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Mao RMD, Williams TP, Shah NR, Snyder C, Person J, Klimberg VS, Mador B, Buchanan B, Perez A. Remote Instruction in Focused Assessment With Sonography in Trauma (FAST) Exams for Surgery Residents: A Pilot Study. Am Surg 2023; 89:5407-5413. [PMID: 36789639 DOI: 10.1177/00031348231157821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The Focused Assessment with Sonography in Trauma (FAST) exam is an important component to the evaluation of trauma patients. With advances in technology and meeting limitations due to COVID-19, remote instruction and learning have gained popularity. We sought to determine whether remote instruction of FAST exams was feasible as sustainable surgical education and a possible alternative to traditional in-person teaching. METHODS General surgery residents completed a baseline survey and skills assessment on FAST exams and were then randomized to remote or in-person instruction. The remote group participated in an instructional session with a content expert through video conference and then practiced on a simulated mannequin while the expert remotely provided feedback. The in-person group received the experience with the content expert in the room. Both groups completed a post-course survey immediately after the session and a follow-up survey and objective assessment at six-months. Results were compared with two-way analysis of variance (ANOVA). RESULTS 14 residents underwent the curriculum, seven in each group. There was a significant increase in self-reported confidence when comparing pre- and immediate post-course results for both the remote and in-person groups. At six months, confidence scores remained elevated and skill assessment scores improved, although the latter did not reach significance. There was no significant difference in post-course results between the groups. CONCLUSIONS Remote instruction of FAST exams was feasible. Pilot data demonstrated an increase in confidence and suggest outcomes that are similar to in-person instruction, which has positive implications for future remote educational and potentially clinical initiatives.
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Affiliation(s)
- Rui-Min D Mao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor P Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Clifford Snyder
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Joshua Person
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brett Mador
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Brian Buchanan
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexander Perez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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3
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Kirkpatrick AW, McKee JL, Couperus K, Colombo CJ. Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care. Diagnostics (Basel) 2022; 12:2884. [PMID: 36428945 PMCID: PMC9689087 DOI: 10.3390/diagnostics12112884] [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: 10/31/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.
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Affiliation(s)
- Andrew W. Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
- Departments of Critical Care Medicine and Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jessica L. McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
| | - Kyle Couperus
- Ready Medic One (RMO) Research Group, Tacoma, WA 98431, USA
| | - Christopher J. Colombo
- Department of Medicine, Uniformed Services University of Health Sciences Bethesda Maryland, Bethesda, MD 20814, USA
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4
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Kirkpatrick AW, McKee JL, Ball CG, Ma IWY, Melniker LA. Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health. Ultrasound J 2022; 14:2. [PMID: 34978611 PMCID: PMC9417136 DOI: 10.1186/s13089-021-00250-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background SARS-CoV-2 infection, manifesting as COVID-19 pneumonia, constitutes
a global pandemic that is disrupting health-care systems. Most patients who are
infected are asymptomatic/pauci-symptomatic can safely self-isolate at home.
However, even previously healthy individuals can deteriorate rapidly with
life-threatening respiratory failure characterized by disproportionate hypoxemic
failure compared to symptoms. Ultrasound findings have been proposed as an early
indicator of progression to severe disease. Furthermore, ultrasound is a safe
imaging modality that can be performed by novice users remotely guided by experts.
We thus examined the feasibility of utilizing common household
informatic-technologies to facilitate self-performed lung ultrasound. Methods A lung ultrasound expert remotely mentored and guided participants
to image their own chests with a hand-held ultrasound transducer. The results were
evaluated in real time by the mentor, and independently scored by three
independent experts [planned a priori]. The primary outcomes were feasibility in
obtaining good-quality interpretable images from each anatomic location
recommended for COVID-19 diagnosis. Results Twenty-seven adults volunteered. All could be guided to obtain
images of the pleura of the 8 anterior and lateral lung zones (216/216 attempts).
These images were rated as interpretable by the 3 experts in 99.8% (647/648) of
reviews. Fully imaging one’s posterior region was harder; only 108/162 (66%) of
image acquisitions was possible. Of these, 99.3% of images were interpretable in
blinded evaluations. However, 52/54 (96%) of participants could image their lower
posterior lung bases, where COVID-19 is most common, with 99.3% rated as
interpretable. Conclusions Ultrasound-novice adults at risk for COVID-19 deterioration can be
successfully mentored using freely available software and low-cost ultrasound
devices to provide meaningful lung ultrasound surveillance of themselves that
could potentially stratify asymptomatic/paucisymptomatic patients with early risk
factors for serious disease. Further studies examining practical logistics should
be conducted. Trial Registration: ID
ISRCTN/77929274 on 07/03/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00250-6.
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Affiliation(s)
- Andrew W Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB, Canada. .,Departments of Surgery, University of Calgary, Calgary, AB, Canada. .,Departments of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. .,Regional Trauma Services, EG 23, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada. .,Canadian Forces Medical Services, University of Calgary, Calgary, AB, Canada.
| | - Jessica L McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB, Canada
| | - Chad G Ball
- Departments of Surgery, University of Calgary, Calgary, AB, Canada.,Regional Trauma Services, EG 23, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Irene W Y Ma
- W21C, University of Calgary, Calgary, AB, Canada.,John A. Buchanan Chair, Division of General Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence A Melniker
- Department of Emergency Medicine, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
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5
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Assessing task understanding in remote ultrasound diagnosis via gesture analysis. Pattern Anal Appl 2021. [DOI: 10.1007/s10044-021-01027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Hadar E, Wolff L, Tenenbaum-Gavish K, Eisner M, Shmueli A, Barbash-Hazan S, Bergel R, Shmuel E, Houri O, Dollinger S, Brzezinski-Sinai NA, Sukenik S, Pardo A, Navon I, Wilk Y, Zafrir-Danieli H, Wiznitzer A. Mobile Self-Operated Home Ultrasound System for Remote Fetal Assessment During Pregnancy. Telemed J E Health 2021; 28:93-101. [PMID: 33729014 DOI: 10.1089/tmj.2020.0541] [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] [Indexed: 01/01/2023] Open
Abstract
Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attached to a commercial smartphone for remote fetal assessment. We aimed to evaluate whether it is feasible to use remote fetal assessment during pregnancy. Materials and Methods: This is an observational noninterventional trial. We included women with a singleton fetus at 14 + 0 to 39 + 6 gestational weeks. Each participant received the device for a self-use period of 7-14 days and was instructed to perform one to three scans a day. Participants completed a self-assessment questionnaire to evaluate safety and usability (i.e., user experience and satisfaction). Each scan was evaluated for fetal heart activity, amniotic fluid volume, fetal tone, fetal body, and breathing movements. Results: One hundred women, completing 1,360 self scans, used the device for 8.1 ± 1.5 days, performing an average of 13.6 ± 6.2 scans each. There were no device-related serious adverse events. Success in detection was 95.3% for fetal heart activity, 88.3% for body movements, 69.4% for tone, 92.2% for normal amniotic fluid volume, and 23.8% for breathing movements. Interobserver agreement was 94.4% for fetal heart rate activity, 85.9% for body movements, 69.5% for fetal tone, 86.9% for amniotic fluid volume, and 94.0% for breathing movements. Self-assessed user experience was rated at 4.4/5, whereas device satisfaction was rated at 3.9/5. Conclusion: The INSTINCT ultrasound system is a feasible solution for remote sonographic fetal assessment. Further studies are needed to assess its role and impact in telehealth antenatal care and fetal surveillance.
