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Silva BS, Ferraz B, Costa MI, Brandão ME, Cortesão N. The Influence of Thoracic Ultrasound on the Clinical Practice of Pulmonologists in Portugal. J Bronchology Interv Pulmonol 2024; 31:e0987. [PMID: 39210531 DOI: 10.1097/lbr.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Thoracic ultrasound (TUS) has garnered increased recognition, both in aiding pleural procedures and as a complement to physical examination. Operator ability is essential to obtain reliable findings. This study aimed to inquire pulmonology specialists and residents about their confidence with the technique and to determine future needs. METHODS A self-administered online survey, including a total of 24 questions, was sent to pulmonology specialists and residents registered as members of the Portuguese Pulmonology Society. Participation was pseudoanonymized and voluntary. RESULTS One hundred fourteen valid answers were obtained. Most responders had prior TUS training. The primary method for knowledge consolidation was unsupervised practice. The majority had an ultrasound machine available in their daily practice; only 17% performed TUS more than 3 times per week. Overall confidence in TUS usage for diagnostic purposes (median: 7/10), disease monitoring (median: 7/10), and invasive procedures (median: 8/10) were high. There was a significant relation between higher levels of confidence and regularly attending TUS courses and performing TUS more than 3 times per week. The main reasons cited as preventing regular use of TUS were the availability/cost of courses and the availability/cost of equipment. CONCLUSION Regular TUS training and utilization are essential to boost user's confidence degree. Its use is already a regular feature in the daily practice of pulmonologists in Portugal, but further and better structured training is required to meet the needs of clinicians. The inclusion of mandatory TUS training in residency programs should be considered in the future.
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Affiliation(s)
- Bruno S Silva
- Pulmonology Department, Unidade de Saúde Local de Santo António
- Institute of Biomedical Sciences Abel Salazar of University of Porto, Porto
| | - Beatriz Ferraz
- Pulmonology Department, Unidade de Saúde Local de Santo António
- Institute of Biomedical Sciences Abel Salazar of University of Porto, Porto
| | | | | | - Nuno Cortesão
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
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Cormack CJ, Childs J, Kent F. Competencies required by sonographers teaching ultrasound interprofessionally: a Delphi consensus study. BMC MEDICAL EDUCATION 2024; 24:970. [PMID: 39238012 PMCID: PMC11378574 DOI: 10.1186/s12909-024-05933-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: 03/26/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Clinicians from multiple professional backgrounds are increasingly using point-of-care ultrasound in clinical practice. Performing ultrasound is a complex skill, and training is required to ensure competency and patient safety. There is a lack of skilled trainers within health professions to meet this increasing educational demand. The role of sonographers in educating other health professionals in point-of-care ultrasound has not yet been well defined. Sonographers can provide ultrasound education interprofessionally, if equipped with appropriate clinical knowledge and educational skills. METHODS A Delphi consensus study was conducted to define the knowledge, skills and attributes required of sonographers teaching point-of-care ultrasound to other health professionals in Australia and New Zealand. Health professionals with subject matter expertise in the leadership, facilitation, and delivery of ultrasound education by sonographers were invited to participate. RESULTS There were 72 expert participants in survey round one, and 49 in round two. Participants included physicians, sonographers, and other health professionals. Consensus was reached on 31 competency items for sonographers teaching ultrasound interprofessionally, with agreement of greater than 94% reached by participants. CONCLUSIONS This consensus study has defined the knowledge, skills and attitudes required for sonographer competence in point-of-care ultrasound education. This is an important step to developing a training pathway for sonographers engaging in this emerging area.
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Affiliation(s)
- Carolynne J Cormack
- Faculty of Medicine Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia.
| | - Jessie Childs
- Faculty of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Fiona Kent
- Faculty of Medicine Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
- Royal College of Surgeons in Ireland (RCSI), Health Professions Education Centre, Dublin, Ireland
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Slaugh JD, Issa M, Grimm E, Calderon AJ, Sindelar S, Van Hook R, McBeth L, Maw A. Integration of Diagnostic Lung Ultrasound Into Clinical Practice by Hospitalists in an Academic Medical Center: A Retrospective Chart Review. Cureus 2024; 16:e69796. [PMID: 39308836 PMCID: PMC11416203 DOI: 10.7759/cureus.69796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 09/25/2024] Open
Abstract
Background Point-of-care lung ultrasound (LUS) is a guideline-recommended imaging modality that has been shown to be more accurate than chest radiography for multiple causes of dyspnea. This study was conducted to understand the impact of LUS on real-world clinical decision-making among hospitalists. Methods A retrospective chart review was conducted of patients who received a LUS while hospitalized at a quaternary care academic medical center between July 2020 and June 2022. Data was extracted from the electronic health record (EHR) into a standardized REDCap form. Cases were defined as patients who had received a LUS that (1) had images archived and accessible to viewing through the EHR and (2) had an imaging report documented in the EHR. Results Of the 820 LUSs reviewed, 297 (36.2%) were performed to evaluate for appropriateness of thoracentesis, 205 (25%) for diagnosing or monitoring of pneumonia related to COVID-19, 169 (20.6%) for volume status assessment, 136 (16.6%) for worsening respiratory status, 114 (13.9%) for monitoring pleural effusions, 64 (7.8%) for diagnosing or monitoring of pneumonia not related to COVID-19, and 12 (1.5%) for monitoring of diuresis. Documentation was sufficient to determine clinical decision-making in 730 (89%) of LUSs reviewed, 739 (90.1%) were considered to be diagnostically useful, and 327 (39.9%) changed management. Conclusions These findings suggest LUS was diagnostically useful and routinely changed management in hospitalist practice. Further, documentation in the EHR was sufficient to allow for the evaluation of real-world clinical decision-making using LUS, which is an important gap in both the education and health services research literature.
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Affiliation(s)
- John-David Slaugh
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Meltiady Issa
- Hospital Internal Medicine, Mayo Clinic, Rochester, USA
| | - Eric Grimm
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Solomon Sindelar
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Reed Van Hook
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Lauren McBeth
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Anna Maw
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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Mohsen N, Yeung T, Fadel NB, Abdul Wahab MG, Elsayed Y, Nasef N, Mohamed A. Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey. Eur J Pediatr 2024; 183:3499-3508. [PMID: 38787415 DOI: 10.1007/s00431-024-05591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs. A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Telford Yeung
- Section of Neonatology, Windsor Regional Hospital, University of Windsor, Windsor, Canada
| | - Nadya Ben Fadel
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Yasser Elsayed
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Heslot C, Khan O, Schnitzler A, Haldane C, David R, Reebye R. Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization. Toxins (Basel) 2024; 16:304. [PMID: 39057944 PMCID: PMC11281316 DOI: 10.3390/toxins16070304] [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: 04/24/2024] [Revised: 05/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A.
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Affiliation(s)
- Camille Heslot
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
- Faculty of Medicine, Paris Cité University, 75006 Paris, France
- Department of Physical Medicine and Rehabilitation, GH St Louis Lariboisière F. Widal, 75010 Paris, France
| | - Omar Khan
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
- Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, ON L2T 4C2, Canada
| | - Alexis Schnitzler
- Faculty of Medicine, Paris Cité University, 75006 Paris, France
- Department of Physical Medicine and Rehabilitation, GH St Louis Lariboisière F. Widal, 75010 Paris, France
| | - Chloe Haldane
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
| | - Romain David
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
- Department of Physical Medicine and Rehabilitation, Poitiers University Hospital, 86000 Poitiers, France
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
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Abuguyan F, Almasry NW, Alzahrani AA. Barriers to Point-of-Care Ultrasound Utilization Among Emergency Medicine Residents in Riyadh, Saudi Arabia. Cureus 2024; 16:e65765. [PMID: 39211663 PMCID: PMC11361400 DOI: 10.7759/cureus.65765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency medicine (EM). This study aimed to identify barriers to POCUS utilization among EM residents in the Riyadh region. MATERIALS AND METHODS An observational cross-sectional study was conducted among 116 EM residents from various training centers in Riyadh. Data were collected through self-administered questionnaires assessing demographics, ultrasound (US) training, perceived barriers, and facilitators to POCUS usage. Statistical analysis included descriptive statistics, multiple response dichotomy analysis, and multivariable linear regression. RESULTS The majority of residents had completed US training and recognized the importance of POCUS in emergency settings. However, significant barriers were identified, including time constraints and logistical challenges. Multivariable regression analysis revealed associations between residents' training status, beliefs in incentives, anticipated POCUS use, and perceived barriers. CONCLUSION This study highlights the importance of addressing barriers to POCUS integration into residency programs. Efforts should focus on optimizing training, addressing workflow challenges, and enhancing residents' confidence in POCUS utilization. Targeted interventions tailored to specific clinical contexts may facilitate greater acceptance and integration of POCUS into routine practice.
