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Bae JY, Fallahi A, Miller W, Leon MB, Abraham TP, Bangalore S, Hsi DH. A call to consider an aortic stenosis screening program. Trends Cardiovasc Med 2024; 34:297-301. [PMID: 37105278 DOI: 10.1016/j.tcm.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 04/29/2023]
Abstract
Aortic stenosis (AS) is the most common age-related valvular condition with a prevalence of 13.1% in patients older than 75 years of age. Based on the severity of AS and symptoms, current guidelines recommend interval monitoring with transthoracic echocardiogram (TTE). However, no guidelines exist regarding screening asymptomatic persons for AS. Prevalence of AS is comparable to conditions such as colorectal cancer, lung cancer, breast cancer, and abdominal aortic aneurysm where dedicated screening programs are offered resulting in reduction of overall morbidity and mortality. We review recent advancements in treatment options, and we propose an AS screening program for high-risk individuals without known history of AS including all persons over age 75 and persons aged 70 years and older with dialysis dependent end-stage renal disease (ESRD).
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Affiliation(s)
- Ju Young Bae
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, United States
| | - Arzhang Fallahi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Wayne Miller
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Martin B Leon
- Columbia University Medical Center/New York Presbyterian Hospital, University of Columbia College of Physicians and Surgeons, New York, NY, United States
| | - Theodore P Abraham
- University of California San Francisco Medical Center, CA, United States
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, NY, United States
| | - David H Hsi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States.
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2
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Gat T, Galante O, Sadeh R, Kobal SL, Fuchs L. Self-learning of cardiac ultrasound by medical students: can augmented online training improve and maintain manual POCUS skills over time? J Ultrasound 2024; 27:73-80. [PMID: 37493967 PMCID: PMC10909045 DOI: 10.1007/s40477-023-00804-5] [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: 04/04/2023] [Accepted: 06/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The use of cardiac point of care ultra-sound is rapidly growing and so is the demand for quality POCUS teaching. POCUS teaching is usually conducted in small groups requiring much space and equipment. This study attempts to test whether providing access to an E-learning module as an adjunct to a cardiac POCUS course can increase students' image acquisition skills. This will show POCUS teaching can improve significantly without having to invest a significant amount of resources. METHODS Medical students (N = 125) were divided into two groups and had undergone a hands-on Cardiac POCUS course before their internal clerkship. During the clerkship, members of both groups got to practice their POCUS skills in the internal wards. One group was provided with accounts to a cardiac POCUS teaching E-learning platform (eMedical Academy©). After limited time for self- practice, both groups underwent a pre-validated ultrasound examination. The two groups' test results were then compared for each POCUS view and for the total exam score. RESULTS The E-learning group performed significantly better than the course-only group in the 6-min exam total score, and at acquiring the following views: parasternal long axis view, apical four-chamber view, and the inferior vena cava view. CONCLUSION E-learning platforms can be an efficient tool for improving cardiac POCUS teaching and maintaining POCUS skills. Using it as a supplement to a hands-on course provides better POCUS skills without the need of extra hands-on teaching.
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Affiliation(s)
- Tomer Gat
- Soroka Medical Center, Beer-Sheva, Israel.
| | | | - Re'em Sadeh
- Emergency Department, Shamir Medical Center, Beer Yaakov, Israel
| | - Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Intensive Care Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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3
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Murat S, Ulus T, Serdar Yılmaz A, Emre Yalvaç H, Çamlı E, Dural M. Hand-held echocardiography during complex electrophysiologic procedures. J Cardiovasc Thorac Res 2023; 15:80-85. [PMID: 37654811 PMCID: PMC10466465 DOI: 10.34172/jcvtr.2023.31621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 05/21/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Complex electrophysiologic (EP) procedures are time consuming and open to complications. Accurate and rapid recognition of cardiac pathologies is essential before, during, and immediately after such procedures. In this study, we aimed to compare hand-held echocardiography (HHE) with standard echocardiography (SE) to determine whether HHE can be used as a practical and reliable diagnostic tool during such procedures. Methods One hundred consecutive patients undergoing complex EP procedures and catheter ablation were included in the study. All patients were evaluated with SE or HHE in terms of main cardiac pathologies at the beginning and immediately after the procedure. The diagnostic accuracy and evaluation time of both methods were compared at the beginning and after the procedure. The agreement between both methods was calculated. Results At the beginning and after the procedure, opening and evaluation times with HHE were significantly shorter than with SE (P<0.001 for all). There was significant agreement between the two methods in the diagnosis of cardiac pathologies (Agreement was 95% for minimal mild aortic regurgitation (AR), 99% for moderate/ severe AR, 93% for minimal/ mild mitral regurgitation (MR), 95% for moderate/ severe MR, 100% for pericardial effusion, and 100% for left ventricular thrombus at the beginning of the procedure). Conclusion With the use of HHE during complex EP procedures, cardiac pathologies can be diagnosed with similar accuracy as SE. In addition, HHE has a significant advantage over SE in terms of time to diagnosis.
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Affiliation(s)
- Selda Murat
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Taner Ulus
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | | | - Halit Emre Yalvaç
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ezgi Çamlı
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Muhammet Dural
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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4
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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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Cid-Serra X, Royse A, Canty D, Johnson DF, Maier AB, Fazio T, El-Ansary D, Royse CF. Effect of a Multiorgan Focused Clinical Ultrasonography on Length of Stay in Patients Admitted With a Cardiopulmonary Diagnosis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2138228. [PMID: 34932107 PMCID: PMC8693211 DOI: 10.1001/jamanetworkopen.2021.38228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. OBJECTIVE To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. DESIGN, SETTING, AND PARTICIPANTS This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. INTERVENTIONS The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. RESULTS A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.
