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Vandenbossche V, Valcke M, Audenaert E, Willaert W. Anatomical knowledge enhancement through echocardiography and videos, with a spotlight on cognitive load, self-efficacy, and motivation. ANATOMICAL SCIENCES EDUCATION 2024; 17:806-817. [PMID: 38351607 DOI: 10.1002/ase.2398] [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: 09/08/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 06/01/2024]
Abstract
In recent years, there has been a growing recognition of the importance of integrating ultrasound into undergraduate medical curricula. However, empirical evidence is lacking as to its effect on anatomy learning and related student cognition. Therefore, the present study compared the impact of echocardiography-based instruction with narrated videos on students' understanding of anatomical relationships, as well as the interaction with students' autonomous motivation, self-efficacy beliefs, mental load, and attitudes. Second-year medical students were given the opportunity to enroll in a supplementary booster course about cardiac anatomy. On the base of a randomized controlled trial with a cross-over design, we studied the effect of taking this course on spatial anatomical knowledge. After completing a pre-test (T0), students were allocated randomly to either the echocardiography-based teaching condition (cohort A) or the narrated anatomy video condition (cohort B). Next, participants were crossed over to the alternative intervention. Immediately after each phase in the intervention, students were asked to rate their mental load. Additionally, a spatial anatomical knowledge test, an autonomous motivation scale, and a self-efficacy scale were administered before (T0) and after the first intervention (T1) and at the end of the study (T2). Finally, each student completed a perception-based survey. The study design allowed a comparative evaluation of both interventions at T1, while the cross-over design facilitated the assessment of the most optimal sequencing in the interventions at T2. A total of 206 students participated (cohort A: n = 99, cohort B: n = 107). At T1, no significant differences in the knowledge test and the autonomous motivation scale were observed between cohorts A and B. However, cohort A showed higher self-efficacy beliefs compared to cohort B (p = 0.043). Moreover, cohort A reported higher levels of perceived mental load (p < 0.001). At T2, the results showed that neither sequence of interventions resulted in significant differences in anatomy scores, autonomous motivation, or self-efficacy. However, a significant difference in mental load was found again, with students in cohort B reporting a higher level of mental load (p < 0.001). Finally, based on the perception-based survey, students reported favorably on the echocardiography experience. In conclusion, the hands-on echocardiography sessions were highly appreciated by the medical students. After participating in the ultrasound sessions, they reported higher levels of self-efficacy beliefs compared to the video-based condition. However, despite embodied cognition principles, students in the echocardiography condition did not outperform students in the narrated anatomy video condition. The reported levels of mental load in the ultrasound condition could explain these findings.
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Affiliation(s)
| | - Martin Valcke
- Department of Educational Studies, Ghent University, Ghent, Belgium
| | - Emmanuel Audenaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Op3Mech Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Gastrointestinal Surgery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ocel S, Kekec Z, Taskin O, Belli F, Tugcan MO. Diagnostic role of thoracic ultrasound in patients with acute respiratory failure at emergency service. Ir J Med Sci 2024; 193:1573-1579. [PMID: 38308140 DOI: 10.1007/s11845-024-03618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND AIM This study aimed to elucidate the effectiveness of bedside thoracic ultrasound according to BLUE protocol and to investigate its superiority over other imaging methods in the emergency service. METHODS A total of 120 patients admitted to our institution's emergency care department due to respiratory distress have been enrolled in this prospective research. Thorax USG has been performed in the right and left hemithorax at the points specified in the BLUE protocol for each patient. Pleural sliding motion, A-lines, B-lines, consolidation, effusion, and the presence of barcode signs were evaluated individually. Age, sex, comorbid diseases, other radiological examination findings, laboratory findings, final clinical diagnosis, and hospitalization-discharge status of the patients were recorded. RESULTS When a correct diagnosis of pneumonia has been analyzed for imaging techniques, the diagnostic rate of chest radiography was 83.3%, CT was 100.0%, and USG was 66.6%. The correct diagnostic rate of chest radiography was 94.5%; CT and USG were 100.0%. The correct diagnosis of pulmonary edema on chest radiography was 94.5%; CT and USG were 100.0%. While the correct diagnosis of pleural effusion on chest radiography and CT was 100.0%, it was 92.3% in USG imaging. Finally, CT and USG imaging performed better than chest radiography in patients with pneumothorax (chest radiography 80.0%, CT and USG 100%). CONCLUSION USG imaging could be preferred in the diagnosis of pneumonia, pulmonary edema, pleural effusion, pneumothorax, pulmonary embolism, and differential diagnosis at the emergency service.
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Affiliation(s)
- Samet Ocel
- Department of Emergency Medicine, Adana City Research and Training Hospital, Health Science University, 01060, Adana, Turkey.
| | - Zeynep Kekec
- Department of Emergency Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Omer Taskin
- Emergency Medicine Clinic, Yuregir State Hospital, Adana, Turkey
| | - Fuat Belli
- 5 Ocak State Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Mustafa Oguz Tugcan
- Department of Emergency Medicine, Adana City Research and Training Hospital, Health Science University, 01060, Adana, Turkey
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Weimer AM, Weimer JM, Berthold S, Stein S, Müller L, Buggenhagen H, Balser G, Stankov K, Sgroi M, Schmidmaier G, Kloeckner R, Schamberger C. Shoulder and Knee Arthroscopy Access Point: Prospective Comparison of Sonographic and Palpatory Detection - Which Method is Better for Novices? Ultrasound Int Open 2024; 10:a22710098. [PMID: 38812890 PMCID: PMC11135419 DOI: 10.1055/a-2271-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/03/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. Materials and Methods The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop. Results The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee.
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Affiliation(s)
- Andreas Michael Weimer
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Johannes M. Weimer
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Svenja Berthold
- Department for Orthopaedics and Trauma Surgery,
University Medical Centre Mannheim, Mannheim, Germany
| | - Stephan Stein
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Holger Buggenhagen
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerd Balser
- Rudolf-Frey Teaching Department, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kay Stankov
- Corporate Finance, Technical University of Darmstadt,
Darmstadt, Germany
| | - Mirco Sgroi
- Department of Orthopaedic Surgery, Ulm University
Medical Center, Ulm, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University
Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, University
Hospital Heidelberg, Heidelberg, Germany
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Margenfeld F, Zendehdel A, Tamborrini G, Müller-Gerbl M. The advantages of utilizing different ultrasound imaging techniques on joints of human cadavers in the teaching of anatomy - A scoping review. Ann Anat 2024; 251:152179. [PMID: 37879500 DOI: 10.1016/j.aanat.2023.152179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A common approach to define sonoanatomy is a reciprocal exchange of macroscopic and microscopic information in ultrasound imaging. High-resolution ultrasound has been long established and is crucial as an inexpensive and adaptable tool, not just in clinical settings but also while teaching anatomy. Early application of ultrasonography provides medical students with a couple of benefits: they acquire an improved understanding of anatomy and learn how to use it. METHODS A comprehensive literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews and Web of Science Core Collection. Gray literature was also considered in two different ways: (1) Regarding grey literature databases: National Gray Literature Collection. (2) For PhD theses and dissertations, the databases EThOS and Open Access Theses and Dissertations were screened for relevant studies by combining the keywords used in the search string. The reference lists of all relevant papers were scanned. Search process was performed on January 3rd, 2023. The search string was developed with the aid of and finally checked by a professional librarian. Only ultrasound studies on human cadavers were included, not animals or phantoms. If the studied subject was a joint, the article was included. Only B-Mode ultrasound was included, whereas Elastosonography, Doppler sonography and quantitative approaches including among others sound speed, backscatter attenuation were excluded. Intravascular, intraosseous, intraarticular, and three-dimensional or four-dimensional ultrasonography were also eliminated from the analysis. All appropriate information comprising articles, PhD theses, dissertations and chapters in textbooks were considered. There were solely English and German studies covered. There was no additional restriction on the publishing year. The included studies' general characteristics and ultrasound techniques were taken from them and examined. Using VOS viewer, a keyword analysis was also carried out. RESULTS 142 of the 8899 results that were returned by the search satisfied the requirements. With a quarter of the included studies, the knee joint was the most extensively studied joint, followed by the elbow joint (10.6%) and the shoulder joint (9.2%). The methodological analysis includes 125 studies. Both the sample size and the ultrasonographer's qualifications were diverse. The probe position and the ultrasound method were precisely documented so that a reader could duplicate them in about three-quarters of the included studies (72.8%). CONCLUSION The current study, in our perspective, is the first scoping review to screen ultrasound studies on human cadaver joints. A heterogeneous field was shown by the methodological investigation. We suggest using a uniform method for conducting and presenting ultrasound examinations in future studies.
