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Plöger R, Behning C, Walter A, Jimenez Cruz J, Gembruch U, Strizek B, Recker F. Next-generation monitoring in obstetrics: Assessing the accuracy of non-piezo portable ultrasound technology. Acta Obstet Gynecol Scand 2024; 103:2031-2041. [PMID: 39032032 PMCID: PMC11426206 DOI: 10.1111/aogs.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. MATERIAL AND METHODS This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients. RESULTS The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. CONCLUSIONS These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings.
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Affiliation(s)
- Ruben Plöger
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and EpidemiologyUniversity Hospital BonnBonnGermany
| | - Adeline Walter
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
| | - Florian Recker
- Department of Obstetrics and Prenatal MedicineUniversity Hospital BonnBonnGermany
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Brann A, Selko S, Krauspe E, Shah K. Biomarkers of Hemodynamic Congestion in Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00684-8. [PMID: 39298084 DOI: 10.1007/s11897-024-00684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/21/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the evidence behind various blood and imaging-based biomarkers that can improve the identification of congestion when not clearly evident on routine examination. RECENT FINDINGS The natriuretic peptides (NPs) BNP and NT-proBNP have been shown to closely correlate with intra-cardiac filling pressures, both at baseline and when trended following improvement in congestion. Additionally, NPs rise well before clinical congestion is apparent so can be used as a tool to help identify subclinical HF decompensation. Additional serum-based biomarkers including MR-proANP and CA-125 can be helpful in assisting with diagnostic certainty when BNP or NT-proBNP are in the "grey zone" or when factors are present which may confound NP levels. Additionally, the emerging use of ultrasound techniques may enhance our ability to fine-tune the assessment and treatment of congestion. Biomarkers, including the blood-based natriuretic peptides and markers on bedside point of care ultrasound, can be used as non-invasive indices of hemodynamic congestion. These biomarkers are particularly valuable to incorporate when the degree of a patient's congestion is not apparent on clinical exam, and they can provide important prognostic information and help guide clinical management.
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Affiliation(s)
- Alison Brann
- Division of Cardiovascular Medicine, University of Utah, 30 N Mario Capecchi Drive 3rd floor North, Salt Lake City, UT, 84112, USA
| | - Sean Selko
- Department of Internal Medicine, University of Utah, Salt Lake City, USA
| | - Ethan Krauspe
- Department of Internal Medicine, University of Utah, Salt Lake City, USA
| | - Kevin Shah
- Division of Cardiovascular Medicine, University of Utah, 30 N Mario Capecchi Drive 3rd floor North, Salt Lake City, UT, 84112, USA.
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Baloescu C, Chen A, Varasteh A, Hall J, Toporek G, Patil S, McNamara RL, Raju B, Moore CL. Deep-learning generated B-line score mirrors clinical progression of disease for patients with heart failure. Ultrasound J 2024; 16:42. [PMID: 39283362 PMCID: PMC11405569 DOI: 10.1186/s13089-024-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/29/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Ultrasound can detect fluid in the alveolar and interstitial spaces of the lung using the presence of artifacts known as B-lines. The aim of this study was to determine whether a deep learning algorithm generated B-line severity score correlated with pulmonary congestion and disease severity based on clinical assessment (as identified by composite congestion score and Rothman index) and to evaluate changes in the score with treatment. Patients suspected of congestive heart failure underwent daily ultrasonography. Eight lung zones (right and left anterior/lateral and superior/inferior) were scanned using a tablet ultrasound system with a phased-array probe. Mixed effects modeling explored the association between average B-line score and the composite congestion score, and average B-line score and Rothman index, respectively. Covariates tested included patient and exam level data (sex, age, presence of selected comorbidities, baseline sodium and hemoglobin, creatinine, vital signs, oxygen delivery amount and delivery method, diuretic dose). RESULTS Analysis included 110 unique subjects (3379 clips). B-line severity score was significantly associated with the composite congestion score, with a coefficient of 0.7 (95% CI 0.1-1.2 p = 0.02), but was not significantly associated with the Rothman index. CONCLUSIONS Use of this technology may allow clinicians with limited ultrasound experience to determine an objective measure of B-line burden.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, Connecticut, 06519, USA.
| | - Alvin Chen
- Philips Research Americas, 222 Jacobs Street, Cambridge, MA, 02141, USA
| | - Alexander Varasteh
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, Connecticut, 06519, USA
- Department of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Jane Hall
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Grzegorz Toporek
- Philips Research Americas, 222 Jacobs Street, Cambridge, MA, 02141, USA
- Inari Medical, One Kendall Square, Building 600/700, Suite 7-501, Cambridge, MA, 02139, USA
| | - Shubham Patil
- Philips Research Americas, 222 Jacobs Street, Cambridge, MA, 02141, USA
| | - Robert L McNamara
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, PO Box 208017, New Haven, CT, 06520, USA
| | - Balasundar Raju
- Philips Research Americas, 222 Jacobs Street, Cambridge, MA, 02141, USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, Connecticut, 06519, USA
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Rajamani A, Arun Bharadwaj P, Hariharan S, Ragavan AV, Hassan A, Arvind H, Huang S. A historical timeline of the development and evolution of medical diagnostic ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39225293 DOI: 10.1002/jcu.23808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
Diagnostic ultrasonography has evolved to become an indispensable imaging tool that permits non-invasive evaluation of the whole body. In this narrative review, we present a historical timeline of the invention, development, and evolution of diagnostic medical ultrasound. It includes interesting fun facts that may help the reader identify with many of the incredible researchers in this field. This review is a tribute to the researchers who contributed to this amazing invention.
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Affiliation(s)
- Arvind Rajamani
- Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | | | | | | | - Anwar Hassan
- Department of Physiotherapy, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Hemamalini Arvind
- Division of Ophthalmology, University of Sydney Central Clinical School, Sydney, New South Wales, Australia
| | - Stephen Huang
- Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
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Duclos G, Marecal L, Resseguier N, Postzich M, Taguet C, Hraiech S, Leone M, Müller L, Zieleskiewicz L. Pleural lung sliding quantification using a speckle tracking technology: A feasibility study on 30 healthy volunteers. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 254:108316. [PMID: 38968827 DOI: 10.1016/j.cmpb.2024.108316] [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: 01/23/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION Speckle tracking technology quantifies lung sliding and detects lung sliding abolition in case of pneumothorax on selected ultrasound loops through the analysis of acoustic markers. OBJECTIVES We aimed to test the ability of speckle tracking technology to quantify lung sliding using a pleural strain value (PS). METHODS We performed a prospective study in 30 healthy volunteers in whom we assessed the pleural speckle tracking using ultrasound loops. Seven breathing conditions with and without non-invasive ventilation were tested. Two observers analyzed the ultrasound loops in four lung areas (anterior and posterior, left and right) and compared the obtained PS values. The first endpoint was to determine the feasibility of the PS measurement in different breathing conditions. The secondary endpoints were to assess the intra- and inter-observer's reliability of the measurement to compare PS values between anterior and posterior lung areas and to explore their correlations with the measured tidal volume. RESULTS We analyzed 1624 ultrasound loops from 29 patients after one volunteer's exclusion. Feasibility of this method was rated at 90.8 [95%CI: 89.6 - 92.4]%. The intra-observer reliability measured through Intraclass Correlation Coefficients was 0.96 [95%CI: 0.91-0.98] and 0.93 [95%CI: 0.86-0.97] depending on the operator. The inter-observer reliability was 0.89 [95%CI: 0.78-0.95]. The PS values were significantly lower in the anterior lung areas compared with the posterior areas in all breathing conditions. A weak positive correlation was found in all the lung areas when a positive end expiratory pressure was applied with r = 0.26 [95%CI: 0.12;0.39]; p < 0.01. CONCLUSION Speckle tracking lung sliding quantification with PS was applicable in most conditions with an excellent intra- and inter-observer reliability. More studies in patients under invasive mechanical ventilation are needed to explore the correlation between PS values of pleural sliding and tidal volumes. CLINICAL REGISTRATION NCT05415605.
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Affiliation(s)
- Gary Duclos
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université.
| | - Ludivine Marecal
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
| | - Noemie Resseguier
- Service d'Épidémiologie et d'Économie de la Santé, AP-HM, Marseille, France, Aix-Marseille Université; CEReSS-Health Services and Quality of Research, Aix-Marseille University, Marseille, France
| | - Martin Postzich
- Service d'Épidémiologie et d'Économie de la Santé, AP-HM, Marseille, France, Aix-Marseille Université
| | - Chloe Taguet
- Service d'assistance Médicale d'urgence (SAMU), AP-HM, Hôpital de la Timone, Marseille, France, Aix-Marseille Université
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Marc Leone
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
| | - Laurent Müller
- Service de Réanimation et Surveillance Continue, Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes Caremeau, Montpellier, France
| | - Laurent Zieleskiewicz
- Service d'anesthésie Réanimation, Hôpital Nord, Marseille, France, Aix-Marseille Université
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Alpert EA, Gold DD, Kobliner-Friedman D, Wagner M, Dadon Z. Revolutionizing Bladder Health: Artificial-Intelligence-Powered Automatic Measurement of Bladder Volume Using Two-Dimensional Ultrasound. Diagnostics (Basel) 2024; 14:1829. [PMID: 39202317 PMCID: PMC11353831 DOI: 10.3390/diagnostics14161829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Measuring elevated post-void residual volume is important for diagnosing urinary outflow tract obstruction and cauda equina syndrome. Catheter placement is exact but painful, invasive, and may cause infection, whereas an ultrasound is accurate, painless, and safe. AIM The purpose of this single-center study is to evaluate the accuracy of a module for artificial-intelligence (AI)-based fully automated bladder volume (BV) prospective measurement using two-dimensional ultrasound images, as compared with manual measurement by expert sonographers. METHODS Pairs of transverse and longitudinal bladder images were obtained from patients evaluated in an urgent care clinic. The scans were prospectively analyzed by the automated module using the prolate ellipsoid method. The same examinations were manually measured by a blinded expert sonographer. The two methods were compared using the Pearson correlation, kappa coefficients, and the Bland-Altman method. RESULTS A total of 111 pairs of transverse and longitudinal views were included. A very strong correlation was found between the manual BV measurements and the AI-based module with r = 0.97 [95% CI: 0.96-0.98]. The specificity and sensitivity for the diagnosis of an elevated post-void residual volume using a threshold ≥200 mL were 1.00 and 0.82, respectively. An almost-perfect agreement between manual and automated methods was obtained (kappa = 0.85). Perfect reproducibility was found for both inter- and intra-observer agreements. CONCLUSION This AI-based module provides an accurate automated measurement of the BV based on ultrasound images. This novel method demonstrates a very strong correlation with the gold standard, making it a potentially valuable decision-support tool for non-experts in acute settings.
