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Doniparthi A, Deutsch AB, Stibbe JD, Khan NM, Palilonis MM. Kissing choroidal sign: A case report. Radiol Case Rep 2024; 19:2934-2936. [PMID: 38737180 PMCID: PMC11087692 DOI: 10.1016/j.radcr.2024.04.017] [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: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
Choroidal detachment (CD) is a rare and potentially vision-threatening complication of glaucoma surgery. Inflammation and prolonged ocular hypotony can promote fluid accumulation between the choroid and sclera. Risk factors include trauma, advanced age, use of anticoagulant medications, systemic hypertension, atherosclerosis, and diabetes. CD ultrasound findings will show 2 layers, detaching as far anteriorly as the ciliary bodies, that protrude convexly into the vitreous without extending to the optic disc, often described as the appositional or kissing choroidal sign. In contrast, retinal detachments will show a distinct "V" shape due to the retina's fixation to the optic nerve head posteriorly. In the case of hemorrhagic CD, therapy should be targeted at reducing intraocular pressure. In this case, the patient was started on atropine and prednisolone drops and discontinued on all glaucoma medications in the left eye. While serous choroidal detachments are usually benign, persistent choroidal effusions may cause significant morbidity with hemorrhagic CD having a worse prognosis. Point of care ultrasound can help emergency physicians quickly distinguish between choroidal and retinal detachments and thus guide management in a safe and timely manner.
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Affiliation(s)
- Ajay Doniparthi
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
| | - Aaron B. Deutsch
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
| | - Joel D. Stibbe
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
| | - Nida M. Khan
- Department of Ophthalmology, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
| | - Matthew M. Palilonis
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, PA, USA
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Kaffas AE, Vo-Phamhi JM, Griffin JF, Hoyt K. Critical Advances for Democratizing Ultrasound Diagnostics in Human and Veterinary Medicine. Annu Rev Biomed Eng 2024; 26:49-65. [PMID: 38166185 PMCID: PMC11238906 DOI: 10.1146/annurev-bioeng-110222-095229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The democratization of ultrasound imaging refers to the process of making ultrasound technology more accessible. Traditionally, ultrasound imaging has been predominately used in specialized medical facilities by trained professionals. Advancements in technology and changes in the health-care landscape have inspired efforts to broaden the availability of ultrasound imaging to various settings such as remote and resource-limited areas. In this review, we highlight several key factors that have contributed to the ongoing democratization of ultrasound imaging, including portable and handheld devices, recent advancements in technology, and training and education. Examples of diagnostic point-of-care ultrasound (POCUS) imaging used in emergency and critical care, gastroenterology, musculoskeletal applications, and other practices are provided for both human and veterinary medicine. Open challenges and the future of POCUS imaging are presented, including the emerging role of artificial intelligence in technology development.
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Affiliation(s)
- Ahmed El Kaffas
- Department of Radiology, School of Medicine, Stanford University, Stanford, California, USA
| | - Jenny M Vo-Phamhi
- Department of Radiology, School of Medicine, Stanford University, Stanford, California, USA
| | - John F Griffin
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - Kenneth Hoyt
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA;
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3
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Won D, Walker J, Horowitz R, Bharadwaj S, Carlton E, Gabriel H. Sound the Alarm: The Sonographer Shortage Is Echoing Across Healthcare. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1289-1301. [PMID: 38534218 DOI: 10.1002/jum.16453] [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: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES The growth in ultrasound usage necessitates concurrent growth in the number of sonographers. Despite the increasing importance of ultrasound, there is a shortage of sonographers in the United States that has never been specifically quantified. This study examines recent trends in the number of ultrasound exams, sonography graduates, open sonographer positions, and wages. METHODS This retrospective study uses public databases and surveys including the Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), Integrated Postsecondary Education Data System (IPEDS), and Zippia, a human resources platform to determine metrics. These metrics include the number of ultrasound exams conducted in the United States (excluding inpatient setting), number of sonographers and sonographer wages, sonography graduates, and open sonographer positions. RESULTS Ultrasound exams in the United States from 2011 to 2021 increased from 38.6 million to 59.8 million (+55.1%,) while the number of sonographers (2011-2021) increased from 54,760 to 78,640 (+43.6%). There was a significant difference between supply and demand of sonographers with the number of sonography graduates (2011-2021) increasing from 4,386 to 5,393 (+23.0%) while the number of open sonographer positions (2012-2021) increased from 18,462 to 25,162 (+36.3%). CONCLUSIONS From 2011 to 2021, the increase in the number of ultrasound exams has significantly outpaced the increase in the number of sonographers. Furthermore, the increase in demand for sonographers has grown significantly faster than the supply, leading to a shortage and consequent strain on the healthcare system. To address the shortage, the number of sonography school openings should be increased, and the attendant challenges addressed.
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Affiliation(s)
- Daniel Won
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James Walker
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Russ Horowitz
- Ann & Robert H Lurie Children's Hospital of Chicago, Division of Emergency Medicine, Department of Pediatrics, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Bharadwaj
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward Carlton
- School of Diagnostic Medical Sonography, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child 2024; 109:543-549. [PMID: 38442949 DOI: 10.1136/archdischild-2024-326904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics. This article describes the development and launch of the UK's inaugural accredited paediatric-specific POCUS curriculum and training pathway: the 'Children's ACuTe UltraSound' course, addressing this significant gap in paediatric healthcare education and describing the training delivered and available for paediatricians and allied health professionals working with children.
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Affiliation(s)
- Michael J Griksaitis
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Bogdana Zoica
- King's College Hospital NHS Foundation Trust, London, UK
| | - Dusan Raffaj
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Jennie Stephens
- Intensive Care & Acute Medicine, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Avishay Sarfatti
- Paediatric Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veena Rajagopal
- Paediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Jessica Green
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Shires
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | | | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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Huang W, Koh T, Tromp J, Chandramouli C, Ewe SH, Ng CT, Lee ASY, Teo LLY, Hummel Y, Huang F, Lam CSP. Point-of-care AI-enhanced novice echocardiography for screening heart failure (PANES-HF). Sci Rep 2024; 14:13503. [PMID: 38866831 PMCID: PMC11169397 DOI: 10.1038/s41598-024-62467-4] [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: 11/16/2023] [Accepted: 05/17/2024] [Indexed: 06/14/2024] Open
Abstract
The increasing prevalence of heart failure (HF) in ageing populations drives demand for echocardiography (echo). There is a worldwide shortage of trained sonographers and long waiting times for expert echo. We hypothesised that artificial intelligence (AI)-enhanced point-of-care echo can enable HF screening by novices. The primary endpoint was the accuracy of AI-enhanced novice pathway in detecting reduced LV ejection fraction (LVEF) < 50%. Symptomatic patients with suspected HF (N = 100, mean age 61 ± 15 years, 56% men) were prospectively recruited. Novices with no prior echo experience underwent 2-weeks' training to acquire echo images with AI guidance using the EchoNous Kosmos handheld echo, with AI-automated reporting by Us2.ai (AI-enhanced novice pathway). All patients also had standard echo by trained sonographers interpreted by cardiologists (reference standard). LVEF < 50% by reference standard was present in 27 patients. AI-enhanced novice pathway yielded interpretable results in 96 patients and took a mean of 12 min 51 s per study. The area under the curve (AUC) of the AI novice pathway was 0.880 (95% CI 0.802, 0.958). The sensitivity, specificity, positive predictive and negative predictive values of the AI-enhanced novice pathway in detecting LVEF < 50% were 84.6%, 91.4%, 78.5% and 94.1% respectively. The median absolute deviation of the AI-novice pathway LVEF from the reference standard LVEF was 6.03%. AI-enhanced novice pathway holds potential to task shift echo beyond tertiary centres and improve the HF diagnostic workflow.
