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Friedmann I, McNamara PJ, Bhattacharya S, Cheng A. Educational Impact of Targeted Neonatal Echocardiography and Hemodynamics Programs on Neonatal-Perinatal Medicine Fellows. Am J Perinatol 2024; 41:e148-e155. [PMID: 35554888 DOI: 10.1055/a-1850-3358] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Targeted neonatal echocardiography (TNE) is a real-time cardiac imaging modality used by a hemodynamics program to aid in diagnosis, treatment, and monitoring of neonatal cardiovascular illness. This study aimed to describe trainees' perspectives on existing hemodynamics education and perceived impacts of TNE and hemodynamics services on their education. STUDY DESIGN This was a mixed quantitative and qualitative study that surveyed neonatal-perinatal medicine (NPM) fellow trainees in Canada and the United States, at programs both with and without a hemodynamics service. RESULTS Ninety-two fellows responded to the survey, of whom 24 (26%) were enrolled in a program with an active hemodynamics service, 64 (70%) were training at a program without a hemodynamics service, and 4 (4%) were unsure. Trainees at centers with a hemodynamics service were more satisfied with their cardiovascular physiology education (91 vs. 69%, p = 0.040). Twenty-five percent of all trainees felt they do not have sufficient hemodynamics training to prepare them for independent practice. Areas of knowledge gaps were identified. Bedside teaching combined with didactic teaching was identified as useful means of teaching. CONCLUSION Most trainees believed that TNE and a hemodynamics service are valuable educational assets. Thoughtful curriculum design for real-time and consolidation learning, with specific emphasis on content gaps, should be considered. KEY POINTS · NPM Fellows perceive TNE & Neonatal Hemodynamics service as a valuable educational opportunity.. · Incorporation of TNE/Hemodynamics teaching into NPM curriculum can enrich trainee experience.. · Combining bedside and classroom teaching is key to successful cardiovascular training..
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Affiliation(s)
- Isabel Friedmann
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J McNamara
- Division of Neonatology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Soume Bhattacharya
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Program, London, Ontario, Canada
| | - Anita Cheng
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Division of Neonatal-Perinatal Medicine, Department of Paediatrics, London Health Sciences Program, London, Ontario, Canada
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Abstract
Background: Focused cardiac ultrasound (FCU) is widely used by healthcare providers to answer specific questions about cardiac structure and function at the bedside. Currently, no widely accepted FCU image acquisition checklist exists to assess learners with varying skill levels from different specialties. Objective: The primary objective of this project was to develop a consensus-based FCU image acquisition checklist using a multispecialty group of point-of-care ultrasound (POCUS) experts. Methods: The essential components of an FCU examination were identified on the basis of published recommendations from echocardiography and international ultrasound societies. A checklist of the essential components of an FCU examination was drafted. A panel of POCUS experts from different medical specialties in the United States and Canada was convened to vote on each checklist item by answering two questions: 1) Is this item important to include in a checklist of essential FCU skills applicable to any medical specialty? and 2) Should the learner be required to successfully complete this item to be considered competent? A modified Delphi approach was used to assess the level of agreement for each checklist item during four rounds of voting. Checklist items that achieved an agreement of 80% or greater were included in the final checklist. Results: Thirty-one POCUS experts from seven different medical specialties voted on sixty-five items to be included in the FCU image acquisition assessment tool. The majority of POCUS experts (61%) completed all four rounds of voting. During the first round of voting, 59 items reached consensus, and after revision and revoting, an additional 3 items achieved 80% or greater consensus. A total of 62 items were included in the final checklist, and 57 items reached consensus as a requirement for demonstration of competency. Conclusion: We have developed a multispecialty, consensus-based FCU image acquisition checklist that may be used to assess the skills of learners from different specialties. Future steps include studies to develop additional validity evidence for the use of the FCU assessment tool and to evaluate its utility for the translation of skills into clinical practice.
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Stephen VS, Wells M. Technically Adequate Images for Preparticipation Screening Echocardiography Can Be Obtained by Novices After a Single Day of Training. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3015-3023. [PMID: 30985021 DOI: 10.1002/jum.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Echocardiography-naïve physicians were trained in a 1-day course to determine whether they could obtain images adequate for preparticipation screening in athletes. METHODS Twenty-six physicians with no previous experience in echocardiography were trained to perform preparticipation screening echocardiography during a 6-hour course. Each image was rated for its technical quality on a diagnostic adequacy score. The time taken to perform the images was also evaluated. RESULTS The images obtained a median score of 3 (interquartile range, 2-4), which was considered adequate for preparticipation screening. Video clips achieved a higher rating than the still images, with a median score of 4 (interquartile range, 3-4). The best-performing 50% of the participants obtained adequate images for screening 95% of the time after the initial training. Considering the group overall, 79.2% of all video clips were adequate. The median time to perform the scans was 39 seconds. The correlation between the time and adequacy score showed that the quickest novices were also able to obtain the best images. CONCLUSIONS It is feasible to use novice sonographers to perform preparticipation screening echocardiography provided that the skill of the candidates is assessed after training, and competent individuals are selected. Video images should be used rather than still images.
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Affiliation(s)
- Victoria Sarah Stephen
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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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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A Review of Echocardiography Training for Internal Medicine Residents: Proposed Goals, Methods, and Metrics. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thoenes M, Bramlage P, Zamorano P, Messika-Zeitoun D, Wendt D, Kasel M, Kurucova J, Steeds RP. Patient screening for early detection of aortic stenosis (AS)-review of current practice and future perspectives. J Thorac Dis 2018; 10:5584-5594. [PMID: 30416809 DOI: 10.21037/jtd.2018.09.02] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In Europe, approximately one million people over 75 years suffer from severe aortic stenosis (AS), one of the most serious and most common valve diseases, and this disease burden is increasing with the aging population. A diagnosis of severe symptomatic AS is associated with an average life expectancy of 2-3 years and necessitates a timely valve intervention. Guidelines for valve replacement therapy have been established but only a proportion of patients with symptomatic AS actually receive this life-saving treatment. The decision for valve intervention in asymptomatic patients with severe AS is often more challenging and likely results in fewer patients receiving treatment in comparison to their symptomatic counterparts. This article reviews the epidemiology and clinical manifestations of AS, the associated economic burden of AS to the healthcare system, the diagnosis of AS and the possible mechanisms for the introduction of routine screening in elderly patients. Elderly patients typically visit healthcare providers more frequently than younger patients, thereby providing increased opportunities for ad hoc AS screening and this, along with raising patient awareness of the symptoms of AS, has the potential to result in the earlier diagnosis and treatment of AS and increased patient survival.