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Affiliation(s)
- Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Leor Wolff
- Translational Innovation and eHealth Wing, Clalit Health Services, Tel-Aviv, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michal Eisner
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Riki Bergel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Elyasaf Shmuel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sarah Dollinger
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa A Brzezinski-Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shay Sukenik
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Inbal Navon
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yulia Wilk
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Hadas Zafrir-Danieli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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7
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Karim N, Rybarczyk MM, Jacquet GA, Pousson A, Aluisio AR, Bilal S, Moretti K, Douglass KA, Henwood PC, Kharel R, Lee JA, MenkinSmith L, Moresky RT, Gonzalez Marques C, Myers JG, O’Laughlin KN, Schmidt J, Kivlehan SM. COVID-19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration. AEM EDUCATION AND TRAINING 2021; 5:79-90. [PMID: 33521495 PMCID: PMC7821062 DOI: 10.1002/aet2.10551] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 05/10/2023]
Abstract
To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.
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Affiliation(s)
- Naz Karim
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Megan M. Rybarczyk
- theDepartment of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Gabrielle A. Jacquet
- theDepartment of Emergency MedicineBoston University School of MedicineBoston Medical CenterBostonMAUSA
| | - Amelia Pousson
- theDepartment of Emergency MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Adam R. Aluisio
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Saadiyah Bilal
- theDepartment of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNYUSA
| | - Katelyn Moretti
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | | | - Patricia C. Henwood
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ramu Kharel
- theDepartment of Emergency MedicineEmory University School of MedicineAtlantaGAUSA
| | - J. Austin Lee
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Lacey MenkinSmith
- theDepartment of Emergency MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Rachel T. Moresky
- theEmergency Medicine DepartmentColumbia University College of Physicians and Surgeons and Columbia University Mailman School of Public Health, Heilbrunn Population and Family HealthNew YorkNYUSA
| | | | - Justin G. Myers
- theDepartment of Emergency MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kelli N. O’Laughlin
- theDepartments of Emergency Medicine and Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jessica Schmidt
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Sean M. Kivlehan
- and theDepartment of Emergency MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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8
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Hampton L, Brindley P, Kirkpatrick A, McKee J, Regehr J, Martin D, LaPorta A, Park J, Vergis A, Gillman L. Strategies to improve communication in telementoring in acute care coordination: a scoping review. Can J Surg 2020; 63:E569-E577. [PMID: 33253511 DOI: 10.1503/cjs.015519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Telementoring facilitates the coordination of advanced medical care in rural, remote or austere environments. Because the interpersonal element of telementoring has been relatively underexplored, we conducted a scoping review to identify strategies to improve communication in telementoring. Methods Two independent reviewers searched all English-language articles in MEDLINE and Scopus from 1964 to 2017, as well as reference lists of relevant articles to identify articles addressing telementored interactions between health care providers. Search results were gathered in June 2017 and updated in January 2018. Identified articles were categorized by theme. Results We identified 144 articles, of which 56 met our inclusion criteria. Forty-one articles focused on improving dispatcher-directed cardiopulmonary resuscitation (CPR). Major themes included the importance of language in identifying out-of-hospital cardiac arrest and how to provide instructions to enable administration of effective CPR. A standardized approach with scripted questions was associated with improved detection of out-of-hospital cardiac arrest, and a concise script was associated with improved CPR quality compared to no mentoring, unscripted mentoring or more complex instructions. Six articles focused on physician-physician consultation. Use of a handover tool that highlighted critical information outperformed an unstructured approach regarding transmission of vital information. Nine articles examined telementoring in trauma resuscitation. A common theme was the need to establish an understanding between mentor and provider regarding the limitations of the provider and his or her environment. Conclusion The available data suggest that standardization coupled with short, concise validated scripts could improve efficacy, safety and engagement. Improvements will require multidisciplinary input, practice and deliberate efforts to address barriers.
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Affiliation(s)
- Lauren Hampton
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Peter Brindley
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Andrew Kirkpatrick
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jessica McKee
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Julian Regehr
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Douglas Martin
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Anthony LaPorta
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Jason Park
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Ashley Vergis
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
| | - Lawrence Gillman
- From the Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Hampton, Park, Vergis, Gillman); the Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Emergency Medicine, University of Manitoba, Winnipeg, Man. (Regehr, Martin); the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Brindley, McKee); the Deparments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick); the Trauma Program, University of Calgary, Calgary, Alta. (Kirkpatrick, McKee); and the Rocky Vista University School of Medicine, Parker, Colo. (LaPorta)
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9
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Kirkpatrick AW, McKee JL, Volpicelli G, Ma IWY. The Potential for Remotely Mentored Patient-Performed Home Self-Monitoring for New Onset Alveolar-Interstitial Lung Disease. Telemed J E Health 2020; 26:1304-1307. [PMID: 32654656 DOI: 10.1089/tmj.2020.0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an acute respiratory illness. Although most infected persons are asymptomatic or have only mild symptoms, some patients progress to devastating disease; such progression is difficult to predict or identify in a timely manner. COVID-19 patients who do not require hospitalization can self-isolate at home. Calls from one disease epicenter identify the need for homebased isolation with telemedicine surveillance to monitor for impending deterioration. Methodology: Although the dominant approach for these asymptomatic/paucisymptomatic patients is to monitor oxygen saturation, we suggest additionally considering the potential merits and utility of home-based imaging. Chest computed tomography is clearly impractical, but ultrasound has shown comparable sensitivity for lung involvement, with major advantages of short and simple procedures, low cost, and excellent repeatability. Thoracic ultrasound may thus allow remotely identifying the development of pneumonitis at an early stage of illness and potentially averting the risk of insidious deterioration to severe pneumonia and critical illness while in home isolation. Conclusions: Lung sonography can be easily performed by motivated nonmedical caregivers when directed and supervised in real time by experts. Remote mentors could thus efficiently monitor, counsel, and triage multiple home-based patients from their "control center." Authors believe that this approach deserves further attention and study to reduce delays and failures in timely hospitalization of home-isolated patients.
