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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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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2179. [PMID: 38138282 PMCID: PMC10744481 DOI: 10.3390/medicina59122179] [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: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.
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Affiliation(s)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd., WCC2, Boston, MA 02215, USA
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Gupta PB, Lighthall G, Htet N. Use of Point-of-Care Ultrasound by Intensive Care Unit Triage Teams in Evaluating Unstable Patients Outside Intensive Care Units. Cureus 2023; 15:e49114. [PMID: 38125228 PMCID: PMC10732337 DOI: 10.7759/cureus.49114] [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: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) has become an integral asset in intensive care units (ICUs). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside the ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU setting. Methods ICU triage fellows were provided a portable ultrasound to use as part of their evaluations during consultations and hospital code activations. Fellows were asked to fill out a survey on how ultrasound was used and its impact on patient management. Free-text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound, and clinical actions were recorded. These data were transcribed and categorized electronically. Results A total of 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%, N=27). The most common clinical focus for ultrasound use was cardiac assessment (53%, N=27), followed by volume status assessment (35%, N=18). The most common ultrasound views per encounter obtained were parasternal long (82%, N=42), followed by apical four-chamber view (76%, N=39) and subcostal view (75%, N=38). Out of 38 encounters with clinical impressions documented, 79% (N=30) of pre-ultrasound clinical impressions were confirmed by ultrasound use. Of total encounters, 35% (N=18) had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc.). Conclusions Ultrasound is a valuable tool for patient evaluation in non-ICU wards, especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of ultrasound use in non-ICU wards.
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Affiliation(s)
- Pranjal B Gupta
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
| | - Geoffrey Lighthall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, USA
- Department of Anesthesia, Veterans Affairs Medical Center, Palo Alto, USA
| | - Natalie Htet
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Asokan R, Bhardwaj BB, Agrawal N, Chauhan U, Pillai A, Shankar T, Lalneiruol DJ, Baid H, Chawang H, Patel SM. Point of care gastric ultrasound to predict aspiration in patients undergoing urgent endotracheal intubation in the emergency medicine department. BMC Emerg Med 2023; 23:111. [PMID: 37735359 PMCID: PMC10512473 DOI: 10.1186/s12873-023-00881-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND One significant cause of morbidity and mortality in patients undergoing endotracheal intubation is the aspiration of gastric contents. Its prevalence is more in the emergency than in elective settings. Point-of-care gastric ultrasound (GUS) is a non-invasive bedside ultrasonogram that provides both qualitative and quantitative information about the stomach contents. The diagnostic accuracy of GUS in terms of gastric parameters (measured antral diameters, antral cross-sectional area, and calculated gastric volume) to predict aspiration is yet unknown. We aim to determine this in the patients undergoing urgent emergency intubation (UEI) in the emergency department. METHODOLOGY A prospective observational study was conducted at the emergency department of a tertiary healthcare center in India. Patients requiring UEI were identified and a bedside gastric ultrasound was done in the right lateral decubitus position using low frequency curved array probe. The qualitative data and the antral diameters (anteroposterior and craniocaudal) were assessed. The patient's clinical parameters and history regarding the last meal were noted. The cross-sectional area of gastric antrum was calculated using CSA = (AP × CC) π/4. The gastric volume is estimated using Perla's formula: GV = 27.0 + 14.6(RLD CSA) -1.28(age). RESULTS A hundred patients requiring urgent endotracheal intubation were enrolled in the study. Visible aspiration was more in participants with a distended gastric status (χ2 = 16.880, p = < 0.001). The median gastric volume in the patients who aspirated was 146.37 mL, and it ranged from 111.59 mL-201.01 mL. Using ROC analysis, a cut-off of CC diameter ≥ 2.35 cm (sensitivity 88%, specificity 91%) and AP diameter ≥ 5.15 cm (sensitivity 88%, specificity 87%) predicts aspiration. A calculated USG CSA cut-off ≥ 9.27cm2 (sensitivity 100%, specificity 87%) and an USG gastric volume ≥ 111.594 mL (sensitivity 100%, a specificity 92%) predicts aspiration. CONCLUSION Point-of-care gastric ultrasound is an useful non-invasive bedside tool for risk stratification for aspiration in busy emergency rooms. We present threshold gastric antral parameters that can be used to predict aspiration along with its diagnostic accuracy. This can help the treating ED physician take adequate precautions, decide on intubation techniques and treatment modifications to aid in better patient management.
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Affiliation(s)
- Reshma Asokan
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Bharat Bhushan Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India.
| | - Naman Agrawal
- Department of Trauma and Emergency, All India Institute of Medical Sciences Raipur, Raipur, India
| | - Udit Chauhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Aadya Pillai
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Takshak Shankar
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - D J Lalneiruol
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Himanshi Baid
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Hannah Chawang
- Department of Emergency Medicine, All India Institute of Medical Sciences Rishikesh, Rishikesh, 249203, Uttarakhand, India
| | - Sanket Mukeshkumar Patel
- Department of Emergency Medicine, Nootan Medical College and Research Centre, Visnagar, Gujarat, India
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Elliott-Burke T, Dillon T, Bailey J, Miller S, Joos R, Buros Stein A. Lumbar multifidus muscle ultrasound imaging: Is handheld technology reliable? Musculoskelet Sci Pract 2023; 65:102771. [PMID: 37182391 DOI: 10.1016/j.msksp.2023.102771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Advancement in ultrasound imaging technology has led to the development of handheld devices that are more accessible to physical therapists due to decreased cost, reduced size, and improved ease of use relative to current established units. Physical therapists use ultrasound imaging of the lumbar multifidus muscle (LMM) to assist in rehabilitation of patients with lumbar pathology. OBJECTIVES To identify the inter-device reliability of measuring the LMM thickness during a sustained contraction when comparing handheld (Butterfly iQ+) and established (SonoSite M-Turbo) ultrasound units. A secondary purpose was to determine the reliability of a student physical therapist using both devices. DESIGN A reliability measurement study METHOD: A blinded examiner identified the LMM at the L4 vertebral level and measured the thickness of the contracted muscle utilizing both the handheld and established ultrasound devices. ICC values were calculated to determine the inter-device and intra-rater reliability. RESULTS The study included 42 healthy participants, 30 females and 12 males, with a mean age of 38.5 years. The inter-device reliability during a sustained LMM contraction was excellent (ICC = 0.92, 95% CI: 0.87-0.94) and the intra-rater reliability was good for both the handheld (ICC = 0.85, 95% CI: 0.73-0.92) and established (ICC = 0.89, 95% CI: 0.82-0.93) ultrasound units. CONCLUSION Results support the use of handheld ultrasound by physical therapists and students to measure the LMM thickness. Future studies could investigate the reliability of handheld ultrasound in a variety of musculoskeletal and pathological structures important to PT practice.