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Affiliation(s)
- Evan Avraham Alpert
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Daniel David Gold
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Deganit Kobliner-Friedman
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
| | - Michael Wagner
- Division of Hospital Medicine, Department of Medicine, Prisma Health Greenville Memorial Hospital, 701 Grove Rd, Greenville, SC 29605, USA
| | - Ziv Dadon
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel
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Höhne E, Schäfer VS, Petzinna SM, Wittek A, Gotta J, Reschke P, Recker F. First insights of integrating the Bonn Internship Curriculum for Point-of-Care Ultrasound (BI-POCUS): progress and educational aspects. BMC MEDICAL EDUCATION 2024; 24:894. [PMID: 39160520 PMCID: PMC11334524 DOI: 10.1186/s12909-024-05904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/14/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is rapidly gaining prominence in various clinical settings. As its use becomes more widespread, there is a growing need for comprehensive ultrasound training in medical education to ensure that future healthcare professionals are proficient in this essential diagnostic tool. OBJECTIVE This study is the first attempt by the University of Bonn to seamlessly integrate ultrasound courses and the use of ultrasound devices into the regular activities of final year medical students and to evaluate the usage of these devices. METHODS A total of forty students in their practical year were provided with a hendheld ultrasound device for a period of four months. During this time, they were invited to take part in eight optional ultrasound courses in which they acquired images and those images were rated using a specially developed rating system. At the end of the tertial, students were able to take part in a voluntary survey on the use of the equipment. RESULTS Participation in the optional ultrasound courses was well received, with the Introduction and FAST module drawing the largest number of participants (29). Among the ultrasound images acquired by students, those of the lungs obtaining the highest rating, with 18.82 (SD ± 4.30) points out of 23 points, while the aorta and vena cava images scored lowest, with an average of 16.62 (SD ± 1.55) points. The overall mean score for all images was 17.47 (SD ± 2.74). Only 21 students responded to the survey. Of the participating students, 67% used the device independently four times or fewer during the tertial. CONCLUSION The study aimed to enhance the BI-POCUS curriculum by improving students' ultrasound skills during their practical year. However, device usage was lower than expected, with most students using it only once a month or less. This raises concerns about the justification of the effort and resources. Future initiatives will focus on technical improvements, better login data provision, and closer monitoring of usage and progress, emphasizing the need for practical ultrasound training in medical education.
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Affiliation(s)
- Elena Höhne
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Valentin Sebastian Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Simon Michael Petzinna
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Agnes Wittek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Jennifer Gotta
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Reschke
- Department of Diagnostic and Interventional Radiology, Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
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Uchida T, Tanaka Y, Suzuki A. Automatic detection of pleural line and lung sliding in lung ultrasonography using convolutional neural networks. Heliyon 2024; 10:e34700. [PMID: 39170189 PMCID: PMC11336331 DOI: 10.1016/j.heliyon.2024.e34700] [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: 08/29/2023] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Background Lung ultrasonography (LUS) is a valuable diagnostic tool, but there is a shortage of LUS experts with extensive knowledge and significant experience in the field. Convolutional neural networks (CNNs) have the potential to mitigate this issue by facilitating computer-aided diagnosis. Methods We propose computer-aided system by a CNN-based method for LUS diagnosis. As the first consideration, we investigated pleural line and lung sliding. The pleural line indicates the position of pleura in an ultrasound image, and LUS is performed after first confirming the position of pleural line. Lung sliding defined as the movement of the pleural line, and the absence of this feature is associated with pneumothorax. Results Our proposed method accurately detected pleural line and lung sliding, demonstrating its potential to provide valuable diagnostic information on lung lesions.
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Affiliation(s)
- Takeyoshi Uchida
- Material Strength Standards Group, Research Institute for Engineering Measurement, National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Central 3, 1-1-1 Umezono, Tsukuba, 305-8563, Japan
| | - Yukimi Tanaka
- Material Strength Standards Group, Research Institute for Engineering Measurement, National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Central 3, 1-1-1 Umezono, Tsukuba, 305-8563, Japan
| | - Akihiro Suzuki
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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Berger L, Coisy F, Sammoud S, de Oliveira F, Grandpierre RG, Grau-Mercier L, Bobbia X, Markarian T. Evaluation of left ventricular ejection fraction by a new automatic tool on a pocket ultrasound device: Concordance study with cardiac magnetic resonance imaging. PLoS One 2024; 19:e0308580. [PMID: 39133705 PMCID: PMC11318925 DOI: 10.1371/journal.pone.0308580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Assessment of left ventricular ejection fraction (LVEF) is one of the primary objectives of echocardiography. The gold standard assessment technique in emergency medicine is eyeballing. A new tool is now available on pocket ultrasound devices (PUD): automatic LVEF. The primary aim of this study was to evaluate the concordance between LVEF values estimated by automatic LVEF with PUD and by cardiac magnetic resonance imaging (MRI). MATERIALS This was a prospective, monocentric, and observational study. All adult patients with an indication for cardiac MRI underwent a point-of-care ultrasound. Blinded to the MRI results, the emergency physician assessed LVEF using the automatic PUD tool and by visual evaluation. RESULTS Sixty patients were included and analyzed. Visual estimation of LVEF was feasible for all patients and automatic evaluation for 52 (87%) patients. Lin's concordance correlation coefficient between automatic ejection fraction with PUD and by cardiac MRI was 0.23 (95% CI, 0.03-0.40). CONCLUSION Concordance between LVEF estimated by the automatic ejection fraction with PUD and LVEF estimated by MRI was non-existent.
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Affiliation(s)
- Lucie Berger
- Department of Emergency Medicine, UR UM 103 (IMAGINE), Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Fabien Coisy
- Department of Emergency Medicine, UR UM 103 (IMAGINE), Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Skander Sammoud
- Department of Medical Imaging, IPI Platform, Nîmes University Hospital, Medical Imaging Group Nîmes, IMAGINE, University of Montpellier, Nîmes, France
| | - Fabien de Oliveira
- Department of Medical Imaging, IPI Platform, Nîmes University Hospital, Medical Imaging Group Nîmes, IMAGINE, University of Montpellier, Nîmes, France
| | - Romain Genre Grandpierre
- Department of Emergency Medicine, UR UM 103 (IMAGINE), Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Laura Grau-Mercier
- Department of Emergency Medicine, UR UM 103 (IMAGINE), Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Xavier Bobbia
- Department of Emergency Medicine, UR UM 103 (IMAGINE), Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Thibaut Markarian
- Department of Emergency Medicine, UMR 1263 (C2VN), Assistance Publique des Hôpitaux de Marseille (APHM), Timone University Hospital, Aix-Marseille University, Marseille, France
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Pedersen MRV, Østergaard ML, Nayahangan LJ, Nielsen KR, Lucius C, Dietrich CF, Nielsen MB. Simulation-based education in ultrasound - diagnostic and interventional abdominal focus. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:348-366. [PMID: 38513687 DOI: 10.1055/a-2277-8183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.
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Affiliation(s)
- Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital - part of Lillebaelt Hospital, Vejle, Denmark
- Department of regional health research, University of Southern Denmark
| | | | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Denmark
| | - Kristina Rue Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Claudia Lucius
- Outpatient Department of Gastroenterology, IBD center, Policlinic Helios Klinikum Buch, Berlin, Germany
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Ali AM, Luntsi G, Abba-Sulum HK, Nkubli FB, Moi AS, Nwobi CI, Ahidjo A. Ultrasound as a triaging tool for the diagnosis of malaria and typhoid in a resource constrained setting: A proposed frame-work. Radiography (Lond) 2024; 30:1483-1490. [PMID: 39198079 DOI: 10.1016/j.radi.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/20/2024] [Accepted: 08/12/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Ultrasound has proven to have great potentials in the diagnosis and work-up of patients affected by tropical diseases. Its role in the diagnosis of malaria and typhoid abounds, but its value as a triaging tool in a resource-constrained settings is indistinct. Our review aimed is aimed at assessing the utility of ultrasound in diagnosis and prognosis of malaria and typhoid. MATERIALS AND METHOD Extensive literature search was conducted using the PubMed electronic database, for original peer reviewed articles in English language within 1964-2023. Keywords like "malaria", "typhoid", "S. Typhi", "Salmonella Typhi", "enteric fever", "ultrasound", "sonography" and "ultrasonography" were searched, using Boolean operators such as (OR, AND) applying the following filters (English, Human). A systematic synthesis of the literature was done. RESULT Our initial search yielded 749 potentially relevant references out of which 55 were found to be eligible. Organs assessed include the liver, spleen, kidneys, intestines, mesenteric lymph nodes, among others. For malaria, pathognomonic conditions like splenic enlargement, hepatomegaly, renal abnormalities as well as mesenteric lymph nodes and intestinal wall thickening in patients with typhoid fever. CONCLUSION Ultrasound by experienced clinicians adds significantly to the diagnosis and work-up of patients with malaria and typhoid fever. However, it is important to note that ultrasound alone may not be sufficient for definitive diagnosis as laboratory tests may still be required for confirmatory diagnosis. IMPLICATION FOR PRACTICE This study provide information on ultrasound in diagnosis of Malaria and typhoid by evaluating the morphological changes in abdominal and other organs of the body. This can be a guide to clinicians and other healthcare providers for early diagnosis and work-up of patients in endemic areas where resources are scarce.
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Affiliation(s)
- A M Ali
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - G Luntsi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria.
| | - H K Abba-Sulum
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - F B Nkubli
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - A S Moi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - C I Nwobi
- Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Nigeria
| | - A Ahidjo
- Department of Radiology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
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12
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Goudelin M, Evrard B, Donisanu R, Gonzalez C, Truffy C, Orabona M, Galy A, Lapébie FX, Jamilloux Y, Vandeix E, Belcour D, Hodler C, Ramirez L, Gagnoud R, Chapellas C, Vignon P. Therapeutic impact of basic critical care echocardiography performed by residents after limited training. Ann Intensive Care 2024; 14:119. [PMID: 39073505 PMCID: PMC11286607 DOI: 10.1186/s13613-024-01354-7] [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: 04/26/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators' answers to simple clinical questions and the concordance between basic two-dimensional measurements. METHODS This observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm. RESULTS Residents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52-74]; SAPS2: 45 [34-59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50-0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size. CONCLUSIONS A limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.
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Affiliation(s)
- Marine Goudelin
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Bruno Evrard
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Roxana Donisanu
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Céline Gonzalez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Christophe Truffy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Marie Orabona
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Antoine Galy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | | | - Yvan Jamilloux
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Elodie Vandeix
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Dominique Belcour
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Charles Hodler
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Lucie Ramirez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Rémi Gagnoud
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Catherine Chapellas
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France.
- Inserm CIC1435, 87000, Limoges, France.
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13
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Nathani A, Keshishyan S, Cho RJ. Advancements in Interventional Pulmonology: Harnessing Ultrasound Techniques for Precision Diagnosis and Treatment. Diagnostics (Basel) 2024; 14:1604. [PMID: 39125480 PMCID: PMC11312290 DOI: 10.3390/diagnostics14151604] [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: 03/28/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 08/12/2024] Open
Abstract
Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and safety in procedures such as transthoracic needle aspiration and pleural effusion drainage, consequently leading to improved patient outcomes. Understanding the fundamentals of ultrasound physics is paramount for clinicians, as it forms the basis for interpreting imaging results and optimizing interventions. Thoracic ultrasound plays a pivotal role in diagnosing conditions like pleural effusions and pneumothorax, while also optimizing procedures such as thoracentesis and biopsy by providing precise guidance. Advanced ultrasound techniques, including endobronchial ultrasound, has transformed the evaluation and biopsy of lymph nodes, bolstered by innovative features like elastography, which contribute to increased procedural efficacy and patient safety. Peripheral ultrasound techniques, notably radial endobronchial ultrasound (rEBUS), have become essential for assessing pulmonary nodules and evaluating airway structures, offering clinicians valuable insights into disease localization and severity. Neck ultrasound serves as a crucial tool in guiding supraclavicular lymph node biopsy and percutaneous dilatational tracheostomy procedures, ensuring safe placement and minimizing associated complications. Ultrasound technology is suited for further advancement through the integration of artificial intelligence, miniaturization, and the development of portable devices. These advancements hold the promise of not only improving diagnostic accuracy but also enhancing the accessibility of ultrasound imaging in diverse healthcare settings, ultimately expanding its utility and impact on patient care. Additionally, the integration of enhanced techniques such as contrast-enhanced ultrasound and 3D imaging is anticipated to revolutionize personalized medicine by providing clinicians with a more comprehensive understanding of anatomical structures and pathological processes. The transformative potential of medical ultrasound in interventional pulmonology extends beyond mere technological advancements; it represents a paradigm shift in healthcare delivery, empowering clinicians with unprecedented capabilities to diagnose and treat pulmonary conditions with precision and efficacy. By leveraging the latest innovations in ultrasound technology, clinicians can navigate complex anatomical structures with confidence, leading to more informed decision-making and ultimately improving patient outcomes. Moreover, the portability and versatility of modern ultrasound devices enable their deployment in various clinical settings, from traditional hospital environments to remote or resource-limited areas, thereby bridging gaps in healthcare access and equity.
