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Aronovitz N, Hazan I, Jedwab R, Ben Shitrit I, Quinn A, Wacht O, Fuchs L. The effect of real-time EF automatic tool on cardiac ultrasound performance among medical students. PLoS One 2024; 19:e0299461. [PMID: 38547257 PMCID: PMC10977790 DOI: 10.1371/journal.pone.0299461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/09/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is a sensitive, safe, and efficient tool used in many clinical settings and is an essential part of medical education in the United States. Numerous studies present improved diagnostic performances and positive clinical outcomes among POCUS users. However, others stress the degree to which the modality is user-dependent, rendering high-quality POCUS training necessary in medical education. In this study, the authors aimed to investigate the potential of an artificial intelligence (AI) based quality indicator tool as a teaching device for cardiac POCUS performance. METHODS The authors integrated the quality indicator tool into the pre-clinical cardiac ultrasound course for 4th-year medical students and analyzed their performances. The analysis included 60 students who were assigned to one of two groups as follows: the intervention group using the AI-based quality indicator tool and the control group. Quality indicator users utilized the tool during both the course and the final test. At the end of the course, the authors tested the standard echocardiographic views, and an experienced clinician blindly graded the recorded clips. Results were analyzed and compared between the groups. RESULTS The results showed an advantage in quality indictor users' median overall scores (P = 0.002) with a relative risk of 2.3 (95% CI: 1.10, 4.93, P = 0.03) for obtaining correct cardiac views. In addition, quality indicator users also had a statistically significant advantage in the overall image quality in various cardiac views. CONCLUSIONS The AI-based quality indicator improved cardiac ultrasound performances among medical students who were trained with it compared to the control group, even in cardiac views in which the indicator was inactive. Performance scores, as well as image quality, were better in the AI-based group. Such tools can potentially enhance ultrasound training, warranting the expansion of the application to more views and prompting further studies on long-term learning effects.
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Affiliation(s)
- Noam Aronovitz
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Hazan
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Jedwab
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itamar Ben Shitrit
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Anna Quinn
- Medical School for International Health in Beer-Sheva, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Ben Gurion University of the Negev in Beer- Sheva, Israel
| | - Lior Fuchs
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
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2
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Aladham R, Liu S, Naqvi TZ. Impact of physician performed point of care ultrasound (POCUS) during first outpatient cardiology consultation on patient management and downstream testing. Echocardiography 2023. [PMID: 37151118 DOI: 10.1111/echo.15576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Goal directed point of care ultrasound (POCUS) is a bedside tool to assist with clinical diagnosis. We examined the impact of POCUS performed by consulting cardiologist (CC) during initial cardiology consult on clinical management and downstream testing. METHODS Sixty-nine study patients (pts) seen in a general cardiology outpatient clinic of a tertiary center by an expert imaging CC were compared to a control group of 65 pts seen by three different CCs without POCUS during the same time-period, in whom the first standard echo (SE) was performed after the initial visit. RESULTS Baseline characteristics were similar between the two groups for age, cardiac risk factors, and referral diagnoses. Echo findings on POCUS and by SE (mean delay of 17.2 days after visit) in the control group were comparable for RV size and function and for valvular heart disease. More patients with lower LVEF, higher LV filling pressures, new regional wall motion abnormalities, and increased aortic root size were present among POCUS group resulting in greater yield of echo abnormalities. There were more cardiovascular medication changes at the first visit (15.3% vs. 5.7%, p < .01), less referral for noninvasive stress testing (10% vs. 29%, p < .01), more advanced cardiac testing and subspecialty referrals (29% vs. 18% pts, p = .06), in the study compared to the control group after cardiology visit. CONCLUSION POCUS at time of consultation detects more abnormal echo findings, results in more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging, and subspecialty cardiac referrals.
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Affiliation(s)
- Raed Aladham
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
| | - Shuang Liu
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Disease, Echocardiography Division, Mayo Clinic, Scottsdale, Arizona, USA
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Edwards P, Anyaogu C, Mezue K, Baugh D, Goha A, Egbuche O, Nunura F, Madu E. Focused cardiac ultrasound in pregnancy. J Investig Med 2023; 71:81-91. [PMID: 36691704 DOI: 10.1177/10815589221142195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.
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Affiliation(s)
- Paul Edwards
- Heart Institute of the Caribbean, Kingston, Jamaica
| | | | - Kenechukwu Mezue
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Dainia Baugh
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ahmed Goha
- Cardiology department, Cardiac Center Hail, Hail, Saudi Arabia
| | - Obiora Egbuche
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Felix Nunura
- Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ernest Madu
- Heart Institute of the Caribbean, Kingston, Jamaica
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4
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Dubey J, Shian B. Point-of-Care Ultrasound for Musculoskeletal Injection and Clinical Evaluation. Prim Care 2022; 49:163-189. [DOI: 10.1016/j.pop.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Lorimer D, Spies R, Chokshi R, Lee CK, Colombo JN. Common indications and impact on clinical management of overnight, inpatient transthoracic echocardiograms performed by pediatric cardiology fellows. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cid-Serra X, Hoang W, El-Ansary D, Canty D, Royse A, Royse C. Clinical Impact of Point-of-Care Ultrasound in Internal Medicine Inpatients: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:170-179. [PMID: 34740496 DOI: 10.1016/j.ultrasmedbio.2021.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
The aim in this systematic review was to determine the effect of point-of-care ultrasound (POCUS) on the clinical decision-making process and patient outcomes in adults admitted to the general medicine ward. A comprehensive search was performed in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Library, ClinicalTrials.gov, Scopus, LILACS and Cinahl. Articles had to fulfill the inclusion criteria of randomised or non-randomised studies assessing the impact of POCUS on the diagnosis, management, length of hospital stay or mortality of patients admitted to the internal medicine ward. Six studies were included involving a total of 1836 patients. The influence of POCUS on the diagnosis was reported as a change in the main diagnosis or the addition of a relevant diagnosis in up to 18% and 24% of the cases, respectively. Impact on the management plan was reported in 37% to 52.1% of the participants. Three studies documented the impact of POCUS on the length of stay. Two of them reported no difference between groups, and the other reported a significant reduction of 1 d of the hospital stay. In conclusion, POCUS appears to have positive effects on the clinical decision-making process with impacts on optimal patient management and possible reduction in the hospital length of stay.