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Affiliation(s)
- Martin Thoenes
- Léman Research Institute, Schaffhausen am Rheinfall, Switzerland.,Edwards Lifesciences, Nyon, Switzerland
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Daniel Wendt
- Klinik für Thorax- und Kardiovaskuläre Chirurgie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Essen, Germany
| | | | | | - Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Vakily A, Parsaei H, Movahhedi MM, Sahmeddini MA. A System for Continuous Estimating and Monitoring Cardiac Output via Arterial Waveform Analysis. J Biomed Phys Eng 2017; 7:181-190. [PMID: 28580340 PMCID: PMC5447255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/08/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cardiac output (CO) is the total volume of blood pumped by the heart per minute and is a function of heart rate and stroke volume. CO is one of the most important parameters for monitoring cardiac function, estimating global oxygen delivery and understanding the causes of high blood pressure. Hence, measuring CO has always been a matter of interest to researchers and clinicians. Several methods have been developed for this purpose, but a majority of them are either invasive, too expensive or need special expertise and experience. Besides, they are not usually risk free and have consequences. OBJECTIVE Here, a semi-invasive system was designed and developed for continuous CO measurement via analyzing and processing arterial pulse waves. RESULTS Quantitative evaluation of developed CO estimation system was performed using 7 signals. It showed that it has an acceptable average error of (6.5%) in estimating CO. In addition, this system has the ability to consistently estimate this parameter and to provide a CO versus time curve that assists in tracking changes of CO. Moreover, the system provides such curve for systolic blood pressure, diastolic blood pressure, average blood pressure, heart rate and stroke volume. CONCLUSION Evaluation of the results showed that the developed system is capable of accurately estimating CO. The curves which the system provides for important parameters may be valuable in monitoring hemodynamic status of high-risk surgical patients and critically ill patients in Intensive Care Units (ICU). Therefore, it could be a suitable system for monitoring hemodynamic status of critically ill patients.
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Affiliation(s)
- A Vakily
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Parsaei
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M M Movahhedi
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M A Sahmeddini
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Dinh VA, Fu JY, Lu S, Chiem A, Fox JC, Blaivas M. Integration of Ultrasound in Medical Education at United States Medical Schools: A National Survey of Directors' Experiences. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:413-419. [PMID: 26782166 DOI: 10.7863/ultra.15.05073] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the implementation of such curricula in medical schools. No studies to date have surveyed individuals who are successfully championing USMED programs. This study aimed to investigate the experiences with ultrasound integration as perceived by active USMED directors across the United States. METHODS In 2014, all allopathic and osteopathic medical schools in the United States were contacted regarding their status with ultrasound education. For schools with required point-of-care ultrasound curricula, we identified the USMED directors in charge of the ultrasound programs and sent them a 27-question survey. The survey included background information about the directors, ultrasound program details, the barriers directors faced toward implementation, and the directors' attitudes toward ultrasound education. RESULTS One-hundred seventy-three medical schools were contacted, and 48 (27.7%) reported having a formal USMED curriculum. Thirty-six USMED directors responded to the survey. The average number of years of USMED curriculum integration was 2.8 years (SD, 2.9). Mandatory ultrasound curricula had most commonly been implemented into years 1 and 2 of medical school (71.4% and 62.9%, respectively). The most common barriers faced by these directors when implementing their ultrasound programs were the lack of funding for faculty/ equipment (52.9%) and lack of time in current medical curricula (50.0%). CONCLUSIONS Financial commitments and the full schedules of medical schools are the current prevailing roadblocks to implementation of ultrasound education. Experiences drawn from current USMED directors in this study may be used to help programs starting their own curricula.
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Affiliation(s)
- Vi Am Dinh
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.).
| | - Jasmine Y Fu
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.)
| | - Samantha Lu
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.)
| | - Alan Chiem
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.)
| | - J Christian Fox
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.)
| | - Michael Blaivas
- Department of Emergency Medicine and Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda, California USA (V.A.D.); School of Medicine, Loma Linda University, Loma Linda, California USA (J.Y.F., S.L.); Department of Emergency Medicine, University of California, Los Angeles, California (A.C.); Department of Emergency Medicine, University of California, Irvine, California (J.C.F.); and Department of Medicine, University of South Carolina, Columbia, South Carolina USA (M.B.)
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Xie JX, Shaw LJ. Creating Opportunities to Guide Efficient and Cost-Effective Echocardiography in the Era of Value-Based Cardiac Imaging. J Am Soc Echocardiogr 2015; 28:1060-1. [DOI: 10.1016/j.echo.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nelson BP, Sanghvi A. Point-of-Care Cardiac Ultrasound: Feasibility of Performance by Noncardiologists. Glob Heart 2015; 8:293-7. [PMID: 25690629 DOI: 10.1016/j.gheart.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Cardiac ultrasound has been used for decades to assess a wide variety of structural and functional pathology, as well as to monitor response to therapy. It offers the advantages of noninvasive, real-time dynamic functional assessment without the risk of radiation. Cardiologists have traditionally employed this modality and have established robust guidelines on the use of echocardiography. However, other specialties such as emergency medicine and critical care have realized the benefit of cardiac ultrasound and have established specialty guidelines in its use. There is growing evidence for the benefit of cardiac ultrasound at the point of care on hospital wards, clinics, and even pre-hospital environments as well. The pervasive use of focused ultrasound is perhaps most evident in the advent of ultrasound training in undergraduate medical curricula. This paper reviews some of the key literature on the use of focused, point-of-care ultrasound by noncardiologists. Feasibility, clinical utility, and emerging trends are reviewed.