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Affiliation(s)
| | | | - Roy Joseph Cho
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN 55455, USA; (A.N.); (S.K.)
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Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, West FM. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. J Am Soc Echocardiogr 2024; 37:S0894-7317(24)00222-0. [PMID: 39230540 DOI: 10.1016/j.echo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Point-of-care ultrasound (POCUS) involves the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician. The current state of cardiac POCUS terminology is heterogeneous and ambiguous, in part because it evolved through siloed specialty practices. In particular, the medical literature and colloquial medical conversation contain a wide variety of terms that equate to cardiac POCUS. While diverse terminology aided in the development and dissemination of cardiac POCUS throughout multiple specialties, it also contributes to confusion and raises patient safety concerns. This statement is the product of a diverse and inclusive Writing Group from multiple specialties, including medical linguistics, that employed an iterative process to contextualize and standardize a nomenclature for cardiac POCUS. We sought to establish a deliberate vocabulary that is sufficiently unrelated to any specialty, ultrasound equipment, or clinical setting to enhance consistency throughout the academic literature and patient care settings. This statement (1) reviews the evolution of cardiac POCUS-related terms; (2) outlines specific recommendations, distinguishing between intrinsic and practical differences in terminology; (3) addresses the implications of these recommendations for current practice; and (4) discusses the implications for novel technologies and future research.
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Affiliation(s)
- James N Kirkpatrick
- Division of Cardiology and Department of Bioethics and Humanities, Department of Medicine, University of Washington, Seattle, Washington
| | - Nova Panebianco
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - José L Díaz-Gómez
- Critical Care Institute, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | | | - Yuriy S Bronshteyn
- Duke University School of Medicine, Durham Veterans Health Administrations, Durham, North Carolina
| | - Sara Damewood
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - Amer Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Bruce J Kimura
- Echocardiography and Vascular Ultrasound Lab, Scripps Mercy Hospital, San Diego, California
| | - Smadar Kort
- Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Arthur Labovitz
- Department of Cardiovascular Sciences, NCH Rooney Heart Institute, Naples, Florida
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Irene W Y Ma
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon L Mulvagh
- Dalhousie University, Women's Heart Health Clinic, Halifax, Nova Scotia, Canada
| | - Sara Nikravan
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington
| | - Sheela Pai Cole
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Michael H Picard
- Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Vincent L Sorrell
- University of Kentucky, Gill Heart and Vascular Institute, Lexington, Kentucky
| | | | - Ritu Thamman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Gabriele Via
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frances Mae West
- Division of Pulmonary & Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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15
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Villar-Zarra K, Balassanian R, Vielh P. Unleash your potential: Inside interventional pathology. Cytopathology 2024. [PMID: 38979853 DOI: 10.1111/cyt.13417] [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: 04/15/2024] [Revised: 06/04/2024] [Accepted: 06/16/2024] [Indexed: 07/10/2024]
Abstract
Interventional pathology has emerged as a pivotal force in modern healthcare, heralding a paradigm shift from traditional diagnostic approaches to patient-centered care. This innovative field bridges the gap between pathology and cytopathology, empowering pathologists to streamline diagnoses and reduce waiting times for patients. Collaborative mentorship and knowledge sharing ensure a lasting legacy of diagnostic excellence for future generations. Interventional pathology stands as a symbol of innovation and patient empowerment, offering a unified approach to diagnostics and improved care in the era of personalized medicine. This narrative chronicles the evolution of interventional pathologists from behind-the-scenes diagnostic specialists to frontline innovators. This is the story of the rise of the interventional pathologist: a testament to innovation, dedication, and an unwavering commitment to patient well-being.
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16
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Zumstein N, Merlo C, Essig S, Auer R, Tal K, Hari R. The use of diagnostic ultrasound by primary care physicians in Switzerland - a cross-sectional study. BMC PRIMARY CARE 2024; 25:246. [PMID: 38971759 PMCID: PMC11227144 DOI: 10.1186/s12875-024-02491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Diagnostic ultrasound has become a bedside tool widely available to many primary care physicians (PCPs) in Europe. It is often used as point-of-care ultrasonography (POCUS) in this setting. In Switzerland, certain POCUS examinations are listed as learning objectives in existing ultrasound training programs (we defined these examinations as swissPOCUS = sPOCUS). Ultrasound performed by PCPs can lead to faster diagnostic workup and reduce referral to secondary care units. However, adequate training is crucial to guarantee high quality. To guide the development of ultrasound training programs for PCPs, this study explores the use of ultrasound in primary care in Switzerland. METHODS This was a cross-sectional study. We invited PCPs from the Swiss practice-based research network "Sentinella" to collect data on the first 5 daily ultrasounds they ordered or performed themselves. Participating PCPs collected data for 3 months - divided into 4 groups to account for seasonal differences. RESULTS Out of 188 PCPs invited, 81.9% provided data through an initial questionnaire. 46.8% provided data on 1616 ultrasounds. 56.5% of PCPs had access to ultrasound machines, while 29.8% had completed formal training. 77% of the reported ultrasounds were self-performed; 27% of the reported scans (35% of all self-performed scans) were performed by PCPs with incomplete or no formal training. The main areas of interest were the abdominal (57.9%) and the musculoskeletal (22%) region. 36.9% of reported examinations were sPOCUS exams. Among PCPs with access to US machines, the percentages of referred examinations were similar for sPOCUS (11.9%) and non-sPOCUS (11.3%) indications. However, some sPOCUS musculoskeletal ultrasounds were often referred (e.g. tendon/ligament/muscle injuries or cutaneous/subcutaneous tumour). CONCLUSION Most Swiss PCPs had access to ultrasound equipment and performed a majority of both sPOCUS and non-sPOCUS scans themselves, often without or with incomplete training. This reflects the fact that POCUS was only recently introduced in Switzerland. There is a need for easily accessible POCUS training programs aimed at PCPs in Switzerland. Training courses for PCPs should focus on abdominal and musculoskeletal ultrasound, because these were the most common sites for scans, and because some sPOCUS musculoskeletal examinations showed a particularly high percentage of referral.
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Affiliation(s)
- Nico Zumstein
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Christoph Merlo
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Swiss Sentinel Surveillance Network, Federal Office of Public Health, Bern, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Dean's Office, Medical Faculty, University of Bern, Bern, Switzerland
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17
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Duggan NM, Jin M, Duran Mendicuti MA, Hallisey S, Bernier D, Selame LA, Asgari-Targhi A, Fischetti CE, Lucassen R, Samir AE, Duhaime E, Kapur T, Goldsmith AJ. Gamified Crowdsourcing as a Novel Approach to Lung Ultrasound Data Set Labeling: Prospective Analysis. J Med Internet Res 2024; 26:e51397. [PMID: 38963923 PMCID: PMC11258523 DOI: 10.2196/51397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/04/2023] [Accepted: 04/10/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Machine learning (ML) models can yield faster and more accurate medical diagnoses; however, developing ML models is limited by a lack of high-quality labeled training data. Crowdsourced labeling is a potential solution but can be constrained by concerns about label quality. OBJECTIVE This study aims to examine whether a gamified crowdsourcing platform with continuous performance assessment, user feedback, and performance-based incentives could produce expert-quality labels on medical imaging data. METHODS In this diagnostic comparison study, 2384 lung ultrasound clips were retrospectively collected from 203 emergency department patients. A total of 6 lung ultrasound experts classified 393 of these clips as having no B-lines, one or more discrete B-lines, or confluent B-lines to create 2 sets of reference standard data sets (195 training clips and 198 test clips). Sets were respectively used to (1) train users on a gamified crowdsourcing platform and (2) compare the concordance of the resulting crowd labels to the concordance of individual experts to reference standards. Crowd opinions were sourced from DiagnosUs (Centaur Labs) iOS app users over 8 days, filtered based on past performance, aggregated using majority rule, and analyzed for label concordance compared with a hold-out test set of expert-labeled clips. The primary outcome was comparing the labeling concordance of collated crowd opinions to trained experts in classifying B-lines on lung ultrasound clips. RESULTS Our clinical data set included patients with a mean age of 60.0 (SD 19.0) years; 105 (51.7%) patients were female and 114 (56.1%) patients were White. Over the 195 training clips, the expert-consensus label distribution was 114 (58%) no B-lines, 56 (29%) discrete B-lines, and 25 (13%) confluent B-lines. Over the 198 test clips, expert-consensus label distribution was 138 (70%) no B-lines, 36 (18%) discrete B-lines, and 24 (12%) confluent B-lines. In total, 99,238 opinions were collected from 426 unique users. On a test set of 198 clips, the mean labeling concordance of individual experts relative to the reference standard was 85.0% (SE 2.0), compared with 87.9% crowdsourced label concordance (P=.15). When individual experts' opinions were compared with reference standard labels created by majority vote excluding their own opinion, crowd concordance was higher than the mean concordance of individual experts to reference standards (87.4% vs 80.8%, SE 1.6 for expert concordance; P<.001). Clips with discrete B-lines had the most disagreement from both the crowd consensus and individual experts with the expert consensus. Using randomly sampled subsets of crowd opinions, 7 quality-filtered opinions were sufficient to achieve near the maximum crowd concordance. CONCLUSIONS Crowdsourced labels for B-line classification on lung ultrasound clips via a gamified approach achieved expert-level accuracy. This suggests a strategic role for gamified crowdsourcing in efficiently generating labeled image data sets for training ML systems.
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Affiliation(s)
- Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mike Jin
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Centaur Labs, Boston, MA, United States
| | | | - Stephen Hallisey
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Denie Bernier
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren A Selame
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ameneh Asgari-Targhi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Chanel E Fischetti
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ruben Lucassen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrew J Goldsmith
- Department of Emergency Medicine, Lahey Hospital, University of Massachusetts Medical School, Burlington, MA, United States
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Reinoso-Párraga PP, González-Montalvo JI, Menéndez-Colino R, Perkisas S, Rivera-Deras I, Garmendia-Prieto B, Arain SJ, Tung-Chen Y, Vilches-Moraga A. Usefulness of point of care ultrasound in older adults: a multicentre study across different geriatric care settings in Spain and the United Kingdom. Age Ageing 2024; 53:afae165. [PMID: 39051145 DOI: 10.1093/ageing/afae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/29/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Point of care ultrasound (POCUS) is an imaging technique performed bedside. To date, few published studies have reported the usefulness of multiorgan POCUS in Geriatrics. The objective of this study was to describe the utility of multiorgan POCUS in the care of older adults admitted to geriatric care settings. METHODOLOGY Observational retrospective study of patients admitted to geriatric settings in Spain and UK. Multiorgan POCUS was performed when there was a specific clinical suspicion or unexplained torpid clinical course despite physical examination and complementary tests. A geriatrician with a certificate degree in comprehensive ultrasound and long-standing experience in POCUS carried out POCUS. All patients underwent multiorgan POCUS in a cephalo-caudal manner. RESULTS Out of 368 patients admitted to geriatric units, 29% met the inclusion criteria. Average age was 85.9 years (SD ± 6.1). POCUS identified 235 clinically significant findings (2.2 per patient). Findings were classified as 37.9% confirmed diagnosis, 16.6% ruled out diagnosis, 14.9% unsuspected relevant diagnoses and 30.6% clinical follow-ups. POCUS findings led to changes in pharmacological and non-pharmacological treatment in 66.3 and 69.2% respectively, resulted in completion or avoidance of invasive procedures in 17.8 and 15.9%, respectively, facilitating early referrals to other specialities in 14.9% and avoiding transfers in 25.2% of patients. CONCLUSION Multiorgan POCUS is a tool that aids in the assessment and treatment of patients receiving care in geriatrics units. These results show the usefulness of POCUS in the management of older adults and suggest its inclusion in any curriculum of Geriatric Medicine speciality training.
