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Shen L, Lobo VE, Cordova D, Larson DB, Kamaya A. An Institutional Approach for Developing a Point-of-Care Ultrasound Program Infrastructure. J Am Coll Radiol 2024; 21:1269-1275. [PMID: 37984768 DOI: 10.1016/j.jacr.2023.10.026] [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: 05/15/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Point-of-care ultrasound (POCUS) is rapidly accelerating in adoption and applications outside the traditional realm of diagnostic radiology departments. Although the use of this imaging technology in a distributed fashion has great potential, there are many associated challenges. To address these challenges, the authors developed an enterprise-wide POCUS program at their institution (Stanford Health Care). Here, the authors share their experience, the governance organization, and their approaches to device and information security, training, and quality assurance. The authors also share the basic principles they use to guide their approach to manage these challenges. Through their work, the authors have learned that a foundational framework of defining POCUS and the different levels of POCUS use and delineating program management elements are critical. The authors hope that their experience will be helpful to others who are also interested in POCUS or in the process of creating POCUS programs at their institutions. With a clearly established framework, patient safety and quality of care are improved for everyone.
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Affiliation(s)
- Luyao Shen
- Codirector of Point-of-Care Ultrasound, Department of Radiology, Stanford University School of Medicine, Stanford, California.
| | - Viveta E Lobo
- Codirector of Point-of-Care Ultrasound, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Dorothy Cordova
- Program Manager of Point-of-Care Ultrasound, Imaging Services, Stanford Health Care, Stanford, California
| | - David B Larson
- Senior Vice Chair for Strategy and Clinical Operations, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Aya Kamaya
- Chief of Body Imaging, Director of Ultrasound, Department of Radiology, Stanford University School of Medicine, Stanford, California
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Aronovitz N, Hazan I, Jedwab R, Ben Shitrit I, Quinn A, Wacht O, Fuchs L. The effect of real-time EF automatic tool on cardiac ultrasound performance among medical students. PLoS One 2024; 19:e0299461. [PMID: 38547257 PMCID: PMC10977790 DOI: 10.1371/journal.pone.0299461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/09/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is a sensitive, safe, and efficient tool used in many clinical settings and is an essential part of medical education in the United States. Numerous studies present improved diagnostic performances and positive clinical outcomes among POCUS users. However, others stress the degree to which the modality is user-dependent, rendering high-quality POCUS training necessary in medical education. In this study, the authors aimed to investigate the potential of an artificial intelligence (AI) based quality indicator tool as a teaching device for cardiac POCUS performance. METHODS The authors integrated the quality indicator tool into the pre-clinical cardiac ultrasound course for 4th-year medical students and analyzed their performances. The analysis included 60 students who were assigned to one of two groups as follows: the intervention group using the AI-based quality indicator tool and the control group. Quality indicator users utilized the tool during both the course and the final test. At the end of the course, the authors tested the standard echocardiographic views, and an experienced clinician blindly graded the recorded clips. Results were analyzed and compared between the groups. RESULTS The results showed an advantage in quality indictor users' median overall scores (P = 0.002) with a relative risk of 2.3 (95% CI: 1.10, 4.93, P = 0.03) for obtaining correct cardiac views. In addition, quality indicator users also had a statistically significant advantage in the overall image quality in various cardiac views. CONCLUSIONS The AI-based quality indicator improved cardiac ultrasound performances among medical students who were trained with it compared to the control group, even in cardiac views in which the indicator was inactive. Performance scores, as well as image quality, were better in the AI-based group. Such tools can potentially enhance ultrasound training, warranting the expansion of the application to more views and prompting further studies on long-term learning effects.
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Affiliation(s)
- Noam Aronovitz
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Hazan
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Jedwab
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itamar Ben Shitrit
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Anna Quinn
- Medical School for International Health in Beer-Sheva, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Ben Gurion University of the Negev in Beer- Sheva, Israel
| | - Lior Fuchs
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
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3
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Tung-Chen Y, Martí-de Gracia M. Physical exam with ultrasound, lights and shadows of an unstoppable multidisciplinary advance. Rev Clin Esp 2024; 224:187-188. [PMID: 38369242 DOI: 10.1016/j.rceng.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Y Tung-Chen
- Coordinador del Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECo-SEMI), Servicio de Medicina Interna, Hospital Universitario La Paz; Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain.