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Affiliation(s)
- Andrew W Kirkpatrick
- Department of Critical Care Medicine and University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Surgery, and the University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Trauma Program, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jessica L McKee
- Department of Surgery, and the University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - 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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10
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Vatsvåg V, Todnem K, Næsheim T, Cathcart J, Kerr D, Oveland NP. Offshore telementored ultrasound: a quality assessment study. Ultrasound J 2020; 12:33. [PMID: 32613261 PMCID: PMC7329972 DOI: 10.1186/s13089-020-00180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Telementored ultrasound (US) connects experts to novices through various types of communication and network technologies with the overall aim to bridge the medical imaging gap between patients’ diagnostic needs and on-site user experience. The recurrent theme in previous research on remote telementored US is the limited access to US machines and experienced users. This study was conducted to determine whether telementored US was feasible in a remote offshore setting. The aim was to assess if an onshore US expert can guide an offshore nurse through focused US scanning protocols by connecting an US machine to existing videoconference units at the offshore hospitals and to evaluate the diagnostic quality of the images and cineloops procured. Results The diagnostic quality of cineloops was scored on a five-point scale. The percentage of cineloops suitable for interpretation (score 3 ≥) for the FATE and e-FAST protocols was 96.4 and 79.1. Lung sliding and seashore sign could be identified in all volunteers. The scan time for the FAST protocol (n = four scanning positions), FATE protocol (n = six scanning positions) and both lungs (n = two scanning positions) was 1 min 20 s, 4 min 15 s and 32 s, respectively. Conclusion A novice US user can be guided by a remote expert through focused US protocols within an acceptable time frame and with good diagnostic quality using existing communication and network systems found onboard offshore oil rigs.
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Affiliation(s)
- Victoria Vatsvåg
- School Health Sciences, Ulster University, Co., Antrim, UK. .,Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.
| | - Kjetil Todnem
- Department of Health and Working Environment, Global Business Support, Equinor ASA, Stavanger, Norway
| | - Torvind Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Anaesthesiology, University Hospital North Norway, Tromsø, Norway
| | - John Cathcart
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Daniel Kerr
- School Health Sciences, Ulster University, Co., Antrim, UK
| | - Nils Petter Oveland
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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11
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Kirkpatrick AW, McKee JL. Lung ultrasonography in a woman with COVID-19: This examination could be remote. CMAJ 2020; 192:E435. [PMID: 32312827 DOI: 10.1503/cmaj.75302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrew W Kirkpatrick
- Acute Care, Trauma, and General Surgery and Critical Care Medicine, TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, Alta
| | - Jessica L McKee
- Project manager, TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Group, University of Calgary, Calgary, Alta
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12
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Salerno A, Tupchong K, Verceles AC, McCurdy MT. Point-of-Care Teleultrasound: A Systematic Review. Telemed J E Health 2020; 26:1314-1321. [PMID: 32302520 DOI: 10.1089/tmj.2019.0177] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Telemedicine and point-of-care ultrasound have merged to create a field known as teleultrasound (TUS). Real-time TUS involves the transmission of bedside ultrasound (US) images with direct feedback from an US expert. In this review, we summarize the current uses of real-time TUS and discuss its potential future uses. Methods: We performed a literature search (PubMed and EMBase) to assess articles related to real-time TUS. Data were extracted using a standardized collection form, and relevant articles were separated into feasibility or clinical studies. Results: Our search yielded 45 articles, with most of the reports taking place in resource-constrained settings. A large portion of the studies discussed the use of the focused assessment with sonography in trauma exam. Others included musculoskeletal, vascular, and echocardiography. Conclusion: Real-time TUS allows for rapid access to diagnostic imaging in various clinical settings. This technology is poised to expand with many uses on the horizon.
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Affiliation(s)
- Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Keegan Tupchong
- Division of Critical Care Medicine, Department of Emergency Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Avelino C Verceles
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael T McCurdy
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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Carrera JF. A Systematic Review of the Use of Google Glass in Graduate Medical Education. J Grad Med Educ 2019; 11:637-648. [PMID: 31871562 PMCID: PMC6919184 DOI: 10.4300/jgme-d-19-00148.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/13/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. OBJECTIVE We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. METHODS We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. RESULTS Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. CONCLUSIONS GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.
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14
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Britton N, Miller MA, Safadi S, Siegel A, Levine AR, McCurdy MT. Tele-Ultrasound in Resource-Limited Settings: A Systematic Review. Front Public Health 2019; 7:244. [PMID: 31552212 PMCID: PMC6738135 DOI: 10.3389/fpubh.2019.00244] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Telemedicine, or healthcare delivery from a distance, has evolved over the past 50 years and helped alter health care delivery to patients around the globe. Its integration into numerous domains has permitted high quality care that transcends obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine (“tele-ultrasound”) has advanced substantially in recent years, particularly in high-income settings. However, the utility of tele-ultrasound in resource-limited settings is less firmly established. Objective: To determine whether remote tele-ultrasound is a feasible, accurate, and care-altering imaging tool in resource-limited settings. Data Sources: PubMed, MEDLINE, and Embase. Study Eligibility Criteria: Twelve original articles met the following eligibility criteria: full manuscript available, written in English, including a direct patient-care intervention, performed in a resource-limited setting, images sent to a remote expert reader for interpretation and feedback, contained objective data on the impact of tele-ultrasound. Study Appraisal and Synthesis Methods: Abstracts were independently screened by two authors against inclusion criteria for full-text review. Any discrepancies were settled by a senior author. Data was extracted from each study using a modified Cochrane Consumers and Communication Review Group's data extraction template. Study bias was evaluated using the ROBINS-I tool. Results: The study results reflect the diverse applications of tele-ultrasound in low-resource settings. Africa was the most common study location. The specialties of cardiology and obstetrics comprised most studies. Two studies primarily relied on smartphones for image recording and transmission. Real-time, rather than asynchronous, tele-ultrasound image interpretation occurred in five of the 12 studies. The most common outcome measures were image quality, telemedicine system requirements, diagnostic accuracy, and changes in clinical management. Limitations: The studies included were of poor quality with a dearth of randomized control trials and with significant between study heterogeneity which resulted in incomplete data and made cross study comparison difficult. Conclusions and Implications of Key Findings: Low-quality evidence suggests that ultrasound images acquired in resource-limited settings and transmitted using a telemedical platform to an expert interpreter are of satisfactory quality and value for clinical diagnosis and management.