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Affiliation(s)
- Teresa Elliott-Burke
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA.
| | - Thomas Dillon
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Jasmin Bailey
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Shannon Miller
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Rachel Joos
- Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Amy Buros Stein
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
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Cheng PJ, Hsu NC. Incorporating Multiorgan Point-of-care Ultrasound into Obstetric Emergency Treatment Protocols. J Med Ultrasound 2023; 31:83-85. [PMID: 37576411 PMCID: PMC10413410 DOI: 10.4103/jmu.jmu_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Hospital Medicine, Department of Internal Medicine, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
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Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
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Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
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Rosenbæk F, Riisgaard H, Nielsen JB, Wehberg S, Waldorff FB, Pedersen LB, Søndergaard J. GPs' prescription patterns, experience, and attitudes towards medicinal cannabis-a nationwide survey at the early stage of the Danish test scheme. BMC PRIMARY CARE 2023; 24:17. [PMID: 36650442 PMCID: PMC9843989 DOI: 10.1186/s12875-023-01971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND On 1 January 2018 a four-year test scheme concerning use of medicinal cannabis (MC) was enacted. It has recently been extended for four more years by the Danish Parliament permitting all Danish physicians to prescribe MC to their patients. Previous studies have shown that general practitioners (GPs) have varying prescription experience, little knowledge, and mixed attitudes about MC. However, the present evidence is still limited, and no studies exist about Danish GPs' prescription experience, knowledge, and attitudes towards MC. Therefore, our aim was to examine Danish GPs' prescription experience, knowledge, and attitudes towards MC. METHODS A national online survey-based study addressing Danish GPs was performed from September 2018 to July 2019. We performed separate multivariable logistic regression analyses including GPs' prescription experience, knowledge, and attitudes towards MC as outcome variables. RESULTS A total of 427 (38.4%) of 1112 GPs completed the questionnaire. Of these, 37 (8.7%) had experience in prescribing MC. The majority had little or no knowledge about MC (80.6%) as well as a negative view on prescription of MC (71.4%) to patients. Factors associated with prescribing MC to patients were: Single-handed practices (OR = 1.6, 95% CI 1.1;1.8) and perception of having quite some knowledge about MC (OR = 4.8, 95% CI 2.2;10.4). Factors associated with having quite some knowledge about MC were: having a positive attitude towards prescribing MC (OR = 5.2, 95% CI 1.9;14.0), being male (OR = 1.7, 95% CI 1.4;1.8), and being at least 60 years of age (OR = 2.8, 95% CI 1.3;6.0). Factors associated with having a positive attitude towards prescribing MC were: having quite some knowledge about MC (OR = 5.2, 95% CI 2.2;12.5) and GPs being male (OR = 1.7, 95% CI 1.1;1.9). CONCLUSION In this first study on prescription experience, knowledge, and attitudes about MC among Danish GPs, conducted one year after the Danish test scheme was enacted, we find a very low proportion of prescribers, little knowledge, and an overall negative attitude towards MC. Among the prescribing GPs, four in ten have little to no knowledge and a negative attitude towards MC. We stress that prescribing patterns, knowledge, and attitudes may change throughout the remaining time of the test scheme.
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Affiliation(s)
- F. Rosenbæk
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - H. Riisgaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - J. B. Nielsen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - S. Wehberg
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
| | - F. B. Waldorff
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark ,grid.5254.60000 0001 0674 042XThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L. B. Pedersen
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark ,grid.10825.3e0000 0001 0728 0170Department of Public Health, DaCHE – Danish Centre for Health Economics, University of Southern Denmark, Winsløws Vej 9B, Odense C, 5000 Denmark
| | - J. Søndergaard
- grid.10825.3e0000 0001 0728 0170Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000 Denmark
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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Yoon CW, Pan Y, Wang Y. The application of mechanobiotechnology for immuno-engineering and cancer immunotherapy. Front Cell Dev Biol 2022; 10:1064484. [PMID: 36483679 PMCID: PMC9725026 DOI: 10.3389/fcell.2022.1064484] [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: 10/08/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Immune-engineering is a rapidly emerging field in the past few years, as immunotherapy evolved from a paradigm-shifting therapeutic approach for cancer treatment to promising immuno-oncology models in clinical trials and commercial products. Linking the field of biomedical engineering with immunology, immuno-engineering applies engineering principles and utilizes synthetic biology tools to study and control the immune system for diseases treatments and interventions. Over the past decades, there has been a deeper understanding that mechanical forces play crucial roles in regulating immune cells at different stages from antigen recognition to actual killing, which suggests potential opportunities to design and tailor mechanobiology tools to novel immunotherapy. In this review, we first provide a brief introduction to recent technological and scientific advances in mechanobiology for immune cells. Different strategies for immuno-engineering are then discussed and evaluated. Furthermore, we describe the opportunities and challenges of applying mechanobiology and related technologies to study and engineer immune cells and ultimately modulate their function for immunotherapy. In summary, the synergetic integration of cutting-edge mechanical biology techniques into immune-engineering strategies can provide a powerful platform and allow new directions for the field of immunotherapy.
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Overview of TFAST and AFAST: point‐of‐care ultrasounds and how to perform them. IN PRACTICE 2022. [DOI: 10.1002/inpr.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Wolter E, Treskatsch S, Kniesel O, Berger C, Angermair S. [76/m-Acutely occurring intense diffuse abdominal pain : Preparation course anesthesiological intensive care medicine: case 17]. DIE ANAESTHESIOLOGIE 2022; 71:93-96. [PMID: 35925177 DOI: 10.1007/s00101-022-01147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Eike Wolter
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland.
| | - Sascha Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Olaf Kniesel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Christian Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Stefan Angermair
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Berlin, Deutschland
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Bista S, Rajbhandari S, Karki S, Pokharel S, Karki S. Knowledge of point-of-care ultrasound and management of deep vein thrombosis patient in resource limited setup: A case report. Ann Med Surg (Lond) 2022; 77:103702. [PMID: 35638037 PMCID: PMC9142702 DOI: 10.1016/j.amsu.2022.103702] [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: 03/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance: Deep vein thrombosis (DVT), frequently encountered in an emergency setting, if not identified and managed early, leads to pulmonary embolism that may be life threatening to the patient. The use of point-of-care ultrasound (POCUS) can be used as an effective and time saving tool for diagnosis of such life threatening conditions. Case presentation We present a case of a 53 years old male who presented to the emergency department (ED) with complaints of swelling and pain in the left lower limb for one week and redness of overlying skin for the same duration. Following a point-of-care ultrasound scan, a diagnosis of DVT was made. The condition was quickly identified and promptly treated preventing possible complications. Discussion Use of point-of-care ultrasound to diagnose DVT has been shown to decrease the need for comprehensive scans, decrease time to diagnosis and length of stay at the emergency department. To improve medical care by increasing early detection, lowering costs, and improving overall patient care, more training of emergency physicians in ultrasound technique and standardized use of ultrasound to screen for DVT in the ED is required. Conclusion This case report highlights how, despite the unavailability of sophisticated diagnostic procedures, a skill of using POCUS can prove to be lifesaving in a resource-limited setting. Deep vein thrombosis is a life-threatening condition requiring prompt diagnosis and treatment. DVT, if not managed timely can lead to complications like pulmonary embolism. Point-of-care ultrasound (POCUS) can help detect DVT timely. Use of POCUS can prove valuable in resource limited setting where sophisticated tools to diagnose conditions such as DVT are unavailable.
