrasound examinations faster (138 s versus 227 s, p = 0.068). Furthermore, experts fixated earlier in the AOI (5 s versus 10 s, p = 0.033). CONCLUSION This feasibility study demonstrates that eye-tracking can be used to analyze experts and non-experts gaze patterns during POCUS. Although, in this study the experts had a longer fixation time in the defined AOIs compared to non-experts, further studies are needed to investigate if eye-tracking could improve teaching of POCUS.
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Affiliation(s)
- Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Philipp Metelka
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Benedikt Hurch
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Daniel Alexander Klaus
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wolfgang Schaubmayr
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Emergency Medical Service Vienna, Radetzkystraße 1, 1030, Vienna, Austria.
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23
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Sourianarayanane A, McCullough AJ. Accuracy of ultrasonographic fatty liver index using point-of-care ultrasound in stratifying non-alcoholic fatty liver disease patients. Eur J Gastroenterol Hepatol 2023; 35:654-661. [PMID: 37115988 DOI: 10.1097/meg.0000000000002544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in the USA. Some of these patients develop non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis. Ultrasound imaging is one of the most used modalities for diagnosing hepatic steatosis. Primary care providers are increasingly using point-of-care ultrasound (POCUS), which could increase the number of subjects diagnosed with NAFLD. This study evaluates the accuracy of POCUS in identifying patients with NASH. METHODS Patients with hepatic steatosis without excess alcohol intake or other liver diseases undergoing liver biopsy were included in this study. These patients underwent POCUS and vibration-controlled transient elastography (VCTE) evaluations within 3 months of a liver biopsy. A comparison of POCUS data with liver histology and VCTE were made to assess the validity of POCUS evaluation in diagnosing NAFLD and NASH. RESULTS The steatosis score from the liver histology had a low correlation with the controlled attenuation parameter score from VCTE ( r = 0.27) and a moderate correlation with the grade of steatosis detected by the POCUS exam ( r = 0.57). The NAFLD activity score on histology was found to correlate with the ultrasonographic fatty liver index (USFLI) from the POCUS exam ( r = 0.59). A USFLI ≥ 6 diagnosed NASH with a sensitivity of 81%, and a value of ≤3 ruled out the diagnosis of NASH with a sensitivity of 100%. CONCLUSION The provider can use the POCUS exam in clinical practice to diagnose NAFLD and reliably stratify patients who have NASH.
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Affiliation(s)
| | - Arthur J McCullough
- Department of Medicine, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Le AN, Nguyen AV, Nguyen TN, Kirkpatrick JN, Nguyen HT, Nguyen HTT. Cardiac metastasis mimicking STEMI-impact of point-of-care ultrasound on clinical decision-making: A case report. Front Cardiovasc Med 2023; 10:1098154. [PMID: 37034345 PMCID: PMC10073711 DOI: 10.3389/fcvm.2023.1098154] [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: 11/14/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The manifestations of cardiac metastases are extremely variable depending on their location and extension. Case presentation A 62-year-old man was admitted to the cardiac emergency department presenting with chest pain, worsening shortness of breath and palpitations. He had a history of esophageal squamous cell carcinoma treated with chemoradiotherapy, and he was not diagnosed with cardiovascular disease before. The electrocardiogram showed significant ST-segment elevations in leads II, III, and aVF. Initially, the patient was diagnosed with ST-segment elevation myocardial infarction. A cardiac point-of-care ultrasound was performed immediately revealing two large heterogeneous masses in the left ventricular wall and the apex, which changed the diagnosis and the management strategy. There was no significant change in serial cardiac biomarkers in the setting of persistent STE. Thoracic computed tomography and cardiac magnetic resonance confirmed that the patient was suffering from cardiac and lung metastases. Conclusion ECG findings of localized and prolonged STE without Q waves or changes in biomarkers may suggest myocardial tumor invasion, especially in the cancer setting. Cardiac point-of-care ultrasound is an effective, convenient, noninvasive imaging modality to guide real-time clinical decision-making.