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Affiliation(s)
- Weiting Huang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Tracy Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jasper Tromp
- Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, and National University Health System Singapore, Singapore, Singapore
| | - Chanchal Chandramouli
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - See Hooi Ewe
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Choon Ta Ng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Audry Shan Yin Lee
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Louis Loon Yee Teo
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Carolyn Su Ping Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Us2.ai, Singapore, Singapore
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Nowak R, Vandekerkhove JN, Wasserman DD. A Qualitative Review of the Air Rescue One Rural Search and Rescue Program in British Columbia, Canada. Wilderness Environ Med 2024:10806032241258425. [PMID: 38860317 DOI: 10.1177/10806032241258425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Rural emergency prehospital care in British Columbia is conducted primarily by the British Columbia Ambulance Services or ground search and rescue volunteers. Since 2014, the volunteer Air Rescue One (AR1) program has provided helicopter emergency winch rescue services to rural British Columbia. The aim of this research was to describe the activity of the AR1 program and to make recommendations to improve future operations. METHODS Data were collected retrospectively from September 2014 to May 2021, and parameters of emergency callout statistics from the organization's standard operating guidelines, rescue reports, and interviews were summarized and reviewed. RESULTS Of 152 missions within the study period, 105 were medically related rescues involving trauma or cardiac events. Snowmobiling, mountain biking, and hiking were the most common activities requiring rescue. The 38 medical callouts that were not completed by AR1 were reviewed for contributing factors. Response time varied due to the vast service area, but median time from request to takeoff was 55 min (interquartile range 47-69 min), and median on-scene time was 21 min (interquartile range 11-33 min). CONCLUSIONS AR1 provides advanced medical care into British Columbia's remote and difficult-to-access areas, minimizing delays in treatment and risk to patients and responders. Callout procedures should be streamlined enabling efficient AR1 activation. Collection of medical and flight information should be improved with standardized documentation, aiding in internal education and future research into the program's impact on emergency prehospital care. Future directions for improvement of care include the possibility of introducing portable ultrasound technology.
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Affiliation(s)
- Raphael Nowak
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Deena D Wasserman
- Department of Emergency Medicine, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024; 25:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [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: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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8
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Healy J, Tzeng CFT, Wolfshohl J, Shedd A, Lin J, Patel C, Chou EH. Point-of-Care Ultrasound in the Emergency Department: Training, Perceptions, Applications, and Barriers from Different Healthcare Professionals. J Acute Med 2024; 14:74-89. [PMID: 38859928 PMCID: PMC11163417 DOI: 10.6705/j.jacme.202406_14(2).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 06/12/2024]
Abstract
Background Point-of-care ultrasound (POCUS) is a valuable tool that assists in diagnosis and management of patients in the emergency department (ED) while being cost-efficient and without the use of ionizing radiation. To discern the opinions and perceptions of ED staff about POCUS applications and barriers, we conducted a cross-sectional survey of employees of 12 EDs in North Texas. Methods Participants completed a 20-item online survey about POCUS with questions pertaining to four domains: (1) employee and training information, (2) perceived benefits, (3) common applications, and (4) barriers to use. Out of 805 eligible ED employees, 103 completed the survey (16.1% response rate). Results The results indicated a generally positive perception of POCUS among all employee types. Physician had significant exposure and training of POCUS than non-physician group ( p < 0.001). Physicians tend to find cardiac assessments more useful for clinical management than non-physicians (47% vs. 23%, p = 0.01), while non-physicians find soft tissue/abscess assessments more useful (27% vs. 9%, p = 0.01). Conclusion The most significant barriers to POCUS use were time constraints for physicians and a lack of training for non-physician employees. Our study provides valuable insights into the perceptions of multiple ED professionals, serving as a foundation for promoting POCUS use in the ED.
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Affiliation(s)
- Jack Healy
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
- Texas Christian University Burnett School of Medicine Fort Worth USA
| | | | - Jon Wolfshohl
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Andrew Shedd
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Judy Lin
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Chinmay Patel
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
| | - Eric H Chou
- Baylor Scott & White All Saints Medical Center Department of Emergency Medicine Fort Worth USA
- Baylor University Medical Center Department of Emergency Medicine Dallas USA
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Okoli ML, Rao P, Kavuma S, Bulusu RV, Hanna-Moussa S, Vahdat K. POCUS for Thrombus: Emphasizing the Importance of Initial Point-of-Care Ultrasound in the Management of Pulmonary Thromboembolism. Cureus 2024; 16:e58272. [PMID: 38752077 PMCID: PMC11094530 DOI: 10.7759/cureus.58272] [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: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Pulmonary embolism (PE) constitutes a substantial health burden among individuals in the United States. It ranks as the third most common cause of cardiovascular death aside from stroke and myocardial infarction. Diagnostic errors are common with PE as patients can present with non-specific symptoms or could be completely asymptomatic with PE being an incidental finding. Diagnostic errors can result in missed or late diagnosis of PE, which, in turn, increases health care costs, morbidity, and mortality rates. Hence, early diagnosis is crucial. Computed tomography pulmonary angiography (CTPA) remains the gold standard in PE diagnosis, despite exposure to high doses of radiation. Point-of-care ultrasound (POCUS) is an underutilized, non-invasive technique that aids in the early diagnosis of PE and can safely reduce the radiation from CTPA in cases where contraindication exists. POCUS has been shown to have a high sensitivity and specificity for early diagnosis of PE.