| | - M Martí-de Gracia
- Presidenta saliente de la Sociedad Española de Radiología Médica (SERAM) y Sociedad Española de Radiología de Urgencias (SERAU), Jefa de Sección de Radiología de Urgencias, Hospital Universitario La Paz, Madrid, Spain
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Schlaepfer CH, Packiam VT, Tracy CR, Takacs EB, Steinberg RL. Current Utilization and Perceptions of Formal Education of Point-of-care Ultrasound in Urology. Urology 2024; 184:8-14. [PMID: 38065312 DOI: 10.1016/j.urology.2023.11.025] [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: 07/06/2023] [Revised: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the extent of formal point-of-care ultrasound (POCUS) training, current utilization of POCUS, and contemporary perceptions of POCUS amongst urologists. METHODS A survey including questions regarding demographics, prior ultrasound education, current ultrasound utilization in practice/training, perceived optimal POCUS utilization, and the perception of formal ultrasound training was developed. The survey was disseminated to residency program directors (PDs) via the SAU and members of AUA subsection organizations. Data were collected via Redcap. RESULTS A total of 40 PDs and 159 other respondents completed the survey with approximately half (51%) in an academic practice and two-thirds (68%) with more than 10years in practice. PD response rate was 28%, and general response rate was 2%. Among all respondents, 95% (186/196) and 82% (160/194) agreed/strongly agreed formal POCUS training would be worthwhile during and after residency. Among urology residency PDs, 93% (37/40) agreed/strongly agreed that formal POCUS training is worthwhile in residency. The majority of respondents used some form of ultrasound in practice (77%, 154/199). However, only 37% (72/199) of all respondents had prior formal POCUS training, and 19% (5/26) of PDs reported formal training in their programs. Of respondents without formal training, 63% (80/127) reported interest in pursuing formal training. CONCLUSION POCUS is widely utilized in many practices. Yet, most urologists have not participated in formal POCUS training and most programs do not have curricula. Urologists have favorable opinions of the utility, safety, and efficacy of POCUS and desire training.
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Affiliation(s)
| | - Vignesh T Packiam
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Chad R Tracy
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Elizabeth B Takacs
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Ryan L Steinberg
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA.
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Lee JY, Conlon TW, Fraga MV, Bauer AJ, Soni NJ, Chen AE, Kaplan SL. Identifying commonalities in definition and governance of point-of-care ultrasound within statements from medical organizations in the United States: A scoping review for a shared understanding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1622-1630. [PMID: 37850556 DOI: 10.1002/jcu.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
This scoping review analyzed statements from 22 medical organizations in the United States to identify commonalities in the definition and governance of point-of-care ultrasound (POCUS). A total of 41 statements were included. The review found that the most commonly used elements in defining POCUS were "focused," "bedside," and "patient care." In terms of governance, consistent requirements included specific training programs, documentation in medical records, continuous quality assurance, and standards for credentialing and privileging. These findings suggest the existence of essential commonalities that could facilitate communication and the development of standardized POCUS programs in the future.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria V Fraga
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nilam J Soni
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Aaron E Chen
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Strike K, Chan A, Maly MR, Newman AN, Solomon P. Scoping Review of Curricula and Pedagogical Approaches for Physiotherapist Performed Point of Care Ultrasonography. Physiother Can 2023; 75:322-336. [PMID: 38037585 PMCID: PMC10686305 DOI: 10.3138/ptc-2021-0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 12/02/2023]
Abstract
Purpose This study collates and maps physiotherapy pre- and post-licensure curricula and pedagogical approaches for point of care ultrasonography (POCUS). Method We used a standardized scoping review methodology and reporting framework. A total of 18,217 titles and abstracts, and 1,372 full text citations were screened, with 209 studies classified as physiotherapist performed POCUS. Results Of the 209 studies, 15 evaluated pre- and post-licensure curricula and pedagogical approaches. Seventy-two to 98% of pre-licensure programs reported including theoretical knowledge of POCUS and 44-45% reported practical teaching or competency assessment. In post-licensure studies of POCUS, 0-61% of physiotherapists reported training for POCUS. All studies of post-licensure pedagogical approaches included an assessment of theoretical knowledge of POCUS, but only one study included a practical assessment of competency. There was considerable variability in POCUS methods and duration of pedagogical approaches. Except for one study, all pedagogical approaches reported improvement in theoretical knowledge. Conclusion Progress in physiotherapy-specific, standardized, competency-based curricula and pedagogical approaches in POCUS has been limited, with minimal research available, and considerable variability both pre- and post-licensure. These findings could be used to advocate for the inclusion of POCUS in pre- and post-licensure physiotherapy curriculum, and suggest a need for clear guidelines from regulatory colleges and licensing bodies, and a common terminology for physiotherapist performed POCUS. Future directions for research include a systematic review of the psychometric properties of physiotherapist performed POCUS within and across anatomical areas, an assessment of value of different forms of training, and an evaluation of the impact of physiotherapist performed POCUS on patient outcomes.