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Affiliation(s)
- Ximena Cid-Serra
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine and Community Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - William Hoang
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Doa El-Ansary
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Melbourne, VIC, Australia; Clinical Research Institute, Westmead Private Hospital, Westmead, Sydney, NSW, Australia
| | - David Canty
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; Department of Surgery, the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH
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A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy. Ultrasound J 2021; 13:29. [PMID: 34089087 PMCID: PMC8178424 DOI: 10.1186/s13089-021-00229-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) has proven itself in many clinical situations. Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. In this study, we hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty. Methods Single-center prospective observational study on adult patients in need for MET assistance. Patients were included in blocks (weeks). During even weeks, the MET physician performed a clinical assessment and registered an initial diagnosis. Subsequently, the POCUS protocol was performed and a second diagnosis was registered (US+). During uneven weeks, no POCUS was performed (US−). A blinded expert reviewed the charts for a final diagnosis. The number of correct diagnoses was compared to the final diagnosis between both groups. Physician’s certainty, mortality and possible differences in first treatment were also evaluated. Results We included 100 patients: 52 in the US + and 48 in the US− group. There were significantly more correct diagnoses in the US+ group compared to the US− group: 78 vs 51% (P = 0.006). Certainty improved significantly with POCUS (P < 0.001). No differences in 28-day mortality and first treatment were found. Conclusions The use of thoracic POCUS during MET calls leads to better diagnosis and increases certainty. Trial registration. ClinicalTrials.gov. Registered 12 July 2017, NCT03214809 https://www.clinicaltrials.gov/ct2/show/NCT03214809?term=metus&cntry=NL&draw=2&rank=1 Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00229-3.
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Jangsirikul S, Siripongsakun S, Chaiteerakij R. Video-assisted liver ultrasound training for non-radiologists: protocol and preliminary results. HPB (Oxford) 2021; 23:962-969. [PMID: 33191107 DOI: 10.1016/j.hpb.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultrasound (US) is increasingly used as a bedside diagnostic tool, with training courses for non-radiologists being developed. However, the training time constraint is an important barrier for non-radiologists. We therefore created a short self-learning course for liver-US for non-radiologists. AIM Assess the participants' ability in identifying the organ structures during a liver-US. METHOD A short video-lecture on liver-US training and a portable guidebook for image acquisition were developed. Eighteen non-radiologist physicians studied the course and attended hands-on liver-US examinations to capture the assigned images and label the acquired organ/structures, which were evaluated by an expert radiologist. RESULT 130 liver-US examinations were performed, 44 (33.8%) was cirrhosis. The overall of mean image acquisition score was 84.5 ± 9.7%. The mean score of the 1st examination was 75.2 ± 16.4. The mean score was >80% since the 2nd examination. The score was significant lower in cirrhotic cases as compared to non-cirrhotic cases (78.8 ± 17.3 vs. 88.3 ± 14.4, p = 0.001). The participants' year of study and experience in previous US training did not affect the image acquisition score. CONCLUSION The liver-US training course in a short video format with a portable guidebook is effective and relatively low time-consuming for teaching non-radiologists to perform bedside liver-US.
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Affiliation(s)
- Sureeporn Jangsirikul
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Surachate Siripongsakun
- Sonographer School, Faculty of Health Science Technology, Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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9
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Gopal D, Baston C, Adusumalli S, Jagasia D, Prenner S. Focused Cardiac Ultrasound Curriculum for Internal Medicine Residents. POCUS JOURNAL 2021; 6:29-32. [PMID: 36895500 PMCID: PMC9979930 DOI: 10.24908/pocus.v6i1.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Focused cardiac ultrasound (FCU) is a safe and efficient diagnostic intervention for internal medicine physicians. FCU is a highly teachable skill, but is used in routine cardiac assessment in only 20% of surveyed training programs.We developed an FCU curriculum for internal medicine residents and an assessment tool to evaluate the impact of the curriculum on trainee knowledge and confidence. Methods: Internal medicine residents rotating through clinical cardiology services underwent 30 minutes of didactic and 60 minutes of hands-on teaching on acquisition and interpretation of FCU. A 20 item pre and post-curriculum online survey was administered (November 2018-December 2019) to assess confidence and knowledge in FCU. Results: 79 of 116 (68%) residents completed the pre-survey and 50 completed the post-survey, of whom 34 received the curriculum. The mean change in confidence score in those who received versus did not receive the curriculum was 0.99 versus 0.39 (p=0.046) on a 5-point Likert scale. Among 33 residents who had paired pre- and post-surveys the mean change in confidence score was 1.2 versus 0.85 (p<0.001) in those who received versus did not receive the curriculum. The mean increase in knowledge score was 13% versus 7% respectively (p<0.0001). Conclusions: We instituted a novel curriculum for internal medicine residents to gain experience in image acquisition and interpretation. Both confidence and knowledge in FCU improved following the curriculum, indicating that this is a highly teachable skill. Additional analysis of the of the FCU study images will be useful for informing future interventions.