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Affiliation(s)
- Fahad Abuguyan
- Emergency Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | - Naief W Almasry
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
| | - Ali A Alzahrani
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
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Dieiev V, Dubrov S, Díaz-Gómez JL, Stevens RA, Salinas P, Gudzenko V, Matolinets N, Kravets O, Krishtafor D, Pavlysh O, Cherniaiev S, Pustavoitau A. Point-of-care ultrasonography in Ukraine: a survey of anesthesiologists-intensivists participating in ultrasonography courses. Can J Anaesth 2024:10.1007/s12630-024-02789-z. [PMID: 38918272 DOI: 10.1007/s12630-024-02789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE Despite the potential value of point-of-care ultrasonography (POCUS) in resource-limited environments, it is not widely used in low- and middle-income countries compared with high-income countries. We sought to evaluate the current POCUS practice of Ukrainian anesthesiologists who attended POCUS courses to guide future POCUS training in Ukraine. METHODS We conducted a 25-question web-based survey. It was distributed to 255 participants of POCUS courses held in Ukraine in 2023. The survey sections described current POCUS practice, perception of POCUS value, POCUS skills self-assessment, and perceived barriers to implementing POCUS in clinical practice. RESULTS Two hundred and forty-four out of 255 course participants completed the survey, representing 214 unique respondents. Those who self-rated their skills identified themselves as either novices or beginners in areas of POCUS knowledge (118/157, 75%), image acquisition (110/158, 70%), image interpretation (117/158, 74%), and integration into clinical decision-making (105/155, 68%). Among all survey responders, 55% (118/214) reported using POCUS for vascular access procedures, 45% (97/214) for trauma assessment, and 44% (93/214) for regional anesthesia. Reported barriers to POCUS implementation included lack of ultrasound devices (101/214, 47%) and lack of trained faculty (112/214, 52%). CONCLUSION Among anesthesiologists who participated in POCUS courses in Ukraine, the majority were in early stages of ultrasound practice. Respondents identified POCUS applications not currently practiced and evaluated barriers to POCUS use. Based upon these survey findings, we propose the following measures in Ukraine: 1) developing a standardized national POCUS curriculum; 2) increasing the number of experienced instructors of POCUS; and 3) acquiring ultrasound devices to support clinical applications of POCUS, especially in the Central, Southern, and Eastern regions.
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Affiliation(s)
- Vladyslav Dieiev
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
- Aurora St. Luke's Medical Center, Suite 315, 2901 W. Kinnikinick River Parkway, Milwaukee, WI, 53215, USA.
| | - Sergii Dubrov
- Bogomolets National Medical University, Kiev, Ukraine
| | | | - Rom A Stevens
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Pedro Salinas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Vadim Gudzenko
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Olga Kravets
- Dnipro State Medical University, Dnipro, Ukraine
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Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, Staiano A, Raponi M, Amendolea A, Colacino V, Gori L, Manganaro A, Ricci R, D'Inzeo V, Grosso S, Villani A, Agostiniani R. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50:114. [PMID: 38853266 PMCID: PMC11163714 DOI: 10.1186/s13052-024-01680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
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Affiliation(s)
- Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Monica Tei
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefania Zampogna
- Department Pediatrics, Hospital of Crotone President of SIMEUP (Italian Society of Pediatric Emergency Medicine Urgency), Crotone, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", President of SIP (Italian Society of Pediatric), Naples, Italy
| | - Massimiliano Raponi
- Management and Diagnostic Innovations and Clinical Pathways Research Area, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | | | | | - Laura Gori
- Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, 56100, Italy
| | - Alessandro Manganaro
- Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Victoria D'Inzeo
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Rino Agostiniani
- Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy
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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024; 25:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [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: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Sabath E. Point of care ultrasonography as the new "Laennec Sthetoscope". World J Nephrol 2024; 13:90542. [PMID: 38596268 PMCID: PMC11000039 DOI: 10.5527/wjn.v13.i1.90542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Point of care ultrasonography (POCUS) has evolved to become the fifth pillar of the conventional physical examination, and use of POCUS protocols have significantly decreased procedure complications and time to diagnose. However, lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use. In rural and low-income areas POCUS may have a transformative effect on health care management.
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Affiliation(s)
- Ernesto Sabath
- Renal and Metabolism Unit, Hospital General de Querétaro, Queretaro 76180, Mexico
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11
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van der Leek AP, Metcalfe P. Point-of-care ultrasound Usage and accuracy within a Canadian urology division. Can Urol Assoc J 2024; 18:48-54. [PMID: 37931281 PMCID: PMC10841567 DOI: 10.5489/cuaj.8513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION This research evaluates the utility and precision of point-of-care ultrasound (POCUS) in urology, inspired by recent affirmations of its feasibility and value.1,2 Our study provides valuable insights for urologists about POCUS's practical usage. METHODS A prospective study assessed POCUS usage and accuracy in the University of Alberta's Division of Urology using data from April 4, 2022, to April 4, 2023. Data include POCUS indications, findings, and correlation with the final diagnosis/gold standard. Additionally, a qualitative survey was conducted among urologists and residents about POCUS's pros, cons, and barriers to integration. RESULTS Thirty-three patients underwent POCUS examinations, mainly for suspected hydronephrosis (27%, n=9). Other indications included urinary retention, testicular mass, torsion, cryptorchidism, renal mass, extended focused assessment with sonography in trauma (eFAST ) exams, nephrostomy tube placement confirmation, and scrotal hematomas. POCUS findings matched the final diagnosis in most cases, showing 86% sensitivity, with an average exam time of 1-5 minutes. POCUS showed potential for suprapubic tube insertions. Residents (60%, n=20) were the most frequent users, followed by staff (33%, n=10), and students (6%, n=2). The surveyed urologists and residents expressed comfort with POCUS but cited time, cost, and practicality as barriers. CONCLUSIONS POCUS proves accurate and beneficial in urology, particularly for hydronephrosis. Most findings align with the gold standard, and the average exam time is brief. Barriers include time and cost. Further research is necessary to evaluate cost-effectiveness and POCUS's impact on patient outcomes in routine urologic practice.
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Affiliation(s)
| | - Peter Metcalfe
- Division of Pediatric Surgery, Department of Surgery, University of Alberta, Stollery Children’s Hospital, Edmonton, AB, Canada
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12
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Salame G, Holden M, Lucas BP, Portillo A. Change in economy of ultrasound probe motion among general medicine trainees. Ultrasound J 2024; 16:5. [PMID: 38289444 PMCID: PMC10828286 DOI: 10.1186/s13089-023-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVES To observe change in economy of 9 ultrasound probe movement metrics among internal medicine trainees during a 5-day training course in cardiac point of care ultrasound (POCUS). METHODS We used a novel probe tracking device to record nine features of ultrasound probe movement, while trainees and experts optimized ultrasound clips on the same volunteer patients. These features included translational movements, gyroscopic movements (titling, rocking, and rotation), smoothness, total path length, and scanning time. We determined the adjusted difference between each trainee's movements and the mean value of the experts' movements for each patient. We then used a mixed effects model to trend average the adjusted differences between trainees and experts throughout the 5 days of the course. RESULTS Fifteen trainees were enrolled. Three echocardiographer technicians and the course director served as experts. Across 16 unique patients, 294 ultrasound clips were acquired. For all 9 movements, the adjusted difference between trainees and experts narrowed day-to-day (p value < 0.05), suggesting ongoing improvement during training. By the last day of the course, there were no statistically significant differences between trainees and experts in translational movement, gyroscopic movement, smoothness, or total path length; yet on average trainees took 28 s (95% CI [14.7-40.3] seconds) more to acquire a clip. CONCLUSIONS We detected improved ultrasound probe motion economy among internal medicine trainees during a 5-day training course in cardiac POCUS using an inexpensive probe tracking device. Objectively quantifying probe motion economy may help assess a trainee's level of proficiency in this skill and individualize their POCUS training.
