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Sinanan R, Moshtaghi A, Koratala A. Point-of-care ultrasound in nephrology: A private practice viewpoint. World J Methodol 2024; 14:95685. [DOI: 10.5662/wjm.v14.i4.95685] [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: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/26/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.
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Affiliation(s)
- Rajiv Sinanan
- Arizona Kidney Disease and Hypertension Centers, Phoenix, AZ 85016, United States
| | - Afsheen Moshtaghi
- Department of Medicine, Verde Valley Medical Center, Cottonwood, AZ 86326, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Khan AA, Saeed H, Haque IU, Iqbal A, Du D, Koratala A. Point-of-care ultrasonography spotlight: Could venous excess ultrasound serve as a shared language for internists and intensivists? World J Crit Care Med 2024; 13:93206. [PMID: 38855280 PMCID: PMC11155496 DOI: 10.5492/wjccm.v13.i2.93206] [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: 02/21/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/03/2024] Open
Abstract
Point-of-care ultrasonography (POCUS), particularly venous excess ultrasound (VExUS) is emerging as a valuable bedside tool to gain real-time hemodynamic insights. This modality, derived from hepatic vein, portal vein, and intrarenal vessel Doppler patterns, offers a scoring system for dynamic venous congestion assessment. Such an assessment can be crucial in effective management of patients with heart failure exacerbation. It facilitates diagnosis, quantification of congestion, prognostication, and monitoring the efficacy of decongestive therapy. As such, it can effectively help to manage cardiorenal syndromes in various clinical settings. Extended or eVExUS explores additional veins, potentially broadening its applications. While VExUS demonstrates promising outcomes, challenges persist, particularly in cases involving renal and liver parenchymal disease, arrhythmias, and situations of pressure and volume overload overlap. Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool. Hence, the integration of POCUS, especially advanced applications like VExUS, into routine clinical practice necessitates enhanced training across medical specialties.
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Affiliation(s)
- Anosh Aslam Khan
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, United States
| | - Hasham Saeed
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
| | - Ibtehaj Ul Haque
- Department of Anesthesiology, Dr. Ruth K M Pfau Civil Hospital, Karachi 74400, Pakistan
| | - Ayman Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Doantrang Du
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Lo Bianco M, Presti S, Finocchiaro MC, Trobia GL, Sciacca TV, Cucuzza ME, Caudullo E, Calcara G, Ruggieri M, Di Stefano VA. Point-of-care ultrasound (POCUS) pediatric resident training course: a cross-sectional survey. Ital J Pediatr 2024; 50:82. [PMID: 38649948 PMCID: PMC11036774 DOI: 10.1186/s13052-024-01652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming increasingly crucial in the Pediatric Emergency Department for objective patient examination. However, despite its growing interest and wide-ranging applications, POCUS remains relatively unexplored in general pediatric training and education. Many physicians still find it challenging to comprehend and implement. METHODS A theoretical-practical POCUS course for pediatric residents was conducted at the University of Catania, Italy. The course's effectiveness and practical impact on residents was assessed through a pre-post training survey. The first part of the questionnaire focused on the self-perceived time needed to learn how to recognize the following conditions using POCUS: (i) Pleural effusion (ii) Lung consolidation (iii) Pneumothorax (PNX) (iv) Cardiac contractility (v) Pericardial effusion (vi) Perisplenic effusion (vii) Morison's pouch effusion (viii) Douglas' pouch effusion (ix) Filling and collapsibility of the inferior vena cava. In the second part, we compared the potential role of POCUS in (i) Reducing the use of ionizing radiation in children (ii) Increasing the sense of security in diagnosis and treatment decisions making and (iii) Increasing the residents' confidence level with POCUS after the course on a 1-to-10 rating scale. RESULTS Seventy-two residents participated in the study. The statistical analysis showed significant pre-post differences in almost all the items considered, except for "cardiac contractility" and "PNX". Furthermore, the perceived potential role of POCUS in reducing ionizing radiation usage and the sense of security in diagnosis and treatment decisions showed statistically significant differences (p < 0.05) before and after the course. Data analysis also revealed a consistently high confidence level with POCUS after the course. CONCLUSIONS The results highlight the importance of including a POCUS track course in pediatric post-graduate programs due to its simplicity, rapid learning time, and clinical usefulness. Based on these findings, it would be recommended to increase the teaching hours dedicated to the recognition of pneumothorax and cardiology POCUS examination. Emphasizing POCUS training in pediatric education can enhance patient care and diagnostic accuracy while minimizing radiation exposure.