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Affiliation(s)
- Paola Pastora Reinoso-Párraga
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González-Montalvo
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine. Universidad Autónoma de, Madrid, Spain
| | - Rocío Menéndez-Colino
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine. Universidad Autónoma de, Madrid, Spain
| | - Stany Perkisas
- University Centre for Geriatrics ZNA (Ziekenhuis Netwerk Antwerpen) University of Antwerp, Antwerp, Belgium
| | | | - Blanca Garmendia-Prieto
- Department of Geriatrics, Cruz Roja University Hospital, Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
| | | | - Yale Tung-Chen
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
- Department of Internal Medicine. La Paz University Hospital, Madrid, Spain
| | - Arturo Vilches-Moraga
- Department of Geriatrics and Long-term Care, Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Bolton University, Bolton, UK
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Zelachowski KA, Rishniw M, DeFrancesco TC. A survey of the use of ultrasound by small animal veterinary clinicians. Vet Radiol Ultrasound 2024; 65:429-436. [PMID: 38668650 DOI: 10.1111/vru.13377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/14/2024] [Accepted: 04/12/2024] [Indexed: 07/21/2024] Open
Abstract
This study aimed to determine the current use of ultrasound amongst small animal veterinarians. A total of 1216 small animal veterinary practitioners responded to an electronic survey that was administered through the Veterinary Information Network to all its members. Descriptive statistics were generated; limited inferential statistics were performed to examine specific relationships. Eighty-four percent of respondents had access to an ultrasound unit, and 86% of respondents reported using their unit multiple times per week. The most common uses were assistance with cystocentesis (93%) and abdominocentesis (71%), pregnancy diagnosis (69%), limited abdominal evaluation (63%), to aid in thoracocentesis (59%), and limited thoracic evaluation (52%). Eighty-nine percent of respondents received some formal training in ultrasound, most commonly from continuing education courses. Most respondents (52%) reported receiving ≤25 h of training. Additionally, 88% of respondents believed it was either extremely or very important for there to be ultrasound training for veterinary students prior to graduation. Based on this survey, most small animal practitioners commonly use ultrasound for limited examinations, being most confident in the sonographic evaluation and centesis of the bladder and for the detection and centesis of effusion in a body cavity. With most respondents having ≤25 h of training in ultrasound, typically obtained in postgraduate courses, an expansion in standardized basic ultrasound training within the veterinary curriculum may be warranted.
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Affiliation(s)
- Kendra A Zelachowski
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Mark Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
- Veterinary Information Network, Davis, California, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Akhtar MN. Relative Value of Point-of-Care Ultrasound in Person Specification of UK Consultant Job Advertisements Across Multiple Acute Specialties. Cureus 2024; 16:e64862. [PMID: 39035589 PMCID: PMC11259529 DOI: 10.7759/cureus.64862] [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: 07/18/2024] [Indexed: 07/23/2024] Open
Abstract
Background Point-of-care ultrasound (POCUS) skills are very useful in the management of acute patients. It is unknown how highly valued they are at the consultant level. The objective of this study was to investigate the prevalence of POCUS skills being listed as essential or desirable in consultant job advertisements for acute medicine (AM), intensive care medicine (ICM), and emergency medicine (EM) in the United Kingdom (UK). Methods We investigated the frequency with which POCUS skills are listed in person specification of consultant jobs advertised in the UK in three acute specialties (AM, ICM, and EM). Data were collected prospectively between May and June 2022 from the NHS Jobs website. Results A total of 286 jobs were identified, and 11 jobs (3.85%) listed POCUS skills as either essential or desirable. In AM consultant jobs, only two (1.83%) categorized POCUS as desirable or essential compared to five (11.6%) in ICM and four (3%) in EM. Conclusion POCUS skills are mentioned in the person specification in a minority of consultant job advertisements in acute specialties and currently do not seem to be widely viewed as essential or desirable for consultant practice in these specialties. It may be due to not many consultants are currently trained for this new skill, which in turn has led to the scarcity of the skill set demanded by the employing trusts in the UK.
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21
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Kubo E, Nagata M, Yoshinaga N. The use of ultrasonography in education for undergraduate nursing students: A literature review. Jpn J Nurs Sci 2024; 21:e12596. [PMID: 38527918 DOI: 10.1111/jjns.12596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
AIM The incorporation of ultrasonography into nursing practice is becoming more common, but how ultrasonography is used or applied in nursing student education is still unclear. This study aimed to review and synthesize relevant literature on the use of ultrasonography in education for undergraduate nursing students. METHODS An electronic literature search was conducted in June 2022 (updated in June 2023) using MEDLINE, CINAHL, Scopus, and Ichushi-Web databases. Two researchers independently screened/assessed the eligibility of the studies, synthesized extracted data using a narrative synthesis (due to anticipated heterogeneity across studies), and evaluated the methodological quality of quantitative studies using the Medical Education Research Study Quality Instrument. RESULTS Thirteen peer-reviewed articles were included in the review. All of the studies were conducted in high-income countries, and the majority of them employed an uncontrolled single-group design. Ultrasonography was used mainly for visualizing the vascular system to improve students' puncture skills, but it was also used with various other applications. The included studies were predominantly of moderate quality and heterogeneous, but all of them reported at least some benefits in nursing student education, such as enhancing knowledge and understanding of subcutaneous anatomical structures, and improving confidence in and/or skills of venipuncture and other visualization/assessment methods. CONCLUSIONS This review provides a broad perspective and highlights the potential use of ultrasonography in education for undergraduate nursing students. Further research is needed to develop standardized teaching methods/curriculum and competency assessments in order to ensure minimum competency standards for students and to improve clinical outcomes for patients.
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Affiliation(s)
- Eri Kubo
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Miu Nagata
- Department of Nursing, University of Miyazaki Hospital, Miyazaki, Japan
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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22
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Atmaca Ö, Liu J, Ly TJ, Bajraktari F, Pott PP. Spatial sensitivity distribution assessment and Monte Carlo simulations for needle-based bioimpedance imaging during venipuncture using the finite element method. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3831. [PMID: 38690649 DOI: 10.1002/cnm.3831] [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: 10/26/2023] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
Despite being among the most common medical procedures, needle insertions suffer from a high error rate. Impedance measurements using electrode-equipped needles offer promise for improved tissue targeting and reduced errors. Impedance visualization usually requires an extensive pre-measured impedance dataset for tissue differentiation and knowledge of the electric fields contributing to the resulting impedances. This work presents two finite element simulation approaches for both problems. The first approach describes the generation of a multitude of impedances with Monte Carlo simulations for both, homogeneous and inhomogeneous tissue to circumvent the need to rely on previously measured data. These datasets could be used for tissue discrimination. The second method describes the simulation of the spatial sensitivity distribution of an electrode layout. Two singularity analysis methods were employed to determine the bulk of the sensitivity within a finite volume, which in turn enables consistent 3D visualization. The modeled electrode layout consists of 12 electrodes radially placed around a hypodermic needle. Electrical excitation was simulated using two neighboring electrodes for current carriage and voltage pickup, which resulted in 12 distinct bipolar excitation states. Both, the impedance simulations and the respective singularity analysis methods were compared with each other. The results show that the statistical spread of impedances is highly dependent on the tissue type and its inhomogeneities. The bounded bulk of sensitivities of both methods are of similar extent and symmetry. Future models should incorporate more detailed tissue properties such as anisotropy or changing material properties due to tissue deformation to gain more accurate predictions.
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Affiliation(s)
- Ömer Atmaca
- Institute of Medical Device Technology (IMT), University of Stuttgart, Baden-Württemberg, Germany
- Institute of Applied Optics (ITO), University of Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Jan Liu
- Institute of Medical Device Technology (IMT), University of Stuttgart, Baden-Württemberg, Germany
| | - Toni J Ly
- Institute of Medical Device Technology (IMT), University of Stuttgart, Baden-Württemberg, Germany
- Fraunhofer Institute for Manufacturing Engineering and Automation (IPA), Stuttgart, Baden-Württemberg, Germany
| | - Flakë Bajraktari
- Institute of Medical Device Technology (IMT), University of Stuttgart, Baden-Württemberg, Germany
| | - Peter P Pott
- Institute of Medical Device Technology (IMT), University of Stuttgart, Baden-Württemberg, Germany
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23
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Dieiev V, Dubrov S, Díaz-Gómez JL, Stevens RA, Salinas P, Gudzenko V, Matolinets N, Kravets O, Krishtafor D, Pavlysh O, Cherniaiev S, Pustavoitau A. Point-of-care ultrasonography in Ukraine: a survey of anesthesiologists-intensivists participating in ultrasonography courses. Can J Anaesth 2024:10.1007/s12630-024-02789-z. [PMID: 38918272 DOI: 10.1007/s12630-024-02789-z] [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: 09/08/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE Despite the potential value of point-of-care ultrasonography (POCUS) in resource-limited environments, it is not widely used in low- and middle-income countries compared with high-income countries. We sought to evaluate the current POCUS practice of Ukrainian anesthesiologists who attended POCUS courses to guide future POCUS training in Ukraine. METHODS We conducted a 25-question web-based survey. It was distributed to 255 participants of POCUS courses held in Ukraine in 2023. The survey sections described current POCUS practice, perception of POCUS value, POCUS skills self-assessment, and perceived barriers to implementing POCUS in clinical practice. RESULTS Two hundred and forty-four out of 255 course participants completed the survey, representing 214 unique respondents. Those who self-rated their skills identified themselves as either novices or beginners in areas of POCUS knowledge (118/157, 75%), image acquisition (110/158, 70%), image interpretation (117/158, 74%), and integration into clinical decision-making (105/155, 68%). Among all survey responders, 55% (118/214) reported using POCUS for vascular access procedures, 45% (97/214) for trauma assessment, and 44% (93/214) for regional anesthesia. Reported barriers to POCUS implementation included lack of ultrasound devices (101/214, 47%) and lack of trained faculty (112/214, 52%). CONCLUSION Among anesthesiologists who participated in POCUS courses in Ukraine, the majority were in early stages of ultrasound practice. Respondents identified POCUS applications not currently practiced and evaluated barriers to POCUS use. Based upon these survey findings, we propose the following measures in Ukraine: 1) developing a standardized national POCUS curriculum; 2) increasing the number of experienced instructors of POCUS; and 3) acquiring ultrasound devices to support clinical applications of POCUS, especially in the Central, Southern, and Eastern regions.
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Affiliation(s)
- Vladyslav Dieiev
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Aurora St. Luke's Medical Center, Suite 315, 2901 W. Kinnikinick River Parkway, Milwaukee, WI, 53215, USA.
| | - Sergii Dubrov
- Bogomolets National Medical University, Kiev, Ukraine
| | | | - Rom A Stevens
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Pedro Salinas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Vadim Gudzenko
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Olga Kravets
- Dnipro State Medical University, Dnipro, Ukraine
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Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child 2024; 109:543-549. [PMID: 38442949 DOI: 10.1136/archdischild-2024-326904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics. This article describes the development and launch of the UK's inaugural accredited paediatric-specific POCUS curriculum and training pathway: the 'Children's ACuTe UltraSound' course, addressing this significant gap in paediatric healthcare education and describing the training delivered and available for paediatricians and allied health professionals working with children.
