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Eberhardt C, Schwarzwald CC. Focused cardiac ultrasound examination in the emergency and critical care equine patient: Training for non-specialist veterinarians and evaluation of proficiency. J Vet Intern Med 2022; 36:1471-1480. [PMID: 35657023 PMCID: PMC9308440 DOI: 10.1111/jvim.16446] [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: 09/02/2021] [Accepted: 05/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available. Hypothesis To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device. Animals Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS). Methods Prospective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience. Results Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience. Conclusions and Clinical Importance Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course.
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Affiliation(s)
- Christina Eberhardt
- Vetsuisse Faculty, Equine Department, University of Zurich, Zurich, Switzerland
| | - Colin C Schwarzwald
- Vetsuisse Faculty, Equine Department, University of Zurich, Zurich, Switzerland
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2
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Su E, Soni NJ, Blaivas M, Bhargava V, Steffen K, Haileselassie B. Regulating Critical Care Ultrasound, It Is All in the Interpretation. Pediatr Crit Care Med 2021; 22:e253-e258. [PMID: 33060421 DOI: 10.1097/pcc.0000000000002600] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point-of-care ultrasound (POCUS) use is rapidly expanding as a practice in adult and pediatric critical care environments. In January 2020, the Joint Commission endorsed a statement from the Emergency Care Research Institute citing point-of-care ultrasound as a potential hazard to patients for reasons related to training and skill verification, oversight of use, and recordkeeping and accountability mechanisms for clinical use; however, no evidence was presented to support these concerns. Existing data on point-of-care ultrasound practices in pediatric critical care settings verify that point-of-care ultrasound use continues to increase, and contrary to the concerns raised, resources are becoming increasingly available for point-of-care ultrasound use. Many institutions have recognized a successful approach to addressing these concerns that can be achieved through multispecialty collaborations.
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Affiliation(s)
- Erik Su
- Department of Pediatrics, McGovern Medical School, Houston, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Michael Blaivas
- Department of Emergency Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
- Department of Medicine, School of Medicine, University of South Carolina, St. Francis Hospital, Columbus, GA
| | - Vidit Bhargava
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Katherine Steffen
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M, Arrighi JA, Mendes LA, Adams JE, Brush JE, Dec GW, Denktas A, Fernandes S, Freeman R, Hahn RT, Halperin JL, Housholder-Hughes SD, Khan SS, Klarich KW, Lin CH, Marine JE, McPherson JA, Niazi K, Ryan T, Solomon MA, Spicer RL, Tam M, Wang A, Weissman G, Weitz HH, Williams ES. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2020; 32:919-943. [PMID: 31378259 DOI: 10.1016/j.echo.2019.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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4
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Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, Denault A, Desjardins G, Fayad A, Funk D, Hegazy AF, Kim H, Kruger M, Kruisselbrink R, Perlas A, Prabhakar C, Syed S, Sidhu S, Tanzola R, Van Rensburg A, Talab H, Vegas A, Bainbridge D. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth 2020; 68:376-386. [DOI: 10.1007/s12630-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
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Marbach JA, Almufleh A, Di Santo P, Simard T, Jung R, Diemer G, West FM, Millington SJ, Mathew R, Le May MR, Hibbert B. A Shifting Paradigm: The Role of Focused Cardiac Ultrasound in Bedside Patient Assessment. Chest 2020; 158:2107-2118. [PMID: 32707179 DOI: 10.1016/j.chest.2020.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022] Open
Abstract
Transthoracic echocardiography is the standard of care in anatomic and functional cardiovascular assessment; however, focused cardiac ultrasound (FoCUS) performed with portable ultrasound equipment is increasingly being used as an adjunct to comprehensive history and physical examination. FoCUS assessments, unlike formal echocardiography, are intended to assist physicians in answering explicit clinical questions with a narrow differential diagnosis in real time. Over the past decade, a growing body of literature has repeatedly shown the value that FoCUS adds to clinical evaluation. Specifically, FoCUS improves point-of-care diagnostic accuracy, which in turn modifies treatment plans, decreases time to diagnosis, and reduces resource utilization. Although less robust, there is also evidence showing improvement in clinical outcomes. Based on this evidence, clinicians, training programs, and clinical societies have embraced FoCUS as a tool to complement bedside patient evaluation. Herein, we review the evidence for FoCUS in clinical practice, specifically evaluating the diagnostic accuracy, the impact on clinical decision-making, and the effect on clinical outcomes.