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Affiliation(s)
- Manuela Lo Bianco
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia, 78, 95125, Catania, Italy.
| | - Santiago Presti
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia, 78, 95125, Catania, Italy
| | - Maria Carla Finocchiaro
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Gian Luca Trobia
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Tiziana Virginia Sciacca
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Maria Elena Cucuzza
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Elia Caudullo
- U.O. Department of Diagnostic for Images, Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Giacomo Calcara
- U.O.S.D. Diagnostics for Emergency Imaging, Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. "Policlinico", P.O. "G. Rodolico", via S. Sofia, 78, 95125, Catania, Italy.
| | - Vita Antonella Di Stefano
- Pediatric Unit and Pediatric Emergency, Room of Emergency Hospital Cannizzaro, Via Messina 829, 95126, Catania, Italy
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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [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: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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Fairchild RM, Deluna MD, Golovko V, Mar DA, Baker MC, Nishio J, Horomanski AL. Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center. Semin Arthritis Rheum 2023; 63:152276. [PMID: 37857047 DOI: 10.1016/j.semarthrit.2023.152276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC). METHODS We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic. RESULTS From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results. CONCLUSIONS These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.
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Affiliation(s)
- Robert M Fairchild
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Mariani D Deluna
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Valentyn Golovko
- Stanford Health Care, Department of Quality, Patient Safety & Effectiveness, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - Diane A Mar
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Matthew C Baker
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jane Nishio
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Audra L Horomanski
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
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Gogtay M, Choudhury RS, Williams JP, Mader MJ, Murray KJ, Haro EK, Drum B, O'Brien E, Khosla R, Boyd JS, Bales B, Wetherbee E, Sauthoff H, Schott CK, Basrai Z, Resop D, Lucas BP, Sanchez-Reilly S, Espinosa S, Soni NJ, Nathanson R. Point-of-care ultrasound in geriatrics: a national survey of VA medical centers. BMC Geriatr 2023; 23:605. [PMID: 37759172 PMCID: PMC10537073 DOI: 10.1186/s12877-023-04313-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). METHODS We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. RESULTS All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. CONCLUSIONS POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.
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Affiliation(s)
- Maya Gogtay
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
| | - Ryan S Choudhury
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Jason P Williams
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
- Medicine Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA
| | - Kevin J Murray
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Brandy Drum
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Edward O'Brien
- Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA
| | - Rahul Khosla
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brain Bales
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, PA, USA
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
- Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Sandra Sanchez-Reilly
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Sara Espinosa
- South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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Finn EM, Zwemer EK, Stephens JR, Dancel R. The State of Internal Medicine Point-of-Care Ultrasound (POCUS) Fellowships in the United States and Canada. Am J Med 2023; 136:830-836. [PMID: 37116671 DOI: 10.1016/j.amjmed.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Erin M Finn
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill.
| | - Eric K Zwemer
- Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - John R Stephens
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - Ria Dancel
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
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Bhasin-Chhabra B, Koratala A. Point of care ultrasonography in onco-nephrology: A stride toward better physical examination. World J Nephrol 2023; 12:29-39. [PMID: 37035508 PMCID: PMC10075017 DOI: 10.5527/wjn.v12.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
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Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Nesbit DA, Wang C, Grenz PM, Roth KR, Eygnor JK. Atraumatic Bi-femoral Axillary Bypass Graft Non-anastomotic Disruption With Pseudoaneurysm Formation Detected by Doppler Ultrasound. Cureus 2022; 14:e30871. [DOI: 10.7759/cureus.30871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
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Williams JP, Nathanson R, LoPresti CM, Mader MJ, Haro EK, Drum B, O'Brien E, Khosla R, Boyd JS, Bales B, Wetherbee E, Sauthoff H, Schott CK, Basrai Z, Resop D, Lucas BP, Soni NJ. Current use, training, and barriers in point-of-care ultrasound in hospital medicine: A national survey of VA hospitals. J Hosp Med 2022; 17:601-608. [PMID: 35844080 DOI: 10.1002/jhm.12911] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can reduce procedural complications and improve the diagnostic accuracy of hospitalists. Currently, it is unknown how many practicing hospitalists use POCUS, which applications are used most often, and what barriers to POCUS use exist. OBJECTIVE This study aimed to characterize current POCUS use, training needs, and barriers to use among hospital medicine groups (HMGs). DESIGN, SETTING, AND PARTICIPANTS A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of HMGs. These data were compared to a similar survey conducted in 2015. RESULT Chiefs from 117 HMGs were surveyed, with a 90% response rate. There was ongoing POCUS use in 64% of HMGs. From 2015 to 2020, procedural POCUS use decreased by 19%, but diagnostic POCUS use increased for cardiac (8%), pulmonary (7%), and abdominal (8%) applications. The most common barrier to POCUS use was lack of training (89%), and only 34% of HMGs had access to POCUS training. Access to ultrasound equipment was the least common barrier (57%). The proportion of HMGs with ≥1 ultrasound machine increased from 29% to 71% from 2015 to 2020. An average of 3.6 ultrasound devices per HMG was available, and 45% were handheld devices. CONCLUSION From 2015 to 2020, diagnostic POCUS use increased, while procedural use decreased among hospitalists in the VA system. Lack of POCUS training is currently the most common barrier to POCUS use among hospitalists.