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Affiliation(s)
- Michael J Griksaitis
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Bogdana Zoica
- King's College Hospital NHS Foundation Trust, London, UK
| | - Dusan Raffaj
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Jennie Stephens
- Intensive Care & Acute Medicine, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Avishay Sarfatti
- Paediatric Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veena Rajagopal
- Paediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Jessica Green
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Shires
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | | | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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Miravent S, Jiménez C, Barbancho N, Lobo MD, Figueiredo T, Gomes C, Ratusneac I, Gonçalves JM, Hasnas C, de Almeida R. Renal screening sonography-A comparative study in a Portuguese basic emergency service. J Med Radiat Sci 2024. [PMID: 38888376 DOI: 10.1002/jmrs.802] [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: 12/02/2023] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Renal Point-of-Care Ultrasound (POCUS) is a screening modality that aids in clinical decision-making for patients with suspected renal colic. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). METHODS Thirty-one patients suspected of having renal pathology underwent initial sonography screening with POCUS at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. RESULTS In our sample, the majority of patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) patients presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables 'Dilatation of pyelocaliceal system' (V = 0.895; P = 0.00), 'Simple cystic formation' (V = 0.878; P = 0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables, respectively (k = 0.890; P = 0.000) and (k = 0.870; P = 0.000). There was also a strong statistically significant correlation in the ultrasonographic findings between BES and RH performers (k = 0.890; P = 0.000 and k = 0.870; P = 0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. CONCLUSION Renal POCUS screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic findings at the BES had a good correlation with the complementary imaging results obtained at the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.
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Affiliation(s)
- Sérgio Miravent
- Algarve Local Health Unit, Basic Emergency Center of Vila Real de Santo António, Faro, Portugal
- Medical Imaging and Radiotherapy Department, University of Algarve, Faro, Portugal
| | - Carmen Jiménez
- Algarve Local Health Unit, Basic Emergency Center of Vila Real de Santo António, Faro, Portugal
| | - Narciso Barbancho
- Algarve Local Health Unit, University Hospital Center of Algarve, Intensive Care Unit- Resuscitation Room, Faro, Portugal
| | - Manuel Duarte Lobo
- Local Health Unit of the Northeast, Bragança, Portugal
- Polytechnic University of Castelo Branco, Castelo Branco, Portugal
| | - Teresa Figueiredo
- Integrated Master of Medicine, Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
| | - Carla Gomes
- Algarve Local Health Unit, Basic Emergency Center of Vila Real de Santo António, Faro, Portugal
- Integrated Master of Medicine, Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
- Algarve Local Health Unit, Levante Family Health Unit, Faro, Portugal
| | - Ion Ratusneac
- Integrated Master of Medicine, Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
- Algarve Local Health Unit, Levante Family Health Unit, Faro, Portugal
| | - João Mário Gonçalves
- Integrated Master of Medicine, Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
- Algarve Local Health Unit, Levante Family Health Unit, Faro, Portugal
| | - Corina Hasnas
- Medical Imaging and Radiotherapy Department, University of Algarve, Faro, Portugal
| | - Rui de Almeida
- Medical Imaging and Radiotherapy Department, University of Algarve, Faro, Portugal
- CHRC-Comprehensive Health Research Center, University of Evora, Évora, Portugal
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26
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Robertson T, Meyer K, Kerr MS, Gibson J, Bradley L, Reeves R, Handler E. Ultrasound Incorporation in Gross Anatomy Labs in a Master of Medical Sciences Program: A Mixed-Methods Analysis of Student Performance and Perception. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:999-1011. [PMID: 38369775 DOI: 10.1002/jum.16427] [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: 10/04/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Teaching ultrasound imaging is on the rise in undergraduate medical anatomy education. However, there is little research exploring the use of ultrasound in preparatory graduate programs. The purpose of this study is to identify the effects of ultrasound imaging inclusion in a graduate gross anatomy course. METHODS Master of Medical Sciences students were enrolled in a prosection-based anatomy course that included pinned cadaver stations and an ultrasound station. Using ultrasound, teaching assistants imaged volunteers demonstrating anatomical structures students previously learned at cadaver stations. Students answered one ultrasound image question on each practical exam and were asked to participate in a pre- and post-course survey. Student practical and lecture exam scores and final course grades from the 2022 cohort were compared to a historical control cohort from 2021 via statistical analysis, including a survey administered to the 2022 cohort. RESULTS Two hundred students from the 2021 cohort and 164 students from the 2022 cohort participated in this study. Students in the 2022 cohort had significantly higher scores in 1 of the 5 practical exams (P < .05, d = .289), and 2 of the 5 written exams (P < .05, d = .207), (P < .05, d = .311). Survey data revealed increased (P < .05, d = 1.203) learning outcome achievement from pre-survey to post-survey in the intervention cohort. Students who correctly answered the ultrasound question performed significantly better on practical's 3 (P < .05) and 4 (P < .05) than those who missed the ultrasound question. CONCLUSIONS These findings suggest that ultrasound imaging in a cadaver lab is beneficial to graduate students' learning and understanding of gross anatomy.
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Affiliation(s)
- Taylor Robertson
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly Meyer
- School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Marcel Satsky Kerr
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - John Gibson
- Department of Family Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Libby Bradley
- Department of Radiology, Division of Anatomy, Michigan State University, Lansing, MI, USA
| | - Rustin Reeves
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emma Handler
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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27
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Kosuta I, Premkumar M, Reddy KR. Review article: Evaluation and care of the critically ill patient with cirrhosis. Aliment Pharmacol Ther 2024; 59:1489-1509. [PMID: 38693712 DOI: 10.1111/apt.18016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While liver transplantation offers a potential life-saving intervention, not all patients are eligible due to limitations such as organ availability, resource constraints, ongoing sepsis or multiple organ failures. Consequently, the focus of critical care of patients with advanced and decompensated cirrhosis turns to liver-centric intensive care protocols, to mitigate the high mortality in such patients. AIM Provide an updated and comprehensive understanding of cirrhosis management in critical care, and which includes emergency care, secondary organ failure management (mechanical ventilation, renal replacement therapy, haemodynamic support and intensive care nutrition), use of innovative liver support systems, infection control, liver transplantation and palliative and end-of life care. METHODS We conducted a structured bibliographic search on PubMed, sourcing articles published up to 31 March 2024, to cover topics addressed. We considered data from observational studies, recommendations of society guidelines, systematic reviews, and meta-analyses, randomised controlled trials, and incorporated our clinical expertise in liver critical care. RESULTS Critical care management of the patient with cirrhosis has evolved over time while mortality remains high despite aggressive management with liver transplantation serving as a crucial but not universally available resource. CONCLUSIONS Implementation of organ support therapies, intensive care protocols, nutrition, palliative care and end-of-life discussions and decisions are an integral part of critical care of the patient with cirrhosis. A multi-disciplinary approach towards critical care management is likely to yield better outcomes.
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Affiliation(s)
- Iva Kosuta
- Department of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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28
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Zhang Y, Hu P, Li L, Cao R, Khadria A, Maslov K, Tong X, Zeng Y, Jiang L, Zhou Q, Wang LV. Ultrafast longitudinal imaging of haemodynamics via single-shot volumetric photoacoustic tomography with a single-element detector. Nat Biomed Eng 2024; 8:712-725. [PMID: 38036618 PMCID: PMC11136871 DOI: 10.1038/s41551-023-01149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023]
Abstract
Techniques for imaging haemodynamics use ionizing radiation or contrast agents or are limited by imaging depth (within approximately 1 mm), complex and expensive data-acquisition systems, or low imaging speeds, system complexity or cost. Here we show that ultrafast volumetric photoacoustic imaging of haemodynamics in the human body at up to 1 kHz can be achieved using a single laser pulse and a single element functioning as 6,400 virtual detectors. The technique, which does not require recalibration for different objects or during long-term operation, enables the longitudinal volumetric imaging of haemodynamics in vasculature a few millimetres below the skin's surface. We demonstrate this technique in vessels in the feet of healthy human volunteers by capturing haemodynamic changes in response to vascular occlusion. Single-shot volumetric photoacoustic imaging using a single-element detector may facilitate the early detection and monitoring of peripheral vascular diseases and may be advantageous for use in biometrics and point-of-care testing.
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Affiliation(s)
- Yide Zhang
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Peng Hu
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Lei Li
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Rui Cao
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Anjul Khadria
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Konstantin Maslov
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Xin Tong
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Yushun Zeng
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Laiming Jiang
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Qifa Zhou
- USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lihong V Wang
- Caltech Optical Imaging Laboratory, Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA.
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29
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Parker M, Johnson L, Paquette R, Sakaguchi A, Kar R. The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey. ANATOMICAL SCIENCES EDUCATION 2024; 17:855-863. [PMID: 38197498 DOI: 10.1002/ase.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.
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Affiliation(s)
- Morgan Parker
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Laura Johnson
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Roland Paquette
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan Sakaguchi
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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30
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Lake S, Brydges R, Penney C, Wilson D, Sweezie R, Bagovich M, Bong D, Barr S, Stroud L. Online vs in-person musculoskeletal ultrasound course: a cohort comparison study. Ultrasound J 2024; 16:30. [PMID: 38819664 PMCID: PMC11143147 DOI: 10.1186/s13089-024-00375-4] [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: 08/30/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Point-of-care musculoskeletal (MSK) ultrasound (US) courses are typically held in-person. The COVID-19 pandemic guidelines forced courses to switch to online delivery. To determine this impact, we conducted an observational cohort study, comparing homework completion and image quality between an Online and a historical In-person cohort. METHODS The In-person (n = 27) and Online (n = 24) cohorts attended two learning sessions spaced six months apart. The course content was the same, while the process of delivery differed. As homework, participants submitted US images biweekly for up to five months after each session. Expert faculty provided written feedback to all participants, and two independent reviewers rated the image quality for a subset of participants in each group who had completed at least 70% of their homework (In-person, n = 9; Online, n = 9). Participants self-reported their satisfaction through post-course evaluation. RESULTS 63% of In-Person and 71% of Online cohort participants submitted their homework images. We observed no differences in the mean amount of homework images submitted for In-person (M = 37.3%, SD = 42.6%) and Online cohorts (M = 48.1%, SD = 38.8%; p > 0.05, Mann-Whitney U Test). At course end, the cohorts did not differ in overall image quality (p > 0.05, Wilcoxon Signed-rank Test). All participants reported high levels of satisfaction. CONCLUSIONS A convenience sample of participants attending a basic MSK US course in-person and online did not differ statistically in homework completion, quality of submitted US images, or course satisfaction. We add to literature suggesting online learning remains a viable option post-pandemic.