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Affiliation(s)
| | - Poonam Rao
- Internal Medicine, CHRISTUS Health/Texas A&M College of Medicine, Longview, USA
| | - Siima Kavuma
- Internal Medicine, CHRISTUS Health/Texas A&M College of Medicine, Longview, USA
| | - Ravi Vijay Bulusu
- Internal Medicine, CHRISTUS Health/Texas A&M College of Medicine, Longview, USA
| | | | - Khashayar Vahdat
- Cardiology, CHRISTUS Health/Texas A&M College of Medicine, Longview, USA
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10
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Elrobaa IH, Khan K, Mohamed E. The Role of Point-of-Care Testing to Improve Acute Care and Health Care Services. Cureus 2024; 16:e55315. [PMID: 38434607 PMCID: PMC10905651 DOI: 10.7759/cureus.55315] [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: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
Health care is one of the most important services that need to be provided to any community. Many challenges exist in delivering proper and effective health services, including ensuring timely delivery, providing adequate care through effective management and achieving good outcomes. Point-of-care testing (POCT) plays a crucial role in delivering urgent and appropriate health services, especially in peripheral communities, emergency situations, disaster areas and overcrowded areas. We collected and reviewed secondary data about point-of-care testing from PubMed, Scopus and Google Scholar. Our findings emphasize that POCT provides fast care with minimal waiting time, avoids unnecessary investigations, aids in triage, and provides decision-makers with a clear understanding of the patient's condition to make informed decisions. We recommend point-of-care testing as a frontline investigation in emergency departments, intensive care units, peripheral hospitals, primary health care centers, disaster areas and field hospitals. Point-of-care testing can improve the quality of health services and ensure the provision of necessary health care.
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Affiliation(s)
- Islam H Elrobaa
- Emergency Medicine, College of Medicine, Qatar University, Doha, QAT
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
| | - Keebat Khan
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
| | - Eslam Mohamed
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [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: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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Bapuji R, Eagles D, Ferreira N, Hecht N, Zhang Y, Woo MY, Cheung WJ, Ly V, Pageau P. Comparison of peer-assisted learning with expert-led learning in medical school ultrasound education: a systematic review and meta-analysis. CAN J EMERG MED 2024; 26:188-197. [PMID: 38363447 DOI: 10.1007/s43678-024-00663-x] [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: 05/05/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Teaching point-of-care ultrasonography (PoCUS) to medical students is resource intensive. Peer-assisted learning, where the teacher can be a medical student, may be a feasible alternative to expert-led learning. The objective of this systematic review and meta-analysis was to compare the PoCUS performance assessments of medical students receiving peer-assisted vs expert-led learning. METHODS This study was submitted to PROSPERO (CRD42023383915) and reported with PRISMA guidelines. MEDLINE, Embase, ERIC, Education Source, Scopus, and Web of Science were searched from inception to November 2022. Inclusion criteria were studies comparing peer-assisted vs expert-led PoCUS teaching for undergraduate medical students. The primary outcome was performance assessment of PoCUS skills. Two reviewers independently screened citations and extracted data. The Cochrane risk-of-bias tool for randomized trials was used to assess study quality. Studies were included in the meta-analysis if mean performance assessment scores with standard deviations and sample sizes were available. A random-effects meta-analysis was conducted to estimate the accuracy score of practical knowledge test for each group. A meta-regression evaluated difference in mean scores. RESULTS The search yielded 2890 citations; 1417 unique citations remained after removing duplicates. Nine randomized-controlled studies conducted in Germany, USA, and Israel, with 593 participants, were included in the meta-analysis. The included studies assessed teaching of abdominal, cardiac, thoracic, musculoskeletal, and ocular PoCUS skills. Most studies had some risk-of-bias concerns. The estimate accuracy score after weighting is 0.56 (95% CI [0.47, 0.65]) for peer-assisted learning and 0.59 (95% CI [0.49, 0.69]) for expert-led learning. The regression coefficient estimate is 0.0281 (95% CI [- 0.1121, 0.1683]); P value is 0.69. CONCLUSION This meta-analysis found that peer-assisted learning was a reasonable alternative to expert-led learning for teaching PoCUS skills to medical students.
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Affiliation(s)
- Raj Bapuji
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nathan Ferreira
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Hecht
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
| | - Yuxin Zhang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada.
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Jedwab R, Boas S, Potashner D, Ostrovsky D, Wacht O, Taragin BH, Gat T, Dayan RR, Fuchs L. A Comparison of Online Self-Training and Standard Bedside Training in Lung Ultrasonography for Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:304-309. [PMID: 37801582 DOI: 10.1097/acm.0000000000005462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
PURPOSE Point-of-care ultrasonography (POCUS) is increasingly integrated into medical education. Traditionally taught at the bedside using a hands-on approach, POCUS is limited by cost, time, faculty availability, and access to POCUS resources. With the recent transition to digitalization in medical education, the authors compare lung POCUS performance and pathology identification among medical students to examine whether using an online, self-learning lung POCUS module is noninferior to traditional bedside, faculty-led lung POCUS training. METHOD This study assessed the performance of 51 medical students from August to October 2021 on an elearning lung POCUS course with traditional bedside training and no training. POCUS students were scored on use of a simulator to identify pathologies, ability to identify lung ultrasonographic pathological clips, and scanning technique. RESULTS The elearning group had a significantly higher median (interquartile range [IQR]) total test score (15/18 [10.5-16] vs. 12/18 [9-13]; P = .03) and scanning technique score (5/5 [4-5] vs. 4/5 [3-4]; P = .03) compared with the standard curriculum group. The median (IQR) accuracy in the clip segment of the examination was 7.5 of 10 (4-9) in the self-learning group and 6 of 10 (4-7) in the standard curriculum group ( P = .18). The median (IQR) grade on the simulator segment of the examination was 2 of 3 (2-3) in the self-learning group and 2 of 3 (1-2) in the standard curriculum group ( P = .06). CONCLUSIONS This study suggests that self-directed elearning of lung POCUS is at least noninferior to bedside teaching and possibly even a superior method of learning lung POCUS. This teaching method POCUS is feasible for medical students to learn lung ultrasonography and has potential to complement or augment the traditional learning process or eliminate or lessen the requirement for bedside teaching by reaching a larger audience while minimizing costs and human resources.