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Affiliation(s)
- Felix Margenfeld
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland.
| | - Adib Zendehdel
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
| | - Giorgio Tamborrini
- Swiss Ultrasound Center UZR and Institute for Rheumatology, Aeschenvorstadt 68, Basel 4051, Switzerland; Rheumatology Clinic, University Hospital of Basel, Basel 4001 Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, Basel 4056, Switzerland
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Ward JL, DeFrancesco TC. The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies. Vet Clin North Am Small Anim Pract 2023; 53:1429-1443. [PMID: 37423842 DOI: 10.1016/j.cvsm.2023.05.017] [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: 07/11/2023]
Abstract
Point-of-care ultrasound (POCUS) is a useful imaging tool for the diagnosis and monitoring of cardiac emergencies. Unlike complete echocardiography, POCUS is a time-sensitive examination involving a subset of targeted thoracic ultrasound views to identify abnormalities of the heart, lungs, pleural space, and caudal vena cava. When integrated with other clinical information, POCUS can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension and can help clinicians monitor resolution or recurrence of these conditions.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA.
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA
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Vandenbossche V, Valcke M, Steyaert A, Verstraete K, Audenaert E, Willaert W. Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition. ANATOMICAL SCIENCES EDUCATION 2023; 16:1089-1101. [PMID: 37356074 DOI: 10.1002/ase.2311] [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: 02/17/2023] [Revised: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.
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Affiliation(s)
| | - Martin Valcke
- Department of Educational Studies, Ghent University, Ghent, Belgium
| | - Adelheid Steyaert
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Emmanuel Audenaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Gastrointestinal Surgery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Weimer J, Dionysopoulou A, Strelow KU, Buggenhagen H, Weinmann-Menke J, Dirks K, Weimer A, Künzel J, Börner N, Ludwig M, Yang Y, Lorenz L, Ille C, Müller L. Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards. BMC MEDICAL EDUCATION 2023; 23:513. [PMID: 37461025 DOI: 10.1186/s12909-023-04511-x] [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: 01/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills. METHODS Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed. RESULTS A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor's didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05). CONCLUSION These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.
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Affiliation(s)
- Johannes Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Anna Dionysopoulou
- Department of obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kai-Uwe Strelow
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Dirks
- Department of General Internal Medicine and Geriatrics, Rems-Murr-Klinikum, Winnenden, Germany
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Börner
- Gastroenterological Medical Group Offices, MED Specialist Center Mainz, Mainz, Germany
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, Berlin, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Liv Lorenz
- Department of Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Carlotta Ille
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Navas de Solis C, Stefanovski D, Johnson AL, Reef VB, Underwood C. Evaluation of a Self-Driven Large Animal Point of Care Ultrasound Learning Program for Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20230009. [PMID: 37115710 DOI: 10.3138/jvme-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Point of care ultrasound (POCUS) has the potential to improve healthcare outcomes and is increasingly used in veterinary primary care and specialty practice. The aim of this study was to evaluate a self-driven POCUS learning program during clinical rotations in a large animal teaching hospital. A randomized controlled trial of 94 students evaluated the hypotheses that access to a self-driven POCUS program would improve scores on a written test and the quality of subjective, objective, assessment and plan (SOAP) documents. Use of the POCUS devices and perceptions of veterinary students towards POCUS were analyzed. The self-driven POCUS learning program was feasible, and the perception of most students (94%) was that the program was useful for their education. Access to equipment, ability to scan individually, the hands-on learning aspect, and clinicians' help were the most valued aspects of the program. Earlier access to POCUS in the curriculum, hands-on tutorials/labs, and a more structured learning program were identified by students as aspects to improve. Access to the self-driven POCUS program resulted in significantly higher scores on the written test in a subpopulation of students with lower scores. No significant differences in results on the multiple-choice tests in the subpopulation with higher scores or in SOAP scores of the complete group or subpopulations were found. A self-driven POCUS learning program was perceived as beneficial by students, increased POCUS knowledge in students with lower test scores, and was possible to implement in a busy large animal teaching hospital.
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Affiliation(s)
- Cristobal Navas de Solis
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Amy L Johnson
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Virginia B Reef
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Claire Underwood
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Ródenas Monteagudo MÁ, Albero Roselló I, Del Mazo Carrasco Á, Carmona García P, Zarragoikoetxea Jauregui I. Update on the use of ultrasound in the diagnosis and monitoring of the critical patient. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:567-577. [PMID: 36253286 DOI: 10.1016/j.redare.2022.01.003] [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: 06/22/2021] [Accepted: 01/07/2022] [Indexed: 06/16/2023]
Abstract
Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.
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Yeon Kang S, Joon Jo I, Lee G, Eun Park J, Kim T, Uk Lee S, Yeon Hwang S, Gun Shin T, Kim K, Sun Shim J, Yoon H. Point-of-Care Ultrasound Compression of the Carotid Artery for Pulse Determination in Cardiopulmonary Resuscitation. Resuscitation 2022; 179:206-213. [PMID: 35792305 DOI: 10.1016/j.resuscitation.2022.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
AIM To identify whether a novel pulse check technique, carotid artery compression using an ultrasound probe, can reduce pulse check times compared to manual palpation (MP). METHODS This prospective study was conducted in an emergency department between February and December 2021. A physician applied point-of-care ultrasound-carotid artery compression (POCUS-CAC) and assessed the carotid artery compressibility and pulsatility by probe compression during rhythm check time. Another clinician performed MP of the femoral artery. The primary outcome was the difference in the average time for pulse assessment between POCUS-CAC and MP. The secondary outcomes included the time difference in each pulse check between methods, the proportion of times greater than 5 s and 10 s, and the prediction of return of spontaneous circulation (ROSC) during ongoing chest compression. RESULTS 25 cardiac arrest patients and 155 pulse checks were analyzed. The median (interquartile range) average time to carotid pulse identification per patient using POCUS-CAC was 1.62 (1.14-2.14) s compared to 3.50 (2.99-4.99) s with MP. In all 155 pulse checks, the POCUS-CAC time to determine ROSC was significantly shortened to 0.44 times the MP time (P < 0.001). The POCUS-CAC approach never exceeded 10 s, and the number of patients who required more than 5 s was significantly lower (5 vs. 37, P < 0.001). Under continuous chest compression, six pulse checks predicted the ROSC. CONCLUSIONS We found that emergency physicians could quickly determine pulses by applying simple POCUS compression of the carotid artery in cardiac arrest patients.
