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Mulder TA, van de Velde T, Dokter E, Boekestijn B, Olgers TJ, Bauer MP, Hierck BP. Unravelling the skillset of point-of-care ultrasound: a systematic review. Ultrasound J 2023; 15:19. [PMID: 37074526 PMCID: PMC10115919 DOI: 10.1186/s13089-023-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The increasing number of physicians that are trained in point-of-care ultrasound (POCUS) warrants critical evaluation and improvement of current training methods. Performing POCUS is a complex task and it is unknown which (neuro)cognitive mechanisms are most important in competence development of this skill. This systematic review was conducted to identify determinants of POCUS competence development that can be used to optimize POCUS training. METHODS PubMed, Web of Science, Cochrane Library, Emcare, PsycINFO and ERIC databases were searched for studies measuring ultrasound (US) skills and aptitude. The papers were divided into three categories: "Relevant knowledge", "Psychomotor ability" and 'Visuospatial ability'. The 'Relevant knowledge' category was further subdivided in 'image interpretation', 'technical aspects' and 'general cognitive abilities'. Visuospatial ability was subdivided in visuospatial subcategories based on the Cattell-Horn-Carroll (CHC) Model of Intelligence v2.2, which includes visuospatial manipulation and visuospatial perception. Post-hoc, a meta-analysis was performed to calculate pooled correlations. RESULTS 26 papers were selected for inclusion in the review. 15 reported on relevant knowledge with a pooled coefficient of determination of 0.26. Four papers reported on psychomotor abilities, one reported a significant relationship with POCUS competence. 13 papers reported on visuospatial abilities, the pooled coefficient of determination was 0.16. CONCLUSION There was a lot of heterogeneity in methods to assess possible determinants of POCUS competence and POCUS competence acquisition. This makes it difficult to draw strong conclusions on which determinants should be part of a framework to improve POCUS education. However, we identified two determinants of POCUS competence development: relevant knowledge and visuospatial ability. The content of relevant knowledge could not be retrieved in more depth. For visuospatial ability we used the CHC model as theoretical framework to analyze this skill. We could not point out psychomotor ability as a determinant of POCUS competence.
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Affiliation(s)
- Tessa A Mulder
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Tim van de Velde
- Department of Neuropsychology, Leiden University, Leiden, The Netherlands
| | - Eveline Dokter
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn P Bauer
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Beerend P Hierck
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Innovation of Medical Education, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Sciences-Anatomy and Physiology, Veterinary Medicine Faculty, Utrecht University, Utrecht, The Netherlands
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Albaroudi B, Haddad M, Albaroudi O, Abdel-Rahman ME, Jarman R, Harris T. Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis. Eur J Emerg Med 2022; 29:18-32. [PMID: 34406134 PMCID: PMC8691376 DOI: 10.1097/mej.0000000000000866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Assessing left ventricular systolic function (LVSF) by echocardiography assists in the diagnosis and management of a diverse range of patients presenting to the emergency department (ED). We evaluated the agreement between ED-based clinician sonographers and apriori-defined expert sonographers. We conducted a systematic review and meta-analysis based on Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. We searched Medline, EMBASE, Cochrane, ClinicalTrials.gov, TRIP and Google Scholar for eligible studies from inception to February 2021. Risk of bias was evaluated using Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The level of agreement between clinician and expert sonographers was measured using kappa, sensitivity, specificity, positive and negative likelihood ratio statistics using random-effects models. Twelve studies were included (1131 patients, 1229 scans and 159 clinician sonographers). Significant heterogeneity was identified in patient selection, methods of assessment of LVSF, reference standards and statistical methods for assessing agreement. The overall quality of studies was low, with most being small, single centre convenience samples. A meta-analysis including seven studies (786 scans) where visual estimation method was used by clinician sonographers demonstrated simple Kappa of 0.68 [95% confidence interval (CI), 0.57-0.79], and sensitivity, specificity, positive and negative likelihood ratio of 89% (95% CI, 80-94%), 85% (95% CI, 80-89%), 5.98 (95% CI, 4.13-8.68) and 0.13 (95% CI, 0.06-0.24), respectively, between clinician sonographer and expert sonographer for normal/abnormal LVSF. The weighted kappa for five studies (429 scans) was 0.70 (95% CI, 0.61-0.80) for normal/reduced/severely reduced LVSF. There is substantial agreement between ED-based clinician sonographers and expert sonographers for assessing LVSF using visual estimation and ranking it as normal/reduced, or normal/reduced/severely reduced, in patients presenting to ED.
