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Sinanan R, Moshtaghi A, Koratala A. Point-of-care ultrasound in nephrology: A private practice viewpoint. World J Methodol 2024; 14:95685. [DOI: 10.5662/wjm.v14.i4.95685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/26/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.
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Affiliation(s)
- Rajiv Sinanan
- Arizona Kidney Disease and Hypertension Centers, Phoenix, AZ 85016, United States
| | - Afsheen Moshtaghi
- Department of Medicine, Verde Valley Medical Center, Cottonwood, AZ 86326, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Zumstein N, Merlo C, Essig S, Auer R, Tal K, Hari R. The use of diagnostic ultrasound by primary care physicians in Switzerland - a cross-sectional study. BMC PRIMARY CARE 2024; 25:246. [PMID: 38971759 PMCID: PMC11227144 DOI: 10.1186/s12875-024-02491-5] [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: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland. METHODS This was a cross-sectional study. We invited PCPs from the Swiss practice-based research network "Sentinella" to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months - divided into 4 groups to account for seasonal differences. RESULTS Out of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training. The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour). CONCLUSION Most Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland. Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.
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Affiliation(s)
- Nico Zumstein
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Christoph Merlo
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Dean's Office, Medical Faculty, University of Bern, Bern, Switzerland
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Sharma A, Kumar G, Nagpal R, Naranje K, Sengupta A, Jagannath V, Suryawanshi S, Suryawanshi P. Efficacy of an online lung ultrasound module on skill acquisition by clinician: a new paradigm. Front Pediatr 2024; 12:1406630. [PMID: 38919839 PMCID: PMC11197977 DOI: 10.3389/fped.2024.1406630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Lung ultrasound (LUS) as an assessment tool has seen significant expansion in adult, paediatric, and neonatal populations due to advancements in point-of-care ultrasound over the past two decades. However, with fewer experts and learning platforms available in low- and middle-income countries and the lack of a standardised supervised training programme, LUS is not currently effectively used to the best of its potential in neonatal units. Methodology A cross-sectional survey assessed the efficacy of learning LUS via a mentor-based online teaching module (NEOPOCUS). The questionnaire comprised the clinicians' demographic profile, pre-course skills, and self-assessment of skill acquisition after course completion with ongoing hands-on practice. Results A total of 175 clinicians responded to the survey, with the majority (87.9%) working in level 3 and 4 neonatal intensive care units. Clinicians had variable clinical experience. Of them, 53.2% were consultant paediatricians/neonatologists with over 10 years of experience. After the course, there was a significant increase in clinician confidence levels in diagnosing and assessing all LUS pathology, as evidenced by the increase in median cumulative scores [from baseline 6 (interquartile range, IQR, 6-9) to 20 (IQR 16-24), p < 0.001] with half of them gaining confidence within 3 months of the course. Conclusion An online curriculum-based neonatal lung ultrasound training programme with clinician image demonstration and peer review of images for image optimisation increases self-reported confidence in diagnosing and managing neonatal lung pathology. Web-based online training in neonatal lung ultrasound has merits that can help with the delivery of training globally, and especially in low- and middle-income countries.
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Affiliation(s)
- Alok Sharma
- Department of Neonatal Medicine, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Gunjana Kumar
- Department of Neonatology, National Institute of Medical Sciences and Research, Jaipur, India
| | - Rema Nagpal
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Kirti Naranje
- Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arnab Sengupta
- Department of Pediatrics, University of Toledo College of Medicine, Toledo, OH, United States
| | - Vanitha Jagannath
- Department of Pediatrics, American Mission Hospital, Manama, Bahrain
| | - Sonali Suryawanshi
- Department of Pharmacology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
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Aguirre-Villarreal D, Leal-Villarreal MADJ, García-Juárez I, Argaiz ER, Koratala A. Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis. World J Crit Care Med 2024; 13:91212. [PMID: 38855265 PMCID: PMC11155499 DOI: 10.5492/wjccm.v13.i2.91212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 06/03/2024] Open
Abstract
This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term "hepatocardiorenal syndrome" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.
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Affiliation(s)
- David Aguirre-Villarreal
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | | | - Ignacio García-Juárez
- Unidad de Hepatología y Trasplante, Departamento de Gastroenterología, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City 14080, Mexico
| | - Eduardo R Argaiz
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City 64710, Mexico
| | - Abhilash Koratala
- Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Malik M, Aziz A, Farooqi MS, Mohammed M, Rind IA. The Role of Point-of-Care Ultrasound in the Emergency Department in the Diagnosis and Management of Infective Endocarditis. Cureus 2024; 16:e63107. [PMID: 39070339 PMCID: PMC11280003 DOI: 10.7759/cureus.63107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Infective endocarditis (IE) is a serious cardiovascular condition with the potential to lead to severe valvular regurgitation. We present a case of a 65-year-old male who presented with a fever and was diagnosed with IE through point-of-care ultrasound (POCUS). The patient's condition subsequently led to severe aortic regurgitation. Timely diagnosis facilitated by POCUS played a crucial role in the management of this case. The patient underwent successful timely surgical intervention to prevent further infective embolism and heart failure due to severe acute aortic regurgitation. This case underscores the pivotal role of POCUS in the early diagnosis and multidisciplinary management of cardiology diseases, highlighting its importance in delivering optimal patient care.
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Affiliation(s)
- Munzir Malik
- Acute Medicine, Wrexham Maelor Hospital, Wrexham, GBR
| | - Abdul Aziz
- Acute Medicine, Wrexham Maelor Hospital, Wrexham, GBR
| | | | | | - Irfan A Rind
- Cardiology, Wrexham Maelor Hospital, Wrexham, GBR
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Parker M, Johnson L, Paquette R, Sakaguchi A, Kar R. The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey. ANATOMICAL SCIENCES EDUCATION 2024; 17:855-863. [PMID: 38197498 DOI: 10.1002/ase.2375] [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: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.
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Affiliation(s)
- Morgan Parker
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Laura Johnson
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Roland Paquette
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan Sakaguchi
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Demetrio GTP, Grumann ACB, Pincelli MP, Staub LJ. Lung ultrasound teaching in medical education: a pilot study at a Brazilian medical school. J Bras Pneumol 2024; 50:e20230382. [PMID: 38808827 PMCID: PMC11185135 DOI: 10.36416/1806-3756/e20230382] [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: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To evaluate cognitive learning, ability to perform and interpret lung ultrasound exams, and self-perception of learning among medical students after a short pedagogical intervention at a medical school in Brazil. METHODS An experimental pilot study was conducted with medical students at different stages of their education (basic cycle, clinical cycle, and medical internship). The participants underwent a cognitive test before and after the intervention, a practical test, a test to recognize lung ultrasound pathologies, and a qualitative evaluation test at the end of the intervention. Statistical analysis was performed using a significance level of p < 0.05. RESULTS A total of 42 students were included in the study, with a median age of 23 years and a predominance of males. The mean score of the pre-intervention cognitive test was 2.97 ± 0.87, and that of the post-intervention test was 6.57 ± 1.41, showing significant improvement (p < 0.001). The score of the practical test and that of the recognition of pathologies test also showed significant improvement after the intervention. There was no significant difference in execution time between the groups. Students in the clinical cycle had a better self-perception of learning. CONCLUSIONS Theoretical teaching and practical training of lung ultrasound in a short pedagogical intervention can improve cognitive performance, practical skills, and interpretation of the exam. The level of learning achievement was higher among more advanced students in medical education. Additionally, the students in the clinical cycle had a better perception of their learning.