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Affiliation(s)
- Soo Yeon Kang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea; Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji Sun Shim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
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Lien WC, Chen JY, Wang PH, Ling DA, Wang HP. An effective AsK ultrasound protocol for patients with abdominal distention. Eur J Emerg Med 2022; 29:236-238. [PMID: 35483371 DOI: 10.1097/mej.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital
- Department of Emergency Medicine, College of Medicine, National Taiwan University
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Peterman NJ, Yeo E, Kaptur B, Smith EJ, Christensen A, Huang E, Rasheed M. Analysis of Rural Disparities in Ultrasound Access. Cureus 2022; 14:e25425. [PMID: 35774712 PMCID: PMC9236672 DOI: 10.7759/cureus.25425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This work aims to conduct a geospatial analysis of recent ultrasound access and usage within the United States, with a particular focus on disparities between rural and urban areas. Methods/Materials Multiple public datasets were merged on a county level, including US Department of Agriculture economic metrics and Centers for Medicare Services data using the most recent years available (2015-2019). From these databases, 39 total variables encompassing the socioeconomic, health, and ultrasound characteristics of each county were obtained. Current Procedural Terminology (CPT) codes incorporated included ultrasound-guided procedures and diagnostic exams. Three thousand eleven counties were included. The combined dataset was then exported to GeoDa for network-based analysis and to produce map visualizations. To identify statistically significant (p < 0.05) hotspots and coldspots in point-of-care ultrasound (POCUS) prevalence, Moran’s I was used. Choropleth maps were created for visualization. ANOVA was run across the four Moran’s I groups for each of 39 variables of interest. Results A total of 30,135,085 ultrasound-related CPT codes were billed to Medicare over 2015-2019, with 26.55% of codes being ultrasound-guided procedures and 73.45% being diagnostic exams. 38.84% of rural counties had access to POC ultrasound compared to 88.56% of metropolitan counties and 74.19% of counties overall. Hotspots of POCUS were in Southern California and the Eastern US (average of 1,441 per 10,000 Medicare members per year). Coldspot areas were seen in the Great Plains and Midwest (average of 7.43 per 10k Medicare members per year). Hotspot clusters, when compared to coldspot clusters, were significantly (p < 0.001) more dense (703.6 to 14.9 people per square mile), more urbanized (3.5 to 7.1 Rural-Urban Continuum (RUC)), more college-educated (25.1% to 20.0%), more likely to have an Emergency Department (ED) visit (725.8 to 616.9 visits per 1,000 Medicare members), more likely to be obese (19.0% to 12.9%), less likely to be uninsured (10.1% to 13.0%), had more Black representation (8.5% to 3.4%), and less Hispanic representation (2.6% to 5.5%). Conclusions Ultrasound access and usage demonstrate significant geospatial trends across the United States. Hotspot and coldspot counties differ on several key sociodemographic and economic variables.
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Chen WT, Kang YN, Wang TC, Lin CW, Cheng CY, Suk FM, Hsu CW, Huang SK, Huang WC. Does ultrasound education improve anatomy learning? Effects of the Parallel Ultrasound Hands-on (PUSH) undergraduate medicine course. BMC MEDICAL EDUCATION 2022; 22:207. [PMID: 35346161 PMCID: PMC8962240 DOI: 10.1186/s12909-022-03255-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/13/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND As ultrasound has become increasingly prominent in medicine, portable ultrasound is perceived as the visual stethoscope of the twenty-first century. Many studies have shown that exposing preclinical students to ultrasound training can increase their motivation and ultrasound competency. However, few studies have discussed the effect of ultrasound training on anatomy learning. METHOD The Parallel Ultrasound Hands-on (PUSH) course was designed to investigate whether or not ultrasonography training affects anatomy knowledge acquisition. The PUSH course included anatomical structures located in the chest and abdomen (target anatomy) and was conducted in parallel to the compulsory gross anatomy course. Learners (n = 140) voluntarily participated in this elective course (learners in the course before the midterm examination (Group 1, n = 69), or after the midterm examination (Group 2, n = 71)). Anatomy examination scores (written and laboratory tests) were utilized to compare the effects of the PUSH course. RESULT Group 1 obtained significantly higher written test scores on the midterm examination (mean difference [MD] = 1.5(7.6%), P = 0.014, Cohen's d = 0.43). There was no significant difference in the final examination scores between the two groups (Written Test: MD = 0.3(1.6%), P = 0.472). In Laboratory test, both mid-term (MD:0.7(2.8%), P = 0.308) and final examination (MD:0.3(1.5%), P = 0.592) showed no significant difference between two groups. Students provided positive feedback in overall learning self-efficacy after the PUSH course (Mean = 3.68, SD = ±0.56 on a 5-point Likert scale). Learning self-efficacy in the cognitive domain was significantly higher than that in the affective domain (MD = 0.58; P < 0.001) and psychomotor domain (MD = 0.12; P = 0.011). CONCLUSION The PUSH course featured a hands-on learning design that empowered medical students to improve their anatomy learning.
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Affiliation(s)
- Wei-Ting Chen
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei City, 11696, Taiwan
- Department of Emergency and Critical Medicine, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Yi-No Kang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Education, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Evidence-Based Medicine Center at Taipei Medical University, Taipei City, Taiwan
| | - Ting-Cheng Wang
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei City, 11696, Taiwan
- Department of Emergency and Critical Medicine, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Che-Wei Lin
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Education, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Center for Education in Medical Simulation, Taipei Medical University, Taipei City, Taiwan
| | - Chung-Yi Cheng
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Fat-Moon Suk
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei City, 11696, Taiwan
- Department of Emergency and Critical Medicine, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Sha-Ku Huang
- Research Center for Environmental Medicine, Kaohsiung Medical University, Sanmin, Kaohsiung, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan Township, Miaoli County, Taiwan
| | - Wen-Cheng Huang
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei City, 11696, Taiwan.
- Department of Emergency and Critical Medicine, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
- Department of Education, Taipei Municipal Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
- Center for Education in Medical Simulation, Taipei Medical University, Taipei City, Taiwan.
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Kalagara H, Manson W, Townsley MM. Point-of-Care Ultrasound (POCUS) Training for Anesthesiologists: Is it Time to Embrace and Attain Competency? J Cardiothorac Vasc Anesth 2021; 36:30-32. [PMID: 34521580 DOI: 10.1053/j.jvca.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - William Manson
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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DeFrancesco TC, Ward JL. Focused Canine Cardiac Ultrasound. Vet Clin North Am Small Anim Pract 2021; 51:1203-1216. [PMID: 34511294 DOI: 10.1016/j.cvsm.2021.07.005] [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: 10/20/2022]
Abstract
Focused cardiac ultrasound (FCU) is a useful point-of-care imaging tool to assess cardiovascular status in symptomatic dogs in the acute care setting. Unlike complete echocardiography, FCU is a time-sensitive examination involving a subset of targeted ultrasound views to identify severe cardiac abnormalities and is performed as part of an integrated thoracic ultrasound including interrogation of the pleural space and lungs. When integrated with other clinical information, FCU can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension, and can provide estimates of fluid responsiveness in hypotensive dogs.
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Affiliation(s)
- Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Dr, Raleigh, NC 27607, USA.