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Affiliation(s)
- Karen Strike
- From the:
From the: School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada, L8S1C7
| | - Anthony Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Monica R. Maly
- Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada, N2L 3G1
| | - Anastasia N.L. Newman
- From the:
From the: School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada, L8S1C7
| | - Patricia Solomon
- From the:
From the: School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada, L8S1C7
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7
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Elhassan MG, Grewal S, Nezarat N. Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users. Cureus 2023; 15:e43655. [PMID: 37600433 PMCID: PMC10436027 DOI: 10.7759/cureus.43655] [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: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.
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Affiliation(s)
| | - Sarbjot Grewal
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Negin Nezarat
- Internal Medicine, Saint Agnes Medical Center, Fresno , USA
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Miravent S, Lobo M, Figueiredo T, Jiménez C, Almeida R. Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service. Health Sci Rep 2023; 6:e1251. [PMID: 37168279 PMCID: PMC10164753 DOI: 10.1002/hsr2.1251] [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: 12/04/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
Background and Aims The use of ultrasound screening is primarily facilitated by point-of-care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal. Methods Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH. Results In our sample, 60% of cases were related to biliary pathology, 20% were liver-related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables "Sonographic Murphy sign" (V = 0.859; p = 0.001), "Cholelithiasis/Gallbladder sludge" (V = 0.840; p = 0.001), and "Intrahepatic biliary tract dilatation" (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the "Sonographic Murphy sign" (k = 0.664; p = 0.001) and the presence of "Cholelithiasis/Gallbladder sludge" (k = 0.712; p = 0.000). Conclusion Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.
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Affiliation(s)
- Sérgio Miravent
- Algarve Regional Health Administration, Shared Assistance Resources Unit (URAP) ‐ Basic Emergency Service of Vila Real de Santo António, Higher Health SchoolUniversity of AlgarveFaroPortugal
| | - Manuel Lobo
- Local Health Unit of the Northeast, Polytechnic Institute of Castelo Branco, International Society of Clinical Ultrasound (SIEC)Medical Imaging and Radiotherapy Portuguese Association (APIMR)BragançaPortugal
| | - Teresa Figueiredo
- Algarve Integrated Diagnostic CentreUniversity of AlgarveFaroPortugal
| | - Carmen Jiménez
- University Hospital Center of Algarve and Basic Emergency Service of Vila Real de Santo AntónioFaroPortugal
| | - Rui Almeida
- Medical Imaging and Radiotherapy Department, Center for Health Studies (CES‐ESSUALG) and CHRC (Comprehensive Health Research Center), APIMR SecretaryUniversity of AlgarveFaroPortugal
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Harel-Sterling M, Kwan C, Pirie J, Tessaro M, Cho DD, Coblentz A, Halabi M, Cohen E, Nield LE, Pusic M, Boutis K. Competency Standard Derivation for Point-of-Care Ultrasound Image Interpretation for Emergency Physicians. Ann Emerg Med 2023; 81:413-426. [PMID: 36774204 DOI: 10.1016/j.annemergmed.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/19/2022] [Accepted: 11/03/2022] [Indexed: 02/12/2023]
Abstract
STUDY OBJECTIVE Because number-based standards are increasingly controversial, the objective of this study was to derive a performance-based competency standard for the image interpretation task of point-of-care ultrasound (POCUS). METHODS This was a prospective study. Operating on a clinically-relevant sample of POCUS images, we adapted the Ebel standard-setting method to derive a performance benchmark in 4 diverse pediatric POCUS applications: soft tissue, lung, cardiac and focused assessment with sonography in trauma (FAST). In Phase I (difficulty calibration), cases were categorized into interpretation difficulty terciles (easy, intermediate, hard) using emergency physician-derived data. In Phase II (significance), a 4-person expert panel categorized cases as low, medium, or high clinical significance. In Phase III (standard setting), a 3x3 matrix was created, categorizing cases by difficulty and significance, and a 6-member panel determined acceptable accuracy for each of the 9 cells. An overall competency standard was derived from the weighted sum. RESULTS We obtained data from 379 emergency physicians resulting in 67,093 interpretations and a median of 184 (interquartile range, 154, 190) interpretations per case. There were 78 (19.5%) easy, 272 (68.0%) medium, and 50 (12.5%) hard-to-interpret cases, and 237 (59.3%) low, 65 (16.3%) medium, and 98 (24.5%) cases of high clinical significance across the 4 POCUS applications. The panel determined an overall performance-based competency score of 85.0% for lung, 89.5% for cardiac, 90.5% for soft tissue, and 92.7% for FAST. CONCLUSION This research provides a transparent chain of evidence that derived clinically relevant competency standards for POCUS image interpretation.