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Affiliation(s)
- Noel Britton
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Michael A Miller
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sami Safadi
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ariel Siegel
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrea R Levine
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.,University of Maryland School of Medicine, Baltimore, MD, United States
| | - Michael T McCurdy
- University of Maryland School of Medicine, Baltimore, MD, United States
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15
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Netzer I, Kirkpatrick AW, Nissan M, McKee JL, McBeth P, Dobron A, Glassberg E. Rubrum Coelis: The Contribution of Real-Time Telementoring in Acute Trauma Scenarios-A Randomized Controlled Trial. Telemed J E Health 2019; 25:1108-1114. [PMID: 30707651 DOI: 10.1089/tmj.2018.0173] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most deaths in military trauma occur soon after wounding, and demand immediate on scene interventions. Although hemorrhage predominates as the cause of potentially preventable death, airway obstruction and tension pneumothorax are also frequent. First responders caring for casualties in operational settings often have limited clinical experience. Introduction: We hypothesized that communications technologies allowing for real-time communications with a senior medically experienced provider might assist in the efficacy of first responding to catastrophic trauma. Methods: Thirty-three basic life saving (BLS) medics were randomized into two groups: either receiving telementoring support (TMS, n = 17) or no telementoring support (NTMS, n = 16) during the diagnosis and resuscitation of a simulated critical battlefield casualty. In addition to basic life support, all medics were required to perform a procedure needle thoracentesis (not performed by BLS medics in Israel) for the first time. TMS was performed by physicians through an internet link. Performance was assessed during the simulation and later on review of videos. Results: The TMS group was significantly more successful in diagnosing (82.35% vs. 56.25%, p = 0.003) and treating pneumothorax (52.94% vs. 37.5%, p = 0.035). However, needle thoracentesis time was slightly longer for the TMS group versus the NTMS group (1:24 ± 1:00 vs. 0:49 ± 0:21 minu, respectively (p = 0.016). Complete treatment time was 12:56 ± 2:58 min for the TMS group, versus 9:33 ± 3:17 min for the NTMS group (p = 0.003). Conclusions: Remote telementoring of basic life support performed by military medics significantly improved the medics' ability to perform an unfamiliar lifesaving procedure at the cost of prolonging time needed to provide care. Future studies must refine the indications and contraindications for using telemedical support.
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Affiliation(s)
- Itamar Netzer
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada.,Canadian Forces Medical Services, Ottawa, Canada
| | - Mor Nissan
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Jessica L McKee
- Canadian Forces Medical Services, Ottawa, Canada.,Innovative Trauma Care, Edmonton, Canada
| | - Paul McBeth
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada.,Canadian Forces Medical Services, Ottawa, Canada
| | - Alex Dobron
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel.,Bar-Ilan University Faculty of Medicine, Safed, Israel
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16
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Kirkpatrick AW, McKee JL, Netzer I, McBeth PB, D'Amours S, Kock V, Dobron A, Ball CG, Glassberg E. Transoceanic Telementoring of Tube Thoracostomy Insertion: A Randomized Controlled Trial of Telementored Versus Unmentored Insertion of Tube Thoracostomy by Military Medical Technicians. Telemed J E Health 2018; 25:730-739. [PMID: 30222511 DOI: 10.1089/tmj.2018.0138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Tension pneumothorax is a frequent cause of potentially preventable death. Tube thoracostomy (TT) can obviate death but is invasive and fraught with complications even in experienced hands. We assessed the utility of a remote international virtual network (RIVN) of specialized mentors to remotely guide military medical technicians (medics) using wireless informatics. Methods: Medics were randomized to insert TT in training mannequins (TraumaMan; Abacus ALS, Meadowbrook, Australia) supervised by RIVN or not. The RIVN consisted of trauma surgeons in Canada and Australia and a senior medic in Ohio. Medics wore a helmet-mounted wireless camera with laser pointer to confirm anatomy and two-way voice communication using commercial software (Skype®). Performance was measured through objective task completion (pass/fail) regarding safety during the procedure, proper location, and secure anchoring of the tube, in addition to remote mentor opinion and subjective debrief. Results: Fourteen medics attempted TT, seven mentored and seven not. The RIVN was functional and surgeons on either side of the globe had real-time communication with the mentees. TT placement was considered safe, successful, and secure in 100% of mentored (n = 7) procedures, although two (29%) received corrective remote guidance. All (100%) of the unmentored attempted and adequately secured the TT and were safe. However, only 71% (n = 5) completed the task successfully (p = 0.46). Participating medics subjectively felt remote telementoring (RTM) increased self-confidence (strong agreement mean 5/5 ± 0); confidence to perform field TT (agreement (4/5 ± 1); and decreased anxiety (strong agreement 5/5 ± 1). Subjectively, the remote mentors felt in 100% of the mentored procedures that "yes" they were able to assist the medics (1.86 ± 0.38), and in 71% (n = 5) felt "yes" they made TT safer (2.29 ± 0.49). Conclusions: RTM descriptively increased the success of TT placement and allowed for real-time troubleshooting from thousands of kilometers with a redundant capability. RTM was subjectively associated with high levels of satisfaction and self-reported self-confidence. Continued controlled and critical evaluation and refinement of telemedical techniques should continue. Trial Registration: ID ISRCTN/77929274.