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Affiliation(s)
- Gerard Salame
- Department of Medicine, Saint Joseph Hospital/SCL Health, 1375 E 19th Ave, Denver, CO, 80218, USA.
| | - Matthew Holden
- School of Computer Science, Carleton University, Ottawa, ON, Canada
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- The Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
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13
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Dupriez F, Jarman RD. Normology: Is it Time to Rethink Point-of-Care Ultrasound Training? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241232498. [PMID: 38357688 PMCID: PMC10865953 DOI: 10.1177/23821205241232498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Point-of-care ultrasound (PoCUS) is increasingly being adopted by clinicians to augment their clinical examination and aid procedures. Evidence-based clinical practice guidelines now support many aspects of PoCUS practice. As a result, more and more medical schools are integrating PoCUS into their curricula, creating a significant demand for training resources. All training must ensure that trainees have the appropriate knowledge, skills and behaviour to enable the clinical integration of PoCUS. The transition from supervised to unsupervised practice is an important step in PoCUS, but should not be confused with expertise. At the start of clinical practice, confirming that something is not normal is probably enough, and trainees can subsequently improve their PoCUS diagnostic accuracy at the bedside during clinical rotations. Our hypothesis is that competency can be achieved without the need to scan patients suspected or suffering from the target pathology. This would enable most of the training to be carried out outside the clinical environment, using volunteers in planned sessions. These planned sessions will be able to accommodate a larger number of trainees and may facilitate collaboration between specialties. When patients are scanned in the clinical environment, trainees should have acquired a good level of competence beforehand. In summary, normology principles could help PoCUS trainees, at the start of their training, to acquire the knowledge, skills and behaviour necessary to achieve a level of competency allowing them to proceed to unsupervised practice. Initially confirming whether something is normal or not is enough. Nevertheless, further research should be conducted to support this concept, and its impact on PoCUS teaching in clinical practice.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Robert David Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Tung-Chen Y, García de Casasola Sánchez G, García Rubio S, Beltrán Romero L, Bernabéu Wittel M, Briongos Figuero LS, Canora Lebrato J, García Gil D, López Palmero S, Luordo Tedesco D, Martín Rico P, Mateos González M, Méndez Bailón M, Porcel JM, Serralta G, Torres Arrese M, Oteiza Olaso J, Varela García P, Torres Macho J. Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI). Rev Clin Esp 2024; 224:57-63. [PMID: 38142977 DOI: 10.1016/j.rceng.2023.12.006] [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: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.
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Affiliation(s)
- Yale Tung-Chen
- Coordinador del Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medina Interna (GTECo-SEMI), Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España; Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain.
| | | | | | - Luis Beltrán Romero
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Jesús Canora Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Daniel García Gil
- Servicio de Medicina Interna, Complejo Hospitalario-Puerta del Mar (Hospital San Carlos), Cádiz, Spain
| | | | | | | | - María Mateos González
- Servicio de Medicina Interna, Hospital Infanta Cristina de Parla, Parla, Madrid, Spain
| | - Manuel Méndez Bailón
- Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - José M Porcel
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Gonzalo Serralta
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Madrid, Spain
| | - Marta Torres Arrese
- Servicio de Urgencias, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - Julio Oteiza Olaso
- Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Pablo Varela García
- Servicio de Medicina Interna, Complejo Universitario Hospital de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Juan Torres Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
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Olgers T, Rozendaal J, van Weringh S, van de Vliert R, Laros R, Bouma H, Ter Maaten J. Teaching point-of-care ultrasound using a serious game: a randomized controlled trial. BMC MEDICAL EDUCATION 2023; 23:977. [PMID: 38115017 PMCID: PMC10731722 DOI: 10.1186/s12909-023-04964-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is an important diagnostic tool for internists. However, there are important barriers in learning POCUS, including lack of practice time and lack of experts for supervision. Alternative learning tools may assist in overcoming these barriers. A serious game is being developed specifically for teaching ultrasound. In this study, we assessed the use of a serious game in learning POCUS. METHODS Ultrasound-native medical students were randomly assigned to the intervention group (N = 27) or the control group (N = 26). Both groups performed a real ultrasound on a volunteer after a brief introduction, but the intervention group played a serious game in advance. The endpoints were the assessments of the videos by experts (scoring quality of the probe movements) and the research team (counting probe movements), and probe movements measured with an accelerometer. RESULTS The intervention group completed the exam faster (247 s vs. 347 s, p = 0.006 (95% CI: [30.20;168.80]) and lifted the probe less frequently from the model (0.54 vs. 3.79, p = 0.001 (95% CI: [1.39;5.11]). Also, we found an in-game learning effect between levels, showing a 48% decrease in total playing time (p < 0.001), 36% reduction in attempts per coin (p = 0.007), a 33% reduction in total probe distance (p = 0.002), and a 61% decrease in contact moments (p < 0.001). However, there was no significant difference in expert score between the two groups. CONCLUSION The serious game 'Underwater' is a fun and useful addition to traditional bedside ultrasound learning, which also may overcome one of the most important barriers in learning ultrasound: lack of supervised practice time. We show that the game improves real-practice probe handling with faster and more goal-oriented probe movements.
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Affiliation(s)
- Tycho Olgers
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Jelle Rozendaal
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Sanne van Weringh
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Rachel van de Vliert
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Ranek Laros
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Hjalmar Bouma
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Jan Ter Maaten
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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Breunig M, Kingsley R, Fischer K, Huckabee M. Physician Assistant Student Preceptors and Point-of-Care Ultrasound: Perceptions and Readiness to Teach. J Physician Assist Educ 2023; 34:344-349. [PMID: 37678810 DOI: 10.1097/jpa.0000000000000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) inclusion in medical education is increasing, and understanding of clinical educators' perceptions and use patterns is needed. The purpose of this research project was to explore current use, interest, knowledge, perceptions, and readiness to teach POCUS from the perspectives of clinical preceptors for physician assistant (PA) students. METHODS A survey research study was completed on previously identified preceptors. Descriptive statistics outlined the frequencies of responses. Bivariate analysis with Chi-Square or Fischer Exact Testing was used to identify statistically significant differences between groupings. RESULTS Most preceptors (87.1%) believe POCUS adds clinical value, but a minority received POCUS training (37%), are familiarity with its use (37.4%), and currently use POCUS (23.4%). Two-thirds (66.1%) of preceptors stated they would allow PA students to practice POCUS skills on clinical rotation; however, few (31%) felt comfortable with this and even fewer (22.6%) felt comfortable findings on POCUS into their clinical decision making. CONCLUSIONS Despite support of incorporation of POCUS into PA education, clinical preceptors' readiness to teach POCUS on clinical rotations is limited. This study shows that preceptors are neither comfortable with student use nor incorporating student findings into clinical decision making. A lack of sufficient clinical preceptors to support POCUS education has not been previously reported. PA programs attempting to incorporate POCUS into their curricula will need to be intentional providing opportunities to continue POCUS on clinical rotations.
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Affiliation(s)
- Michael Breunig
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Ryan Kingsley
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Karen Fischer
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Michael Huckabee
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
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Adelman MH, Deshwal H, Pradhan D. Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey. POCUS JOURNAL 2023; 8:202-211. [PMID: 38099164 PMCID: PMC10721306 DOI: 10.24908/pocus.v8i2.16640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Purpose: Competency assessment standards for Critical Care Ultrasonography (CCUS) for Graduate Medical Education (GME) trainees in pulmonary/critical care medicine (PCCM) fellowship programs are lacking. We sought to answer the following research questions: How are PCCM fellows and teaching faculty assessed for CCUS competency? Which CCUS teaching methods are perceived as most effective by program directors (PDs) and fellows. Methods: Cross-sectional, nationwide, electronic survey of PCCM PDs and fellows in accredited GME training programs. Results: PDs and fellows both reported the highest rates of fellow competence to use CCUS for invasive procedural guidance, but lower rates for assessment of deep vein thrombosis and abdominal organs. 54% and 90% of PDs reported never assessing fellows or teaching faculty for CCUS competency, respectively. PDs and fellows perceived hands-on workshops and directly supervised CCUS exams as more effective learning methods than unsupervised CCUS archival with subsequent review and self-directed learning. Conclusions: There is substantial variation in CCUS competency assessment among PCCM fellows and teaching faculty nationwide. The majority of training programs do not formally assess fellows or teaching faculty for CCUS competence. Guidelines are needed to formulate standardized competency assessment tools for PCCM fellowship programs.
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Affiliation(s)
- Mark H Adelman
- Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of MedicineNew York, NYUSA
| | - Himanshu Deshwal
- Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University Health Sciences CenterMorgantown, WVUSA
| | - Deepak Pradhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University Health Sciences CenterMorgantown, WVUSA
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Yastrebov K, Costello C, Taylor B, Torda A. Point-of-care ultrasonography-An essential skill for medical graduates? Australas J Ultrasound Med 2023; 26:272-274. [PMID: 38098619 PMCID: PMC10716562 DOI: 10.1002/ajum.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The recent proliferation of point-of-care ultrasonography (POCUS) in the clinical practice of many medical specialties has exposed persistent barriers to education, training and standardisation. Specialist training curriculums are already overwhelming, having grossly insufficient time available for the specialist trainees and for the small number of available trainers alike to incorporate POCUS into postgraduate education. The logical solution to overcome these barriers could be to incorporate basic POCUS education and training into the undergraduate university curriculums, introducing longitudinal integration with other relevant medical sciences. The Australasian Society of Ultrasound in Medicine already has well-established educational programmes in POCUS with standardised assessment of competency, which could potentially offer the basis for symbiosis with the Australian and New Zealand medical schools.