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Affiliation(s)
- Maya Harel-Sterling
- Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Charisse Kwan
- Department of Pediatric Emergency Medicine, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan Pirie
- Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Tessaro
- Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dennis D Cho
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ailish Coblentz
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mohamad Halabi
- Department of Pediatric Emergency Medicine, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lynne E Nield
- Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Pusic
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kathy Boutis
- Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Hannula O, Hällberg V, Meuronen A, Suominen O, Rautiainen S, Palomäki A, Hyppölä H, Vanninen R, Mattila K. Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians. BMC Emerg Med 2023; 23:23. [PMID: 36859177 PMCID: PMC9979460 DOI: 10.1186/s12873-023-00795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. METHODS A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student's t-test, Pearson's correlation test, Loess method and ROC curve analysis. RESULTS A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. CONCLUSIONS The Finnish emergency practitioners' self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.
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Affiliation(s)
- Ossi Hannula
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Emergency Department, Päijät-Häme Social and Health Care District, Lahti, Finland.
| | - Ville Hällberg
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Anna Meuronen
- Emergency Department, Helsinki University Hospital, Porvoo, Finland
| | - Olli Suominen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Rautiainen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Pihlajalinna Medical Centre Eastern Finland, Kuopio, Finland
| | - Ari Palomäki
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Harri Hyppölä
- Emergency Department, South Savo Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Kalle Mattila
- Emergency Department, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
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11
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Peach M, Milne J, Diegelmann L, Lamprecht H, Stander M, Lussier D, Pham C, Henneberry R, Fraser J, Chandra K, Howlett M, Mekwan J, Ramrattan B, Middleton J, van Hoving N, Taylor L, Dahn T, Hurley S, MacSween K, Richardson L, Stoica G, Hunter S, Olszynski P, Chandra K, Lewis D, Atkinson P. Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHOC-ED investigators. CAN J EMERG MED 2023; 25:48-56. [PMID: 36577931 DOI: 10.1007/s43678-022-00431-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Point-of-care ultrasonography (POCUS) is an established tool in the management of hypotensive patients in the emergency department (ED). We compared the diagnostic accuracy of a POCUS protocol versus standard assessment without POCUS in patients with undifferentiated hypotension. METHODS This was an international, multicenter randomized controlled trial included three EDs in North America and three in South Africa from September 2012 to December 2016. Hypotensive patients were randomized to early POCUS protocol plus standard care (POCUS group) or standard care without POCUS (control group). Initial and secondary diagnoses were recorded at 0 and 60 min. The main outcome was measures of diagnostic accuracy of a POCUS protocol in differentiating between cardiogenic and non-cardiogenic shock. Secondary outcomes were diagnostic performance for shock sub-types, as well as changes in perceived category of shock and overall diagnosis. RESULTS Follow-up was completed for 270 of 273 patients. For cardiogenic shock, the POCUS-based diagnostic approach (POCUS) performed similarly to the non-POCUS approach (control) for specificity [95.5% (89.9-98.5) vs.93.8% (87.7-97.5)]; positive likelihood ratio (17.92 vs 14.80); negative likelihood ratio (0.21 vs 0.09) and diagnostic odds ratio (85.6 vs 166.57), with a similar overall diagnostic accuracy between the two approaches [93.7% (88-97.2) vs 93.6% (87.8-97.2)]. Diagnostic performance measures were similar across sub-categories of shock. CONCLUSION This is the first randomized controlled trial to compare diagnostic performance of a POCUS protocol to standard care without POCUS in undifferentiated hypotensive ED patients. POCUS performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test; however, performance did not differ meaningfully from standard assessment.