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Affiliation(s)
| | - Mahmoud Haddad
- Department of Emergency Medicine, Hamad Medical Corporation
| | - Omar Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation
| | | | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne
- Teesside University, Middlesbrough
| | - Tim Harris
- Department of Emergency Medicine, Hamad Medical Corporation
- Barts Health NHS Trust and the Queen Mary University of London, London, UK
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Pezel T, Coisne A, Bonnet G, Martins RP, Adjedj J, Bière L, Lattuca B, Turpeau S, Popovic B, Ivanes F, Lafitte S, Deharo JC, Bernard A. Simulation-based training in cardiology: State-of-the-art review from the French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology. Arch Cardiovasc Dis 2021; 114:73-84. [PMID: 33419690 DOI: 10.1016/j.acvd.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
In our healthcare system, mindful of patient safety and the reduction of medical errors, simulation-based training has emerged as the cornerstone of medical education, allowing quality training in complete safety for patients. Initiated by anaesthesiologists, this teaching mode effectively allows a gradual transfer of learning, and has become an essential tool in cardiology teaching. Cardiologists are embracing simulation to master complex techniques in interventional cardiology, to manage crisis situations and unusual complications and to develop medical teamwork. Simulation methods in cardiology include high-fidelity simulators, clinical scenarios, serious games, hybrid simulation and virtual reality. Simulation involves all fields of cardiology: transoesophageal echocardiography, cardiac catheterization, coronary angioplasty and electrophysiology. Beyond purely technical issues, simulation can also enhance communication skills, by using standardized patients, and can improve the management of situations related to the announcement of serious diseases. In this review of recent literature, we present existing simulation modalities, their applications in different fields of cardiology and their advantages and limitations. Finally, we detail the growing role for simulation in the teaching of medical students following the recent legal obligation to use simulation to evaluate medical students in France.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, MD 21287-0409 Baltimore, USA; Ilumens Simulation Department, Paris Diderot University, 75010 Paris, France; French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France
| | - Augustin Coisne
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography-Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, 59000 Lille, France
| | - Guillaume Bonnet
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Paris, PARCC, INSERM, 75015 Paris, France; Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Raphael P Martins
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Rennes, CHU de Rennes, INSERM, LTSI-UMR 1099, 35000 Rennes, France
| | - Julien Adjedj
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Loïc Bière
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de Cardiologie, CHU de Angers, Université Angers, 49100 Angers, France
| | - Benoit Lattuca
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Stéphanie Turpeau
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Pôle Cardiologie, Angiologie, Néphrologie, Endocrinologie, Centre Hospitalier d'Avignon, 84000 Avignon, France
| | - Batric Popovic
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, CHRU de Nancy, Université de Lorraine, 54000 Nancy, France
| | - Fabrice Ivanes
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France
| | - Stéphane Lafitte
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Cardiology Department, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Jean Claude Deharo
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Service de cardiologie, hôpital de la Timone, 33000 Marseille, France
| | - Anne Bernard
- French Commission of Simulation Teaching (Commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Tours University, 37000 Tours, France; Cardiology Department, Tours University Hospital, 37000 Tours, France.
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Waweru-Siika W, Barasa A, Wachira B, Nekyon D, Karau B, Juma F, Wanjiku G, Otieno H, Bloomfield GS, Sloth E. Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact. Afr J Emerg Med 2020; 10:136-143. [PMID: 32923324 PMCID: PMC7474241 DOI: 10.1016/j.afjem.2020.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/14/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally. Methods This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement. Results Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.
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Affiliation(s)
- Wangari Waweru-Siika
- Department of Anaesthesia, Aga Khan University, Nairobi, Kenya
- Corresponding author.
| | - Anders Barasa
- Department of Medicine, Aga Khan University, Nairobi, Kenya
- Department of Cardiology, Copenhagen University Hospital Amager & Hvidovre, Hvidovre, Denmark
| | - Benjamin Wachira
- Department of Emergency Medicine, Aga Khan University, Nairobi, Kenya
| | - David Nekyon
- Department of Anaesthesia, Aga Khan University, Nairobi, Kenya
| | - Barbara Karau
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Fatimah Juma
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Grace Wanjiku
- Section of Global Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Harun Otieno
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke Global Health Institute, Department of Medicine, Duke University, Durham, NC, USA
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Pezel T, Coisne A, Picard F, Gueret P. How simulation teaching is revolutionizing our relationship with cardiology. Arch Cardiovasc Dis 2020; 113:297-302. [PMID: 32291188 DOI: 10.1016/j.acvd.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Théo Pezel
- Inserm UMRS 942, Department of Cardiology, University of Paris, Lariboisière Hospital, Centre Hospitalo-Universitaire Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, 21287-0409 Baltimore, MD, USA; French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France.