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Affiliation(s)
- Ximena Cid-Serra
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alistair Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Canty
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anesthesia and Perioperative Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Douglas F. Johnson
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of General Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea B. Maier
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universitet, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Fazio
- Department of Medicine and Community Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Health Intelligence Unit, Melbourne Health, Melbourne, Victoria, Australia
- Department of Medicine and Radiology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Doa El-Ansary
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia
- Department of Surgery, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Research Institute, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
| | - Colin F. Royse
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio
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6
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Milwidsky A, Greidinger D, Frydman S, Hochstadt A, Ifrach-Kashtan N, Mizrachi M, Topilsky Y. Echocardiographic Killip Classification. J Am Soc Echocardiogr 2021; 35:287-294. [PMID: 34767929 DOI: 10.1016/j.echo.2021.10.012] [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: 08/08/2021] [Revised: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although routine echocardiographic parameters such as ejection fraction are used to risk-stratify for death in patients referred for echocardiography, they have limited predictive value. The authors speculated that noninvasive hemodynamic echocardiographic data, assessing left ventricular filling pressure and output, stratified on the basis of the clinical Killip score, might have additive prognostic value on top of routine echocardiographic parameters. The authors created an echocardiographic correlate of this classification, using diastolic grade and stroke volume index (SVI) as indicators of pulmonary congestion and systemic perfusion, respectively, and evaluated the prognostic value of this correlate. METHODS A retrospective study of consecutive patients (hospitalized or not) referred for echocardiography for a range of cardiac diagnoses in a tertiary medical center. A total of 556 patients in sinus rhythm who were evaluated by two sonographers, and reviewed by a single cardiologist, were included. Normal filling pressure and normal SVI (>35 mL/m2) defined echocardiographic Killip (eKillip) class 1. Patients with pseudonormal or restrictive diastolic patterns and normal SVI were ascribed to eKillip class 2 or 3, respectively. A pseudonormal or restrictive diastolic pattern and a subnormal SVI defined eKillip class 4. RESULTS eKillip class 1 was present in 382 patients (68%); 115 (20%), 26 (5%), and 42 (7%) patients were in eKillip classes 2 to 4, respectively. Median follow-up time was 1,056 days (interquartile range, 729-1,390 days). A total of 105 deaths occurred. Univariate Cox regression analysis showed that eKillip class was associated with all-cause mortality; hazard ratios (HR) -2.73 (95% CI, 1.67-4.48), 3.19 (95% CI, 1.42-7.17), and 4.79 (95% CI, 2.58-8.89) for each eKillip class above 1 (P < .001). In a multivariate analysis adjusted for the Charlson comorbidity index, eKillip class remained independently associated with all-cause mortality (P = .04). CONCLUSIONS eKillip class was associated with all-cause mortality among all patients undergoing echocardiography at a tertiary hospital.
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Affiliation(s)
- Assi Milwidsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Greidinger
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Ifrach-Kashtan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Mizrachi
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pagliuca S, Bailly C, Talbot A, Bertinchamp R, Peyrony O, Elezi A, Bourrier P, Lengline E. Point-of-care ultrasound with handheld devices in hematology: a monocentric single-stage phase II study. Leuk Lymphoma 2021; 62:1379-1385. [PMID: 33416408 DOI: 10.1080/10428194.2020.1869958] [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: 10/22/2022]
Abstract
Point of care ultrasound (PoCUS) with pocket-size devices is an efficient and safe imaging modality that became a standard of care in various clinical settings. However, its implementation in hematology has never been evaluated so far. We conducted a prospective monocentric study aiming to harvest data on its usage and to assess its diagnostic and interventional performance in improving the accuracy of basic physical examination in hematological patients. After a focused training program, six hematologists were trained and conducted this study. Sixty-two patients were included. Only in 19 cases, further specialized imaging was required, whereas, in 43 patients PoCUS was sufficient to address the clinical inquiries. The use of PoCUS devices was assessed for its performance difficulty and usefulness perception with satisfactory outcomes. This study represents a proof-of-concept application of PoCUS in hematology, suggesting benefits over the physical examination.KEY POINTSPoCUS is particularly attractive in a hematological setting because able to improve the accuracy of physical examination.A hematology-focused training in PoCUS using handheld devices can allow hematologists to perform bed-side diagnostic and interventional US-based exams.
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Affiliation(s)
- Simona Pagliuca
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Cecile Bailly
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Alexis Talbot
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Rémi Bertinchamp
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
| | - Olivier Peyrony
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Arben Elezi
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Emergency Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Pierre Bourrier
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France.,Radiology Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Etienne Lengline
- Hematology Department, Saint-Louis University Hospital, University of Paris, AP-HP, Paris, France
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8
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Abe Y. Screening for aortic stenosis using physical examination and echocardiography. J Echocardiogr 2021; 19:80-85. [PMID: 33415574 DOI: 10.1007/s12574-020-00511-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Most patients with aortic stenosis (AS) can be treated with either traditional surgical aortic valve replacement or newly emerged transcatheter aortic valve implantation. Therefore, the early and appropriate detection of significant AS has become more important for avoiding overlooking patients who require treatment. AS is initially detected by the presence of a systolic ejection murmur (SEM). However, it is time-consuming and expensive for all subjects presenting with SEM to undergo comprehensive standard echocardiography using high-end ultrasound machines since the SEM is audible in a large proportion of elderly patients and is not specific for significant AS. Therefore, further physical examination and/or focused cardiac ultrasound (FoCUS) is required to determine whether patients with a SEM should be referred for standard echocardiography. One or more abnormal physical findings in addition to a SEM can rule out a certain proportion of normal cases without overlooking severe AS. Most of the previous studies suggesting the usefulness of FoCUS in screening for valvular heart disease only used visual impressions in their assessment of AS. By contrast, visual AS and calcification scores are good objective parameters in screening for AS with FoCUS. Patients with severe AS and patients with a high probability of AS-related events are rarely overlooked even if comprehensive standard echocardiography is performed only when either (or both) of the FoCUS scores is 3 or more. The appropriate combination of physical examinations and FoCUS to screen for AS is discussed in this review article.
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Affiliation(s)
- Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
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9
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Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: Closing guideline gaps in screening for valvular heart disease. Clin Cardiol 2020; 43:1368-1375. [PMID: 33174635 PMCID: PMC7724242 DOI: 10.1002/clc.23499] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. HYPOTHESIS POCUS can serve as a screening tool for valvular heart disease. METHODS We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. RESULTS POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. CONCLUSION POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and cost-effectiveness in the screening of patients with valvular heart disease.
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Affiliation(s)
- Muhammad Hammadah
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Christopher Ponce
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Paul Sorajja
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - João L. Cavalcante
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Santiago Garcia
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Mario Gössl
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
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10
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Abstract
Purpose of the Review Point-of-care ultrasound using small ultrasound devices has expanded beyond emergency and critical care medicine to many other subspecialties. Awareness of the strengths and limitations of the technology and knowledge of the appropriate settings and common indications for point-of-care ultrasound is important. Recent Findings Point-of-care ultrasound is widely embraced as an extension of the physical exam and is employed in acute care and medical education settings. Echocardiography laboratories involved in education must individualize training to the intended scope of practice of the user. Advances in artificial intelligence may assist in image acquisition and interpretation by novice users. Summary Point-of-care ultrasound is widely available in a variety of clinical settings. The field has advanced substantially in the past 2 decades and will likely continue to expand with advancement in technology, reduced cost, and improved opportunities to assist new users.
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Affiliation(s)
- Linda Lee
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Ave., MC 9067, Chicago, IL, 60637, USA
| | - Jeanne M DeCara
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Ave., MC 9067, Chicago, IL, 60637, USA.