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Affiliation(s)
- Shirley Lake
- Division of Rheumatology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N3M5, Toronto, ON, Canada.
| | - Ryan Brydges
- Department of Medicine, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Chris Penney
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | | | | | - Maria Bagovich
- Division of Rheumatology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N3M5, Toronto, ON, Canada
| | - David Bong
- University of Barcelona School of Medicine, Barcelona, Spain
| | - Susan Barr
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Canada
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Yoo J, Kang SY, Joon Jo I, Kim T, Lee GT, Park JE, Lee SU, Hwang SY, Cha WC, Shin TG, Cho YS, Jang H, Yoon H. Status and perception of point-of-care ultrasound education in Korean medical schools: A national cross-sectional study. Medicine (Baltimore) 2024; 103:e38026. [PMID: 38701308 PMCID: PMC11062660 DOI: 10.1097/md.0000000000038026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
As point-of-care ultrasound (POCUS) is increasingly being used in clinical settings, ultrasound education is expanding into student curricula. We aimed to determine the status and awareness of POCUS education in Korean medical schools using a nationwide cross-sectional survey. In October 2021, a survey questionnaire consisting of 20 questions was distributed via e-mail to professors in the emergency medicine (EM) departments of Korean medical schools. The questionnaire encompassed 19 multiple-choice questions covering demographics, current education, perceptions, and barriers, and the final question was an open-ended inquiry seeking suggestions for POCUS education. All EM departments of the 40 medical schools responded, of which only 13 (33%) reported providing POCUS education. The implementation of POCUS education primarily occurred in the third and fourth years, with less than 4 hours of dedicated training time. Five schools offered a hands-on education. Among schools offering ultrasound education, POCUS training for trauma cases is the most common. Eight schools had designated professors responsible for POCUS education and only 2 possessed educational ultrasound devices. Of the respondents, 64% expressed the belief that POCUS education for medical students is necessary, whereas 36%, including those with neutral opinions, did not anticipate its importance. The identified barriers to POCUS education included faculty shortages (83%), infrastructure limitations (76%), training time constraints (74%), and a limited awareness of POCUS (29%). POCUS education in Korean medical schools was limited to a minority of EM departments (33%). To successfully implement POCUS education in medical curricula, it is crucial to clarify learning objectives, enhance faculty recognition, and improve the infrastructure. These findings provide valuable insights for advancing ultrasound training in medical schools to ensure the provision of high-quality POCUS education for future healthcare professionals.
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Affiliation(s)
- Jonghoon Yoo
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Soo Yeon Kang
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyewon Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pai VV, Noh CY, Dasani R, Vallandingham S, Manipon C, Haileselassie B, Profit J, Balasundaram M, Davis AS, Bhombal S. Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e76-e84. [PMID: 35691294 DOI: 10.1055/s-0042-1750118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program. STUDY DESIGN A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound. RESULTS A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful. CONCLUSIONS Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management. KEY POINTS · Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.. · Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.. · Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound..
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Affiliation(s)
- Vidya V Pai
- Division of Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Caroline Y Noh
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Reedhi Dasani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shelby Vallandingham
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Christine Manipon
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Bereketeab Haileselassie
- Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Malathi Balasundaram
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Russo A, Patanè V, Fusco L, Faggioni L, Boschetti CE, Santagata M, Neri E, Cappabianca S, Reginelli A. Reliability of Ultrasonographic Assessment of Depth of Invasion and Tumor Thickness in Intraoral Mucosa Lesions: A Preliminary Experience. J Clin Med 2024; 13:2595. [PMID: 38731124 PMCID: PMC11084595 DOI: 10.3390/jcm13092595] [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: 03/07/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Despite the progress made in multidisciplinary care, there has been little improvement in the oncologic outcomes of oral cavity squamous cell carcinomas (OSCCs). In the latest edition of the TNM staging, "depth of invasion" (DOI) has recently been introduced as one of the criteria for determining the T stage, alongside other factors. DOI is widely recognized as an independent risk factor for nodal metastases and is a crucial consideration in the preoperative staging of OSCCs, along with measurements of tumor thickness (TT). While various diagnostic methods exist for assessing DOI, intraoral ultrasonography (IOUS) has gained popularity for its efficacy in evaluating OSCCs. Methods: This study sought to evaluate the diagnostic accuracy and reliability of ultrahigh-frequency ultrasound (UHFUS) in assessing oral cavity lesions compared to histopathological analysis. Results: The results revealed strong reliability in ultrasonographic measurements (ICC TT: 0.94; ICC DOI: 0.97) and distinct ultrasonographic features specific to different oral pathologies. This highlights the potential of UHFUS as a non-invasive imaging tool for precise diagnostic evaluations. Conclusions: Despite limitations such as a small sample size and focus on specific lesions, these promising results suggest that UHFUS could significantly enhance oral lesion diagnostics. Further research involving larger cohorts is necessary to validate and build upon these initial findings.
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Affiliation(s)
- Anna Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigia Fusco
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Lorenzo Faggioni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Ciro Emiliano Boschetti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Mario Santagata
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy; (L.F.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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Lo Bianco M, Presti S, Finocchiaro MC, Trobia GL, Sciacca TV, Cucuzza ME, Caudullo E, Calcara G, Ruggieri M, Di Stefano VA. Point-of-care ultrasound (POCUS) pediatric resident training course: a cross-sectional survey. Ital J Pediatr 2024; 50:82. [PMID: 38649948 PMCID: PMC11036774 DOI: 10.1186/s13052-024-01652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming increasingly crucial in the Pediatric Emergency Department for objective patient examination. However, despite its growing interest and wide-ranging applications, POCUS remains relatively unexplored in general pediatric training and education. Many physicians still find it challenging to comprehend and implement. METHODS A theoretical-practical POCUS course for pediatric residents was conducted at the University of Catania, Italy. The course's effectiveness and practical impact on residents was assessed through a pre-post training survey. The first part of the questionnaire focused on the self-perceived time needed to learn how to recognize the following conditions using POCUS: (i) Pleural effusion (ii) Lung consolidation (iii) Pneumothorax (PNX) (iv) Cardiac contractility (v) Pericardial effusion (vi) Perisplenic effusion (vii) Morison's pouch effusion (viii) Douglas' pouch effusion (ix) Filling and collapsibility of the inferior vena cava. In the second part, we compared the potential role of POCUS in (i) Reducing the use of ionizing radiation in children (ii) Increasing the sense of security in diagnosis and treatment decisions making and (iii) Increasing the residents' confidence level with POCUS after the course on a 1-to-10 rating scale. RESULTS Seventy-two residents participated in the study. The statistical analysis showed significant pre-post differences in almost all the items considered, except for "cardiac contractility" and "PNX". Furthermore, the perceived potential role of POCUS in reducing ionizing radiation usage and the sense of security in diagnosis and treatment decisions showed statistically significant differences (p < 0.05) before and after the course. Data analysis also revealed a consistently high confidence level with POCUS after the course. CONCLUSIONS The results highlight the importance of including a POCUS track course in pediatric post-graduate programs due to its simplicity, rapid learning time, and clinical usefulness. Based on these findings, it would be recommended to increase the teaching hours dedicated to the recognition of pneumothorax and cardiology POCUS examination. Emphasizing POCUS training in pediatric education can enhance patient care and diagnostic accuracy while minimizing radiation exposure.
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Affiliation(s)
- Manuela Lo Bianco
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia, 78, 95125, Catania, Italy.
| | - Santiago Presti
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia, 78, 95125, Catania, Italy
| | - Maria Carla Finocchiaro
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Gian Luca Trobia
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Tiziana Virginia Sciacca
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Maria Elena Cucuzza
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Elia Caudullo
- U.O. Department of Diagnostic for Images, Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Giacomo Calcara
- U.O.S.D. Diagnostics for Emergency Imaging, Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. "Policlinico", P.O. "G. Rodolico", via S. Sofia, 78, 95125, Catania, Italy.
| | - Vita Antonella Di Stefano
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
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MacKay EJ, Bharat S, Mukaddim RA, Erkamp R, Sutton J, Muhammad AK, Savino JS, Horak J. Pragmatic Evaluation of a Deep-Learning Algorithm to Automate Ejection Fraction on Hand-Held, Point-of-Care Echocardiography in a Cardiac Surgical Operating Room. J Cardiothorac Vasc Anesth 2024; 38:895-904. [PMID: 38307740 DOI: 10.1053/j.jvca.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To test the correlation of ejection fraction (EF) estimated by a deep-learning-based, automated algorithm (Auto EF) versus an EF estimated by Simpson's method. DESIGN A prospective observational study. SETTING A single-center study at the Hospital of the University of Pennsylvania. PARTICIPANTS Study participants were ≥18 years of age and scheduled to undergo valve, aortic, coronary artery bypass graft, heart, or lung transplant surgery. INTERVENTIONS This noninterventional study involved acquiring apical 4-chamber transthoracic echocardiographic clips using the Philips hand-held ultrasound device, Lumify. MEASUREMENTS AND MAIN RESULTS In the primary analysis of 54 clips, compared to Simpson's method for EF estimation, bias was similar for Auto EF (-10.17%) and the experienced reader-estimated EF (-9.82%), but the correlation was lower for Auto EF (r = 0.56) than the experienced reader-estimated EF (r = 0.80). In the secondary analyses, the correlation between EF estimated by Simpson's method and Auto EF increased when applied to 27 acquisitions classified as adequate (r = 0.86), but decreased when applied to 27 acquisitions classified as inadequate (r = 0.46). CONCLUSIONS Applied to acquisitions of adequate image quality, Auto EF produced a numerical EF estimate equivalent to Simpson's method. However, when applied to acquisitions of inadequate image quality, discrepancies arose between EF estimated by Auto EF and Simpson's method. Visual EF estimates by experienced readers correlated highly with Simpson's method in both variable and inadequate imaging conditions, emphasizing its enduring clinical utility.
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Affiliation(s)
- Emily J MacKay
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | | | | | | | | | | | - Joseph S Savino
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jiri Horak
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Risgaard AL, Andersen IB, Friis ML, Tolsgaard MG, Danstrup CS. Validating the virtual: a deep dive into ultrasound simulator metrics in otorhinolaryngology. Eur Arch Otorhinolaryngol 2024; 281:1905-1911. [PMID: 38177897 PMCID: PMC10942893 DOI: 10.1007/s00405-023-08421-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study aimed to assess the validity of simulation-based assessment of ultrasound skills for thyroid ultrasound. METHODS The study collected validity evidence for simulation-based ultrasound assessment of thyroid ultrasound skills. Experts (n = 8) and novices (n = 21) completed a test containing two tasks and four cases on a virtual reality ultrasound simulator (U/S Mentor's Neck Ultrasound Module). Validity evidence was collected and structured according to Messick's validity framework. The assessments being evaluated included built-in simulator metrics and expert-based evaluations using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. RESULTS Out of 64 built-in simulator metrics, 9 (14.1%) exhibited validity evidence. The internal consistency of these metrics was strong (Cronbach's α = 0.805) with high test-retest reliability (intraclass correlation coefficient = 0.911). Novices achieved an average score of 41.9% (SD = 24.3) of the maximum, contrasting with experts at 81.9% (SD = 16.7). Time comparisons indicated minor differences between experts (median: 359 s) and novices (median: 376.5 s). All OSAUS items differed significantly between the two groups. The correlation between correctly entered clinical findings and the OSAUS scores was 0.748 (p < 0.001). The correlation between correctly entered clinical findings and the metric scores was 0.801 (p < 0.001). CONCLUSION While simulation-based training is promising, only 14% of built-in simulator metrics could discriminate between novices and ultrasound experts. Already-established competency frameworks such as OSAUS provided strong validity evidence for the assessment of otorhinolaryngology ultrasound competence.
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Affiliation(s)
- Anne Line Risgaard
- NordSim, Centre for Skills Training and Simulation, Aalborg University Hospital, Aalborg, Denmark
- Department of Otorhinolaryngology - Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Iben Bang Andersen
- NordSim, Centre for Skills Training and Simulation, Aalborg University Hospital, Aalborg, Denmark.