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Affiliation(s)
- Jason P Williams
- Medical Education, Atlanta VA Medical Center, Medicine Service, Atlanta, Georgia, USA
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Robert Nathanson
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Charles M LoPresti
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael J Mader
- Department of Medicine, South Texas Veterans Health Care System, Research Service, San Antonio, Texas, USA
| | - Elizabeth K Haro
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Brandy Drum
- Department of Veterans Affairs, Healthcare Analysis and Information Group, Milwaukee, Wisconsin, USA
| | - Edward O'Brien
- Department of Veterans Affairs, Healthcare Analysis and Information Group, Milwaukee, Wisconsin, USA
| | - Rahul Khosla
- Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University Medical Faculty Associates, Washington, District of Columbia, USA
- Pulmonary and Critical Care Medicine, Washington Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, Tennessee, USA
| | - Brian Bales
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, Tennessee, USA
| | - Erin Wetherbee
- Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Harald Sauthoff
- Medicine Service, VA NY Harbor Healthcare System, New York, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York, USA
| | - Christopher K Schott
- Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, Pennsylvania, USA
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
- Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Nilam J Soni
- Department of Medicine, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, USA
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
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Development of a Point-of-Care Ultrasound Track for Internal Medicine Residents. J Gen Intern Med 2022; 37:2308-2313. [PMID: 35713808 PMCID: PMC9205286 DOI: 10.1007/s11606-022-07505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/23/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) training has been increasing among internal medicine (IM) residency programs, but few programs can provide longitudinal training due to barriers such as lack of trained faculty. AIM Describe the development of a longitudinal POCUS track for IM residents using local and external resources, including a national POCUS certificate program. SETTING University-based IM residency program affiliated with a public and veterans affairs hospital. PARTICIPANTS Twelve IM residents from 2018 to 2021. PROGRAM DESCRIPTION Residents complete a national POCUS certificate program by attending live courses and completing online modules, an image portfolio, and final knowledge/skills assessments. Locally, residents participate in 1-month procedure and diagnostic POCUS rotations and provide peer-to-peer POCUS teaching of residents and medical students. PROGRAM EVALUATION The POCUS track increased residents' use and comfort with diagnostic and procedural applications. All residents rated being satisfied or very satisfied with the track and would recommend it to prospective applicants (100%). The most commonly reported barriers to utilizing POCUS per residents were time constraints (83%), lack of available ultrasound equipment (83%), and lack of trained faculty (58%). DISCUSSION IM residency programs with limited faculty expertise in POCUS can leverage external resources to provide longitudinal POCUS training to its residents.
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Janjigian M, Dembitzer A, Srisarajivakul-Klein C, Mednick A, Hardower K, Cooke D, Zabar S, Sauthoff H. Design and comparison of a hybrid to a traditional in-person point-of-care ultrasound course. Ultrasound J 2022; 14:12. [PMID: 35278145 PMCID: PMC8917361 DOI: 10.1186/s13089-022-00261-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Traditional introductory point-of-care ultrasound (POCUS) courses are resource intensive, typically requiring 2–3 days at a remote site, consisting of lectures and hands-on components. Social distancing requirements resulting from the COVID-19 pandemic led us to create a novel hybrid course curriculum consisting of virtual and in-person components. Methods Faculty, chief residents, fellows and advanced practice providers (APPs) in the Department of Medicine were invited to participate in the hybrid curriculum. The course structure included 4 modules of recorded lectures, quizzes, online image interpretation sessions, online case discussions, and hands-on sessions at the bedside of course participant’s patients. The components of the course were delivered over approximately 8 months. Those participants who completed a minimum of 3 modules over the year were invited for final assessments. Results from the hybrid curriculum cohort were compared to the year-end data from a prior traditional in-person cohort. Results Participant knowledge scores were not different between traditional (n = 19) and hybrid (n = 24) groups (81% and 84%, respectively, P = 0.9). There was no change in POCUS skills as measured by the hands-on test from both groups at end-of-course (76% and 76%, respectively, P = 0.93). Confidence ratings were similar across groups from 2.73 traditional to 3.0 hybrid (out of possible 4, P = 0.46). Participants rated the course highly, with an average overall rating of 4.6 out 5. Conclusions A hybrid virtual and in-person POCUS course was highly rated and as successful as a traditional course in improving learner knowledge, hands-on skill and confidence at 8 months after course initiation. These results support expanding virtual elements of POCUS educational curricula. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00261-x.