| | - Augustin Coisne
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography, Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Inserm UMR 1011, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France
| | - Fabien Picard
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, Cochin Hospital, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges Pompidou European Hospital, 75015 Paris, France
| | - Pascal Gueret
- French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiology, Foch Hospital, 92150 Suresnes, France
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- Inserm UMRS 942, Department of Cardiology, University of Paris, Lariboisière Hospital, Centre Hospitalo-Universitaire Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; Division of Cardiology, Johns Hopkins University, 21287-0409 Baltimore, MD, USA; French Commission of Simulation Teaching (Commission d'enseignement par simulation [COMSI]) of the French Society of Cardiology, 75012 Paris, France; Department of Cardiovascular Explorations and Echocardiography, Heart Valve Clinic, CHU de Lille, 59000 Lille, France; Inserm UMR 1011, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France; Department of Cardiology, Cochin Hospital, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges Pompidou European Hospital, 75015 Paris, France; Department of Cardiology, Foch Hospital, 92150 Suresnes, France
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Stephen VS, Wells M. Technically Adequate Images for Preparticipation Screening Echocardiography Can Be Obtained by Novices After a Single Day of Training. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3015-3023. [PMID: 30985021 DOI: 10.1002/jum.15009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Echocardiography-naïve physicians were trained in a 1-day course to determine whether they could obtain images adequate for preparticipation screening in athletes. METHODS Twenty-six physicians with no previous experience in echocardiography were trained to perform preparticipation screening echocardiography during a 6-hour course. Each image was rated for its technical quality on a diagnostic adequacy score. The time taken to perform the images was also evaluated. RESULTS The images obtained a median score of 3 (interquartile range, 2-4), which was considered adequate for preparticipation screening. Video clips achieved a higher rating than the still images, with a median score of 4 (interquartile range, 3-4). The best-performing 50% of the participants obtained adequate images for screening 95% of the time after the initial training. Considering the group overall, 79.2% of all video clips were adequate. The median time to perform the scans was 39 seconds. The correlation between the time and adequacy score showed that the quickest novices were also able to obtain the best images. CONCLUSIONS It is feasible to use novice sonographers to perform preparticipation screening echocardiography provided that the skill of the candidates is assessed after training, and competent individuals are selected. Video images should be used rather than still images.
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Affiliation(s)
- Victoria Sarah Stephen
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Nabeshima Y, Namisaki H, Teshima T, Kurashige Y, Kakio A, Fukumitsu A, Otsuji Y, Takeuchi M. Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction. Cardiovasc Ultrasound 2019; 17:23. [PMID: 31672160 PMCID: PMC6824039 DOI: 10.1186/s12947-019-0173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background Left ventricular (LV) ejection fraction (LVEF) assessed by two-dimensional echocardiography (2DE) is the most widely used parameter for clinical decision-making, but reproducibility and accuracy problems remain. We evaluated the usefulness of a novel training program based on cardiac magnetic resonance (CMR) imaging to obtain more reliable values of 2DE-derived LVEF and LV volumes. Methods Fifty-four sonographers from five hospitals independently measured LV volumes and LVEF using the same 2DE images from 15 patients who underwent CMR and 2DE. After receiving a lecture from an expert on how to properly trace the LV endocardium, each sonographer voluntary performed the measurements using the same datasets, and was invited to perform the same analysis for additional patients. The effect of the training intervention was evaluated using the coefficient of variation (CV) and coverage probability (CP). Results Before the intervention, the LV volumes were significantly underestimated and the LVEF was significantly overestimated compared to the CMR results; however, these differences were reduced after the intervention. In particular, the CP (0.52 vs. 0.76, p < 0.001) for the LVEF showed significant improvement. However, the degree of improvement differed among institutions, and the CV actually became worse in two hospitals after the intervention. Level of experience and self-practice was associated with the reproducibility after the intervention. Conclusions A training program using CMR as a reference improved the accuracy of 2DE-determined LV measurements. Since the degree of improvements differed among hospitals, individualization of training programs and periodical objective evaluation may be required to reduce inter-institutional variability.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556, Japan.