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Affiliation(s)
| | - Cartan Costello
- College of Intensive Care Medicine of Australia and New ZealandPrahranVictoriaAustralia
| | - Ben Taylor
- University of New South WalesSydneyNew South WalesAustralia
| | - Adrienne Torda
- University of New South WalesSydneyNew South WalesAustralia
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19
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Yamada T, Minami T, Kitano Y, Yoshino S, Mabuchi S, Soni NJ. Development of a national point-of-care ultrasound training course for physicians in Japan: A 3-year evaluation. MEDEDPUBLISH 2023; 13:223. [PMID: 38303735 PMCID: PMC10831232 DOI: 10.12688/mep.19679.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose: Point-of-care ultrasound (POCUS) allows bedside clinicians to acquire, interpret, and integrate ultrasound images into patient care. Although the availability of POCUS training courses has increased, the educational effectiveness of these courses is unclear. Methods: From 2017 to 2019, we investigated the educational effectiveness of a standardized 2-day hands-on POCUS training course and changes in pre- and post-course exam scores in relationship to participants' (n = 571) clinical rank, years of POCUS experience, and frequency of POCUS use in clinical practice. Results: The mean pre- and post-course examination scores were 67.2 (standard deviation [SD] 12.3) and 79.7 (SD 9.7), respectively. Higher pre-course examination scores were associated with higher clinical rank, more years of POCUS experience, and more frequent POCUS use (p < 0.05). All participants showed significant changes in pre- to post-course exam scores. Though pre-course scores differed by clinical rank, POCUS experience, and frequency of POCUS use, differences in post-course scores according to participant baseline differences were non-significant. Conclusion: A standardized hands-on POCUS training course is effective for improving POCUS knowledge regardless of baseline differences in clinical rank, POCUS experience, or frequency of POCUS use. Future studies shall evaluate changes in POCUS use in clinical practice after POCUS training.
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Affiliation(s)
- Toru Yamada
- General Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, 279-0001, Japan
- General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Taro Minami
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
- Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Health System, Providence, Rhode Island, USA
| | - Yuka Kitano
- Emergency and Critical Care Medicine, St. Marianna University, School of Medicine, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shunpei Yoshino
- General Internal Medicine, Iizuka Byoin, Iizuka, Fukuoka Prefecture, 135-0041, Japan
| | - Suguru Mabuchi
- General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Nilam J. Soni
- Medicine, Division of Hospital Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
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Wilson M. A case study of cardiogenic shock to survival: Critical Care Outreach and Focused Cardiac Ultrasound. Intensive Crit Care Nurs 2023; 78:103481. [PMID: 37384976 DOI: 10.1016/j.iccn.2023.103481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Mark Wilson
- Critical Care Outreach, Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, United Kingdom.
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Knight J, Zhou Y, Keen C, Hareendranathan AR, Alves-Pereira F, Ghasseminia S, Wichuk S, Brilz A, Kirschner D, Jaremko J. 2D/3D ultrasound diagnosis of pediatric distal radius fractures by human readers vs artificial intelligence. Sci Rep 2023; 13:14535. [PMID: 37666945 PMCID: PMC10477281 DOI: 10.1038/s41598-023-41807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Wrist trauma is common in children and generally requires radiography for exclusion of fractures, subjecting children to radiation and long wait times in the emergency department. Ultrasound (US) has potential to be a safer, faster diagnostic tool. This study aimed to determine how reliably US could detect distal radius fractures in children, to contrast the accuracy of 2DUS to 3DUS, and to assess the utility of artificial intelligence for image interpretation. 127 children were scanned with 2DUS and 3DUS on the affected wrist. US scans were then read by 7 blinded human readers and an AI model. With radiographs used as the gold standard, expert human readers obtained a mean sensitivity of 0.97 and 0.98 for 2DUS and 3DUS respectively. The AI model sensitivity was 0.91 and 1.00 for 2DUS and 3DUS respectively. Study data suggests that 2DUS is comparable to 3DUS and AI diagnosis is comparable to human experts.
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Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Yuyue Zhou
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Christopher Keen
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Abhilash Rakkunedeth Hareendranathan
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Fatima Alves-Pereira
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Siyavesh Ghasseminia
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Stephanie Wichuk
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Alan Brilz
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - David Kirschner
- Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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Grubic N, Belliveau DJ, Herr JE, Nihal S, Wong SWS, Lam J, Gauthier S, Montague SJ, Durbin J, Mulvagh SL, Johri AM. Training of Non-expert Users Using Remotely Delivered, Point-of-Care Tele-Ultrasound: A Proof-of-Concept Study in 2 Canadian Communities. Ultrasound Q 2023; 39:118-123. [PMID: 36197076 DOI: 10.1097/ruq.0000000000000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Many physicians, particularly those practicing in remote regions, lack training opportunities to develop point-of-care ultrasound (POCUS) skills. This pretest-posttest study quantified the skill improvement of learners after participating in a virtual training program that used real-time, remotely delivered point-of-care tele-ultrasound (tele-POCUS) for teaching and learner feedback provision. Ten physicians practicing in an urban tertiary (Kingston, Ontario, Canada, n = 6) or remote care center (Moose Factory, Ontario, Canada, n = 4) completed a 3-week educational program that consisted of e-learning module review, independent image acquisition practice, and expert-guided tele-POCUS consultations. Pretraining and posttraining assessments were performed to evaluate skill enhancement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS using a 5-point Likert scale. A total of 76 tele-POCUS consultations were performed during the study period. Significant improvements in image quality were noted following remotely delivered mentorship and guidance (all P < 0.01). In cardiac POCUS, pretraining and posttraining comparisons noted significant improvements in image acquisition (means, 2.69-4.33; P < 0.02), quality (means, 2.40-4.03; P < 0.01), and interpretation (means, 2.50-4.40; P < 0.02). In lung/pleura POCUS, significant improvements in image acquisition (means, 3.00-4.43; P < 0.01), quality (means, 3.23-4.37; P < 0.01), and interpretation (means, 3.00-4.40; P < 0.01) were demonstrated. Introductory ultrasound can be taught to novice users using a virtual, live-streamed training format with tele-POCUS while demonstrating significant enhancement in imaging skills.
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Affiliation(s)
| | | | | | - Salwa Nihal
- Medicine, Queen's University, Kingston, Ontario
| | | | - Jeffrey Lam
- Medicine, Queen's University, Kingston, Ontario
| | | | | | | | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Patrick DP, Bradley XG, Wolek C, Anderson B, Grady J, Herbst MK. Minutes matter: Time it takes to perform point-of-care ultrasound. AEM EDUCATION AND TRAINING 2023; 7:e10901. [PMID: 37600853 PMCID: PMC10436032 DOI: 10.1002/aet2.10901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
Background While point-of-care ultrasound (PoCUS) is a safe, versatile tool that can improve patient care, the perceived time investment needed to incorporate PoCUS into clinical care is cited as a barrier to performance. We sought to determine the time it takes to perform a PoCUS examination and whether this time was influenced by training level and prior ultrasound experience. Methods This was a retrospective study looking at time stamps of all emergency medicine (EM) provider-performed PoCUS examinations during clinical shifts from August 10, 2019, to June 7, 2022, at a suburban academic emergency department that is the site for a 3-year EM residency. Our workflow is order-based; when PoCUS is ordered, that patient's information populates the ultrasound machine worklist. Selecting the patient's name from the worklist generates a time-stamped patient information page (PIP). We defined the PIP time stamp as the start of the PoCUS examination. The duration of one PoCUS examination was defined as the time of the last image acquired minus the time of the PIP. General estimating equations were used to estimate differences between training level and between prior scan status using an exchangeable correlation and Tukey adjusted pairwise comparisons. A two-tailed chi-square analysis was used for comparing accuracy according to training level. Results Of 4187 PoCUS examinations abstracted, 2144 met study criteria. The median (IQR) time spent per examination was 6.0 (3-9) min. First-year residents took the longest to perform PoCUS among all providers (p < 0.0001). Residents with fewer than 250 prior scans took longer than residents with 501-800 (p = 0.0002) and >800 (p = 0.0013). Resident accuracy was not significantly different according to training level. Conclusions Overall median time to perform PoCUS was 6.0 min. EM residents became more efficient in performing PoCUS as they advanced from first- to third-year, without compromising accuracy.
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Affiliation(s)
| | - Xenia Gia Bradley
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Caroline Wolek
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Bowen Anderson
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - James Grady
- Department of Public Health SciencesUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Meghan Kelly Herbst
- Department of Emergency MedicineUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
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Shah RD, Leviter J, Riera A. Acute and Critical Pathology Diagnosed by Timely Point-of-Care Ultrasound Review at a Tertiary Children's Hospital. Pediatr Emerg Care 2023; 39:636-640. [PMID: 37256276 DOI: 10.1097/pec.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Elhassan MG, Grewal S, Nezarat N. Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users. Cureus 2023; 15:e43655. [PMID: 37600433 PMCID: PMC10436027 DOI: 10.7759/cureus.43655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.