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Affiliation(s)
- M Peach
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - J Milne
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Fraser Health Authority, Vancouver, BC, Canada
| | - L Diegelmann
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, USA
| | - H Lamprecht
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - M Stander
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - D Lussier
- Department of Emergency Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - C Pham
- Department of Emergency Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - R Henneberry
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - J Fraser
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
| | - K Chandra
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - M Howlett
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - J Mekwan
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - B Ramrattan
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - J Middleton
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - N van Hoving
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - L Taylor
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
| | - T Dahn
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - S Hurley
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - K MacSween
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - L Richardson
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - G Stoica
- Research Services, Horizon Health Network, Saint John, NB, Canada
| | - Samuel Hunter
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - P Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
| | - K Chandra
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - D Lewis
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada.
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada.
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada.
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12
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Strike K, Chan AKC, Maly MR, Newman ANL, Solomon P. Physiotherapist performed Point of Care Ultrasonography (POCUS): a scoping review of 209 studies. Physiotherapy 2022; 119:34-43. [PMID: 36940488 DOI: 10.1016/j.physio.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Point of care ultrasonography (POCUS) is a non-ionizing imaging technique that is emerging in physiotherapy practice. OBJECTIVE To systematically map the research literature on physiotherapist performed POCUS. DATA SOURCES Following PRISMA-ScR guidelines, OVID Medline, CINAHL, AMED, and EMBASE were searched. ELIGIBILITY CRITERIA Peer-reviewed publications of physiotherapist performed POCUS were included. DATA EXTRACTION AND DATA SYNTHESIS Data collected included: title, author(s), journal, year of publication, design of included studies, sample size, age category of the sample, anatomical area of POCUS, geographical location of research, study setting, and disease condition/patient population. Data analysis consisted of descriptive statistics for the key characteristics of each research question. RESULTS A total of 18 217 titles and abstracts and 1 372 full-text citations were screened, with 209 studies included. Most included studies were measurement studies that assessed the psychometric properties of POCUS in adult patients, were published in the United States of America and imaged the abdominal lumbo-pelvic region. Eighty-two percent of studies were published in the last 10 years. LIMITATIONS Non-English language, review articles and grey literature were excluded for feasibility. Studies were excluded if it was not clearly reported that a physiotherapist performed the POCUS. CONCLUSION This review identified a wide variety of practice settings and a diverse number of patient conditions in which physiotherapists are performing POCUS. This breadth and depth of this review highlighted the need for improved reporting of study methodology and key areas of future research in physiotherapy performed POCUS. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Karen Strike
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Institute for Applied Health Sciences (IAHS) Building, 1400 Main Street West, Hamilton, Canada L8C1C7.
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, Health Sciences Centre, 1280 Main Street West, Hamilton, Canada L8S4K1
| | - Monica R Maly
- Department of Kinesiology, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, Canada N2L3G1
| | - Anastasia N L Newman
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Institute for Applied Health Sciences (IAHS) Building, 1400 Main Street West, Hamilton, Canada L8C1C7
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Institute for Applied Health Sciences (IAHS) Building, 1400 Main Street West, Hamilton, Canada L8C1C7
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13
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Affiliation(s)
- José L Díaz-Gómez
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Paul H Mayo
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Seth J Koenig
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
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15
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Tanael M. Point-of-Care Ultrasonography: Focused Versus Generalized Approaches to Scanning. J Gen Intern Med 2021; 36:2115-2116. [PMID: 33063200 PMCID: PMC8298730 DOI: 10.1007/s11606-020-06290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Tanael
- Maxwell Air Force Base, Flight Medicine, United States Air Force, , Montgomery, AL, USA.
