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Poppleton A, Tsukagoshi S, Vinker S, Heritier F, Frappé P, Dupont F, Sigmund P, Iacob M, Vilaseca J, Ungan M, Aakjær Andersen C, Frese T, Halata D. World Organization of National Colleges, Academies and Academic Associations of General Practitioners and Family Physicians (WONCA) Europe position paper on the use of point-of-care ultrasound (POCUS) in primary care. Prim Health Care Res Dev 2024; 25:e21. [PMID: 38651341 PMCID: PMC11091537 DOI: 10.1017/s1463423624000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/29/2023] [Accepted: 02/17/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
| | | | | | | | - Paul Frappé
- Université Jean Monnet, Saint-Etienne, France
| | | | - Peter Sigmund
- Steirischen Akademie für Allgemeinmedizin, Graz, Austria
| | - Mihai Iacob
- Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Mehmet Ungan
- School of Medicine, Ankara University, Ankara, Turkey
| | | | - Thomas Frese
- University Halle-Wittenberg, Halle (Saale), Germany
- European General Practice Research Network, Halle-Wittenberg, Germany
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2
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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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3
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Gillon JT, Liu EL, Dutreuil V, Cohen SG, Shah LA. Comparison of in-person versus virtual ultrasound instruction for pediatric residents. BMC MEDICAL EDUCATION 2024; 24:203. [PMID: 38413943 PMCID: PMC10900688 DOI: 10.1186/s12909-024-05196-6] [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: 11/04/2022] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) instruction is prevalent in medical schools but not in pediatric residency programs, even though the majority of pediatric residents desire POCUS instruction. Virtual ultrasound instruction with affordable handheld ultrasound devices may help remedy this deficiency by allowing qualified instructors to circumvent geographic and financial limitations to reach this population. This study sought to determine if virtual ultrasound instruction is an effective alternative to traditional in-person instruction in a cohort of pediatric residents for the extended Focused Assessment with Sonography in Trauma (eFAST) exam. METHODS Pediatric residents were randomized to receive either in-person or virtual instruction to learn the eFAST exam using a Sonosite Edge (Sonosite, Inc., Bothell, WA) or Butterfly iQ (Butterfly Network, Inc., Guilford, CT), respectively. After the instructional session, the participants completed a timed assessment in which all required images for the eFAST exam were obtained on the same anatomic model. The content and quality of the images were then scored by expert faculty. RESULTS There were no significant differences in assessment scores (65.8% and 61.8%, p = 0.349) and assessment duration (482.6 s and 432.6 s, p = 0.346) between pediatric residents who received in-person instruction and those who received virtual instruction. CONCLUSION Virtual ultrasound instruction appears to be an effective alternative to traditional in-person instruction.
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Affiliation(s)
- Jason T Gillon
- Department of Pediatrics, LSU Health New Orleans School of Medicine, 200 Henry Clay Ave, 70118, New Orleans, LA, USA.
- Children's Hospital New Orleans LCMC Health, New Orleans, USA.