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Affiliation(s)
- Dipika Gopal
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Cameron Baston
- Division of Pulmonary & Critical Care, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Dinesh Jagasia
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Stuart Prenner
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
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10
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Gibson LE, White-Dzuro GA, Lindsay PJ, Berg SM, Bittner EA, Chang MG. Ensuring competency in focused cardiac ultrasound: a systematic review of training programs. J Intensive Care 2020; 8:93. [PMID: 33308314 PMCID: PMC7730755 DOI: 10.1186/s40560-020-00503-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a valuable skill for rapid assessment of cardiac function and volume status. Despite recent widespread adoption among physicians, there is limited data on the optimal training methods for teaching FoCUS and metrics for determining competency. We conducted a systematic review to gain insight on the optimal training strategies, including type and duration, that would allow physicians to achieve basic competency in FoCUS. METHODS Embase, PubMed, and Cochrane Library databases were searched from inception to June 2020. Included studies described standardized training programs for at least 5 medical students or physicians on adult FoCUS, followed by an assessment of competency relative to an expert. Data were extracted, and bias was assessed for each study. RESULTS Data were extracted from 23 studies on 292 learners. Existing FoCUS training programs remain varied in duration and type of training. Learners achieved near perfect agreement (κ > 0.8) with expert echocardiographers on detecting left ventricular systolic dysfunction and pericardial effusion with 6 h each of didactics and hands-on training. Substantial agreement (κ > 0.6) on could be achieved in half this time. CONCLUSION A short training program will allow most learners to achieve competency in detecting left ventricular systolic dysfunction and pericardial effusion by FoCUS. Additional training is necessary to ensure skill retention, improve efficiency in image acquisition, and detect other pathologies.
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Affiliation(s)
- Lauren E Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA.
| | - Gabrielle A White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Patrick J Lindsay
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Sheri M Berg
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street GRB 444, Boston, MA, 02114, USA
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Importance of Ultrasound Education in Undergraduate Medical Curriculum: A Survey Study Based on First-Year Medical Students' Perception of the 6-Year Doctor of Medicine Program of the University of Nicosia Medical School in Cyprus. Ultrasound Q 2020; 36:328-332. [PMID: 33136934 DOI: 10.1097/ruq.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound imaging modality is a tool used in clinical practice and is being introduced gradually in the undergraduate curriculum of several medical schools worldwide. This study aims to assess medical students' perception regarding the integration of ultrasound training as part of undergraduate education. A questionnaire was given to first-year medical students after a 2-hour-long session, which was developed to introduce them in the fundamental physics theory and function of ultrasound equipment in the clinical practice. Analysis of the results indicated that students acknowledged that ultrasound training would improve their knowledge of internal medicine (P = 0.027) and of different diagnostic modalities (P = 0.019), and enhance their medical decision making (P = 0.0004). Moreover, students found beneficial the ultrasound education regarding correlating clinical knowledge with basic sciences (P = 0.0004). The study pointed out that the majority of first-year students have the opinion that the integration of ultrasound training in the medical program is valuable in medical education and patient care. However, work is needed to determine how to provide an optimal learning environment and to assess the competency of the training sessions.
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12
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Cid X, Canty D, Royse A, Maier AB, Johnson D, El-Ansary D, Clarke-Errey S, Fazio T, Royse C. Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial-the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study. Trials 2020; 21:53. [PMID: 31915052 PMCID: PMC6951003 DOI: 10.1186/s13063-019-4003-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.
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Affiliation(s)
- Ximena Cid
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia. .,Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - David Canty
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Anesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia.,Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universitet, Amsterdam, The Netherlands
| | - Douglas Johnson
- Department of Medicine and Community Care, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Doa El-Ansary
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Health Professions, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, University of Melbourne, Parkville, VIC, Australia
| | - Timothy Fazio
- Business Intelligence Unit, Melbourne Health, Parkville, VIC, Australia.,Department of Medicine and Radiology, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia.,Outcomes Consortium, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Insonation, or the use of ultrasound, has been proposed to be included in the medical school curriculum, both for education and bedside physical examination. It is important to consider what impact insonation should have on medical student education. Increasingly students are exposed to ultrasound use on clinical rotations, but to what extent should ultrasound be an integrated part of the preclinical curriculum in the United States? Ultrasound can serve to augment an existing curriculum in anatomy, physiology, physical examination, and disease assessment and treatment. In addition, the actual performance and interpretation of the insonation component of physical examination in real time may be an emerging skill set to be expected of medical students. Here we describe the utility and challenges of incorporating an ultrasound curriculum into undergraduate medical education, including examples from institutions that have pioneered this innovative curricular change.
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14
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Spencer KT, Flachskampf FA. Focused Cardiac Ultrasonography. JACC Cardiovasc Imaging 2019; 12:1243-1253. [DOI: 10.1016/j.jcmg.2018.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022]
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15
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A Review of Echocardiography Training for Internal Medicine Residents: Proposed Goals, Methods, and Metrics. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pérez de Isla L, Díaz Sánchez S, Pagola J, García de Casasola Sánchez G, López Fernández T, Sánchez Barrancos IM, Martínez-Sánchez P, Zapatero Gaviria A, Anguita M, Ruiz Serrano AL, Torres Macho J. Documento de consenso de SEMI, semFYC, SEN y SEC sobre ecocardioscopia en España. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pérez de Isla L, Díaz Sánchez S, Pagola J, García de Casasola Sánchez G, López Fernández T, Sánchez Barrancos IM, Martínez-Sánchez P, Zapatero Gaviria A, Anguita M, Ruiz Serrano AL, Torres Macho J. Consensus Document of the SEMI, semFYC, SEN, and SEC on Focused Cardiac Ultrasound in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:935-940. [PMID: 30119954 DOI: 10.1016/j.rec.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC).
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Affiliation(s)
| | | | - Jorge Pagola
- Servicio de Neurología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | | | - Juan Torres Macho
- Servicio de Medicina Interna-Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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Wagner M, Shen-Wagner J, Zhang KX, Flynn T, Bergman K. Point-of-Care Ultrasound Applications in the Outpatient Clinic. South Med J 2018; 111:404-410. [DOI: 10.14423/smj.0000000000000835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Though the use of point-of-care ultrasound (POCUS) has increased over the last decade, formal hospital credentialing for POCUS may still be a challenge for hospitalists. This document details the Hospital Medicine Department Ultrasound Credentialing Policy from Regions Hospital, which is part of the HealthPartners organization in Saint Paul, Minnesota. National organizations from internal medicine and hospital medicine (HM) have not published recommended guidelines for POCUS credentialing. Revised guidelines for POCUS have been published by the American College of Emergency Physicians, though these are not likely intended to guide hospitalists when working with credentialing committees and medical boards. This document describes the scope of ultrasound in HM and our training, credentialing, and quality assurance program. This report is intended to be used as a guide for hospitalists as they work with their own credentialing committees and will require modification for each institution. However, the overall process described here should assist in the establishment of POCUS at various institutions.