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16
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Bollard SM, Kelly B, McDermott C, Potter S. The Use of Point of Care Ultrasound in Hand Surgery. J Hand Surg Am 2021; 46:602-607. [PMID: 33832787 DOI: 10.1016/j.jhsa.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 02/02/2023]
Abstract
Point of care ultrasound (POCUS) is the use of ultrasound (US) imaging technology by non-sonographer, non-radiologist treating clinicians. Handheld US systems are increasing in popularity and becoming widely available and easily accessible to hand surgeons in clinical practice. Adapting POCUS into the repertoire of the hand surgeon can aid in the diagnosis of many common hand surgery presentations and shorten operative times. In this review, we outline the potential uses and advantages of incorporating POCUS into hand surgery practice incuding its use in emergencies such as trauma, infections, and foreign body localization, as well as elective presentations such as nerve compression, procedural guidance, and anesthesia. Finally, this review outlines the training and curriculum development required to ensure safe implementation of POCUS into a hand surgery practice.
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Affiliation(s)
- Stephanie Marie Bollard
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Brendan Kelly
- School of Medicine, University College Dublin, Dublin, Ireland; Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Cian McDermott
- Emergency Department and the Pillar Centre for Transformative Healthcare, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Shirley Potter
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
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17
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Brindisino F, Mourad F, Maselli F. Elastofibroma presented as shoulder pain in an amateur swimmer: screening for referral in physiotherapy. A case report. Physiother Theory Pract 2021; 38:2257-2267. [PMID: 33910473 DOI: 10.1080/09593985.2021.1920077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Elastofibroma is a benign and rare fibroblast/myofibroblast tumor usually located near the periosteum of the ribs. Patients with elastofibroma can remain asymptomatic or can experience a clicking sensation during shoulder movements, shoulder stiffness, scapular and shoulder pain and dysfunction. Importantly, the symptoms can mimic a musculoskeletal condition being mistaken for orthopedic shoulder joint disease. A 54 years-old amateur swimmer self-referred to physiotherapy for left subscapular and shoulder pain. Concerns from the patient's history that caused suspicion of a medical condition included an insidious onset of nagging deep pain that increased with upper limb exertion and an audible thoracic clunk at arm end range flexion. Deep palpatory examination revealed a mass below the latissimus dorsi and rhomboids further screened by the physiotherapist with Rehabilitative Ultrasound Imaging. The physiotherapist referred the patient to a thoracic surgeon who removed the mass. After an exercise-based physiotherapy management program, the patient returned to previous activities including swimming after 5 months. The challenge for clinicians is to screen patients in whom shoulder pain may be related to non-musculoskeletal conditions. Prompt referral of patients presenting with the suspicion of elastofibroma to an appropriate physician may lead to a timely diagnosis and could avoid expensive and unnecessary rehabilitation procedures.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy
| | - Firas Mourad
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Roma "Tor Vergata", Roma, Italy.,Department of Physical Therapy, Poliambulatorio Physio Power, Brescia, Italy
| | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova-Campus of Savona, Savona, Italy
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18
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Uy M, Lovatt CA, Hoogenes J, Bernacci C, Matsumoto ED. Point-of-care ultrasound in urology: Design and evaluation of a feasible introductory training program for Canadian residents. Can Urol Assoc J 2021; 15:E210-E214. [PMID: 33007177 PMCID: PMC8021428 DOI: 10.5489/cuaj.6637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is an increasingly used bedside tool. Applications in urology include the assessment of an undifferentiated acute scrotum, renal colic, and the guidance of suprapubic catheter placement. However, the user-dependent nature of this modality necessitates appropriate use and competence. The objective of this study was to develop and evaluate a low-cost, feasible, and guideline-based introductory POCUS program for Canadian urology residents. METHODS Residents from McMaster University's urology program completed a three-hour online course, followed by a three-hour hands-on seminar. Course material was developed by ultrasound educators based on national guidelines. Low-cost testicular phantoms and suprapubic catheter insertion models were constructed. Pre- and post-course surveys focused on participant skill confidence, while multiple-choice questionnaires assessed theoretical knowledge. RESULTS Fourteen residents participated in the course. Theoretical knowledge in POCUS improved significantly (p<0.001, d=2.2) and mean confidence scores improved for all skills, including performing kidney, bladder, and testicular POCUS (all p<0.001; d=3.4, 1.9, 2.9, respectively). Participants indicated that the course increased their confidence and likelihood of using POCUS in clinical practice, and that POCUS training should be integrated into urology training curricula. CONCLUSIONS This novel study included the development of an inexpensive, feasible, guideline-based introductory training program for urological POCUS, developed in collaboration with ultrasound educators. Participants significantly improved in theoretical knowledge and skill confidence. Although this study was limited to one residency program, the basis of this course may serve as a foundation for the development of competency-based training for urological POCUS in Canada.