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Affiliation(s)
- Anh Ngoc Le
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Anh Van Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | | | - James N. Kirkpatrick
- Cardiovascular Division, Department of Medicine, University of Washington Medical Center, Seattle, WA, United States
- Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, WA, United States
| | | | - Hoai Thi Thu Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Internal Medicine, VNU – University of Medicine and Pharmacy, Hanoi, Vietnam
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25
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Johri AM, Glass C, Hill B, Jensen T, Puentes W, Olusanya O, Capizzano JN, Dancel R, Reierson K, Reisinger N, Liblik K, Galen BT. The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. Am J Med 2023:S0002-9343(23)00158-4. [PMID: 36889497 DOI: 10.1016/j.amjmed.2023.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields.
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Affiliation(s)
- Amer M Johri
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Casey Glass
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Trevor Jensen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wilfredo Puentes
- Department of Anesthesia, Western University, London, ON, Canada
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ria Dancel
- Departments of Internal Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Minnesota and Wisconsin, USA
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin T Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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26
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Graham JD, Grissom CK. From Pac-Man to UltraMan. Crit Care Med 2023; 51:415-418. [PMID: 36809263 DOI: 10.1097/ccm.0000000000005777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Jeffrey D Graham
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT
- Department of Pulmonary and Critical Care, Intermountain Healthcare, Salt Lake City, UT
| | - Colin K Grissom
- Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT
- Department of Pulmonary and Critical Care, Intermountain Healthcare, Salt Lake City, UT
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Reeve R, Higginson A, Ball C, Beable R, Smith M. Role extension in advanced ultrasound practice: A framework approach and case study. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:4-10. [PMID: 36794119 PMCID: PMC9923144 DOI: 10.1177/1742271x221102577] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Introduction Role extension into novel areas of ultrasound practice can be challenging for health care professionals. Expansion into existing areas of advanced practice typically occurs using established processes and accredited training; however, in areas where there is no formal training, there can be a lack of support for how to develop new and progressive clinical roles. Topic Description This article presents how the use of a framework approach for establishing areas of advanced practice can support individuals and departments with safely and successfully developing new roles in ultrasound. The authors illustrate this via the example of a gastrointestinal ultrasound role, developed in an NHS department. Discussion The framework approach comprises three elements, each interdependent upon and inform each other: (A) Scope of practice, (B) Education and competency and (C) Governance. (A) Defines (and communicates) the role extension and area(s) of subsequent ultrasound imaging, interpretation and reporting. By identifying the why, how and what is required this informs (B) the education and assessment of competency for those taking on new roles or areas of expertise. (C) Is informed by (A) and is an ongoing process of quality assurance to safeguard high standards in clinical care. In supporting role extension, this approach can facilitate new workforce configurations, skill expansion and enable increasing service demands to be met. Summary By defining and aligning the components of scope of practice, education/competency and governance, role development in ultrasound can be initiated and sustained. Role extension utilising this approach brings benefits for patients, clinicians and departments.
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Affiliation(s)
- Ruth Reeve
- Portsmouth University Hospital NHS
trust, Portsmouth, UK,University of Southampton, Southampton,
UK,Ruth Reeve, Portsmouth University Hospital
NHS trust, Portsmouth PO6 3LY, UK.
| | | | | | - Richard Beable
- Portsmouth University Hospital NHS
trust, Portsmouth, UK
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28
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Akanuwe JN, Siriwardena AN, Bidaut L, Mitchell P, Bird P, Lasserson D, Apenteng P, Lilford R. Practitioners' views on community implementation of point-of-care ultrasound (POCUS) in the UK: a qualitative interview study. BMC Health Serv Res 2023; 23:84. [PMID: 36698100 PMCID: PMC9876652 DOI: 10.1186/s12913-023-09069-4] [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: 07/01/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK. METHODS We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12. RESULTS We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals. Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience. CONCLUSIONS POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.