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Affiliation(s)
| | | | - Saurab Karki
- Military Hospital Itahari, Itahari, Sunsari, Nepal
- Corresponding author. Military Hospital, Itahari, Sunsari, Nepal.
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Use of Point-of-Care Ultrasound by Non-Physicians to Assess Respiratory Distress in the Out-of-Hospital Environment: A Scoping Review. Prehosp Disaster Med 2022; 37:520-528. [PMID: 35506171 PMCID: PMC9280071 DOI: 10.1017/s1049023x22000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The use of ultrasound in the out-of-hospital environment is increasingly feasible. The potential uses for point-of-care ultrasound (POCUS) by paramedics are many, but have historically been limited to traumatic indications. This study utilized a scoping review methodology to map the evidence for the use of POCUS by paramedics to assess respiratory distress and to gain a broader understanding of the topic. Methods: Databases Ovid MEDLINE, EMBASE, CINAHL Plus, and PUBMED were searched from January 1, 1990 through April 14, 2021. Google Scholar was searched, and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital POCUS performed by non-physicians for non-traumatic respiratory distress. Results: A total of 591 unique articles were identified, of which seven articles met the inclusion criteria. The articles reported various different scan protocols and, with one exception, suffered from low enrolments and low participation. Most articles reported that non-physician-performed ultrasound was feasible. Articles reported moderate to high levels of agreement between paramedics and expert reviewers for scan interpretation in most studies. Conclusion: Paramedics and emergency medical technicians (EMTs) have demonstrated the feasibility of lung ultrasound in the out-of-hospital environment. Further research should investigate the utility of standardized education and scanning protocols in paramedic-performed lung ultrasound for the differentiation of respiratory distress and the implications for patient outcomes.
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DePhilip RM, Quinn MM. Adaptation of an anatomy graduate course in ultrasound imaging from in-person to live, remote instruction during the Covid-19 pandemic. ANATOMICAL SCIENCES EDUCATION 2022; 15:493-507. [PMID: 35271761 PMCID: PMC9082486 DOI: 10.1002/ase.2177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 05/28/2023]
Abstract
Health concerns during the Covid-19 pandemic required the adaptation of a lecture-laboratory course in ultrasound imaging for graduate students from an in-person to a live, remote learning format. The adaptation of in-person lectures to live, remote delivery was achieved by using videoconferencing. The adaptation of in-person laboratory sessions to live, remote instruction was achieved in the first half of the course by providing a hand-held ultrasound instrument to each student who performed self-scanning at their remote locations, while the instructor provided live instruction using videoconferencing. In the second half of the course, the students transitioned to using cart-based, hospital-type instruments and self-scanning in the ultrasound laboratory on campus. The aim of this study was to measure the success of this adaptation to the course by comparing assessment scores of students in the live, remote course with assessment scores of students in the in-person course offered in the previous year. There were no statistically significant differences in the assessment scores of students in the two courses. The adaptation of a course in ultrasound imaging from an in-person to a live, remote learning format during the Covid-19 pandemic described here suggests that contrary to the prevailing view, ultrasound imaging can be taught to students without in-person instruction. The adapted course can serve as a model for teaching ultrasound where instructors and learners are physically separated by constraints other than health concerns during a pandemic.
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Affiliation(s)
- Robert M. DePhilip
- Division of AnatomyDepartment of Biomedical Education and AnatomyThe Ohio State University College of MedicineColumbusOhioUSA
| | - Melissa M. Quinn
- Division of AnatomyDepartment of Biomedical Education and AnatomyThe Ohio State University College of MedicineColumbusOhioUSA
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Drake A, Dreyer N, Hoffer M, Boniface K. Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2022; 6:1-7. [PMID: 35226837 PMCID: PMC8885218 DOI: 10.5811/cpcem.2021.11.54904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction The use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology. Case Series Here, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm. Conclusion The incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.
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Affiliation(s)
- Aaran Drake
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC
| | - Nicholas Dreyer
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC
| | - Megan Hoffer
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC
| | - Keith Boniface
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, Washington, DC
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Acoustic-Field Beamforming-Based Generalized Coherence Factor for Handheld Ultrasound. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Handheld ultrasound devices have been widely used for diagnostic applications. The use of the acoustic-field beamforming (AFB) method has been proposed for handheld ultrasound to reduce electricity consumption and avoid battery and unwanted heat issues. However, the image quality, such as the contrast ratio and contrast-to-noise-ratio, are poorer with this technique than with the conventional delay-and-sum method. To address the problems associated with the worse image quality in AFB imaging, in this paper we propose the use of an AFB-based generalized coherence factor (GCF) technique, in which the GCF weighting developed for adaptive beamforming is extended to AFB. Simulation data, experimental results, and in vivo testing verified the efficacy of our proposed AFB-based GCF technique.
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Rebours C, Glatre R, Plaisance P, Dohan A, Truchot J, Chauvin A. Diagnostic errors of nasal fractures in the emergency department: A monocentric retrospective study. World J Emerg Med 2022; 13:120-123. [PMID: 35237365 PMCID: PMC8861338 DOI: 10.5847/wjem.j.1920-8642.2022.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/12/2021] [Indexed: 04/16/2024] Open
Affiliation(s)
- Celeste Rebours
- Department of Ear Nose Throat-Head and Neck Surgery, Center Hospitalier Poissy-Saint Germaine en Laye, Poissy 78100, France
| | - Romain Glatre
- Department of Ear Nose Throat-Head and Neck Surgery, Center Hospitalier Poissy-Saint Germaine en Laye, Poissy 78100, France
| | - Patrick Plaisance
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Diderot University, Paris 75010, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Sorbonne Paris Cité, Paris Descartes University, Paris 75014, France
- INSERM U965 CAP Paris-Tech: Carcinose Péritoine Paris technologique, Paris 75010, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Diderot University, Paris 75010, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Diderot University, Paris 75010, France
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel- Dieu Hospital, Paris 75001, France
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Andronikou S, Otero HJ, Belard S, Heuvelings CC, Ruby LC, Grobusch MP. Radiologists should support non-radiologist point-of-care ultrasonography in children: a case for involvement and collaboration. Pediatr Radiol 2022; 52:604-607. [PMID: 34559280 PMCID: PMC8475878 DOI: 10.1007/s00247-021-05185-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/08/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401, Civic Center Blvd., Philadelphia, PA 19104, USA. .,Department of Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hansel J Otero
- Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA ,Department of Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Sabine Belard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin, Berlin, Germany ,Berlin Institute of Health, Berlin, Germany
| | - Charlotte Carina Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa C. Ruby
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité – Universitätsmedizin, Berlin, Germany
| | - Martin Peter Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
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21
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Bastos MG. Lung ultrasound: an opportunity to increase the accuracy of the physical examination by the nephrologist. Rev Assoc Med Bras (1992) 2021; 67:1729-1734. [DOI: 10.1590/1806-9282.20210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022] Open
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Camilo GB, Toledo GC, Olímpio H, Dias EN, Oliveira BLD, Ferreira JP, Mendes PDFB, Bastos MG. Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students. J Pediatr (Rio J) 2021; 97:651-657. [PMID: 33713629 PMCID: PMC9432132 DOI: 10.1016/j.jped.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. METHODS The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. RESULTS The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. CONCLUSION Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.