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Affiliation(s)
- Bret P Nelson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Amy Sanghvi
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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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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Mozzini C, Garbin U, Fratta Pasini AM, Cominacini L. Short training in focused cardiac ultrasound in an Internal Medicine department: what realistic skill targets could be achieved? Intern Emerg Med 2015; 10:73-80. [PMID: 25492052 DOI: 10.1007/s11739-014-1167-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/27/2014] [Indexed: 12/21/2022]
Abstract
The importance of focused cardiac ultrasound (FCU) in Internal Medicine care has been recognized by the American Society of Echocardiography. The aim of this study was to test what realistic skill targets could be achieved in FCU, with a relatively short training (theoretical and practical) of 9 h offered to Internal Medicine certification board attending students, and if the addition of further 9 h of training could significantly improve the level of competence. Kappa statistic was used to calculate the inter-observer agreement (trainees/tutor). The agreement between the trainees (who completed the entire training) and the tutor was, respectively, "substantial" (k = 0.71) for the identification of pericardial effusion, "moderate" (k = 0.56-0.54) for the identification of marked right ventricular and left ventricular enlargement, "substantial" (k = 0.77) for the assessment of global cardiac systolic function by visual inspection and "fair" (k = 0.35) for the assessment of size and respiratory change in the diameter of the inferior cave vein (IVC). 18 h training in FCU provided proficiency in obtaining adequate images from the parasternal window without providing the ability to correctly master the apical and subcostal windows. As concerns the interpretative skills, only pericardial effusion and visual estimation of global systolic function could be correctly identified, while ventricular enlargement and IVC prove to be more difficult to evaluate. This study supports incorporating FCU into Internal Medicine fellowship training programs, and should facilitate the design of other similar training courses.
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Affiliation(s)
- Chiara Mozzini
- Section of Internal Medicine, Department of Medicine, University of Verona, 10, Piazzale L.A. Scuro, 37134, Verona, Italy,
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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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Jozwiak M, Monnet X, Cinotti R, Bontemps F, Reignier J, Belliard G. Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients. Ann Intensive Care 2014; 4:12. [PMID: 25097797 PMCID: PMC4113285 DOI: 10.1186/2110-5820-4-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/07/2014] [Indexed: 11/20/2022] Open
Abstract
Background We studied a score for assessing basic transthoracic echocardiography (TTE) skills exhibited by residents who examined critically ill patients receiving mechanical ventilation. Methods We conducted a prospective study in the 16 residents who worked in our medical-surgical ICU between 1 May 2008 and 1 November 2009. The residents received theoretical teaching (two hours) then performed supervised TTEs during their six-month rotation. Their basic TTE skills in mechanically ventilated patients were evaluated after one (M1), three (M3), and six (M6) months by two experts, who used a scoring system devised for the study. After scoring, residents gave their hemodynamic diagnosis and suggested a treatment. Results The 4 residents with previous TTE skills obtained a significantly higher total score than did the 12 novices at M1 (18 (16 to 19) versus 13 (10 to 15), respectively, P = 0.03). In the novices, the total score increased significantly during training (M1, 13 (10 to 14); M3, 15 (12 to 16); and M6, 17 (15 to 18); P < 0.001) and correlated significantly with the number of supervised TTEs (r = 0.68, P < 0.0001). In the overall population, agreement with experts regarding the diagnosis and treatment was associated with a significantly higher total score (17 (16 to 18) versus 13 (12 to 16), P = 0.002). A total score ≥ 19/20 points had 100% specificity (95% confidence interval, 79 to 100%) for full agreement with the experts regarding the diagnosis and treatment. Conclusions Our results validate the scoring system developed for our study of the assessment of basic critical-care TTE skills in residents.
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Affiliation(s)
- Mathieu Jozwiak
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Xavier Monnet
- AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre F-94270, France ; Faculté de Médecine Paris-Sud, Université Paris-Sud, EA4533, Le Kremlin-Bicêtre F-94270, France
| | - Raphaël Cinotti
- Centre Hospitalo-Universitaire Guillaume et René Laennec, service de réanimation chirurgicale, Nantes F-44000, France
| | - Fréderic Bontemps
- Centre Hospitalier Côte de Lumière, service de médecine polyvalente, Les Sables d'Olonne F-85100, France
| | - Jean Reignier
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Guillaume Belliard
- Centre Hospitalier Bretagne Sud Lorient, service de réanimation médicale, Lorient F-56100, France
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Noriega O, Ho H, Wright J. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10009-1340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, this reliable diagnostic instrument has started showing its age with the arrival of a newer diagnostic instrument: the hand-held ultrasound.
Hand-held ultrasound is rapidly expanding in many specialties but not yet in obstetrics and gynecology. There is a paucity of literature on the application of hand-held ultrasound in obstetrics and gynecology, in contrast to a large volume of literature published by other specialties. Several studies demonstrated that medical students and residents can improve the accuracy of their physical examinations with the use of hand-held ultrasound. Similarly, physical examinations performed by hospitalists with hand-carried ultrasound are more accurate than those performed without the instrument. Advances in technology have contributed to the improvement of image quality and portability. As a result, these devices become increasingly available in many clinical settings such as point of care, telemedicine and rural medicine. The quality of ultrasound images of the hand-held scanner is inferior to those of standard laptop ultrasound. However, the hand-held ultrasound requires much less time for setup.
Although there have been recommendations for training guidelines for operators of hand-held ultrasound, standards for optimal training to achieve level of competency have not been determined.
How to cite this article
Wright J, Noriega O, Ho H. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. Donald School J Ultrasound Obstet Gynecol 2014;8(1):87-91.
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Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:567-81. [DOI: 10.1016/j.echo.2013.04.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abu-Zidan FM. Point-of-care ultrasound in critically ill patients: Where do we stand? J Emerg Trauma Shock 2012; 5:70-1. [PMID: 22416159 PMCID: PMC3299159 DOI: 10.4103/0974-2700.93120] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 05/17/2011] [Indexed: 12/15/2022] Open
Abstract
Experience over the last 25 years has shown that point-of-care ultrasound is a very useful tool when used by nonradiologists. Its value will be optimized by understanding its limitations and by adopting a focused binary decision making approach to answer specific questions without going into detailed radiological studies. Point-of-care ultrasound became an extension of the clinical examination. There are extensive efforts trying to design low-cost portable ultrasound systems by changing the transducer design, the transmission and reception circuitry needs, or the beam forming algorithms which may lead to horizontal expansion of the use of reliable non expensive portable ultrasound machines. The successful story of using ultrasound by nonradiologists, the advanced technology, and the refinement of the educational methods will encourage future clinicians to use ultrasound in their domains.