| | - Hidehiro Namisaki
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Toshihiro Teshima
- Department of Laboratory, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Akiko Kakio
- Department of Laboratory, Kyushu Rousai Hospital, Kitakyushu, Japan
| | - Azusa Fukumitsu
- Department of Laboratory, JCHO Kyushu Hospital, Kitakyushu, Japan
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8556, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Evaluation of the efficacy of a self-training programme in focus cardiac ultrasound with simulator. Arch Cardiovasc Dis 2019; 112:576-584. [PMID: 31350012 DOI: 10.1016/j.acvd.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Focus cardiac ultrasound is a great tool for quick evaluation of cardiac function in acute settings with limited time and expertise in echocardiography. Adequate training is essential for physicians willing to use this imaging technique. AIM The goal of this study was to assess the efficacy of a self-training programme using a cardiac ultrasound simulator. METHODS Thirty-five trainees in cardiology, emergency medicine or anaesthesiology entered the programme, which started with an e-learning lecture on focus cardiac ultrasound, with practice on a simulator, followed by implementation on patients, and ended with self-training in image analysis on an online platform. A post-test evaluation was carried out at the end of the theoretical training, followed by a final live evaluation on patients (timed acquisition of the five reference views used in focus cardiac ultrasound, grading each view on a scale of 1 to 5). Trainees were also evaluated online regarding their interpretation of 20 video clips. RESULTS The median (interquartile range) interpretability scores following simulator training were 5 (4-5) for the parasternal long-axis view, 5 (4-5) for the apical four-chamber view, and 4 (4-5) for the subcostal window. Interpretability was significantly inferior in the live evaluation compared with the post-test evaluation, except for the parasternal long-axis and subcostal views. The mean score for the video clips (out of 20) was 14.5±2.4. CONCLUSIONS After a short self-training programme, trainees were able to acquire the main views of focus cardiac ultrasound with sufficient quality and in a short time period.
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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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Jain D, Grejs AM, Bhavsar R, Bang U, Sloth E, Juhl-Olsen P. Focused cardiac ultrasound is feasible in parturients; a prospective observational study. Acta Anaesthesiol Scand 2017; 61:1105-1113. [PMID: 28832901 DOI: 10.1111/aas.12956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND In pregnancy, the major causes of morbidity and mortality include diseases that affect circulation profoundly and restoration of normal circulation is a key objective. Focused cardiac ultrasound provides information on the individual determinants of circulation and has a significant impact on patient management. This study aimed to determine the feasibility of focused cardiac ultrasound in term parturients. METHODS Forty parturients underwent focused cardiac ultrasound. Parasternal long-axis, parasternal short-axis, 4-chamber and subcostal views were performed in the left-lateral position and the supine position by a novice operator. All images were graded on the following scale: 1 = no image; 2 = poor and insufficient image; 3 = sufficient image quality; 4 = good image quality; 5 = perfect image quality. A cut-off grade of three signified images sufficient for clinical decision-making. RESULTS Images sufficient for clinical decision-making were obtained in all patients when including all imaging views. 37/40 (93 %) patients presented images of grade ≥ 4, whereas 10/40 (25%) patients had images of grade 5. Image grades were higher in the left lateral position (all P < 0.001). Parturients with a body mass index ≤ 30 kg/m2 did not present different image grades than parturients with a higher body mass index (P = 0.753). Subcostal views could not be obtained. CONCLUSION Focused cardiac ultrasound is feasible in the obstetric population and images of sufficient quality for clinical decision-making were obtained in all parturients by an operator with limited experience.