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Affiliation(s)
- Gustavo Bittencourt Camilo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil.
| | - Gabriela Cumani Toledo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil; Hospital e Maternidade Teresinha de Jesus (HMTJ), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Hebert Olímpio
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil
| | - Eleusa Nogueira Dias
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Bianca Lopes de Oliveira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Júlia Perches Ferreira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | | | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade Federal de Juiz de Fora (UFJF), Departamento de Nefrologia, Juiz de Fora, MG, Brazil
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Mehdiratta L, Kumar N, Bajwa SJS. Advancing, strengthening and reshaping obstetric critical care with Point-of-Care Ultrasound (POCUS). Indian J Anaesth 2021; 65:711-715. [PMID: 34898697 PMCID: PMC8607862 DOI: 10.4103/ija.ija_924_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Nishant Kumar
- Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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Kurepa D, Boyar V, Zaghloul N, Beachy J, Zaytseva A, Teng D, Cooper R, Klewer S, Amodio J. Structured Neonatal Point-of-Care Ultrasound Training Program. Am J Perinatol 2021; 38:e284-e291. [PMID: 32344442 DOI: 10.1055/s-0040-1709667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (POC US) has been increasingly used by intensive care physicians. Growing use of POC US necessitates defining distinct clinical indications for its application, as well as structured POC US training programs. Homogeneous approach to POC US education combined with rigorous quality assurance should further enable POC US to become standard-of-care clinical tool. This study aimed to present the first, innovative, and structured POC US program in neonatal-perinatal medicine field. In addition, we reviewed the availability of the POC US training programs across different medical specialties. STUDY DESIGN Available English-language publications on POC US training programs in general and neonatal-perinatal medicine were reviewed in this study. DISCUSSION Mounting body of evidence suggests improved procedural completion rates, as well as clinical decision making with the use of POC US. However, limited research supported the existence of structured, comprehensive POC US programs. It was recognized that medical institutions need to develop syllabuses, teach, and credential increasing number of health care professionals in the use of POC US. We defined intuitive educational strategy that encompasses POC US clinical indications, educational curriculum, scanning protocols, competence evaluation, and finally credentialing process. In addition, we offered description of the imaging quality assurance, as well as POC US coding, and reimbursement. CONCLUSION Future efforts need to be dedicated to the ongoing development of neonatal POC US as a clinical instrument. It should allow for eventual paradigm change and improved effectiveness in management of critically ill neonates.
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Affiliation(s)
- Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Vitalya Boyar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Nahla Zaghloul
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Joanna Beachy
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Alla Zaytseva
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - David Teng
- Division of Emergency Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Rubin Cooper
- Division of Cardiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - Scott Klewer
- Division of Cardiology, Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - John Amodio
- Division of Radiology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
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Blaivas M, Blaivas L, Philips G, Merchant R, Levy M, Abbasi A, Eickhoff C, Shapiro N, Corl K. Development of a Deep Learning Network to Classify Inferior Vena Cava Collapse to Predict Fluid Responsiveness. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1495-1504. [PMID: 33038035 DOI: 10.1002/jum.15527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To create a deep learning algorithm capable of video classification, using a long short-term memory (LSTM) network, to analyze collapsibility of the inferior vena cava (IVC) to predict fluid responsiveness in critically ill patients. METHODS We used a data set of IVC ultrasound (US) videos to train the LSTM network. The data set was created from IVC US videos of spontaneously breathing critically ill patients undergoing intravenous fluid resuscitation as part of 2 prior prospective studies. We randomly selected 90% of the IVC videos to train the LSTM network and 10% of the videos to test the LSTM network's ability to predict fluid responsiveness. Fluid responsiveness was defined as a greater than 10% increase in the cardiac index after a 500-mL fluid bolus, as measured by bioreactance. RESULTS We analyzed 211 videos from 175 critically ill patients: 191 to train the LSTM network and 20 to test it. Using standard data augmentation techniques, we increased our sample size from 191 to 3820 videos. Of the 175 patients, 91 (52%) were fluid responders. The LSTM network was able to predict fluid responsiveness moderately well, with an area under the receiver operating characteristic curve of 0.70 (95% confidence interval [CI], 0.43-1.00), a positive likelihood ratio of infinity, and a negative likelihood ratio of 0.3 (95% CI, 0.12-0.77). In comparison, point-of-care US experts using video review offline and manual diameter measurement via software caliper tools achieved an area under the receiver operating characteristic curve of 0.94 (95% CI, 0.83-0.99). CONCLUSIONS We demonstrated that an LSTM network can be trained by using videos of IVC US to classify IVC collapse to predict fluid responsiveness. Our LSTM network performed moderately well given the small training cohort but worse than point-of-care US experts. Further training and testing of the LSTM network with a larger data sets is warranted.
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Affiliation(s)
- Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Department of Emergency Medicine, St Francis Hospital, Columbus, Georgia, USA
| | - Laura Blaivas
- Michigan State University, East Lansing, Michigan, USA
| | - Gary Philips
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Roland Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell Levy
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adeel Abbasi
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
| | - Carsten Eickhoff
- Brown Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | - Nathan Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith Corl
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
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Montorfano L, Yu Q, Bordes SJ, Sivanushanthan S, Rosenthal RJ, Montorfano M. Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis. Ultrasound J 2021; 13:35. [PMID: 34215966 PMCID: PMC8253877 DOI: 10.1186/s13089-021-00235-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Timely diagnosis and treatment of increased intracranial pressure can decrease morbidity and prevent mortality. The present meta-analysis aims to determine the mean value of the ONSD measured in patients with various elevated ICP etiologies under different clinical settings, as well as comparing the value of ONSD between patients with and without elevated ICP. Methods This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement8. PubMed, Embase, and Cochrane Library were searched to identify ONSD measured by US for patients with increased ICP from establishment to October 2020. Results A total of 779 patients with elevated ICP among 22 studies were included in the present meta-analysis. Studies were published between 2003 and 2020. Eighteen were comparative (18/22, 81.8%), and four were single-armed study (4/22, 18.2%). Twenty were prospective studies (20/22, 90.9%). There was moderate-to-high heterogeneity based on the prediction ellipse area and variance logit of sensitivity and specificity. Conclusions The mean value of the ONSD among patients diagnosed with increased ICP was 5.82 mm (95% CI 5.58–6.06 mm). Variations were observed based on etiology of intracranial hypertension, clinical settings where ONSD was measured, and standards for diagnosing intracranial hypertension. The US-ONSD among patient with elevated ICP was significantly higher than the normal control. Although a cut-off value is not clearly determined, these mean values can be implemented to evaluate the sensitivity and specificity of US-ONSD in diagnosing intracranial hypertension in future studies.
