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Gogtay M, Choudhury RS, Williams JP, Mader MJ, Murray KJ, Haro EK, Drum B, O'Brien E, Khosla R, Boyd JS, Bales B, Wetherbee E, Sauthoff H, Schott CK, Basrai Z, Resop D, Lucas BP, Sanchez-Reilly S, Espinosa S, Soni NJ, Nathanson R. Point-of-care ultrasound in geriatrics: a national survey of VA medical centers. BMC Geriatr 2023; 23:605. [PMID: 37759172 PMCID: PMC10537073 DOI: 10.1186/s12877-023-04313-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). METHODS We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. RESULTS All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. CONCLUSIONS POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.
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Affiliation(s)
- Maya Gogtay
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
| | - Ryan S Choudhury
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Jason P Williams
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA
| | - Kevin J Murray
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Brandy Drum
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Edward O'Brien
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Rahul Khosla
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brain Bales
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, PA, USA
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
- Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Sandra Sanchez-Reilly
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Sara Espinosa
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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Madden KM, Feldman B, Arishenkoff S, Meneilly GS. A rapid point-of-care ultrasound marker for muscle mass and muscle strength in older adults. Age Ageing 2021; 50:505-510. [PMID: 32909032 PMCID: PMC7936023 DOI: 10.1093/ageing/afaa163] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is defined as the gradual age-associated loss of both muscle quantity and strength in older adults, and is associated with increased mortality, falls, fractures and hospitalisations. Current sarcopenia criteria use dual-energy X-ray absorptiometry (DXA) measures of muscle mass, a test that cannot be performed at the bedside, unlike point-of-care ultrasound (PoCUS). We examined the association between ultrasonic measures of muscle thickness (MT, vastus medialis muscle thickness) and measures of muscle quantity and strength in older adults. METHODS A total of 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited sequentially from geriatric medicine clinics. Each subject had lean body mass (LBM, by bioimpedance assay), grip strength, mid-arm biceps circumference (MABC), gait speed and MT measured. All initial models were adjusted for biological sex. RESULTS In our final parsimonious models, MT showed a strong significant correlation with all measures of muscle mass, including LBM (Standardised β = 0.204 ± 0.058, R2 = 0.577, P < 0.001) and MABC (Standardised β = 0.141 ± 0.067, R2 = 0.417, P = 0.038). With respect to measures of muscle quality, there was a strong significant correlation with grip strength (Standardised β = 0.118 ± 0.115, R2 = 0.511, P < 0.001) but not with subject performance (gait speed). CONCLUSIONS MT showed strong correlations with both measures of muscle mass (LBM and MABC) and with muscle strength (grip strength). Although more work needs to be done, PoCUS shows potential as a screening tool for sarcopenia in older adults.
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Affiliation(s)
- Kenneth M Madden
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Feldman
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Aubertin-Leheudre M, Martel D, Narici M, Bonnefoy M. The usefulness of muscle architecture assessed with ultrasound to identify hospitalized older adults with physical decline. Exp Gerontol 2019; 125:110678. [PMID: 31376472 DOI: 10.1016/j.exger.2019.110678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Muscle mass and strength decline are known to be key factors in the development of physical incapacities in later life. These structural and functional declines are even more significant in older people during hospitalizations, increasing risk of falls, fractures, and loss of quality of life. In clinical daily practice, functional and muscular decline are assessed using the validated Short Physical Performance Battery (SPPB). Nevertheless, psychological conditions (pain, demotivation, depression) and temporary physical incapacities (e.g: hip fracture) during hospitalization can be significant barriers to evaluate these patients. Skeletal muscle ultrasound assessment could be an alternative in clinical daily practice since muscle