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Affiliation(s)
| | - Sarbjot Grewal
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Negin Nezarat
- Internal Medicine, Saint Agnes Medical Center, Fresno , USA
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Arnold AC, Fleet R, Lim D. Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105821. [PMID: 37239548 DOI: 10.3390/ijerph20105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.
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Affiliation(s)
- Annie C Arnold
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Richard Fleet
- Family and Emergency Medicine, Universite Laval, Quebec City, QC G1V0A6, Canada
| | - David Lim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Translational Health Research Institute, School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
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Dupriez F, de Castro BR, Gendebien F, Fasseaux A, Gensburger M, Marissiaux L, Penaloza A, Bobbia X, Jarman R. Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial. Ultrasound J 2023; 15:18. [PMID: 37036612 PMCID: PMC10086079 DOI: 10.1186/s13089-023-00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula. MATERIALS AND METHODS Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students' PoCUS gallstone diagnosis were assessed. Secondary outcomes were students' confidence, image quality, acquisition time, and PoCUS skills. RESULTS Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes. CONCLUSIONS Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium.
| | | | - Félix Gendebien
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
- Emergency Department, Hôpital de Jolimont - Lobbes, Lobbes, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont - Lobbes, Haine-Saint-Paul, Belgium
| | - Matthieu Gensburger
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
| | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle, UK
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Russell FM, Herbert A, Lobo D, Ferre R, Nti BK. Evaluation of Point-of-Care Ultrasound Training for Family Physicians Using Teleultrasound. Fam Med 2023; 55:263-266. [PMID: 37043188 PMCID: PMC10622021 DOI: 10.22454/fammed.2023.469019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The goal of this study was to assess family physicians' change in knowledge and ability to perform abdominal aorta ultrasound after implementation of a novel teleultrasound curriculum. METHODS This was a prospective, observational study conducted at a single academic institution. Family physicians completed a preassessment, test, and objective structured clinical evaluation (OSCE). Physicians then individually completed a standard curriculum consisting of online content and an hour-long, hands-on training session on abdominal aorta ultrasound using teleultrasound technology. Physicians then performed a minimum of 10 independent examinations over a period of 8 weeks. After physicians completed the training curriculum and 10 independent scans, we administered a postassessment, test, and OSCE. We analyzed differences between pre- and postcurriculum responses using Fisher exact and Wilcoxon signed rank tests. RESULTS Thirteen family physicians completed the curriculum. Comparing pre- to postcurriculum responses, we found significant reductions in barriers to using aorta POCUS and improved confidence in using, obtaining, and interpreting aorta POCUS (P<0.01). Knowledge improved from a median score of 70% to 90% (P<0.01), and OSCE scores improved from a median of 80% to 100% (P=0.012). Overall, 211 aorta ultrasound examinations were independently acquired with a median image quality of 4 (scale 1 to 4). CONCLUSIONS After an 8-week teleultrasound curriculum, family physicians with minimal experience with POCUS showed improved knowledge and psychomotor skill in abdominal aorta POCUS.
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Affiliation(s)
- Frances M. Russell
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Audrey Herbert
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Daniela Lobo
- Department of Family Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Robinson Ferre
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
| | - Benjamin K. Nti
- Department of Emergency Medicine, Indiana University School of MedicineIndianapolis, IN
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Gaudreau-Simard M, Kilabuk E, Halman S, Wooller K, Woo MY, Arntfield R, Ma I, Forster AJ. Start spreading the news: a deliberate approach to POCUS program development and implementation. Ultrasound J 2023; 15:13. [PMID: 36892686 PMCID: PMC9998745 DOI: 10.1186/s13089-023-00309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 03/10/2023] Open
Abstract
While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.
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Affiliation(s)
- Mathilde Gaudreau-Simard
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada.
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada.
| | - Elaine Kilabuk
- Division of General Internal Medicine, Department of Medicine, The Ottawa General Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1Y 4E9, Canada
| | - Samantha Halman
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
- Division of General Internal Medicine, Department of Medicine, The Ottawa General Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1Y 4E9, Canada
| | - Krista Wooller
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
| | - Michael Y Woo
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
- Department of Emergency Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Robert Arntfield
- Division of Critical Care, London Health Sciences Center, Victoria Hospital, Western University, 800 Commissioners Road East, Room D2 521A, London, ON, N6A 5W9, Canada
| | - Irene Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Alan J Forster
- Division of General Internal Medicine, Department of Medicine, The Ottawa Civic Hospital, University of Ottawa, 1053 Carling Ave, D 107, Box 209, Ottawa, ON, K1Y 4E9, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 725 Parkdale Ave, Ottawa, ON, K1y 4E9, Canada
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Utility of hand-held ultrasound for image acquisition and interpretation by trained Kenyan providers. Ultrasound J 2023; 15:12. [PMID: 36884093 PMCID: PMC9995612 DOI: 10.1186/s13089-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) plays a prominent role in the timely recognition and management of multiple medical, surgical, and obstetric conditions. A POCUS training program for primary healthcare providers in rural Kenya was developed in 2013. A significant challenge to this program is the acquisition of reasonably priced ultrasound machines with adequate image quality and the ability to transmit images for remote review. The goal of this study is to compare the utility of a smartphone-connected, hand-held ultrasound with a traditional ultrasound device for image acquisition and interpretation by trained healthcare providers in Kenya. METHODS This study took place during a routine re-training and testing session for healthcare providers who had already received POCUS training. The testing session involved a locally validated Observed Structured Clinical Exam (OSCE) that assessed trainees' skills in performing the Extended Focused Assessment with Sonography for Trauma (E-FAST) and focused obstetric exams. Each trainee performed the OSCE twice, once using a smartphone-connected hand-held ultrasound and once using their notebook ultrasound model. RESULTS Five trainees obtained a total of 120 images and were scored on image quality and interpretation. Overall E-FAST imaging quality scores were significantly higher for the notebook ultrasound compared to the hand-held ultrasound but there was no significant difference in image interpretation. Overall focused obstetric image quality and image interpretation scores were the same for both ultrasound systems. When separated into individual E-FAST and focused obstetric views, there were no statistically significant differences in the image quality or image interpretation scores between the two ultrasound systems. Images obtained using the hand-held ultrasound were uploaded to the associated cloud storage using a local 3G-cell phone network. Upload times were 2-3 min. CONCLUSION Among POCUS trainees in rural Kenya, the hand-held ultrasound was found to be non-inferior to the traditional notebook ultrasound for focused obstetric image quality, focused obstetric image interpretation, and E-FAST image interpretation. However, hand-held ultrasound use was found to be inferior for E-FAST image quality. These differences were not observed when evaluating each E-FAST and focused obstetric views separately. The hand-held ultrasound allowed for rapid image transmission for remote review.
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Kern J, Scarpulla M, Finch C, Martini W, Bolch CA, Al-Nakkash L. The assessment of point-of-care-ultrasound (POCUS) in acute care settings is benefitted by early medical school integration and fellowship training. J Osteopath Med 2023; 123:65-72. [PMID: 36121935 DOI: 10.1515/jom-2021-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/29/2022] [Indexed: 01/29/2023]
Abstract
CONTEXT Point-of-care ultrasound (POCUS) has widespread utilization in multiple clinical settings. It has been shown to positively influence clinician confidence in diagnosis and can help appropriately manage patients in acute care settings. There has been a growing trend of increased emphasis on incorporating POCUS training in the first 2 years of the medical school curriculum. OBJECTIVES This article aims to analyze the clinical use of POCUS in acute settings and how training early in medical school may strengthen clinician confidence and utilization. METHODS An anonymous 10-question survey on POCUS use was conducted via a secure online platform and distributed to board-certified practicing physicians (MDs and DOs) with educational agreements with Midwestern University (MWU) across acute care specialties. This included preceptors within the MWU graduate medical education clinical consortium. Survey questions were aimed at assessing frequency of use, machine type, reasons for utilizing POCUS, initial ultrasound training, confidence in performing/interpreting POCUS, and perceived impact on patient outcomes. Surveys less than 50% complete were excluded. All surveys returned were more than 50% complete and thus included in the study. Statistical analyses were conducted utilizing the statistical software R version 4.0. RESULTS Surveys were sent out to 187 participants with 68 responses (36.4% response rate). The survey results demonstrated a relationship between learning POCUS earlier in one's medical career (medical school, residency, or fellowship) to increased use in acute settings when compared to learning POCUS during clinical practice. Of the 68 respondents, 65 (95.6%) indicated that they agree or strongly agree that POCUS use improves patient care, and 64 (94.1%) indicated that they agree or strongly agree that the use of POCUS can improve patient outcomes. CONCLUSIONS Our survey of acute care physicians indicated that most respondents utilize POCUS daily or weekly (90.8%), and this was related to fewer years of practice (under 10 years from medical school graduation, 94.6%). Moreover, POCUS was utilized primarily in acute care settings for procedures (25%, n=17/68 respondents). These survey results indicate that early integration of POCUS education in osteopathic medical school curricula and throughout fellowship training could likely enhance POCUS utilization in acute care settings.