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Affiliation(s)
- Benji K Mathews
- Department of Hospital Medicine, HealthPartners, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael Zwank
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota, USA
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Feilchenfeld Z, Dornan T, Whitehead C, Kuper A. Ultrasound in undergraduate medical education: a systematic and critical review. MEDICAL EDUCATION 2017; 51:366-378. [PMID: 28118684 DOI: 10.1111/medu.13211] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/26/2016] [Accepted: 08/15/2016] [Indexed: 05/18/2023]
Abstract
CONTEXT The use of point-of-care ultrasound (POCUS) in clinical care is growing rapidly and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. OBJECTIVES We conducted a critical and systematic review framed by the rationales enumerated in academic publications by advocates of ultrasound in UME. METHODS This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified from an archive of 403 academic publications using techniques from Foucauldian critical discourse analysis (CDA). We then sought empirical evidence in support of these rationales, using a critical synthesis methodology also adapted from CDA. RESULTS We identified four dominant discursive rationales with different levels of evidentiary support. The use of ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve the quality of patient care was difficult to evaluate. CONCLUSIONS Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimises them and may preclude further primary research. As the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
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21
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Fiorelli EM, Casella F, Torzillo D, Cogliati C. Bedside focused cardiac ultrasound in the evaluation of systolic dysfunction. Intern Emerg Med 2017; 12:241-245. [PMID: 28063115 DOI: 10.1007/s11739-016-1598-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Elisa Maria Fiorelli
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy.
| | - Francesco Casella
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
| | - Daniela Torzillo
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L. Sacco Hospital, University of Milan, via GB Grassi 74, Milan, Italy
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Bhagra A, Tierney DM, Sekiguchi H, Soni NJ. Point-of-Care Ultrasonography for Primary Care Physicians and General Internists. Mayo Clin Proc 2016; 91:1811-1827. [PMID: 27825617 DOI: 10.1016/j.mayocp.2016.08.023] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/02/2016] [Accepted: 08/17/2016] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.
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Affiliation(s)
- Anjali Bhagra
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - David M Tierney
- Abbott Northwestern Hospital, Medical Education Department, Minneapolis, MN
| | - Hiroshi Sekiguchi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nilam J Soni
- Section of Hospital Medicine, South Texas Veterans Health Care System and Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
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Sabath BF, Singh G. Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now. J Community Hosp Intern Med Perspect 2016; 6:33094. [PMID: 27802866 PMCID: PMC5089158 DOI: 10.3402/jchimp.v6.33094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022] Open
Abstract
Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution – a community hospital – in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.
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Affiliation(s)
- Bruce F Sabath
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA; @gbmc.org
| | - Gurkeerat Singh
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
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Mukerji A, Diambomba Y, Lee SK, Jain A. Use of Targeted Neonatal Echocardiography and Focused Cardiac Sonography in Tertiary Neonatal Intensive Care Units: Time to Embrace It? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1579-91. [PMID: 27269001 DOI: 10.7863/ultra.15.06037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/02/2015] [Indexed: 05/28/2023]
Abstract
Focused cardiac sonography and targeted neonatal echocardiography refer to goal-directed cardiac imaging using ultrasound, typically by noncardiologic specialists. Although the former consists of a rapid qualitative assessment of cardiac function, which is usually performed by acute care practitioners, the latter refers to detailed functional echocardiography to obtain quantitative and qualitative indexes of pulmonary and systemic hemodynamics in sick neonates and is typically performed by neonatologists. Although the use of these modalities is increasing, they still remain unavailable in most North American centers providing acute care to neonates, partly because of limited data regarding their direct impact on patient care. Here we present a series of 5 cases from a large perinatal unit in which immediate availability of relevant expertise led to important and arguably life-saving clinical interventions. In 4 of these cases, focused cardiac sonography was sufficient to make the diagnosis, whereas in 1 case, clinical integration of detailed systemic hemodynamics measured on target neonatal echocardiography was required.
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Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Yenge Diambomba
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Johnson BK, Tierney DM, Rosborough TK, Harris KM, Newell MC. Internal medicine point-of-care ultrasound assessment of left ventricular function correlates with formal echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:92-9. [PMID: 26179460 DOI: 10.1002/jcu.22272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/01/2015] [Indexed: 05/24/2023]
Abstract
PURPOSE Although focused cardiac ultrasonographic (FoCUS) examination has been evaluated in emergency departments and intensive care units with good correlation to formal echocardiography, accuracy for the assessment of left ventricular systolic function (LVSF) when performed by internal medicine physicians still needs independent evaluation. METHODS This prospective observational study in a 640-bed, academic, quaternary care center, included 178 inpatients examined by 10 internal medicine physicians who had completed our internal medicine bedside ultrasound training program. The ability to estimate LVSF with FoCUS as "normal," "mild to moderately decreased," or "severely decreased" was compared with left ventricular ejection fraction (>50%, 31-49%, and <31%, respectively) from formal echocardiography interpreted by a cardiologist. RESULTS Sensitivity and specificity of FoCUS for any degree of LVSF impairment were 0.91 (95% confidence interval [CI] 0.80, 0.97) and 0.88 (95% CI 0.81, 0.93), respectively. The interrater agreement between internal medicine physician-performed FoCUS and formal echocardiography for any LVSF impairment was "good/substantial" with κ = 0.77 (p < 0.001), 95% CI (0.67, 0.87). Formal echocardiography was classified as "technically limited due to patient factors" in 20% of patients; however, echogenicity was sufficient in 100% of FoCUS exams to classify LVSF. CONCLUSIONS Internal medicine physicians using FoCUS identify normal versus decreased LVSF with high sensitivity, specificity, and "good/substantial" interrater agreement when compared with formal echocardiography. These results support the role of cardiac FoCUS by properly trained internal medicine physicians for discriminating normal from reduced LVSF.