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Affiliation(s)
- Gabrielle Turnes Pereira Demetrio
- . Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
- . Hospital Regional de São José Dr. Homero de Miranda Gomes, São José (SC) Brasil
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Yoo J, Kang SY, Joon Jo I, Kim T, Lee GT, Park JE, Lee SU, Hwang SY, Cha WC, Shin TG, Cho YS, Jang H, Yoon H. Status and perception of point-of-care ultrasound education in Korean medical schools: A national cross-sectional study. Medicine (Baltimore) 2024; 103:e38026. [PMID: 38701308 PMCID: PMC11062660 DOI: 10.1097/md.0000000000038026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
As point-of-care ultrasound (POCUS) is increasingly being used in clinical settings, ultrasound education is expanding into student curricula. We aimed to determine the status and awareness of POCUS education in Korean medical schools using a nationwide cross-sectional survey. In October 2021, a survey questionnaire consisting of 20 questions was distributed via e-mail to professors in the emergency medicine (EM) departments of Korean medical schools. The questionnaire encompassed 19 multiple-choice questions covering demographics, current education, perceptions, and barriers, and the final question was an open-ended inquiry seeking suggestions for POCUS education. All EM departments of the 40 medical schools responded, of which only 13 (33%) reported providing POCUS education. The implementation of POCUS education primarily occurred in the third and fourth years, with less than 4 hours of dedicated training time. Five schools offered a hands-on education. Among schools offering ultrasound education, POCUS training for trauma cases is the most common. Eight schools had designated professors responsible for POCUS education and only 2 possessed educational ultrasound devices. Of the respondents, 64% expressed the belief that POCUS education for medical students is necessary, whereas 36%, including those with neutral opinions, did not anticipate its importance. The identified barriers to POCUS education included faculty shortages (83%), infrastructure limitations (76%), training time constraints (74%), and a limited awareness of POCUS (29%). POCUS education in Korean medical schools was limited to a minority of EM departments (33%). To successfully implement POCUS education in medical curricula, it is crucial to clarify learning objectives, enhance faculty recognition, and improve the infrastructure. These findings provide valuable insights for advancing ultrasound training in medical schools to ensure the provision of high-quality POCUS education for future healthcare professionals.
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Affiliation(s)
- Jonghoon Yoo
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Soo Yeon Kang
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyewon Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Roskvist R, Eggleton K, Arroll B, Stewart R. Non-acute heart failure management in primary care. BMJ 2024; 385:e077057. [PMID: 38580384 DOI: 10.1136/bmj-2023-077057] [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] [Indexed: 04/07/2024]
Affiliation(s)
- Rachel Roskvist
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Kyle Eggleton
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Ralph Stewart
- Department of Medicine, School of Medicine, University of Auckland, New Zealand
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Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 2024; 19:803-811. [PMID: 38041765 DOI: 10.1007/s11739-023-03480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI - 2.7 to - 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI - 1.8 to - 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI - 1.7 to - 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Claire Couvreur
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Félix Gendebien
- Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium
| | - Laurent Peyskens
- Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Boris Germeau
- Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium
| | | | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
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11
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China D, Feng Z, Hooshangnejad H, Sforza D, Vagdargi P, Bell MAL, Uneri A, Sisniega A, Ding K. FLEX: FLexible Transducer With External Tracking for Ultrasound Imaging With Patient-Specific Geometry Estimation. IEEE Trans Biomed Eng 2024; 71:1298-1307. [PMID: 38048239 PMCID: PMC10998498 DOI: 10.1109/tbme.2023.3333216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Flexible array transducers can adapt to patient-specific geometries during real-time ultrasound (US) image-guided therapy monitoring. This makes the system radiation-free and less user-dependency. Precise estimation of the flexible transducer's geometry is crucial for the delay-and-sum (DAS) beamforming algorithm to reconstruct B-mode US images. The primary innovation of this research is to build a system named FLexible transducer with EXternal tracking (FLEX) to estimate the position of each element of the flexible transducer and reconstruct precise US images. FLEX utilizes customized optical markers and a tracker to monitor the probe's geometry, employing a polygon fitting algorithm to estimate the position and azimuth angle of each transducer element. Subsequently, the traditional DAS algorithm processes the delay estimation from the tracked element position, reconstructing US images from radio-frequency (RF) channel data. The proposed method underwent evaluation on phantoms and cadaveric specimens, demonstrating its clinical feasibility. Deviations in tracked probe geometry compared to ground truth were minimal, measuring 0.50 ± 0.29 mm for the CIRS phantom, 0.54 ± 0.35 mm for the deformable phantom, and 0.36 ± 0.24 mm on the cadaveric specimen. Reconstructing the US image using tracked probe geometry significantly outperformed the untracked geometry, as indicated by a Dice score of 95.1 ± 3.3% versus 62.3 ± 9.2% for the CIRS phantom. The proposed method achieved high accuracy (<0.5 mm error) in tracking the element position for various random curvatures applicable for clinical deployment. The evaluation results show that the radiation-free proposed method can effectively reconstruct US images and assist in monitoring image-guided therapy with minimal user dependency.
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12
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Schädler J, Azeke AT, Ondruschka B, Steurer S, Lütgehetmann M, Fitzek A, Möbius D. Concordance between MITS and conventional autopsies for pathological and virological diagnoses. Int J Legal Med 2024; 138:431-442. [PMID: 37837537 PMCID: PMC10861633 DOI: 10.1007/s00414-023-03088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
In pandemics or to further study highly contagious infectious diseases, new strategies are needed for the collection of post-mortem tissue samples to identify the pathogen as well as its morphological impact. In this study, an ultrasound-guided minimally invasive tissue sampling (MITS) protocol was developed and validated for post-mortem use. The histological and microbiological qualities of post-mortem specimens were evaluated and compared between MITS and conventional autopsy (CA) in a series of COVID-19 deaths. Thirty-six ultrasound-guided MITS were performed. In five cases more, specimens for histological and virological examination were also obtained and compared during the subsequently performed CA. Summary statistics and qualitative interpretations (positive, negative) were calculated for each organ tissue sample from MITS and CA, and target genes were determined for both human cell count (beta-globin) and virus (SARS-CoV-2 specific E gene). There are no significant differences between MITS and CA with respect to the detectability of viral load in individual organs, which is why MITS can be of utmost importance and an useful alternative, especially during outbreaks of infectious diseases.
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Affiliation(s)
- Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Akhator Terence Azeke
- Department of Anatomic Pathology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rappaport C, Schwartz A, McConomy B, Choice S, Ten Eyck P, Smock J. Implementing a 3 year, longitudinal point of care ultrasound curriculum in an internal medicine residency program. J Ultrasound 2024; 27:123-127. [PMID: 37973677 PMCID: PMC10908930 DOI: 10.1007/s40477-023-00838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. METHODS The POCUS instruction was delivered as a combination of pre-workshop self-study learning materials (monthly textbook chapters, online modules etc.), with short didactic sessions, and hands-on-scanning of healthy, male volunteers at 10-week intervals. RESULTS A total of 62 residents (23 Post-Graduate Year 1 (PGY), 24 PGY2, 15 PGY3) participated in the year-long curriculum. When pretest and post test data were analyzed at the end of the curriculum, we calculated the odds ratio for acquiring the correct image (score of 1) vs partial/incorrect acquisition (scores of 2 and 3). Significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86-20.74, p < 0.001), Inferior vena cava (IVC) (OR 5.05, 95% CI 1.91-13.35, p = 0.001) and bladder (OR 5.06, 95% CI 1.76-14.55, p = 0.003). Non-significant differences were found in acquisition of apical 4 chamber, pl (A-Line) and internal jugular vein (IJV). CONCLUSION We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper-level residents to include quantitative left ventricular and right ventricular function analysis, and including more case based pathologic image review.