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Affiliation(s)
- Joseph N.A Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Aloysius Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Luc Bidaut
- grid.36511.300000 0004 0420 4262School of Computer Science, College of Science, University of Lincoln, Lincoln, England
| | - Pauline Mitchell
- grid.36511.300000 0004 0420 4262School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Paul Bird
- grid.412563.70000 0004 0376 6589Institute for Translational Medicine Research & Development, University Hospitals Birmingham NHS Foundation Trust, West Midlands Academic Health Science Network, Birmingham, England
| | - Daniel Lasserson
- grid.7372.10000 0000 8809 1613Warwick Medical School, University of Warwick, Coventry, England ,grid.410556.30000 0001 0440 1440Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, England
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29
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Haskings EM, Eissa M, Allard RV, MirGhassemi A, McFaul CM, Miller EC. Point-of-care ultrasound use in emergencies: what every anaesthetist should know. Anaesthesia 2023; 78:105-118. [PMID: 36449358 DOI: 10.1111/anae.15910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 12/05/2022]
Abstract
Point-of-care ultrasound has been embraced by anaesthetists as an invaluable tool for rapid diagnosis of haemodynamic instability, to ensure procedural safety and monitor response to treatments. Increasingly available, affordable and portable, with emerging evidence of improved patient outcomes, point-of-care ultrasound has become a valuable tool in the emergency setting. This state-of-the-art review describes the feasibility of point-of-care ultrasound practice, training and maintenance of competence. It also describes the many uses of point-of-care ultrasound for the anaesthetist and describes the most salient point-of-care ultrasound views for anaesthetic emergencies including: undifferentiated shock; hypoxemia; and trauma. Procedural safety is also discussed in addition to relevant important governance aspects. Cardiac function should be assessed using the parasternal long axis, parasternal short basal/mid-papillary/apical, apical four chamber and subcostal four chamber views, and should include a visual estimation of global left ventricular ejection fraction. Other cardiovascular conditions that can be identified using point-of-care ultrasound include: pericardial effusion; cardiac tamponade; and pulmonary embolism. Pulmonary emergency conditions that can be diagnosed using point-of-care ultrasound include pneumothorax; pleural effusion; and interstitial syndrome. The extended focused assessment with sonography for trauma examination may of value in patients who are hypotensive in order to identify intra-abdominal haemorrhage, pneumothoraces and haemothoraces.
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Affiliation(s)
- E M Haskings
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M Eissa
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - R V Allard
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - A MirGhassemi
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - C M McFaul
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - E C Miller
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
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Muacevic A, Adler JR, Pereira J, Biloslavo A, Zago M, Hashem JH, Kumar N, Corbally M, Bass GA, Walsh TN. Surgeon-Performed Point-of-Care Ultrasound in the Diagnosis of Acute Sigmoid Diverticulitis: A Pragmatic Prospective Multicenter Cohort Study. Cureus 2023; 15:e33292. [PMID: 36741667 PMCID: PMC9893173 DOI: 10.7759/cureus.33292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
Background and purpose Early diagnosis and risk stratification of sigmoid diverticulitis rely heavily on timely imaging. Computerized tomography (CT), the gold standard diagnostic test, may be delayed due to resource constraints or patient comorbidity. Point-of-care ultrasound (POCUS) has an established role in trauma evaluation, and could potentially diagnose and stage acute diverticulitis, thus shortening the time to definitive treatment. Aims This study aimed to benchmark the accuracy of surgeon-performed POCUS against CT in diagnosing and staging acute diverticulitis. A secondary aim was to evaluate the duration between the POCUS and the confirmatory CT scan report. Patients and methods A pragmatic prospective multicenter cohort study (ClinicalTrials.gov Identifier: NCT02682368) was conducted. Surgeons performed point-of-care ultrasound as first-line imaging for suspected acute diverticulitis. POCUS diagnosis and radiologic Hinchey classification were compared to CT as the reference standard. Results Of 45 patients with suspected acute diverticulitis, POCUS classified 37 (82.2%) as uncomplicated diverticulitis, four (8.8%) as complicated diverticulitis, and four (8.8%) as other diagnoses. The POCUS-estimated modified radiologic Hinchey classification was largely concordant with CT staging with an accuracy of 88.8% (95% CI, 75.95-96.2%), a sensitivity of 100% (95% CI, 90.2- 100%) and a specificity of 44.4% (95% CI, 13.7-78.8%). The positive predictive value (PPV) was 87.8% and the negative predictive value (NPV) was 100%. There was moderate agreement between CT and POCUS, with a Cohen's kappa coefficient of 0.56. The mean delay between CT and POCUS was 9.14 hours (range 0.33 to 43.5). Conclusion We examined the role of POCUS in the management of acute diverticulitis and our findings suggest that it is a promising imaging modality with the potential to reduce radiation exposure and treatment delays. Adding a POCUS training module to the surgical curriculum could enhance diagnosis and expedite the management of acute diverticulitis.