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Affiliation(s)
- Benjamin K Johnson
- Abbott Northwestern Hospital, Department of Medical Education, 800 East 28th Street, Minneapolis, MN, 55407
| | - David M Tierney
- Abbott Northwestern Hospital, Department of Medical Education, 800 East 28th Street, Minneapolis, MN, 55407
| | - Terry K Rosborough
- Abbott Northwestern Hospital, Department of Medical Education, 800 East 28th Street, Minneapolis, MN, 55407
| | - Kevin M Harris
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 300, Minneapolis, MN, 55407
| | - Marc C Newell
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 300, Minneapolis, MN, 55407
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The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal. BIOMED RESEARCH INTERNATIONAL 2015; 2015:596451. [PMID: 26605333 PMCID: PMC4641179 DOI: 10.1155/2015/596451] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 10/18/2015] [Indexed: 01/22/2023]
Abstract
Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.
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Abstract
Focused cardiac ultrasound (FCU) is a bedside examination of the heart performed with a small, portable ultrasound platform by a physician as an adjunct to their physical examination. The goal is to recognize a narrow list of abnormalities that are both detectable by physicians with limited ultrasound training and have high clinical assessment value. Results from the FCU examination are integrated with traditional bedside assessment (physical examination and history) to provide early management plans and patient triage in settings when echocardiography cannot be obtained or is not immediately available.
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Affiliation(s)
- Kirk T Spencer
- University of Chicago, 5841 S Maryland MC 5084, Chicago, IL, 60637, USA,
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28
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López-Palmero S, Bolivar-Herrera N, López-Lloret G, Merchán-Ortega G, Macancela-Quiñones J, López-Martínez G. Diagnostic utility of handheld ultrasonography as an extension of the physical examination of patients with heart failure. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rceng.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Utilidad diagnóstica de la ecografía de bolsillo en la insuficiencia cardiaca. Rev Clin Esp 2015; 215:204-10. [DOI: 10.1016/j.rce.2015.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/11/2014] [Accepted: 01/24/2015] [Indexed: 11/17/2022]
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Di Bello V, La Carrubba S, Conte L, Fabiani I, Posteraro A, Antonini-Canterin F, Barletta V, Nicastro I, Mariotti E, Severino S, Caso P, Benedetto F, Savino K, Carerj S. Incremental Value of Pocket-Sized Echocardiography in Addition to Physical Examination during Inpatient Cardiology Evaluation: A Multicenter Italian Study (SIEC). Echocardiography 2015; 32:1463-70. [DOI: 10.1111/echo.12910] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vitantonio Di Bello
- University Cardio-angiology Departmental Section; Cisanello Hospital; AOUP; Pisa Italy
| | | | - Lorenzo Conte
- University Cardio-angiology Departmental Section; Cisanello Hospital; AOUP; Pisa Italy
| | - Iacopo Fabiani
- University Cardio-angiology Departmental Section; Cisanello Hospital; AOUP; Pisa Italy
| | | | | | - Valentina Barletta
- University Cardio-angiology Departmental Section; Cisanello Hospital; AOUP; Pisa Italy
| | - Irene Nicastro
- University Cardio-angiology Departmental Section; Cisanello Hospital; AOUP; Pisa Italy
| | | | | | - Pio Caso
- Department of Cardiology; Monaldi Hospital; Naples Italy
| | | | - Ketty Savino
- Cardiology and Cardiovascular Physiopathology; University of Perugia; Perugia Italy
| | - Scipione Carerj
- Clinical and Experimental Medicine Department; University of Messina; Messina Italy
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Nelson BP, Sanghvi A. Point-of-Care Cardiac Ultrasound: Feasibility of Performance by Noncardiologists. Glob Heart 2015; 8:293-7. [PMID: 25690629 DOI: 10.1016/j.gheart.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Cardiac ultrasound has been used for decades to assess a wide variety of structural and functional pathology, as well as to monitor response to therapy. It offers the advantages of noninvasive, real-time dynamic functional assessment without the risk of radiation. Cardiologists have traditionally employed this modality and have established robust guidelines on the use of echocardiography. However, other specialties such as emergency medicine and critical care have realized the benefit of cardiac ultrasound and have established specialty guidelines in its use. There is growing evidence for the benefit of cardiac ultrasound at the point of care on hospital wards, clinics, and even pre-hospital environments as well. The pervasive use of focused ultrasound is perhaps most evident in the advent of ultrasound training in undergraduate medical curricula. This paper reviews some of the key literature on the use of focused, point-of-care ultrasound by noncardiologists. Feasibility, clinical utility, and emerging trends are reviewed.
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Affiliation(s)
- Bret P Nelson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Amy Sanghvi
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. RESULTS During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. CONCLUSIONS This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
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Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med 2015; 16:219-26. [PMID: 25607741 DOI: 10.1097/pcc.0000000000000340] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the feasibility and describe the process of implementing a pediatric critical care bedside ultrasound program in a large academic PICU and to evaluate the impact of bedside ultrasound on clinical management. DESIGN Retrospective case series, description of program implementation. SETTING Single-center quaternary noncardiac PICU in a children's hospital. PATIENTS Consecutive patients from January 22, 2012, to July 22, 2012, with bedside ultrasounds performed and interpreted by pediatric critical care practitioners. INTERVENTIONS A pediatric critical care bedside ultrasound program consisting of a 2-day immersive course followed by clinical performance with internal quality assurance review was implemented. Studies performed in the PICU following training were documented and reviewed against reference standards including subspecialist-performed ultrasound or clinical response. MEASUREMENTS AND MAIN RESULTS Seventeen critical care faculties and eight fellows recorded 201 bedside ultrasound studies over 6 months in defined core applications: 57 procedural (28%), 76 hemodynamic (38%), 35 thoracic (17%), and 33 abdominal (16%). A quality assurance review identified 23 studies (16% of all nonprocedural studies) as critical (affected clinical management or gave valuable information). Forty-eight percent of those studies (11/23) were within the hemodynamic core. The proportion of critical studies were not significantly different across the applications (hemodynamic, 11/76 [15%] vs thoracic and abdominal, 12/68 [18%]; p = 0.65). Examples of critical studies include evidence of tamponade secondary to pleural effusions, identification of pulmonary hypertension, hemodynamic assessment before tracheal intubation, recognition of hypovolemia and systemic vascular resistance abnormalities, determination of pneumothorax, location of chest tube and urinary catheter, and differentiation of pleural fluid from pulmonary consolidation. CONCLUSIONS Implementation of a critical care bedside ultrasound program for critical care providers in a large academic PICU is feasible. Bedside ultrasound evaluation and interpretation by intensivists affected the management of critically ill children.