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Affiliation(s)
- Julia Kern
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Megan Scarpulla
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Charles Finch
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Wayne Martini
- Department of Emergency Medicine, Abrazo Health Network, Goodyear, AZ, USA
| | - Charlotte A Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
| | - Layla Al-Nakkash
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
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Doran J, Hanna R, Nyagura-Mangori T, Mahotra N, Das SK, Borok M, Musani A, Maw AM. Stakeholder perspectives on current determinants of ultrasound-guided thoracentesis in resource limited settings: a qualitative study. BMJ Open 2022; 12:e064638. [PMID: 36523247 PMCID: PMC9748956 DOI: 10.1136/bmjopen-2022-064638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Preprocedure pleural fluid localization using bedside ultrasound has been shown to reduce complications related to thoracentesis and is now considered the standard of care. However, ultrasound-guided thoracentesis (USGT) has not been broadly adopted in many low-resource settings. With increasing affordability and portability of ultrasound equipment, barriers to USGT are changing. The aim of this multisite qualitative study is to understand the current barriers to USGT in two resource-limited settings. SETTING We studied two geographically diverse settings, Harare, Zimbabwe, and Kathmandu, Nepal. PARTICIPANTS 19 multilevel stakeholders including clinical trainees, attendings, clinical educators and hospital administrators were interviewed. There were no exclusion criteria. PRIMARY OUTCOME To understand the current determinants of USGT adoption in these settings. RESULTS Three main themes emerged from these interviews: (1) stakeholders perceived multiple advantages of USGT, (2) access to equipment and training were perceived as limited and (3) while an online training approach is feasible, stakeholders expressed scepticism that this was an appropriate modality for procedural training. CONCLUSION Our data suggests that USGT implementation is desired by local stakeholders and that the development of an educational intervention, cocreated with local stakeholders, should be explored to ensure optimal contextual fit.
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Affiliation(s)
- Jennifer Doran
- Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA
| | - Reem Hanna
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Narayan Mahotra
- Division of Physiology, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | - Santa Kumar Das
- Division of Pulmonary and Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Magaret Borok
- Unit of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Ali Musani
- Division of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anna M Maw
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
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Schiavon R, Casella F, Cogliati C. Moving forward with point-of-care ultrasound: An (early) educational effort can (also) strengthen research. Eur J Intern Med 2022; 106:54-55. [PMID: 36229284 DOI: 10.1016/j.ejim.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022]
Affiliation(s)
- R Schiavon
- Internal Medicine, L. Sacco Hospital, ASST FBF-Sacco, Milan, Italy
| | - F Casella
- Internal Medicine, L. Sacco Hospital, ASST FBF-Sacco, Milan, Italy
| | - C Cogliati
- Internal Medicine, L. Sacco Hospital, ASST FBF-Sacco, Milan, Italy; Department of biochemical and clinical sciences, University of Milan, Italy.
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Bedside Point-of-Care Ultrasonography in Anesthesiology and Pain Management: A New Trend in Iran: A Narrative Review. Neuromodulation 2022. [DOI: 10.5812/ipmn-123157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
: Since the emergence of ultrasonography, many specialists, including anesthesiologists, have become interested in its practices. Technological innovations in portable ultrasonography devices and their quality enable anesthesiologists to use ultrasonography in various medical conditions and improve their diagnostic and therapeutic interventions. This article clarifies the significance of point-of-care ultra-sonography (POCUS) and highlights the challenges ahead. POCUS can help regional anesthesiologists and pain physicians in vascular access, airway management, focused cardiac ultra-sound (FoCUS), lung ultrasound, gastric ultrasound, focus assessment with sonography in trauma (FAST), regional and neuraxial nerve blocks, and acute and chronic pain management. However, similar to any new clinical method, there are challenges to POCUS, especially in developing countries like Iran. These challenges include the need for more budget allocation for medical equipment and portable devices, developing a comprehensive local curriculum and transparent framework to train residents and postgraduates, creating and/or revising university policies, clinical coordination with healthcare networks, and collaboration with healthcare providers. This article expresses the importance and effectiveness of point-of-care sonography performed by anesthesiologists and pain specialists in Iran and highlights the challenges ahead.
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Mao JY, Zhang HM, Liu DW, Wang XT. Visual Rounds Based on Multiorgan Point-of-Care Ultrasound in the ICU. Front Med (Lausanne) 2022; 9:869958. [PMID: 35692540 PMCID: PMC9174546 DOI: 10.3389/fmed.2022.869958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/15/2022] [Indexed: 11/20/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) is performed by a treating clinician at the patient's bedside, provides a acquisition, interpretation, and immediate clinical integration based on ultrasonographic imaging. The use of POCUS is not limited to one specialty, protocol, or organ system. POCUS provides the treating clinician with real-time diagnostic and monitoring information. Visual rounds based on multiorgan POCUS act as an initiative to improve clinical practice in the Intensive Care Unit and are urgently needed as part of routine clinical practice.
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Affiliation(s)
- Jia-Yu Mao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiao-Ting Wang
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Majzoub J, Tavelli L, Barootchi S, Salami A, Inglehart MR, Kripfgans OD, Chan HL. Agreement in measurements of ultrasonography-derived periodontal diagnostic parameters among multiple raters: A diagnostic accuracy study. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:375-385. [PMID: 35568639 DOI: 10.1016/j.oooo.2022.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 03/08/2022] [Accepted: 03/19/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the reproducibility of measurements of ultrasound-derived periodontal diagnostic parameters (PDPs) among raters. STUDY DESIGN Periodontists with various degrees of ultrasound experience were invited to measure 3 PDPs: soft tissue height (STH), soft tissue thickness (STT), and crestal bone thickness (CBT) on 37 human periodontal ultrasound scans acquired at the midfacial site of non-molar maxillary teeth. After an online training session and a 2-week calibration exercise, intraclass correlation coefficients (ICCs) were estimated with mixed linear regression models. The interrater mean absolute differences (MADs) were calculated among the raters and between the raters and a reference standard examiner. RESULTS Thirteen raters participated in the study. MADs among the 13 raters were 0.18 mm (STH), 0.16 mm (STT), and 0.12 mm (CBT). ICC values for STH, STT, and CBT were 0.83, 0.77, and 0.76, respectively. The MADs between the raters and the reference standard were 0.23 mm (STH), 0.19 mm (STT), and 0.14 mm (CBT). Survey results showed that ultrasound has diagnostic value and is generally easy to learn. CONCLUSIONS Within the limitations of this study, good agreement was observed among ultrasound learners with various degrees of experience when measuring ultrasound-derived PDPs.
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Affiliation(s)
- Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard, School of Dental Medicine, Boston, MA, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA; Department of Psychology, College of Literature, Science and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Biomedical Engineering, College of Engineering, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
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Smith CJ, Barron K, Shope RJ, Beam E, Piro K. Motivations, barriers, and professional engagement: a multisite qualitative study of internal medicine faculty's experiences learning and teaching point-of-care ultrasound. BMC MEDICAL EDUCATION 2022; 22:171. [PMID: 35279153 PMCID: PMC8918294 DOI: 10.1186/s12909-022-03225-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) graduate medical education is expanding across many specialties, but a lack of trained faculty is a common barrier. Even well-designed faculty development programs struggle with retention, yet little is known about the experiences of practicing physicians learning POCUS. Our objective is to explore the experiences of clinician-educators as they integrate POCUS into their clinical and teaching practices to help inform curriculum design. METHODS Qualitative study using instrumental case study design to analyze interview data from 18 internal medicine clinician-educators at 3 academic health centers. Interviewees were recruited by program directors at each site to include participants with a range of POCUS use patterns. Interviews took place from July-August 2019. RESULTS Analysis yielded 6 themes: teaching performance, patient care, curriculum needs, workflow and access, administrative support, and professional engagement. Participants felt POCUS enhanced their teaching skills, clinical decision making, and engagement with patients. The themes highlighted the importance of longitudinal supervision and feedback, streamlined integration of POCUS into clinical workflow, and administrative support of time and resources. Interviewees reported learning and teaching POCUS helped combat burn-out and enhance their sense of professional engagement. CONCLUSIONS Learning POCUS as a practicing clinician-educator is a complicated endeavor that must take into account mastery of psychomotor skills, existing practice habits, and local institutional concerns. Based upon the themes generated from this study, we make recommendations to help guide POCUS faculty development curriculum design. Although this study focused on internists, the findings are likely generalizable to other specialties with growing interest in POCUS education.