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11
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Ben-Baruch Golan Y, Sadeh R, Mizrakli Y, Shafat T, Sagy I, Slutsky T, Kobal SL, Novack V, Fuchs L. Early Point-of-Care Ultrasound Assessment for Medical Patients Reduces Time to Appropriate Treatment: A Pilot Randomized Controlled Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1908-1915. [PMID: 32430108 DOI: 10.1016/j.ultrasmedbio.2020.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect of POCUS exam on medical patient's management and clinical outcomes. Patients presenting with chest pain or dyspnea were enrolled and randomly allocated to an early POCUS scan group and a control group. POCUS assessment, within 24 h of internal ward admission, was conducted only for the intervention group. The primary outcome was time to correct diagnosis. Secondary outcomes included time to appropriate treatment, POCUS-related rate of primary diagnosis alteration and new clinically relevant findings and time to hospital discharge. Sixty patients were enrolled. Thirty patients were randomly allocated to each study arm. The POCUS exam revealed clinically relevant findings among 79% of patients and led to alteration of the primary diagnosis among 28% of patients. Time to appropriate treatment was significantly shorter among patients in the POCUS group compared with the control group (median time of 5 h [95% confidence interval: 0.5-9] vs. 24 h [95% CI: 19-29] p = 0.014). The time needed to achieve correct diagnosis by the primary team was shorter in the POCUS group compared with the control group, yet it did not reach statistical significance (median time of 24 h [95% CI: 18-30] vs. 48 h [95% CI: 20-76], p = 0.12). These results indicate that POCUS assessment conducted early among patients with dyspnea or chest pain improves diagnostic accuracy and shortens significantly the time to appropriate treatment.
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Affiliation(s)
| | - Re'em Sadeh
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuval Mizrakli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tali Shafat
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iftach Sagy
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzachi Slutsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Emergency Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergio L Kobal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lior Fuchs
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Cid X, Canty D, Royse A, Maier AB, Johnson D, El-Ansary D, Clarke-Errey S, Fazio T, Royse C. Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial-the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study. Trials 2020; 21:53. [PMID: 31915052 PMCID: PMC6951003 DOI: 10.1186/s13063-019-4003-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.
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Affiliation(s)
- Ximena Cid
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia. .,Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - David Canty
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Anesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia.,Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universitet, Amsterdam, The Netherlands
| | - Douglas Johnson
- Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Doa El-Ansary
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Health Professions, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, University of Melbourne, Parkville, VIC, Australia
| | - Timothy Fazio
- Business Intelligence Unit, Melbourne Health, Parkville, VIC, Australia.,Department of Medicine and Radiology, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia.,Outcomes Consortium, Cleveland Clinic, Cleveland, OH, USA
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13
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Mancusi C, Carlino MV, Sforza A. Point-of-care ultrasound with pocket-size devices in emergency department. Echocardiography 2019; 36:1755-1764. [PMID: 31393640 DOI: 10.1111/echo.14451] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound is a useful tool for clinicians in the management of patients. Particularly in emergency department, the role of point-of-care ultrasound is strongly increasing due to the need for a rapid assessment of critically ill patients and to speed up the diagnostic process. Hand-carried ultrasound devices are particularly useful in emergency setting and allow rapid assessment of patient even in prehospital setting. This article will review the role of point-of-care ultrasonography, performed with pocket-size devices, in the management of patients presenting with acute onset of undifferentiating dyspnea, chest pain, and shock in emergency department.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
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14
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Adler AC, Chandrakantan A, Conlin FT. Perioperative point of care ultrasound in pediatric anesthesiology: a case series highlighting real-time intraoperative diagnosis and alteration of management augmenting physical examination. J Anesth 2019; 33:435-440. [PMID: 31076947 DOI: 10.1007/s00540-019-02654-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/02/2019] [Indexed: 01/06/2023]
Abstract
Use of diagnostic point of care ultrasound, has come to the forefront of interest within anesthesiology. Much data on the use of point of care ultrasound in emergency medicine and critical care medicine for diagnosis and treatment in acute situations exists. While use of point of care ultrasound has become more prevalent in anesthesia practice, documentation of its use and especially alteration in management based on real-time ultrasound findings in the perioperative period remains scarce. This case series discusses six pediatric patients in which real-time intra-operative use of point of care ultrasound resulted in alteration of management.
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Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | - Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Frederick T Conlin
- Department of Anesthesiology, Baystate Medical Center, University of Massachusetts, Springfield, MA, USA
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15
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Ben-Sasson A, Lior Y, Krispel J, Rucham M, Liel-Cohen N, Fuchs L, Kobal SL. Peer-teaching cardiac ultrasound among medical students: A real option. PLoS One 2019; 14:e0212794. [PMID: 30917143 PMCID: PMC6436682 DOI: 10.1371/journal.pone.0212794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Teaching cardiac ultrasound (CU) image acquisition requires hands-on practice under qualified instructors supervision. We assessed the efficacy of teaching medical students by their previously trained classmates (teaching assistants [TAs]) compared to teaching by expert trainers (cardiologists or diagnostic medical sonographers. METHODS Sixty-six students received 8-hour CU training: 4-hour lectures on ultrasound anatomy and imaging techniques of 6 main CU views (parasternal long [PLAV] and short axis [PSAV]; apical 4-chamber [4ch], 2-chamber [2ch], and 3-chamber [3ch]; and sub costal [SC]) followed by 4 hours of hands-on exercise in groups of ≤5 students under direct supervision of a TA (group A: 44 students) or a qualified trainer (group B: 22 students). Students' proficiency was evaluated on a 6-minute test in which they were required to demonstrate 32 predetermined anatomic landmarks spread across the 6 views and ranked on a 0-100 scale according to a predetermined key. RESULTS The 6-minute test final grade displayed superiority of group A over group B (54±17 vs. 39±21, respectively [p = 0.001]). This trend was continuous across all 6 main views: PLAV (69±18 vs. 54±23, respectively), PSAV (65±33 vs. 41±32, respectively), 4ch (57±19 vs. 43±26, respectively), 2ch (37±29 vs. 33±27, respectively), 3ch (48±23 vs. 35±25, respectively), and SC (36±27 vs. 24±28, respectively). CONCLUSIONS Teaching medical students CU imaging acquisition by qualified classmates is feasible. Moreover, students instructors were superior to senior instructors when comparing their students' capabilities in a practical test. Replacing experienced instructors with TAs could help medical schools teach ultrasound techniques with minimal dependence on highly qualified trainers.