| | - E Liang Liu
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Valerie Dutreuil
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie G Cohen
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lekha A Shah
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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4
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Weimer JM, Beer D, Schneider C, Yousefzada M, Gottwald M, Züllich TF, Weimer A, Jonck C, Buggenhagen H, Kloeckner R, Merkel D. Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices-A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive Care. Diagnostics (Basel) 2023; 14:54. [PMID: 38201363 PMCID: PMC10795594 DOI: 10.3390/diagnostics14010054] [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: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the use of handheld ultrasonography (HHUS) devices is well established in prehospital emergency diagnostics, as well as in intensive care settings. This is based on several studies in which HHUS devices were compared to conventional high-end ultrasonography (HEUS) devices. Nonetheless, there is limited evidence regarding potential variations in B-scan quality among HHUS devices from various manufacturers, and regarding whether any such differences hold clinical significance in intensive care medicine settings. METHODS this study included the evaluation of eight HHUS devices sourced from diverse manufacturers. Ultrasound videos of five previously defined sonographic questions (volume status/inferior vena cava, pleural effusion, pulmonary B-lines, gallbladder, and needle tracking in situ) were recorded with all devices. The analogue recording of the same pathologies with a HEUS device served as gold standard. The corresponding findings (HHUS and HEUS) were then played side by side and evaluated by sixteen intensive care physicians experienced in sonography. The B-scan quality and the clinical significance of the HHUS were assessed using a five-point Likert scale (5 points = very good; 1 point = insufficient). RESULTS both in assessing the quality of B-scans and in their ability to answer clinical questions, the HHUS achieved convincing results-regardless of the manufacturer. For example, only 8.6% (B-scan quality) and 9.8% (clinical question) of all submitted assessments received an "insufficient" rating. One HHUS device showed a significantly higher (p < 0.01) average points score in the assessment of B-scan quality (3.9 ± 0.65 points) and in the evaluation of clinical significance (4.03 ± 0.73 points), compared to the other devices. CONCLUSIONS HHUS systems are able to reliably answer various clinical intensive care questions and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS devices. Irrespective of this, the present study was able to demonstrate relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Michael Gottwald
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Christopher Jonck
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Daniel Merkel
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany
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Merkel D, Züllich TF, Schneider C, Yousefzada M, Beer D, Ludwig M, Weimer A, Künzel J, Kloeckner R, Weimer JM. Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions. Diagnostics (Basel) 2023; 13:3622. [PMID: 38132206 PMCID: PMC10742722 DOI: 10.3390/diagnostics13243622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. METHOD The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). RESULTS The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. CONCLUSION In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Daniel Merkel
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany;
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (T.F.Z.); (C.S.); (M.Y.); (D.B.)
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, 10115 Berlin, Germany;
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany;
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Zhou YJ, Guo LH, Bo XW, Sun LP, Zhang YF, Chai HH, Ye RZ, Peng CZ, Qin C, Xu HX. Tele-Mentored Handheld Ultrasound System for General Practitioners: A Prospective, Descriptive Study in Remote and Rural Communities. Diagnostics (Basel) 2023; 13:2932. [PMID: 37761299 PMCID: PMC10530153 DOI: 10.3390/diagnostics13182932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. METHODS Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. RESULTS Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). CONCLUSIONS The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.
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Affiliation(s)
- Yu-Jing Zhou
- Department of Medical Ultrasound, Jinshan Hospital, Fudan University, Shanghai 201508, China;
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Hui-Hui Chai
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Rui-Zhong Ye
- Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, China;
| | - Cheng-Zhong Peng
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China; (L.-H.G.); (X.-W.B.); (L.-P.S.); (Y.-F.Z.); (H.-H.C.)
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Chuan Qin
- Department of Medical Ultrasound, Jinshan Hospital, Fudan University, Shanghai 201508, China;
- Department of Ultrasound, Karamay Central Hospital, Karamay 834000, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China;
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Karlas T, Blank V, Trenker C, Ignee A, Dietrich CF. [Ultrasound systems for abdominal diagnostics - current methods, clinical applications and new technologies]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1235-1245. [PMID: 36634681 DOI: 10.1055/a-1993-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abdominal ultrasound is the method of first choice in many clinical situations. Gray scale imaging (B-mode) and conventional Doppler techniques are nowadays complemented by contrast-enhanced ultrasound (CEUS), elastography, fat quantification and further technologies which allow multimodal characterization of organs and tissue structure using panoramic imaging, 3D-techniques and image fusion. The development of small portable devices augments the spectrum for sonographic diagnostics. In this review, we describe the current status of ultrasound technology based on published evidence. In addition, we provide guidance for quality assurance.