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Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, Faculty of Medicine and Health Sciences, UAE University, United Arab Emirates
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19
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Panoulas VF, Daigeler AL, Malaweera AS, Lota AS, Baskaran D, Rahman S, Nihoyannopoulos P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. ACTA ACUST UNITED AC 2012; 14:323-30. [DOI: 10.1093/ehjci/jes140] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Ecocardiografía clínica básica en Medicina Interna. Rev Clin Esp 2012; 212:141-6. [DOI: 10.1016/j.rce.2011.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/15/2011] [Accepted: 09/18/2011] [Indexed: 11/20/2022]
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Bauman KA, Hyzy RC. ICU 2020: five interventions to revolutionize quality of care in the ICU. J Intensive Care Med 2012; 29:13-21. [PMID: 22328598 DOI: 10.1177/0885066611434399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Intensive care units (ICUs) are an essential and unique component of modern medicine. The number of critically ill individuals, complexity of illness, and cost of care continue to increase with time. In order to meet future demands, maintain quality, and minimize medical errors, intensivists will need to look beyond traditional medical practice, seeking lessons on quality assurance from industry and aviation. Intensivists will be challenged to keep pace with rapidly advancing information technology and its diverse roles in ICU care delivery. Modern ICU quality improvement initiatives include ensuring evidence-based best practice, participation in multicenter ICU collaborations, employing state-of-the-art information technology, providing point-of-care diagnostic testing, and efficient organization of ICU care delivery. This article demonstrates that each of these initiatives has the potential to revolutionize the quality of future ICU care in the United States.
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Affiliation(s)
- Kristy A Bauman
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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22
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Arienti V, Camaggi V. Clinical applications of bedside ultrasonography in internal and emergency medicine. Intern Emerg Med 2011; 6:195-201. [PMID: 20680519 DOI: 10.1007/s11739-010-0424-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 06/16/2010] [Indexed: 11/26/2022]
Abstract
Ultrasonography (US) is an invaluable tool in the management of many types of patients in Internal Medicine and Emergency Departments, as it provides rapid, detailed information regarding abdominal organs and the cardiovascular system, and facilitates the assessment and safe drainage of pleural or intra-abdominal fluid and placement of central venous catheters. Bedside US is a common practice in Emergency Departments, Internal Medicine Departments and Intensive Care Units. US performed by clinicians is an excellent risk reducing tool, shortening the time to definitive therapy, and decreasing the rate of complications from blind invasive procedures. US can be performed at different levels of practice in Internal Medicine, according to the experience of ultrasound practitioners and equipment availability. In this review, the indications for bedside US that can be performed with basic or intermediate US training will be highlighted.
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Affiliation(s)
- Vincenzo Arienti
- Department of Internal Medicine, Maggiore Hospital, Largo B. Nigrisoli 2, 40133, Bologna, Italy
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Lipczyńska M, Szymański P, Klisiewicz A, Hoffman P. Hand-Carried Echocardiography in Heart Failure and Heart Failure Risk Population: A Community Based Prospective Study. J Am Soc Echocardiogr 2011; 24:125-31. [DOI: 10.1016/j.echo.2010.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 11/28/2022]
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Affiliation(s)
- Andy Potter
- Bedford Hospital NHS Trust, Bedford MK42 9DJ
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26
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Doniger SJ. Bedside emergency cardiac ultrasound in children. J Emerg Trauma Shock 2010; 3:282-91. [PMID: 20930974 PMCID: PMC2938495 DOI: 10.4103/0974-2700.66535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 04/24/2010] [Indexed: 02/02/2023] Open
Abstract
Bedside emergency ultrasound has rapidly developed over the past several years and has now become part of the standard of care for several applications. While it has only recently been applied to critically ill pediatric patients, several of the well-established adult indications may be applied to pediatric patients. One of the most important and life-saving applications is bedside echocardiography. While bedside emergency ultrasonography does not serve to replace formal comprehensive studies, it serves as an extension of the physical examination. It is especially useful as a rapid and effective tool in the diagnosis of pericardial effusions, tamponade and in distinguishing potentially reversible causes of pulseless electrical activity from asystole. Most recently, left ventricular function and inferior vena cava measurements have proven helpful in the assessment of undifferentiated hypotension and shock in adults and children. Future research remains to be carried out in determining the efficacy of bedside ultrasonography in pediatric-specific pathology such as congenital heart disease. This article serves as a comprehensive review of the adult literature and a review of the recent applications in the pediatric emergency department. It also highlights the techniques of bedside ultrasonography with examples of normal and pathologic images.
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Affiliation(s)
- Stephanie J Doniger
- Department of Emergency Medicine, Children’s Hospital & Research Center, Oakland 747, 52 Street, Oakland CA 94609
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27
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Abstract
Caring for critically ill patients requires rapid and accurate diagnosis followed by prompt interventions. The physical examination remains an important part of the assessment of such patients, but it has been shown to have a low sensitivity and specificity in judging left ventricular function and intravascular volume. Invasive hemodynamic monitoring has similarly been shown to have significant limitations and has failed to demonstrate a mortality benefit in several recent studies. In some studies, it has been shown to be harmful. Focused transthoracic echocardiography (TTE) has emerged as a noninvasive and portable imaging technique that is capable of providing rapid and accurate information about the heart at the bedside. It can be used to complement the physical examination and result in marked improvement in diagnostic accuracy. Focused TTE can be used as a screening and monitoring tool. Studies have shown that clinicians can be trained to determine left ventricular function, detect pericardial effusions, predict intravenous fluid responsiveness, and identify important valvular defects in a relatively short period. This article describes the indications for focused TTE, provides evidence that clinicians can be rapidly taught the technique, reviews how the focused studies affect management, and discusses the advantages and limitations of this tool.
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Affiliation(s)
- Faisal A Khasawneh
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
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28
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Morris C, Bennett S, Burn S, Russell C, Jarman B, Swanevelder J. Echocardiography in the Intensive Care Unit: Current Position, Future Directions. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There are many indications for the use of echocardiography in the critically ill and little consensus about how best to provide training for intensivists in its use. There are a profusion of opinions, courses and accreditation pathways available for training in the UK. The National Point of Care Ultrasound working group aims to facilitate learning and training in both echocardiography and ultrasound. In this article, an intermediate level of training suitable for most general UK-based intensivists, that provides more depth than focused resuscitation-based protocols but less depth than British Society of Echocardiography accreditation pathways, is proposed which, if endorsed by Royal Colleges and specialist societies, could be developed into a viable national training programme within five years.