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Affiliation(s)
- Andrew W Kirkpatrick
- 1Regional Trauma Services, University of Calgary, Calgary, Canada.,2Canadian Forces Medical Services, Ottawa, Canada
| | - Jessica L McKee
- 1Regional Trauma Services, University of Calgary, Calgary, Canada.,2Canadian Forces Medical Services, Ottawa, Canada
| | | | - Paul B McBeth
- 1Regional Trauma Services, University of Calgary, Calgary, Canada
| | | | - Volker Kock
- 2Canadian Forces Medical Services, Ottawa, Canada
| | - Alex Dobron
- 3Israeli Defence Force Medical Corp, Haifa, Israel
| | - Chad G Ball
- 1Regional Trauma Services, University of Calgary, Calgary, Canada
| | - Elon Glassberg
- 3Israeli Defence Force Medical Corp, Haifa, Israel.,5Faculty of Medicine, Bar-Ilan University, Safed, Israel.,6The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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17
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Abstract
Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.
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Affiliation(s)
| | - Leila Eadie
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
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18
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Morchel H, Ogedegbe C, Chaplin W, Cheney B, Zakharchenko S, Misch D, Schwartz M, Feldman J, Kaul S. Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances. Mil Med 2018; 183:111-118. [PMID: 29635573 DOI: 10.1093/milmed/usx167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/23/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Methods Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Results Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Conclusion Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.
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Affiliation(s)
- Herman Morchel
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Chinwe Ogedegbe
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - William Chaplin
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Brianna Cheney
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Svetlana Zakharchenko
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - David Misch
- School of Medicine, St. George's University, University Centre, Grenada, West Indies
| | - Matthew Schwartz
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Joseph Feldman
- Emergency Trauma Center, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
| | - Sanjeev Kaul
- Trauma and Injury Prevention, Hackensack Meridian Health, 30 Prospect Avenue, Hackensack, NJ 07601
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19
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Pinto J, Azevedo R, Pereira E, Caldeira A. Ultrasonography in Gastroenterology: The Need for Training. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:308-316. [PMID: 30480048 DOI: 10.1159/000487156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022]
Abstract
The use of ultrasonography (US) as an imaging modality in medicine has spread across almost every clinical specialty. This diffusion is based on the simplicity, accessibility, portability and affordability of the technique producing real-time high-resolution images using non-ionising radiation. On the other hand, this trend also extended the technique to settings other than healthcare, such as public facilities, private houses or remote sites. This tendency can be observed worldwide, from developing countries to prestigious medical schools and tertiary referral hospitals. Furthermore, point-of-care US (POCUS), i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. In gastroenterology, despite the essential role of endoscopy, clinical practice is highly dependent on non-endoscopic imaging techniques. However, as in other specialties, the indications of US in gastroenterology have been increasing steadily, covering a broad range of conditions. In response to the generalised employment of US by non-radiologists, institutions such as the European Federation of Societies for Ultrasound in Medicine and Biology and the Royal College of Radiologists issued recommendations to ensure high-quality practice. These theoretical and practical requisites include performing a certain number of examinations and mandatory skills in order to achieve certification to execute unsupervised US. Therefore, there is a need for modern gastroenterology to include US as a basic skill in its clinical practice. To ensure the provision of high-quality US, adequate instruction of future specialists should be guaranteed by the gastroenterology departments and required in the residency training programme.
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Affiliation(s)
- João Pinto
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Richard Azevedo
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Eduardo Pereira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Ana Caldeira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
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20
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Kim C, Cha H, Kang BS, Choi HJ, Lim TH, Oh J. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 2018; 29:347-56. [PMID: 26620200 DOI: 10.1007/s10278-015-9849-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunmin Cha
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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Galván P, Velázquez M, Benítez G, Ortellado J, Rivas R, Barrios A, Hilario E. [Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]. Rev Panam Salud Publica 2017. [PMID: 28614483 PMCID: PMC6645396 DOI: 10.26633/rpsp.2017.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objetivo. Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay. Métodos. El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud. Resultados. Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037. Conclusión. Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.
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Affiliation(s)
- Pedro Galván
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Miguel Velázquez
- Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | | | - José Ortellado
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Ronald Rivas
- Departamento de Ingeniería Biomédica e Imágenes, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Antonio Barrios
- Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
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Eadie LH. New technology and potential for telemedicine in battlefield brain injury diagnostics. Concussion 2016; 1:CNC22. [PMID: 30202564 PMCID: PMC6094064 DOI: 10.2217/cnc-2016-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/19/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Leila H Eadie
- Centre for Rural Health, University of Aberdeen; Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK
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Gargani L, Sicari R, Raciti M, Serasini L, Passera M, Torino C, Letachowicz K, Ekart R, Fliser D, Covic A, Balafa O, Stavroulopoulos A, Massy ZA, Fiaccadori E, Caiazza A, Bachelet T, Slotki I, Shavit L, Martinez-Castelao A, Coudert-Krier MJ, Rossignol P, Kraemer TD, Hannedouche T, Panichi V, Wiecek A, Pontoriero G, Sarafidis P, Klinger M, Hojs R, Seiler-Mußler S, Lizzi F, Onofriescu M, Zarzoulas F, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project. Nephrol Dial Transplant 2016; 31:1982-1988. [DOI: 10.1093/ndt/gfw329] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/24/2016] [Indexed: 02/06/2023] Open
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Kirkpatrick AW, Tien H, LaPorta AT, Lavell K, Keillor J, Wright Beatty HE, McKee JL, Brien S, Roberts DJ, Wong J, Ball CG, Beckett A. The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study. J Trauma Acute Care Surg 2015; 79:741-7. [PMID: 26422331 PMCID: PMC4623848 DOI: 10.1097/ta.0000000000000829] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings. METHODS An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon. RESULTS There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004). CONCLUSION Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Canadian Forces Health Services (A.W.K., H.T., J.W., A.B.); Departments of Surgery (A.W.K., D.J.R., C.G.B.), Critical Care Medicine (A.W.K.), and Community Health Sciences (D.J.R.), and Regional Trauma Services (A.W.K., C.G.B.), Foothills Medical Centre; and Innovative Trauma Care (J.L.M.), Edmonton, Calgary, Alberta; Sunnybrook Health Sciences Centre (H.T.), Toronto; and Royal College of Physicians and Surgeons (S.B.); and Flight Research Laboratory (J.K., H.E.W.B.), National Research Council of Canada, Ottawa, Ontario, Canada; Rocky Vista University, Parker, Colorado (A.T.L.); and Strategic Operations (K.L.), San Diego, California
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Levine AR, McCurdy MT, Zubrow MT, Papali A, Mallemat HA, Verceles AC. Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care 2015; 30:871-5. [PMID: 26122274 DOI: 10.1016/j.jcrc.2015.05.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/25/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Intensive care unit telemedicine (tele-ICU) uses audiovisual systems to remotely monitor and manage patients. Intensive care unit ultrasound can augment an otherwise limited bedside evaluation. To date, no studies have utilized tele-ICU technology to assess the quality and clinical use of real-time ultrasound images. We assessed whether tele-intensivists can instruct nonphysicians to obtain high-quality, clinically useful ultrasound images. METHODS This prospective pilot evaluated the effectiveness of a brief educational session of nonphysician "ultrasonographers" on their ability to obtain ultrasound images (right internal jugular vein, bilateral lung apices and bases, cardiac subxiphoid view, bladder) with real-time tele-intensivist guidance. All ultrasound screen images were simultaneously photographed with a 2-way camera and saved on the ultrasound machine. The tele-intensivist assessed image quality, and an independent ultrasound expert rated their use in guiding clinical decisions. RESULTS The intensivist rated the tele-ICU camera images as high quality (70/77, 91%) and suitable for guiding clinical decisions (74/77, 96%). Only bilateral lung apices demonstrated differences in quality and clinical use. All other images were rated noninferior and clinically useful. CONCLUSION Tele-intensivists can guide minimally trained nonphysicians to obtain high-quality, clinically useful ultrasound images. For most anatomic sites, tele-ICU images are of similar quality to those acquired directly by ultrasound.