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Affiliation(s)
- Alon Ben-Sasson
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- * E-mail:
| | - Jonathan Krispel
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Rucham
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergio L. Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
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16
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Almufleh A, Di Santo P, Marbach JA. Training Cardiology Fellows in Focused Cardiac Ultrasound. J Am Coll Cardiol 2019; 73:1097-1100. [PMID: 30846104 DOI: 10.1016/j.jacc.2019.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Aws Almufleh
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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17
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Legget ME, Toh M, Meintjes A, Fitzsimons S, Gamble G, Doughty RN. Digital devices for teaching cardiac auscultation - a randomized pilot study. MEDICAL EDUCATION ONLINE 2018; 23:1524688. [PMID: 30499380 PMCID: PMC6282469 DOI: 10.1080/10872981.2018.1524688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Competent cardiac auscultation is a declining skill. Digital stethoscopes and hand-held echocardiography (HHE) are modern devices which may improve the accuracy of heart murmur recognition and diagnosis. Their incremental value compared to conventional examination has not been evaluated in depth. OBJECTIVES Our aim was to quantify the utility of digital stethoscopes and HHE as teaching aids to improve medical students' diagnostic accuracy in the evaluation of heart murmurs using a novel clinically weighted scoring system. DESIGN This pilot study involved eight medical students and eight patients with heart murmurs. Four patients were examined at 2 sessions, 1 week apart. Medical students were randomised into two groups: the 'intervention group' examined patients with a standard and digital stethoscope, and then received demonstration of the valvular lesion with HHE to illustrate the diagnosis. The 'control group' used a standard stethoscope only and were taught using traditional methods. Students' scores were compared to a 'gold standard' derived from a consensus of auscultation findings of three cardiologists. RESULTS Overall the mean percent correct of total possible score was 65.4% (SD8.4). Using a mixed models ANOVA approach to repeated measures, the mean [95% CI] increase from training to validation period for the control group was 2.5% [-11.5, 16.5] P(Tukey) = 0.95 and 15.8% [1.7,29.8] P(Tukey) = 0.027 for the intervention group. Between the validation and training sessions for both groups, there was an increase of 9.1% [1.82, 16.4] in scores (p = 0.018). The mean [95% CI] difference in scores of the control and intervention groups was 1.9% [-5.4, 9.2] (p = 0.59). The Cohen's effect size estimate was 0.9. CONCLUSION Digital stethoscopes and hand-held echo may be useful devices for teaching cardiac auscultation. This pilot study provides a novel study design, a heart murmur grading system, and data that will help develop definitive studies to assess new teaching techniques for cardiac auscultation using digital technology.
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Affiliation(s)
- Malcolm E. Legget
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - MeiYen Toh
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andries Meintjes
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Fitzsimons
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Robert N. Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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18
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Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in Undergraduate Medical Education: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2667-2679. [PMID: 29708268 DOI: 10.1002/jum.14628] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/18/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students. METHODS A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors. RESULTS Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed. CONCLUSIONS There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.
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Affiliation(s)
- Joshua J Davis
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Jacqueline Potts
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles A Pohl
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
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19
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Thomas F, Flint N, Setareh-Shenas S, Rader F, Kobal SL, Siegel RJ. Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review. Am J Med 2018; 131:1155-1160. [PMID: 29856962 DOI: 10.1016/j.amjmed.2018.04.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 01/12/2023]
Abstract
In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.
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Affiliation(s)
| | - Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Saman Setareh-Shenas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Mount Sinai St. Luke's-Mount Sinai West Hospital Center, New York, NY
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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21
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Conlin F, Connelly NR, Eaton MP, Broderick PJ, Friderici J, Adler AC. Perioperative Use of Focused Transthoracic Cardiac Ultrasound. Anesth Analg 2017; 125:1878-1882. [DOI: 10.1213/ane.0000000000002089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study. Clin Res Cardiol 2017; 107:95-107. [DOI: 10.1007/s00392-017-1181-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Abstract
Competent cardiac auscultation remains a most important skill for the detection of heart disease. Currently it is poorly taught and often ignored or poorly performed, resulting in inaccurate and inefficient patient assessments. This review documents that teaching can be over 90% effective with new, proven teaching methods emphasizing repetition and normal-abnormal comparisons of sounds, using computer-aided and online resources. At present, these concepts are not widely adopted by medical schools. Our current knowledge of teaching heart auscultation is critically reviewed, including traditional bedside, clinic and classroom settings, as well as computer, simulator, and multimedia-based learning. The assessment of auscultation skill in the learning process. The adoption of competence-based learning promises to integrate the assessment of auscultation skill in the learning process. Newer teaching methods, such as auditory training and repetitive listening, offer excellent murmur recognition and diagnosis learning, and hand-held ultrasound is proposed as a helpful adjunct to teaching auscultation. Although ongoing research remains important to develop better teaching methods, the adoption of proven existing concepts has great potential to improve teaching and practice of this valuable skill.
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24
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Choi YJ, Jung JY, Kwon H. Effectiveness of education in point-of-care ultrasound-assisted physical examinations in an emergency department: A before-and-after study. Medicine (Baltimore) 2017. [PMID: 28640133 PMCID: PMC5484241 DOI: 10.1097/md.0000000000007269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Implementation of point-of-care ultrasonography (POCUS)-assisted physical examination (PE) in emergency departments (EDs) was conducted in the ED of an urban tertiary teaching hospital. This study examines the effect of POCUS implementation in emergency medicine departments by using a systematic education program on image acquisition to analyze decision making.Educating staff on POCUS involved a technique related to image acquisition and then accurately diagnosing subsequent POCUS results. The quasi-experimental, uncontrolled before-and-after study was performed to evaluate the education effect. POCUS orders for eligible patients, length of stay (LOS) in ED, and return visits (RVs) to ED between the "before" period (March 1, 2015 to February 28, 2016) and the "after" period (March 1, 2016 to February 28, 2017) were compared. Piecewise regression was used to assess trend differences of LOS and RVs between the periods.A total of 16,942 and 16,287 patients were included in the before and after periods of education, respectively. During the study periods, 966 (6%) and 2801 (18%) POCUS were ordered, respectively (rate difference = 12%; P < .001). Before the education, the median LOS was 6.55 (interquartile rage [IQR]: 6.2-6.75) and the trend slope of LOS was -0.01. After the education, the median LOS was 5.25 (IQR: 4.85-5.45) and the trend slope (the change of which was considered significant, at a P value of .012) was -0.15. Before the education, the median RV rate was 6.4% (IQR: 6.15-6.65) and the trend slope of RVs was -0.01. After the education, the median RVs was 5.25% (IQR: 4.95-5.35) and the trend slope of RVs was also significant, at -0.11.The education of POCUS-PE in ED successfully increased use of POCUS, and reduced the LOS and RV rate in ED.
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Affiliation(s)
- Yoo Jin Choi
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu, Seoul-si, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do
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Kobal SL, Lior Y, Ben-Sasson A, Liel-Cohen N, Galante O, Fuchs L. The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum. BMC MEDICAL EDUCATION 2017; 17:94. [PMID: 28558692 PMCID: PMC5450418 DOI: 10.1186/s12909-017-0928-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. METHODS Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students' proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. RESULTS Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. CONCLUSIONS Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies.
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Affiliation(s)
- Sergio L Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alon Ben-Sasson
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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26
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Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart 2017; 103:987-994. [PMID: 28259843 DOI: 10.1136/heartjnl-2016-309915] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/02/2017] [Indexed: 12/19/2022] Open
Abstract
The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis.