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Affiliation(s)
- Craig Morris
- Craig Morris Consultant Intensivist, Royal Derby Hospital
| | - Sean Bennett
- Sean Bennett Consultant Cardiothoracic Anaesthetist, Castle Hill Hospital, Hull
| | - Steven Burn
- Steven Burn Consultant Cardiologist, Royal Derby Hospital
| | - Conn Russell
- Conn Russell Consultant Intensivist, Ulster Hospital Belfast
| | - Bob Jarman
- Bob Jarman Consultant Emergency Physician, Queen Elizabeth Hospital, Gateshead
| | - Justiaan Swanevelder
- Justiaan Swanevelder Consultant Cardiothoracic Anaesthetist, Glenfield Hospital, Leicester
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29
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Feldman MD, Petersen AJ, Tice JA. "On the other hand ...": the evidence does not support the use of hand-carried ultrasound by hospitalists. J Hosp Med 2010; 5:168-71. [PMID: 20235286 DOI: 10.1002/jhm.604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the right hands, ultrasound is a safe and helpful diagnostic imaging tool. However, evidence supporting the use of hand-carried ultrasound (HCU) by hospitalist physicians has not kept pace with expanding application of these devices. In spite of its strategic point-of-care benefit, use of this technology by hospitalists may not ultimately translate into improved efficiency and better clinical outcomes. Optimal levels of training in image acquisition and interpretation remain to be established. Novelty, availability, and the results of a few small studies lacking patient-centered outcomes remain insufficient grounds to justify the expanded clinical utilization of these medical imaging devices by nonspecialists.
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Affiliation(s)
- Mitchell D Feldman
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California 94143-0320, USA.
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30
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Hudaverdi M, Hamilton-Craig C, Platts D, Chan J, Burstow DJ. Echocardiography for the clinician: a practical update. Intern Med J 2010; 40:476-85. [PMID: 20059600 DOI: 10.1111/j.1445-5994.2010.02167.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. Such techniques are now routinely available on standard echocardiography equipment in Australian centres for daily use. Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.
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Affiliation(s)
- M Hudaverdi
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
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31
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Faris JG, Veltman MG, Royse CF. Limited transthoracic echocardiography assessment in anaesthesia and critical care. Best Pract Res Clin Anaesthesiol 2009; 23:285-98. [DOI: 10.1016/j.bpa.2009.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lucas BP, Candotti C, Margeta B, Evans AT, Mba B, Baru J, Asbury JK, Asmar A, Kumapley R, Patel M, Borkowsky S, Fung S, Charles-Damte M. Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program. J Hosp Med 2009; 4:340-9. [PMID: 19670355 DOI: 10.1002/jhm.438] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain. OBJECTIVE To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program. DESIGN Prospective cohort study. SETTING Large public teaching hospital. PATIENTS A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007. INTERVENTION Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE. MEASUREMENTS Diagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC). RESULTS A total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5-fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2-fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments. CONCLUSIONS The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA.
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García-Vicente E, Campos-Nogué A, Gobernado Serrano MM. [Echocardiography in the Intensive Care Unit]. Med Intensiva 2009; 32:236-47. [PMID: 18570834 DOI: 10.1016/s0210-5691(08)70946-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The echocardiography can provide important and relevant information and the critically ill patient presents a challenge for the echocardiographer: from limitations in image acquisition to interpretation in the context of rapid physiological and intervention changes. The most frequent reason for requesting an echocardiogram in the ICU is probably to assess left ventricular function. In any case, information of direct relevance for clinical management can in relationship to abnormalities of structure and function can be obtained and used to estimate pulmonary arterial and venous pressures. It can help to investigate the consequences of myocardial ischemia, valvular dysfunction and pericardial disease and detect changes characteristic of specific conditions (e.g. sepsis, pulmonary thromboembolism), although this must be interpreted in the context of each individual patient. The echocardiography also can be used to monitor the therapeutic interventions. The applications of echocardiography in the critical care setting are reviewed, with special emphasis on the assessment of cardiac physiology.
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Affiliation(s)
- E García-Vicente
- Unidad de Cuidados Intensivos, Hospital Santa Bárbara, Soria, España.
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Chen FL, Pai JY. The Economic Evaluation of a Health Screening Program on Congenital Heart Disease for School Children in Taichung, Taiwan. Asia Pac J Public Health 2008; 20:307-16. [DOI: 10.1177/1010539508322248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this study was the economic evaluation of screening school children for congenital heart disease (CHD). Methods The sample consisted of all the 45 725 students in grades 1 and 7 from Taichung County, Taiwan. STATISTICA, version 7.1, was used to determine descriptive statistics and Student's t tests on students' height, weight, and body mass index (BMI). Results The total cost of CHD screening was NT$4 863 866 (NT$32 = US$1), and the average cost was NT$106.37 per child. The rate of finding new asymptomatic students was 2.9174%, and the cost of finding 1 asymptomatic student was NT$3646. Also, a cost-effective analysis showed NT$165.7 per year of life saved. Conclusions Twelve Student's t tests were conducted, and it found that students' height, weight, and BMI was not associated with asymptomatic students. A goodness-of-fit χ2 found that females have a higher rate of asymptomatic CHD.
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Affiliation(s)
- Fong-Lin Chen
- Division of Pediatric Cardiology, Chung Shan Medical
University Hospital, Institute of Medicine, Chung Shan Medical University
| | - Jar-Yuan Pai
- Department of Health Services, Chung Shan Medical University,
Taichung City, Taiwan,
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Abstract
AIMS Hand-carried ultrasound scanners are getting smaller. The Acuson P10 is the latest and smallest portable echocardiograph available on the market. METHODS AND RESULTS We tested the ability of this scanner to allow qualitative assessment of LV size and function in an unselected group of 30 patients [19 male, 11 female; mean age (SD) 64.7 (10.3) years] seen by a consultant cardiologist (accredited for advanced echocardiography) during a week on call in a regional cardiac tertiary facility. Patients had focused scans (parasternal long-axis and apical four chamber views) for a maximum of 4 min, and an assessment of LVEF (normal/abnormal) and LV dimension (LVD) (dilated/non-dilated) was recorded. Where available, this was compared with results of alternative imaging modalities. In 23 (77%) patients, it was possible to assess LVEF and LVD; of these, 19 (83%) had alternative imaging techniques, which confirmed the findings. It was possible to obtain a parasternal long-axis image in 28 (93%) patients and apical four-chamber views in 23 (77%). Clinical management was altered by the findings of the portable scan in two patients. CONCLUSION The 'pocket scanner' allows accurate qualitative assessment of left ventricular dimensions and function in a substantial proportion of patients seen in tertiary cardiology practice.