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Affiliation(s)
- Andrea R Levine
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, United States.
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States; Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Marc T Zubrow
- Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., Suite 5-N-162, Baltimore, MD, 21201, United States.
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
| | - Haney A Mallemat
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD, 21201, United States.
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD, 21201, United States.
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Out of hospital point of care ultrasound: current use models and future directions. Eur J Trauma Emerg Surg 2015; 42:139-50. [PMID: 26038015 DOI: 10.1007/s00068-015-0494-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/16/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Ultrasound has evolved from a modality that was once exclusively reserved to certain specialities of its current state, in which its portability and durability lend to its broadly increasing applications. OBJECTIVES This review describes portable ultrasound in the hospital setting and its comparison to gold standard imaging modalities. Also, this review summarizes current literature describing portable ultrasound use in prehospital, austere and remote environments, highlighting successes and barriers to use in these environments. DISCUSSION Prehospital ultrasound has the ability to increase diagnostic ability and allow for therapeutic intervention in the field. In austere environments, ultrasound may be the only available imaging modality and thus can guide diagnosis, therapeutics and determine which patients may need emergent transfer to a healthcare facility. The most cutting edge applications of portable ultrasound employ telemedicine to obtain and transmit ultrasound images. This technology and ability to transmit images via satellite and cellular transmission can allow for even novice users to obtain interpretable images in austere environments. Portable ultrasound uses have steadily grown and will continue to do so with the introduction of more portable and durable technologies. As applications continue to grow, certain technologic considerations and future directions are explored.
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Russell PM, Mallin M, Youngquist ST, Cotton J, Aboul‐Hosn N, Dawson M. First "glass" education: telementored cardiac ultrasonography using Google Glass- a pilot study. Acad Emerg Med 2014; 21:1297-9. [PMID: 25377415 DOI: 10.1111/acem.12504] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/12/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to determine the feasibility of telementored instruction in bedside ultrasonography (US) using Google Glass. The authors sought to examine whether first-time US users could obtain adequate parasternal long axis (PSLA) views to approximate ejection fraction (EF) using Google Glass telementoring. METHODS This was a prospective, randomized, single-blinded study. Eighteen second-year medical students were randomized into three groups and tasked with obtaining PSLA cardiac imaging. Group A received real-time telementored education through Google Glass via Google Hangout from a remotely located expert. Group B received bedside education from the same expert. Group C represented the control and received no instruction. Each subject was given 3 minutes to obtain a best PSLA cardiac imaging using a portable GE Vscan. Image clips obtained by each subject were stored. A second expert, blinded to instructional mode, evaluated images for adequacy and assigned an image quality rating on a 0 to 10 scale. RESULTS Group A was able to obtain adequate images six out of six times (100%) with a median image quality rating of 7.5 (interquartile range [IQR] = 6 to 10) out of 10. Group B was also able to obtain adequate views six out of six times (100%), with a median image quality rating of 8 (IQR = 7 to 9). Group C was able to obtain adequate views one out of six times (17%), with a median image quality of 0 (IQR = 0 to 2). There were no statistically significant differences between Group A and Group B in the achievement of adequate images for E-point septal separation measurement or in image quality. CONCLUSIONS In this pilot/feasibility study, novice US users were able to obtain adequate imaging to determine a healthy patient's EF through telementored education using Google Glass. These preliminary data suggest telementoring as an adequate means of medical education in bedside US. This conclusion will need to be validated with larger, more powerful studies including evaluation of pathologic findings and varying body habitus among models.
