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Ulziibat M, Munkhuu B, Schmid R, Wyder C, Baumann T, Essig S. Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience. PLoS One 2024; 19:e0300753. [PMID: 38635681 PMCID: PMC11025947 DOI: 10.1371/journal.pone.0300753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. METHODS A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. RESULTS A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. CONCLUSION Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.
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Affiliation(s)
- Munkhtulga Ulziibat
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Thomas Baumann
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stefan Essig
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Panebianco N, Baston C. Training, Competency, and Interdisciplinary Collaboration in Point-of-Care Ultrasound. Semin Ultrasound CT MR 2024; 45:91-97. [PMID: 38056786 DOI: 10.1053/j.sult.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-care ultrasound can provide critical diagnostic information and add to procedural safety. As with any clinical skill, however, it must be applied by an adequately trained provider, with systems to ensure safety. Training can include a mix of hands-on training with traditional didactics, online coursework, and simulation, but each carries its own costs and benefits worth of review. Following training it is essential to think about assessment of competency in point-of-care ultrasound to reflect the combination of cognitive and procedural skills that makes up the practice. Within the frameworks described, expansion can be expected across specialty and professional boundaries.
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Affiliation(s)
- Nova Panebianco
- Perelman School of Medicine at the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA.
| | - Cameron Baston
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia, PA
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Cormack CJ, Childs J, Kent F. Point-of-Care Ultrasound Educational Development in Australasia: A Scoping Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1375-1384. [PMID: 36941181 DOI: 10.1016/j.ultrasmedbio.2023.02.011] [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: 10/24/2022] [Revised: 01/12/2023] [Accepted: 02/16/2023] [Indexed: 05/11/2023]
Abstract
Point-of-care ultrasound (PoCUS) technology is evolving rapidly and is being adopted by many health professionals in their clinical practice. Ultrasound is a complex skill requiring dedicated training. Appropriate integration of ultrasound education into medical, surgical, nursing and allied health professions is a current challenge worldwide. There are patient safety implications for use of ultrasound without adequate training and frameworks. The purpose of the review was to overview the status of PoCUS education in Australasia; investigate what is being taught and learned about ultrasound across the health professions; and identify potential gaps. The review was limited to postgraduate and qualified health professionals with established or emerging clinical use for PoCUS. A scoping review methodology was used to include literature in peer-reviewed articles, policies, guidelines, position statements, curricula and online material relating to ultrasound education. One hundred thirty-six documents were included. The literature revealed heterogeneity in ultrasound teaching and learning across the health professions. Several health professions lacked any defined scopes of practice, policies or curricula. Significant investment in resourcing ultrasound education is required to address the current needs in Australia and New Zealand.
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Affiliation(s)
- Carolynne J Cormack
- Monash University, Faculty of Medicine Nursing and Health Sciences, Victoria, Australia; Monash Health, Department of Medical Imaging, Victoria, Australia.
| | - Jessie Childs
- Faculty of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Fiona Kent
- Monash University, Faculty of Medicine Nursing and Health Sciences, Victoria, Australia
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Casey KO, Pearson T. Evaluating knowledge, confidence, and self-efficacy of NPs and PAs in the emergency department: extended focused assessment using sonography in trauma. J Am Assoc Nurse Pract 2022; 34:876-882. [PMID: 35703933 DOI: 10.1097/jxx.0000000000000738] [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: 01/24/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developing and translating knowledge gained in the classroom into skills that are practiced in the clinical setting is an ongoing, iterative, and dynamic process. Health care clinicians require continually evolving knowledge, ongoing education, and hands-on skills practice particular to the specialty. PURPOSE This prospective observational study was conceived based on the existing evidence demonstrating that Point of Care Ultrasound (POCUS) is not routinely taught in nurse practitioner (NP) or physician assistant (PA) graduate programs. This study examines outcomes of an educational intervention aimed at improving knowledge, self-confidence, and self-efficacy of the Extended Focused Assessment using Sonography in Trauma (E-FAST examination) for both NPs and PAs working in emergency settings. METHODOLOGY Twenty participants attended a short course including both didactic learning and hands-on learning of the E-FAST examination. Participants rated themselves using a self-assessment tool for pre- and postintervention self-evaluation. The Wilcoxon signed-rank test was used to evaluate data. A second tool used to evaluate participants' hands-on use of the E-FAST examination is the Objective Structured Assessment of Ultrasound, in which participants were evaluated by clinical experts. These data were assessed using regression analysis. RESULTS Participants showed improvement on the pre/post course self-assessment tool. Participants also showed proficiency using ultrasound and analyzing images as evaluated by experts. CONCLUSIONS A short multimodal course can improve clinicians' knowledge, confidence, and self-efficacy in the use of POCUS and the E-FAST examination. IMPLICATIONS Hands-on education is a valuable tool for ongoing learning.