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Affiliation(s)
- Charles Rappaport
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Andrei Schwartz
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Bryan McConomy
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Samuel Choice
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA.
| | - Patrick Ten Eyck
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA
| | - Justin Smock
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Morales-Ortega A, Duarte-Millán MÁ, Canora-Lebrato J, Zapatero-Gaviria A. [Point-of-care ultrasound: Indications and utility in internal medicine]. Med Clin (Barc) 2024; 162:190-196. [PMID: 38016854 DOI: 10.1016/j.medcli.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Alejandro Morales-Ortega
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, España.
| | | | - Jesús Canora-Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España
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15
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Passero VC, Conley N, Finley EP, Schott CK. The Feasibility of Using Point of Care Ultrasound as a Visual Substitute for Physical Examination During Telehealth Visits: A Pilot Project. J Patient Exp 2024; 11:23743735231224516. [PMID: 38223207 PMCID: PMC10785720 DOI: 10.1177/23743735231224516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Telehealth provides greater opportunity for specialty access but lacks components of the physical exam. Point-of-care ultrasound (POCUS) may assist telehealth as a visual substitute for the provision of palpation. We conducted a prospective observational pilot project to survey oncologists about (1) their expectations of POCUS, (2) their use of POCUS in oncology telehealth visits, and (3) post-project assessment of their experiences. The results of the pre-assessment survey showed an interest among the oncologists in the ability to evaluate structures remotely via POCUS. POCUS was utilized in 6.4% of visits, most commonly for lymph node assessment (60% of use). POCUS was not utilized most often due to not being applicable to the patient's visit. There were 14 instances of technical issues limiting views of the relevant anatomy reported. Oncologists rated the use of POCUS as very satisfied or satisfied in the vast number of recorded responses. This pilot study suggests POCUS can be integrated into oncology telehealth visits for specific applications such as lymph node assessment. The surveys indicated a potential interest and positive responses that provide for the foundation of expansion to subspecialty care access for patients with telehealth supported by POCUS.
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Affiliation(s)
- Vida C. Passero
- Department of Hematology-Oncology, Veterans Affairs of Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Division of Hematology-Oncology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Nicole Conley
- Division of Hematology-Oncology, Connected Care Department, James E. Van Zandt VA Medical Center Altoona, Altoona, PA, USA
| | - Erin P. Finley
- Medicine Service, VA South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Christopher Kevin Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Overgaard J, Thilagar BP, Bhuiyan MN. A Clinician's Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice. J Prim Care Community Health 2024; 15:21501319241255576. [PMID: 38773821 PMCID: PMC11113028 DOI: 10.1177/21501319241255576] [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: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a valuable clinical tool used at the patient bedside to rapidly assess a wide variety of symptoms and problems which would otherwise take hours or even days. Though it has become the standard of care in Emergency Medicine and is becoming so in hospital internal medicine, less uptake has been appreciated in the outpatient setting despite reported interest from clinicians practicing there. A number of common barriers have been cited to explain this gap in use, which usually include access to equipment, mentorship, and time. In this review we present a proposed framework for clinicians who have an interest in implementing POCUS in their outpatient practice which we hope can mitigate some of these barriers and provide a more streamlined pathway to their desired goals.
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17
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Phillips SF, Weaver L, Jones E, Loeffert J. Impact of Didactic Instruction on the Utilization of Point-of-Care Ultrasound in Family Medicine Residents. Cureus 2023; 15:e49579. [PMID: 38156134 PMCID: PMC10754295 DOI: 10.7759/cureus.49579] [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: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Background and Objectives In 2014, the Council of Academic Family Medicine released recommendations for the education of family medicine residents in point-of-care ultrasound (POCUS) curricula for Family Medicine Residency programs. One barrier to resident education in POCUS is the lack of access to equipment. This pilot study evaluates whether introducing didactic education on POCUS within a Family Medicine Residency program, with limited access to equipment, correlated with increased utilization of ultrasound by residents. Methods Sixteen family medicine residents participated in the intervention, consisting of a four-hour didactic ultrasound session. Resident confidence in POCUS was evaluated utilizing a Likert scale. Resident utilization of POCUS in a clinical setting was also evaluated by review and analysis of resident procedure logs in the New Innovations database. Results The resident confidence in all skills increased immediately after the completion of the didactic teaching session. Residents demonstrated improved confidence in needle guidance immediately and six weeks after the session (p < 0.001). A review of resident activity two years after the intervention revealed a 9.6% increase in the proportion of resident ultrasounds performed compared to the academic year before the intervention. Conclusions Access to equipment is an ongoing barrier to Family Medicine Residency programs in providing education on POCUS. The results of this study indicate that introducing the basics of POCUS via a didactic teaching session not only increased resident confidence in basic ultrasound but also correlated with increased utilization of POCUS. This increased utilization occurred despite residents not having access to ultrasound in their home clinics.
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Affiliation(s)
- Shawn F Phillips
- Department of Family and Community Medicine and Orthopedics and Rehabilitation, Penn State College of Medicine, Hershey, USA
| | - Lynn Weaver
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, USA
| | - Erin Jones
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, USA
| | - Jayson Loeffert
- Department of Family and Community and Orthopedics and Rehabilitation, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
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18
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Potter E, Cid Serra X, Johnson D. Point-of-care ultrasound: ready for prime time in internal medicine? Intern Med J 2023; 53:1942-1945. [PMID: 37997277 DOI: 10.1111/imj.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/09/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Elizabeth Potter
- Departments of General Medicine and Hospital in the Home, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ximena Cid Serra
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Johnson
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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19
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Andersen CA, Brodersen JB, Graumann O, Davidsen AS, Jensen MB. Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics. BMJ Open 2023; 13:e077702. [PMID: 37848298 PMCID: PMC10582891 DOI: 10.1136/bmjopen-2023-077702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs' concerns related to POCUS use in general practice. DESIGN An online survey was distributed in June 2019. SETTING General practice. PARTICIPANTS GPs working in office-based primary care clinics in Denmark. MAIN OUTCOME MEASURES The questionnaire was developed using mixed methods and included questions about participants' characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs' background characteristics and POCUS use was tested using logistics regression. RESULTS Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future. CONCLUSION Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs' capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.
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Affiliation(s)
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Region Zealand, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette Sofie Davidsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Chen N, Chen HJ, Chen T, Zhang W, Fu XY, Xing ZX. Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report. World J Clin Cases 2023; 11:7207-7213. [PMID: 37946778 PMCID: PMC10631420 DOI: 10.12998/wjcc.v11.i29.7207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) often cause life-threatening complications, especially CVC-related bloodstream infection (CVC-BSI) and catheter-related thrombosis (CRT). Here, we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis, a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation. CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h. Computed tomography (CT) revealed right basal ganglia hemorrhage, so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia. Two days later, the patient was transferred to the intensive care unit of our hospital for further critical care. On day 9 after CVC insertion, the patient suddenly developed fever and hypotension. Point-of-care ultrasound (POCUS) demonstrated thrombosis and dilatation of the right internal jugular vein (IJV) filled with thrombosis. Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles, which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts. Further CT scan confirmed air bubbles surrounding the CVC in the right neck. The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock. The responsible CVC was removed immediately. The patient received fluid resuscitation, intravenous noradrenaline, and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock. Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii. The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d. CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein. A misplaced CVC may facilitate the development of emphysematous thrombophlebitis. POCUS can easily identify the artifacts produced by gas and thrombosis, facilitating rapid diagnosis at the bedside.
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Affiliation(s)
- Ni Chen
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hua-Jun Chen
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Tao Chen
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Wen Zhang
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Xiao-Yun Fu
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Zhou-Xiong Xing
- Department of Critical Care Medicine, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
- Department of Critical Care Medicine, Kweichow Moutai Hospital, Renhuai 564500, Guizhou Province, China
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21
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Badejoko SO, Nso N, Buhari C, Amr O, Erwin JP. Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States. Cureus 2023; 15:e42997. [PMID: 37671219 PMCID: PMC10476883 DOI: 10.7759/cureus.42997] [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: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.