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Affiliation(s)
- Bruce J Kimura
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA.,Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, California, USA
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Steeds RP, Garbi M, Cardim N, Kasprzak JD, Sade E, Nihoyannopoulos P, Popescu BA, Stefanidis A, Cosyns B, Monaghan M, Aakhus S, Edvardsen T, Flachskampf F, Galiuto L, Athanassopoulos G, Lancellotti P, Delgado V, Donal E, Galderisi M, Lombardi M, Muraru D, Haugaa K. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017; 18:1191-1204. [DOI: 10.1093/ehjci/jew333] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Richard P. Steeds
- University Hospital Birmingham NHS Foundation Trust, Mindelsohn Road, Edgbaston, Birmingham, UK B15 2GW and Honorary Reader, Institute of Cardiovascular Sciences, University of Birmingham; UK
| | - Madalina Garbi
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS UK
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz Av. Lus죡, n° 100 - 1500-650, Lisbon, Portugal
| | - Jaroslaw D. Kasprzak
- Department of Cardiology, Bieganski Hospital Medical University of Lodz, Kniaziewicza 1/5, 91-347, Lodz, Poland
| | - Elif Sade
- Department of Cardiology, Baskent University School of Medicine, Fevzi ơkmak Cad. 10. Sok. Bahcelievler 06490 Ankara, Turkey
| | - Petros Nihoyannopoulos
- Imperial College London, NHLI Hammersmith Hospital, Du Cane Road, London W12 0NN, UK and University of Athens, Greece
| | - Bogdan Alexandru Popescu
- University of Medicine and Pharmacy “Carol Davila”–Euroecolab, Institute of Cardiovascular Diseases, Sos. Fundeni 258, sector 2, 022328, Bucharest, Romania
| | - Alexandros Stefanidis
- 1st Department of Cardiology, General Hospital of Nikea, 3 P. Mela str., 184 54, Athens, Greece
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten) Universitair Ziekenhuis, VUB, Laarbeeklaan 101, 1090 Jette, Brussel, Belgium
| | - Mark Monaghan
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS UK
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, postboks 4950 Nydalen, 0424 Oslo and Faculty of Medicine, Norwegian University of Science and Technology, NTNU, 7491 Trondheim
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, NO-0027 Oslo , Norway
| | - Frank Flachskampf
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Akademiska ingang 40, 751 85 Uppsala, Sweden
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Policlinico Agostino Gemelli, Largo A Gemelli 8, 00168 Roma, Italy
| | | | - Patrizio Lancellotti
- Departments of Cardiology, University of Lie`ge Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Lie‘ge, Belgium and Gruppo Villa Maria Care and Research, Anthea, Hospital, Bari, Italy
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Bhagra A, Tierney DM, Sekiguchi H, Soni NJ. Point-of-Care Ultrasonography for Primary Care Physicians and General Internists. Mayo Clin Proc 2016; 91:1811-1827. [PMID: 27825617 DOI: 10.1016/j.mayocp.2016.08.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/02/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.
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Affiliation(s)
- Anjali Bhagra
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - David M Tierney
- Abbott Northwestern Hospital, Medical Education Department, Minneapolis, MN
| | - Hiroshi Sekiguchi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nilam J Soni
- Section of Hospital Medicine, South Texas Veterans Health Care System and Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
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Kobal SL, Liel-Cohen N, Shimony S, Neuman Y, Konstantino Y, Dray EM, Horowitz I, Siegel RJ. Impact of Point-of-Care Ultrasound Examination on Triage of Patients With Suspected Cardiac Disease. Am J Cardiol 2016; 118:1583-1587. [PMID: 27634025 DOI: 10.1016/j.amjcard.2016.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
Complementing the physical examination with a point-of-care ultrasound study (POCUS) can improve patient triage. We aimed to study the impact of POCUS on the diagnosis and management of outpatients and hospitalized patients with suspected cardiac disease. In this multicenter study, a pocket-sized device was used to perform POCUS when the diagnosis or patient management was unclear based on anamnesis, physical examination, and basic diagnostic testing. Eighteen physicians (cardiac fellows 49%, cardiologists 30%, and echocardiographers 21%) performed physical examinations extended by POCUS on 207 patients (inpatients 83% and outpatients 17%). POCUS findings resulted in a change in the primary diagnosis in 14% of patients. In patients whose diagnosis remained unchanged, POCUS results reinforced the initial diagnosis in 48% of the cases. In 39% of the patients, the diagnostic plan was altered, including referral (16%) or deferral (23%) to other diagnostic techniques. Alteration in medical treatment (drug discontinuation or initiation) occurred in 11% of the patients, and in 7% POCUS results influenced the decision whether to perform a therapeutic procedure. Hospitalization or discharge was determined after POCUS in 11% of the patients. In conclusion, during patient triage, extension of the physical examination by POCUS can cause physicians to alter their initial diagnosis, resulting in an immediate change of diagnostic and therapeutic procedures. Based on POCUS results, physicians altered the diagnostic plan either by avoiding or referring patients to other diagnostic procedures in almost half of the studied population.
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Affiliation(s)
- Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarah Shimony
- Heart Institute, Kaplan Medical Center, Rehovot and Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Yoram Neuman
- Division of Cardiology, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yuval Konstantino
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Mazor Dray
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Horowitz
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert J Siegel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center and UCLA, Los Angeles, California.
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Cardiac Examination: Stethoscope or Pocket Echo-Why Not Both? Am J Med 2016; 129:649-50. [PMID: 26953062 DOI: 10.1016/j.amjmed.2016.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/23/2022]
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Seraphim A, Paschou SA, Grapsa J, Nihoyannopoulos P. Pocket-Sized Echocardiography Devices: One Stop Shop Service? J Cardiovasc Ultrasound 2016; 24:1-6. [PMID: 27081437 PMCID: PMC4828408 DOI: 10.4250/jcu.2016.24.1.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
The introduction of portable, pocket-sized echocardiography devices in various healthcare systems has raised new questions with regards to their realistic use in clinical practice. Several studies have already attempted to provide information regarding their safety and diagnostic potential, the training required to operate them, as well as their direct comparison with standard echocardiography machines. This manuscript is a review of the literature of the documents or position papers which employ the use of pocket or handheld devices. Following review of the literature, we suggest that these miniaturized devices can provide a valuable diagnostic tool that can complement and improve the diagnostic yield of clinical examination. When operated by appropriately trained professionals, they can provide a limited but very reliable echocardiographic assessment. Pocket-sized echocardiography is a part of physical examination and should not be considered a complete echocardiographic scan. Optimal training is required for the smooth operation of handheld echocardiography.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiovascular Sciences, Royal Brompton, London, United Kingdom
| | - Stavroula A Paschou
- Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Royal Brompton, London, United Kingdom.; Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
| | - Petros Nihoyannopoulos
- Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
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Gulič TG, Makuc J, Prosen G, Dinevski D. Pocket-size imaging device as a screening tool for aortic stenosis. Wien Klin Wochenschr 2015; 128:348-53. [PMID: 26659701 DOI: 10.1007/s00508-015-0904-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 11/18/2015] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to assess the usefulness of a pocket-size imaging device in the hands of a noncardiologist as a screening tool for diagnosing aortic stenosis in individuals with newly discovered systolic murmur. METHODS AND RESULTS A total of 200 consecutive patients with systolic murmur were included; a limited focused cardiac ultrasound was performed with a pocket-size imaging device and compared to standard echocardiography. It was performed by a noncardiologist with no formal training in echocardiography. In all, 150 patients had morphological changes on the aortic valve, 77 had more than mild aortic stenosis, 30 had more than mild mitral regurgitation, 64 patients had more than moderate hypertrophy, 113 had more than moderately enlarged left atriums, and 3 had severely enlarged left ventricles. There were no significant difference in recognizing severe changes between Vscan focused cardiac ultrasound and comprehensive echocardiography. CONCLUSION Pocket-size ultrasound imaging devices without continuous and pulse wave Doppler modalities can, even in the hands of a noncardiologist with limited cardiac ultrasound instructions with high sensitivity and specificity, be a useful tool for detecting more than mild aortic stenosis and more than mild mitral regurgitation. As such a focused cardiac ultrasound can be an extension of physical examinations for patients with newly discovered systolic murmur.