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Affiliation(s)
- Lisandro Montorfano
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Qian Yu
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Stephen J Bordes
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | | | - Raul J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Miguel Montorfano
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina.
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Kayne AN, Fritzges JA, Huang ML, Evans E. Detection of Unknown Pregnancy With Complications Using Point-of-Care Ultrasound. Cureus 2021; 13:e16510. [PMID: 34430124 PMCID: PMC8375000 DOI: 10.7759/cureus.16510] [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: 02/15/2021] [Accepted: 05/30/2021] [Indexed: 11/23/2022] Open
Abstract
Eclampsia, a condition diagnosed in pre-eclamptic patients who experience seizures, can lead to maternal and fetal death if not treated early. The present case discusses the clinical management of an 18-year-old female who presented to the emergency department (ED) after a generalized tonic-clonic seizure. A physical examination revealed that she was also hypertensive. Based on these symptoms which required urgency due to the patient's instability, and the suspicion that the patient could be pregnant, point-of-care ultrasound (POCUS) was performed. In this case, a POCUS was a faster more accessible modality than a urine or serum human chorionic gonadotropin test. Although the patient denied that she was pregnant, POCUS identified that she was approximately 22-24 weeks pregnant. The patient was promptly diagnosed with eclampsia and given medication to control her blood pressure and seizures. This case highlights the benefits of using POCUS in the ED to expedite clinical decisions by identifying the etiology of a patient's condition and lends itself to the discussion of its utility in a critically ill pregnant woman. It also serves to reinforce the importance of keeping eclampsia as part of an emergency physician's differential when confronted with a potentially pregnant patient with relevant symptoms.
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Affiliation(s)
- Allison N Kayne
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Julie A Fritzges
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Michelle L Huang
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, USA
| | - Elizabeth Evans
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, USA
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Wang A, McCabe M, Gow-Lee E, James S, Austin B, Wailes D, Dinh V, Ramsingh D. Evaluation of a survey for acute care programme directors on the utilisation of point-of-care ultrasound. Postgrad Med J 2021; 98:694-699. [PMID: 37062971 DOI: 10.1136/postgradmedj-2021-140127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/21/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is ultrasound brought to the patient's bedside and performed in 'real time' by the healthcare provider. The utility of POCUS to facilitate management of the acutely ill patient has been demonstrated for multiple pathologies. However, the integration of ultrasonography and echocardiography training into residency curriculum varies across the acute care specialties. STUDY DESIGN After an institutional review board approval, anaesthesiology, emergency medicine, family medicine, internal medicine, paediatrics and general surgery programme directors (PDs) were surveyed. The survey consisted of 11 questions evaluating the primary bedside assessment tool for common acute care situations, POCUS topics that the PDs were comfortable practising and topics that the PDs felt were useful for their specialty. Barriers to POCUS use, certification and documentation were also surveyed. RESULTS Overall, 270 PD surveys were completed. The preferred primary assessment tool for common acute care situations varied with specialty; emergency medicine PDs consistently responded that POCUS was the diagnostic modality of choice (p<0.0001). The majority of the PDs reported lack of educational opportunities as the primary barrier to learning POCUS (64%). Most PDs indicated that POCUS examinations should be documented (95.7%), and 39% reported that departmental certification would be sufficient. CONCLUSIONS This study is the first to evaluate differences in the preferred initial bedside assessment tool between the acute care specialties. Although POCUS is a superior tool for evaluating acute pathologies, disconnect between education and utilisation remains. This study highlights the need to incorporate POCUS into the acute care specialty curriculum.
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Affiliation(s)
- Annie Wang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Melissa McCabe
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Esther Gow-Lee
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Stephanie James
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Briahnna Austin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Dustin Wailes
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Vi Dinh
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
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Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative Point-of-Care Ultrasound Use by Anesthesiologists. Cureus 2021; 13:e15217. [PMID: 34178536 PMCID: PMC8221658 DOI: 10.7759/cureus.15217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Point-of-Care ultrasound (POCUS) is the bedside utilization of ultrasound, in real-time, to aid in the diagnosis and treatment of patients. Image acquisition from POCUS utilization by anesthesiologists involves the assessment of multiple organs in different perioperative situations. POCUS can be utilized to enhance clinical decision-making in a variety of perioperative situations due to its ability to assess endotracheal tube placement, cardiac function, pulmonary function, aspiration risk, hemodynamics, vascular access, and nerve visualization for regional procedures. The mounting clinical evidence for the value of POCUS in perioperative settings, its growing affordability, and its low associated risks are responsible for the nationwide movement across many anesthesiology residency programs to increase the focus on perioperative ultrasound training. The purpose of this review is to present to current anesthesiologists and anesthesiology trainees, a broad discussion regarding the diverse utility and importance of POCUS in perioperative settings.
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Affiliation(s)
- Abdullah Naji
- Anesthesiology and Perioperative Medicine, Oregon Health Science University Hospital, Portland, USA
| | - Monica Chappidi
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | | | - Aaron Monga
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
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Koratala A, Kazory A. An Introduction to Point-of-Care Ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis 2021; 28:193-199. [PMID: 34906303 DOI: 10.1053/j.ackd.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.