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Affiliation(s)
- Margaret Egan
- Morriston Cardiac Centre, Morriston, Swansea SA6 6NL, UK
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Stawicki SP, Seamon MJ, Meredith DM, Chovanes J, Paszczuk A, Kim PK, Gracias VH. Transthoracic echocardiography for suspected pulmonary embolism in the intensive care unit: unjustly underused or rightfully ignored? JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:291-302. [PMID: 18361466 DOI: 10.1002/jcu.20461] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transthoracic echocardiography (TTE) is an established part of modern medical practice, and its use in documenting cardiac disorders has long been recognized. Since the introduction of 2-dimensional TTE, the right-sided heart chambers have become amenable to fairly accurate analysis, enabling the evaluation of morphologic and functional abnormalities associated with many cardiopulmonary diseases, including pulmonary embolism (PE). The availability of small, portable echocardiographic units combined with an increasing number of intensive care specialists trained in echocardiography makes TTE an attractive modality for the diagnosis of PE in the intensive care unit (ICU). In the ICU setting, prompt decision-making and appropriate triage of critically ill patients can facilitate early institution of therapy for PE while awaiting patient stabilization and further definitive testing. Although several prior reviews incorporate TTE in the overall approach and clinical decision algorithms pertaining to the diagnosis and treatment of pulmonary embolism, no dedicated review exists that focuses purely on TTE. We attempt to fill that gap by reviewing the available literature pertaining to use of TTE in the diagnosis of suspected PE, and by better defining the use of TTE in the ICU setting. Emphasis is placed on the use of TTE as a clinical triage tool for suspected PE.
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Affiliation(s)
- S Peter Stawicki
- Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, 2 Dulles, Philadelphia, PA 19104, USA
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Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, Jackson M, Dulchavsky SA. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:745-9. [PMID: 18424650 DOI: 10.7863/jum.2008.27.5.745] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Ultrasound is a versatile diagnostic modality used in a variety of medical fields. Wayne State University School of Medicine (WSUSOM) is one of the first medical schools in the United States to integrate an ultrasound curriculum through both basic science courses and clinical clerkships. METHODS In 2006, 25 portable ultrasound units were donated to WSUSOM. First-year medical students were provided an ultrasound curriculum consisting of 6 organ-system sessions that addressed the basics of ultrasound techniques, anatomy, and procedural skills. After the last session, students were administered 2 anonymous and voluntary evaluations. The first assessed their overall experience with the ultrasound curriculum, and the second assessed their technical skills in applying ultrasound techniques. RESULTS Eighty-three percent of students agreed or strongly agreed that their experience with ultrasound education was positive. On the summative evaluation, nearly 91% of students agreed or strongly agreed that they would benefit from continued ultrasound education throughout their 4 years of medical school. Student performance on the technical assessment was also very positive, with mean class performance of 87%. CONCLUSIONS As residency programs adopt ultrasound training, medical school faculty should consider incorporating ultrasound education into their curriculum. Portable ultrasound has the potential to be used in many different settings, including rural practice sites and sporting events. The WSUSOM committee's pilot ultrasound curriculum will continue to use student feedback to enhance the ultrasound experience, helping students prepare for challenges that they will face in the future.
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Affiliation(s)
- Sishir Rao
- Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
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38
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Abstract
This article reviews the clinically available devices that have been approved for noninvasive hemodynamic monitoring in critically ill patients. In addition this article reviews some of the surrogate markers that can be used to assess adequacy of cardiac output.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA.
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Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, Marin B, François B, Gastinne H. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med 2007; 33:1795-9. [PMID: 17572874 DOI: 10.1007/s00134-007-0742-8] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 05/16/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to evaluate the efficacy of a limited training dedicated to residents without knowledge in ultrasound for performing goal-oriented echocardiography in ICU patients. DESIGN Prospective pilot observational study. SETTING Medical-surgical ICU of a teaching hospital. PATIENTS 61 consecutive adult ICU patients (SAPS II score: 38 +/- 17; 46 ventilated patients) requiring a transthoracic echocardiography were studied. INTERVENTIONS After a curriculum including a 3-h training course and 5 h of hands-on training, one of four noncardiologist residents and an intensivist experienced in ultrasound subsequently performed hand-held echocardiography (HHE), independently and in random order. Assessable "rule in, rule out" clinical questions were purposely limited to easily identifiable conditions by the sole use of two-dimensional imaging. MEASUREMENTS AND RESULTS When compared with residents, the experienced intensivist performed shorter examinations (4 +/- 1 vs. 11 +/- 4 min: p < 0.0001) and had significantly less unsolved clinical questions [3 (0.8%) vs. 27 (7.4%) of 366 clinical questions: p < 0.0001]. When addressed, clinical questions were adequately appraised by residents: left ventricular systolic dysfunction [Kappa: 0.76 +/- 0.09 (95% CI: 0.59-0.93)], left ventricular dilatation [Kappa: 0.66 +/- 0.12 (95% CI: 0.43-0.90)], right ventricular dilatation [Kappa: 0.71 +/- 0.12 (95% CI: 0.46-0.95)], pericardial effusion [Kappa: 0.68 +/- 0.18 (95 CI: 0.33-1.03)], and pleural effusion [Kappa: 0.71 +/- 0.09 (95% CI: 0.53-0.88)]. The only case of tamponade was accurately diagnosed by the resident. CONCLUSIONS Limited training of noncardiologist ICU residents without previous knowledge in ultrasound appears feasible and efficient to address simple clinical questions using point-of-care echography. Influence of the learning curve on diagnostic accuracy and potential therapeutic impact remain to be determined.
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Affiliation(s)
- Philippe Vignon
- Medical-Surgical Intensive Care Unit, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France.