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Affiliation(s)
- Michael Uy
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Catherine A. Lovatt
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Carol Bernacci
- School of Medical Radiation Sciences, Mohawk College & McMaster University, Hamilton, ON, Canada
| | - Edward D. Matsumoto
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
- St. Joseph’s Healthcare Hamilton, McMaster Institute of Urology, Hamilton, ON, Canada
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The Era of Point-of-Care Ultrasound Has Arrived: Are Cardiologists Ready? Am J Cardiol 2020; 132:173-175. [PMID: 32718548 PMCID: PMC7324332 DOI: 10.1016/j.amjcard.2020.06.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 02/04/2023]
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Patel MD, Horrow MM, Kamaya A, Frates MC, Dahiya N, Golding L, Chong WK, Gerena M, Ghate S, Glanc P, Goldbach AR, Gupta S, Hill PA, Johnson SI, Kocher MR, Rubin E, Sohaey R, Waltz JT, Wolfman DJ, Middleton WD. Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound. J Am Coll Radiol 2020; 18:42-52. [PMID: 33007309 DOI: 10.1016/j.jacr.2020.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
Current descriptions of ultrasound evaluations, including use of the term "point-of-care ultrasound" (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness. Details of this classification scheme are elaborated, including important clarifications regarding what ensures comprehensiveness and completeness. Practical implications of this framework for future research and reimbursement paradigms are highlighted.
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Affiliation(s)
- Maitray D Patel
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Mindy M Horrow
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Aya Kamaya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Stanford Medical Center, Stanford, California
| | - Mary C Frates
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nirvikar Dahiya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Division Chair, Ultrasound, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Lauren Golding
- Triad Radiology Associates, Winston Salem, North Carolina; Chair, American College of Radiology Commission on Ultrasound, Reston, Virginia
| | - Wui K Chong
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Chair, American College of Radiology Economics Committee on Ultrasound, Reston, Virginia
| | - Marielia Gerena
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Quality and Patient Safety, Department of Radiology and Biomedical Sciences, Loyola University Medical Center, Maywood, Illinois
| | - Sujata Ghate
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Duke University Medical Center, Durham, North Carolina; Treasurer, North Carolina Radiological Society, Lewisville, North Carolina
| | - Phyllis Glanc
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alyssa R Goldbach
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sonia Gupta
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Paul A Hill
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen I Johnson
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Section Head, Ultrasound, Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Madison R Kocher
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Eric Rubin
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Crozer-Keystone Health System, Springfield, Pennsylvania; Chair, American College of Radiology Commission on Human Resources, Reston, Virginia
| | - Roya Sohaey
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey T Waltz
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Darcy J Wolfman
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Johns Hopkins School of Medicine, Washington, District of Columbia; Chair, American College of Radiology Ultrasound Accreditation Committee, Reston, Virginia
| | - William D Middleton
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Olszynski P, Kim D, Liu R, Arntfield R. A Multidisciplinary Response to the Canadian Association of Radiologists' Point-of-Care Ultrasound Position Statement. Can Assoc Radiol J 2020; 71:136-137. [PMID: 32063015 DOI: 10.1177/0846537119898004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul Olszynski
- CAEP Emergency Ultrasound Committee, Emergency Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Daniel Kim
- Emergency Medicine, University of British Columbia, Vancouver, British Colombia, Canada
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert Arntfield
- Critical Care Medicine, Western University, London, Ontario, Canada
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22
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Olszynski P, Kim DJ, Ma IWY, Clunie M, Lambos P, Guzowski T, Butz M, Thoma B. The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan. Ultrasound J 2019; 11:28. [PMID: 31624937 PMCID: PMC6797680 DOI: 10.1186/s13089-019-0142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards. METHODS A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan's annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system. RESULTS The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents. CONCLUSION The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.
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Affiliation(s)
- Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michelle Clunie
- Department of Anesthesia and Perioperative Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Peggy Lambos
- Department of Pediatrics, University of Saskatchewan, Prince Albert, Canada
| | - Tom Guzowski
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Matthew Butz
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
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