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Al-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, Anwar S, Kashiwagi DT. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J 2024; 16:12. [PMID: 38383673 PMCID: PMC10881927 DOI: 10.1186/s13089-023-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The use of Point-of-Care Ultrasound (POCUS) has become prevalent across a variety of clinical settings. Many healthcare professionals have started getting hands-on training. To evaluate the effectiveness of such training programs, this study aimed to assess a 4 day POCUS training course on healthcare providers' skills and knowledge acquisition. A secondary objective of this study is to gain valuable insights into the degree of perception, attitude, interest levels and perceived barriers of medical providers performing POCUS. METHODS This is a prospective cohort study performed on healthcare providers in an integrated healthcare facility in Abu Dhabi undergoing the POCUS training course in February 2022. Course participants took a pre-course survey to evaluate their baseline knowledge, skills, confidence, perception, and interest in POCUS. The same survey was repeated immediately post-course. In total, seven healthcare professionals responded to the survey with a response rate of 53.8%. All data and information gathered were used to understand the effectiveness of POCUS training and gain insights into the degree of perception, interest and preparedness of POCUS among healthcare professionals in practice. RESULTS Our results demonstrated that the brief POCUS course was effective in improving POCUS skills, knowledge and confidence amongst in-practice healthcare providers from varying medical specialties. The median skill score increased from 25% pre-course to 50% post-course. There is a notable increase in all skills scores after the POCUS training course with the greatest change in scores seen for adjusting 'gain and depth of image (54.84%), assessing VeXUS score (52.38%) and evaluating lung congestion (50%). The study also provided valuable insights into the perception, attitude, interest and potential barriers of POCUS implementation. Although significant barriers to POCUS are present including the lack of POCUS curriculum, what is challenging is lack of expertise and skills to perform POCUS. Therefore, medical providers must acquire prespecified skills to fully utilize POCUS effectively. CONCLUSION The study confirmed the effectiveness of short POCUS training in improving the skills, knowledge and confidence of medical providers in practice. Healthcare professionals can master POCUS skills and techniques and gain confidence through brief training courses.
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Affiliation(s)
- Dima Tareq Al-Absi
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mohammed Atif Omar
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hatem Soliman-Aboumarie
- Department of Anaesthesia and Intensive Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular, Metabolic Sciences and Medicine, King's College London, London, UK
| | - Noha Abou Khater
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Tahir Mehmood
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Siddiq Anwar
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates.
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
| | - Deanne Tomie Kashiwagi
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
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Dupriez F, Hall A, Diop T, Collard A, de Castro BR, Smets F, Penaloza A, Vanpee D. Point-of-Care Ultrasound training in undergraduate education in the European Union: current situation and perspectives. Ultrasound J 2024; 16:9. [PMID: 38349580 PMCID: PMC10864236 DOI: 10.1186/s13089-024-00361-w] [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: 08/07/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Given the widespread use of Point-of-Care UltraSound (PoCUS) in clinical practice, with ultrasound machines becoming more portable and affordable, recommendations and position statements from ultrasound societies now promote teaching PoCUS in the undergraduate curriculum. Nevertheless, surveys about PoCUS teaching in European medical schools are lacking. This survey aims to overview the current and future undergraduate PoCUS courses in the European Union (EU). RESULTS A questionnaire was sent to medical schools in 26 of the 27 countries of the EU; Luxembourg is the only country without a medical school. The survey was completed by the dean or a member of the medical school with knowledge of the medical curriculum. Of the 58 medical schools from 19 countries that responded to the survey, 18 (31.0%) from 13 (68.4%) EU countries reported the existence of an undergraduate PoCUS curriculum and a further 16 (27.6%) from 12 (41.4%) EU countries intended to offer it in the future. No significant difference was observed between the current and future PoCUS curricula regarding its content and purpose. Less than 40 h of theoretical teaching is provided in all the medical schools and less than 40 h of practical training is provided in 12 (75%) of the 16 medical schools which answered this specific question. Of the 40 (69%) surveyed medical schools that do not currently teach PoCUS, 20 (50%) intend to offer PoCUS courses in the future. CONCLUSION Although the lack of teaching hours in curricula suggests that most PoCUS courses are introductory in nature and that medical students are possibly not trained to become autonomous in clinical practice, evaluating the feasibility and impact of PoCUS teaching on clinical practice should be promoted. The medical schools that intend to develop this curriculum should be encouraged to implement validated tools to objectively assess their programs and students' performances.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Audrey Hall
- Emergency Department, Cliniques Universitaires Saint Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Toumane Diop
- Emergency Department, Cliniques Universitaires Saint Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Alix Collard
- Statistical Support Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Françoise Smets
- Faculty of Medicine and Dental Medicine, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Andrea Penaloza
- Faculty of Medicine and Dental Medicine, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Brussels, Belgium
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16
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Cal EM, Gunnell E, Olinger K, Benefield T, Nelson J, Maggioncalda E, McGinty K. Utility of tele-guidance for point-of-care ultrasound: a single center prospective diagnostic study. J Ultrasound 2024:10.1007/s40477-023-00860-x. [PMID: 38340216 DOI: 10.1007/s40477-023-00860-x] [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: 09/30/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Point-of-care-ultrasound (POCUS) improves diagnostic accuracy and expedites lifesaving procedures. Remote areas disproportionately underuse ultrasound (US) due to a dearth of US trained professionals, imaging tools, and lack of quality assurance. Handheld US probes have been approved for diagnostic imaging but there have been limited studies examining their tele-guidance features. This study investigates whether physician tele-guidance improved ultrasound image acquisition by untrained scanners. METHODS To determine the effectiveness of tele-guidance for ultrasound image acquisition, 30 participants (15 in each study arm: experimental and control) with no ultrasound or medical experience gathered images of the heart, right kidney, and gallbladder of a standardized patient using a handheld ultrasound probe (Butterfly iQ +). All participants watched a standardized ultrasound tutorial video and were randomized into the control or experimental group. A physician assisted the experimental group using ultrasound probe's tele-guidance feature while the control group received no assistance. Time to image acquisition was recorded for both groups, and the images were graded by 3 blinded radiologists using the RACE tool to determine image and diagnostic quality. RESULTS There was evidence that mean imaging time was greater in the control group for the heart, right kidney, and gallbladder (p < 0.0001, all; Cohen's DL: 2.0, 1.7, 3.0, respectively). Similarly, there was evidence that the predicted mean image quality for the heart, right kidney, and gallbladder was higher for the experimental group compared to the control group (3.46 versus 1.86, 4.49 versus 1.58, and 3.93 versus 1.5, respectively; p < 0.0001, all). There was also evidence that the diagnostic quality of images had a statistically higher predicted probability of meaningful interpretation for the experimental group for pericardial fluid, intraperitoneal fluid, and acute cholecystitis (p = 0.003, p < 0.0001, p < 0.0001, respectively). CONCLUSIONS Tele-guidance improves time to image acquisition and clinical applicability of ultrasound images obtained by untrained scanners.