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Miharu M, Nobuko H, Hiromitsu K. Short- and long-term reproducibility of peripheral superficial vein depth and diameter measurements using ultrasound imaging. BMC Med Imaging 2022; 22:212. [DOI: 10.1186/s12880-022-00945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
Ultrasound imaging is used for diagnosis, treatment, and blood vessel visualization during venous catheter placement. However, various physiological factors (e.g., body temperature and exercise) influence vein diameters, which are expected to exhibit daily or diurnal fluctuations. Therefore, this study aimed to determine the intraday (short-term) and interday (long-term) reproducibility of repeated measurements of the depth and diameter of peripheral superficial veins.
Methods
Twenty-three healthy young women (mean age, 21.7 ± 0.8 years) participated in the study to examine the short- and long-term reproducibility of the depth and diameter of the cutaneous vein in the left elbow fossa acquired by ultrasound imaging. Short-term measurement intervals were 10 s, and the probe was released from the skin for each acquisition, which was repeated five consecutive times. Long-term measurements were performed at the same time on the next day following the same procedure. The acquired images were analyzed for vein depth and diameter using ImageJ software. The intraclass correlation coefficient (ICC) was calculated to determine the short- and long-term reproducibility of the measurements. The relationship between the venous depth and venous diameter intra-individual variation was analyzed, as well as the influence of body composition (body fat and muscle mass) on the venous diameter and depth.
Results
For vein depth measurements, the short- and long-term ICCs were 0.94–0.96 and 0.88, respectively. For the vein diameter, the short- and long-term ICCs were 0.94–0.97 and 0.67, respectively. The short-term ICCs for both vein depth and diameter exceeded 0.9, indicating that the ultrasound vascular measurement was sufficiently reliable. However, long-term reproducibility was slightly lower, especially for the vein diameter. No correlation was found between the intra-individual variation of the vein diameter and vein depth. Although the vein diameter and body fat mass uncorrelated, the vein depth and body fat mass significantly correlated (r = 0.675, 95% confidence interval = 0.281–0.830).
Conclusions
The long-term reproducibility of vein diameters was somewhat lower than that of the short-term reproducibility. This could be attributed to fluctuations in the physiological state of the participant rather than to the instability of the measurement. Therefore, ultrasound measurement of the peripheral superficial vein is sufficiently reliable.
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Smith M, Hayward S, Innes S. A proposed framework for point of care lung ultrasound by respiratory physiotherapists: scope of practice, education and governance. Ultrasound J 2022; 14:24. [PMID: 35708815 PMCID: PMC9201799 DOI: 10.1186/s13089-022-00266-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/04/2022] [Indexed: 01/23/2023] Open
Abstract
Background Point of care ultrasound (PoCUS) has the potential to provide a step change in the management of patients across a range of healthcare settings. Increasingly, healthcare practitioners who are not medical doctors are incorporating PoCUS into their clinical practice. However, the professional, educational and regulatory environment in which this occurs is poorly developed, leaving clinicians, managers and patients at risk. Main body Drawing upon existing medical and non-medical literature, the authors present a proposed framework for the use of PoCUS. Throughout, mechanisms for applying the principles to other professionals and healthcare settings are signposted. Application of the framework is illustrated via one such group of healthcare practitioners and in a particular healthcare setting: respiratory physiotherapists in the UK. In defining the point of care LUS scope of practice we detail what structures are imaged, differentials reported upon and clinical decisions informed by their imaging. This is used to outline the educational and competency requirements for respiratory physiotherapists to safely and effectively use the modality. Together, these are aligned with the regulatory (professional, legal and insurance) arrangements for this professional group in the UK. In so doing, a comprehensive approach for respiratory physiotherapists to consolidate and expand their use of point of care LUS is presented. This provides clarity for clinicians as to the boundaries of their practice and how to train in the modality; it supports educators with the design of courses and alignment of competency assessments; it supports managers with the staffing of existing and new care pathways. Ultimately it provides greater accessibility for patients to safe and effective point of care lung ultrasound. For clinicians who are not respiratory physiotherapists and/or are not based in the UK, the framework can be adapted to other professional groups using point of care LUS as well as other point of care ultrasound (PoCUS) applications, thereby providing a comprehensive and sustainable foundation for PoCUS consolidation and expansion. Conclusion This paper presents a comprehensive framework to support the use of point of care LUS by respiratory physiotherapists in the UK. Mechanisms to adapt the model to support a wide range of other PoCUS users are outlined.