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Affiliation(s)
- Christopher J Smith
- Department of Internal Medicine, Division of Hospital Medicine, University of Nebraska Medical Center, 986430 Nebraska Medical Center, Omaha, NE, USA.
| | - Keith Barron
- Prisma Health Midlands - University of South Carolina School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 14 Richland Medical Park Drive, Suite, Columbia, SC, 320, USA
| | - Ronald J Shope
- Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Beam
- Interprofessional Academy of Educators, University of Nebraska Medical Center, 987115 Nebraska Medical Center, Omaha, NE, USA
| | - Kevin Piro
- Department of Internal Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3270 SW Pavilion Loop Suite, Portland, OR, 350, USA
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Kang SY, Park S, Jo IJ, Jeon K, Kim S, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG, Yoon H. Impact of Insurance Benefits and Education on Point-of-Care Ultrasound Use in a Single Emergency Department: An Interrupted Time Series Analysis. Medicina (B Aires) 2022; 58:medicina58020217. [PMID: 35208540 PMCID: PMC8878237 DOI: 10.3390/medicina58020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions—expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p < 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.
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Affiliation(s)
- Soo-Yeon Kang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
- Department of Emergency Medicine, Graduate School of Kangwon National University, Chuncheon-si 24341, Korea
| | - Sookyung Park
- Samsung Medical Center, Department of Nursing, Seoul 06351, Korea;
| | - Ik-Joon Jo
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Seonwoo Kim
- Biomedical Statistics Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul 06351, Korea;
| | - Guntak Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Jong-Eun Park
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Taerim Kim
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Se-Uk Lee
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Sung-Yeon Hwang
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Won-Chul Cha
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Tae-Gun Shin
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
| | - Hee Yoon
- Samsung Medical Center, Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.-Y.K.); (I.-J.J.); (G.L.); (J.-E.P.); (T.K.); (S.-U.L.); (S.-Y.H.); (W.-C.C.); (T.-G.S.)
- Correspondence:
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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Rajendram R, Alrasheed AO, Boqaeid AA, Alkharashi FK, Qasim SS, Hussain A. Training medical students in physical examination and point-of-care ultrasound: An assessment of the needs and barriers to acquiring skills in point-of-care ultrasound. J Family Community Med 2022; 29:62-70. [PMID: 35197730 PMCID: PMC8802732 DOI: 10.4103/jfcm.jfcm_369_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: With growth of the use of point of care ultrasound (PoCUS) around the world, some medical schools have incorporated this skill into their undergraduate curricula. However, because of epidemiology of disease and regional differences in approaches to patient care, global application of PoCUS might not be possible. Before creating a PoCUS teaching course, it is critical to perform a needs analysis and recognize the training obstacles. MATERIALS AND METHODS: A validated online questionnaire was given to final-year medical students at our institution to evaluate their perceptions of the applicability of specific clinical findings, and their own capability to detect these signs clinically and with PoCUS. The skill insufficiency was assessed by deducting the self-reported clinical and ultrasound skill level from the perceived usefulness of each clinical finding. RESULTS: The levels of expertise and knowledge in the 229 students who participated were not up to the expected standard. The applicability of detection of abdominal aortic aneurysm (AAA) (3.9 ± standard deviation [SD] 1.4) was the highest. However, detection of interstitial syndrome (3.0 ± SD 1.1) was perceived as the least applicable. The deficit was highest in the detection of AAA (mean 0.95 ± SD 2.4) and lowest for hepatomegaly (mean 0.57 ± SD 2.3). Although the majority agreed that training of preclinical and clinical medical students would be beneficial, 52 (22.7%) showed no interest, and 60% (n = 136) reported that they did not have the time to develop the skill. CONCLUSION: Although medical students in Saudi Arabia claim that PoCUS is an important skill, there are significant gaps in their skill, indicating the need for PoCUS training. However, a number of obstacles must be overcome in the process.
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Affiliation(s)
- Rajkumar Rajendram
- Department of Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah O Alrasheed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz A Boqaeid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Faris K Alkharashi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salman S Qasim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Arif Hussain
- Department of Cardiac Sciences, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Bell C, Kim D. A picture is worth a thousand words, but only if you can see it. CAN J EMERG MED 2021; 24:345-346. [PMID: 34797557 DOI: 10.1007/s43678-021-00232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Colin Bell
- Department of Emergency Medicine and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Daniel Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
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Arntfield R, Wu D, Tschirhart J, VanBerlo B, Ford A, Ho J, McCauley J, Wu B, Deglint J, Chaudhary R, Dave C, VanBerlo B, Basmaji J, Millington S. Automation of Lung Ultrasound Interpretation via Deep Learning for the Classification of Normal versus Abnormal Lung Parenchyma: A Multicenter Study. Diagnostics (Basel) 2021; 11:2049. [PMID: 34829396 PMCID: PMC8621216 DOI: 10.3390/diagnostics11112049] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 12/12/2022] Open
Abstract
Lung ultrasound (LUS) is an accurate thoracic imaging technique distinguished by its handheld size, low-cost, and lack of radiation. User dependence and poor access to training have limited the impact and dissemination of LUS outside of acute care hospital environments. Automated interpretation of LUS using deep learning can overcome these barriers by increasing accuracy while allowing point-of-care use by non-experts. In this multicenter study, we seek to automate the clinically vital distinction between A line (normal parenchyma) and B line (abnormal parenchyma) on LUS by training a customized neural network using 272,891 labelled LUS images. After external validation on 23,393 frames, pragmatic clinical application at the clip level was performed on 1162 videos. The trained classifier demonstrated an area under the receiver operating curve (AUC) of 0.96 (±0.02) through 10-fold cross-validation on local frames and an AUC of 0.93 on the external validation dataset. Clip-level inference yielded sensitivities and specificities of 90% and 92% (local) and 83% and 82% (external), respectively, for detecting the B line pattern. This study demonstrates accurate deep-learning-enabled LUS interpretation between normal and abnormal lung parenchyma on ultrasound frames while rendering diagnostically important sensitivity and specificity at the video clip level.
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Affiliation(s)
- Robert Arntfield
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada
| | - Derek Wu
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Jared Tschirhart
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Blake VanBerlo
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alex Ford
- Independent Researcher, London, ON N6A 1L8, Canada
| | - Jordan Ho
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Joseph McCauley
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Benjamin Wu
- Independent Researcher, London, ON N6C 4P9, Canada
| | - Jason Deglint
- Faculty of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Rushil Chaudhary
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Chintan Dave
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada
| | - Bennett VanBerlo
- Faculty of Engineering, University of Western Ontario, London, ON N6A 5C1, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada
| | - Scott Millington
- Department of Critical Care Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Development and Remodeling of Point-of-Care Ultrasound Education for Emergency Medicine Residents in Resource Limited Countries during the COVID-19 Pandemic. Tomography 2021; 7:721-733. [PMID: 34842824 PMCID: PMC8628902 DOI: 10.3390/tomography7040060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultra-sound learning materials were useful tools which showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps, including the availability of handheld devices, as well as the re-modeling of the ultrasound rotation course, which should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade.
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Abstract
Purpose of Review Sepsis is a leading cause of death worldwide. Groundbreaking international collaborative efforts have culminated in the widely accepted surviving sepsis guidelines, with iterative improvements in management strategies and definitions providing important advances in care for patients. Key to the diagnosis of sepsis is identification of infection, and whilst the diagnostic criteria for sepsis is now clear, the diagnosis of infection remains a challenge and there is often discordance between clinician assessments for infection. Recent Findings We review the utility of common biochemical, microbiological and radiological tools employed by clinicians to diagnose infection and explore the difficulty of making a diagnosis of infection in severe inflammatory states through illustrative case reports. Finally, we discuss some of the novel and emerging approaches in diagnosis of infection and sepsis. Summary While prompt diagnosis and treatment of sepsis is essential to improve outcomes in sepsis, there remains no single tool to reliably identify or exclude infection. This contributes to unnecessary antimicrobial use that is harmful to individuals and populations. There is therefore a pressing need for novel solutions. Machine learning approaches using multiple diagnostic and clinical inputs may offer a potential solution but as yet these approaches remain experimental.
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Affiliation(s)
- José L Díaz-Gómez
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Paul H Mayo
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
| | - Seth J Koenig
- From the Baylor College of Medicine, Houston (J.L.D.-G.); and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (P.H.M.), and the Albert Einstein College of Medicine, New York (S.J.K.) - both in New York
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Chahley T, Lam AW, Halman S, Watson K, Ma IW. First year internal medicine residents' self-report point-of-care ultrasound knowledge and skills: what (Little) difference three years make. BMC MEDICAL EDUCATION 2021; 21:476. [PMID: 34493276 PMCID: PMC8422684 DOI: 10.1186/s12909-021-02915-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND With increasing availability of point-of-care ultrasound (POCUS) education in medical schools, it is unclear whether or not learning needs of junior medical residents have evolved over time. METHODS We invited all postgraduate year (PGY)-1 residents at three Canadian internal medicine residency training programs in 2019 to complete a survey previously completed by 47 Canadian Internal Medicine PGY-1 s in 2016. Using a five-point Likert scale, participants rated perceived applicability of POCUS to the practice of internal medicine and self-reported skills in 15 diagnostic POCUS applications and 9 procedures. RESULTS Of the 97 invited residents, 58 (60 %) completed the survey in 2019. Participants reported high applicability but low skills across all POCUS applications and procedures. The 2019 cohort reported higher skills in assessing pulmonary B lines than the 2016 cohort (2.3 ± SD 1.0 vs. 1.5 ± SD 0.7, adjusted p-value = 0.01). No other differences were noted. CONCLUSIONS POCUS educational needs continue to be high in Canadian internal medicine learners. The results of this needs assessment study support ongoing inclusion of basic POCUS elements in the current internal medicine residency curriculum.