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Point of care ultrasound use by Registered Nurses and Nurse Practitioners in clinical practice: An integrative review. Collegian 2021. [DOI: 10.1016/j.colegn.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Baratloo A, Bagheri-Hariri S, Bahreini M, Farshidmehr P, Barazandeh S, Babaniamansour S, Aliniagerdroudbari E. The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal trauma. ARCHIVES OF TRAUMA RESEARCH 2019. [DOI: 10.4103/atr.atr_57_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varndell W, Topacio M, Hagness C, Lemon H, Tracy D. Nurse-performed focused ultrasound in the emergency department: A systematic review. Australas Emerg Care 2018; 21:121-130. [DOI: 10.1016/j.auec.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/22/2018] [Accepted: 09/30/2018] [Indexed: 01/12/2023]
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Tai PH, Lau WS, Chan PY, Ng SY, Lam YC, Mak HT, Mak YT. Nurse Performed Ultrasonography in Confirming the Position of Nasogastric Tube in the Emergency Department: A Prospective Single Group Diagnostic Test Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Emergency nurses often encounter patients with nasogastric tube (NGT) dislodgements who require reinsertion. Empirical evidence supporting the use of ultrasonography in verifying the position of NGT in local accident and emergency departments (AED) is scanty. There is also a lack of validation of nurse performed ultrasonography in Hong Kong. With the support from hospitals and medical personnel, a prospective, single group diagnostic test study was conducted to review the possibility of nurse performed ultrasonography in verifying the position of NGT in AED. Methods This study was conducted in the AED of three local hospitals. Investigators with specific ultrasound training performed ultrasonography scans to the subjects in addition to conventional pH test and “whoosh” test. Results were compared with chest or abdominal X-ray for evaluation of accuracies. Results This study confirmed a high sensitivity and specificity of nurse performed ultrasonography in confirming the position of NGT in the AED. The high positive predictive value and positive likelihood ratio supported the confirmation of NGT position by bedside ultrasound. The high specificities and minimal negative likelihood ratios of ultrasonography tests also suggested the application of bedside ultrasound in ruling out patients with misplaced NGTs. Conclusions Nurse performed ultrasonography allows immediate bedside confirmation of the position of NGT in the overcrowded AED. Considered the limitations of conventional methods, nurse performed ultrasonography can be incorporated into daily practice for providing extra evidence for the confirmation of NGT position.
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Affiliation(s)
| | | | - PY Chan
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, N.T., Hong Kong
| | - SY Ng
- Yan Chai Hospital, Accident and Emergency Department, 7-11 Yan Chai Street, Tsuen Wan, N.T., Hong Kong
| | - YC Lam
- Tseung Kwan O Hospital, Accident and Emergency Department, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, N.T., Hong Kong
| | - HT Mak
- Tseung Kwan O Hospital, Accident and Emergency Department, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, N.T., Hong Kong
| | - YT Mak
- Tseung Kwan O Hospital, Accident and Emergency Department, 2 Po Ning Lane, Hang Hau, Tseung Kwan O, N.T., Hong Kong
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Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med 2017; 9:57-62. [PMID: 28794661 PMCID: PMC5536884 DOI: 10.2147/oaem.s120145] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.