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Affiliation(s)
- Solomon O Badejoko
- Internal Medicine, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Nso Nso
- Internal Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
| | - Cyrus Buhari
- Cardiology, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Omar Amr
- Emergency Medicine (Ultrasound), St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - John P Erwin
- Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
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22
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Patrick DP, Bradley XG, Wolek C, Anderson B, Grady J, Herbst MK. Minutes matter: Time it takes to perform point-of-care ultrasound. AEM EDUCATION AND TRAINING 2023; 7:e10901. [PMID: 37600853 PMCID: PMC10436032 DOI: 10.1002/aet2.10901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
Background While point-of-care ultrasound (PoCUS) is a safe, versatile tool that can improve patient care, the perceived time investment needed to incorporate PoCUS into clinical care is cited as a barrier to performance. We sought to determine the time it takes to perform a PoCUS examination and whether this time was influenced by training level and prior ultrasound experience. Methods This was a retrospective study looking at time stamps of all emergency medicine (EM) provider-performed PoCUS examinations during clinical shifts from August 10, 2019, to June 7, 2022, at a suburban academic emergency department that is the site for a 3-year EM residency. Our workflow is order-based; when PoCUS is ordered, that patient's information populates the ultrasound machine worklist. Selecting the patient's name from the worklist generates a time-stamped patient information page (PIP). We defined the PIP time stamp as the start of the PoCUS examination. The duration of one PoCUS examination was defined as the time of the last image acquired minus the time of the PIP. General estimating equations were used to estimate differences between training level and between prior scan status using an exchangeable correlation and Tukey adjusted pairwise comparisons. A two-tailed chi-square analysis was used for comparing accuracy according to training level. Results Of 4187 PoCUS examinations abstracted, 2144 met study criteria. The median (IQR) time spent per examination was 6.0 (3-9) min. First-year residents took the longest to perform PoCUS among all providers (p < 0.0001). Residents with fewer than 250 prior scans took longer than residents with 501-800 (p = 0.0002) and >800 (p = 0.0013). Resident accuracy was not significantly different according to training level. Conclusions Overall median time to perform PoCUS was 6.0 min. EM residents became more efficient in performing PoCUS as they advanced from first- to third-year, without compromising accuracy.
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Affiliation(s)
| | - Xenia Gia Bradley
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Caroline Wolek
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Bowen Anderson
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - James Grady
- Department of Public Health SciencesUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Meghan Kelly Herbst
- Department of Emergency MedicineUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
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Finn EM, Zwemer EK, Stephens JR, Dancel R. The State of Internal Medicine Point-of-Care Ultrasound (POCUS) Fellowships in the United States and Canada. Am J Med 2023; 136:830-836. [PMID: 37116671 DOI: 10.1016/j.amjmed.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Erin M Finn
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill.
| | - Eric K Zwemer
- Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - John R Stephens
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - Ria Dancel
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
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24
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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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25
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Omar M, Jabir AR, Khan I, Novelli EM, Xu JZ. Diagnostic Test Accuracy of Lung Ultrasound for Acute Chest Syndrome in Sickle Cell Disease: A Systematic Review and Meta-analysis. Chest 2023; 163:1506-1518. [PMID: 36509124 PMCID: PMC10258441 DOI: 10.1016/j.chest.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a leading cause of death in patients with sickle cell disease. Lung ultrasound (LUS) is emerging as a point-of-care method to diagnose ACS, allowing for more rapid diagnosis in the ED setting and sparing patients from ionizing radiation exposure. RESEARCH QUESTION What is the diagnostic accuracy of LUS for ACS diagnosis, using the current reference standard of chest radiography? STUDY DESIGN AND METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review and meta-analysis. Embase, MEDLINE, Web of Science, and Google Scholar were used to compile all relevant studies. Two reviewers screened the studies for inclusion in this review. Cases of discrepancy were resolved by a third reviewer. Meta-analyses were conducted using both metadta and midas STATA software packages to retrieve summary receiver operating characteristic curves, sensitivities, and specificities. Three reviewers scored the studies with QUADAS-2 for risk of bias assessment. RESULTS From a total of 713 unique studies retrieved, six studies were included in the final quantitative synthesis. Of these, five studies were in pediatric EDs. Two studies were conference abstracts and not published manuscripts. Data were available for 625 possible ACS cases (97% of cases in patients aged ≤ 21 years) and 95 confirmed ACS diagnoses (pretest probability of 15.2%). The summary sensitivity was 0.92 (95% CI, 0.68-0.98) and the summary specificity was 0.89 (95% CI, 0.69-0.97) with an area under the curve of the summary receiver operating characteristic curve of 0.96 (95% CI, 0.94-0.97). INTERPRETATION LUS has excellent sensitivity and very good specificity for ACS diagnosis and may serve as an initial point-of-care test to facilitate rapid treatment of ACS and spare pediatric patients from ionizing radiation; however, further research is warranted to improve the generalizability to the adult sickle cell disease population.
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Affiliation(s)
- Mahmoud Omar
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Imadh Khan
- Southern Illinois University School of Medicine, Springfield, IL
| | - Enrico M Novelli
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julia Z Xu
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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García-Gil D, Beltrán-Romero LM, Flox-Benítez G, Castillo-Padrós M, Díaz-Gómez AL, Mujal-Martínez A, Torres-Macho J. Main applications of point-of care ultrasound in palliative care. Rev Clin Esp 2023:S2254-8874(23)00059-0. [PMID: 37146748 DOI: 10.1016/j.rceng.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 05/07/2023]
Abstract
Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies.
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Affiliation(s)
- Daniel García-Gil
- Unidad de Ecografía Clínica Asistencial, Servicio de Medicina Interna, Hospital San Carlos, San Fernando, Grupo de Trabajo Ecografía Clínica de la Sociedad Española de Medicina Interna (SEMI), Madrid, Spain.
| | - Luis M Beltrán-Romero
- Servicio de Medicina Interna. Hospital Universitario Virgen del Rocío, Sevilla, Grupo de Trabajo Ecografía Clínica de la Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
| | - Gema Flox-Benítez
- Unidad de Cuidados Paliativos, Servicio de Medicina Interna, Hospital Universitario Severo Ochoa, Leganés, Grupo de Trabajo Cuidados Paliativos de la Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
| | - Manuel Castillo-Padrós
- Unidad de Cuidados Paliativos, Coordinador de Grupos de Trabajo, Sociedad Española de Cuidados Paliativos (SECPAL), Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Alfredo L Díaz-Gómez
- Unidad de Ecografía Clínica Asistencial, Servicio de Medicina Interna, Hospital San Carlos, San Fernando, Grupo de Trabajo Ecografía Clínica de la Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
| | - Abel Mujal-Martínez
- Unidad de Hospitalización a Domicilio, Servicio de Medicina Interna, Coordinador del Grupo de Trabajo Hospitalización a Domicilio y Telemedicina, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Juan Torres-Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Grupo de Trabajo Cuidados Paliativos de la Sociedad Española de Medicina Interna (SEMI), Madrid, Spain
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Mulder TA, van de Velde T, Dokter E, Boekestijn B, Olgers TJ, Bauer MP, Hierck BP. Unravelling the skillset of point-of-care ultrasound: a systematic review. Ultrasound J 2023; 15:19. [PMID: 37074526 PMCID: PMC10115919 DOI: 10.1186/s13089-023-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The increasing number of physicians that are trained in point-of-care ultrasound (POCUS) warrants critical evaluation and improvement of current training methods. Performing POCUS is a complex task and it is unknown which (neuro)cognitive mechanisms are most important in competence development of this skill. This systematic review was conducted to identify determinants of POCUS competence development that can be used to optimize POCUS training. METHODS PubMed, Web of Science, Cochrane Library, Emcare, PsycINFO and ERIC databases were searched for studies measuring ultrasound (US) skills and aptitude. The papers were divided into three categories: "Relevant knowledge", "Psychomotor ability" and 'Visuospatial ability'. The 'Relevant knowledge' category was further subdivided in 'image interpretation', 'technical aspects' and 'general cognitive abilities'. Visuospatial ability was subdivided in visuospatial subcategories based on the Cattell-Horn-Carroll (CHC) Model of Intelligence v2.2, which includes visuospatial manipulation and visuospatial perception. Post-hoc, a meta-analysis was performed to calculate pooled correlations. RESULTS 26 papers were selected for inclusion in the review. 15 reported on relevant knowledge with a pooled coefficient of determination of 0.26. Four papers reported on psychomotor abilities, one reported a significant relationship with POCUS competence. 13 papers reported on visuospatial abilities, the pooled coefficient of determination was 0.16. CONCLUSION There was a lot of heterogeneity in methods to assess possible determinants of POCUS competence and POCUS competence acquisition. This makes it difficult to draw strong conclusions on which determinants should be part of a framework to improve POCUS education. However, we identified two determinants of POCUS competence development: relevant knowledge and visuospatial ability. The content of relevant knowledge could not be retrieved in more depth. For visuospatial ability we used the CHC model as theoretical framework to analyze this skill. We could not point out psychomotor ability as a determinant of POCUS competence.