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Affiliation(s)
- Patrick M. Russell
- The Department of Emergency Medicine University of Kentucky Lexington KY
| | - Michael Mallin
- The Department of Emergency Medicine University of Utah Salt Lake City UT
| | | | | | - Nael Aboul‐Hosn
- The Department of Internal Medicine University of Kentucky Lexington KY
| | - Matt Dawson
- The Department of Emergency Medicine University of Kentucky Lexington KY
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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McBeth P, Crawford I, Tiruta C, Xiao Z, Zhu GQ, Shuster M, Sewell L, Panebianco N, Lautner D, Nicolaou S, Ball CG, Blaivas M, Dente CJ, Wyrzykowski AD, Kirkpatrick AW. Help is in your pocket: the potential accuracy of smartphone- and laptop-based remotely guided resuscitative telesonography. Telemed J E Health 2013; 19:924-30. [PMID: 24138615 DOI: 10.1089/tmj.2013.0034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Ultrasound (US) examination has many uses in resuscitation, but to use it to its full effectiveness typically requires a trained and proficient user. We sought to use information technology advances to remotely guide US-naive examiners (UNEs) using a portable battery-powered tele-US system mentored using either a smartphone or laptop computer. MATERIALS AND METHODS A cohort of UNEs (5 tactical emergency medicine technicians, 10 ski-patrollers, and 4 nurses) was guided to perform partial or complete Extended Focused Assessment with Sonography of Trauma (EFAST) examinations on both a healthy volunteer and on a US phantom, while being mentored by a remote examiner who viewed the US images over either an iPhone(®) (Apple, Cupertino, CA) or a laptop computer with an inlaid depiction of the US probe and the "patient," derived from a videocamera mounted on the UNE's head. Examinations were recorded as still images and over-read from a Web site by seven expert reviewers (ERs) (three surgeons, two emergentologists, and two radiologists). Examination goals were to identify lung sliding (LS) documented by color power Doppler (CPD) in the human and to identify intraperitoneal (IP) fluid in the phantom. RESULTS All UNEs were successfully mentored to easily and clearly identify both LS (19 determinations) and IP fluid (14 determinations), as assessed in real time by the remote mentor. ERs confirmed IP fluid in 95 of 98 determinations (97%), with 100% of ERs perceiving clinical utility for the abdominal Focused Assessment with Sonography of Trauma. Based on single still CPD images, 70% of ERs agreed on the presence or absence of LS. In 16 out of 19 cases, over 70% of the ERs felt the EFAST exam was clinically useful. CONCLUSIONS UNEs can confidently be guided to obtain critical findings using simple information technology resources, based on the receiving/transmitting device found in most trauma surgeons' pocket or briefcase. Global US mentoring requires only Internet connectivity and initiative.
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Affiliation(s)
- Paul McBeth
- 1 Regional Trauma Services, Foothills Medical Centre, University of Calgary , Calgary, Alberta, Canada
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Rudolph SS, Sørensen MK, Svane C, Hesselfeldt R, Steinmetz J. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients--a systematic review. Resuscitation 2013; 85:21-30. [PMID: 24056394 DOI: 10.1016/j.resuscitation.2013.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/18/2013] [Accepted: 09/15/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Advances in technology have made prehospital ultrasound (US) examination available. Whether US in the prehospital setting can lead to improvement in clinical outcomes is yet unclear. OBJECTIVE The aim of this systematic review was to assess whether prehospital US improves clinical outcomes for non-trauma patients. METHOD We conducted a systematic review on non-trauma patients who had an US examination performed in the prehospital setting. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the ISI Web of Science and the references of the included studies for additional relevant studies. We then performed a risk of bias analysis and descriptive data analysis. RESULTS We identified 1707 unique citations and included ten studies with a total of 1068 patients undergoing prehospital US examination. Included publications ranged from case series to non-randomized, descriptive studies, and all showed a high risk of bias. The large heterogeneity between the different studies made further statistical analysis impossible. CONCLUSION There are currently no randomized, controlled studies on the use of US for non-trauma patients in the prehospital setting. The included studies were of large heterogeneity and all showed a high risk of bias. We were thus unable to assess the effect of prehospital US on clinical outcomes. However, consistent reports suggested that US may improve patient management with respect to diagnosis, treatment, and hospital referral.
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Affiliation(s)
- Søren Steemann Rudolph
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark.
| | | | - Christian Svane
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Rasmus Hesselfeldt
- Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
| | - Jacob Steinmetz
- The Emergency Medical Services in Copenhagen, Denmark; Centre of Head and Orthopaedics, Department of Anaesthesia, Rigshospitalet, Denmark
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Feasibility of remote real-time guidance of a cardiac examination performed by novices using a pocket-sized ultrasound device. Emerg Med Int 2013; 2013:627230. [PMID: 24024032 PMCID: PMC3762173 DOI: 10.1155/2013/627230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/22/2013] [Indexed: 11/17/2022] Open
Abstract
Background. The potential of pocket-sized ultrasound devices (PUDs) to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users. Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE) through wireless guidance of novice users. Methods. Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD), LA enlargement (LAE), ultrasound lung comets (ULC+), and elevated CVP (eCVP). Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc.) attached to the PUD and transmitted data wirelessly. Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds. Results. Novice versus sonographer imaging yielded technically adequate views in 122/135 (90%) versus 130/135 (96%) (P < 0.05). CLUE's combined SN, SP, and ACC were 0.67, 0.96, and 0.90. Technical adequacy (%) and accuracy for each abnormality (n) were LVSD (85%, 0.93, n = 5), LAE (89%, 0.74, n = 16), ULC+ (100%, 0.94, n = 5), and eCVP (78%, 0.91, n = 1). Conclusion. A novice can perform the CLUE using PUD when wirelessly guided by an expert. This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.
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Kirkpatrick AW, Blaivas M, Sargsyan AE, McBeth PB, Patel C, Xiao Z, Pian L, Panebianco N, Hamilton DR, Ball CG, Dulchavsky SA. Enabling the Mission Through Trans-Atlantic Remote Mentored Musculoskeletal Ultrasound: Case Report of a Portable Hand-Carried Tele-ultrasound System for Medical Relief Missions. Telemed J E Health 2013; 19:530-4. [DOI: 10.1089/tmj.2012.0243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew W. Kirkpatrick
- Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Foothills Medical Centre, Calgary, Alberta, Canada
- Regional Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada
- Canadian Forces Medical Services, Ottawa, Ontario, Canada
| | - Michael Blaivas
- University of South Carolina School of Medicine, Columbia, South Carolina
| | | | - Paul B. McBeth
- Critical Care Medicine Training Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chirag Patel
- Department of Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Zhengwen Xiao
- Regional Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Linping Pian
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan, China
| | | | | | - Chad G. Ball
- Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
- Regional Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada
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Biegler N, McBeth PB, Tiruta C, Hamilton DR, Xiao Z, Crawford I, Tevez-Molina M, Miletic N, Ball CG, Pian L, Kirkpatrick AW. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - 'a remote virtual mentor'. Crit Ultrasound J 2013; 5:5. [PMID: 23805869 PMCID: PMC3735420 DOI: 10.1186/2036-7902-5-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/12/2013] [Indexed: 01/01/2023] Open
Abstract
Background Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal. Methods The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted. Results Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination. Conclusions Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
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Affiliation(s)
- Nancy Biegler
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada.