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Affiliation(s)
| | - Sirote Wongwaisayawan
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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O'Dochartaigh D, Douma M, MacKenzie M. Five-year Retrospective Review of Physician and Non-physician Performed Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service. PREHOSP EMERG CARE 2016; 21:24-31. [PMID: 27436374 DOI: 10.1080/10903127.2016.1204036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). METHODS A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. RESULTS PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18-34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34-56) p = < 0.006. Incomplete PHUS scans were common and reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. CONCLUSIONS The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care.
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Rooney KP, Lahham S, Lahham S, Anderson CL, Bledsoe B, Sloane B, Joseph L, Osborn MB, Fox JC. Pre-hospital assessment with ultrasound in emergencies: implementation in the field. World J Emerg Med 2016; 7:117-23. [PMID: 27313806 DOI: 10.5847/wjem.j.1920-8642.2016.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (US) is a proven diagnostic imaging tool in the emergency department (ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients. METHODS We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest. RESULTS Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making (89%, 95%CI 67%-99%). Paramedics accurately recorded 17 cases of cardiac activity (100%, 95%CI 84%-100%) and 2 cases of cardiac standstill (100%, 95%CI 22%-100%). CONCLUSION Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.
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Affiliation(s)
- Kevin P Rooney
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA
| | - Sari Lahham
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Shadi Lahham
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Craig L Anderson
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Bryan Bledsoe
- Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA
| | - Bryan Sloane
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Linda Joseph
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Megan B Osborn
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - John C Fox
- Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
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Wydo SM, Seamon MJ, Melanson SW, Thomas P, Bahner DP, Stawicki SP. Portable ultrasound in disaster triage: a focused review. Eur J Trauma Emerg Surg 2015; 42:151-9. [PMID: 26038019 DOI: 10.1007/s00068-015-0498-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/04/2015] [Indexed: 12/13/2022]
Abstract
Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.
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Affiliation(s)
- S M Wydo
- Cooper University Hospital, Camden, NJ, USA
| | - M J Seamon
- The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S W Melanson
- St Luke's University Health Network, Bethlehem, PA, USA
| | - P Thomas
- St Luke's University Health Network, Bethlehem, PA, USA
| | - D P Bahner
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - S P Stawicki
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, PA, 18015, USA.
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Nelson BD, Ahn R, Markovchick V, Hines RA, Lauretti AR, Lauretti JR, Dahl-Regis M, Burke TF. Emergency care and referral among isolated island populations in the Bahamas. J Emerg Med 2014; 48:356-65. [PMID: 25534899 DOI: 10.1016/j.jemermed.2014.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/29/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Isolated island populations face unique health challenges. In the Bahamas, the islands of Mayaguana, Inagua, Crooked Island, Acklins, and Long Cay-referred to as the MICAL Constituency-are among the most isolated. OBJECTIVES Our objective was to better understand regional emergency care needs and capabilities, and determine how emergency care can be optimized among island populations. METHODS During the summer of 2013, the project team conducted semi-structured key-informant interviews and small-group discussions among all health care teams in the MICAL region, as well as a community-based household survey on the island of Mayaguana. The interviews and small-group discussions consisted of open-response questions related to health care services, equipment, supplies, medications, and human resources. The community-based survey examined the prevalence of chronic noncommunicable diseases (CNCDs) and associated risk factors affecting the inhabitants of the region. RESULTS The average number of annual emergency referrals from each of the MICAL islands was approximately 25-30, and reasons for referrals off-island included chest pain, abdominal pain, trauma, and dysfunctional uterine bleeding. Traditional prehospital care is not established in the MICAL Constituency. Providers reported feelings of isolation from the distant health system in Nassau. Whereas most clinics have a well-stocked pharmacy of oral medications, diagnostic capabilities are limited. The household survey showed a high prevalence of CNCDs and associated risk factors. CONCLUSION Ongoing in-service emergency care training among MICAL providers is needed. Additional equipment could significantly improve emergency care capabilities, specifically, equipment to manage chest pain, fractures, and other trauma. Community-based preventive services and education could improve the overall health of the island populations.