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Desai SR, Tang L, Hwang NC. Infection Control for Perioperative Ultrasonography and Echocardiography. J Cardiothorac Vasc Anesth 2022; 36:4440-4448. [PMID: 36123263 DOI: 10.1053/j.jvca.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Ultrasound technology has revolutionized point-of-care diagnostics, decision-making, and the guidance of interventional procedures in Anesthesiology and Perioperative Medicine. Recent literature has highlighted important infection control considerations when performing transesophageal or transthoracic echocardiography, point-of-care ultrasound, and ultrasound-guided procedures. This narrative review focuses on operator precautions and disinfection methods and summarizes key recommendations from the international Echocardiography and Radiology Societies.
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Affiliation(s)
- Suneel Ramesh Desai
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore; Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Leonard Tang
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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Ultrasonic Texture Features for Assessing Cardiac Remodeling and Dysfunction. J Am Coll Cardiol 2022; 80:2187-2201. [DOI: 10.1016/j.jacc.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
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Martocchia A, Bentivegna E, Sergi D, Luciani M, Barlattani M, Notarangelo MF, Piccoli C, Sesti G, Martelletti P. The Point-of-Care Ultrasound (POCUS) by the Handheld Ultrasound Devices (HUDs) in the COVID-19 Scenario: a Review of the Literature. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:1. [PMID: 36407770 PMCID: PMC9665043 DOI: 10.1007/s42399-022-01316-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/10/2023]
Abstract
The use of portable ultrasound (US) devices is increasing, due to its accessibility, versatility, non-invasiveness, and its significant support in the patient management, extending the traditional physical examination through the POCUS (point-of-care ultrasound). The pocket-size or handheld ultrasound devices (HUDs) can easily perform focused exams, not aiming to substitute for the high-end US systems (gold standard), since the HUDs usually have more limited functions. The HUDs are promising tools for the diagnosis, prognosis, and monitoring of the COVID-19 infection and its related disorders. In conclusion, the routine use of HUDs may ameliorate the management of COVID-19 pandemic, according to the guidelines for the POCUS approach and the procedures for the protection of the patients and the professionals.
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Affiliation(s)
- Antonio Martocchia
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Enrico Bentivegna
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Daniela Sergi
- Radiology Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michelangelo Luciani
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Michela Barlattani
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Fortunato Notarangelo
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Cinzia Piccoli
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
| | - Giorgio Sesti
- Internal Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, S. Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, 00189 Rome, Italy
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Point-of-care ultrasound in the head and neck region. J Med Ultrason (2001) 2022; 49:593-600. [DOI: 10.1007/s10396-022-01266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022]
Abstract
AbstractPoint-of-care ultrasound (POCUS) in the head and neck region plays a particularly significant role in the diagnosis and treatment of upper airway stenosis, swelling, and painful diseases in the neck, and in the evaluation of swallowing function. Therefore, it should be performed in various medical settings beyond the boundaries of the clinical department such as general medicine, emergency medicine, anesthesiology, orthopedics, and pediatrics. The target diseases are salivary gland disease, lymph node disease, pharyngeal disease, laryngeal disease, esophageal disease, thyroid disease, and dysphagia and dyspnea due to various causes. Head and neck POCUS is an extremely useful diagnostic method for both patients and doctors, and its use is expected to become more widespread in the future.
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Lane CM, Young KA, Norton MS, Bennett CE, Anavekar NS. Right Heart Thrombus in Transit on Point-of-Care Ultrasound: A Rare Finding with Key Management Repercussions. CASE 2022; 6:239-242. [PMID: 36036053 PMCID: PMC9399530 DOI: 10.1016/j.case.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right heart thrombi are associated with high early mortality in PE. POCUS allows rapid assessment in hemodynamic compromise and suspected PE. Triple POCUS assessment of the lung, heart, and leg veins may improve PE detection.