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Affiliation(s)
- Thomas Karlas
- Medizinischen Klinik 2, Bereich Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Valentin Blank
- Medizinischen Klinik 2, Bereich Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Germany
- Klinik für Innere Medizin I (Gastroenterologie, Pneumologie) und Interdisziplinäre Ultraschallabteilung, Universitätsklinikum Halle (Saale), Halle, Germany
| | - Corinna Trenker
- Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Marburg, Marburg, Germany
| | - André Ignee
- Medizinische Klinik mit Schwerpunkt Gastroenterologie & Rheumatologie, Klinikum Würzburg Mitte gGmbH Standort Juliusspital, Wurzburg, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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8
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Thota RS, Ramkiran S, Ramanjulu R. Time to FOCUS - 'Palliative Medicine Point-of-Care Ultrasound'. Indian J Palliat Care 2023; 29:36-45. [PMID: 36846289 PMCID: PMC9945239 DOI: 10.25259/ijpc_274_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Point-of-care diagnosis has become the need of the hour and along with its guided interventions, ultrasound could be utilised bedside in a palliative care patient. Point-of-care ultrasound (POCUS) in palliative care medicine is fast emerging and has varied applications ranging from performing bedside diagnostic evaluation to the performance of interventional paracentesis, thoracocentesis and chronic pain interventions. Handheld ultrasound devices have transformed the application of POCUS and should revolutionise the future of home-based palliative care. Palliative care physicians should be enabled to carry out bedside ultrasounds at home care and hospice setting for achieving rapid symptom relief. The aim of POCUS in palliative care medicine should be adequate training of palliative care physicians, transforming the applicability of this technology to OPD as well as community driven to achieve home outreach. The goal is towards empowering technology by reaching out to the community rather than the terminally ill patient transported for the hospital admission. Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency and early triaging. The inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis. Limiting POCUS application to certain selected sub-specialities such as emergency medicine, internal medicine and critical care medicine should be overcome. This would need acquiring higher training as well as improvised skill sets to perform bedside interventions. Ultrasonography competency among palliative care providers proposed as palliative medicine point-of-care ultrasound (PM-POCUS) could be achieved by imparting dedicated POCUS training within the core curriculum.
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Affiliation(s)
| | - Seshadri Ramkiran
- Department of Anaesthesia and Critical Care, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Aster Hospitals, Bengaluru, Karnataka, India
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9
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Lo H, Eder N, Boten D, Jenssen C, Nuernberg D. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8:E68-E76. [PMID: 36937375 PMCID: PMC10023243 DOI: 10.1055/a-1999-7834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 03/19/2023] Open
Abstract
Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.
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Affiliation(s)
- Hendra Lo
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine – Gastroenterology, Diabetology
and Hepatology, Vivantes Hospital Neukölln, Berlin,
Germany
- Correspondence Mr. Hendra Lo Brandenburg
Medical University Theodor Fontane, Institute for Clinical Ultrasound
(BICUS) and Faculty of Health Sciences Brandenburg, Fehrbelliner
Straße 3816816NeuruppinGermany+ 49
3391 3914710
,
| | - Nicole Eder
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - David Boten
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
| | - Christian Jenssen
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - Dieter Nuernberg
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
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10
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Dietrich CF, Bulla P, Dudwiesus H, Lo H, Hocke M, Hoffmann B, Horn R, Lehmann B, Morf S, Nuernberg D, Prosch H, Serra A, Spengler J, Blaskova A, Jenssen C. [Perspectives and Challenges of hand-held Ultrasound]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022. [PMID: 36170860 DOI: 10.1055/a-1901-9394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The use of handheld ultrasound devices from a technical and data protection point of view, device properties, functionality, documentation, indications, delegation of performance, applications by doctors, students and non-medical staff is examined and discussed.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Peter Bulla
- Medizinische Klinik I, Klinik für Gastroenterologie, Gastrointestinale Onkologie, Hepatologie, Infektiologie und Geriatrie, Universitätsklinikum Tübingen, Deutschland, Tübingen, Germany
| | | | - Hendra Lo
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Michael Hocke
- Klinik für Innere Medizin II, HELIOS Klinikum Meiningen, Meiningen, Germany
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Boston MA, Boston, United States
| | - Rudolf Horn
- Center da sandà Val Müstair, Sta. Maria, Switzerland
| | - Beat Lehmann
- Universitäres Notfallzentrum, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Susanne Morf
- Center da sandà Val Müstair, Sta. Maria, Val Müstair, Switzerland
| | - Dieter Nuernberg
- Brandenburgisches Institut für Klinischen Ultraschall und Fakultät Gesundheitswissenschaften, Medizinische Hochschule Brandenburg, Neuruppin, Germany
| | - Helmut Prosch
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Austria
| | | | | | - Andrea Blaskova
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Brandenburgisches Institut für Klinischen Ultraschall, Medizinische Hochschule Brandenburg, Neuruppin, Germany
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
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