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Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III. J Thromb Thrombolysis 2015; 37:298-302. [PMID: 23722715 DOI: 10.1007/s11239-013-0945-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis (DVT) but is often delayed. Clinician-performed focused vascular sonography (FVS) has proven to accurately diagnose DVT in the ambulatory and emergency room settings. Whether trained medical residents can perform quality FVS in the critically ill is unknown. Medical residents were trained in a 2-hour module in FVS assessing for complete compressibility of common femoral and popliteal veins. Residents imaged consecutive medical ICU and intermediate care patients awaiting comprehensive, sonographer-performed and radiologist-interpreted examinations. Sensitivity, specificity, positive and negative predictive values of the focused examination were calculated against the comprehensive study. Fleiss Kappa (κ), the degree of agreement between resident and radiologist, was calculated. Time savings was measured. Nineteen residents performed 143 studies on 75 patients. Twelve patients had above-the-knee DVTs, a prevalence of 16 %. All 6 common femoral and 7 of 9 popliteal vein DVTs were identified. None of 6 isolated superficial femoral DVTs were identified. Sensitivity for above-the-knee DVT was 63 %, specificity 97 %. Sensitivity for common femoral and popliteal DVT was 86 %, specificity 97 %. Residents showed substantial agreement with radiologists for diagnosis of DVT (κ = 0.70, SE 0.114, p < 0.001).Time from order of a formal ultrasound to a radiologist's read averaged 14.7 h. The two-point compression ultrasound method demonstrated insufficient sensitivity in a cohort of critically ill medical patients due to a high-incidence of superficial femoral DVT. However, residents demonstrated substantial agreement with radiologists for the diagnosis of clinically relevant DVT after a 2-hour course. FVS should include the superficial femoral vein and is associated with a significant time savings.
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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: 44] [Impact Index Per Article: 4.9] [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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Riley A, Sable C, Prasad A, Spurney C, Harahsheh A, Clauss S, Colyer J, Gierdalski M, Johnson A, Pearson GD, Rosenthal J. Utility of hand-held echocardiography in outpatient pediatric cardiology management. Pediatr Cardiol 2014; 35:1379-86. [PMID: 24913414 DOI: 10.1007/s00246-014-0940-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/16/2014] [Indexed: 12/20/2022]
Abstract
Adult patient series have shown hand-held echocardiography (echo) units (HHE) to be accurate for rapid diagnosis and triage. This is the first study to evaluate the ability of HHE to inform decision making in outpatient pediatric cardiology. New pediatric cardiology patients in outpatient clinics staffed by six pediatric cardiologists (experience 1-17 years) were prospectively enrolled if an echocardiogram (echo) was ordered during their initial visit. After history and physical examination and before a standard echo, the cardiologists performed a bedside HHE examination (GE Vscan 1.7-3.8 MHz), documented findings, and made a clinical decision. Diagnoses and decisions based on HHE were compared with final management after the standard echo. The study enrolled 101 subjects (ages 9 days to 19 years). The cardiologists considered HHE imaging adequate for decision making for 80 of the 101 subjects. For 77 of the 80 subjects with acceptable HHE imaging (68/68 normal and 9/12 abnormal standard echoes), the HHE-based primary diagnoses and decisions agreed with the final management. The sensitivity of HHE was 75 % (95 % confidence interval [CI] 43-94 %) and the positive predictive value 100 % (95 % CI 66-100 %) for pediatric heart disease. The agreement between standard echocardiography and HHE imaging was substantial (κ = 0.82). Excluding one of the least experienced cardiologists, HHE provided the basis for correct cardiac diagnoses and management for all the subjects with acceptable HHE imaging (58/58 normal and 9/9 abnormal echoes). In outpatient pediatric cardiology, HHE has potential as a tool to complement physical examination. Further investigation is needed to evaluate how value improves with clinical experience.
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Affiliation(s)
- Alan Riley
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA,
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Brief Group Training of Medical Students in Focused Cardiac Ultrasound May Improve Diagnostic Accuracy of Physical Examination. J Am Soc Echocardiogr 2014; 27:1238-46. [DOI: 10.1016/j.echo.2014.08.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Indexed: 11/23/2022]
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Jozwiak M, Monnet X, Cinotti R, Bontemps F, Reignier J, Belliard G. Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients. Ann Intensive Care 2014; 4:12. [PMID: 25097797 PMCID: PMC4113285 DOI: 10.1186/2110-5820-4-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/07/2014] [Indexed: 11/20/2022] Open
Abstract
Background We studied a score for assessing basic transthoracic echocardiography (TTE) skills exhibited by residents who examined critically ill patients receiving mechanical ventilation. Methods We conducted a prospective study in the 16 residents who worked in our medical-surgical ICU between 1 May 2008 and 1 November 2009. The residents received theoretical teaching (two hours) then performed supervised TTEs during their six-month rotation. Their basic TTE skills in mechanically ventilated patients were evaluated after one (M1), three (M3), and six (M6) months by two experts, who used a scoring system devised for the study. After scoring, residents gave their hemodynamic diagnosis and suggested a treatment. Results The 4 residents with previous TTE skills obtained a significantly higher total score than did the 12 novices at M1 (18 (16 to 19) versus 13 (10 to 15), respectively, P = 0.03). In the novices, the total score increased significantly during training (M1, 13 (10 to 14); M3, 15 (12 to 16); and M6, 17 (15 to 18); P < 0.001) and correlated significantly with the number of supervised TTEs (r = 0.68, P < 0.0001). In the overall population, agreement with experts regarding the diagnosis and treatment was associated with a significantly higher total score (17 (16 to 18) versus 13 (12 to 16), P = 0.002). A total score ≥ 19/20 points had 100% specificity (95% confidence interval, 79 to 100%) for full agreement with the experts regarding the diagnosis and treatment. Conclusions Our results validate the scoring system developed for our study of the assessment of basic critical-care TTE skills in residents.