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Affiliation(s)
- Eric M Cal
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA.
| | - Elias Gunnell
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Kristen Olinger
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Thad Benefield
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Jacob Nelson
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Elise Maggioncalda
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
| | - Katrina McGinty
- The University of North Carolina at Chapel Hill School of Medicine, 2229 Legacy Oak Drive Waxhaw, Chapel Hill, NC, 28173, USA
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Rahmah M, Al-Ashwal RH, Salim MIM, Lam YT, Hau YW. Anatomically realistic aortic dissection simulator as a potential training tool for point-of-care ultrasound. J Ultrason 2024; 24:1-9. [PMID: 38343785 PMCID: PMC10850942 DOI: 10.15557/jou.2024.0002] [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: 04/18/2023] [Accepted: 08/23/2023] [Indexed: 04/26/2024] Open
Abstract
Aim Simulators for aortic dissection diagnosis are limited by complex anatomy influencing the accuracy of point-of-care ultrasound for diagnosing aortic dissection. Therefore, this study aimed to create a healthy ascending aorta and class DeBakey, type II aortic dissection simulator as a potential point-of-care ultrasound training model. Material and methods 3D mould simulators were created based on computed tomography images of one healthy and one DeBakey type II aortic dissection patient. In the next step, two polyvinyl alcohol-based and two silicone-based simulators were synthesised. Results The results of the scanning electron microscope assessment showed an aortic dissection simulator's surface with disorganised surface texture and higher root mean square (RMS or Rq) value than the healthy model of polyvinyl alcohol (RqAD = 20.28 > RqAAo = 10.26) and silicone (RqAD = 33.8 > RqAAo = 23.07). The ultrasound assessment of diameter aortic dissection showed higher than the healthy ascending aorta in polyvinyl alcohol (dAD = 28.2 mm > dAAo = 20.2 mm) and Si (dAD = 31.0 mm > dAAo = 22.4 mm), while the wall thickness of aortic dissection showed thinner than the healthy aorta in polyvinyl alcohol, which is comparable with the actual aorta measurement. The intimal flap of aortic dissection was able to replicate and showed a false lumen in the ultrasound images. The flap was measured quantitatively, indicating that the intimal flap was hyperechoic. Conclusions The simulators were able to replicate the surface morphology and echogenicity of the intimal flap, which is a linear hyperechoic area representing the separation of the aorta wall.
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Affiliation(s)
- Mutiah Rahmah
- Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Rania Hussien Al-Ashwal
- Advanced Diagnostic and Progressive Human Care research Group, Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Maheza Irna Mohamad Salim
- Advanced Diagnostic and Progressive Human Care research Group, Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Yan Tung Lam
- Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Yuan Wen Hau
- IJN-UTM Cardiovascular Engineering Centre, Department of Biomedical Engineering and Health Sciences, Faculty of Electrical Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
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Nagi A, Boots R, Ajlouni O, Nair S, Werhan A, Ivey R, Misasi P. The Effectiveness of Different Teaching Modalities for the Detection of Heart Murmurs in Undergraduate Medical Education: A Review. Cureus 2024; 16:e53013. [PMID: 38410315 PMCID: PMC10895079 DOI: 10.7759/cureus.53013] [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: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
One of the many physical exam skills introduced to medical students during their pre-clerkship education is cardiac auscultation, one purpose of which is to teach the detection and identification of heart murmurs. Cardiac auscultation with a stethoscope has been the standard method of teaching. Another method, point-of-care ultrasound (POCUS), has been recently introduced as another modality by which students learn to detect and identify murmurs. The emerging popularity of POCUS in undergraduate medical curricula has led many institutions to include it in their curricula; however, doing so is challenging. Not only is cost a major factor, but reorganizing curricula to allow sufficient time for POCUS training has proven to be difficult. Additionally, the presence of notable gaps in the literature regarding the efficacy of POCUS for teaching the detection and identification of heart murmur has increased scrutiny of its value. Studies that assessed teaching cardiac auscultation to medical students in their pre-clinical years via stethoscope have used different teaching methods. However, evaluation of these studies identified numerous limitations, one being little long-term retention of cardiac auscultation knowledge. Furthermore, several barriers to integration of POCUS in undergraduate medical education were identified. The purpose of this review is to synthesize the literature comparing the effectiveness of these different tools of a cardiac exam for detection of heart murmurs in undergraduate medical education and identify gaps in literature requiring future exploration.
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Affiliation(s)
- Alvin Nagi
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Rachel Boots
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Omar Ajlouni
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Sharad Nair
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Abigail Werhan
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Ryan Ivey
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
| | - Paul Misasi
- Research, Kansas Health Science Center - Kansas College of Osteopathic Medicine, Wichita, USA
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Seabrooke M, Seabrooke A. In situ clinical education of frontline healthcare providers in under-resourced areas: A rapid review. CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:20-29. [PMID: 38372264 DOI: 10.4103/cjrm.cjrm_95_22] [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: 12/22/2022] [Accepted: 02/15/2023] [Indexed: 02/20/2024]
Abstract
ABSTRACT Rural communities are geographically isolated from large urban areas, affecting access to definitive care, specialists and other health services that only service urban areas. Rural decision-makers are often faced with numerous challenges regarding the availability, capacity, sustainability and performance of health systems in rural and remote areas. We evaluated the current body of literature on educational initiatives being used in under-resourced areas to increase the knowledge or skills of healthcare workers. This rapid review followed the methods laid out by the Cochrane Rapid Reviews Methods Group and included published articles from any of three databases that described and evaluated an educational intervention, in which healthcare workers were the learners and which took place in an under-resourced area. Papers were excluded if they were deemed to be too resource intensive, were an opinion or concept paper or took place in an urban area. Results were synthesised descriptively. Ten studies were identified that contained information on educational initiatives in a variety of countries. The healthcare workers targeted in the studies varied from physicians, nurses and midwives to community health workers and students. The quality of studies also varied and included randomised control trials, systematic reviews and both prospective and retrospective studies. Initiatives involving simulation or point-of-care ultrasound were most common and showed the most benefit to a learner's knowledge and skill development. A limited body of literature exists on educational initiatives for healthcare workers in under-resourced areas. While simulation and hands-on learning showed positive results, the opportunity remains for a low-cost, high-yield educational initiative tailored to the unique needs of healthcare workers in under-resourced areas.Les communautés rurales sont géographiquement isolées des grandes zones urbaines, ce qui affecte l'accès à des soins définitifs, à des spécialistes et à d'autres services de santé qui ne desservent que les zones urbaines. Les décideurs ruraux sont souvent confrontés à de nombreux défis concernant la disponibilité, la capacité, la durabilité et la performance des systèmes de santé dans les zones rurales et éloignées. Nous avons évalué l'ensemble de la littérature actuelle sur les initiatives éducatives utilisées dans les zones sous-dotées pour améliorer les connaissances ou les compétences des travailleuses et travailleurs de la santé. Cette examen rapide a suivi les méthodes définies par le Cochrane Rapid Reviews Methods Group et a inclus des articles publiés dans l'une des trois bases de données qui décrivaient et évaluaient une intervention éducative dans laquelle les travailleuses et travailleurs de la santé étaient les apprenants et qui SE déroulait dans une zone manquant de ressources. Des articles jugés trop gourmands en ressources, des opinions, des documents conceptuels ou en lien avec des zones urbaines, ont été exclus. Les résultats ont été synthétisés de manière descriptive. 10 études ont été identifiées, contenant des informations sur des initiatives éducatives dans divers pays. Les travailleurs de la santé ciblés dans les études variaient des médecins, des infirmières et des sages-femmes aux travailleurs de la santé communautaire et aux étudiants. La qualité des études était également variable et comprenait des essais contrôlés randomisés, des revues systématiques et des études prospectives et rétrospectives. Les initiatives impliquant la simulation ou le POCUS étaient les plus courantes et présentaient le plus d'avantages pour le développement des connaissances et des compétences de l'apprenant. Il existe un nombre limité de documents sur les initiatives éducatives destinées aux travailleurs de la santé dans les zones sous-dotées. Bien que la simulation et l'apprentissage pratique aient donné des résultats positifs, il est toujours possible de mettre en place une initiative éducative peu coûteuse et à haut rendement, adaptée aux besoins spécifiques des travailleuses et travailleurs de la santé dans les zones sous-dotées.