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Affiliation(s)
- Jeffrey A Marbach
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Aws Almufleh
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Trevor Simard
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Gretchen Diemer
- Division of Hospital Medicine, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Frances Mae West
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Scott J Millington
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michel R Le May
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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Guerrero CE, Medina HM, Pérez-Fernández ÓM, Flórez G, Zorro M, Salazar G. Concordancia entre ecoscopia realizada por médicos no cardiológos y ecocardiografía convencional. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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7
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz‐Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin M, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography). Catheter Cardiovasc Interv 2019; 94:481-505. [DOI: 10.1002/ccd.28313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography). J Am Coll Cardiol 2019; 74:377-402. [DOI: 10.1016/j.jacc.2019.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. Circ Cardiovasc Imaging 2019. [DOI: 10.1161/hci.0000000000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Junior medical student performed focused cardiac ultrasound after brief training to detect significant valvular heart disease. IJC HEART & VASCULATURE 2018; 19:41-45. [PMID: 29946563 PMCID: PMC6016074 DOI: 10.1016/j.ijcha.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/25/2018] [Indexed: 01/28/2023]
Abstract
Background Focused cardiac ultrasound (FOCUS) examination using a portable device is increasingly used for bedside diagnosis of cardiovascular diseases. This is a 4-week pilot project aiming to teach medical students to perform FOCUS to detect valvular heart lesions. Methods Patients undergoing routine transthoracic echocardiography (TTE) were recruited by third year medical students who performed physical examination (PE) and FOCUS after 6-hour training to detect significant (moderate-to-severe) valvular lesions. Performance of FOCUS and PE was compared to TTE as reference using kappa statistics. Results 10 medical students performed 212 PE and FOCUS on 107 patients with mean age 63.7 ± 14.9 years. TTE detected 126 significant valvular lesions of which FOCUS correctly identified 54 lesions (κ = 0.45) compared to 32 lesions by PE (κ = 0.28, p < 0.01). FOCUS was better than PE in identifying mitral stenosis (κ = 0.51 vs. 0.17), aortic stenosis (κ = 0.45 vs. 0.16) and tricuspid regurgitation (κ = 0.39 vs. 0.09, all p < 0.01). Students became more proficient in performing FOCUS examination with time. Conclusions Teaching junior medical students to perform and interpret FOCUS was feasible after brief training and better than PE in detecting significant valvular lesions. Further studies are warranted to determine the utility of incorporating this new technology into mainstream medical training. Teaching junior medical students to perform and interpret limited pocket-sized ultrasound was feasible after brief training. Accuracy of student performed limited pocket-sized ultrasound was higher than physical examination in detecting significant valvular lesions.
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Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study. Clin Res Cardiol 2017; 107:95-107. [DOI: 10.1007/s00392-017-1181-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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12
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De Marchi L, Meineri M. POCUS in perioperative medicine: a North American perspective. Crit Ultrasound J 2017; 9:19. [PMID: 28993991 PMCID: PMC5633585 DOI: 10.1186/s13089-017-0075-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Ultrasound (US) performed at the point of care has found fertile ground in perioperative medicine. In the hands of anesthesiologists, transesophageal echocardiography (TEE) has become established as a powerful diagnostic and monitoring tool in the perioperative care of cardiac and non-cardiac patients. A number of point-of-care US (POCUS) applications are relevant to perioperative care, including airway, cardiac, lung and gastric US. Although guidelines exist to define the scope of practice for basic and advanced TEE, there remains a lack of such guidelines for perioperative point-of-care ultrasound (POCUS), despite a number of recent calls for action in the academic anesthesia community. POCUS training has been integrated into anesthesia residency curricula in Canada and the United States of America (USA). However, a nation-wide curriculum is still lacking. Many limitations to the development of perioperative POCUS curricula exist, including the need to define the scope of practice and design integrated longitudinal learning approaches. The main anesthesiologist societies in both the USA and Canada are promoting the development of guidelines and have introduced POCUS courses into their national conferences. Although bedside US imaging has been integrated into the curricula of many medical schools in North America, the need for specific national guidelines for the training and practice of POCUS in the perioperative setting by anesthesiologists is crucial to the further development of POCUS in perioperative medicine.