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Abstract
BACKGROUND Graduate medical education is being transformed from a time-based training model to a competency-based training model. While the application of ultrasound in the perioperative arena has become an expected skill set for anesthesiologists, clinical exposure during training is intermittent and nongraduated without a structured program. We developed a formal structured perioperative ultrasound program to efficiently train first-year clinical anesthesia (CA-1) residents and evaluated its effectiveness quantitatively in the form of a proficiency index. METHODS In this prospective study, a multimodal perioperative ultrasound training program spread over 3 months was designed by experts at an accredited anesthesiology residency program to train the CA-1 residents. The training model was based on self-learning through web-based modules and instructor-based learning by performing perioperative ultrasound techniques on simulators and live models. The effectiveness of the program was evaluated by comparing the CA-1 residents who completed the training to graduating third-year clinical anesthesia (CA-3) residents who underwent the traditional ultrasound training in the residency program using a designed index called a "proficiency index." The proficiency index was composed of scores on a cognitive knowledge test (20%) and scores on an objective structured clinical examination (OSCE) to evaluate the workflow understanding (40%) and psychomotor skills (40%). RESULTS Sixteen CA-1 residents successfully completed the perioperative ultrasound training program and the subsequent evaluation with the proficiency index. The total duration of training was 60 hours of self-based learning and instructor-based learning. There was a significant improvement observed in the cognitive knowledge test scores for the CA-1 residents after the training program (pretest: 71% [0.141 ± 0.019]; posttest: 83% [0.165 ± 0.041]; P < .001). At the end of the program, the CA-1 residents achieved an average proficiency index that was not significantly different from the average proficiency index of graduating CA-3 residents who underwent traditional ultrasound training (CA-1: 0.803 ± 0.049; CA-3: 0.823 ± 0.063, P = .307). CONCLUSIONS Our results suggest that the implementation of a formal, structured curriculum allows CA-1 residents to achieve a level of proficiency in perioperative ultrasound applications before clinical exposure.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Nina Buchtele
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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The Most Useful Method To Evaluate The Volume Status Of Critical Patients In The Emergency And Intensive Care Units: Point Of Care Ultrasound. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.728902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hussain A, Ma IWY. Internal Medicine Point of Care Ultrasound in the 21st Century: A 'FoCUS' on the Middle East. J Saudi Heart Assoc 2020; 32:479-482. [PMID: 33537196 PMCID: PMC7849845 DOI: 10.37616/2212-5043.1225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Arif Hussain
- Cardiac Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Irene W Y Ma
- John A. Buchanan Chair, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lum M, Sheehy L, Lai J, Tillman D, Damewood S, Schmidt J. Integration of Lung Point-of-care Ultrasound into Clinical Decision Making for Medical Students in Simulated Cases. West J Emerg Med 2020; 22:124-129. [PMID: 33439818 PMCID: PMC7806326 DOI: 10.5811/westjem.2020.12.48717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) has an emerging presence in medical student education; however, there is limited evidence that this translates into appropriate clinical care. We aimed to evaluate the ability of medical students to integrate newly obtained POCUS knowledge into simulated clinical cases. Methods We conducted an observational study of medical students participating in a mandatory rotation during their clinical years. Students in small groups underwent formalized lung POCUS lectures and hands-on training. Students participated in simulated “dyspnea” cases focused on either congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). They were observed for critical actions including elements related to medical decision-making and ultrasound use and interpretation. Ultrasound-specific written knowledge was gauged with a short assessment after the first lecture and at week 4. Results A total of 62 students participated and were observed during simulations. All groups correctly identified and treated CHF in the simulated case. Most groups (7 out of 9) attempted to use ultrasound in the CHF case; five groups correctly recognized B-lines; and four groups correctly interpreted B-lines as pulmonary edema. No groups used ultrasound in the COPD case. Conclusion Most students attempted to use ultrasound during simulated CHF cases after a brief didactic intervention; however, many students struggled with clinical application. Interestingly, no students recognized the need to apply ultrasound for diagnosis and management of COPD. Future studies are needed to better understand how to optimize teaching for medical students to improve translation into POCUS skills and improved clinical practice.
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Affiliation(s)
- Michelle Lum
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Lauren Sheehy
- Tucson Medical Center, Department of Emergency Medicine, Tucson, Arizona
| | - Jason Lai
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - David Tillman
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Sara Damewood
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Jessica Schmidt
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
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Dahl AB. The POCUS Paradigm. J Cardiothorac Vasc Anesth 2020; 34:3158-3159. [DOI: 10.1053/j.jvca.2020.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022]
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Hakim SM, Abdellatif AA, Ali MI, Ammar MA. Reliability of transcranial sonography for assessment of brain midline shift in adult neurocritical patients: a systematic review and meta-analysis. Minerva Anestesiol 2020; 87:467-475. [PMID: 33054015 DOI: 10.23736/s0375-9393.20.14624-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis was to determine the reliability of transcranial sonography as an alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients. EVIDENCE AQUISITION The PubMed, EMBASE, Cochrane Library, Scopus and Web of Science databases were searched. Original studies evaluating brain midline shift in adult neurocritical patients using both transcranial sonography and computed tomography were eligible. Primary outcome measure was concordance between both methods as quantified in terms of concordance correlation coefficient. Secondary outcome measure was limits of agreement, defined as mean difference between sonography and computed tomography plus and minus 1.96 standard deviations. EVIDENCE SYNTHESIS Twelve studies (574 patients, 689 examinations) were eligible. Ten studies (416 patients, 492 examinations) provided adequate data for evaluation of concordance. Pooling of effect sizes showed strong concordance between both methods (concordance correlation coefficient, 0.91; 95% CI, 0.87 to 0.94). Two missing studies were imputed and effect size was adjusted to 0.88 (95% CI, 0.81 to 0.93). Nine studies (442 patients, 571 examinations) provided adequate data for estimation of limits of agreement. Pooling of effect sizes showed a bias of -0.53 mm (95% limits of agreement, -1.22 to 0.16 mm). Four missing studies were imputed and bias was adjusted to -0.68 mm (95% limits of agreement, -1.31 to -0.04 mm). CONCLUSIONS Transcranial sonography may serve as reliable alternative to computed tomography for evaluation of brain midline shift in adult neurocritical patients. Both methods have strong concordance with acceptably narrow limits of agreement.
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Affiliation(s)
- Sameh M Hakim
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt -
| | - Ayman A Abdellatif
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammad I Ali
- Department of Intensive Care, King Abdulaziz Hospital, Al-Jouf, Saudi Arabia
| | - Mona A Ammar
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Lu SY, Dalia AA, Cudemus G, Shelton KT. Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit. J Cardiothorac Vasc Anesth 2020; 34:2682-2688. [DOI: 10.1053/j.jvca.2020.03.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 01/09/2023]
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Lai AKH, Noor Azhar AMB, Bustam AB, Tiong XT, Chan HC, Ahmad RB, Chew KS. A comparison between the effectiveness of a gamified approach with the conventional approach in point-of-care ultrasonographic training. BMC MEDICAL EDUCATION 2020; 20:263. [PMID: 32787921 PMCID: PMC7425000 DOI: 10.1186/s12909-020-02173-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/22/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Although gamification increases user engagement, its effectiveness in point-of-care ultrasonographic training has yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasonographic training as compared to conventional approach. METHODS Participants consisting of junior doctors were randomized into either the (1) gamified or the (2) conventional educational approach for ultrasonographic training. RESULTS A total of 31 junior doctors participated in this study (16 participants in gamified arm, 15 in the conventional arm after one participant from the conventional arm dropped out due to work commitment). Two-way mixed ANOVA test showed that there was no statistically significant interaction between the types of educational approach and time of testing (pre-test, post-test, 2 months post-training) for both theoretical knowledge score and practical skills score, with F(2, 58) = 39.6, p < 0.001, partial η2 = 0.4 and F(2, 58) = 3.06, p = 0.06, partial η2 = 0.095, respectively. For theoretical knowledge score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were better than the pre-test scores (12.99 +/- 0.50, 95% CI 11.97-14.00) with p-values < 0.001 for both comparisons respectively. Similarly, for practical skill score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were also better than the pre-test scores (12.99 +/- 0.50, 95% CI 11.97-14.00) with p-values < 0.001 for both comparisons respectively. Participants in the gamification arm generally perceived the various game elements and game mechanics as useful in contributing and motivating them to learn ultrasonography. CONCLUSIONS Gamification approach could be an effective alternative to conventional approach in point-of-care ultrasonographic training.