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Affiliation(s)
- Tessa A Mulder
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Tim van de Velde
- Department of Neuropsychology, Leiden University, Leiden, The Netherlands
| | - Eveline Dokter
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn P Bauer
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Beerend P Hierck
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Innovation of Medical Education, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Sciences-Anatomy and Physiology, Veterinary Medicine Faculty, Utrecht University, Utrecht, The Netherlands
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Frasure SE, Treat R, Dow J, Dearing E, Dominguez L, Drake A, Ogle KY, Portela M, Willis J, Boniface KS. An Interdisciplinary Approach to the Introduction of Point-of-Care Ultrasound in an Urban Academic Primary Care Center. Cureus 2023; 15:e36329. [PMID: 37077608 PMCID: PMC10108744 DOI: 10.7759/cureus.36329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/20/2023] Open
Abstract
Introduction Limited guidance exists for primary and urgent care ultrasound applications. This study sought to identify the most useful applications for providers in these clinical settings, to create and implement a structured interdisciplinary point-of-care ultrasound (POCUS) curriculum, and to assess the effectiveness of the course. Methods This prospective cohort study took place at an urban academic medical center. After a needs-based assessment of ultrasound applications in primary and urgent care, the Emergency Medicine ultrasound faculty and fellows were paired with a primary or urgent care provider (N = 6). The pairings met for scanning sessions in the emergency department to practice image acquisition, documentation, and incorporation of ultrasound into the workflow. Participants were given POCUS pre-work to review before each session. The final bedside session included a formal Objective Standard Clinical Examination (OSCE) to assess learner proficiency to be cleared for independent imaging. The program was assessed using pre- and post-training surveys. Results The survey results demonstrated that renal, gallbladder, and soft tissue scans were the most interesting and useful to primary and urgent care providers after completion of the training course. Conclusion The course was effective, and efficient, simple, high-yield POCUS applications should be included in future programs and organizational guidelines for primary and urgent care POCUS education.
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A survey of barriers and facilitators to ultrasound use in low- and middle-income countries. Sci Rep 2023; 13:3322. [PMID: 36849625 PMCID: PMC9969046 DOI: 10.1038/s41598-023-30454-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Point-of-care ultrasound has the potential to help inform assessment, diagnosis, and management of illness in low- and middle-income countries (LMIC). To better understand current ultrasound use, barriers and facilitators to use, and perceptions and practices in LMIC, we conducted an anonymous online global survey targeting healthcare providers training and using ultrasound in LMIC. A total of 241 respondents representing 62 countries participated and most were physicians working in publicly-funded urban tertiary hospitals in LMIC. Most had received ultrasound training (78%), reported expertise (65%) and confidence (90%) in ultrasound use, and had access to ultrasound (88%), utilizing ultrasound most commonly for procedures and for evaluations of lungs, heart, and trauma. Access to an ultrasound machine was reported as both the top barrier (17%) and top facilitator (53%); other common barriers included access to education and training, cost, and competition for use and other common facilitators included access to a probe, gel, and electricity, and acceptance by healthcare providers, administrators, and patients. Most (80%) noted ultrasound access was important and 96% agreed that ultrasound improves quality of care and patient outcomes. Improving access to low-cost ultrasound equipment is critical to increasing ultrasound use among those who are trained.
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Nathanson R, Williams JP, Gupta N, Rezigh A, Mader MJ, 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, Soni NJ. Current Use and Barriers to Point-of-Care Ultrasound in Primary Care: A National Survey of VA Medical Centers. Am J Med 2023; 136:592-595.e2. [PMID: 36828205 DOI: 10.1016/j.amjmed.2023.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND More primary care providers (PCPs) have begun to embrace the use of point-of-care ultrasound (POCUS), but little is known about how PCPs are currently using POCUS and what barriers exist. In this prospective study, the largest systematic survey of POCUS use among PCPs, we assessed the current use, barriers to use, program management, and training needs for POCUS in primary care. METHODS We conducted a prospective observational study of all VA Medical Centers (VAMCs) between June 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of primary care clinics (PCCs). RESULTS Chiefs of PCCs at 105 VAMCs completed the survey (82% response rate). Only 13% of PCCs currently use POCUS, and the most common applications used were bladder and musculoskeletal ultrasound. Desire for POCUS training exceeded current use, but lack of trained providers (78%), ultrasound equipment (66%), and funding for training (41%) were common barriers. Program infrastructure to support POCUS use was uncommon, and only 9% of VAMCs had local policies related to POCUS. Most PCC chiefs (64%) would support POCUS training. CONCLUSIONS Current use of POCUS in primary care is low despite the recent growth of POCUS training in Internal Medicine residency programs. Investment in POCUS training and program infrastructure is needed to expand POCUS use in primary care and ensure adequate supervision of trainees.
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Affiliation(s)
- Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Division of Hospital Medicine, University of Texas Health San Antonio.
| | - Jason P Williams
- Atlanta VA Medical Center, Medicine Service, Ga; Division of Hospital Medicine, Emory School of Medicine, Atlanta, Ga
| | - Neil Gupta
- Joe R. & Teresa Lozano Long School of Medicine
| | - Austin Rezigh
- Division of General Internal Medicine, University of Texas Health San Antonio
| | - Michael J Mader
- Research Service, South Texas Veterans Health Care System, San Antonio
| | - Elizabeth K Haro
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio
| | - Brandy Drum
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, Wis
| | - Edward O'Brien
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, Wis
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC; Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville
| | - Brian Bales
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minn; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pa; Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pa
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Calif; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison; Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, Wis
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, Vt; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Division of Hospital Medicine, University of Texas Health San Antonio; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio
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31
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Gohar E, Herling A, Mazuz M, Tsaban G, Gat T, Kobal S, Fuchs L. Artificial Intelligence (AI) versus POCUS Expert: A Validation Study of Three Automatic AI-Based, Real-Time, Hemodynamic Echocardiographic Assessment Tools. J Clin Med 2023; 12:jcm12041352. [PMID: 36835888 PMCID: PMC9959768 DOI: 10.3390/jcm12041352] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Point Of Care Ultra-Sound (POCUS) is an operator dependent modality. POCUS examinations usually include 'Eyeballing' the inspected anatomical structure without conducting accurate measurements due to complexity and insufficient time. Automatic real time measuring tools can make accurate measurements fast and simple and dramatically increase examination reliability while saving the operator much time and effort. In this study we aim to assess three automatic tools which are integrated into the Venue™ device by GE: the automatic ejection fraction, velocity time integral, and inferior vena cava tools in comparison to the gold standard-an examination by a POCUS expert. METHODS A separate study was conducted for each of the three automatic tools. In each study, cardiac views were acquired by a POCUS expert. Relevant measurements were taken by both an auto tool and a POCUS expert who was blinded to the auto tool's measurement. The agreement between the POCUS expert and the auto tool was measured for both the measurements and the image quality using a Cohen's Kappa test. RESULTS All three tools have shown good agreement with the POCUS expert for high quality views: auto LVEF (0.498; p < 0.001), auto IVC (0.536; p = 0.009), and the auto VTI (0.655; p = 0.024). Auto VTI has also shown a good agreement for medium quality clips (0.914; p < 0.001). Image quality agreement was significant for the auto EF and auto IVC tools. CONCLUSIONS The Venue™ show a high agreement with a POCUS expert for high quality views. This shows that auto tools can provide reliable real time assistance in performing accurate measurements, but do not reduce the need of a good image acquisition technique.