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Affiliation(s)
- Lorenzo De Marchi
- Department of Anesthesia, Georgetown University, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, CCC Building, Lower Level, Washington, DC, USA
| | - Massimiliano Meineri
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street EN 3-400, Toronto, ON, M5G 2C4, Canada.
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Margale S, Marudhachalam K, Natani S. Clinical application of point of care transthoracic echocardiography in perioperative period. Indian J Anaesth 2017; 61:7-16. [PMID: 28216698 PMCID: PMC5296812 DOI: 10.4103/0019-5049.198407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Transthoracic echocardiography (TTE) has established its role for diagnosis and management in cardiology and is used by various other specialities in medicine, but it is not routinely practised by anaesthesiologists in the perioperative period including the pre-admission clinic/outpatient clinic. The last decade has seen the emerging role of anaesthesiologist as a 'Perioperative physician'. This review article highlights the potential role and clinical utility, education, teaching and limitations of point of care (POC) TTE modality in perioperative care. Various echocardiography society guidelines and endorsements, diagnostic protocols and limitations are enumerated. This article also discusses some of the possibilities for future education and development related to clinical ultrasound including POC TTE in anaesthetic training curriculum.
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Affiliation(s)
- Swaroop Margale
- Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Queensland Health, Brisbane, Australia
| | - Kurichi Marudhachalam
- Senior Lecturer, Northside Clinical School, University of Queensland, Brisbane, Australia
| | - Sarvesh Natani
- Consultant Cardiothoracic Anesthetist, Pune Anesthesia and Criti Care Private Limited, Pune, Maharashtra, India
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Seraphim A, Paschou SA, Grapsa J, Nihoyannopoulos P. Pocket-Sized Echocardiography Devices: One Stop Shop Service? J Cardiovasc Ultrasound 2016; 24:1-6. [PMID: 27081437 PMCID: PMC4828408 DOI: 10.4250/jcu.2016.24.1.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
The introduction of portable, pocket-sized echocardiography devices in various healthcare systems has raised new questions with regards to their realistic use in clinical practice. Several studies have already attempted to provide information regarding their safety and diagnostic potential, the training required to operate them, as well as their direct comparison with standard echocardiography machines. This manuscript is a review of the literature of the documents or position papers which employ the use of pocket or handheld devices. Following review of the literature, we suggest that these miniaturized devices can provide a valuable diagnostic tool that can complement and improve the diagnostic yield of clinical examination. When operated by appropriately trained professionals, they can provide a limited but very reliable echocardiographic assessment. Pocket-sized echocardiography is a part of physical examination and should not be considered a complete echocardiographic scan. Optimal training is required for the smooth operation of handheld echocardiography.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiovascular Sciences, Royal Brompton, London, United Kingdom
| | - Stavroula A Paschou
- Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Royal Brompton, London, United Kingdom.; Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
| | - Petros Nihoyannopoulos
- Department of Cardiovascular Sciences, Imperial College of London, London, United Kingdom
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography: Endorsed by the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 28:615-27. [PMID: 26041570 DOI: 10.1016/j.echo.2015.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Bank I, Vliegen HW, Bruschke AVG. The 200th anniversary of the stethoscope: Can this low-tech device survive in the high-tech 21st century? Eur Heart J 2016; 37:3536-3543. [PMID: 26908946 DOI: 10.1093/eurheartj/ehw034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
In 1816, Laennec discovered that auscultation of the heart and lungs could effectively be performed by placing a hollow cylinder (initially made of a roll of paper) between the chest of the patient and the ear of the examiner. This was the first step in the development of the stethoscope, which was a breakthrough in the diagnosis and management of cardiac and pulmonary patients. Technical improvements of the stethoscope followed and in cardiac patients auscultation soon became a major diagnostic tool. In the second half of the 20th century, new powerful non-invasive diagnostic modalities were developed and the interest in auscultation declined. As a result, the auscultatory skills of students and physicians at all levels of training decreased to a disappointingly low level. We now must decide whether we should stimulate the use of and proficiency in auscultation or if we should accept the further decline and eventual abolishment of this component of the physical examination. Reviewing the literature and taking into consideration the setting in which the patients are presented, including the availability of advanced diagnostic facilities, we conclude that the time-honoured stethoscope, in spite of its limitations, still has potential as a patient-friendly, effective, and economical instrument in medical practice. However, new initiatives are required to train students, physicians and allied health professionals in cardiac auscultation to avoid misinterpretations that may harm the patients and generate extra costs. To be successful such programs will require wide support from the medical community.