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Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings. Emerg Med Int 2013; 2013:986160. [PMID: 23431455 PMCID: PMC3568862 DOI: 10.1155/2013/986160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/30/2012] [Accepted: 12/31/2012] [Indexed: 12/03/2022] Open
Abstract
Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, “nontraditional” providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.
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Biegler N, McBeth PB, Tevez-Molina MC, McMillan J, Crawford I, Hamilton DR, Kirkpatrick AW. Just-in-time cost-effective off-the-shelf remote telementoring of paramedical personnel in bedside lung sonography-a technical case study. Telemed J E Health 2012; 18:807-9. [PMID: 23101484 DOI: 10.1089/tmj.2012.0038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Remote telementored ultrasound (RTMUS) is a new discipline that allows a remote expert to guide variably experienced clinical responders through focused ultrasound examinations. We used the examination of the pleural spaces after tube thoracostomy (TT) removal by a nurse with no prior ultrasound experience as an illustrative but highly accurate example of the technique using a simple cost-effective system. MATERIALS AND METHODS The image outputs of a handheld ultrasound machine and a head-mounted Web camera were input into a customized graphical user interface and streamed over a freely available voice over Internet protocol system that allowed two-way audio and visual communication between the novice examiner and the remote expert. The bedside nurse was then guided to examine the anterior chest of a patient who had recently had bilateral TTs removed. The team sought to determine the presence or absence of any recurrent pneumothoraces using the standard criteria for the ultrasound diagnosis of post-removal pneumothorax (PTXs). An upright chest radiograph (CXR) was obtained immediately after the RTMUS examination. RESULTS The RTMUS system enabled the novice user to learn how to hold the ultrasound probe, where to place it on the chest, and thereafter to diagnose a subtle unilateral PTX characterized as "tiny" on the subsequent formal CXR report. CONCLUSIONS As ultrasound has almost limitless clinical utility, using simple but advanced informatics and communication technologies has potential to improve worldwide healthcare delivery. RTMUS could be used both to enhance the information content as well as to digitally document important physiologic findings in any clinical encounter wherever a portable ultrasound and Internet connectivity are available.
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Affiliation(s)
- Nancy Biegler
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta, Canada
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Point of care ultrasound for sepsis management in resource-limited settings: time for a new paradigm for global health care. Intensive Care Med 2012; 38:1405-7; author reply 1408-9. [PMID: 22653371 DOI: 10.1007/s00134-012-2606-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 01/02/2023]
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Crawford I, McBeth PB, Mitchelson M, Ferguson J, Tiruta C, Kirkpatrick AW. How to set up a low cost tele-ultrasound capable videoconferencing system with wide applicability. Crit Ultrasound J 2012; 4:13. [PMID: 22871099 PMCID: PMC3447660 DOI: 10.1186/2036-7902-4-13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/03/2012] [Indexed: 11/21/2022] Open
Abstract
Background Worldwide ultrasound equipment accessibility is at an all-time high, as technology improves and costs decrease. Ensuring that patients benefit from more accurate resuscitation and diagnoses from a user-dependent technology, such as ultrasound, requires accurate examination, typically entailing significant training. Remote tele-mentored ultrasound (RTUS) examination is, however, a technique pioneered in space medicine that has increased applicability on earth. We, thus, sought to create and demonstrate a cost-minimal approach and system with potentially global applicability. Methods The cost-minimal RTUS system was constructed by utilizing a standard off-the-shelf laptop computer that connected to the internet through an internal wireless receiver and/or was tethered through a smartphone. A number of portable hand-held ultrasound devices were digitally streamed into the laptop utilizing a video converter. Both the ultrasound video and the output of a head-mounted video camera were transmitted over freely available Voice Over Internet Protocol (VOIP) software to remote experts who could receive and communicate using any mobile device (computer, tablet, or smartphone) that could access secure VOIP transmissions from the internet. Results The RTUS system allowed real-time mentored tele-ultrasound to be conducted from a variety of settings that were inside buildings, outside on mountainsides, and even within aircraft in flight all unified by the simple capability of receiving and transmitting VOIP transmissions. . Numerous types of ultrasound examinations were conducted such as abdominal and thoracic examinations with a variety of users mentored who had previous skills ranging from none to expert. Internet connectivity was rarely a limiting factor, with competing logistical and scheduling demands of the participants predominating. Conclusions RTUS examinations can educate and guide point of care clinical providers to enhance their use of ultrasound. The scope of the examinations conducted is limited only by the time available and the criticality of the subject being examined. As internet connectivity will only improve worldwide, future developments need to focus on the human factors to optimize tele-sonographic interactions.
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Affiliation(s)
- Innes Crawford
- Department of Surgery, Foothills Medical Centre, Calgary, Alberta, AB-T2N-2T9, Canada.
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Blaivas M. Ultrasound confirmation of nasogastric tube placement in the pre-hospital setting: So why is this of any interest? Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Drudi L, Ball CG, Kirkpatrick AW, Saary J, Grenon SM. Surgery in Space: Where are we at now? ACTA ASTRONAUTICA 2012; 79:61-66. [PMID: 23990690 PMCID: PMC3752909 DOI: 10.1016/j.actaastro.2012.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the coming decades, as we continue our path of space exploration beyond Earth's orbit, we will be required to provide sound medical and surgical care for the safety of space travellers and space flight participants. A few investigations have taken place in the field of surgery in space. In this paper, the authors review the present literature in order to identify possible limitations that currently exist and that could impair our ability to provide surgical care during spaceflight, from the pre-operative to the post-operative period.
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Affiliation(s)
- Laura Drudi
- Medical Student, McGill University. Montreal, Quebec
| | - Chad G. Ball
- Assistant Professor of Surgery. University of Calgary. Calgary, Alberta
| | - Andrew W. Kirkpatrick
- Assistant Professor of Surgery, University of Calgary Foothills Medical Centre, Department of Surgery and Critical Care Medicine. Calgary, Alberta
| | - Joan Saary
- Assistant Professor, Department of Medicine, Division of Occupational Medicine, University of Toronto, Toronto, Ontario
| | - S. Marlene Grenon
- Assistant Professor of Surgery, University of California Francisco Veterans Affairs Medical Center, Division of Vascular and Endovascular Surgery. San Francisco, California
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