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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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Degefu N, Jambo A, Nigusse S, Dechasa M, Gashaw T, Getachew M. The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia. Open Access Emerg Med 2023; 15:405-414. [PMID: 37965444 PMCID: PMC10642536 DOI: 10.2147/oaem.s436352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
Background Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia. Patients and Methods An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant. Results The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF. Conclusion Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.
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Affiliation(s)
- Natanim Degefu
- Department of Pharmaceutics, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Abera Jambo
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Shambel Nigusse
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Melaku Getachew
- Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Fernández-Jiménez R, Cabrera Cesar E, Sánchez García A, Espíldora Hernández F, Vegas-Aguilar IM, Amaya-Campos MDM, Cornejo-Pareja I, Guirado-Peláez P, Simón-Frapolli V, Murri M, Garrido-Sánchez L, Martínez Mesa A, Piñel-Jimenez L, Benítez-Cano Gamonoso M, Dalla-Rovere L, García Olivares M, Velasco-Garrido JL, Tinahones-Madueño F, García-Almeida JM. Rectus Femoris Cross-Sectional Area and Phase Angle asPredictors of 12-Month Mortality in Idiopathic Pulmonary Fibrosis Patients. Nutrients 2023; 15:4473. [PMID: 37892547 PMCID: PMC10609753 DOI: 10.3390/nu15204473] [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: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The value of the phase angle (PhA), measured via bioelectrical impedance analysis (BIA), could be considered a good marker of the cell mass and the cell damage of a patient; however, there are new techniques, such as muscle ultrasonography, that allow the quantity and quality of muscle to be assessed in a minimally invasive way. The aim of this study is to determine the prognostic value of morphofunctional techniques in the prognosis of mortality in patients with idiopathic pulmonary fibrosis (IPF). METHODS This multicenter, cross-sectional study included 86 patients with idiopathic pulmonary fibrosis with a mean age of 71 years, 82.7% of whom were male. The nutritional risk of the patients was assessed by means of questionnaires, such as the Subjective Global Assessment (SGA), and non-invasive functional techniques, including BIA, nutritional ultrasound, and hand grip strength (HGS). Statistical analysis of the sample was performed using JAMOVI version 2.3.22. RESULTS Correlations were made between the RF-CSA techniques with PhA (r = 0.48, p < 0.001), BCM (r = 0.70, p < 0.001), SMI (r = 0.64, p < 0.001), and HGS (r = 0.54, p < 0.001). The cut-off points for 12-month mortality were PhA = 4.5° (AUC = 0.722, sensitivity of 72.7% and specificity of 66.6%), BCM = 28.8 kg (AUC = 0.609, sensitivity of 32.4% and specificity of 100.0%), RF-CSA = 3.00 cm2 (AUC = 0.857, sensitivity of 64.4% and specificity of 100.0%), 6MMW = 420 m (AUC = 0.830, sensitivity of 63.27% and specificity of 100.0%), and TUG = 7.2 s (AUC = 0.771, sensitivity of 100.0% and specificity of 56.67%). In addition, a multivariate analysis was performed with RF-CSA, HR = 8.11 (1.39-47.16, p = 0.020), and PhA of 6.35 (1.29-31.15, p = 0.023), taking into account age, sex, and BMI to determine mortality. Finally, a Kaplan-Meier survival analysis was conducted with low or normal values for classical parameters (GAP and T6MM) and new parameters (PhA, BCM, RF-CSA, and TUG). CONCLUSION RF-CSA and PhA were shown to be good prognostic markers of 12-month mortality and could, therefore, be useful screening tools to complement the nutritional assessment of IPF patients.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
| | - Eva Cabrera Cesar
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Ana Sánchez García
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | | | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Maria del Mar Amaya-Campos
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Victor Simón-Frapolli
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
| | - Mora Murri
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
- Heart Area Clinical Management Unit, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
| | - Lourdes Garrido-Sánchez
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
| | - Alvaro Martínez Mesa
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Lorena Piñel-Jimenez
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Miguel Benítez-Cano Gamonoso
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Lara Dalla-Rovere
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
| | - Maria García Olivares
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain;
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
- Department of Endocrinology and Nutrition, Carlos de Haya Regional University Hospital, 29010 Malaga, Spain
| | - Jose Luis Velasco-Garrido
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (A.M.M.); (L.P.-J.); (M.B.-C.G.); (J.L.V.-G.)
| | - Francisco Tinahones-Madueño
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (R.F.-J.); (I.M.V.-A.); (M.d.M.A.-C.); (P.G.-P.); (V.S.-F.); (J.M.G.-A.)
- IBIMA, Málaga Biomedical Research Institute and BIONAND Platform, 29010 Malaga, Spain; (A.S.G.); (M.M.); (L.G.-S.); (M.G.O.)
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, CIBEROBN, Carlos III Health Institute (ISCIII), University of Málaga, 29016 Malaga, Spain;
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Ali N, Chhotani AA, Iqbal SP, Soomar SM, Raheem A, Waheed S. Point of Care Ultrasonographic Life Support in Emergency (PULSE)-a quasi-experimental study. Int J Emerg Med 2023; 16:49. [PMID: 37559012 PMCID: PMC10410962 DOI: 10.1186/s12245-023-00525-w] [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: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians' retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. METHODS A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar's test. A p value of ≤ 0.05 was considered significant. RESULTS There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001). CONCLUSION All participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice.