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Affiliation(s)
- Mathieu Jozwiak
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Xavier Monnet
- AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre F-94270, France ; Faculté de Médecine Paris-Sud, Université Paris-Sud, EA4533, Le Kremlin-Bicêtre F-94270, France
| | - Raphaël Cinotti
- Centre Hospitalo-Universitaire Guillaume et René Laennec, service de réanimation chirurgicale, Nantes F-44000, France
| | - Fréderic Bontemps
- Centre Hospitalier Côte de Lumière, service de médecine polyvalente, Les Sables d'Olonne F-85100, France
| | - Jean Reignier
- Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France
| | - Guillaume Belliard
- Centre Hospitalier Bretagne Sud Lorient, service de réanimation médicale, Lorient F-56100, France
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Noriega O, Ho H, Wright J. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/jp-journals-10009-1340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Stethoscope, the symbol of modern medicine has been in place for more than 150 years. However, this reliable diagnostic instrument has started showing its age with the arrival of a newer diagnostic instrument: the hand-held ultrasound.
Hand-held ultrasound is rapidly expanding in many specialties but not yet in obstetrics and gynecology. There is a paucity of literature on the application of hand-held ultrasound in obstetrics and gynecology, in contrast to a large volume of literature published by other specialties. Several studies demonstrated that medical students and residents can improve the accuracy of their physical examinations with the use of hand-held ultrasound. Similarly, physical examinations performed by hospitalists with hand-carried ultrasound are more accurate than those performed without the instrument. Advances in technology have contributed to the improvement of image quality and portability. As a result, these devices become increasingly available in many clinical settings such as point of care, telemedicine and rural medicine. The quality of ultrasound images of the hand-held scanner is inferior to those of standard laptop ultrasound. However, the hand-held ultrasound requires much less time for setup.
Although there have been recommendations for training guidelines for operators of hand-held ultrasound, standards for optimal training to achieve level of competency have not been determined.
How to cite this article
Wright J, Noriega O, Ho H. The Application of Hand-Held Ultrasound Scanner in Teaching of Telemedicine and Rural Medicine. Donald School J Ultrasound Obstet Gynecol 2014;8(1):87-91.
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41
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Andrus P, Dean A. Focused Cardiac Ultrasound. Glob Heart 2013; 8:299-303. [DOI: 10.1016/j.gheart.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/05/2013] [Indexed: 11/27/2022] Open
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Caronia J, Panagopoulos G, Devita M, Tofighi B, Mahdavi R, Levin B, Carrera L, Mina B. Focused renal sonography performed and interpreted by internal medicine residents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2007-2012. [PMID: 24154905 DOI: 10.7863/ultra.32.11.2007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Intensivist-performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings. METHODS Internal medicine residents were trained in a 5-hour module on focused renal sonography evaluating renal length, echogenicity, hydronephrosis, and cysts on a convenience sample of medical ward, intermediate care, and medical intensive care unit patients. All patients underwent comprehensive sonography within 24 hours. The primary outcome was represented by the Fleiss κ statistic, which indicated the degree of interobserver agreement between residents and radiologists. Sensitivity, specificity, and positive and negative predictive values were calculated using the comprehensive radiologist-read examination as the reference. RESULTS Seventeen internal medicine residents imaged 125 kidneys on 66 patients. The average number of studies performed was 7.3 (SD, 6.6). Residents demonstrated excellent agreement with radiologists for hydronephrosis (κ = 0.73; P < .001; SE, 0.15; sensitivity, 94%; specificity, 93%), moderate agreement for echogenic kidneys (κ = 0.43; P < .001; SE, 0.13; sensitivity, 40%; specificity, 98%), and substantial agreement for renal cysts (κ = 0.61; P < .001; SE, 0.12; sensitivity, 60%; specificity, 96%). Residents showed sensitivity of 100% and specificity of 88% for identification of atrophic kidneys, defined as length less than 8 cm. CONCLUSIONS After a 5-hour training course, medical residents accurately identified hydronephrosis and key sonographic findings of chronic kidney disease in a cohort of medical patients. Screening for hydronephrosis and renal atrophy can be performed by medical residents after adequate training.
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Affiliation(s)
- Jonathan Caronia
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, 100 E 77th St, New York, NY 10075 USA.
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Alba GA, Kelmenson DA, Noble VE, Murray AF, Currier PF. Faculty staff-guided versus self-guided ultrasound training for internal medicine residents. MEDICAL EDUCATION 2013; 47:1099-108. [PMID: 24117556 DOI: 10.1111/medu.12259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/12/2013] [Accepted: 04/17/2013] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Ultrasonography is of growing importance within internal medicine (IM), but the optimal method of training doctors to use it is uncertain. In this study, the authors provide the first objective comparison of two approaches to training IM residents in ultrasonography. METHODS In this randomised trial, a simulation-based ultrasound training curriculum was implemented during IM intern orientation at a tertiary care teaching hospital. All 72 incoming interns attended a lecture and were given access to online modules. Interns were then randomly assigned to a 4-hour faculty-guided (FG) or self-guided (SG) ultrasound training session in a simulation laboratory with both human and manikin models. Interns were asked to self-assess their competence in ultrasonography and underwent an objective structured clinical examination (OSCE) to assess their competence in basic and procedurally oriented ultrasound tasks. The primary outcome was the score on the OSCE. RESULTS Faculty-guided training was superior to self-guided training based on the OSCE scores. Subjects in the FG training group achieved significantly higher OSCE scores on the two subsets of task completion (0.9-point difference, 95% confidence interval [CI] 0.27-1.54; p = 0.008) and ultrasound image quality (2.43-point difference, 95% CI 1.5-3.36; p < 0.001). Both training groups demonstrated an increase in self-assessed competence after their respective training sessions and there was little difference between the groups. Subjects rated the FG training group much more favourably than the SG training group. CONCLUSIONS Both FG and SG ultrasound training curricula can improve the self-reported competence of IM interns in ultrasonography. However, FG training was superior to SG training in both skills acquisition and intern preference. Incorporating mandatory ultrasound training into IM residencies can address the perceived need for ultrasound training, improve confidence and procedural skills, and may enhance patient safety. However, the optimal training method may require significant faculty input.