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Affiliation(s)
- Aaron Kuo Huo Lai
- Emergency and Trauma Department, Sarawak General Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Abdul Muhaimin Bin Noor Azhar
- Faculty of Medicine, University of Malaya, Jalan Universiti, Wilayah Persekutuan Kuala Lumpur, 50603, Kuala Lumpur, Malaysia
| | - Aidawati Binti Bustam
- Faculty of Medicine, University of Malaya, Jalan Universiti, Wilayah Persekutuan Kuala Lumpur, 50603, Kuala Lumpur, Malaysia
| | - Xun Ting Tiong
- Clinical Research Centre, Sarawak General Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Hiang Chuan Chan
- Emergency and Trauma Department, Sarawak General Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Rashidi Bin Ahmad
- Faculty of Medicine, University of Malaya, Jalan Universiti, Wilayah Persekutuan Kuala Lumpur, 50603, Kuala Lumpur, Malaysia
| | - Keng Sheng Chew
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, 94300, Kuching, Sarawak, Malaysia.
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Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med 2020; 8:2050312120932706. [PMID: 32782792 PMCID: PMC7383635 DOI: 10.1177/2050312120932706] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
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Affiliation(s)
- Colton B Amaral
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel C Ralston
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
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Vernieuwe L, Van de Putte P, Deen J, Bouchez S. Focus on PoCUS or hocus pocus? Integrating point-of-care ultrasound into residency and clinical practice. ACTA ANAESTHESIOLOGICA BELGICA 2020. [DOI: 10.56126/71.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Point-of care ultrasound (PoCUS) is a new clinical diagnostic paradigm that plays an instrumental role in the ongoing anesthesiologist’s evolving role towards a perioperative physician. Currently, there are few approved curricula that incorporate a PoCUS program into anesthesia residency. This article examines relevant PoCUS applications for anesthesiologists, presents an overview of existing international guidelines for education and training, and reflects on the need for specialty-wide standards. We present a possible framework, that could offer a first move towards a structured PoCUS pathway for Belgian anesthesia residents and facilitate its incorporation into national anesthesia practice.
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Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory. Curr Opin Anaesthesiol 2020; 33:277-283. [DOI: 10.1097/aco.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Khishfe B, El Majzoub I, Hamade H, Cheaito R. The use of evaluation tool for ultrasound skills development and education to assess the extent of point-of-care ultrasound adoption in lebanese emergency departments. J Emerg Trauma Shock 2020; 13:219-223. [PMID: 33304073 PMCID: PMC7717455 DOI: 10.4103/jets.jets_111_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/09/2019] [Accepted: 11/21/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Previously acknowledged as “bedside ultrasound”, point-of-care ultrasound (PoCUS) is gaining great recognition nowadays and more physicians are using it to effectively diagnose and adequately manage patients. To measure previous, present and potential adoption of PoCUS and barriers to its use in Canada, Woo et al established the questionnaire “Evaluation Tool for Ultrasound skills Development and Education” (ETUDE) in 2007. This questionnaire sorted respondents into innovators, early adopters, majority, and nonadopters. Objectives: In this article, we attempt to evaluate the prevalence of PoCUS and the barriers to its adoption in Lebanese EDs, using the ETUDE. Materials and Methods: The same questionnaire was again utilized in Lebanon to assess the extent of PoCUS adoption. Our target population is emergency physicians (EPs). To achieve a high response rate, hospitals all over Lebanon were contacted to obtain contact details of their EPs. Questionnaires with daily reminders were sent on daily basis. Results: The response rate was higher in our population (78.8%) compared to Woo et al's (36.4%), as the questionnaire was sent by email to each physician with subsequent daily reminders to fill it. In fact, out of the total number of the surveyed (85 physicians), respondents were 67, of which 76.1% were males and of a median age of 43. Using ETUDE, results came as nonadopters (47.8%), majority (28.3%), early adopters (16.4%), and innovators (7.5%). Respondents advocated using PoCUS currently and in the future in five main circumstances: focused assessment with sonography in trauma (FAST) (current 22.9%/future 62.9%), first-trimester pregnancy (current 17.1%/future 68.6%), suspected abdominal aortic aneurysm (current 5.7%/future 51.4%), basic cardiac indications (current 8.6%/future 57.1%), and central venous catheterization (current 22.9%/future 85.7%). Conclusion: This study is the first to tackle the extent of use and the hurdles to PoCUS adoption in Lebanese emergency medicine practice, using ETUDE. The findings from this study can be used in Lebanon to strengthen PoCUS use in the future.
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Abstract
In resource limited settings with limited tests and diagnostic tools, most of diagnoses are based on clinical findings, and patients are managed empirically, e.g. with anti-tuberculosis drugs. This article aims at describing the use of point-of-care ultrasound in diagnosing the most important conditions in Africa, in addition to clinical work-up. Different protocols exist for the diagnosis of trauma-related disorders, tuberculosis, schistosomiasis, thromboembolism, causes of dyspnea, and non- traumatic shock. Point-of-care ultrasound might be a beneficial tool in Africa, aiding diagnostics and management of patients with these conditions. However, studies must be done to assess the impact of point-of-care ultrasound on mortality.