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Affiliation(s)
- Ivan Bank
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Lange Land Hospital, Zoetermeer, The Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Albert V G Bruschke
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Utility of ultrasound in resuscitation. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Pérez-Coronado JD, Franco-Gruntorad GA. Utilidad de la ecografía en reanimación. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ryan T, Berlacher K, Lindner JR, Mankad SV, Rose GA, Wang A. COCATS 4 Task Force 5: Training in Echocardiography. J Am Coll Cardiol 2015; 65:1786-99. [DOI: 10.1016/j.jacc.2015.03.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. RESULTS During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. CONCLUSIONS This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
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Ojeda JC, Colbert JA, Lin X, McMahon GT, Doubilet PM, Benson CB, Wu J, Katz JT, Yialamas MA. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30:199-206. [PMID: 25387438 PMCID: PMC4314490 DOI: 10.1007/s11606-014-3086-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/17/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded. OBJECTIVE We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice. DESIGN This was a randomized parallel group controlled trial. PARTICIPANTS Forty internal medicine residents in a single program at an academic medical center participated in the study. INTERVENTION Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice. MAIN MEASURES The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound. KEY RESULTS Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023). CONCLUSIONS The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice. TRIAL REGISTRATION clinicaltrials.gov: number NCT01948076; URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2.
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Affiliation(s)
- Jason C Ojeda
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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Siqueira VN, Mancuso FJN, Campos O, De Paola AA, Carvalho AC, Moises VA. Training Program for Cardiology Residents to Perform Focused Cardiac Ultrasound Examination with Portable Device. Echocardiography 2015; 32:1455-62. [DOI: 10.1111/echo.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vicente N. Siqueira
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | | | - Orlando Campos
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Angelo A. De Paola
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Antonio C. Carvalho
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
| | - Valdir A. Moises
- Cardiology Department; Paulista School of Medicine; Federal University of São Paulo; Brazil
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Utility of ultrasound in resuscitation☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543040-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Handheld Ultrasound Versus Physical Examination in Patients Referred for Transthoracic Echocardiography for a Suspected Cardiac Condition. JACC Cardiovasc Imaging 2014; 7:983-90. [DOI: 10.1016/j.jcmg.2014.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 11/22/2022]
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Pocket-size echocardiograph--a valuable tool for nonexperts or just a portable device for echocardiographers? Adv Med Sci 2014; 58:67-72. [PMID: 23612676 DOI: 10.2478/v10039-012-0054-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The diagnostic value of examinations performed with the use of pocket-size echocardiograph by medical professionals with different levels of experience remains to be determined. The aim of this study was to assess the diagnostic value of bedside echocardiographic examinations performed with the use of pocket-size echocardiograph by experienced cardiologist and medical students. MATERIAL/METHODS The study group comprised 90 patients (63 men, 27 women; mean age 64±14 years) admitted to the cardiac intensive care unit and 30 patients from an out-patient clinic (21 men, 9 women; mean age 62±17 years). All patients underwent bedside echocardiographic examination performed with pocket-size echocardiograph by two briefly trained medical students (n=90 patients) or cardiologist (n=30 patients). Major findings were recorded using a simplified questionnaire. Within 24 hours standard echocardiographic examination was performed in all patients by another cardiologist using a full sized echocardiograph. The study group was divided into 4 subgroups: A / B - first / second half of in-patients examined by students, group C - inpatients examined by cardiologist, group D- out-patients examined by students. RESULTS The agreement between standard transthoracic echocardiography (sTTE) and major findings on bedside transthoracic echocardiography (bTTE) was fair to moderate (kappa 0.293-0.57) in group A, moderate to very good (kappa 0.535-1.00) in group B, good to very good (kappa 0.734-1.00) in group C and moderate to very good (kappa 0.590-1.00) in group D. CONCLUSIONS Pocket-size echocardiograph enables an expert echocardiographer to perform reliable bedside examinations. When used by briefly trained medical students it provides an acceptable diagnostic value with notable learning curve effect.