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Affiliation(s)
- George A Alba
- Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:567-81. [DOI: 10.1016/j.echo.2013.04.001] [Citation(s) in RCA: 415] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Caronia J, Kutnick R, Sarzynski A, Panagopoulos G, Mahdavi R, Mina B. Focused Transthoracic Echocardiography Performed and Interpreted by Medical Residents in the Critically Ill. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1944451613488798] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose. Intensivist-performed focused echocardiography (FE) is accepted practice. Whether medical residents can perform and interpret quality FE in the critically ill is unknown. Methods. Novice residents trained in an 8-hour module in FE, evaluating ejection fraction (EF), pericardial effusion, right ventricular (RV) strain, valvular pathology, wall motion abnormalities (WMAs), and inferior vena cava collapsibility in patients awaiting comprehensive echocardiograms. The Fleiss kappa (κ), sensitivity, specificity, positive predictive values, and negative predictive values were calculated against the comprehensive echocardiogram. Results. Seven residents performed 102 FE, demonstrating substantial agreement with cardiologists for EF as decreased versus normal or hyperdynamic (κ = .67, P < .001, sensitivity = 94%, specificity = 93%) and pericardial effusion (κ = .60, P < .001, sensitivity = 85%, specificity = 93%); moderate agreement for aortic stenosis (κ = .54, P < .001, sensitivity = 56%, specificity = 98%), aortic insufficiency (κ = .50, P < .001, sensitivity = 47%, specificity = 97%), mitral regurgitation (κ = 0.51, P < .001, sensitivity = 65%, specificity = 90%), and WMAs (κ = .49, P < .001, sensitivity = 71%, specificity = 88%) and fair agreement for RV strain (κ = .38, P < .001, sensitivity = 41%, specificity = 95%). Conclusions. After an 8-hour course, resident FE demonstrated substantial agreement with comprehensive echocardiography for EF and pericardial effusion, moderate agreement for valvulopathy and WMAs and fair agreement for RV strain. Sensitivity and specificity were high for systolic dysfunction and pericardial effusion. Whereas sensitivity was lower for RV strain, valvular abnormalities, and WMAs, residents demonstrated excellent specificity for all parameters studied. Clinical implications. FE can be taught to residents to hasten diagnosis of key pathologies while awaiting comprehensive echocardiography.
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Affiliation(s)
- Jonathan Caronia
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
| | - Richard Kutnick
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
| | - Adrian Sarzynski
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
| | - Georgia Panagopoulos
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
| | - Ramyar Mahdavi
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
| | - Bushra Mina
- Departments of Cardiology and Critical Care Medicine, Lenox Hill Hospital, New York, New York
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Shmueli H, Burstein Y, Sagy I, Perry ZH, Ilia R, Henkin Y, Shafat T, Liel-Cohen N, Kobal SL. Briefly Trained Medical Students Can Effectively Identify Rheumatic Mitral Valve Injury Using a Hand-Carried Ultrasound. Echocardiography 2013; 30:621-6. [DOI: 10.1111/echo.12122] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hezzy Shmueli
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva; Israel
| | - Yuval Burstein
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva; Israel
| | - Iftach Sagy
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva; Israel
| | - Zvi H. Perry
- Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva; Israel
| | - Ruben Ilia
- Cardiology Department; Soroka University Medical Center; Beer Sheva; Israel
| | - Yaakov Henkin
- Cardiology Department; Soroka University Medical Center; Beer Sheva; Israel
| | - Tali Shafat
- Clinical Research Center; Soroka University Medical Center; Beer Sheva; Israel
| | - Noah Liel-Cohen
- Cardiology Department; Soroka University Medical Center; Beer Sheva; Israel
| | - Sergio L. Kobal
- Cardiology Department; Soroka University Medical Center; Beer Sheva; Israel
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Haji DL, Royse A, Royse CF. Review article: Clinical impact of non-cardiologist-performed transthoracic echocardiography in emergency medicine, intensive care medicine and anaesthesia. Emerg Med Australas 2012; 25:4-12. [PMID: 23379446 DOI: 10.1111/1742-6723.12033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 02/06/2023]
Abstract
There is increased realisation of the emerging role of point-of-care transthoracic echocardiography (TTE) as 'ultrasound-assisted examination', given the low sensitivity of clinical examination for cardiovascular pathologies and the time-critical nature of these pathologies. There is evidence that point-of-care TTE provides higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point-of-care TTE is increasingly used by non-cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaesthesia. The diagnostic capability of new portable devices is improving rapidly and outdating its predecessors, thereby improving confidence in echocardiography findings.
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Affiliation(s)
- Darsim L Haji
- Emergency Department, Frankston Hospital, Frankston, Victoria, Australia.
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Platz E, Solomon SD. Point-of-Care Echocardiography in the Accountable Care Organization Era. Circ Cardiovasc Imaging 2012; 5:676-82. [DOI: 10.1161/circimaging.112.973578] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Elke Platz
- From the Department of Emergency Medicine (E.P.) and Cardiovascular Division (S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Scott D. Solomon
- From the Department of Emergency Medicine (E.P.) and Cardiovascular Division (S.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Panoulas VF, Daigeler AL, Malaweera AS, Lota AS, Baskaran D, Rahman S, Nihoyannopoulos P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. ACTA ACUST UNITED AC 2012; 14:323-30. [DOI: 10.1093/ehjci/jes140] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Geriatricians’ Interest to Learn Bedside Portable Ultrasound (GEBUS) for Application in the Clinical Practice and in Education. J Am Med Dir Assoc 2012; 13:308.e7-10. [DOI: 10.1016/j.jamda.2011.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/01/2011] [Indexed: 11/21/2022]
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