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Affiliation(s)
- Noman Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | | | - Sannia Perwaiz Iqbal
- Department of Family Medicine, Bahria University of Health Sciences, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Shahan Waheed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Enders M, Sarani N, Malik A. Isolated left ventricular cardiac tamponade diagnosed on point-of-care ultrasound in the emergency department: A case report and brief literature review. J Am Coll Emerg Physicians Open 2023; 4:e12990. [PMID: 37426555 PMCID: PMC10324463 DOI: 10.1002/emp2.12990] [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: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
In this case report, we describe isolated left ventricular cardiac tamponade, a rare complication of cardiac surgery, diagnosed on point-of-care ultrasound (POCUS) in the emergency department (ED). To our knowledge, this is the first report of such a diagnosis made on ED bedside ultrasound. Our patient was a young adult female with a history of recent mitral valve replacement who presented to the ED with dyspnea and was found to have a large loculated pericardial effusion causing left ventricular diastolic collapse. Rapid diagnosis via POCUS in the ED allowed for expedited definitive treatment by cardiothoracic surgery in the operative room and emphasizes the importance of a standard 5-view cardiac POCUS examination when post-cardiac surgery patients present to the ED.
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Affiliation(s)
- Maria Enders
- Department of Emergency MedicineUniversity of Kansas Health SystemKansas CityKansasUSA
| | - Nima Sarani
- Department of Emergency MedicineUniversity of Kansas Health SystemKansas CityKansasUSA
| | - Adrienne Malik
- Department of Emergency MedicineUniversity of Kansas Health SystemKansas CityKansasUSA
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Atalla M, Yacoub A, Al-Ali H, Lupia B, Ezzeddine L, Barzani S, Moussa M, Coey J, Alambrouk T, Hilal H. Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training. Cureus 2023; 15:e44414. [PMID: 37664275 PMCID: PMC10469331 DOI: 10.7759/cureus.44414] [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: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. OBJECTIVES Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. METHODS The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior US experience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. RESULTS Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. CONCLUSION Previous experience with US significantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.
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Affiliation(s)
- Michael Atalla
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Medical Imaging, University of Toronto, Toronto, CAN
| | - Andrew Yacoub
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Hasan Al-Ali
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Bianca Lupia
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Layal Ezzeddine
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Shaliz Barzani
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Michelle Moussa
- School of Medicine, St. George's University School of Medicine, True Blue, GRD
- Faculty of Science, University of Waterloo, Waterloo, CAN
| | - James Coey
- Anatomy, St. George's University School of Medicine, Newcastle upon Tyne, GBR
| | - Tarek Alambrouk
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GRD
| | - Haider Hilal
- School of Medicine, St. George's University School of Medicine, Newcastle upon Tyne, GBR
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Kalkanis A, Testelmans D, Papadopoulos D, Van den Driessche A, Buyse B. Insights into the Use of Point-of-Care Ultrasound for Diagnosing Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2262. [PMID: 37443656 DOI: 10.3390/diagnostics13132262] [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: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a sleeping disorder caused by complete or partial disturbance of breathing during the night. Existing screening methods include questionnaire-based evaluations which are time-consuming, vary in specificity, and are not globally adopted. Point-of-care ultrasound (PoCUS), on the other hand, is a painless, inexpensive, portable, and useful tool that has already been introduced for the evaluation of upper airways by anesthetists. PoCUS could also serve as a potential screening tool for the diagnosis of OSA by measuring different airway parameters, including retropalatal pharynx transverse diameter, tongue base thickness, distance between lingual arteries, lateral parapharyngeal wall thickness, palatine tonsil volume, and some non-airway parameters like carotid intima-media thickness, mesenteric fat thickness, and diaphragm characteristics. This study reviewed previously reported studies to highlight the importance of PoCUS as a potential screening tool for OSA.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
| | | | - Bertien Buyse
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium
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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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Ienghong K, Cheung LW, Tiamkao S, Bhudhisawasdi V, Apiratwarakul K. The Impact of Prehospital Point of Care Ultrasounds on Emergency Patients Length of Stay in Thailand. J Multidiscip Healthc 2023; 16:219-226. [PMID: 36718379 PMCID: PMC9883996 DOI: 10.2147/jmdh.s396986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Purpose Globally, emergency departments (ED) are faced with an overcrowding problem. This issue is further compounded due to the multitude of contributing factors. Point of Care ultrasound (POCUS), especially when performed in prehospital care, that is before the patient is admitted to the ED has a high potential to reduce time of diagnosis and time of investigation which leads to shorter ED length of stay (LOS). The primary focus was on variances in ED LOS between the prehospital POCUS group and the standard care group. Patients and Methods A cross-sectional study was conducted on prehospital patients who were admitted to the ED at Srinagarind Hospital, Thailand, from January to December 2021. We divided patients into two groups including patients who obtained prehospital POCUS (the prehospital POCUS group) and patients who received standard care treatment in which there was no prehospital POCUS performed (the standard care group). POCUS and ED medical records were documented and submitted for analysis. Results Of 1348 prehospital patients, 840 were enrolled in this study: 169 with prehospital POCUS and 671 with standard care. Median LOS in the prehospital POCUS group was 159 min (IQR 89,289) versus 165 (IQR 102,330) in the standard care group (p = 0.125). Further imaging diagnostic test which affected ED LOS more than four hours was lower in the prehospital POCUS group (adjusted odds ratio [OR], 0.92; 95% confidence intervals [CI], 0.729-1.666) than in the standard care group. The factor associated with increased odds of ED LOS more than four hour in the prehospital POCUS group was admission to hospital (adjusted OR 1.88; 95% CI, 1.230-2.239). Conclusion Patients evaluated with prehospital POCUS had a shorter LOS than the only standard care treatment without statistical significance.