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Affiliation(s)
- Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Roy Ahn
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vince Markovchick
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado
| | - Rosemary A Hines
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandre R Lauretti
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Julien R Lauretti
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Mohammad A, Hefny AF, Abu-Zidan FM. Focused Assessment Sonography for Trauma (FAST) training: a systematic review. World J Surg 2014; 38:1009-18. [PMID: 24357247 DOI: 10.1007/s00268-013-2408-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to systematically review the different methods for training Focused Assessment Sonography for Trauma (FAST), course design, and requirements for hospital credentialing. METHODS We searched MEDLINE/PubMed, EMBASE, and the Cochrane database and performed a manual search of selected papers. All papers and abstracts written in English that studied training and education of FAST were included. Papers were critically evaluated, looking into training methods and models of FAST, their advantages and disadvantages, number and type of training hours, practice exams in the course, and number of cases advised to achieve hospital credentialing. RESULTS A total of 52 studies were critically analyzed. The theoretical part of the courses lasted over a median (range) of 4 (1-16) h (n = 35 studies), while the practical part lasted over a median (range) of 4 (1-32) h (n = 34 studies). The participants performed a median (range) of 10 (3-20) FAST exams during the courses (n = 13 studies). The most commonly used model was the normal human model (65 %), followed by peritoneal dialysis patients (27 %). The least used models were animal (4 %) and cadaveric models (2 %). Each of these models had their advantages and disadvantages. The median number (range) of FAST exams needed for credentialing was 50 (10-200) (n = 19 studies). CONCLUSION Standardization of FAST training is important to improving the clinical impact of FAST. Different models used in FAST training are complementary; each has its own advantages and disadvantages. It is recommended that FAST courses be at least 2 days (16 h) long. The first day should include 4 h of theory and 4 h of training on normal human models. The second day should enforce learning using animal models, case scenarios including video clips, or simulators.
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Affiliation(s)
- Alshafi Mohammad
- Trauma Group, Department of Surgery, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates
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Lung ultrasound by emergency nursing as an aid for rapid triage of dyspneic patients: a pilot study. Int Emerg Nurs 2014; 22:226-31. [DOI: 10.1016/j.ienj.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/26/2014] [Accepted: 03/30/2014] [Indexed: 11/24/2022]
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Mumoli N, Vitale J, Cocciolo M, Cei M, Brondi B, Basile V, Sabatini S, Gambaccini L, Carrara I, Camaiti A, Giuntoli S, Dentali F. Accuracy of nurse-performed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis: a prospective cohort study. J Thromb Haemost 2014; 12:430-5. [PMID: 24495051 DOI: 10.1111/jth.12522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. MATERIAL AND METHODS We prospectively evaluated all consecutive outpatients referred for suspected DVT from January 2011 to December 2012. All patients underwent bilateral proximal lower limb CUS, first by trained nurses and then by physicians expert in vascular ultrasonography, with every group blinded with respect to each other. This test was repeated after 5-7 days in all negative or unclear examinations. Interobserver agreement and accuracy of nurse-performed CUS were calculated, considering the physician's final diagnosis as the reference test. RESULTS Six hundred ninety-seven patients were included in the study. DVT was diagnosed in 122 patients by expert ultrasound physicians with an overall prevalence of 17.5% (95% confidence interval [CI] 15.8%-20.6%). Nurse agreement with the physician in DVT diagnosis was excellent (Cohen's κ 0.82, 95% CI 0.79-0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI 81.7%-87.1%) and a specificity of 97.0% (95% CI 95.8%-98.3%) with a diagnostic accuracy of 94.8% (95% CI 93.2%-96.5%). CONCLUSION Our results suggest that nurse-performed CUS may be a potential useful alternative to physician performed CUS with a good accuracy. However, sensibility of nurse-performed CUS appeared suboptimal and future studies should incorporate in the evaluation of this technique other pretest tools that may increase its accuracy.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy
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Kasotakis G, Duggan M, Li Y, O'Dowd D, Baldwin K, de Moya MA, King DR, Alam HB, Velmahos G. Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model. J Surg Res 2013; 184:931-6. [DOI: 10.1016/j.jss.2013.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings. Emerg Med Int 2013; 2013:986160. [PMID: 23431455 PMCID: PMC3568862 DOI: 10.1155/2013/986160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 12/03/2022] Open
Abstract
Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, “nontraditional” providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.