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 S. Riverside Dr, Ames, IA 50010, USA
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Wang TC, Chen WT, Kang YN, Lin CW, Cheng CY, Suk FM, Chen HY, Hsu CW, Fong TH, Huang WC. Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory. BMC MEDICAL EDUCATION 2021; 21:438. [PMID: 34412610 PMCID: PMC8375120 DOI: 10.1186/s12909-021-02869-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In recent years, point-of-care ultrasound (POCUS) has become an essential field of medical education. Bedside ultrasound has become a necessary skill for clinical physicians. Previous studies have already discussed the importance of advancements in ultrasound education. However, learning motivations for ultrasound education have seldom been analyzed in the literature. For medical students, learning ultrasound could have a relevance for their future career. The Existence, Relatedness and Growth (ERG) theory extended Maslow's hierarchy of needs through these three concepts. This theory has been widely used in the workplace to analyze employee job performance but has not yet been applied in medical education. In this study ERG theory was applied to analyze pre-clinical medical students' learning motivation toward ultrasound education. METHOD This mixed method study used online questionnaires consisting of open-ended questions as a data collection tool, and based on these results, both qualitative and quantitative analysis were conducted. Participants answered a series of neutral and open-ended questions regarding their motivations to learn ultrasonography. After data collection, a three-step analysis was conducted based on the grounded theory approach. Finally, the results of the thematic coding were used to complete additional quantitative analysis. RESULTS The study involved 140 pre-clinical medical students, and their responses fell into 13 specific categories. The analysis demonstrated that students' motivations toward ultrasound education were unbalanced across the three ERG domains (F = 41.257, p < .001). Pairwise comparisons showed that students mentioned existence motivation (MD = 39.3%; p < .001) and growth motivation (MD = 40.7%; p < .001) more frequently than relatedness motivation. However, there was no significant difference between existence motivation and growth motivation (MD = - 1.4%; p = .830). CONCLUSION The results revealed that students placed a high value on existence and growth needs rather than relatedness based on the survey. In addition, the findings suggest that ERG theory can be a useful tool to conduct medical education motivation analysis.
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Affiliation(s)
- Ting-Cheng Wang
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei, 11696, Taiwan
| | - Wei-Ting Chen
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei, 11696, Taiwan
| | - Yi-No Kang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Lin
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Education in Medical Simulation, Taipei Medical University, Taipei, Taiwan
| | - Chung-Yi Cheng
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fat-Moon Suk
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, Division of Gastroenterology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hao-Yu Chen
- Center for Education in Medical Simulation, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei, 11696, Taiwan
| | - Tsorng-Harn Fong
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd, Taipei, 11696, Taiwan.
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Education, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Center for Education in Medical Simulation, Taipei Medical University, Taipei, Taiwan.
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Pioneering Remotely Piloted Aerial Systems (Drone) Delivery of a Remotely Telementored Ultrasound Capability for Self Diagnosis and Assessment of Vulnerable Populations-the Sky Is the Limit. J Digit Imaging 2021; 34:841-845. [PMID: 34173090 PMCID: PMC8232562 DOI: 10.1007/s10278-021-00475-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 11/01/2022] Open
Abstract
Remotely Piloted Aerial Systems (RPAS) are poised to revolutionize healthcare in out-of-hospital settings, either from necessity or practicality, especially for remote locations. RPAS have been successfully used for surveillance, search and rescue, delivery, and equipping drones with telemedical capabilities being considered. However, we know of no previous consideration of RPAS-delivered tele-ultrasound capabilities. Of all imaging technologies, ultrasound is the most portable and capable of providing real-time point-of-care information regarding anatomy, physiology, and procedural guidance. Moreover, remotely guided ultrasound including self-performed has been a backbone of medical care on the International Space Station since construction. The TeleMentored Ultrasound Supported Medical Interventions Group of the University of Calgary partnered with the Southern Alberta Institute of Technology to demonstrate RPAS delivery of a smartphone-supported tele-ultrasound system by the SwissDrones SDO50 RPAS. Upon receipt of the sanitized probe, a completely ultrasound-naïve volunteer was guided by a remote expert located 100 km away using online video conferencing (Zoom), to conduct a self-performed lung ultrasound examination. It proved feasible for the volunteer to examine their anterior chest, sides, and lower back bilaterally, correlating with standard recommended examinations in trauma/critical care, including the critical locations of a detailed COVID-19 lung diagnosis/surveillance examination. We contend that drone-delivered telemedicine including a tele-ultrasound capability could be leveraged to enhance point-of-care diagnostic accuracy in catastrophic emergencies, and allow diagnostic capabilities to be delivered to vulnerable populations in remote locations for whom transport is impractical or undesirable, speeding response times, or obviating the risk of disease transmission depending on the circumstances.
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Kong S, Wang J, Li Y, Tian Y, Yu C, Zhang D, Li H, Zhang L, Pang X, Xie M. Value of Bedside Lung Ultrasound in Severe and Critical COVID-19 Pneumonia. Respir Care 2021; 66:920-927. [PMID: 33758057 DOI: 10.4187/respcare.08382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is an effective imaging modality that can differentiate pathological lung from non-diseased lung. We aimed to explore the value of bedside LUS in patients with severe and critical coronavirus disease 2019 (COVID-19)-associated lung injury. METHODS Sixty-three severe and 33 critical hospitalized subjects with COVID-19 were enrolled in this study. Bedside LUS was performed in all subjects; chest computed tomography was performed on the same day as bedside LUS in 23 cases. The LUS protocol consisted of 12 scanning zones. LUS score based on B-lines and lung consolidation was evaluated. RESULTS The most common abnormality of LUS was the various forms of B-lines, detected in 93 (96.9%) subjects; as the second most frequent abnormality, 80 (83.3%) subjects exhibited lung consolidation, mainly located in the posterior lung region. Twenty-four (25.0%) subjects had pleural line abnormalities, and 16 (16.7%) had pleural effusion; 78 (81.3%) subjects had ≥ 2 abnormal LUS patterns, and 93 (96.9%) had bilateral lung involvement. The proportion of bilateral or unilateral lung consolidation and pleural effusion in the critical COVID-19 group were higher than that in the severe group (P < .05). The lung consolidation of critical subjects showed a marked increase in most lung areas, including bilateral lateral lung, posterior lung, and left anterior-inferior lung area. The median (interquartile range) LUS scores of critical cases were higher than those of severe cases: left: 14 (12-17) vs 7 (5-12); right: 14 (10-16) vs 8 (3-12); bilateral: 28 (23-31) vs 15 (8-22) (P < .001 for all). There was a good correlation between the LUS score and the chest computed tomography score (r = 0.887, P < .001). CONCLUSIONS The most common abnormal LUS pattern in subjects with severe and critical COVID-19 pneumonia was B-lines, followed by lung consolidation. Bedside LUS can provide important information for pulmonary involvement in patients with COVID-19.