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Affiliation(s)
- Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lap Woon Cheung
- Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong,Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Somsak Tiamkao
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Correspondence: Korakot Apiratwarakul, Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Mueang Khon Kaen District, Khon Kaen, 40002, Thailand, Tel +66 89 416 3663, Fax +66 43 366 870, Email
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Thota RS, Ramkiran S, Ramanjulu R. Time to FOCUS - 'Palliative Medicine Point-of-Care Ultrasound'. Indian J Palliat Care 2023; 29:36-45. [PMID: 36846289 PMCID: PMC9945239 DOI: 10.25259/ijpc_274_2022] [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: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Point-of-care diagnosis has become the need of the hour and along with its guided interventions, ultrasound could be utilised bedside in a palliative care patient. Point-of-care ultrasound (POCUS) in palliative care medicine is fast emerging and has varied applications ranging from performing bedside diagnostic evaluation to the performance of interventional paracentesis, thoracocentesis and chronic pain interventions. Handheld ultrasound devices have transformed the application of POCUS and should revolutionise the future of home-based palliative care. Palliative care physicians should be enabled to carry out bedside ultrasounds at home care and hospice setting for achieving rapid symptom relief. The aim of POCUS in palliative care medicine should be adequate training of palliative care physicians, transforming the applicability of this technology to OPD as well as community driven to achieve home outreach. The goal is towards empowering technology by reaching out to the community rather than the terminally ill patient transported for the hospital admission. Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency and early triaging. The inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis. Limiting POCUS application to certain selected sub-specialities such as emergency medicine, internal medicine and critical care medicine should be overcome. This would need acquiring higher training as well as improvised skill sets to perform bedside interventions. Ultrasonography competency among palliative care providers proposed as palliative medicine point-of-care ultrasound (PM-POCUS) could be achieved by imparting dedicated POCUS training within the core curriculum.
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Affiliation(s)
| | - Seshadri Ramkiran
- Department of Anaesthesia and Critical Care, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Aster Hospitals, Bengaluru, Karnataka, India
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Donald E, Dulohery K, Khamuani M, Miles H, Nott J, Patten D, Roberts A. Putting the Cart Before the Horse? Developing a Blended Anatomy Curriculum Supplemented by Cadaveric Anatomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1421:15-35. [PMID: 37524982 DOI: 10.1007/978-3-031-30379-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Cadaveric anatomy is frequently described as the gold standard for anatomy education. Increasingly and especially following the COVID-19 pandemic, there is acceptance that a blended approach for anatomy curriculum delivery is optimal for learners.Setting up a new UK Medical School in 2019 necessitated building a new cadaveric anatomy facility. To enable anatomy curriculum delivery during the construction period (2019-2021), a technology-enhanced learning (TEL) anatomy curriculum was developed, as well as an anatomy laboratory suitable for TEL. Development of a TEL anatomy curriculum with the later inclusion of cadaveric anatomy is unusual since the typical model is to supplement cadaveric anatomy with TEL approaches.TEL solutions that provide digital visualisation of anatomy may support learners by reducing cognitive load. Examples include using colour and/or translucency features to highlight and signpost pertinent anatomy and constructing virtual anatomical models in real time, rather than dissection. Radiology and portable ultrasound provide clinically contextualised visualisations of anatomy; the latter offers a haptic learning experience too. A TEL anatomy laboratory can provide interactive learning experiences for engagement and outreach activities for young school children, where cadaveric anatomy is not suitable.
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Affiliation(s)
- E Donald
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
| | - K Dulohery
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
| | - M Khamuani
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
| | - H Miles
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
| | - J Nott
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
| | - D Patten
- School of Medicine, University of Sunderland, Sunderland, United Kingdom.
| | - A Roberts
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
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van Hoving DJ, Alenyo AN, Komagum F, Lamprecht H. Current use and perceived barriers of emergency point-of-care ultrasound by African health care practitioners. Afr J Emerg Med 2022; 12:333-338. [PMID: 35967088 PMCID: PMC9363966 DOI: 10.1016/j.afjem.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/06/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Point-of-care ultrasound is a key skill for emergency care practitioners in Africa. Access barriers to point-of-care ultrasound training and equipment are still relevant in Africa. Many users of point-of-care ultrasound in Africa have not been formally credentialed. A potential discordance exists between local burden of disease and point-of-care ultrasound training.
Introduction The African Federation of Emergency Medicine (AFEM) recommends the use of emergency point-of-care ultrasound (ePOCUS) as a core skill for health care practitioners in Africa. The study explored the use of ePOCUS by health care practitioners among AFEM members who work across Africa. Methods An anonymous online survey was distributed to individual members of AFEM and affiliated organisations. The questionnaire was tested by the AFEM Scientific Committee for potential content modifications prior to distribution. Summary statistics are presented. Results Of the 220 participants that were analysed, 148 (67.3%) were using ePOCUS. The mean age was 36 years; 146 (66%) were male; and 198 (90%) obtained their primary medical qualification in Africa. In total, 168 (76%) were doctors, and most participants (n = 204, 93%) have worked in Africa during the last 5 years. Reasons for not using ePOCUS mainly related to lack of training and problems with ultrasound machines or consumables. Most ePOCUS users (116/148, 78%) attended courses with hands-on training, but only 65 (44%) participants were credentialed (by 18 different organizations). The median score for self-perceived level of ePOCUS skills was 75 in credentialed users versus 50 in those that were not credentialed. Ultrasound in trauma was the most frequently used module (n = 141, 99%), followed by focused cardiac assessment (n = 128, 90%) and thoracic (including lung) assessment (n = 128, 90.1%). The FASH-module (Focused Assessment with Sonography for HIV/TB) was the least used (n = 69, 49%). Conclusion Access barriers to ePOCUS training, mentorship, equipment and consumables are still relevant in Africa. The low credentialing rate and the potential discordance between local burden of disease and ePOCUS training requires further investigation.
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Affiliation(s)
| | | | - Faith Komagum
- Department of Emergency Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hein Lamprecht
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
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Carrera KG, Hassen G, Camacho-Leon GP, Rossitto F, Martinez F, Debele TK. The Benefits and Barriers of Using Point-of-Care Ultrasound in Primary Healthcare in the United States. Cureus 2022; 14:e28373. [PMID: 36171847 PMCID: PMC9508689 DOI: 10.7759/cureus.28373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
An effective healthcare system should embrace practices that enhance overall quality and productivity. Training primary care physicians in Point-of-Care Ultrasound (POCUS) has become part of the processes that improve the quality of patient care and serve to guide the diagnostic impression quickly and effectively. With the purpose of highlighting the applications and challenges of POCUS use in US primary health care, we conducted a narrative review based on PubMed-indexed and Cochrane Library English text publications searched in May-July 2022 using a combination of key terms including point of care ultrasound, primary care, and US healthcare. Many studies have shown that POCUS has a positive impact on fostering medical attention and reducing morbidity, mortality, and healthcare costs. Besides assisting in procedures, POCUS has a head-to-toe application in evaluating inflammatory and infectious conditions, acute abdomen, cardiopulmonary function, musculoskeletal and vascular pathologies. However, its uniform implementation is limited across the US healthcare system due to multitudes of barriers such as lack of training, resource scarcity, and low reimbursement. Training primary care physicians in general and emergency care providers, in particular, is key to scaleup POCUS use. Large size studies are paramount to further explore the effectiveness of POCUS and identify key challenges to its implementation.
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