- Department of Otorhinolaryngology - Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Mikkel Lønborg Friis
- NordSim, Centre for Skills Training and Simulation, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet and Center for Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Sander Danstrup
- Department of Otorhinolaryngology - Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Camard L, Liard R, Duverne S, Ibanez G, Skendi M. Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study. BMC MEDICAL EDUCATION 2024; 24:341. [PMID: 38532436 DOI: 10.1186/s12909-024-05072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/18/2024] [Indexed: 03/28/2024]
Abstract
CONTEXT Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored. OBJECTIVE The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions. METHOD We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training. RESULTS 11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of "7-9" ratings) and 19 skills with a relative agreement (100% of "5-9" ratings). CONCLUSION These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.
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Affiliation(s)
- Louis Camard
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France.
| | - Roxane Liard
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
| | - Sophie Duverne
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
| | - Gladys Ibanez
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
- Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
| | - Mariela Skendi
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France.
- Department of Adult Radiology, Necker Hospital, Paris, France.
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Signor E, Gerstenberger J, Cotton J, Colbert-Getz J, Lappé K. Integrating a self-directed ultrasound curriculum for the internal medicine clerkship. Ultrasound J 2024; 16:19. [PMID: 38443723 PMCID: PMC10914648 DOI: 10.1186/s13089-024-00367-4] [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: 08/20/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Incorporating ultrasound into the clinical curriculum of undergraduate medical education has been limited by a need for faculty support. Without integration into the clinical learning environment, ultrasound skills become a stand-alone skill and may decline by the time of matriculation into residency. A less time intensive ultrasound curriculum is needed to preserve skills acquired in preclinical years. We aimed to create a self-directed ultrasound curriculum to support and assess students' ability to acquire ultrasound images and to utilize ultrasound to inform clinical decision-making. METHODS Third year students completed the self-directed ultrasound curriculum during their required internal medicine clerkship. Students used Butterfly iQ+ portable ultrasound probes. The curriculum included online modules that focused on clinical application of ultrasound as well as image acquisition technique. Students were graded on image acquisition quality and setting, a patient write-up focused on clinical decision-making, and a multiple-choice quiz. Student feedback was gathered with an end-of-course survey. Faculty time was tracked. RESULTS One hundred and ten students participated. Students averaged 1.79 (scale 0-2; SD = 0.21) on image acquisition, 78% (SD = 15%) on the quiz, and all students passed the patient write-up. Most reported the curriculum improved their clinical reasoning (72%), learning of pathophysiology (69%), and patient care (55%). Faculty time to create the curriculum was approximately 45 h. Faculty time to grade student assignments was 38.5 h per year. CONCLUSIONS Students were able to demonstrate adequate image acquisition, use of ultrasound to aid in clinical decision-making, and interpretation of ultrasound pathology with no in-person faculty instruction. Additionally, students reported improved learning of pathophysiology, clinical reasoning, and rapport with patients. The self-directed curriculum required less faculty time than prior descriptions of ultrasound curricula in the clinical years and could be considered at institutions that have limited faculty support.
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Affiliation(s)
- Emily Signor
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - John Gerstenberger
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - Jennifer Cotton
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie Colbert-Getz
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - Katie Lappé
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States.
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Francisco MJ, de Lira EB, de Queiroz MRG. Point-of-Care in Clinical Practice: Consolidated Reality. Arq Bras Cardiol 2024; 121:e20230688. [PMID: 38451562 PMCID: PMC11081179 DOI: 10.36660/abc.20230688] [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: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024] Open
Affiliation(s)
- Miguel José Francisco
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
| | - Edgar Bezerra de Lira
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
| | - Marcos Roberto Gomes de Queiroz
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Albert EinsteinSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP – Brasil
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Chang A, Wu X, Liu K. Deep learning from latent spatiotemporal information of the heart: Identifying advanced bioimaging markers from echocardiograms. BIOPHYSICS REVIEWS 2024; 5:011304. [PMID: 38559589 PMCID: PMC10978053 DOI: 10.1063/5.0176850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
A key strength of echocardiography lies in its integration of comprehensive spatiotemporal cardiac imaging data in real-time, to aid frontline or bedside patient risk stratification and management. Nonetheless, its acquisition, processing, and interpretation are known to all be subject to heterogeneity from its reliance on manual and subjective human tracings, which challenges workflow and protocol standardization and final interpretation accuracy. In the era of advanced computational power, utilization of machine learning algorithms for big data analytics in echocardiography promises reduction in cost, cognitive errors, and intra- and inter-observer variability. Novel spatiotemporal deep learning (DL) models allow the integration of temporal arm information based on unlabeled pixel echocardiographic data for convolution of an adaptive semantic spatiotemporal calibration to construct personalized 4D heart meshes, assess global and regional cardiac function, detect early valve pathology, and differentiate uncommon cardiovascular disorders. Meanwhile, data visualization on spatiotemporal DL prediction models helps extract latent temporal imaging features to develop advanced imaging biomarkers in early disease stages and advance our understanding of pathophysiology to support the development of personalized prevention or treatment strategies. Since portable echocardiograms have been increasingly used as point-of-care imaging tools to aid rural care delivery, the application of these new spatiotemporal DL techniques show the potentials in streamlining echocardiographic acquisition, processing, and data analysis to improve workflow standardization and efficiencies, and provide risk stratification and decision supporting tools in real-time, to prompt the building of new imaging diagnostic networks to enhance rural healthcare engagement.
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Affiliation(s)
- Amanda Chang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa 52242, USA
| | - Kan Liu
- Division of Cardiology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr 2024; 183:1079-1089. [PMID: 38127086 DOI: 10.1007/s00431-023-05377-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
In the realm of emergency medicine, the swift adoption of lung ultrasound (LU) has extended from the adult population to encompass pediatric and neonatal intensivists. LU stands out as a bedside, replicable, and cost-effective modality, distinct in its avoidance of ionizing radiations, a departure from conventional chest radiography. Recent years have witnessed a seamless adaptation of experiences gained in the adult setting to the neonatal and pediatric contexts, underscoring the versatility of bedside Point of care ultrasound (POCUS). This adaptability has proven reliable in diagnosing common pathologies and executing therapeutic interventions, including chest drainage, and central and peripheral vascular cannulation. The surge in POCUS utilization among neonatologists and pediatric intensivists is notable, spanning economically advanced Western nations with sophisticated, high-cost intensive care facilities and extending to low-income countries. Within the neonatal and pediatric population, POCUS has become integral for diagnosing and monitoring respiratory infections and chronic and acute lung pathologies. This, in turn, contributes to a reduction in radiation exposure during critical periods of growth, thereby mitigating oncological risks. Collaboration among various national and international societies has led to the formulation of guidelines addressing both the clinical application and regulatory aspects of operator training. Nevertheless, unified guidelines specific to the pediatric and neonatal population remain lacking, in contrast to the well-established protocols for adults. The initial application of POCUS in neonatal and pediatric settings centered on goal-directed echocardiography. Pivotal developments include expert statements in 2011, the UK consensus statement on echocardiography by neonatologists, and European training recommendations. The Australian Clinician Performed Ultrasound (CPU) program has played a crucial role, providing a robust academic curriculum tailored for training neonatologists in cerebral and cardiac assessment. Notably, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recently disseminated evidence-based guidelines through an international panel, delineating the use and applications of POCUS in the pediatric setting. These guidelines are pertinent to any professional tending to critically ill children in routine or emergency scenarios. In light of the burgeoning literature, this paper will succinctly elucidate the methodology of performing an LU scan and underscore its primary indications in the neonatal and pediatric patient cohort. The focal points of this review comprise as follows: (1) methodology for conducting a lung ultrasound scan, (2) key ultrasonographic features characterizing a healthy lung, and (3) the functional approach: Lung Ultrasound Score in the child and the neonate. Conclusion: the aim of this review is to discuss the following key points: 1. How to perform a lung ultrasound scan 2. Main ultrasonographic features of the healthy lung 3. The functional approach: Lung Ultrasound Score in the child and the neonate What is Known: • Lung Ultrasound (LUS) is applied in pediatric and neonatal age for the diagnosis of pneumothorax, consolidation, and pleural effusion. • Recently, LUS has been introduced into clinical practice as a bedside diagnostic method for monitoring surfactant use in NARDS and lung recruitment in PARDS. What is New: • Lung Ultrasound (LUS) has proven to be useful in confirming diagnoses of pneumothorax, consolidation, and pleural effusion. • Furthermore, it has demonstrated effectiveness in monitoring the response to surfactant therapy in neonates, in staging the severity of bronchiolitis, and in PARDS.
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Affiliation(s)
- Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Anaesthesia, Intensive Care and Emergency Medicine Department, Milan, Italy.
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
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Bughrara NF, Neilson MR, Jones S, Workman L, Chopra A, Pustavoitau A. Is 1 Day of Focused Training in Echocardiographic Assessment Using Subxiphoid-Only (EASy) Examination Enough? A Tertiary Hospital Response to the COVID-19 Crisis and the Use of the EASy Examination to Support Unit-Wide Image Acquisition. Crit Care Explor 2024; 6:e1038. [PMID: 38415022 PMCID: PMC10898658 DOI: 10.1097/cce.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES We assessed the efficacy of 1-day training in echocardiography assessment using subxiphoid-only (EASy) followed by supervised image interpretation and decision-making during patient rounds as a novel approach to scaling up the use of point-of-care ultrasound (POCUS) in critically ill patients. DESIGN Retrospective analysis of medical records and EASy examination images. SETTING Tertiary care academic hospital. PATIENTS A total of 14 adults (> 18 yr old) with COVID-19-associated respiratory failure under the care of Albany Medical Center's surge response team from April 6-17, 2020 who received at least one EASy examination. INTERVENTIONS Residents (previously novice sonographers) were trained in EASy examination using 1 day of didactic and hands-on training, followed by independent image acquisition and supervised image interpretation, identification of hemodynamic patterns, and clinical decision-making facilitated by an echocardiography-certified physician during daily rounds. MEASUREMENTS AND MAIN RESULTS We recorded the quality of resident-obtained EASy images, scanning time, and frequency with which the supervising physician had to repeat the examination or obtain additional images. A total of 63 EASy examinations were performed; average scanning time was 4.3 minutes. Resident-obtained images were sufficient for clinical decision-making on 55 occasions (87%), in the remaining 8 (13%) the supervising physician obtained further images. CONCLUSIONS EASy examination is an efficient, valuable tool under conditions of scarce resources. The educational model of 1-day training followed by supervised image interpretation and decision-making allows rapid expansion of the pool of sonographers and implementation of bedside echocardiography into routine ICU patient management.