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Affiliation(s)
- Eyal Gohar
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Amit Herling
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Mor Mazuz
- Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Gal Tsaban
- Soroka Medical Center, Beer Sheva 84101, Israel
| | - Tomer Gat
- Soroka Medical Center, Beer Sheva 84101, Israel
- Correspondence:
| | | | - Lior Fuchs
- Soroka Medical Center, Beer Sheva 84101, Israel
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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Allocca M, Kucharzik T, Rubin DT. Intestinal Ultrasound in the Assessment and Management of Inflammatory Bowel Disease: Is It Ready for Standard Practice? Gastroenterology 2023; 164:851-855. [PMID: 36708790 DOI: 10.1053/j.gastro.2023.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois
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Akanuwe JN, Siriwardena AN, Bidaut L, Mitchell P, Bird P, Lasserson D, Apenteng P, Lilford R. Practitioners' views on community implementation of point-of-care ultrasound (POCUS) in the UK: a qualitative interview study. BMC Health Serv Res 2023; 23:84. [PMID: 36698100 PMCID: PMC9876652 DOI: 10.1186/s12913-023-09069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK. METHODS We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12. RESULTS We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals. Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience. CONCLUSIONS POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.
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Affiliation(s)
- Joseph N.A Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Aloysius Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Luc Bidaut
- grid.36511.300000 0004 0420 4262School of Computer Science, College of Science, University of Lincoln, Lincoln, England
| | - Pauline Mitchell
- grid.36511.300000 0004 0420 4262School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Paul Bird
- grid.412563.70000 0004 0376 6589Institute for Translational Medicine Research & Development, University Hospitals Birmingham NHS Foundation Trust, West Midlands Academic Health Science Network, Birmingham, England
| | - Daniel Lasserson
- grid.7372.10000 0000 8809 1613Warwick Medical School, University of Warwick, Coventry, England ,grid.410556.30000 0001 0440 1440Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, England
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Drapkina OM, Dzhioeva ON, Balakhonova TV, Safarova AF, Ershova AI, Zorya OT, Pisaryuk AS, Kobalava ZD. Ultrasound-assisted examination in internal medicine practice. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The guidelines have been developed for internists, general practitioners, emergency physicians, and paramedics. The guidelines are based on expert consensus papers, accumulated clinical and scientific experience. The methodology for organizing and conducting ultrasound-assisted examinations is described in detail. Algorithms for diagnosing the main syndromes in internal medicine practice are presented to help the practitioner. Particular attention is paid to the methodology of ultrasoundassisted examinations. These guidelines will be of interest to doctors, heads of medical facilities, as well as students of medical universities.
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Affiliation(s)
- O. M. Drapkina
- Russian Society for the Prevention of Noncommunicable Diseases
| | - O. N. Dzhioeva
- Russian Society for the Prevention of Noncommunicable Diseases
| | | | - A. F. Safarova
- Russian Society for the Prevention of Noncommunicable Diseases
| | - A. I. Ershova
- Russian Society for the Prevention of Noncommunicable Diseases
| | - O. T. Zorya
- Russian Society for the Prevention of Noncommunicable Diseases
| | - A. S. Pisaryuk
- Russian Society for the Prevention of Noncommunicable Diseases
| | - Zh. D. Kobalava
- Russian Society for the Prevention of Noncommunicable Diseases
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Dadon Z, Carasso S, Gottlieb S. The Role of Hand-Held Cardiac Ultrasound in Patients with COVID-19. Biomedicines 2023; 11:biomedicines11020239. [PMID: 36830776 PMCID: PMC9953352 DOI: 10.3390/biomedicines11020239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
The role of point-of-care ultrasound (POCUS) in patient management has been established in recent years as an important tool. It is increasingly used by multiple medical disciplines in numerous clinical settings, for different applications and diagnostic purposes and in the guidance of procedures. The introduction of small-sized and inexpensive hand-held ultrasound devices (HUDs) has addressed some of the POCUS-related challenges and has thus extended POCUS' applicability. HUD utilization is even more relevant in the COVID-19 setting given the operators' infection risk, excessive workload concerns and general equipment contamination. This review focuses on the available technology, usefulness, feasibility and clinical applications of HUD for echocardiogram assessment in patients with COVID-19.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 1311502, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
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Restrepo D, Heyne TF, Schutzer C, Dversdal R. "Teaching old dogs new tricks" - POCUS Education for Senior Faculty. POCUS JOURNAL 2023; 8:9-12. [PMID: 37152338 PMCID: PMC10155720 DOI: 10.24908/pocus.v8i1.16145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Point of Care Ultrasound (POCUS) is a growing diagnostic modality across a variety of specialties and is increasingly being taught in undergraduate medical education. Uptake within internal medicine has been slow but is becoming more commonplace. Training of extant hospital medicine faculty, including senior members, in POCUS is an unmet need in graduate medical education with significant pedagogical and patient safety implications. With this in mind, we created a training program for the core teaching faculty at our academic internal medicine residency program. The experiential, hands-on curriculum explored the reasoning behind concepts and emphasized psychological safety for senior faculty learners and was successful and well-received. In our piece, we aim to explore the existing literature around training this unique population in POCUS and report on our single-center experience. We also provide a framework for how our program succeeded, collate tips derived from the expert ultrasound teachers and list pearls learned while teaching these experienced educators. Although this worthwhile effort requires planning and support, it was appreciated even by senior faculty.
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Affiliation(s)
- Daniel Restrepo
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Harvard Medical SchoolBoston, MA
| | - Thomas F Heyne
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Harvard Medical SchoolBoston, MA
| | - Christine Schutzer
- Point-of-Care Ultrasound Program, Oregon Health & Science UniversityPortland, OR
| | - Renee Dversdal
- Point-of-Care Ultrasound Program, Oregon Health & Science UniversityPortland, OR
- Division of Hospital Medicine, Oregon Health & Science UniversityPortland, OR
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Kuroda Y, Kaneko T, Yoshikawa H, Uchiyama S, Nagata Y, Matsushita Y, Hiki M, Minamino T, Takahashi K, Daida H, Kagiyama N. Artificial intelligence-based point-of-care lung ultrasound for screening COVID-19 pneumoniae: Comparison with CT scans. PLoS One 2023; 18:e0281127. [PMID: 36928805 PMCID: PMC10019704 DOI: 10.1371/journal.pone.0281127] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/15/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Here, we aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19). METHODS We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study. RESULTS A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1%- 98.1%), sensitivity of 92.3% (79.7%- 97.3%), specificity of 100% (80.6%- 100%), positive predictive value of 95.0% (89.6% - 97.7%), and Kappa of 0.33 (0.27-0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2%- 91.3%), 77.5% (62.5%- 87.7%), and 100% (80.6%- 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4%- 69.1%), 37.2% (32.0%- 42.7%), and 97.8% (95.2%- 99.0%), respectively. INTERPRETATION AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
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Affiliation(s)
- Yumi Kuroda
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hitomi Yoshikawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Saori Uchiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Nagata
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Matsushita
- Department of Emergency Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Internal Medicine and Rheumatology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Emergency Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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Jin L, Tong LY, Sha L, Cao MM, Shen CQ, Du LF, Li ZJ. Handheld versus conventional ultrasound for assessing carotid artery in routine volunteers. Clin Hemorheol Microcirc 2022; 82:255-263. [PMID: 35848014 DOI: 10.3233/ch-221521] [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] [Indexed: 12/27/2022]
Abstract
AIM Carotid ultrasound is a key tool for the diagnosis and evaluation of cardio disease, and the measurement of carotid intima-media thickness (CIMT) and hemodynamic parameters is of paramount importance for the imaging method. The aim of this study was to evaluate the feasibility and accuracy of handheld ultrasound devices for measuring carotid parameters. METHODS We performed a carotid ultrasound on 25 participants using a handheld ultrasound device and a conventional ultrasound machine. For each participant, max and mean CIMT of common carotid artery (CCA) and peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of CCA, bilateral external carotid artery (ECA), internal carotid artery (ICA) and the vertebral artery were measured. Agreement and repeatability were evaluated by linear regression and Bland-Altman analysis. RESULTS We found a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT (r = 0.68, P < 0.01). Furthermore, there was a moderate to good agreement between handheld and conventional ultrasound systems in measuring max IMT, mean IMT, PSV, EDV and RI of CCA (0.73, 0.79, 0.52, 0.58 and 0.84, respectively). CONCLUSION Handheld ultrasound devices were able to provide carotid IMT and hemodynamic parameters measurements similar to those of conventional ultrasound. Such capabilities of handheld ultrasound devices might be useful for the primary assessment of carotid in clinical work.