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Dalen H, Haugen BO, Graven T. Feasibility and clinical implementation of hand-held echocardiography. Expert Rev Cardiovasc Ther 2014; 11:49-54. [DOI: 10.1586/erc.12.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaul S. Is it Time to Replace Physical Examination with a Hand-Held Ultrasound Device? J Cardiovasc Echogr 2014; 24:97-102. [PMID: 28465916 PMCID: PMC5353562 DOI: 10.4103/2211-4122.147199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Attempts at using physical examination (PE) go back centuries, with inspection, palpation, and percussion being the mainstay of this approach until 2 centuries ago when the stethoscope was invented and auscultation became probably the most important element of PE for patients with known or suspected cardiovascular disease (CVD). Despite its several limitations, PE is still used, sometimes as the only means, of evaluating and following patients with CVD. In this paper I shall argue for the substitution of this inaccurate and archaic approach by direct visualization of the heart using a hand-held ultrasound (HHU) device. I am not in any way suggesting the substitution of a comprehensive echocardiographic examination by an expert sonographer/echocardiographer by HHU in patients with significant CVD. Instead, I am arguing for the replacement of PE for evaluation of the heart at the point of care as well as at the bedside, simply because HHU is more accurate and provides more meaningful information.
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Affiliation(s)
- Sanjiv Kaul
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Does the integration of personalized ultrasound change patient management in critical care medicine? Observational trials. Emerg Med Int 2013; 2013:946059. [PMID: 24455272 PMCID: PMC3879634 DOI: 10.1155/2013/946059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/26/2013] [Indexed: 02/02/2023] Open
Abstract
Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician's judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS.
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Roelandt JRTC. The decline of our physical examination skills: is echocardiography to blame? Eur Heart J Cardiovasc Imaging 2013; 15:249-52. [PMID: 24282219 DOI: 10.1093/ehjci/jet195] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- J R T C Roelandt
- Thoraxcenter, Erasmus Medical Center, Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
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Pocket-Size Devices, Physical Examination, and High-End Echocardiography Machines in Perspective: Are the Times A'Changing? J Am Soc Echocardiogr 2013; 26:597-9. [DOI: 10.1016/j.echo.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:567-81. [DOI: 10.1016/j.echo.2013.04.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Prinz C, Dohrmann J, van Buuren F, Bitter T, Bogunovic N, Horstkotte D, Faber L. The importance of training in echocardiography: a validation study using pocket echocardiography. J Cardiovasc Med (Hagerstown) 2013; 13:700-7. [PMID: 22929564 DOI: 10.2459/jcm.0b013e328356a55f] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate the training effect in echocardiography by using recent hand-held ultrasound scanners (HANDs). METHODS In this prospective study, 320 consecutive patients were scanned with HAND by an inexperienced ultrasonographer over a period of 8 weeks. Imaging studies were compared with high-end echocardiography as gold standard. Segmental endocardial border delineation was scored to describe image quality. Assessment of left ventricular dimensions, regional/global left ventricular function and grading of valve disease were compared. RESULTS A significant reduction in examination duration, improvement in image quality, substantial agreement in functional assessment (κ > 0.61, P < 0.01) and wall motion scoring (κ=0.67, P < 0.01) could be observed over time. The correlation in left ventricular measurements was excellent (r > 0.98, P < 0.01). The detection of valve diseases and pericardial effusions was sufficient, but the grading only moderate (κ < 0.6). CONCLUSION Well-grounded training in echocardiography leads to a rapid improvement in image acquisition and interpretation over a period of a few weeks. Basic diagnostic findings could be interpreted with high accuracy after short training. Interpretation of complex findings remained difficult. The time needed to carry out an examination using pocket echocardiography could not be reduced to less than 3-4 min per patient. New educational concepts are warranted.
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Affiliation(s)
- Christian Prinz
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital of Bochum, Ruhr-University Bochum, Bad Oeynhausen, Germany.