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Affiliation(s)
- D. Jain
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - A. M. Grejs
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - R. Bhavsar
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - U. Bang
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
| | - E. Sloth
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus C Denmark
| | - P. Juhl-Olsen
- Department of Anaesthesiology & Intensive Care; Aarhus University Hospital; Aarhus N Denmark
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Haskins SC, Zhao J, Nejim JA, Fields K, Garvin S, Dehipawala S, Beckman JD, Zhang A, Osorio JA, Tanaka C. Evaluation of Postgraduates Following Implementation of a Focus Assessed Transthoracic Echocardiography (FATE) Training Course-A Pilot Study. ACTA ACUST UNITED AC 2017; 8. [PMID: 29130022 PMCID: PMC5679106 DOI: 10.4172/2155-6148.1000763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At our institution, implementation of a formal training course in Basic Focus Assessed Transthoracic Echocardiography (FATE) was associated with an improvement in anesthesia trainees’ ability to obtain transthoracic echocardiography (TTE) images. Total image acquisition scores improved by a median (Q1, Q3) 9.1 (2.9,14.7) percentage points from pre-to post-hands-on FATE course (n=20; p=0.001). Participants who returned for a subsequent assessment 5 months following the course demonstrated a median (Q1, Q3) 18.0 (9.1,22.1) percentage point improvement from their pre-course total image acquisition scores (n=11; p=0.002). This pilot study established the feasibility of our program and results suggest that the basic FATE course can be used to teach trainees TTE quickly, effectively, and with significant retention.
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Affiliation(s)
| | - Jinhui Zhao
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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14
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Kratz T, Steinfeldt T, Exner M, Dell´Orto MC, Timmesfeld N, Kratz C, Skrodzki M, Wulf H, Zoremba M. Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients. J Cardiothorac Vasc Anesth 2017; 31:602-609. [DOI: 10.1053/j.jvca.2016.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 11/11/2022]
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15
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Bøtker MT, Vang ML, Grøfte T, Kirkegaard H, Frederiksen CA, Sloth E. Implementing point-of-care ultrasonography of the heart and lungs in an anesthesia department. Acta Anaesthesiol Scand 2017; 61:156-165. [PMID: 28066904 DOI: 10.1111/aas.12847] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 11/20/2016] [Accepted: 11/24/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Implementation of point-of-care ultrasonography (POCUS) of the heart and lungs requires image acquisition skills among providers. We aimed to determine the effect of POCUS implementation using a systematic education program on image acquisition skills and subsequent use and barriers in a department of anesthesiology. METHODS Twenty-five anesthesiologists underwent a systematic education program in POCUS during the fall of 2012. A POCUS expert evaluated images from baseline and evaluation examinations performed on two healthy individuals as useful or not useful for clinical interpretation. In August 2016, anesthesiologists employed at the department answered a questionnaire regarding the use of POCUS and perceived barriers to its use. RESULTS The systematic education program increased the proportion of images useful for clinical interpretation from 0.70 (95% CI 0.65-0.75) to 0.98 (95% CI 0.95-0.99). This difference was significant when adjusted for prior cardiac ultrasonography courses, prior clinical cardiac ultrasonography experience, ultrasonography view, and ultrasound model (P < 0.001). After 3.5 years, 15/25 (60%) of perioperative medicine providers, 22/24 (92%) of intensive care providers, and 21/21 (100%) of pre-hospital care providers used POCUS either routinely, in selected patient groups, or sporadically. CONCLUSION Implementation of POCUS by a systematic education program increased image acquisition skills across anesthesiologists employed at the department. POCUS was used in the intensive care setting, the pre-hospital setting, and to a lesser extent in the perioperative setting. Educational strategies for obtaining images under difficult conditions, practical equipment and evidence for effect on patient outcomes are required for full implementation of POCUS.
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Affiliation(s)
- M. T. Bøtker
- Research and Development, Prehospital Emergency Medical Services; Central Denmark Region; Aarhus Denmark
- Department of Anesthesiology and Intensive Care Medicine; Randers Regional Hospital; Randers Denmark
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - M. L. Vang
- Department of Anesthesiology and Intensive Care Medicine; Randers Regional Hospital; Randers Denmark
| | - T. Grøfte
- Department of Anesthesiology and Intensive Care Medicine; Randers Regional Hospital; Randers Denmark
| | - H. Kirkegaard
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
| | - C. A. Frederiksen
- Department of Internal Medicine; Randers Regional Hospital; Randers Denmark
| | - E. Sloth
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
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Abstract
PURPOSE OF REVIEW A need for further assessment of patients in the perioperative setting and an increasing availability of ultrasonography equipment have facilitated the diffusion of ultrasonography and lately focused transthoracic echocardiography (TTE) in anesthesiology practice. This review will discuss the possible use of focused TTE in the perioperative setting and provides an update on present and future perspectives. RECENT FINDINGS Several studies focusing on patient management and diagnostic accuracy of perioperative, focused TTE, have been published recently. Several multidisciplinary guidelines addressing use and educational aspects of focused ultrasonography are available, yet guidelines focusing solely on the use in the perioperative setting are lacking. SUMMARY Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.