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Affiliation(s)
- Lin Jin
- Department of Ultrasound, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lan-Yue Tong
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Sha
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meng-Meng Cao
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cui-Qin Shen
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhao-Jun Li
- Department of Ultrasound, Shanghai General Hospital Jiading Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ross DW, Moses AA, Niyyar VD. Point-of-care ultrasonography in nephrology comes of age. Clin Kidney J 2022; 15:2220-2227. [PMID: 36381376 PMCID: PMC9664573 DOI: 10.1093/ckj/sfac160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 03/22/2024] Open
Abstract
The physical exam is changing. Many have argued that the physical exam of the 21st century should include point-of-care ultrasound (POCUS). POCUS is being taught in medical schools and has been endorsed by the major professional societies of internal medicine. In this review we describe the trend toward using POCUS in medicine and describe where the practicing nephrologist fits in. We discuss what a nephrologist's POCUS exam should entail and we give special attention to what nephrologists can gain from learning POCUS. We suggest a 'nephro-centric' approach that includes not only ultrasound of the kidney and bladder, but of the heart, lungs and vascular access. We conclude by reviewing some of the sparse data available to guide training initiatives and give suggested next steps for advancing POCUS in nephrology.
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Affiliation(s)
- Daniel W Ross
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Division of Kidney Diseases and Hypertension, Great Neck, NY, USA
| | - Andrew A Moses
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Lenox Hill Division of Nephrology, New York, NY, USA
| | - Vandana Dua Niyyar
- Emory University, Division of Nephrology, Woodruff Memorial Research Building, Atlanta GA, USA
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Lo H, Frauendorf V, Wischke S, Schimmath-Deutrich C, Kersten M, Nuernberg M, Nuernberg D, Jenssen C. Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg - A Pilot Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:584-591. [PMID: 33626573 DOI: 10.1055/a-1354-5958] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aims to evaluate the use of handheld ultrasound devices (HHUS) for point-of-care ultrasound (POCUS) to improve outpatient care in rural Brandenburg. MATERIALS AND METHODS A group of general practitioners (n = 9), palliative care physicians (n = 6), emergency physicians (n = 4), and nurses from palliative care services (n = 5) participated in this study. Following a 3-hour workshop and 2 weeks of individual training, participants performed POCUS using HHUS (HH-POCUS). Indications, examination results, and resulting treatment changes (e. g., acute interventions, new medication) were documented in a standardized data entry form. RESULTS 19 physicians with different ultrasound experience and 5 palliative care nurses attended the workshop program and took part in the study. Three of the participating physicians were out of training in ultrasound and received prolonged supervision. Among 427 HH-POCUS examinations, the FAST scan and kidney scan were performed most often. Pain and dyspnea were the most common indications for HH-POCUS. Among the examinations performed by physicians (n = 311), ascites was the most common pathology (27 % of cases). Using a simplified examination protocol, palliative care nurses diagnosed fluid collections, hydronephrosis and transurethral catheter position or urinary retention. In 80.4 % of physician-performed cases, HH-POCUS made a valuable impact on patient management. HH-POCUS contributed to treatment decisions in 49.5 % of cases, including a change of medication in 29.6 % and performance of therapeutic interventions in 19.9 %. Hospital admission or referral to an ambulatory specialist was initiated due to HH-POCUS findings in 17.7 % of patients. CONCLUSION HH-POCUS helped doctors in rural areas to optimize patient care through rapid on-site collection of therapeutically relevant findings. In addition, it was shown that specialized and motivated nurses can independently detect simple ultrasound findings and thus provide clinically relevant information to doctors.
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Affiliation(s)
- Hendra Lo
- Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Sandra Wischke
- Private Practice, Practice for Internal Medicine and Cardiology, Oberkramer, Germany
| | | | - Markus Kersten
- Private Practice, Practice for General Medicine, Rheinsberg, Germany
| | - Maria Nuernberg
- Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dieter Nuernberg
- Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Christian Jenssen
- Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Palamattam DJ, Sreedhar R, Gadhinglajkar SV, Dash PK, Sukesan S. Bedside Chest Ultrasound in Postoperative Pediatric Cardiac Surgery Patients: Comparison With Bedside Chest Radiography. J Cardiothorac Vasc Anesth 2022; 36:4039-4044. [PMID: 35953404 DOI: 10.1053/j.jvca.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting. DESIGN A prospective observational study. SETTING At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center. PARTICIPANTS One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases. INTERVENTIONS After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1. MEASUREMENTS AND MAIN RESULTS The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k = 0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k = 0.787) between CUS and CXR regarding the necessity for interventions. CONCLUSIONS The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.
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Affiliation(s)
- Don J Palamattam
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Rupa Sreedhar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
| | - Shrinivas V Gadhinglajkar
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Prasanta K Dash
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Subin Sukesan
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Point-of-care ultrasound in the head and neck region. J Med Ultrason (2001) 2022; 49:593-600. [DOI: 10.1007/s10396-022-01266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022]
Abstract
AbstractPoint-of-care ultrasound (POCUS) in the head and neck region plays a particularly significant role in the diagnosis and treatment of upper airway stenosis, swelling, and painful diseases in the neck, and in the evaluation of swallowing function. Therefore, it should be performed in various medical settings beyond the boundaries of the clinical department such as general medicine, emergency medicine, anesthesiology, orthopedics, and pediatrics. The target diseases are salivary gland disease, lymph node disease, pharyngeal disease, laryngeal disease, esophageal disease, thyroid disease, and dysphagia and dyspnea due to various causes. Head and neck POCUS is an extremely useful diagnostic method for both patients and doctors, and its use is expected to become more widespread in the future.
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Focused Cardiac Ultrasound Training for Non-cardiologists: An Overview and Recommendations for a Lower Middle-Income Country. Crit Care Clin 2022; 38:827-837. [PMID: 36162913 DOI: 10.1016/j.ccc.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Poor outcomes among the critically ill in low- and middle-income countries (LMICs) have been attributed in part to the challenge of diagnostic delays caused by lack of skilled personnel. Focused cardiac ultrasound (FoCUS) by non-cardiologists may mitigate the shortage of echocardiography experts to perform emergency echocardiography at the point of care in these settings. It is however crucial that FoCUS training for non-cardiologists in LMICs be based on robust evidence to support training delivery if diagnostic accuracy is to be assured.