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Affiliation(s)
- Omary Ngome
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Mwananyamala Regional Referral Hospital, Dar es Salaam, United Republic of Tanzania
| | - Martin Rohacek
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- St Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Ramsingh D, Ma M, Le DQ, Davis W, Ringer M, Austin B, Ricks C. Feasibility Evaluation of Commercially Available Video Conferencing Devices to Technically Direct Untrained Nonmedical Personnel to Perform a Rapid Trauma Ultrasound Examination. Diagnostics (Basel) 2019; 9:diagnostics9040188. [PMID: 31739422 PMCID: PMC6963664 DOI: 10.3390/diagnostics9040188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction: Point-of-care ultrasound (POCUS) is a rapidly expanding discipline that has proven to be a valuable modality in the hospital setting. Recent evidence has demonstrated the utility of commercially available video conferencing technologies, namely, FaceTime (Apple Inc, Cupertino, CA, USA) and Google Glass (Google Inc, Mountain View, CA, USA), to allow an expert POCUS examiner to remotely guide a novice medical professional. However, few studies have evaluated the ability to use these teleultrasound technologies to guide a nonmedical novice to perform an acute care POCUS examination for cardiac, pulmonary, and abdominal assessments. Additionally, few studies have shown the ability of a POCUS-trained cardiac anesthesiologist to perform the role of an expert instructor. This study sought to evaluate the ability of a POCUS-trained anesthesiologist to remotely guide a nonmedically trained participant to perform an acute care POCUS examination. Methods: A total of 21 nonmedically trained undergraduate students who had no prior ultrasound experience were recruited to perform a three-part ultrasound examination on a standardized patient with the guidance of a remote expert who was a POCUS-trained cardiac anesthesiologist. The examination included the following acute care POCUS topics: (1) cardiac function via parasternal long/short axis views, (2) pneumothorax assessment via pleural sliding exam via anterior lung views, and (3) abdominal free fluid exam via right upper quadrant abdominal view. Each examiner was given a handout with static images of probe placement and actual ultrasound images for the three views. After a brief 8 min tutorial on the teleultrasound technologies, a connection was established with the expert, and they were guided through the acute care POCUS exam. Each view was deemed to be complete when the expert sonographer was satisfied with the obtained image or if the expert sonographer determined that the image could not be obtained after 5 min. Image quality was scored on a previously validated 0 to 4 grading scale. The entire session was recorded, and the image quality was scored during the exam by the remote expert instructor as well as by a separate POCUS-trained, blinded expert anesthesiologist. Results: A total of 21 subjects completed the study. The average total time for the exam was 8.5 min (standard deviation = 4.6). A comparison between the live expert examiner and the blinded postexam reviewer showed a 100% agreement between image interpretations. A review of the exams rated as three or higher demonstrated that 87% of abdominal, 90% of cardiac, and 95% of pulmonary exams achieved this level of image quality. A satisfaction survey of the novice users demonstrated higher ease of following commands for the cardiac and pulmonary exams compared to the abdominal exam. Conclusions: The results from this pilot study demonstrate that nonmedically trained individuals can be guided to complete a relevant ultrasound examination within a short period. Further evaluation of using telemedicine technologies to promote POCUS should be evaluated.
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Affiliation(s)
- Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Health, 11234 Anderson St. MC-2532, Loma Linda, CA 92354, USA
- Correspondence:
| | - Michael Ma
- Department of Anesthesiology, UCI Medical Center, Orange, CA 92868, USA; (M.M.); (C.R.)
| | - Danny Quy Le
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA;
| | - Warren Davis
- Department of Anesthesiology, St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA;
| | - Mark Ringer
- Loma Linda University School of Medicine, Loma Linda, CA 92350, USA;
| | - Briahnna Austin
- Department of Anesthesiology, Loma Linda University Health, 11234 Anderson St. MC-2532, Loma Linda, CA 92354, USA
| | - Cameron Ricks
- Department of Anesthesiology, UCI Medical Center, Orange, CA 92868, USA; (M.M.); (C.R.)
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Balderston JR, Gertz ZM, Brooks S, Joyce JM, Evans DP. Diagnostic Yield and Accuracy of Bedside Echocardiography in the Emergency Department in Hemodynamically Stable Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2845-2851. [PMID: 30882920 DOI: 10.1002/jum.14985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The goal of this study was to determine the diagnostic yield of focused cardiac ultrasound (FOCUS) in hemodynamically stable patients in the emergency department and secondarily to confirm the accuracy of these studies when compared to formal echocardiography. METHODS All hemodynamically stable adult patients who had an emergency physician-performed FOCUS examination completed over a 1-year period were identified using our electronic ultrasound database. Hemodynamic stability was defined as presenting systolic blood pressure higher than 90 mm Hg and not requiring any form of positive pressure ventilation. RESULTS There were 1198 FOCUS examinations performed: 976 in hemodynamically stable patients who were included in our analysis. Twenty-seven percent of patients had new findings, including 154 (16%) new diagnoses of reduced left ventricular function, 105 (11%) new pericardial effusions, and 44 (5%) new diagnoses of RV dilatation. Dyspnea as an indication for the FOCUS examination was the strongest predictor of a positive study. Of patients included, 28% underwent formal echocardiography within 2 days and were analyzed for concordance with regard to left ventricular function and the presence of pericardial effusion. Of 270 studies, 208 were accurate, and 62 were inaccurate, for raw agreement of 77% (κ = 0.53). When stratified by sonographer experience, there was no impact on accuracy. CONCLUSIONS Focused cardiac ultrasound in the emergency department for hemodynamically stable patients revealed new findings in 27% of studies, with a modest correlation with formal echocardiography. In stable patients, FOCUS has the potential for rapid diagnosis of cardiac disease, particularly in patients with dyspnea.
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Affiliation(s)
- Jessica R Balderston
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sean Brooks
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - J Michael Joyce
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - David P Evans
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Taylor-Fujikawa J, Andrist LS. The (Updated) History of Sonography: Education and Credentialing. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319876233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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49
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Cereda M, Xin Y, Goffi A, Herrmann J, Kaczka DW, Kavanagh BP, Perchiazzi G, Yoshida T, Rizi RR. Imaging the Injured Lung: Mechanisms of Action and Clinical Use. Anesthesiology 2019; 131:716-749. [PMID: 30664057 PMCID: PMC6692186 DOI: 10.1097/aln.0000000000002583] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Acute respiratory distress syndrome (ARDS) consists of acute hypoxemic respiratory failure characterized by massive and heterogeneously distributed loss of lung aeration caused by diffuse inflammation and edema present in interstitial and alveolar spaces. It is defined by consensus criteria, which include diffuse infiltrates on chest imaging-either plain radiography or computed tomography. This review will summarize how imaging sciences can inform modern respiratory management of ARDS and continue to increase the understanding of the acutely injured lung. This review also describes newer imaging methodologies that are likely to inform future clinical decision-making and potentially improve outcome. For each imaging modality, this review systematically describes the underlying principles, technology involved, measurements obtained, insights gained by the technique, emerging approaches, limitations, and future developments. Finally, integrated approaches are considered whereby multimodal imaging may impact management of ARDS.
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Affiliation(s)
- Maurizio Cereda
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi Xin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, ON, Canada
| | - Jacob Herrmann
- Departments of Anesthesia and Biomedical Engineering, University of Iowa, IA
| | - David W. Kaczka
- Departments of Anesthesia, Radiology, and Biomedical Engineering, University of Iowa, IA
| | | | - Gaetano Perchiazzi
- Hedenstierna Laboratory and Uppsala University Hospital, Uppsala University, Sweden
| | - Takeshi Yoshida
- Hospital for Sick Children, University of Toronto, ON, Canada
| | - Rahim R. Rizi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Royer DF. Seeing with Sound: How Ultrasound Is Changing the Way We Look at Anatomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1138:47-56. [PMID: 31313257 DOI: 10.1007/978-3-030-14227-8_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.
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Affiliation(s)
- Danielle F Royer
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, USA.
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