Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the Time of COVID-19

Utility of focused cardiac ultrasonography training in veterinary students to differentiate stages of subclinical myxomatous mitral valve disease in dogs

BACKGROUND

Differentiation of the subclinical phases of myxomatous mitral valve disease (MMVD) in dogs relies heavily on echocardiography. Focused cardiac ultrasonography (FCU) is a point-of-care technique that can assess heart size.

HYPOTHESIS/OBJECTIVES

Veterinary students trained in FCU can differentiate dogs with subclinical MMVD based on left ventricular (LV) and left atrial (LA) dimensions.

ANIMALS

Forty-eight dogs with subclinical MMVD.

METHODS

Veterinary students were trained to measure LV dimension and LA-to-aortic root dimension ratio (LA : Ao) using FCU. Dogs were categorized into 2 cohorts based on whether or not the LV normalized internal diastolic dimension was ≥1.7 and LA : Ao was ≥1.6. Agreement between FCU and echocardiographic studies performed by cardiologists was evaluated.

RESULTS

One-hundred and forty-six FCU examinations were performed by 58 veterinary students on 48 dogs. Overall agreement between students and cardiologists was moderate (Fleiss' kappa, 0.54; 95% confidence interval [CI], 0.39-0.69; P < .001). Percentage accuracy in observations with heart dimensions less than the cutoffs (86/89, 97%) was significantly higher than in observations in with larger hearts (31/57, 54%; P < .001). Agreement increased from moderate to good as heart sizes became more extreme. Degree of confidence by students in performing FCU was significantly higher at the end vs start of the study.

CONCLUSIONS AND CLINICAL IMPORTANCE

Categorization of dogs with subclinical MMVD by veterinary students using FCU was associated with moderate to good agreement with echocardiography. Focused cardiac ultrasonography is a point-of-care method that can help assess clinical stage in dogs with subclinical MMVD.

Evaluation of a Self-Driven Large Animal Point of Care Ultrasound Learning Program for Veterinary Students

Point of care ultrasound (POCUS) has the potential to improve healthcare outcomes and is increasingly used in veterinary primary care and specialty practice. The aim of this study was to evaluate a self-driven POCUS learning program during clinical rotations in a large animal teaching hospital. A randomized controlled trial of 94 students evaluated the hypotheses that access to a self-driven POCUS program would improve scores on a written test and the quality of subjective, objective, assessment and plan (SOAP) documents. Use of the POCUS devices and perceptions of veterinary students towards POCUS were analyzed. The self-driven POCUS learning program was feasible, and the perception of most students (94%) was that the program was useful for their education. Access to equipment, ability to scan individually, the hands-on learning aspect, and clinicians' help were the most valued aspects of the program. Earlier access to POCUS in the curriculum, hands-on tutorials/labs, and a more structured learning program were identified by students as aspects to improve. Access to the self-driven POCUS program resulted in significantly higher scores on the written test in a subpopulation of students with lower scores. No significant differences in results on the multiple-choice tests in the subpopulation with higher scores or in SOAP scores of the complete group or subpopulations were found. A self-driven POCUS learning program was perceived as beneficial by students, increased POCUS knowledge in students with lower test scores, and was possible to implement in a busy large animal teaching hospital.

The impact of body position on measurement of equine lumbar and hindquarter volume using 3-dimensional scans

Well-developed musculature is important for performance yet difficult to quantify. Recently, we validated infrared 3-dimensional (3-D) photonic scanning as an accurate measure of body volume and proxy for regional muscle mass in horses. Our current objective was to determine the impact of body position on measures of lumbar (LV) and hindquarter (HQV) volume. Anatomic markers were placed on 8 horses, positioned at: (1) four hooves square, (2) neck turned ~25°, (3) head raised mean 17 cm, (4) one hind hoof (HH) forward 14±5 cm, (5) a front and contralateral HH ~15 cm all offset, (6) one HH resting. A handheld Occipital Structure Sensor photonic scanner, iPad, Skanect and Materialise 3-Matic programs captured LV and HQV. Measured LV and HQV for whole, same and opposite-side with altered head positions and whole LV and HQV with altered HH positions were compared to volume standing square using repeated measures ANOVA. The volumes of the opposite-side or same-side with altered HH positions were compared to the corresponding side when square using a paired t test with multiple test correction (P<0.017). Head elevated negatively impacted measured left LV (-10% difference, P=0.1) compared to square, however, differences were not significant. Head turned did not impact measured LV. Resting HH significantly increased measured whole (18%, P=0.04) and same-side LV (49%, P=0.001) versus square but not the opposite-side LV. One HH forward (whole 16%, P=0.02; same-side 19%, P=0.01) or all offset (whole 14%, P=0.002; same-side 27%, P=0.0001) significantly increased measured whole or same-side LV versus square. Measured HQV was not impacted by head elevated or limb position but was 2% higher on the opposite-side of the turned head (P=0.01). We conclude that alterations in body position have minimal impact on measured HQV, whereas accurate assessment of LV requires horses stand squarely.