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Affiliation(s)
- Shuangshuang Kong
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ying Tian
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Cheng Yu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Danqing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hong Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xueqin Pang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point of care diaphragm ultrasound: An objective tool to predict the severity of pneumonia and outcomes in children. Pediatr Pulmonol 2021; 56:1666-1672. [PMID: 33656255 DOI: 10.1002/ppul.25352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia. METHODS Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated. RESULTS There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values. CONCLUSION DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point of care diaphragm ultrasound in acute bronchiolitis: A measurable tool to predict the clinical, sonographic severity of the disease, and outcomes. Pediatr Pulmonol 2021; 56:1053-1059. [PMID: 33442908 DOI: 10.1002/ppul.25268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/04/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes to develop a more objective and useful tool in the emergency department. METHODS Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured. RESULTS There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate-severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital. CONCLUSION Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Soto-Murillo MA, Galván-Tejada JI, Galván-Tejada CE, Celaya-Padilla JM, Luna-García H, Magallanes-Quintanar R, Gutiérrez-García TA, Gamboa-Rosales H. Automatic Evaluation of Heart Condition According to the Sounds Emitted and Implementing Six Classification Methods. Healthcare (Basel) 2021; 9:317. [PMID: 33809283 PMCID: PMC7999739 DOI: 10.3390/healthcare9030317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
The main cause of death in Mexico and the world is heart disease, and it will continue to lead the death rate in the next decade according to data from the World Health Organization (WHO) and the National Institute of Statistics and Geography (INEGI). Therefore, the objective of this work is to implement, compare and evaluate machine learning algorithms that are capable of classifying normal and abnormal heart sounds. Three different sounds were analyzed in this study; normal heart sounds, heart murmur sounds and extra systolic sounds, which were labeled as healthy sounds (normal sounds) and unhealthy sounds (murmur and extra systolic sounds). From these sounds, fifty-two features were calculated to create a numerical dataset; thirty-six statistical features, eight Linear Predictive Coding (LPC) coefficients and eight Cepstral Frequency-Mel Coefficients (MFCC). From this dataset two more were created; one normalized and one standardized. These datasets were analyzed with six classifiers: k-Nearest Neighbors, Naive Bayes, Decision Trees, Logistic Regression, Support Vector Machine and Artificial Neural Networks, all of them were evaluated with six metrics: accuracy, specificity, sensitivity, ROC curve, precision and F1-score, respectively. The performances of all the models were statistically significant, but the models that performed best for this problem were logistic regression for the standardized data set, with a specificity of 0.7500 and a ROC curve of 0.8405, logistic regression for the normalized data set, with a specificity of 0.7083 and a ROC curve of 0.8407, and Support Vector Machine with a lineal kernel for the non-normalized data; with a specificity of 0.6842 and a ROC curve of 0.7703. Both of these metrics are of utmost importance in evaluating the performance of computer-assisted diagnostic systems.
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Affiliation(s)
- Manuel A. Soto-Murillo
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Jorge I. Galván-Tejada
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Carlos E. Galván-Tejada
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Jose M. Celaya-Padilla
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Huizilopoztli Luna-García
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Rafael Magallanes-Quintanar
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
| | - Tania A. Gutiérrez-García
- Departamento de Ciencias Computacionales, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Blvd. Marcelino García Barragán 1421, Guadalajara, Jalisco 44430, Mexico;
| | - Hamurabi Gamboa-Rosales
- Unidad Académica de Ingeniería Eléctrica, Universidad Autónoma de Zacatecas, Jardín Juarez 147, Centro, Zacatecas 98000, Mexico; (M.A.S.-M.); (C.E.G.-T.); (J.M.C.-P.); (H.L.-G.); (R.M.-Q.); (H.G.-R.)
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Madden KM, Feldman B, Arishenkoff S, Meneilly GS. A rapid point-of-care ultrasound marker for muscle mass and muscle strength in older adults. Age Ageing 2021; 50:505-510. [PMID: 32909032 PMCID: PMC7936023 DOI: 10.1093/ageing/afaa163] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is defined as the gradual age-associated loss of both muscle quantity and strength in older adults, and is associated with increased mortality, falls, fractures and hospitalisations. Current sarcopenia criteria use dual-energy X-ray absorptiometry (DXA) measures of muscle mass, a test that cannot be performed at the bedside, unlike point-of-care ultrasound (PoCUS). We examined the association between ultrasonic measures of muscle thickness (MT, vastus medialis muscle thickness) and measures of muscle quantity and strength in older adults. METHODS A total of 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited sequentially from geriatric medicine clinics. Each subject had lean body mass (LBM, by bioimpedance assay), grip strength, mid-arm biceps circumference (MABC), gait speed and MT measured. All initial models were adjusted for biological sex. RESULTS In our final parsimonious models, MT showed a strong significant correlation with all measures of muscle mass, including LBM (Standardised β = 0.204 ± 0.058, R2 = 0.577, P < 0.001) and MABC (Standardised β = 0.141 ± 0.067, R2 = 0.417, P = 0.038). With respect to measures of muscle quality, there was a strong significant correlation with grip strength (Standardised β = 0.118 ± 0.115, R2 = 0.511, P < 0.001) but not with subject performance (gait speed). CONCLUSIONS MT showed strong correlations with both measures of muscle mass (LBM and MABC) and with muscle strength (grip strength). Although more work needs to be done, PoCUS shows potential as a screening tool for sarcopenia in older adults.
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Affiliation(s)
- Kenneth M Madden
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Feldman
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Yan Y, Ye M, Dong X, Chen Q, Hong H, Chen L, Luo Y. Prevention of Contrast-Induced Nephropathy by Inferior Vena Cava Ultrasonography-Guided Hydration in Chronic Heart Failure Patients. Cardiology 2021; 146:187-194. [PMID: 33486475 DOI: 10.1159/000512434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contrast-induced nephropathy (CIN) is a common complication resulting from the administration of contrast media. This study was designed to determine whether inferior vena cava (IVC) ultrasonography (IVCU)-guided hydration can reduce the risk of CIN in chronic heart failure patients undergoing coronary angiography or coronary angiography with percutaneous coronary intervention compared with standard hydration. METHODS This prospective clinical trial enrolled 207 chronic heart failure patients from February 2016 to November 2017, who were randomly assigned to either the IVCU-guided hydration group (n = 104) or the routine hydration group (n = 103). In the IVCU-guided group, the hydration infusion rate was set according to the IVC diameter determined by IVCU, while the control group received intravenous infusion of 0.9% saline at 0.5 mL/(kg·h). Serum Cr was measured before and 48-72 h after the procedure. All patients were followed up for 18 months. The incidence of nephropathy and major adverse cardiovascular or cerebrovascular events (MACCEs) was also compared between the 2 groups. RESULTS Statistically significant difference between the 2 groups regarding the occurrence of CIN was observed (12.5 vs. 29.1%, p = 0.004). The hydration volume of the IVCU-guided group was significantly higher than that of the routine group (p < 0.001). In addition, patients receiving IVCU-guided hydration had significantly lower risk of developing MACCEs than patients in the control group during the 18-month follow-up (14.4 vs. 27.2%, p = 0.027). CONCLUSION Our findings support that IVCU-guided hydration is superior to standard hydration in prevention of CIN and may substantially reduce longtime composite major adverse events.
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Affiliation(s)
- Yuanming Yan
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingfang Ye
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xianfeng Dong
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qin Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huashan Hong
- Department of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yukun Luo
- Department of Cardiology, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Yaoting WMD, Huihui CMD, Ruizhong YMD, Jingzhi LMDP, Ji-Bin LMD, Chen L, Chengzhong PMD. Point-of-Care Ultrasound: New Concepts and Future Trends. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rapid Ultrasound for Shock and Hypotension: A Clinical Update for the Advanced Practice Provider: Part 1. Adv Emerg Nurs J 2020; 42:270-283. [PMID: 33105180 DOI: 10.1097/tme.0000000000000321] [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
The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.
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Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020; 24:498-499. [PMID: 32963427 PMCID: PMC7482338 DOI: 10.5005/jp-journals-10071-23510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Bhalla A. Can We Place Central Venous Catheter Safely in Intensive Care Units? Indian J Crit Care Med 2020;24(7):498-499.