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Sniecinski RM. Perioperative echocardiography…evolving back to basics. J Am Soc Echocardiogr 2012; 26:A21-2. [PMID: 23261372 DOI: 10.1016/j.echo.2012.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115:1007-28. [PMID: 23011559 DOI: 10.1213/ane.0b013e31826a79c1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Affiliation(s)
- Colin F Royse
- Department of Surgery, The University of Melbourne, 245 Cardigan St., Carlton, Victoria, Australia, 3053.
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Hoffmann R. Sinnvolle Diagnostik in der Notaufnahme. Med Klin Intensivmed Notfmed 2012; 108:209-13. [DOI: 10.1007/s00063-012-0136-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/27/2012] [Accepted: 06/26/2012] [Indexed: 10/27/2022]
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Panoulas VF, Daigeler AL, Malaweera AS, Lota AS, Baskaran D, Rahman S, Nihoyannopoulos P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. ACTA ACUST UNITED AC 2012; 14:323-30. [DOI: 10.1093/ehjci/jes140] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Prinz C, Dohrmann J, Buuren FV, Bitter T, Bogunovic N, Horstkotte D, Faber L. Diagnostic Performance of Handheld Echocardiography for the Assessment of Basic Cardiac Morphology and Function: A Validation Study in Routine Cardiac Patients. Echocardiography 2012; 29:887-94. [DOI: 10.1111/j.1540-8175.2012.01728.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pelliccia F, Palmiero P, Maiello M, Losi MA. Italian Chapter of the International Society of Cardiovascular Ultrasound Expert Consensus Document on Training Requirements for Noncardiologists Using Hand-Carried Ultrasound Devices. Echocardiography 2012; 29:745-50. [DOI: 10.1111/j.1540-8175.2012.01720.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R82. [PMID: 22583539 PMCID: PMC3580625 DOI: 10.1186/cc11340] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/14/2012] [Indexed: 11/14/2022]
Abstract
Introduction In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department. Methods During 4 months, patients admitted to our emergency department and requiring transthoracic echocardiography (TTE) were included in this single-center, prospective and observational study. Patients underwent TTE using a PUD and a conventional echocardiography system. Each examination was performed independently by a physician experienced in echocardiography, unaware of the results found by the alternative device. During the focused cardiac echocardiography, the following parameters were assessed: global cardiac systolic function, identification of ventricular enlargement or hypertrophy, assessment for pericardial effusion and estimation of the size and the respiratory changes of the inferior vena cava (IVC) diameter. Results One hundred fifty-one (151) patients were analyzed. With the tested PUD, the image quality was sufficient to perform focused cardiac ultrasonography in all patients. Examination using PUD adequately qualified with a very good agreement global left ventricular systolic dysfunction (κ = 0.87; 95%CI: 0.76-0.97), severe right ventricular dilation (κ = 0.87; 95%CI: 0.71-1.00), inferior vena cava dilation (κ = 0.90; 95%CI: 0.80-1.00), respiratory-induced variations in inferior vena cava size in spontaneous breathing (κ = 0.84; 95%CI: 0.71-0.98), pericardial effusion (κ = 0.75; 95%CI: 0.55-0.95) and compressive pericardial effusion (κ = 1.00; 95%CI: 1.00-1.00). Conclusions In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
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Limited transthoracic echocardiogram: so easy any trauma attending can do it. ACTA ACUST UNITED AC 2011; 71:1327-31; discussion 1331-2. [PMID: 22071932 DOI: 10.1097/ta.0b013e3182318574] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited transthoracic echocardiogram (LTTE) represents an attractive alternative to formal transthoracic echocardiogram (TTE), because it does not require an echocardiogram machine. Our hypothesis is that trauma attendings can learn LTTE effectively with minimal training. METHODS Seven attendings at a Level I trauma center received didactic and hands-on training in LTTE and performed this test on hypotensive patients to evaluate for contractility, fluid status, and pericardial effusion. Therapy to improve perfusion (administration of fluids, ionotropes, or vasopressors) was guided by LTTE findings. Perfusion status was determined by serum lactate level before and 6 hours after LTTE. Findings were compared with cardiology-performed TTE. RESULTS Range of postresidency training was 1 year to 29 years. LTTE teaching entailed 70 minutes of didactics and 25 minutes of hands-on. In all, 52 LTTEs were performed; two patients were excluded due to blunt trauma arrest. Age ranged from 22 years to 89 years with an average of 55 years. Admission diagnosis was blunt trauma (n = 34), penetrating trauma (n = 3), and intra-abdominal sepsis (n = 13). Average time for LTTE was 4 minutes 38 seconds. Cardiology-performed TTE was obtained in all patients, and correlation with LTTE was 100%. A total of 37 patients received intravenous fluid, 9 received vasopressors, and 4 received ionotropes as guided by LTTE findings, with lactate reduction in all patients (p < 0.00001). Attendings scored a mean of 88% in a written test after training. CONCLUSIONS Trauma attendings can successfully learn LTTE with minimal training and use the technique as a resuscitation tool in the hypotensive patient.