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Abstract
Accurate assessment and rapid decision-making are essential to save lives and improve performance in critical care medicine. Real-time point-of-care ultrasound has become an invaluable adjunct to the clinical evaluation of critically ill and injured patients both for pre- and in-hospital situations. However, a high level of quality is necessary, guaranteed by appropriate education, experience, credentialing, quality control, continuing education, and professional development. Although educational recommendations have been proposed by a variety of nonimaging specialties, to date they are still scattered and limited examples of standards for critical and intensive care professionals. The challenge of providing adequate specialty-specific training, as encouraged by major medical societies, is made even more difficult by the diversity of critical care ultrasound utilization by various subspecialties in a variety of settings and numerous countries. In order to meet this educational challenge, a standard core curriculum is presented in this manuscript. The proposed curriculum is built on a competence, performance, and outcomes-based approach that is tailored to setting-specific training needs and prioritized according to critical problem-based pathways, rather than traditional organ-based systems. A multiple goal-oriented style fully addresses the specialty-specific approach of critical and intensive care professionals, who typically deal with disease states in complex scenarios rather than individual organ complaints. Because of the variation in the concept of what constitutes critical care worldwide, and the rate of change of information and technology, this manuscript attempts to present a learning system addressing a variety of needs for a rapidly changing world.
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Affiliation(s)
- Luca Neri
- General Intensive Care Unit "Bozza," Niguarda Ca' Granda Hospital, Milan, Italy.
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Abstract
Advances in ultrasound technology continue to enhance its diagnostic applications in daily medical practice. Bedside echocardiographic examination has become useful to properly trained cardiologists, anesthesiologists, intensivists, surgeons, and emergency room physicians. Cardiac ultrasound can permit rapid, accurate, and noninvasive diagnosis of a broad range of acute cardiovascular pathologies. Although transesophageal echocardiography was once the principal diagnostic approach using ultrasound to evaluate intensive care unit patients, advances in ultrasound imaging, including harmonic imaging, digital acquisition, and contrast for endocardial enhancement, has improved the diagnostic yield of transthoracic echocardiography. Ultrasound devices continue to become more portable, and hand-carried devices are now readily available for bedside applications. This article discusses the application of bedside echocardiography in the intensive care unit. The emphasis is on echocardiography and cardiovascular diagnostics, specifically on goal-directed bedside cardiac ultrasonography.
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Affiliation(s)
- Yanick Beaulieu
- Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.
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Angtuaco TL, Hopkins RH, DuBose TJ, Bursac Z, Angtuaco MJ, Ferris EJ. Sonographic physical diagnosis 101: teaching senior medical students basic ultrasound scanning skills using a compact ultrasound system. Ultrasound Q 2007; 23:157-60. [PMID: 17538509 DOI: 10.1097/01.ruq.0000263847.00185.28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This project was designed to test the feasibility of introducing ultrasound to senior medical students as a primary diagnostic tool in the evaluation of patients. Specifically, its aim was to determine if it is possible for medical students untrained in sonography to gain basic competence in performing abdominal ultrasound with limited didactic and hands-on instructions. Registered sonographers provided the students with hands-on instructions on the use of a compact ultrasound system. They were likewise shown how to evaluate specific organs and perform measurements. The results of the student measurements and those obtained by the sonographers were compared. There was close correlation between the results obtained by sonographers and students on both normal and abnormal findings. This supports the concept that medical students can be taught basic ultrasound skills with limited didactic and hands-on instructions with the potential of using these skills in the patient clinics as an adjunct to routine physical diagnosis.
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Affiliation(s)
- Teresita L Angtuaco
- Department of Radiology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Abstract
Echocardiography in the critical care setting can provide crucial information about the patient's cardiac anatomy, ejection fraction, valvular function, and volume status. There is a need for more involvement by intensivists in performing focused echocardiographic studies as this modality has been well shown to improve patient care. Several factors limit the widespread use of this technology by intensivists that are noncardiologists. One of them is the lack of formal didactic and practical training programs in "goal-directed" echocardiography specifically oriented for the critical care specialist. Although it is clear that extensive training and experience are needed to perform and interpret a complete echocardiographic study, a growing body of literature demonstrates that noncardiology medical professionals can be trained to acquire and interpret echocardiographic imaging in a goal-directed or "focused" manner with an acceptable overall level of accuracy. Performance of such focused echocardiography by intensivists has been shown to provide new information not assessable by physical examination, and often leads to change in therapeutic management at the bedside. Echocardiography using the transthoracic approach is a noninvasive imaging modality and is of great value in the critical care setting because of its portability, widespread availability, and rapid diagnostic capability. Programs for intensivists should cover both the transthoracic and transesophageal approach. Focused training with the transthoracic approach should be offered to all intensivists, while training with the transesophageal approach should be offered to intensivists who desire more advanced training. This article will go over important issues regarding current and potential avenues for training of critical care physicians in performance of focused bedside echocardiography.
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Affiliation(s)
- Yanick Beaulieu
- Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
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Lee HC, Silverman N, Hintz SR. Diagnosis of patent ductus arteriosus by a neonatologist with a compact, portable ultrasound machine. J Perinatol 2007; 27:291-6. [PMID: 17363908 DOI: 10.1038/sj.jp.7211693] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To conduct a pilot study assessing a neonatologist's accuracy in diagnosing patent ductus arteriosus (PDA) using compact, portable ultrasound after limited training. STUDY DESIGN Prospective study of premature infants scheduled for echocardiography for suspected PDA. A neonatologist with limited training performed study exams before scheduled exams. Sensitivity and specificity were calculated, compared to the scheduled echocardiogram interpreted by a cardiologist. RESULTS There were 24 exams. Compared to the scheduled exam, the neonatologist's exam had sensitivity 69% (95% confidence interval (CI), 41 to 89%) and specificity 88% (95% CI, 47 to 99%). When a cardiologist interpreted the study exams, the sensitivity was 87% (95% CI, 60 to 98%) and specificity 71% (95% CI, 29 to 96%). CONCLUSION A neonatologist with limited training was able to detect PDA with moderate success. A more rigorous training process or real-time transmission with cardiologist interpretation may substantially improve accuracy. Institutions with experienced technicians and on-site pediatric cardiologists may not gain from intensive training of neonatologists, but hospitals where diagnosis and treatment of PDA would be delayed may benefit from such processes.