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Affiliation(s)
- Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Marín-Gomez FX, Mendioroz Peña J, Canal Casals V, Romero Mendez M, Darnés Surroca A, Nieto Maclino A, Vidal-Alaball J. Environmental and Patient Impact of Applying a Point-of-Care Ultrasound Model in Primary Care: Rural vs. Urban Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3333. [PMID: 32403439 PMCID: PMC7246434 DOI: 10.3390/ijerph17093333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
Motor vehicles are a major contributor to air pollution, and the exposure to this human-caused air pollution can lead to harmful health effects. This study evaluates the impact of the provision of point-of-care ultrasounds (POCUS) by primary care (PC) to avoid the patient's need to travel to a specialized service. The study estimates the costs and air pollution avoided during 2019. The results confirm that performing this ultrasound at the point of care reduces the emission of 61.4 gr of carbon monoxide, 14.8 gr of nitric oxide and 2.7 gr of sulfur dioxide on each trip. During the study, an average of 17.8 km, 21.4 min per trip and almost 2000 L of fuel consumed in a year were avoided. Performing POCUS from PC reduces fuel consumption and the emission of air pollutants and also saves time and money. Furthermore, only 0.3% of the scans had to be repeated by radiologists. However, more studies with more participants need to be done to calculate the exact impact that these pollution reductions will have on human health.
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Affiliation(s)
- Francesc X Marín-Gomez
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Servei d’Atenció Primària Osona, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | - Vicenç Canal Casals
- Centre d’Atenció Primària Vic Nord, Gerència Territorial de Barcelona, Institut Català de la Salut, 08500 Vic, Barcelona, Spain;
| | - Marcos Romero Mendez
- Centre d’Atenció Primària St. Quirze de Besora, Gerència Territorial de Barcelona, Institut Català de la Salut, 08580 Sant Quirze de Besora, Barcelona, Spain;
| | - Ana Darnés Surroca
- Centre d’Atenció Primària Manlleu, Gerència Territorial de Barcelona, Institut Català de la Salut, 08560 Manlleu, Barcelona, Spain;
| | - Antoni Nieto Maclino
- Centre d’Atenció Primària Sta. Eugènia de Berga, Gerència Territorial de Barcelona, Institut Català de la Salut, 08507 Santa Eugènia de Berga, Barcelona, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, 08272 Sant Fruitós de Bages, Spain; (J.M.P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Comparison of Transabdominal and Transrectal Ultrasound for Sizing of the Prostate. Urology 2020; 141:125-129. [PMID: 32333985 DOI: 10.1016/j.urology.2020.04.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the accuracy of prostate sizing between pelvic abdominal (PUS) and transrectal (TRUS) ultrasound in a large, diverse cohort of men at our institution. Prostate volume plays a vital role in all types of prostate disease. American Urological Association guidelines (2018) for surgical management of benign prostatic hyperplasia now include consideration of prostate volume measurement prior to surgical intervention. Ultrasound is a quick and radiation-free imaging modality. METHODS We performed a single-center, retrospective study of 299 patients with prostate sizing between January 1, 2012 and August 31, 2017. Prostate volume was derived from ellipsoid volume calculation using dimensions measured on ultrasound. PUS and TRUS were compared by calculating the Pearson correlation coefficient and intraclass correlation coefficient, and agreement between modalities assessed using the Bland Altman analysis. This analysis was done for the whole sample population as well as for specific groupings according to body mass index, prostate size, and time between exams. RESULTS A total of 236 patients had PUS followed by TRUS and met study inclusion criteria. Median age was 63, median prostate specific antigen value prior to PUS was 7.6 ng/mL, and only 20% were white. Mean volume differences between the two modalities for the data (volPUS - volTRUS) were (-0.3 ± 1.1) cm3. Bland-Altman analysis showed agreement between PUS and TRUS only for prostates ≤ 30 cm3. CONCLUSION For prostates less than 30 cc, we found that PUS is interchangeable with TRUS in estimating prostate volume. However, for larger prostates where size may alter surgical management, we would recommend TRUS or cross-sectional imaging.
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The Use of Ultrasonography in the Emergency Department to Screen Patients After Blunt and Penetrating Trauma: A Clinical Update for the Advanced Practice Provider. Adv Emerg Nurs J 2020; 41:290-305. [PMID: 31687993 DOI: 10.1097/tme.0000000000000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Use of bedside ultrasonography to identify life-threatening injuries for patients with blunt and penetrating trauma is the standard of care in the emergency department. The "FAST" examination-focused assessment with sonography for trauma-ultrasound scan of the chest and abdomen allows clinicians to assess critical regions for free fluid without use of invasive procedures as quickly and as often as needed. In addition, ultrasonography has a high degree of sensitivity and specificity and is safe during pregnancy. For patients requiring evaluation of the pleura, the "eFAST" (or extended FAST) may be conducted, which may serve to locate pleural effusions, hemothorax, and pneumothorax. However, ultrasound quality is operator dependent and is recommended with other diagnostic measures to provide a complete clinical picture of trauma patients. Ongoing development of ultrasound competency among established clinicians and nurse practitioner students is vital to maintain diagnostic accuracy and ensure quality care for trauma patients in the emergency department.
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Mathis G. [Lung Ultrasound in Differential Diagnosis of Dyspnea]. PRAXIS 2020; 109:592-595. [PMID: 32517598 DOI: 10.1024/1661-8157/a003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Lung Ultrasound in Differential Diagnosis of Dyspnea Abstract. Lung ultrasound offers an immediate diagnosis in accordance with the clinical examination in many causes of dyspnea: pleural effusion, pulmonary edema, pneumonia, pulmonary embolism and interstitial lung diseases. At first level exam, CXR, despite its intrinsic limitations and low accuracy, may still play a relevant role. CT scan remains the gold standard, but it requires patient transportation and use of radiation, which precludes an extensive use especially within the same patient. Lung ultrasound, after proper training of the physician, is able to provide greater accuracy than CXR and similar accuracy to the CT scan.
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Abstract
Ultrasonography is a noninvasive, reliable, repeatable, and inexpensive technology that has dramatically changed the practice of medicine. The clinical use of portable ultrasound devices has grown tremendously over the last 10 years in the fields of intensive care, emergency medicine, and anesthesiology. In this review we present the various ways that handheld portable ultrasound devices can be used in austere environments. The purpose of this review is to consider the wide-ranging applications for providers going into the austere environment, which include pulmonary, ocular, vascular, and trauma evaluations, the postdisaster setting, and the role of ultrasonography in tropical diseases. This review is not meant to be a comprehensive how-to guide for each study type, but an overview of some of the more common wilderness applications. This review also focuses on the limitation of each study type. The goal is to help wilderness medicine providers feel more comfortable incorporating ultrasonography as part of their tool kit when heading into austere environments.
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Affiliation(s)
| | - N Stuart Harris
- 2 Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts.,3 Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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A National Survey of Neonatologists: Barriers and Prerequisites to Introduce Point-of-Care Ultrasound in Neonatal ICUs. Ultrasound Q 2018; 33:265-271. [PMID: 28430713 DOI: 10.1097/ruq.0000000000000281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point-of-care (POC) ultrasound refers to the use of portable imaging. Although POC ultrasound is widely available to the neonatologists in Australia and Europe, neonatologists in the United States report limited availability. Our objective was to seek the US neonatologists' perception of barriers and prerequisites in adopting POC ultrasound in neonatal intensive care units. An online survey link was sent via e-mail to 3000 neonatologists included in the database maintained by the American Academy of Pediatrics. Survey results (n = 574) were reported as percentage of total responses. Personal experience requiring an urgent sonography in managing cardiac tamponade or pleural effusion was reported by 78% respondents. However, emergent ultrasound (≤10 min) was not available in 80% of the neonatal intensive care units. We compared the responses based on years of clinical experience (>20 vs <20 years), with 272 (48%) neonatologist reporting more than 20 years of experience. Similarly, results from neonatal fellowship programs were compared with nonteaching/teaching hospitals, with 288 (50%) replies from neonatology fellowship programs. Compared with senior neonatologists, respondents with less than 20 years of clinical experience consider POC ultrasound enhances safety and accuracy of clinical procedures (87% vs 82%) and favor adopting POC ultrasound in clinical practice (92% vs 84%). There were no differences in opinion from neonatology fellowship programs compared with the nonteaching/teaching hospitals. Lack of training guidelines, inadequate support from local radiology department, and legal concerns were reported as the top 3 primary barriers in adopting POC ultrasound. If these barriers could be resolved, 89% respondents were inclined to adopt POC ultrasound in clinical practice.