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Affiliation(s)
- Conor M. Lane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathleen A. Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark S. Norton
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Nandan S. Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Correspondence: Nandan S. Anavekar, MB, BCh, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Optical Chemical Sensor Based on Fast-Protein Liquid Chromatography for Regular Peritoneal Protein Loss Assessment in End-Stage Renal Disease Patients on Continuous Ambulatory Peritoneal Dialysis. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10060232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Point-of-care testing (POCT) devices are becoming increasingly popular in the medical community as an alternative to conventional laboratory testing, especially for home treatments or other forms of outpatient care. Multiple-use chemical sensors with minimal requirements for disposables are among the most practical and cost-effective POC diagnostic instruments, especially in managing chronic conditions. An affordable, simple, and easy-to-use optical sensor based on fast protein liquid chromatography with direct UV absorption detection was developed for the rapid determination of the total protein concentration in effluent peritoneal dialysate and for the assessment of protein losses in end-stage renal disease (ESRD) patients on constant ambulatory peritoneal dialysis (CAPD). The sensor employs non-disposable PD-10 desalting columns for the separation of molecules with different molecular weights and a deep UV LED (maximum at 285 nm) as a light source for optical detection. The analytic procedure is relatively simple, takes 10–15 min, and potentially can be performed by patients themselves or nursing staff without laboratory training. Preliminary clinical trials on a group of 23 patients on CAPD revealed a good concordance between the protein concentrations in dialysate samples measured with the sensor and an automated biochemical analyzer; the mean relative error was about 10%, which is comparable with routine clinical laboratory methods.
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Solomon L, Emma M, Gibbons LM, Kusulas MP. Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation. Am J Emerg Med 2022; 58:16-21. [PMID: 35623178 DOI: 10.1016/j.ajem.2022.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. METHODS A search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. RESULTS No cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DISCUSSION PoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.
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Affiliation(s)
- Linda Solomon
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America.
| | - Maggie Emma
- Risk Management, Northwell Health, New Hyde Park, NY, United States of America
| | - Lisa M Gibbons
- Claims Management, Northwell Health, Great Neck, NY, United States of America
| | - Matthew P Kusulas
- Departments of Pediatrics and Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
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Burton L, Bhargava V, Kong M. Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. Front Pediatr 2022; 9:830160. [PMID: 35178366 PMCID: PMC8845897 DOI: 10.3389/fped.2021.830160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022] Open
Abstract
Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.
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Albaroudi B, Haddad M, Albaroudi O, Abdel-Rahman ME, Jarman R, Harris T. Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis. Eur J Emerg Med 2022; 29:18-32. [PMID: 34406134 PMCID: PMC8691376 DOI: 10.1097/mej.0000000000000866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Assessing left ventricular systolic function (LVSF) by echocardiography assists in the diagnosis and management of a diverse range of patients presenting to the emergency department (ED). We evaluated the agreement between ED-based clinician sonographers and apriori-defined expert sonographers. We conducted a systematic review and meta-analysis based on Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. We searched Medline, EMBASE, Cochrane, ClinicalTrials.gov, TRIP and Google Scholar for eligible studies from inception to February 2021. Risk of bias was evaluated using Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The level of agreement between clinician and expert sonographers was measured using kappa, sensitivity, specificity, positive and negative likelihood ratio statistics using random-effects models. Twelve studies were included (1131 patients, 1229 scans and 159 clinician sonographers). Significant heterogeneity was identified in patient selection, methods of assessment of LVSF, reference standards and statistical methods for assessing agreement. The overall quality of studies was low, with most being small, single centre convenience samples. A meta-analysis including seven studies (786 scans) where visual estimation method was used by clinician sonographers demonstrated simple Kappa of 0.68 [95% confidence interval (CI), 0.57-0.79], and sensitivity, specificity, positive and negative likelihood ratio of 89% (95% CI, 80-94%), 85% (95% CI, 80-89%), 5.98 (95% CI, 4.13-8.68) and 0.13 (95% CI, 0.06-0.24), respectively, between clinician sonographer and expert sonographer for normal/abnormal LVSF. The weighted kappa for five studies (429 scans) was 0.70 (95% CI, 0.61-0.80) for normal/reduced/severely reduced LVSF. There is substantial agreement between ED-based clinician sonographers and expert sonographers for assessing LVSF using visual estimation and ranking it as normal/reduced, or normal/reduced/severely reduced, in patients presenting to ED.