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Affiliation(s)
- Michael Janjigian
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA.
| | - Anne Dembitzer
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
| | - Caroline Srisarajivakul-Klein
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, Bellevue Hospital Center, New York, USA
| | - Aron Mednick
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Khemraj Hardower
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Deborah Cooke
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Harald Sauthoff
- Department of Medicine, New York University Grossman School of Medicine, NY Harbor Healthcare System, New York, USA
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13
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Bernstein E, Wang TY. Point-of-Care Ultrasonography: Visually Satisfying Medicine or Evidence-Based Medicine? JAMA Intern Med 2021; 181:1558-1559. [PMID: 34633409 DOI: 10.1001/jamainternmed.2021.5831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Eden Bernstein
- Cleveland Clinic Foundation, Cleveland Clinic Community Care, Cleveland, Ohio
| | - Tracy Y Wang
- Duke University, Duke Clinical Research Institute, Durham, North Carolina
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14
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Koratala A, Olaoye OA, Bhasin-Chhabra B, Kazory A. A Blueprint for an Integrated Point-of-Care Ultrasound Curriculum for Nephrology Trainees. KIDNEY360 2021; 2:1669-1676. [PMID: 35372975 PMCID: PMC8785780 DOI: 10.34067/kid.0005082021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at the bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice, including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum, including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, is needed before POCUS training is universally incorporated across nephrology fellowship programs.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Olanrewaju A. Olaoye
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
| | | | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida
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15
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Koratala A, Reisinger N. POCUS for Nephrologists: Basic Principles and a General Approach. KIDNEY360 2021; 2:1660-1668. [PMID: 35372985 PMCID: PMC8785785 DOI: 10.34067/kid.0002482021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023]
Abstract
Point-of-care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multiorgan POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. Although the need for further imaging studies is obviated in selected patients, POCUS is not meant to serve as an alternative to consultative imaging. In addition, the utility of POCUS depends on the skills and experience of the operator, which in turn depend on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss patient examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Koratala A, Kazory A. An Introduction to Point-of-Care Ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis 2021; 28:193-199. [PMID: 34906303 DOI: 10.1053/j.ackd.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Point-of-care ultrasonography (POCUS) is rapidly evolving as a noninvasive adjunct to physical examination among various specialties. POCUS increases the sensitivity of conventional physical examination by providing the answers to simple clinical questions at the bedside. As such, it can reduce fragmentation of care and expedite management. In addition, using bedside ultrasound as the first-line investigation may eliminate unnecessary radiation and contrast exposure. The advent of highly portable and affordable ultrasound devices has made the use of POCUS more practical and user-friendly, making it the stethoscope of the 21st century. This review will provide an overview of the rationale for integrating POCUS into nephrology practice. We also discuss the current scope of POCUS practice and state of training.
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Janjigian M, Dembitzer A, Srisarajivakul-Klein C, Hardower K, Cooke D, Zabar S, Sauthoff H. Design and evaluation of the I-SCAN faculty POCUS program. BMC MEDICAL EDUCATION 2021; 21:22. [PMID: 33407431 PMCID: PMC7789543 DOI: 10.1186/s12909-020-02453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming widely adopted with increasing accessibility of courses. Little is known about the optimal design of the introductory course or longitudinal training programs targeting hospitalists that are critical to success. METHODS Hospitalists at four academic sites participated in a two-day introductory course and a longitudinal phase comprising clinical POCUS practice, clip uploading with online feedback, hands-on teaching, and monthly ultrasound conferences. Assessments were performed immediately before and after the two-day course and after 1 year. RESULTS Knowledge increased from baseline to post two-day course (median score 58 and 85%, respectively, p < 0.001) and decreased slightly at 1 year (median score 81%, p = 0.012). After the two-day introductory course, the median score for hands-on image acquisition skills, the principal metric of participant success, was 75%. After 1 year, scores were similar (median score 74%). Confidence increased from baseline to post two-day course (1.5 to 3.1 on a 4 point Likert scale from Not at all confident (1) to Very confident (4), p < 0.001), and remained unchanged after 1 year (2.73). Course elements correlating with a passing score on the final hands-on test included number of clip uploads (r = 0.85, p,0.001), attendance at hands-on sessions (r = 0.7, p = 0.001), and attendance at monthly conferences (r = 0.50, p = 0.03). CONCLUSIONS The I-ScaN POCUS training program increased hospitalist knowledge, skill and confidence with maintained skill and confidence after 1 year. Uploading clips and attending hands-on teaching sessions were most correlative with participant success.