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Arthur M, Pichamuthu K, Turaka VP, Putta T, Jeeyavudeen MS, Zachariah A, Sathyendra S, Hansdak SG, Iyadurai R, Karuppusami R, Sudarsanam TD. Bedside lung ultrasonography: comparison with chest radiography (BLUR), a diagnostic study in a developing country. Postgrad Med J 2022:7146669. [PMID: 37117036 DOI: 10.1136/pmj-2021-141343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
BackgroundThis study determines the diagnostic utility of lung ultrasonography (LUS) in a medical ward in a developing country. In a low resource country like India, we hope that use of lung ultrasound in primary and secondary hospitals will assist in earlier and better bedside diagnosis.MethodsThis prospective diagnostic study was done to test the diagnostic accuracy of LUS against a composite reference standard, which included clinical history and examination, basic laboratory investigations, imaging and the diagnosis at discharge. We evaluated 321 consecutive patients, admitted in our medical wards with an LUS within 24 hours of the chest radiograph being done.FindingsBetween August 2016 and August 2017, we enrolled 321 patients. The sensitivity and specificity of the LUS for all pathologies were found to be 82.5% (76.50 to 87.20) and 78.2% (69.09 to 85.26) respectively. A subgroup analysis including the patients in whom CT was part of the composite reference standard showed sensitivity and specificity of 87.9% and 92.9% for all lung pathologies. It was found that there was superior sensitivity and specificity of LUS compared with chest radiograph in a subgroup analysis of pulmonary oedema and acute respiratory distress syndrome (ARDS).InterpretationWe found that the LUS was better than chest radiograph and as good as CT in most pathologies, especially pulmonary oedema and ARDS. We believe that training in the basics of bedside LUS must be part of the medical curriculum and a low-cost ultrasound machine must be made available in medical wards, so that clinical diagnosis can be supplemented with this tool. In a low resource setting like India, where access to chest radiograph and CT may be difficult particularly in a rural setup, expertise in LUS would be helpful in easy bedside diagnosis and saving cost on a CT scan.
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Affiliation(s)
- Manisha Arthur
- Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Kishore Pichamuthu
- Department of Critical Care, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Vijay Prakash Turaka
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Tharani Putta
- Department of Radiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - Anand Zachariah
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Sowmya Sathyendra
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Samuel George Hansdak
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Thambu David Sudarsanam
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
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Zare MA, Bahmani A, Fathi M, Arefi M, Hossein Sarbazi A, Teimoori M. Role of point-of-care ultrasound study in early disposition of patients with undifferentiated acute dyspnea in emergency department: a multi-center prospective study. J Ultrasound 2022; 25:443-449. [PMID: 34050914 PMCID: PMC9402883 DOI: 10.1007/s40477-021-00582-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Sonography is a safe and simple diagnostic modality which can help emergency physicians in their clinical decision makings and improve the patient disposition process in emergency departments. OBJECTIVE This prospective multi-center study evaluates the role of bedside ultrasound performed by emergency physicians in accelerating the patient disposition process in cases with acute undifferentiated dyspnea. METHODS 103 patients were randomized to "early ultrasound" and "routine assessment" groups. In early ultrasound group, emergency physicians performed bedside ultrasound scans on heart and lungs as soon as possible after triage and randomization. In routine assessment group, ultrasound was used whenever the emergency physician or other consultant services ordered or performed it. Mean randomization-to-diagnosis time was compared in two studied groups. RESULTS Mean randomization-to-diagnosis time was 79.33 (± 38.90) min in routine assessment and 42.61 (± 19.20) min in early ultrasound groups, showing a statistically significant difference (p value < 0.01). CONCLUSION Using early sonography in assessing the patients with undifferentiated acute dyspnea in emergency department decreases the patient turnover time while increasing the diagnostic accuracy.
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Affiliation(s)
- Mohammad Amin Zare
- Trauma and Injury Research Center (TIRC), Iran University of Medical Sciences, Tehran, Iran
- Emergency Medicine Department, Zahedan University of Medical Sciences, Balouchestan Boulevard, Main Campus of Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan Province Iran
- Emergency Medicine Department, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Bahmani
- Emergency Medicine Department, Zahedan University of Medical Sciences, Balouchestan Boulevard, Main Campus of Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan Province Iran
| | - Marzieh Fathi
- Trauma and Injury Research Center (TIRC), Iran University of Medical Sciences, Tehran, Iran
| | - Marieh Arefi
- Emergency Medicine Department, Zahedan University of Medical Sciences, Balouchestan Boulevard, Main Campus of Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan Province Iran
| | - Armaghan Hossein Sarbazi
- Emergency Medicine Department, Zahedan University of Medical Sciences, Balouchestan Boulevard, Main Campus of Zahedan University of Medical Sciences, Zahedan, Sistan and Baluchestan Province Iran
| | - Mahrokh Teimoori
- Emergency Medicine Department, Golestan University of Medical Sciences, Gorgan, Iran
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Abstract
ABSTRACT Point-of-care ultrasound (PoCUS) is a cost-effective diagnostic technology that, with training, is accessible, portable, and a convenient diagnostic modality to complement physical assessments. PoCUS is beneficial in that it can reduce the number of imaging tests required, while also mitigating barriers to healthcare for rural and remote communities.
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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- Internal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | | | - Vicki Noble
- Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- Francisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Steve Wilson
- University of South Carolina School of Medicine, Columbia, USA
| | | | - Jongyeol Kim
- Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- Library Services, University of South Carolina School of Medicine, Columbia, USA
| | | | - Bret P. Nelson
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- Physiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- Medicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | | | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- Ultrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | | | - Vi Am Dinh
- Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- Internal Medicine, University of Manitoba, Manitoba, Canada
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Canakci ME, Sevik OE, Acar N. How Should We Approach Syncope in the Emergency Department? Current Perspectives. Open Access Emerg Med 2022; 14:299-309. [PMID: 35789812 PMCID: PMC9249662 DOI: 10.2147/oaem.s247023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.
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Affiliation(s)
- Mustafa Emin Canakci
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
- Correspondence: Mustafa Emin Canakci, Emergency Department, Eskisehir Osmangazi University, Prof. Dr. Nabi Avcı Boulevard, No: 4, Meselik, Odunpazarı, Eskisehir, 26040, Turkey, Tel +902222392979 – 5607, Email
| | - Omer Erdem Sevik
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nurdan Acar
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
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50
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Rosborough TK, Becker JS, Desautels CN, Fennell NN, Lange AKS, Porter JL, Post BD, Shepherd MF, St Hill CA, Tierney DM. An Ultrasound Screening Exam During Medicare Wellness Visits May Be Beneficial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1069-1076. [PMID: 34272888 DOI: 10.1002/jum.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/28/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The physical exam component of a periodic health visit in the elderly has not been considered useful. Standard Medicare Wellness visits require no physical exam beyond blood pressure and most physicians perform limited exams during these visits. The objective of this study was to test the feasibility, potential benefit, and costs of performing a screening ultrasound (US) exam during Medicare Wellness visits. METHODS A physician examiner at an academic internal medicine primary care clinic performed a screening US exam targeting important abnormalities of patients 65-85 years old during a Medicare Wellness visit. The primary care physician (PCP) recorded the follow-up items for each abnormality identified by the US examiner and assessed the benefit of each abnormality for the participant. Abnormality benefit, net exam benefit per participant, follow-up items and costs, participant survey results, and exam duration were assessed. RESULTS Participants numbered 108. Total abnormalities numbered 283 and new diagnoses were 172. Positive benefit scores were assigned to 38.8%, neutral (zero) scores to 59.4%, and negative benefit scores to 1.8% of abnormalities. Net benefit scores per participant were positive in 63.9%, 0 in 34.3%, and negative in 1.8%. Follow-up items were infrequent resulting in 76% of participants without follow-up cost. Participant survey showed excellent acceptance of the exam. CONCLUSIONS The US screening exam identified frequent abnormalities in Medicare Wellness patients. The assessed benefits were rarely negative and often mild to moderately positive, with important new chronic conditions identified. Follow-up costs were low when the PCPs were also US experts.
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Affiliation(s)
- Terry K Rosborough
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Joshua S Becker
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Christine N Desautels
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Naomi N Fennell
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Anna K S Lange
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Jean L Porter
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Bryan D Post
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | - Michele F Shepherd
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
| | | | - David M Tierney
- Abbott Northwestern Hospital Department of Graduate Medical Education, Minneapolis, MN, USA
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