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Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 45:271-281. [PMID: 30497768 DOI: 10.1016/j.ultrasmedbio.2018.09.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.
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Ketelaars R, Gülpinar E, Roes T, Kuut M, van Geffen GJ. Which ultrasound transducer type is best for diagnosing pneumothorax? Crit Ultrasound J 2018; 10:27. [PMID: 30345473 PMCID: PMC6196148 DOI: 10.1186/s13089-018-0109-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background An accurate physical examination is essential in the care of critically ill and injured patients. However, to diagnose or exclude a pneumothorax, chest auscultation is unreliable compared to lung ultrasonography. In the dynamic prehospital environment, it is desirable to have the best possible ultrasound transducer readily available. The objective is to assess the difference between a linear-array, curved-array, and phased-array ultrasound transducer in the assessment for pneumothorax and to determine which is best. Methods In this double-blinded, cross-sectional, observational study, 15 observers, experienced in lung ultrasonography, each assessed 66 blinded ultrasound video clips of either normal ventilation or pneumothorax that were recorded with three types of ultrasound transducers. The clips were recorded in 11 adult patients that underwent thoracoscopic lung surgery immediately before and after the surgeon opened the thorax. The diagnostic accuracy of the three transducers, elapsed time until a diagnosis was made, and the perceived image quality was recorded. Results In total, 15 observers assessed 990 ultrasound video clips. The overall sensitivity and specificity were 98.2% and 97.2%, relatively. No significant difference was found in the diagnostic performance between transducers. A diagnosis was made slightly faster in the linear-array transducer clips, compared to the phased-array transducer (p = .031). For the linear-, curved-, and phased-array transducer, the image quality was rated at a median (interquartile range [IQR]) of 4 (IQR 3–4), 3 (IQR 2–4), and 2 (IQR 1–2), relatively. Between the transducers, the difference in image quality was significant (p < .0001). Conclusions There was no difference in diagnostic performance of the three transducers. Based on image quality, the linear-array transducer might be preferred for (prehospital) lung ultrasonography for the diagnosis of pneumothorax.
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Affiliation(s)
- R Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Helicopter Emergency Medical Service-Lifeliner 3, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - E Gülpinar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - T Roes
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - M Kuut
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - G J van Geffen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Helicopter Emergency Medical Service-Lifeliner 3, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Michon A, Jammal S, Passeron A, De Luna G, Bomahou C, Jullien V, Pouchot J, Arlet JB, Ranque B. [Use of pocket-sized ultrasound in internal medicine (hospitalist) practice: Feedback and perspectives]. Rev Med Interne 2018; 40:220-225. [PMID: 30078545 DOI: 10.1016/j.revmed.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department. The device used was a Vscan Dual Probe, GE, whose two probes and presets allow for cardiac, abdominal, pulmonary, obstetric, vascular, pulmonary, and superficial soft tissue exploration. One physician of the ward received a course for POCUS that was initially dedicated for emergency physicians. This study reports on the results of the examinations made between January and September 2015. For each examination performed, clinical usefulness was assessed at the time of patient discharge, by two independent physicians who reviewed the clinical course and the results of conventional imaging and rated their evaluation on a Likert scale. RESULTS One hundred and four examinations were evaluated. The mean duration of the ultrasound examination was 9±5minutes. The POCUS conclusions were corrected by disease course or the results of conventional imaging in 10 (9.6%) cases. The presets of the device: heart, soft tissue, lung, abdomen and vascular were used respectively in 32, 30, 21, 12 and 5% of the examinations. The main indications of POCUS examination were for identification of pleural, pericardial or peritoneal effusion, and to assess the central venous pressure by inferior vena cava examination. Eighteen examinations were performed for puncture of effusion. The retrospectively evaluated clinical benefit was clearly demonstrated in 78% of cases. The agreement between the two blinded assessors was good (kappa coefficient at 0.82). CONCLUSION Pocket-sized ultrasound device could be used in internal medicine wards. However, its limited performance compared to more sophisticated echography limits the possible explorations and their reliability, which encourages caution and makes critical the question of the initial training of doctors and medical students.
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Affiliation(s)
- A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - S Jammal
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - G De Luna
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Bomahou
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - V Jullien
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
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Shekarchi B, Hejripour Rafsanjani SZ, Shekar Riz Fomani N, Chahardoli M. Emergency Department Bedside Ultrasonography for Diagnosis of Acute Cholecystitis; a Diagnostic Accuracy Study. EMERGENCY (TEHRAN, IRAN) 2018; 6:e11. [PMID: 29503836 PMCID: PMC5827043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Using bedside ultrasound in diagnosing acute cholecystitis in the emergency department (ED) can save time, help the decision making process and allocate resources wisely. This study aimed to evaluate the diagnostic accuracy of bedside right upper quadrant (RUQ) ultrasonography in detection of acute cholecystitis. METHOD In this diagnostic accuracy study, patients presenting to ED, suffering from RUQ pain in favor of acute cholecystitis underwent RUQ ultrasonography in emergency and radiology departments and interrater agreement between reports was calculated. RESULTS 342 patients with the mean age of 53.92 ± 11.18 (20 - 83) years were studied (63.2% female). The number of patients with at least one sonographic finding of acute cholecystitis were 53 (15.50%) and 48 (14.00%) based on ED and radiology reports (Kappa = 0.826). Sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios of bedside sonography were 89.58 (95%CI: 76.55 - 96.10), 96.59 (95%CI: 93.63 - 98.29), 81.13 (95%CI: 67.58 - 90.11), 98.26 (95%CI: 95.77 - 99.36), 4.30 (95%CI: 2.42 - 7.62) and 0.017 (95%CI: 0.007 - 0.041), respectively. CONCLUSION There was a very good agreement between ED and radiology departments' sonography reports regarding the presence or absence of acute cholecystitis. Sensitivity and specificity of bedside RUQ sonography were 89.58 and 96.59, respectively.
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Affiliation(s)
- Babak Shekarchi
- Department of Radiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | - Nima Shekar Riz Fomani
- Emergency Department, Besat Hospital, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.,Emergency Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.,Corresponding author: Nima Shekar Riz Fomani; Emergency Department, Firoozgar Hospital, Valiasr square, Tehran, Iran. , Mobile phone: +989124984280
| | - Mojtaba Chahardoli
- Emergency Department, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Mengarelli M, Nepusz A, Kondrashova T. A Comparison of Point-of-Care Ultrasonography Use in Rural Versus Urban Emergency Departments Throughout Missouri. MISSOURI MEDICINE 2018; 115:56-60. [PMID: 30228684 PMCID: PMC6139795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We surveyed emergency department directors at 56 Missouri hospitals about availability of ultrasound equipment, primary uses for ultrasonography, and factors that could increase ultrasonography use in the emergency departments. Results indicated large-sized hospitals, typically in urban areas, used ultrasonography more than medium-sized or small-sized hospitals. Lack of ultrasound equipment and appropriately trained physicians contributed to limited use of ultrasonography in small-sized hospitals, typically in rural areas.