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Affiliation(s)
- Nibras F Bughrara
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Maegan R Neilson
- Department of Anesthesiology and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Stephanie Jones
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Lorna Workman
- Department of Anesthesiology and Critical Care Medicine, Wagga Wagga Base Hospital, Wagga, NSW, Australia
| | - Amit Chopra
- Department of Anesthesiology and Critical Care Medicine, Albany Medical Center, Albany, NY
- Department of Surgery, Albany Medical Center, Albany, NY
- Department of Internal Medicine, Albany Medical College, Albany Medical Center, Albany, NY
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
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Morales-Ortega A, Duarte-Millán MÁ, Canora-Lebrato J, Zapatero-Gaviria A. [Point-of-care ultrasound: Indications and utility in internal medicine]. Med Clin (Barc) 2024; 162:190-196. [PMID: 38016854 DOI: 10.1016/j.medcli.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Alejandro Morales-Ortega
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, España.
| | | | - Jesús Canora-Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España
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Al-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, Anwar S, Kashiwagi DT. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J 2024; 16:12. [PMID: 38383673 PMCID: PMC10881927 DOI: 10.1186/s13089-023-00350-5] [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: 06/05/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The use of Point-of-Care Ultrasound (POCUS) has become prevalent across a variety of clinical settings. Many healthcare professionals have started getting hands-on training. To evaluate the effectiveness of such training programs, this study aimed to assess a 4 day POCUS training course on healthcare providers' skills and knowledge acquisition. A secondary objective of this study is to gain valuable insights into the degree of perception, attitude, interest levels and perceived barriers of medical providers performing POCUS. METHODS This is a prospective cohort study performed on healthcare providers in an integrated healthcare facility in Abu Dhabi undergoing the POCUS training course in February 2022. Course participants took a pre-course survey to evaluate their baseline knowledge, skills, confidence, perception, and interest in POCUS. The same survey was repeated immediately post-course. In total, seven healthcare professionals responded to the survey with a response rate of 53.8%. All data and information gathered were used to understand the effectiveness of POCUS training and gain insights into the degree of perception, interest and preparedness of POCUS among healthcare professionals in practice. RESULTS Our results demonstrated that the brief POCUS course was effective in improving POCUS skills, knowledge and confidence amongst in-practice healthcare providers from varying medical specialties. The median skill score increased from 25% pre-course to 50% post-course. There is a notable increase in all skills scores after the POCUS training course with the greatest change in scores seen for adjusting 'gain and depth of image (54.84%), assessing VeXUS score (52.38%) and evaluating lung congestion (50%). The study also provided valuable insights into the perception, attitude, interest and potential barriers of POCUS implementation. Although significant barriers to POCUS are present including the lack of POCUS curriculum, what is challenging is lack of expertise and skills to perform POCUS. Therefore, medical providers must acquire prespecified skills to fully utilize POCUS effectively. CONCLUSION The study confirmed the effectiveness of short POCUS training in improving the skills, knowledge and confidence of medical providers in practice. Healthcare professionals can master POCUS skills and techniques and gain confidence through brief training courses.
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Affiliation(s)
- Dima Tareq Al-Absi
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mohammed Atif Omar
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hatem Soliman-Aboumarie
- Department of Anaesthesia and Intensive Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular, Metabolic Sciences and Medicine, King's College London, London, UK
| | - Noha Abou Khater
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Tahir Mehmood
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Siddiq Anwar
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates.
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
| | - Deanne Tomie Kashiwagi
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
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Wanjiku GW, Bell G, Kapadia S, Wachira BW. Impact of point-of-care ultrasound use on patient referral decisions in rural Kenya: a mixed methods study. BMC Health Serv Res 2024; 24:212. [PMID: 38360660 PMCID: PMC10870490 DOI: 10.1186/s12913-024-10673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is recognized as a key imaging modality to bridge the diagnostic imaging gap in Low- and Middle-Income Countries (LMICs). POCUS use has been shown to impact patient management decisions including referral for specialist care. This study explored the impact of POCUS use on referral decisions among trained healthcare providers working in primary rural and peri-urban health facilities in Kenya. METHODS A concurrent mixed methods approach was used, including a locally developed survey (N = 38) and semi-structured interviews of POCUS trained healthcare providers (N = 12). Data from the survey was descriptively analyzed and interviews were evaluated through the framework matrix method. RESULTS Survey results of in-facility access to Xray, Ultrasonography, CT scan and MRI were 49%, 33%, 3% and 0% respectively. Only 54% of the facilities where trainees worked had the capacity to perform cesarean sections, and 38% could perform general surgery. Through a combined inductive and deductive evaluation of interview data, we found that the emerging themes could be organized through the framework of the six domains of healthcare quality as described by the Institute of Medicine: Providers reported that POCUS use allowed them to make referral decisions which were timely, safe, effective, efficient, equitable and patient-centered. Challenges included machine breakdown, poor image quality, practice isolation, lack of institutional support and insufficient feedback on the condition of patients after referral. CONCLUSION This study highlighted that in the setting of limited imaging and surgical capacity, POCUS use by trained providers in Kenyan primary health facilities has the potential to improve the patient referral process and to promote key dimensions of healthcare quality. Therefore, there is a need to expand POCUS training programs and to develop context specific POCUS referral algorithms.
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Affiliation(s)
- Grace W Wanjiku
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, 55 Claverick Street Suite 101, Providence, RI, 02903, USA.
| | - Gregory Bell
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sonja Kapadia
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Benjamin W Wachira
- Accident and Emergency Department, The Aga Khan University, Nairobi, Kenya
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Frantz AM, Fahy BG. POCUS focus: Dilemmas of the technologically advanced device. J Clin Anesth 2024; 92:111305. [PMID: 37919164 DOI: 10.1016/j.jclinane.2023.111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Amanda M Frantz
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA.
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Schlaepfer CH, Packiam VT, Tracy CR, Takacs EB, Steinberg RL. Current Utilization and Perceptions of Formal Education of Point-of-care Ultrasound in Urology. Urology 2024; 184:8-14. [PMID: 38065312 DOI: 10.1016/j.urology.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the extent of formal point-of-care ultrasound (POCUS) training, current utilization of POCUS, and contemporary perceptions of POCUS amongst urologists. METHODS A survey including questions regarding demographics, prior ultrasound education, current ultrasound utilization in practice/training, perceived optimal POCUS utilization, and the perception of formal ultrasound training was developed. The survey was disseminated to residency program directors (PDs) via the SAU and members of AUA subsection organizations. Data were collected via Redcap. RESULTS A total of 40 PDs and 159 other respondents completed the survey with approximately half (51%) in an academic practice and two-thirds (68%) with more than 10years in practice. PD response rate was 28%, and general response rate was 2%. Among all respondents, 95% (186/196) and 82% (160/194) agreed/strongly agreed formal POCUS training would be worthwhile during and after residency. Among urology residency PDs, 93% (37/40) agreed/strongly agreed that formal POCUS training is worthwhile in residency. The majority of respondents used some form of ultrasound in practice (77%, 154/199). However, only 37% (72/199) of all respondents had prior formal POCUS training, and 19% (5/26) of PDs reported formal training in their programs. Of respondents without formal training, 63% (80/127) reported interest in pursuing formal training. CONCLUSION POCUS is widely utilized in many practices. Yet, most urologists have not participated in formal POCUS training and most programs do not have curricula. Urologists have favorable opinions of the utility, safety, and efficacy of POCUS and desire training.
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Affiliation(s)
| | - Vignesh T Packiam
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Chad R Tracy
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Elizabeth B Takacs
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
| | - Ryan L Steinberg
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA.
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Maheshwari S, Dagor H. Evolving the Scope of Cardiac Point-of-Care Ultrasound in the Current Era. Cureus 2024; 16:e53985. [PMID: 38476776 PMCID: PMC10928454 DOI: 10.7759/cureus.53985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
Point-of-care ultrasound (POCUS) has become a flexible and multifaceted diagnostic instrument in the realm of cardiac care, transforming the landscape of cardiovascular assessment. This review aims to explore the extensive scope of POCUS applications in cardiac care, highlighting its diverse utility across various medical specialties. POCUS, conducted at the patient's bedside, offers real-time insights into cardiac anatomy and function, providing a valuable adjunct to traditional diagnostic methods. In critically ill patients, POCUS has demonstrated its effectiveness in the rapid evaluation of the left and right ventricular function, identification of pericardial effusion and tamponade, assessment of volume status, and detection of valvular lesions. Its role as an adjunct to the physical examination has been particularly impactful, leading to early diagnoses and significantly influencing medical management decisions. The review also discusses the current limitations of POCUS technology. As the utilization of POCUS continues to expand across diverse medical disciplines, its ability to offer timely and accurate diagnostic information is poised to reshape the standard of care in cardiac medicine. This comprehensive review provides insights into the evolving role of POCUS in cardiac care and underscores its potential to enhance patient outcomes through rapid and informed decision-making at the point of care.
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Affiliation(s)
| | - Himansu Dagor
- Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, IND
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Hoffman HT, Koch M, Witt RL, Ryan WR, Zenk J, Katz P, Rahmati R, Rassekh C, Donato F, McCulloch TM, Joshi AS, Chang JL, Gillespie MB, Pichardo PFA, Orloff LA, Marcelino A, Wenzel P, Cohen D, Fundakowski CE, Cognetti DM, Walvekar RR, Bertelli A, Quon H, Anderson C, Policeni B, Siegel G. Proposal for standardized ultrasound analysis of the salivary glands: Part 1 submandibular gland. Laryngoscope Investig Otolaryngol 2024; 9:e1224. [PMID: 38362174 PMCID: PMC10866606 DOI: 10.1002/lio2.1224] [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: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.
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Affiliation(s)
| | | | - Robert Lee Witt
- Christiana Care/Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William R. Ryan
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Philippe Katz
- Institut d'Explorations Fonctionnelles des Glandes SalivairesParisFrance
| | | | - Christopher Rassekh
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | | | - Arjun S. Joshi
- The George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - M. Boyd Gillespie
- University of Tennessee Health Science Center College of MedicineMemphisTennesseeUSA
| | | | | | | | - Piper Wenzel
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - David Cohen
- Kaiser Permanente Los Angeles Medical CenterLos AngelesCaliforniaUSA
| | | | | | | | - Antonio Bertelli
- Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo BrazilSao PauloBrazil
| | - Harry Quon
- Johns Hopkins Medical Institutions CampusBaltimoreMarylandUSA
| | | | - Bruno Policeni
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Gordy Siegel
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
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50
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Warm JJ, Melchiors J, Kristensen TT, Aabenhus K, Charabi BW, Eberhard K, Konge L, von Buchwald C, Todsen T. Head and neck ultrasound training improves the diagnostic performance of otolaryngology residents. Laryngoscope Investig Otolaryngol 2024; 9:e1201. [PMID: 38362178 PMCID: PMC10866603 DOI: 10.1002/lio2.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Surgeon-performed head and neck ultrasound (US) is increasingly used among otolaryngologists in office-based and surgical settings. However, it is unknown how formal US training affects otolaryngology residents' diagnostic workup of patients with cervical pathology. This study examined how a formal US course for residents affected their outpatient clinic US performance and diagnostic accuracy. Methods We conducted a randomized cross-over trial, where 13 otolaryngology residents participated in a 6-h formal US course. Participants were randomized to perform head and neck US on four patient cases before and after completing the course. Eight patients with and without neck pathology were invited to participate as test cases. The ultrasound examinations were video recorded and anonymized before two consultants rated the US performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. Otolaryngology residents wrote an ultrasound report with a diagnosis based on their US examination, which was used to calculate the specificity and sensitivity. Results We found a statistically significant difference in the OSAUS score before compared to after the hands-on training (p = .035). The diagnostic accuracy also increased from 62% before the course to 75% after the course (p = .02). Specificity increased from 54% prior to the course to 62% following the course, and sensitivity increased from 64% prior to the course to 79% following the course. The intraclass correlation coefficient with "absolute agreement" was 0.63. Conclusion This study demonstrates that short, formal ultrasound training can improve otolaryngology residents' ultrasound skills and diagnostic accuracy in an outpatient clinic setting. Lay summary This study looks at the change of otolaryngology residents' diagnostic workup of patients after they take a formal ultrasound course and shows that they get better at using ultrasound and make more accurate diagnoses if they take a formal course. Level of Evidence Level 2.
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Affiliation(s)
- Jens Jessen Warm
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
| | - Jacob Melchiors
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Tina Toft Kristensen
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
| | - Kristine Aabenhus
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
| | - Birgitte Wittenborg Charabi
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Kristine Eberhard
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
| | - Lars Konge
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Copenhagen Academy for Medical Education and SimulationUniversity of Copenhagen and the Capital Region of DenmarkCopenhagenDenmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and AudiologyCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Copenhagen Academy for Medical Education and SimulationUniversity of Copenhagen and the Capital Region of DenmarkCopenhagenDenmark
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