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17
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Yates J, Royse CF, Royse C, Royse AG, Canty DJ. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease. Echo Res Pract 2016; 3:63-9. [PMID: 27457967 PMCID: PMC5045516 DOI: 10.1530/erp-16-0026] [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: 07/05/2016] [Accepted: 07/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient's with suspected cardiac disease. This has not been reported in a general practice setting. AIM To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. DESIGN AND SETTING A prospective observational study of 80 patients aged over 50years and who had not received echocardiography or chest CT within 12months presenting to a general practice. METHOD Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. RESULTS AND CONCLUSION Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20%) patients, including aortic stenosis in 9 (11%) and cardiac failure in 7 (9%), which were missed by clinical examination in 10 (62.5%) of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease) including referral for diagnostic echocardiography in 8 (10%), commencement of heart failure treatment in 3 (4%) and referral to a cardiologist in 1 patient (1%).Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50years presenting to a general practice.
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Affiliation(s)
- James Yates
- The University of Melbourne, Parkville, Victoria, Australia
| | - Colin Forbes Royse
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Carolyn Royse
- Nillumbik and Research Medical Centre, Eltham, Victoria, Australia
| | - Alistair George Royse
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Jeffrey Canty
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia Department of Medicine, Monash University, Clayton, Victoria, Australia Department of Anaesthesia and Perioperative Medicine, Clayton, Victoria, Australia
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18
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Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, Sniecinski R, Mitchell JD, Taylor M, Haskins S, Shahul S, Oren-Grinberg A, Wouters P, Shook D, Reeves ST. Perioperative Ultrasound Training in Anesthesiology. Anesth Analg 2016; 122:1794-804. [DOI: 10.1213/ane.0000000000001134] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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19
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Kratz T, Exner M, Campo dell'Orto M, Timmesfeld N, Schüttler K, Efe T, Zoremba M, Wulf H, Steinfeldt T. A pocket-sized hand held ultrasound system for intraoperative transthoracic echocardiography by anaesthesiologists: A feasibility study. Technol Health Care 2016; 24:309-15. [DOI: 10.3233/thc-161131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T. Kratz
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
- Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France
| | - M. Exner
- Department of Anaesthesia, Intensive Care Medicin and Pain Therapy, Unfallkrankenhaus, Berlin, Germany
| | - M. Campo dell'Orto
- Department of Cardiology and Medecine, Sportklinik Bad Nauheim, Bad Nauheim, Germany
| | - N. Timmesfeld
- Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Bunsenstr, Marburg, Germany
| | - K.F. Schüttler
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - T. Efe
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - M. Zoremba
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
| | - H. Wulf
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
| | - T. Steinfeldt
- Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany
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20
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Stochholm A, Løgstrup BB. When you hear hoofbeats, think of horses but do not forget the zebras. BMJ Case Rep 2015; 2015:bcr-2013-203075. [PMID: 25791520 DOI: 10.1136/bcr-2013-203075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 68-year-old man who was admitted to the department of cardiology with increasing abdominal and chest pain during the day. The prehospital ECG showed clear ST segment elevation in inferior leads. The patient was routed directly to the catheterisation laboratory with acute myocardial infarction as a tentative diagnosis. The coronary angiography showed an occluded right coronary artery that was reopened with a plain old balloon angioplasty procedure. After the procedure, the patient was expected to feel better, but the abdominal pain worsened. The following bedside ultrasound examination was quite surprising.
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Affiliation(s)
- Anders Stochholm
- Aarhus University Hospital, Aarhus, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
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21
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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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22
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Moaveni DM, Cohn JH, Zahid ZD, Ranasinghe JS. Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0094-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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BØTKER MT, VANG ML, GRØFTE T, SLOTH E, FREDERIKSEN CA. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures. Acta Anaesthesiol Scand 2014; 58:807-14. [PMID: 24865842 DOI: 10.1111/aas.12343] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Unexpected cardiopulmonary complications are well described during surgery and anesthesia. Pre-operative evaluation by focused cardiopulmonary ultrasonography may prevent such mishaps. The aim of this study was to determine the frequency of unexpected cardiopulmonary pathology with focused ultrasonography in patients undergoing urgent surgical procedures. METHODS We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. RESULTS A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society of Anesthesiologists (ASA) class 1, 39% were ASA class 2, 32% were ASA class 3, and 4% were ASA class 4. Unexpected cardiopulmonary pathology was disclosed in 27% [95% confidence interval (CI) 19-36] of the patients and led to a change in anesthesia technique or supportive actions in 43% (95% CI 25-63) of these. Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. CONCLUSION Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical procedures and induced changes in the anesthesia technique or supportive actions. Pre-operative focused ultrasonography seems feasible in patients above 60 year and/or with physical limitations but not in young, healthy individuals.