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Kono Y, Fukuda S, Shimada K, Oe H, Maeda K, Kawasaki T, Fujimoto H, Otsuka K, Kubo T, Jissho S, Taguchi H, Yoshiyama M, Ito H, Yoshikawa J. Pocket-sized echo for evaluation of mitral and tricuspid regurgitation. JACC Cardiovasc Imaging 2011; 4:921. [PMID: 21835386 DOI: 10.1016/j.jcmg.2011.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 02/22/2011] [Accepted: 02/24/2011] [Indexed: 11/26/2022]
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Choi BG, Mukherjee M, Dala P, Young HA, Tracy CM, Katz RJ, Lewis JF. Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone: validation against workstation evaluation. J Am Soc Echocardiogr 2011; 24:1325-30. [PMID: 21925836 DOI: 10.1016/j.echo.2011.08.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care interpretation may not be readily available. The aim of this study was to test the hypothesis that remote interpretation on a smartphone with dedicated medical imaging software can be as accurate as on a workstation. METHODS Eighty-nine patients in a remote Honduran village underwent echocardiography by a nonexpert using a pocket-size ultrasound device. Images were sent for verification of point-of-care diagnosis to two expert echocardiographers in the United States reading on a workstation. Studies were then anonymized, randomly ordered, and reinterpreted on a smartphone with a dedicated, Health Insurance Portability and Accountability Act-compliant application. Point-of-care diagnosis was considered accurate if any abnormal finding was matched and categorized at the same level of severity (mild, moderate, or severe) by either expert interpretation. RESULTS The mean age was 54 ± 23 years, and 57% of patients were women. The most common indications for echocardiography were arrhythmia (33%), cardiomyopathy (28%), and syncope (15%). Using the workstation, point-of-care diagnoses were changed in 38% of cases by expert overread (41% left ventricular function correction, 38% valvulopathy correction, 18% poor image quality). Expert interobserver agreement was excellent at 82%, with a Cohen's κ value of 0.82 (95% confidence interval, 0.70-0.94). Intraobserver agreement comparing interpretations on workstations and smartphones was 90%, with a Cohen's κ value of 0.86 (95% confidence interval, 0.76-0.97), signifying excellent intertechnology agreement. CONCLUSIONS Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.
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Affiliation(s)
- Brian G Choi
- Division of Cardiology, Department of Medicine, The George Washington University, Washington, District of Columbia, USA.
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Cowie B, Kluger R. Evaluation of systolic murmurs using transthoracic echocardiography by anaesthetic trainees. Anaesthesia 2011; 66:785-90. [DOI: 10.1111/j.1365-2044.2011.06786.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Snare SR, Mjølstad OC, Orderud F, Haugen BO, Torp H. Fast automatic measurement of mitral annulus excursion using a pocket-sized ultrasound system. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:617-631. [PMID: 21371809 DOI: 10.1016/j.ultrasmedbio.2010.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/20/2010] [Accepted: 12/21/2010] [Indexed: 05/30/2023]
Abstract
We present a fast, automatic method for mitral annulus excursion measurement using pocket-sized ultrasound (PSU). The motivation is to provide PSU users with a rapid measurement of cardiac systolic function. The algorithm combines low-frame-rate tolerance, computational efficiency and automation in a novel way. The method uses a speckle-tracking scheme, initialized and constrained by a deformable model. A feasibility study using 30 apical four-chamber PSU recordings from an unselected patient population revealed an error of (mean ± SD) -1.80 ± 1.96 mm, p < 0.001, when compared with manual anatomic m-mode analysis using laptop scanner data. When only septal side excursion was measured, the mean error was -0.27 ± 1.89 mm, p < 0.001. The accuracy is comparable with previously reported results using semiautomatic methods and full-size scanners. The computation time of 3.7 ms/frame on a laptop computer suggests that a real-time implementation on a PSU device is feasible.