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Affiliation(s)
- Tatjana Golob Gulič
- Department of Cardiosurgery, University Clinical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Jana Makuc
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Gregor Prosen
- Center for Emergency Medicine, Community Health Center Maribor, Maribor, Slovenia
| | - Dejan Dinevski
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Adler AC, Greeley WJ, Conlin F, Feldman JM. Perioperative Anesthesiology UltraSonographic Evaluation (PAUSE): A Guided Approach to Perioperative Bedside Ultrasound. J Cardiothorac Vasc Anesth 2015; 30:521-9. [PMID: 27013122 DOI: 10.1053/j.jvca.2015.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - William J Greeley
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frederick Conlin
- Department of Anesthesiology, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA
| | - Jeffrey M Feldman
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology; The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Schiano-Lomoriello V, Esposito R, Santoro C, de Simone G, Galderisi M. Early markers of right heart involvement in regular smokers by Pocket Size Imaging Device. Cardiovasc Ultrasound 2015; 13:33. [PMID: 26201963 PMCID: PMC4511232 DOI: 10.1186/s12947-015-0024-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/23/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To test the diagnostic power of Pocket Size Imaging Device (PSID) in detecting early signs of right heart (RH) involvement in regular smokers (RS) free of overt cardiac involvement. METHODS One-hundred-forty-three regular smokers and 51 healthy controls, comparable for age and sex, underwent physical exam (PE), PSID exam and standard echocardiography. Based on a simplified Boston score, ≥1 of clinical signs (jugular venous distension, hepatomegaly, peripheral pitting oedema and abnormal pulmonary sounds) were considered indicative of RH involvement. A composite score (1 to 4) obtained by summing the points of four quantitative RH abnormalities detectable by PSID (inferior vena cava [IVC] dilatation, reduced IVC respiratory variation, right ventricular dilatation and right atrial dilatation), was generated and ≥1 of PSID abnormal signs was considered indicative of RH involvement. RESULTS Boston score was not significantly different between the two groups. By using PSID, smokers exhibited greater IVC diameter (p < 0.0001), right atrial diameter (p < 0.002) and higher PSID score (p < 0.005) than controls. Compared to PE, the additional diagnostic power of PSID (≥1 abnormal sign of both Boston and PSID score) was 44.9% in smokers. By dividing smokers in tertiles according to number of cigarettes per day, the third tertile showed the largest values of both IVC and right atrial dimension. Differences were confirmed by standard echocardiography. Reproducibility of PSID measurements and concordance of linear measurements between PSID and standard echo measurements was very good except for concordance of right ventricular basal diameter. CONCLUSIONS PSID detects early ultrasound signs of RH involvement in regular otherwise healthy smokers in comparison with PE.
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Affiliation(s)
- Vincenzo Schiano-Lomoriello
- Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Hypertension Research Center (CIRIAPA), Federico II University Hospital, Naples, Italy.
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S. Pansini 5,bld 1, Naples, 80131, Italy.
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PéREZ DE Isla LP, Moreno F, Garcia Saez JAG, Clavero M, Moreno N, Aguado DE LA Rosa CA, DE Agustin JA, Gomez DE Diego JJG, Cobos MA, Saltijeral A, Macaya C, Garcia-Fernandez MA. Efficacy and learning curve of a hand-held echocardiography device in an oncology outpatient clinic: Expanding the use of echoscopic heart examination beyond cardiology. Mol Clin Oncol 2015; 3:820-824. [PMID: 26171188 DOI: 10.3892/mco.2015.543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/20/2015] [Indexed: 11/05/2022] Open
Abstract
Certain chemotherapy drugs for breast cancer may induce cardiotoxicity and these patients should be echocardiographically monitored. The performance of a focused echocardiographic evaluation (echoscopy) at the patient's location by a non-cardiologist appears to be feasible. The aim of the present study was to assess the accuracy of echoscopy performed by medical oncologists in an outpatient clinic using hand-held echocardiography devices. The study cohort comprised consecutive unselected patients who attended an oncology outpatient clinic. Two medical oncologists attended a one-week training period, which included theoretical and practical teaching by an expert cardiologist. Every subject underwent two echo examinations. The first examination was performed by an oncologist using a hand-held echo device and the second was performed by a cardiologist using a 'premium' device. Out of the 101 enrolled patients, 32 were men (31.7%) and the mean age was 56.03±16.88 years. There was a good global agreement [intra-class correlation coefficient (ICC): 0.65 for left ventricular ejection fraction (LVEF)]. When the results were analyzed depending on the period of time when the echo studies were performed, a clear and short learning curve was observed: LVEF started at ICC=0.58 and increased to 0.66 and 0.77 in the second and third period, respectively. There were extremely few clinically significant differences and a learning curve was also evident. In conclusion, cardiac echoscopy performed by an oncologist with a hand-held device may lead to a similar clinical management as a study performed by an expert cardiologist with a 'premium' system in patients under chemotherapy following a short training period.
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Affiliation(s)
- Leopoldo Pérez PéREZ DE Isla
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | - Fernando Moreno
- Department of Oncology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | | | - Matias Clavero
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | - Nuno Moreno
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | | | - Jose Alberto DE Agustin
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | | | - Miguel Angel Cobos
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
| | | | - Carlos Macaya
- Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, 28040 Madrid, Spain
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Saxena A. Rheumatic heart disease screening by "point-of-care" echocardiography: an acceptable alternative in resource limited settings? Transl Pediatr 2015; 4:210-3. [PMID: 26835377 PMCID: PMC4729056 DOI: 10.3978/j.issn.2224-4336.2015.06.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rheumatic heart disease (RHD) is estimated to affect over 20 million people worldwide, the vast majority being in developing countries. Screening for RHD has been recommended by World Health Organization (WHO) since 2004. Conventionally, auscultation has been used for diagnosing RHD. Auscultation has its limitations and may not detect mild cases. With the evolution of portable echocardiographic systems, mass screening for subclinical RHD has become possible. Portable echo has the advantage of rapid access and hence screening in schools or communities is possible. Its cost is lower than that of standard echo equipment. A large number of studies have reported echocardiographic screening for RHD over the last decade or so. A 3-10 fold increase in prevalence of RHD has been detected by using portable echo when compared with conventional method of auscultation. More recently, a small, compact, easy to carry in a pocket, hand held system has been introduced which is much cheaper than the conventional portable system. A few previous reports have shown the feasibility of using hand held echo system for diagnosis of various cardiac diseases. A recently published article has shown that the hand held system can be used to screen for RHD. It is more sensitive than the conventional auscultation for RHD. Authors of this report have concluded that screening with the hand held device may be a more cost effective strategy for screening for RHD in resource limited settings, since it is much cheaper than the portable echocardiography equipment.