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Affiliation(s)
- Tanner Chahley
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada
| | - Ada W Lam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha Halman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn Watson
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada
| | - Irene Wy Ma
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
- W21C, University of Calgary, Alberta, Calgary, Canada.
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Soni NJ, Boyd JS, Mints G, Proud KC, Jensen TP, Liu G, Mathews BK, Schott CK, Kurian L, LoPresti CM, Andrus P, Nathanson R, Smith N, Haro EK, Mader MJ, Pugh J, Restrepo MI, Lucas BP. Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic. Ultrasound J 2021; 13:39. [PMID: 34487262 PMCID: PMC8419826 DOI: 10.1186/s13089-021-00242-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-19 pandemic. Results Pre- and post-course knowledge test scores of learners from the in-person (n = 88) and tele-ultrasound course (n = 52) were compared. Though mean pre-course knowledge test scores were higher among learners of the tele-ultrasound versus in-person course (78% vs. 71%; p = 0.001), there was no significant difference in the post-course test scores between learners of the two course formats (89% vs. 87%; p = 0.069). Both learners and faculty rated the tele-ultrasound course highly (4.6–5.0 on a 5-point scale) for effectiveness of virtual lectures, tele-ultrasound hands-on scanning sessions, and course administration. Faculty generally expressed less satisfaction with their ability to engage with learners, troubleshoot image acquisition, and provide feedback during the tele-ultrasound course but felt learners completed the tele-ultrasound course with a better basic POCUS skillset. Conclusions Compared to a traditional in-person course, tele-ultrasound POCUS CME courses appeared to be as effective for improving POCUS knowledge post-course and fulfilling learning objectives. Our findings can serve as a roadmap for educators seeking guidance on development of a tele-ultrasound POCUS training course whose demand will likely persist beyond the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00242-6.
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Affiliation(s)
- Nilam J Soni
- South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA. .,University of Texas Health San Antonio, South Texas Veterans Health Care System, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Jeremy S Boyd
- Department of Emergency Medicine, Veterans Affairs - Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory Mints
- Division of Hospital Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kevin C Proud
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, CA, USA
| | - Gigi Liu
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Benji K Mathews
- Department of Hospital Medicine, Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Christopher K Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care System, Pittsburgh, PA, USA.,Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Kurian
- Division of Hospital Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Charles M LoPresti
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Phil Andrus
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Robert Nathanson
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Natalie Smith
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Elizabeth K Haro
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Michael J Mader
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Marcos I Restrepo
- South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, VT, USA.,Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH, USA
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Ma IWY, Hussain A, Wagner M, Walker B, Chee A, Arishenkoff S, Buchanan B, Liu RB, Mints G, Wong T, Noble V, Tonelli AC, Dumoulin E, Miller DJ, Hergott CA, Liteplo AS. Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the Use of Lung Ultrasound for the Assessment of Medical Inpatients With Known or Suspected Coronavirus Disease 2019. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1879-1892. [PMID: 33274782 PMCID: PMC8451849 DOI: 10.1002/jum.15571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Arif Hussain
- Division of Cardiac Critical Care, Department of Cardiac SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Michael Wagner
- Division of Hospital Medicine, Department of MedicinePrisma Health–UpstateGreenvilleSouth CarolinaUSA
| | - Brandie Walker
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alex Chee
- Division of Thoracic Surgery and Interventional PulmonologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Shane Arishenkoff
- Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Brian Buchanan
- Department of Critical CareUniversity of AlbertaEdmontonAlbertaCanada
| | - Rachel B. Liu
- Section of Emergency Ultrasound, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Gregory Mints
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Tanping Wong
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals, Cleveland Medical CenterCase Western Reserve School of MedicineClevelandOhioUSA
| | - Ana Claudia Tonelli
- Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of MedicineUnisinos UniversitySão LeopoldoBrazil
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Daniel J. Miller
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Christopher A. Hergott
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrew S. Liteplo
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Maw AM, Ho PM, Morris MA, Glasgow RE, Huebschmann AG, Barnard JG, Metter R, Tierney DM, Mathews BK, Havranek EP, Kissler M, Fleshner M, Burian BK, Platz E, Soni NJ. Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments. Diagnostics (Basel) 2021; 11:diagnostics11081451. [PMID: 34441385 PMCID: PMC8391960 DOI: 10.3390/diagnostics11081451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 01/16/2023] Open
Abstract
Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, its adoption among hospitalists has been slow. We performed semi-structured interviews of hospitals from four diverse health systems in the United States to understand determinants of adoption within a range of clinical settings. We used the diffusion of innovation theory to guide a framework analysis of the data. Of the 27 hospitalists invited, we performed 22 interviews from four hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: (1) There are important clinical advantages to LUS despite operator dependence, (2) LUS enhances patient and clinician experience, (3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and (4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite the perceived benefits of LUS for patients, clinicians and health systems, a significant barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.
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Affiliation(s)
- Anna M. Maw
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA; (R.M.); (M.K.); (M.F.)
- Correspondence:
| | - P. Michael Ho
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Megan A. Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.A.M.); (R.E.G.); (J.G.B.)
| | - Russell E. Glasgow
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.A.M.); (R.E.G.); (J.G.B.)
| | - Amy G. Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Juliana G. Barnard
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.A.M.); (R.E.G.); (J.G.B.)
| | - Robert Metter
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA; (R.M.); (M.K.); (M.F.)
| | - David M. Tierney
- Medical Education Department, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA;
| | - Benji K. Mathews
- Department of Hospital Medicine, HealthPartners, Bloomington, MI 55420, USA;
| | | | - Mark Kissler
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA; (R.M.); (M.K.); (M.F.)
| | - Michelle Fleshner
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA; (R.M.); (M.K.); (M.F.)
| | - Barbara K. Burian
- Human Systems Integration Division NASA Ames Research Center, Mountain View, CA 94043, USA;
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Nilam J. Soni
- Division of Pulmonary and Critical Care Medicine and Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
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50
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Kennedy SK, Duncan T, Herbert AG, Rood LK, Rutz MA, Zahn GS, Welch JL, Russell FM. Teaching Seasoned Doctors New Technology: An Intervention to Reduce Barriers and Improve Comfort With Clinical Ultrasound. Cureus 2021; 13:e17248. [PMID: 34540474 PMCID: PMC8445865 DOI: 10.7759/cureus.17248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Although clinical ultrasound (CUS) is a core skill that is a requirement for emergency medicine (EM) residency graduation, only a fraction of EM practitioners who trained prior to this requirement are certified in CUS. The objective of the study was to implement a CUS workshop for practicing EM physicians, identify barriers to utilization, and assess comfort with the machine, obtaining and interpreting images, and incorporating CUS into clinical practice. Methods This was a prospective descriptive cohort study of EM physician faculty who participated in an interactive 5-hour CUS workshop intervention that introduced four core CUS modalities via didactics and hands-on scanning stations. Pre- and post-surveys were administered to identify barriers to utilization and assess perceived comfort with CUS using a 5-point Likert scale. Results were analyzed using Fisher's exact and paired t-tests. Results Thirty-five EM physicians participated with a 100% survey response rate. Only five of the physicians were ultrasound certified at the time of the workshop. On average, physicians were 16 years post-residency. Prior to the workshop, 29% had minimal ultrasound experience and 43% had not performed more than 50 ultrasounds. In the pre-course survey, every physician expressed at least one barrier to CUS utilization. Post-workshop, physicians felt significantly more comfortable using the ultrasound machine (p=0.0008), obtaining and interpreting images (p=0.0009 and p=0.0004), and incorporating CUS into clinical practice (p=0.002). Conclusion This workshop is an effective tool to expose practicing physicians to core concepts of CUS, improve their comfort level, and reduce barriers to ultrasound utilization.
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Affiliation(s)
- Sarah K Kennedy
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Taylor Duncan
- Emergency Department, St. Elizabeth Hospital, Edgewood, USA
| | - Audrey G Herbert
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Loren K Rood
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Matt A Rutz
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Gregory S Zahn
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Julie L Welch
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Frances M Russell
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
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