architecture (MA) is related to poor muscle function. However, this potential objective and clinical tool is not yet implemented in geriatric setting during hospitalization. Our study aimed at: 1) comparing MA, muscle mass and strength measurements in hospitalized older adults with different functional levels, 2) evaluating the association between these measurements. METHODS Forty-four hospitalized older adults were divided in 2 groups: 21 Pre-Disabled (PDis (SPPBscore: 6-9): 81 ± 7 years old, SPPBscore:7.6 ± 1.1) and 23 Disabled (Dis (SPPBscore:<6): 83 ± 7 years old, SPPBscore:3.6 ± 1.6). SPPB, body mass (BM) and composition (bio-impedance), handgrip strength (HS, dynamometer) and MA (Pennation angle (PA), muscle thickness (MT); ultrasound) were evaluated. RESULTS Relative muscle strength (HS/BM: 0.28 ± 0.08 vs 0.34 ± 0.09 kg/kg), PA (10.6 ± 1.8 vs 12.3 ± 1.9°), and MT (16.4 ± 0.4 vs 19.2 0.4 mm) but not lean body mass were significantly different between Dis and PDis, respectively. Significant associations between PA and the SPPBscore (r2 = 0.37) or walking speed (r2 = 0.38); between SCF and walking speed (r2 = -0.36); as well as between MT and SPPBscore (r2 = 0.29), walking speed (r2 = 0.30), LBM (r2 = 0.382) or MMI (r2 = 0.361) were observed. CONCLUSION Muscle architecture (proxy of muscle quality) and functional capacities/status of hospitalized older adults are related. Thus, ultrasound seems to be a potential useful and objective screening tool for clinicians to assess/prevent physical decline during hospitalization. Larger and/or longitudinal studies are needed to confirm our findings from a pilot pragmatic study.
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Affiliation(s)
- Mylène Aubertin-Leheudre
- Département des Sciences de l'activité physique, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Groupe de recherche en activité physique adaptée, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada.
| | - Dominic Martel
- Département des Sciences de l'activité physique, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Groupe de recherche en activité physique adaptée, Université du Québec à Montréal (UQÀM), Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Marco Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marc Bonnefoy
- Centre Hospitalier Universitaire de Lyon Sud, Lyon, France; Université Claude Bernard Lyon1, Faculté Lyon Sud, Inserm U 1060, France
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Gulati G, Alweis R, George D. Musculoskeletal ultrasound in internal medicine residency - a feasibility study. J Community Hosp Intern Med Perspect 2015; 5:27481. [PMID: 26091660 PMCID: PMC4475265 DOI: 10.3402/jchimp.v5.27481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/27/2015] [Accepted: 04/10/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Ultrasound has become indispensable in medicine for diagnosis and therapeutics. In Internal Medicine Residency Training Program (IMRTP), there is a deficiency of a structured, competency-based musculoskeletal ultrasound (MSKUS) training despite its growing popularity. Methods We conducted a feasibility study for incorporating MSKUS in IMRTP and competency assessment. We recruited internal medicine residents from all training levels. Rheumatology attending with expertise in MSKUS supervised curriculum-design and patient-based assessment. A structured curriculum was developed for knee MSKUS, including training material and a pre- and post-test. An Observed Structured Clinical Exam (OSCE) was used for competency assessment. Attending evaluations and participant feedbacks were collected. Results Fifteen residents participated and 12 completed the OSCE. The pre–post tests showed a statistically significant increase (p<0.001) for all subcomponents (anatomy, pathology, and biophysics). The residents scored high on the OSCE [8.8±1.1 (range 7–10)]. Attending evaluations for cognitive and technical skills were rated ‘Excellent’ (66%) and ‘Good’ (87%), respectively. The training program was perceived very valuable with regard to time and resources spent by residents and faculty, although some felt a need for more patient assessments. Discussion The competency assessed with our OSCE and highly positive feedback reflects this preliminary study's importance and sets the platform for future studies of formal ultrasound training in internal medicine.
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Affiliation(s)
- Gaurav Gulati
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA;
| | - Richard Alweis
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - David George
- Department of Medicine, Reading Health System, West Reading, PA, USA
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