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Affiliation(s)
| | - Mahmoud Haddad
- Department of Emergency Medicine, Hamad Medical Corporation
| | - Omar Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation
| | | | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne
- Teesside University, Middlesbrough
| | - Tim Harris
- Department of Emergency Medicine, Hamad Medical Corporation
- Barts Health NHS Trust and the Queen Mary University of London, London, UK
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Weimer JM, Rink M, Müller L, Arens C, Bozzato A, Künzel J. Sonografische Diagnostik im Kopf-Hals-Bereich – Teil 2: Transzervikale Sonografie. Laryngorhinootologie 2022; 101:156-175. [DOI: 10.1055/a-1667-8675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | - Julian Künzel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Regensburg
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Echocardiographic Assessment of Patients with Pulmonary Tumor Thrombotic Microangiopathy First Diagnosed in the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12020259. [PMID: 35204350 PMCID: PMC8871463 DOI: 10.3390/diagnostics12020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/10/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease that obstructs pulmonary vessels, leading to pulmonary hypertension (PH) and right-sided heart failure causing rapid progressive dyspnea in patients with cancer. This retrospective chart review involved nine patients with PTTM who were first clinically diagnosed in a tertiary emergency department (ED) between January 2015 and June 2021. They underwent laboratory tests, chest radiography, chest computed tomography (CT), and echocardiography. All patients presented with severe and rapidly progressive dyspnea within a few days, a high oxygen demand. The right ventricle (RV): left ventricle ratio was >1 on chest CT, and no life-threatening pulmonary thromboembolism (PTE) was observed. Echocardiographic findings indicated that all patients had moderate-to-severe RV dilatation with a D-shaped LV. The median tricuspid regurgitation maximum velocity was 3.8 m/s, and the median RV systolic pressure was 63 mmHg, indicating severe PH. The median value of tricuspid annular plane systolic excursion was 15 mm, showing a decrease in RV systolic function, and McConnell’s sign was observed in five patients. Two patients immediately underwent chemotherapy and are currently alive. PTTM should be suspected and evaluated using echocardiography in patients with cancer presenting to the ED with acute dyspnea and RV failure without PTE.
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Normalising lung ultrasound. Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i4.289. [PMID: 36911654 PMCID: PMC9994625 DOI: 10.7196/ajtccm.2022.v28i4.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Smith M, Donnelly GM, Berry L, Innes S, Dixon J. Point of care ultrasound in pelvic health: scope of practice, education and governance for physiotherapists. Int Urogynecol J 2022; 33:2669-2680. [PMID: 35552775 PMCID: PMC9477927 DOI: 10.1007/s00192-022-05200-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 02/05/2023]
Abstract
Pelvic health and pelvic floor dysfunction have wide-reaching implications across a range of patient groups. Placing ultrasound imaging into the hands of assessing and treating clinicians (i.e. point of care ultrasound, PoCUS) can provide a step change in clinical effectiveness and efficiency. Pelvic floor dysfunction is managed by one or more members of a multi-disciplinary team that includes physiotherapists. Physiotherapists' involvement includes diagnosis, patient education, identifying shared treatment goals, using rehabilitative strategies and empowering patients through self-management. Drawing upon existing publications in this area and applying framework principles, the authors propose a clinical and sonographic scope of practice for physiotherapists as part of supporting the consolidation and expansion of pelvic health PoCUS. Education and governance considerations are detailed to ensure the robust and safe use of this modality. Alongside empowering the use of ultrasound imaging by clinicians such as physiotherapists in the UK and internationally, we provide clarity to other members of the care pathway and ultrasound imaging professionals.