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Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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López-Palmero S, Bolivar-Herrera N, López-Lloret G, Merchán-Ortega G, Macancela-Quiñones J, López-Martínez G. Diagnostic utility of handheld ultrasonography as an extension of the physical examination of patients with heart failure. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rceng.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Utilidad diagnóstica de la ecografía de bolsillo en la insuficiencia cardiaca. Rev Clin Esp 2015; 215:204-10. [DOI: 10.1016/j.rce.2015.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/11/2014] [Accepted: 01/24/2015] [Indexed: 11/17/2022]
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Godown J, Lu JC, Beaton A, Sable C, Mirembe G, Sanya R, Aliku T, Yu S, Lwabi P, Webb CL, Ensing GJ. Handheld echocardiography versus auscultation for detection of rheumatic heart disease. Pediatrics 2015; 135:e939-44. [PMID: 25780068 DOI: 10.1542/peds.2014-2774] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a major public health concern in developing countries, and routine screening has the potential to improve outcomes. Standard portable echocardiography (STAND) is far more sensitive than auscultation for the detection of RHD but remains cost-prohibitive in resource-limited settings. Handheld echocardiography (HAND) is a lower-cost alternative. The purpose of this study was to assess the incremental value of HAND over auscultation to identify RHD. METHODS RHD screening was completed for schoolchildren in Gulu, Uganda, by using STAND performed by experienced echocardiographers. Any child with mitral or aortic regurgitation or stenosis plus a randomly selected group of children with normal STAND findings underwent HAND and auscultation. STAND and HAND studies were interpreted by 6 experienced cardiologists using the 2012 World Heart Federation criteria. Sensitivity and specificity of HAND and auscultation for the detection of RHD and pathologic mitral or aortic regurgitation were calculated by using STAND as the gold standard. RESULTS Of 4773 children who underwent screening with STAND, a subgroup of 1317 children underwent HAND and auscultation. Auscultation had uniformly poor sensitivity for the detection of RHD or valve disease. Sensitivity was significantly improved by using HAND compared with auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%). CONCLUSIONS Auscultation alone is a poor screening test for RHD. HAND significantly improves detection of RHD and may be a cost-effective screening strategy for RHD in resource-limited settings.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee;
| | - Jimmy C Lu
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Andrea Beaton
- Division of Pediatric Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Craig Sable
- Division of Pediatric Cardiology, Children's National Medical Center, Washington, District of Columbia
| | | | | | | | - Sunkyung Yu
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Catherine L Webb
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Gregory J Ensing
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Sobczyk D, Nycz K, Andruszkiewicz P. Validity of a 5-minute focused echocardiography with A-F mnemonic performed by non-echocardiographers in the management of patients with acute chest pain. Cardiovasc Ultrasound 2015; 13:16. [PMID: 25880201 PMCID: PMC4377191 DOI: 10.1186/s12947-015-0010-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/17/2015] [Indexed: 11/22/2022] Open
Abstract
Study objective To validate the practicality of focused echocardiography with A-F mnemonic performed by non-specialists in patients with suspected acute coronary syndrome (ACS). Design This prospective observational study was conducted in the Emergency Room within 12 months period. Study population consisted of consecutive patients with preliminary diagnosis of an ACS. The following data were analyzed: demographics, clinical condition, medical history, ECG, transthoracic echocardiography (TTE) and levels of cardiac necrotic markers. TTE was performed within the first 15 minutes after the admission by the resident on-call. TTE images were interpreted and reported with mnemonic A-F. All studies were recorded and reviewed within 24 hours by the cardiologist. Results 1312 consecutive patients were enrolled to the study. TTE with A-F mnemonic revealed: RWMAs in 82,87% patients with confirmed ACS, other significant cardiac pathologies were found in 2,21% in ACS and 46,52% in non-ACS groups respectively. On the basis of these findings, 20 (1,92%) ACS and 29 (10,62%) non-ACS group patients underwent target operative treatment. Survey showed that both echocardiographic image acquisition and its interpretation with A-F mnemonic, took less than 5 minutes in 95% of cases. Residents found A-F mnemonic algorithm simple and useful. No differences were found in key findings between TTE performed by resident and the cardiologist. Conclusion Focused echocardiography with A-F mnemonic allows both confirmation of acute myocardial ischemia and detection of the other life-threatening cardiac conditions resulting in proper bedside decision of directed treatment. Mnemonic based TTE enables reliable examination by properly trained residents.
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Affiliation(s)
- Dorota Sobczyk
- The Department of Interventional Cardiology, John Paul 2nd Hospital, Pradnicka 80, 31 202, Cracow, Poland.
| | - Krzysztof Nycz
- The Department of Interventional Cardiology, John Paul 2nd Hospital, Pradnicka 80, 31 202, Cracow, Poland.
| | - Pawel Andruszkiewicz
- 2nd Clinic of Anaesthesiology and Intensive Care, Warsaw Medical University, Warszawa, Poland.
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Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. RESULTS During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. CONCLUSIONS This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
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Kaul S. VIEWS FROM THE MASTERS: Pocket ultrasound devices: time to discard the stethoscope? Echo Res Pract 2014; 1:E7-8. [PMID: 26693305 PMCID: PMC4676485 DOI: 10.1530/erp-14-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 08/28/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute, UHN-62, Oregon Health and Science University , 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239 , USA
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Handheld Ultrasound Versus Physical Examination in Patients Referred for Transthoracic Echocardiography for a Suspected Cardiac Condition. JACC Cardiovasc Imaging 2014; 7:983-90. [DOI: 10.1016/j.jcmg.2014.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 11/22/2022]
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Guppy-Coles KB, Prasad SB, Smith KC, Hillier S, Lo A, Atherton JJ. Evaluation of training nurses to perform semi-automated three-dimensional left ventricular ejection fraction using a customised workstation-based training protocol. J Clin Nurs 2014; 24:1479-88. [DOI: 10.1111/jocn.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Kristyan B Guppy-Coles
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
| | - Sandhir B Prasad
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
- Mater Adult Hospital; Brisbane Qld Australia
| | - Kym C Smith
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Samuel Hillier
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Ada Lo
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - John J Atherton
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
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Woo JSL, Magotti R, Benzie R. A futuristic vision of pocket ultrasound machines: watch this space. Australas J Ultrasound Med 2014; 17:110-112. [PMID: 28191219 PMCID: PMC5024944 DOI: 10.1002/j.2205-0140.2014.tb00025.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Australian medical ultrasound started in 1959 with the establishment of the Ultrasonics Institute. Since then the technology has advanced tremendously. We are now not only able to obtain clearer images on high specification ultrasound machines but also on pocket-sized ultrasound machines that are compact, lightweight and affordable. Method: The following descriptive review will examine the indication for use of pocket ultrasound machines in different clinical settings as well as provide evidence of its image clarity and accuracy. Potentially eligible studies were sought primarily through searches of the electronic databases PubMed, Medline (1996-Present), Embase (1996-Present) and Cochrane Library. Conclusion: Pocket ultrasound machines, with appropriate ultrasound knowledge and training, can be incorporated successfully in patient management. The addition of point-of-care ultrasound has been shown to improve management recommendations and outcomes.
