Echocardiography in the time of Covid-19: Ultrasound enhancing agents save time and augment diagnostic information

BACKGROUND

There are currently no clear guidelines regarding the use of ultrasound enhancing agents (UEAs) with transthoracic echocardiography (TTE) for patients hospitalized with Covid-19. We investigated whether the performance of TTE with UEAs provides more diagnostic information and allows for shorter acquisition time compared to unenhanced TTE imaging in this patient population.

METHODS

We analyzed the TTEs of 107 hospitalized Covid-19 patients between April and June 2020 who were administered UEAs (Definity®, Lantheus). The time to acquire images with and without UEAs was calculated. A level III echocardiographer determined if new, clinically significant findings were visualized with the addition of UEAs.

RESULTS

There was a mean of 11.84±3.59 UEA cineloops/study vs 20.74±8.10 non-UEA cineloops/study (p < 0.0001). Mean time to acquire UEA cineloop images was 72.28±28.18 s/study compared to 188.07±86.04 s/study for non-UEA cineloop images (p < 0.0001). Forty-eight patients (45%) had at least one new finding on UEA imaging, with a total of 62 new findings seen. New information gained with UEAs was more likely to be found in patients with acute respiratory distress syndrome (21 vs 9, p < 0.001) and in those on mechanical ventilation (21 vs 15, p = 0.046).

CONCLUSIONS

TTE with UEAs required less time and fewer cineloop images compared to non-UEA imaging in patients hospitalized with Covid-19. Additionally, Covid-19 patients with severe respiratory disease benefited most with regard to new diagnostic information. Health care personnel should consider early use of UEAs in select hospitalized Covid-19 patients in order to reduce exposure and optimize diagnostic yield.

The Case of Ty Jackson: An Interactive Module on LGBT Health Employing Introspective Techniques and Video-Based Case Discussion

Introduction

The Institute of Medicine's 2011 report on lesbian, gay, bisexual, and transgender (LGBT) health and the legalization of same-sex marriage are just two of the numerous milestones that have hastened medical schools' efforts to prepare trainees to address the needs of LGBT community members. Early awareness of sexual diversity through self- and peer introspection and video-based education can help trainees build a foundation towards providing affirming care to LGBT patients.

Methods

The Kern model was used to develop, implement, and evaluate an interactive multimodal workshop to provide first-year medical students with a formative introduction to LGBT health. Learning objectives focused on comprehending the spectrum of human sexuality, health issues for LGBT patients, and better practices for promoting affirming care. The module consisted of a PowerPoint presentation, sexuality survey, videos of provider-patient encounters, and community-based resources.

Results

The workshop was implemented among 178 first-year medical students in September 2018, with 93% completing the pre-/postworkshop evaluations. Comparison of evaluations showed an increase in confidence in addressing each of the three learning objectives. Over 85% rated the PowerPoint and videos as very good or excellent.

Discussion

This workshop was effective in helping first-year medical students appreciate the spectrum of sexual diversity, health issues facing LGBT individuals, and better practices to promote affirming care. The real-time sexuality survey helped trainees appreciate sexual diversity through self-reflection and near-peer sharing. The videos and accompanying discussion provided real-life encounters, along with common pitfalls in and pearls for communicating with LGBT patients.

Adolescent girls and pelvic inflammatory disease: experience and practices of emergency department pediatricians

OBJECTIVE

To describe the experience and practices of emergency department pediatricians in the United States related to the diagnosis and management of pelvic inflammatory disease (PID) in adolescent girls and to compare this experience with Centers for Disease Control and Prevention recommended management guidelines.

DESIGN

National telephone survey.

SUBJECTS

One hundred four pediatricians randomly selected from the 659 members of the Section on Emergency Medicine of the American Academy of Pediatrics. Response rate was 56%.

MEASURES

A 42-item structured interview questionnaire assessed physician demographics, practice characteristics, PID diagnosis and management, and attitudes about sexually transmitted diseases in adolescents.

RESULTS

Fifty-one (94%) of 54 emergency department pediatricians had diagnosed PID in adolescents at least once within the past 2 years, and 35 (69%) had diagnosed PID, on average, once per month or more. Less than half the pediatricians (23/51 [45%]) routinely recommended hospital admission for adolescents with PID as suggested by the Centers for Disease Control and Prevention, and among those treating adolescents with PID as outpatients,just over half (20/37 [54%]) arranged close follow-up within 72 hours of initiating antibiotic treatment. Although most emergency department pediatricians routinely suggested condom use (47/54 [87%]) and human immunodeficiency virus testing (34/54 [63%]) after diagnosing a sexually transmitted disease, a minority routinely provided contraceptive counseling (23/54 [43%]) or written partner notification (17/54 [31%]). Approximately two thirds of pediatricians surveyed indicated that they thought that the care of an adolescent with a sexually transmitted disease should be different from that of an adult (35/54 [65%]) and that this age group was more prone to medical complications (38/54 [70%]).

CONCLUSIONS

The results of this survey suggest that emergency department pediatricians frequently diagnose PID in adolescent girls and understand the high risk of medical complications in this age group, but their management is often less aggressive than that recommended by Centers for Disease Control and Prevention guidelines and sexually transmitted disease experts.