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Simple, almost anywhere, with almost anyone: remote low-cost telementored resuscitative lung ultrasound. ACTA ACUST UNITED AC 2012; 71:1528-35. [PMID: 22182864 DOI: 10.1097/ta.0b013e318232cca7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apnea (APN) and pneumothorax (PTX) are common immediately life-threatening conditions. Ultrasound is a portable tool that captures anatomy and physiology as digital information allowing it to be readily transferred by electronic means. Both APN and PTX are simply ruled out by visualizing respiratory motion at the visceral-parietal pleural interface known as lung sliding (LS), corroborated by either the M-mode or color-power Doppler depiction of LS. We thus assessed how economically and practically this information could be obtained remotely over a cellular network. METHODS Ultrasound images were obtained on handheld ultrasound machines streamed to a standard free internet service (Skype) using an iPhone. Remote expert sonographers directed remote providers (with variable to no ultrasound experience) to obtain images by viewing the transmitted ultrasound signal and by viewing the remote examiner over a head-mounted webcam. Examinations were conducted between a series of remote sites and a base station. Remote sites included two remote on-mountain sites, a small airplane in flight, and a Calgary household, with base sites located in Pisa, Rome, Philadelphia, and Calgary. RESULTS In all lung fields (20/20) on all occasions, LS could easily and quickly be seen. LS was easily corroborated and documented through capture of color-power Doppler and M-mode images. Other ultrasound applications such as the Focused Assessment with Sonography for Trauma examination, vascular anatomy, and a fetal wellness assessment were also demonstrated. CONCLUSION The emergent exclusion of APN-PTX can be immediately accomplished by a remote expert economically linked to almost any responder over cellular networks. Further work should explore the range of other physiologic functions and anatomy that could be so remotely assessed.
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The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs 2011; 19:120-4. [DOI: 10.1016/j.ienj.2010.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/22/2010] [Accepted: 08/27/2010] [Indexed: 11/17/2022]
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Davis VW, Wallace JM, Ahern MT, Dawson MS, Battaglia DF, Sherwood KL, Sugerman SA, Mallin MP, Madsen TE. Mid-level providers demonstrate proficiency in FAST after directed training. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction
Focused Assessment with Sonography for Trauma (FAST) is commonly used to detect intra-peritoneal blood as part of the evaluation of trauma patients. In our level 1 trauma center, mid-level providers (MLPs) perform serial FAST exams on trauma patients. We describe our training approach and proficiency achieved.
Methods
Subjects were MLPs with no previous training in FAST. The training consisted of hands-on training on live models, two on-line ultrasound (US) modules, and a video image review session. Participants were evaluated with pre-, post-, and 6-month follow-up video tests. Subsequently, they independently performed FAST exams which were reviewed by ED US faculty.
Results
11 MLPs participated, completing an average of 17 scans; 91% were technically adequate. Average scores were: pre-test 50.5% (31.7–68.3%), post-test 76.7% (65.9–87.8%), and 6-month test 77% (58.5–87.8%), for an initial improvement of 26.2% (p < 0.001) and a sustained improvement over the pre-test of 26.5% (p = 0.011) at 6 months.
Conclusion
MLPs demonstrated proficiency in FAST after brief training.
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Stawicki SP, Howard JM, Pryor JP, Bahner DP, Whitmill ML, Dean AJ. Portable ultrasonography in mass casualty incidents: The CAVEAT examination. World J Orthop 2010; 1:10-9. [PMID: 22474622 PMCID: PMC3302028 DOI: 10.5312/wjo.v1.i1.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 02/06/2023] Open
Abstract
Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.
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