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Affiliation(s)
- M. T. BØTKER
- Department of Anesthesiology and Intensive Care; Regional Hospital of Randers; Randers Denmark
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
| | - M. L. VANG
- Department of Anesthesiology and Intensive Care; Regional Hospital of Randers; Randers Denmark
| | - T. GRØFTE
- Department of Anesthesiology and Intensive Care; Regional Hospital of Randers; Randers Denmark
| | - E. SLOTH
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - C. A. FREDERIKSEN
- Department of Internal Medicine; Regional Hospital of Randers; Randers Denmark
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24
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Abstract
Abstract
Background:
Standardized training via simulation as an educational adjunct may lead to a more rapid and complete skill achievement. The authors hypothesized that simulation training will also enhance performance in transesophageal echocardiography image acquisition among anesthesia residents.
Methods:
A total of 42 clinical anesthesia residents were randomized to one of two groups: a control group, which received traditional didactic training, and a simulator group, whose training used a transesophageal echocardiography–mannequin simulator. Each participating resident was directed to obtain 10 commonly used standard views on an anesthetized patient under attending supervision. Each of the 10 selected echocardiographic views were evaluated on a grading scale of 0 to 10, according to predetermined criteria. The effect of the intervention was assessed by using a linear mixed model implemented in SAS 9.3 (SAS Institute Inc., Cary, NC).
Results:
Residents in the simulation group obtained significantly higher-quality images with a mean total image quality score of 83 (95% CI, 74 to 92) versus the control group score of 67 (95% CI, 58 to 76); P = 0.016. On average, 71% (95% CI, 58 to 85) of images acquired by each resident in the simulator group were acceptable for clinical use compared with 48% (95% CI, 35 to 62) in the control; P = 0.021. Additionally, the mean difference in score between training groups was the greatest for the clinical anesthesia-1 residents (difference 24; P = 0.031; n = 7 per group) and for those with no previous transesophageal echocardiography experience (difference 26; P = 0.005; simulator n = 13; control n = 11).
Conclusion:
Simulation-based transesophageal echocardiography education enhances image acquisition skills in anesthesiology residents.
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25
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Frederiksen CA, Juhl-Olsen P, Andersen NH, Sloth E. Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard. Scand J Trauma Resusc Emerg Med 2013; 21:87. [PMID: 24330752 PMCID: PMC3866928 DOI: 10.1186/1757-7241-21-87] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to compare the diagnostic accuracy of point-of-care cardiac ultrasonography performed by a novice examiner against results from a specialist in cardiology with expert skills in echocardiography, with regard to the assessment of six clinically relevant cardiac conditions in a population of ward patients from the Department of Cardiology or the Department of Cardiothoracic Surgery. Methods Cardiac ultrasonography was performed by a novice examiner at the bedside and images were interpreted in a point-of-care context with dichotomous outcomes (yes/no). Six outcome categories were defined: 1) pericardial effusion (≥10 mm), 2) left ventricular dilatation (≥62 mm), 3) right ventricular dilatation (≥42 mm or ≥ left ventricular diameter), 4) left ventricular hypertrophy (≥13 mm), 5) left ventricular failure (EF ≤ 40%), 6) aortic stenosis (maximum flow velocity ≥3 m/s). The examiner was blinded to the patients’ medical history and results from previous echocardiographic examinations. Results from the interpreted point-of-care ultrasonography examination were compared with echocardiographic diagnosis made by a specialist in cardiology. Results A total of 102 medical and surgical patients were included. Assessments were made in six categories totalling 612 assessments. There was agreement between the novice examiner and the specialist in 95.6% of the cases; overall sensitivity was 0.91 and specificity was 0.97. Positive predictive value was 0.92 and negative predictive value was 0.97. Kappa statistics showed good agreement between observers (κ=0.88). Conclusions This study showed that a novice examiner was able to detect common and significant heart pathology in six different categories with good accuracy using POC ultrasonography.
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