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Affiliation(s)
- Michael Mengarelli
- Michael Mengarelli, BS Osteopathic Medical Student, at Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri
| | - Anthony Nepusz
- Anthony Nepusz, BS, Osteopathic Medical Student, at Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri
| | - Tatyana Kondrashova
- Tatyana Kondrashova, MD, PhD, Department of Family Medicine, Preventive Medicine, and Community Health, at Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri
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Cormack CJ, Coombs PR, Guskich KE, Blecher GE, Goldie N, Ptasznik R. Collaborative model for training and credentialing point-of-care ultrasound: 6-year experience and quality outcomes. J Med Imaging Radiat Oncol 2017; 62:330-336. [DOI: 10.1111/1754-9485.12697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Peter R Coombs
- Department of Diagnostic Imaging; Monash Health; Victoria Australia
| | - Kate E Guskich
- Department of Diagnostic Imaging; Monash Health; Victoria Australia
| | | | - Neil Goldie
- Department of Emergency Medicine; Monash Health; Victoria Australia
| | - Ronnie Ptasznik
- Department of Diagnostic Imaging; Monash Health; Victoria Australia
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Wareluk P, Jakubowski W. Evaluation of musculoskeletal symptoms among physicians performing ultrasound. J Ultrason 2017; 17:154-159. [PMID: 29075519 PMCID: PMC5647609 DOI: 10.15557/jou.2017.0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/08/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022] Open
Abstract
Aim of the study Owing to its wide availability, relatively low cost and lack of negative effect on the patient, ultrasound has become the most commonly and readily used imaging modality. However, scanning for increasingly long periods of time on a given day and in a given week tends to negatively affect sonographers’ health, primarily resulting with the overuse of the musculoskeletal system, as multiple muscles and joints are engaged during scanning. This research has been aimed at evaluating the prevalence and type of musculoskeletal symptoms among diagnostic medical sonographers, as well as identifying their professional profile. Material and method The study covered 553 sonographers who responded to an online survey comprising 27 questions, including branching questions allowing to provide more detailed information depending on the answers given, as well as open questions. The survey was geared towards identifying the type and frequency of the experienced symptoms, and determining additional contributing factors. Results 83% of the respondents have experienced work-related musculoskeletal disorders (WRMSD). The study presents the detailed characteristics of the symptoms experienced by sonographers in their work, and their professional profile. Conclusions A majority of physicians performing ultrasound experience musculoskeletal pain. Deeper analysis of the underlying causes and potential correlations with given contributing factors (variables) that could be effectively addressed may facilitate introduction of some preventive measures and occupational hygiene rules in the field of ultrasound diagnostics, as well as help to implement interventions aimed at relieving the experienced symptoms and improving the health of the examining specialists.
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Affiliation(s)
- Paweł Wareluk
- Diagnostic Imaging Department, 2 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Wiesław Jakubowski
- Diagnostic Imaging Department, 2 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Gillman LM, Zeiler FA, Unger B, Karakitsos D. Response to a letter to the editor "Ultrasound assessment of optic nerve sheath diameter in healthy volunteers". J Crit Care 2017; 40:280. [PMID: 28457565 DOI: 10.1016/j.jcrc.2017.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Lawrence M Gillman
- Departments of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Frederick A Zeiler
- Departments of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Bertram Unger
- Medical Education, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dimitrios Karakitsos
- Department of Internal Medicine, University of South Carolina, Columbia, SC, USA
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Wimalasena Y, Kocierz L, Strong D, Watterson J, Burns B. Lung ultrasound: a useful tool in the assessment of the dyspnoeic patient in the emergency department. Fact or fiction? Emerg Med J 2017; 35:258-266. [PMID: 28258097 DOI: 10.1136/emermed-2016-205937] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 12/26/2016] [Accepted: 02/18/2017] [Indexed: 02/01/2023]
Abstract
Patients with respiratory distress present a frequent and challenging dilemma for emergency physicians (EPs). The accurate diagnosis and treatment of the underlying pathology is vitally important in these sick patients to ensure the best outcome and minimise harm from unnecessary treatments. Within the last decade, studies have shown lung ultrasonography (LU) to be valuable in the accurate diagnosis of a variety of lung pathologies, including cardiogenic pulmonary oedema, pleural effusion, pneumothorax, haemothorax and pneumonia. However, despite advances in techniques and the evidence for the use of LU in the diagnosis of respiratory pathology, it remains poorly understood and rarely used by EPs. This clinical review article provides an overview of LU and its relevance as a diagnostic aid to the detection of respiratory pathology in the Emergency Department (ED).
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Affiliation(s)
- Yashvi Wimalasena
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, New South Wales, Australia.,Emergency Department, Lismore Base Hospital, New South Wales, Australia.,University of Sydney, New South Wales, Australia
| | - Laura Kocierz
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Dan Strong
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Joanna Watterson
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, New South Wales, Australia
| | - Brian Burns
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, New South Wales, Australia.,University of Sydney, New South Wales, Australia
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Stanley A, Wajanga BMK, Jaka H, Purcell R, Byrne L, Williams F, Rypien C, Sharpe A, Laws P, Faustine L, Leeme T, Mwabutwa E, Peck R, Stephens M, Kaminstein D. The Impact of Systematic Point-of-Care Ultrasound on Management of Patients in a Resource-Limited Setting. Am J Trop Med Hyg 2017; 96:488-492. [PMID: 27994100 PMCID: PMC5303058 DOI: 10.4269/ajtmh.16-0201] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/14/2016] [Indexed: 11/07/2022] Open
Abstract
Although target point-of-care (POC) ultrasonography has been shown to benefit patients in resource-limited settings, it is not clear whether a systematic POC ultrasound assessment in these settings can also lead to similar changes in patient management. A predefined systematic set of POC ultrasound scans were performed on inpatients at a tertiary referral hospital in Tanzania to see if this resulted in changes to patient management. Of the 55 patients scanned, an abnormality was detected in 75% (N = 41), and a change in patient management was recommended or implemented on the basis of POC ultrasound findings in 53% (N = 29). The main impact was earlier initiation of treatment due to more rapid and accurate diagnosis. Further research is warranted to determine whether systematic POC ultrasonography would result in improved patient outcomes in resource-limited settings.
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Affiliation(s)
- Alastair Stanley
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | - Rachael Purcell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Lauren Byrne
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Felicity Williams
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Candace Rypien
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abigail Sharpe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patrick Laws
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucas Faustine
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tshepo Leeme
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emmanuel Mwabutwa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Peck
- Weill Cornell Medical College, New York, New York
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Point-of-Care Ultrasound for the Regional Anesthesiologist and Pain Specialist. Reg Anesth Pain Med 2017; 42:281-282. [DOI: 10.1097/aap.0000000000000570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist. Reg Anesth Pain Med 2017; 42:632-644. [DOI: 10.1097/aap.0000000000000650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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49
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Point-of-Care Thoracic Ultrasonography in the Diagnosis and Management of Kaposiform Lymphangiomatosis. Pediatr Emerg Care 2016; 32:888-891. [PMID: 27898632 DOI: 10.1097/pec.0000000000000968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Kaposiform lymphangiomatosis is a generalized lymphatic disorder complicated by consumptive coagulopathy and pericardial and pleural effusions. We present the case of a 13-year-old female adolescent given a diagnosis of a large pleural effusion by point-of-care thoracic ultrasonography, which led to further evaluation and diagnosis of this rare disorder. We review the use of point-of-care thoracic ultrasonography for the diagnosis of pleural effusion.
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