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Affiliation(s)
- Sten Roar Snare
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Culp BC, Mock JD, Chiles CD, Culp WC. The pocket echocardiograph: validation and feasibility. Echocardiography 2011; 27:759-64. [PMID: 20412264 DOI: 10.1111/j.1540-8175.2009.01125.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A new, miniaturized ultrasound device, the pocket echocardiograph (PE), is highly portable and can be carried inside a lab-coat pocket. Studies of this device are limited and have not examined the use by novice echocardiographers. We hypothesize that a novice echocardiographer can use PE to produce interpretable cardiac images, and that both novice and expert echocardiographers can use PE to accurately quantify ejection fraction. METHODS Unselected subjects (n = 40) in an echocardiography laboratory underwent blinded formal transthoracic echocardiography (TTE) and PE (Acuson P10, Siemens, Mountain View, CA, USA). A cardiology fellow with 2 months of echocardiography training acquired PE images. The fellow and an experienced echocardiographer interpreted the PE studies offline in a blinded fashion. To assess adequacy, studies were graded as technically adequate, limited, or inadequate. A visual estimation of ejection fraction was made. Comparisons were made to the formal reported TTE. RESULTS Subjects were heterogeneous, 43% male; age 64 ± 17 years, and ejection fraction 52.4%± 12.3%. All PE studies were interpretable, and the vast majority of PE and TTE images were considered technically adequate (77.5% and 85% respectively; P = 0.32). Ejection fraction showed a good correlation, bias, and limits of agreement for the fellow's interpretation (r = 0.78, -5.9%, ±16.6%) with stronger association for the experienced echocardiographer (r = 0.88, -0.8%, ±11.4%). CONCLUSION Novice echocardiographers using the PE can produce adequate quality images. Both expert and novice echocardiographers can use PE to quantify ejection fraction over a broad range of patients. The device's low cost and portability may greatly expand the availability of bedside echocardiography for routine or urgent cardiovascular assessment.
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Affiliation(s)
- Benjamin C Culp
- Department of Internal Medicine, The TexasA&M University System Health Science Center College of Medicine/Scott and White Hospital, Temple, TX, USA.
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Culp BC, Mock JD, Ball TR, Chiles CD, Culp Jr. WC. The Pocket Echocardiograph: A Pilot Study of Its Validation and Feasibility in Intubated Patients. Echocardiography 2011; 28:371-7. [DOI: 10.1111/j.1540-8175.2010.01370.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Evans N, Gournay V, Cabanas F, Kluckow M, Leone T, Groves A, McNamara P, Mertens L. Point-of-care ultrasound in the neonatal intensive care unit: international perspectives. Semin Fetal Neonatal Med 2011; 16:61-8. [PMID: 20663724 DOI: 10.1016/j.siny.2010.06.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To explore international variation in implementation of point-of-care ultrasound in the neonatal intensive care unit (NICU), contributions were invited from neonatologists and paediatric cardiologists in six countries. The contributors show variation in national implementation that ranges from almost total coverage through to a minority of NICUs having point-of-care ultrasound capability. To a varying degree in all systems the main barriers have been concerns from the consultative specialties that traditionally use ultrasound, relating to the risk of misdiagnosis but also involving different clinical needs, liability concerns and lack of outcome-based evidence. All contributors agreed that safe point-of-care ultrasound depends on close collaboration with the consultative specialties and also that there is a need to develop training and accreditation structures for neonatologists using ultrasound.
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Affiliation(s)
- Nick Evans
- Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW 2050, Australia.
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Lipczyńska M, Szymański P, Klisiewicz A, Hoffman P. Hand-Carried Echocardiography in Heart Failure and Heart Failure Risk Population: A Community Based Prospective Study. J Am Soc Echocardiogr 2011; 24:125-31. [DOI: 10.1016/j.echo.2010.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 11/28/2022]
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