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Affiliation(s)
- Joyce Su Ling Woo
- Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales Australia
| | - Robert Magotti
- Christopher Kohlenberg Department of Perinatal UltrasoundNepean HospitalPenrithNew South WalesAustralia; Sydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia
| | - Ronald Benzie
- Christopher Kohlenberg Department of Perinatal UltrasoundNepean HospitalPenrithNew South WalesAustralia; Sydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia
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Torrazza RM, Chandran A, Co-Vu J, DeGroff C. Pocket echocardiography system for detection of patent ductus arteriosus in neonates. Echocardiography 2014; 32:319-24. [PMID: 24919825 DOI: 10.1111/echo.12656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neonates are commonly referred for a cardiology consult and an echocardiogram to rule out patent ductus arteriosus (PDA). OBJECTIVES Evaluate the usefulness of current pocket echocardiography system (PES) in PDA detection compared to traditional full-featured echo system (FFES). HYPOTHESIS The determination of the presence of a PDA in neonates can be done using PES. METHODS Fifty newborns with orders for echo evaluation were included in this study. A 5-minute PES scan was performed first. Then a full echo study was performed on a traditional FFES. Images were evaluated by three pediatric cardiologists blinded to the patients and the FFES results. RESULTS The overall accuracy of reviewers rating PES versus FFES to rule in PDA had low false-positive rates 9.5% (95% CI: 1.2-30%), 11.8% (95% CI: 1.5-36%), 11.1% (95% CI: 1.4-35%) and the false-negative rate to rule out PDA was 0% (95% CI: 0-18%), 5.5% (95% CI: 0.14-27%), 0% (95% CI: 0-26%) for each reviewer 1, 2, and 3, respectively. Upon further analysis, PES scan was shown not to be accurate on infants with body weight below 1000 g with encouraging results for infants above 1000 g and those >37 weeks gestational age. CONCLUSIONS Our results suggest that the current PES could potentially be used in larger and near-term infants but has less than acceptable performance in low birth weight and premature infants in determining who should undergo a FFES study for persistent PDA diagnosis. Improvements in the technology along with developing limited training protocols for noncardiology personnel should make it possible for PES scan to be used as a screening tool and as an extension of physical examination especially in limited resource settings.
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Affiliation(s)
- Roberto Murgas Torrazza
- Department of Pediatrics/Division of Neonatology, University of Florida, Gainesville, Florida
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Cullen MW, Blauwet LA, Vatury OM, Mulvagh SL, Behrenbeck TR, Scott CG, Pellikka PA. Diagnostic capability of comprehensive handheld vs transthoracic echocardiography. Mayo Clin Proc 2014; 89:790-8. [PMID: 24684783 PMCID: PMC4082693 DOI: 10.1016/j.mayocp.2013.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers. PATIENTS AND METHODS We conducted a prospective study of adult outpatients undergoing comprehensive TTE between July 9, 2012, and April 3, 2013. Experienced sonographers performed a detailed, standardized examination using a handheld ultrasound device that included 2-dimensional and color Doppler images from standard imaging windows. Images from TTE and HHE were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed. RESULTS The study group contained 190 patients (mean ± SD age, 62 ± 17 years; 49% male [n=93]). The κ values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings. CONCLUSION In experienced hands, HHE shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. Even when performed and interpreted by experienced operators, HHE should not be used as a surrogate for standard TTE. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01558518.
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Affiliation(s)
| | - Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ori M Vatury
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Pocket-size echocardiograph--a valuable tool for nonexperts or just a portable device for echocardiographers? Adv Med Sci 2014; 58:67-72. [PMID: 23612676 DOI: 10.2478/v10039-012-0054-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The diagnostic value of examinations performed with the use of pocket-size echocardiograph by medical professionals with different levels of experience remains to be determined. The aim of this study was to assess the diagnostic value of bedside echocardiographic examinations performed with the use of pocket-size echocardiograph by experienced cardiologist and medical students. MATERIAL/METHODS The study group comprised 90 patients (63 men, 27 women; mean age 64±14 years) admitted to the cardiac intensive care unit and 30 patients from an out-patient clinic (21 men, 9 women; mean age 62±17 years). All patients underwent bedside echocardiographic examination performed with pocket-size echocardiograph by two briefly trained medical students (n=90 patients) or cardiologist (n=30 patients). Major findings were recorded using a simplified questionnaire. Within 24 hours standard echocardiographic examination was performed in all patients by another cardiologist using a full sized echocardiograph. The study group was divided into 4 subgroups: A / B - first / second half of in-patients examined by students, group C - inpatients examined by cardiologist, group D- out-patients examined by students. RESULTS The agreement between standard transthoracic echocardiography (sTTE) and major findings on bedside transthoracic echocardiography (bTTE) was fair to moderate (kappa 0.293-0.57) in group A, moderate to very good (kappa 0.535-1.00) in group B, good to very good (kappa 0.734-1.00) in group C and moderate to very good (kappa 0.590-1.00) in group D. CONCLUSIONS Pocket-size echocardiograph enables an expert echocardiographer to perform reliable bedside examinations. When used by briefly trained medical students it provides an acceptable diagnostic value with notable learning curve effect.
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Kaul S. Is it Time to Replace Physical Examination with a Hand-Held Ultrasound Device? J Cardiovasc Echogr 2014; 24:97-102. [PMID: 28465916 PMCID: PMC5353562 DOI: 10.4103/2211-4122.147199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Attempts at using physical examination (PE) go back centuries, with inspection, palpation, and percussion being the mainstay of this approach until 2 centuries ago when the stethoscope was invented and auscultation became probably the most important element of PE for patients with known or suspected cardiovascular disease (CVD). Despite its several limitations, PE is still used, sometimes as the only means, of evaluating and following patients with CVD. In this paper I shall argue for the substitution of this inaccurate and archaic approach by direct visualization of the heart using a hand-held ultrasound (HHU) device. I am not in any way suggesting the substitution of a comprehensive echocardiographic examination by an expert sonographer/echocardiographer by HHU in patients with significant CVD. Instead, I am arguing for the replacement of PE for evaluation of the heart at the point of care as well as at the bedside, simply because HHU is more accurate and provides more meaningful information.
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Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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50
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Roelandt JRTC. The decline of our physical examination skills: is echocardiography to blame? Eur Heart J Cardiovasc Imaging 2013; 15:249-52. [PMID: 24282219 DOI: 10.1093/ehjci/jet195] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- J R T C Roelandt
- Thoraxcenter, Erasmus Medical Center, Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
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