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Affiliation(s)
- H C Lee
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, CA 94304, USA
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Ghani SN, Kirkpatrick JN, Spencer KT, Smith GL, Burke MC, Kim SS, Desai AD, Knight BP. Rapid assessment of left ventricular systolic function in a pacemaker clinic using a hand-carried ultrasound device. J Interv Card Electrophysiol 2006; 16:39-43. [PMID: 17051437 DOI: 10.1007/s10840-006-9011-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pacemaker recipients with left ventricular (LV) dysfunction are potential candidates for upgrades to implantable defibrillators or cardiac resynchronization devices. This study sought to determine if a hand-carried ultrasound (HCU) device could be used for rapid, inexpensive identification of LV dysfunction in a busy pacemaker clinic. MATERIALS AND METHODS Eighty patients undergoing routine pacemaker check were enrolled. Patients underwent HCU imaging in the sitting position during device interrogation, by an internist who had 20 h of didactic training and 20 practice examinations. LV dysfunction was defined as ejection fraction (EF) <40%. Patients also underwent echocardiography limited to EF assessment by a sonographer using a full-feature platform. RESULTS The mean age was 75 +/- 13 years; 49% were female. Coronary artery disease was present in 29%; 82% were NYHA class I or II. At the time of HCU imaging, 48% of patients were receiving RV pacing. HCU images were interpretable in 91% (73/80) and required 3.7 +/- 0.9 min to complete. Based on the full-feature echo, LV dysfunction prevalence was 17/80 (21%); 25% of these patients were NYHA class I. The sensitivity of the HCU exam was 75%, specificity was 91%, negative predictive value was 93%, positive predictive value was 71%, and accuracy was 88%. CONCLUSIONS HCU screening in a pacemaker clinic by a non-cardiologist can rapidly and accurately identify pacemaker recipients with at least moderate LV dysfunction who might be candidates for device upgrades. Ventricular dyssynchrony associated with RV pacing does not limit HCU identification of LV dysfunction.
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Affiliation(s)
- Syed Nasir Ghani
- Section of Cardiology, Department of Internal Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Croft LB, Duvall WL, Goldman ME. A Pilot Study of the Clinical Impact of Hand-Carried Cardiac Ultrasound in the Medical Clinic. Echocardiography 2006; 23:439-46. [PMID: 16839380 DOI: 10.1111/j.1540-8175.2006.00240.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Small, hand-carried ultrasound devices have become widely available, making point-of-care echocardiograms (echos) accessible to all medical personnel as a means to augment and improve the increasingly inefficient physical examination. This study was designed to determine the clinical utility of hand-carried echo by medical residents in clinical decision making. METHODS Nine residents underwent brief, practical echo training to perform and interpret a limited hand-carried echo as an integral component of their office examination. The residents' hand-carried echo consisting of four basic views to define left ventricular (LV) function and wall thickness, valvular disease, and any pericardial effusions was compared to one performed by a level III echocardiographer. RESULTS Seventy-two consecutive medical clinic patients were enrolled with an average image acquisition time of 4.45 minutes. Residents obtained diagnostic images in 94% of the cases and interpreted them correctly 93% of the time. They correctly identified 92% of the major echo findings and 78% of the minor findings. Their diagnosis of LV dysfunction, valvular disease, and LV hypertrophy improved by 19%, 39%, and 14% with hand-carried echo compared to history and physical alone. Management decisions were reinforced in 76% and changed in 40% of patients with the use of hand-carried echo. CONCLUSION This study demonstrates that it is possible to train medical residents to perform an effective and reasonably accurate hand-carried echo during their physical examination, which can impact clinical management.
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Affiliation(s)
- Lori B Croft
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029, USA.
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Abstract
Bedside sonography has become an important tool in the emergency physician's diagnostic armamentarium. Sonography is useful in the evaluation of a number of conditions, including cholecystitis, abdominal aortic aneurysm, and ectopic pregnancy. Applied to the heart, sonography aids in the assessment of pericardial tamponade, electromechanical dissection, pulmonary embolus, and other cardiorespiratory emergencies. Echocardiography also has a role in differentiating patients with cardiac activity from those in ventricular standstill and in estimating central venous pressure. This article reviews these and other clinical applications and the physics of ultrasound, techniques for sonographic evaluation, and the practical aspects of emergency department use, such as strategic placement of the equipment for quick activation and storage of collected data.
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Affiliation(s)
- Alice Tang
- Division of Emergency Medicine, University of Maryland School of Medicine, Baltimore, 21201, USA.
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Herzog E, Pudpud D, Chaudhry FA. Transesophageal Echocardiography Using Cypress-Miniaturized Echocardiogram Unit: Initial Clinical Experience. Echocardiography 2005; 22:809-13. [PMID: 16343162 DOI: 10.1111/j.1540-8175.2005.00073.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Transesophageal echocardiography (TEE) was introduced clinically in the United States in 1987. Recent technologic advances have resulted in the creation of a small portable hand-carried ultrasound (HCU) device that can be easily carried throughout the hospital with greater flexibility for cardiac imaging. These HCU devices have harmonic, color, and spectral Doppler (continuous/pulsed wave). Siemens Medical Solutions USA, Inc. has incorporated a TEE connector, which connects to its Cypress (highly miniaturized echocardiogram unit) and allows the performance of a TEE with this unit, which is mildly heavier than a typical HCU. We describe our initial clinical experience with this unit. The image quality is comparable to routine TEEs, with the advantages of shorter duration, portability, affordable cost, avoiding the use of high-end machine from the echo lab, availability of non-HCU units for other studies, and preventing the need for an echo technician to be involved in the procedure.
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Affiliation(s)
- Eyal Herzog
- Division of Cardiology, St. Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
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Abstract
This is the second of a two-part review on the application of bedside ultrasonography in the ICU. In this part, the following procedures will be covered: (1) echocardiography and cardiovascular diagnostics (second part); (2) the use of bedside ultrasound to facilitate central-line placement and to aid in the care of patients with pleural effusions and intra-abdominal fluid collections; (3) the role of hand-carried ultrasound in the ICU; and (4) the performance of bedside ultrasound by the intensivist. The safety and utility of bedside ultrasonography performed by adequately trained intensivists has now been well demonstrated. This technology, as a powerful adjunct to the physical examination, will become an indispensable tool in the management of critically ill patients.
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Affiliation(s)
- Yanick Beaulieu
- Division of Cardiology and Critical Care Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin O., Montreal, Quebec, Canada, H4J 1C5.
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Kimura BJ, Fowler SJ, Fergus TS, Minuto JJ, Amundson SA, Gilpin EA, DeMaria AN. Detection of left atrial enlargement using hand-carried ultrasound devices to screen for cardiac abnormalities. Am J Med 2005; 118:912-6. [PMID: 16084186 DOI: 10.1016/j.amjmed.2005.03.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 03/21/2005] [Accepted: 03/21/2005] [Indexed: 10/25/2022]
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