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Affiliation(s)
- Michael Janjigian
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, New York, USA.
| | - Anne Dembitzer
- Department of Medicine, New York University Grossman School of Medicine, VA NY Harbor Healthcare System, New York, USA
| | - Caroline Srisarajivakul-Klein
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, New York, USA
| | - Khemraj Hardower
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Deborah Cooke
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Harald Sauthoff
- Department of Medicine, New York University Grossman School of Medicine, VA NY Harbor Healthcare System, New York, USA
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18
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Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: Closing guideline gaps in screening for valvular heart disease. Clin Cardiol 2020; 43:1368-1375. [PMID: 33174635 PMCID: PMC7724242 DOI: 10.1002/clc.23499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. HYPOTHESIS POCUS can serve as a screening tool for valvular heart disease. METHODS We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. RESULTS POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. CONCLUSION POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and cost-effectiveness in the screening of patients with valvular heart disease.
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Affiliation(s)
- Muhammad Hammadah
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Christopher Ponce
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Paul Sorajja
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - João L. Cavalcante
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Santiago Garcia
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Mario Gössl
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
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19
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Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med 2020; 8:2050312120932706. [PMID: 32782792 PMCID: PMC7383635 DOI: 10.1177/2050312120932706] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
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Affiliation(s)
- Colton B Amaral
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel C Ralston
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
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20
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Koratala A. Point of Care Ultrasonography Enhanced Physical Examination: A Nephrologist's Perspective. Am J Med 2020; 133:e384-e385. [PMID: 32600549 DOI: 10.1016/j.amjmed.2020.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 10/24/2022]
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21
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Reaume M, Farishta M, Costello JA, Gibb T, Melgar TA. Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA. Postgrad Med J 2020; 97:55-58. [PMID: 32457206 DOI: 10.1136/postgradmedj-2020-137832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known. METHODS We conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers. RESULTS Our search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS. CONCLUSION Our results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.
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Affiliation(s)
- Michael Reaume
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mehdi Farishta
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Joseph A Costello
- Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tyler Gibb
- Department of Medical Ethics-Humanities and Law, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Thomas A Melgar
- Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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22
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LoPresti CM. Point of care ultrasound training in internal medicine: Steps towards standardization. Eur J Intern Med 2020; 75:25-27. [PMID: 32192859 DOI: 10.1016/j.ejim.2020.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Charles M LoPresti
- Louis Stokes Cleveland Veterans Affairs Medical Center, Division of Medicine, 10701 East Boulevard. Cleveland, OH 44106, United States; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, United States.
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23
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LoPresti CM, Jensen TP, Dversdal RK, Astiz DJ. Point-of-Care Ultrasound for Internal Medicine Residency Training: A Position Statement from the Alliance of Academic Internal Medicine. Am J Med 2019; 132:1356-1360. [PMID: 31400298 DOI: 10.1016/j.amjmed.2019.07.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Charles M LoPresti
- Section of Acute Care Medicine, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Trevor P Jensen
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Renee K Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Donna J Astiz
- Atlantic Health, Department of Medicine, Morristown Medical Center, Morristown, New Jersey
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Phillips L, Hiew M. Point of care ultrasound: Breaking the sound barrier in the emergency department. Australas J Ultrasound Med 2019; 22:3-5. [PMID: 34760529 PMCID: PMC8411775 DOI: 10.1002/ajum.12129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Luke Phillips
- Emergency & Trauma CentreThe Alfred HospitalCommercial RoadMelbourneVictoria3004Australia
- Emergency Medicine Ultrasound Group (EMUGs)Virtual OfficeMelbourneVictoria3000Australia
| | - Melody Hiew
- Emergency Medicine Ultrasound Group (EMUGs)Virtual OfficeMelbourneVictoria3000Australia
- Emergency DepartmentCasey HospitalMonash Health62‐70 Kangan DriveBerwickVictoria3806Australia
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25
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Kwan JL, Singh H. General Internists in Pursuit of Diagnostic Excellence. J Gen Intern Med 2018; 33:2026. [PMID: 30225767 PMCID: PMC6258618 DOI: 10.1007/s11606-018-4667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Janice L Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and the Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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