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Affiliation(s)
- Mike Smith
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | | | - Lucia Berry
- College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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Veitla V, Bhasin B. Focused Cardiac Assessment in Kidney Care. POCUS JOURNAL 2022; 7:45-50. [PMID: 36896102 PMCID: PMC9994304 DOI: 10.24908/pocus.v7ikidney.14996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Point of care ultrasonography (POCUS) is considered to be a very useful and informative extension of the bedside physical exam. The information obtained from POCUS allows for real time assessment for expedited decision making to improve efficiency in patient care and management. Many programs across the country are now incorporating POCUS into their training schedules to allow their residents, fellows, and faculty to gain competence in the techniques and varied clinical uses of POCUS [1-3]. In nephrology, POCUS has been used at the bedside for access planning, dialysis catheter placement, and to guide kidney biopsies to mention a few applications [4]. There is a wide scope for POCUS in nephrology in addition to kidney and bladder assessment. This includes focused cardiac ultrasound to evaluate the heart for structural and functional abnormalities and lung ultrasound as well. These bedside ultrasound assessments help with point of care management decisions pertaining to volume assessment in acute and chronic kidney disease, adjustment of ultrafiltration goals in dialysis patients, and evaluation of hypotension and dyspnea.
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Affiliation(s)
- Vineet Veitla
- Division of Nephrology, Medical College of Wisconsin Milwaukee, WI
| | - Bhavna Bhasin
- Division of Nephrology, Medical College of Wisconsin Milwaukee, WI
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Affiliation(s)
- José L Díaz-Gómez
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Paul H Mayo
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Seth J Koenig
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
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Cheng J, Arntfield R. Training strategies for point of care ultrasound in the ICU. Curr Opin Anaesthesiol 2021; 34:654-658. [PMID: 34310365 DOI: 10.1097/aco.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Ultrasound in critical care medicine (CCUS) is a relatively young tool that has been evolving rapidly as skillsets, applications and technology continue to progress. Although ultrasound is identified as a core competency in intensive care unit (ICU) training, there remains significant variability and inconsistencies in the delivery of ultrasound training. The goal of this narrative review is to explore areas of consensus and highlight areas where consensus is lacking to bring attention to future directions of ultrasound training in critical care medicine. RECENT FINDINGS There exists considerable variation in competencies identified as basic for CCUS. Recent efforts by the European Society of Intensive Care Medicine serve as the most up to date iteration however implementation is still limited by regional expertise and practice patterns. Major barriers to ultrasound training in the ICU include a lack of available experts for bedside teaching and a lack of familiarity with new technology. SUMMARY Though international uptake of CCUS has made many gains in the past 20 years, further adoption of technology will be required to overcome the traditional barriers of CCUS training. Although the availability and time constraints of experts will remain a limitation even with wireless capabilities, the ability to expand beyond the physical constraints of an ultrasound machine will vastly benefit efforts to standardize training and improve access to knowledge.
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Affiliation(s)
- Jason Cheng
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Early Detection of Post-Endarterectomy Complication by Point-of-Care Ultrasound. REPORTS 2021. [DOI: 10.3390/reports4030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endarterectomy is an effective intervention to remove the atheromatous plaque in the inner lining of the artery, aiming to revascularize the occluded/stenosed vessel in patients with peripheral arterial occlusive disease (PAOD). The most common wound-related complication is postoperative bleeding, followed by infection, hematoma, and seroma. However, hematoma complications with air surrounded have rarely been reported in clinical cases. Case presentation: A 90-year-old female patient visited our emergency department because of a rapidly growing hematoma with pulsatile bleeding over her right groin area. She had received bilateral percutaneous transluminal angioplasty with endarterectomy for PAOD one month prior. A point-of-care ultrasound revealed a large hypoechoic mass, with a dirty shadow on the right groin area. Computed tomography angiography showed a hematoma over her right femoral region, with free air surrounding the right femoral artery. Angiography revealed an irregular shaped lesion on the right femoral artery without contrast extravasation. The patient was diagnosed with right-femoral post-endarterectomy infection with infected hematoma, with the inclusion of air. She underwent urgent excision and repair of the right femoral artery infectious lesion, debridement of the infectious hematoma and stenting of the right external iliac artery, common femoral artery and superficial femoral artery.
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Jung EM, Dinkel J, Verloh N, Brandenstein M, Stroszczynski C, Jung F, Rennert J. Wireless point-of-care ultrasound: First experiences with a new generation handheld device. Clin Hemorheol Microcirc 2021; 79:463-474. [PMID: 34151848 PMCID: PMC8764604 DOI: 10.3233/ch-211197] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 –80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2–5 MHz (convex probe) and 3–12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/LOGIQ E10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0–4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions. Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD ± 0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD ± 0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - J Dinkel
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - N Verloh
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - M Brandenstein
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
| | - J Rennert
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
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