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Andersen CA, Lundbye-Christensen S, Riis A, Mehnert U, Løkkegaard T, Mengel-Jørgensen T, Rasmussen LD, Soll N, Stork B, Andersen SK, Pil L, Stjernebjerg C, Graumann O, Jensen MB. General practitioners' scanning competence following tailored ultrasound training: a hybrid effectiveness-implementation study. BMC MEDICAL EDUCATION 2025; 25:733. [PMID: 40394656 PMCID: PMC12093869 DOI: 10.1186/s12909-025-07356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 05/16/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND As an imaging modality, ultrasound relies on user skill and demands the integration of anatomical understanding, image acquisition techniques, and clinical knowledge. Proficiency in performing Point-of-Care Ultrasound (POCUS) examinations is a gradual process necessitating ongoing practice and exposure. Office-based general practitioners (GPs) encounter distinctive educational challenges when striving to acquire and sustain scanning competences. Therefore, traditional short workshops and training programs are not well suited for GPs. This hybrid effectiveness-implementation study aimed to explore whether a novel educational program, specifically tailored to meet the learning needs of office-based GPs, could lead to scanning competence by the program's conclusion and if this competence can be sustained post-course. METHODS GPs working in office-based general practice in Denmark were invited to participate in a three-months ultrasound educational program. To assess its effectiveness, participants underwent scanning competence evaluation by external experts at the end of the training program and again three months later. The experts assessed the participants twice using the objective structured assessment of ultrasounds skills (OSAUS) standardized evaluation tool. This evaluation covered seven items: 'indication for the examination', 'applied knowledge of ultrasound equipment', 'image optimization', 'systematic examination', 'interpretation of images', 'documentation of the examination', and 'medical decision-making'. To evaluate implementation of the educational program, data were collected on the participants' completion of the program's educational elements and their use of POCUS following the program. RESULTS The 18 participating GPs were found to have scanning competence scores after completing the educational program, ranging from 68.9% to 82.3% of the maximum score, depending on the POCUS application. At follow-up, their scores had significantly increased for all POCUS applications, ranging from 80.9% to 92.6% of the maximum score. While completion of the educational elements varied between participants, all implemented POCUS in their daily practice during the educational program. CONCLUSION This study emphasizes that a customized training program, considering the learning challenges faced by office-based GPs, can result in scanning proficiency that continues to develop in the months following the training. TRIAL REGISTRATION Clinical trials registration ID NCT05274581.
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Affiliation(s)
- Camilla Aakjær Andersen
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark.
| | - Søren Lundbye-Christensen
- Research Data and Biostatistics, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Allan Riis
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
- Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | - Ulrike Mehnert
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Thomas Løkkegaard
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Troels Mengel-Jørgensen
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Liv Dyre Rasmussen
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Nicolai Soll
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Bo Stork
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Søren Kæseler Andersen
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Louise Pil
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Christian Stjernebjerg
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Bach Jensen
- Center for General Practice at Aalborg University, Aalborg University, Selma Lagerløfs Vej 249, Aalborg, Gistrup, DK-9260, Denmark
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Ben Shitrit I, Ilan K, Shmueli M, Karni O, Hasidim AA, Cicurel A, Quinn A, Pinto MI, Wacth O, Fuchs L. Continuing professional development for primary care physicians: a pre-post analysis of a focused abdominal point-of-care ultrasound pilot training. BMC MEDICAL EDUCATION 2025; 25:678. [PMID: 40340841 PMCID: PMC12063416 DOI: 10.1186/s12909-025-07152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 04/08/2025] [Indexed: 05/10/2025]
Abstract
INTRODUCTION Abdominal pain is a leading cause of primary care visits and emergency department admissions. The recent surge in the implementation of point-of-care ultrasound into primary care underscores the necessity for specialized training to enhance the expertise of primary care physicians and foster a positive attitude toward its routine use in clinical activities. METHODS This prospective cohort study, conducted between March and August 2023 at Ben Gurion University, introduced an integrative abdominal ultrasound program for 48 participating primary care physicians with no prior formal experience in abdominal ultrasound. Physicians' knowledge, practical skills, and attitudes towards abdominal ultrasound integration were evaluated using a pre/post-course clips-based pathology test, a hands-on exam immediately following the course, and a survey conducted ten weeks later. RESULTS Post-course evaluations showed an improvement in primary care physicians' proficiency with hands-on skills, increasing from 26 to 69% (p < 0.001), with increased comfort using abdominal ultrasound (from 0 to 42%, p < 0.001) and enhanced understanding of its capabilities and limitations (from 0 to 58%, p < 0.001). Pattern recognition skills, assessed through clips, presented a notable rise from an average of 26% to 69% (p < 0.001). Ten weeks following the training, an increase in its utilization was observed; weekly usage rose from zero to 44%, and the proportion not using it declined from 94 to 19% (p < 0.001, p < 0.001, respectively). CONCLUSIONS An integrative two-day training program increases the application of abdominal bedside ultrasound in clinical settings, demonstrating the effectiveness of combining practical training with flexible, theoretical learning.
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Affiliation(s)
- Itamar Ben Shitrit
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 151, 84101, Be'er-Sheva, Israel.
| | - Karny Ilan
- General Surgery Department, Sheba Medical Center, Beer- Sheva, Israel
| | - Moshe Shmueli
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 151, 84101, Be'er-Sheva, Israel
| | - Ofri Karni
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Avraham Hasidim
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Cicurel
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services Southern District, Beer- Sheva, Israel
| | - Anna Quinn
- Medical School for International Health, Ben Gurion University of the Negev, Beer- Sheva, Israel
| | - Meir Israel Pinto
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Wacth
- Department of Emergency Medicine, Ben Gurion University of the Negev in Beer- Sheva, Beer- Sheva, Israel
| | - Lior Fuchs
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Medical Intensive Care Unit, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
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Cortellini F, Fichera A, Guarino AD, Laterza L, Alemanni LV, Lopetuso L, Marasco G, Costantino A. Abdominal and Bowel Ultrasound Knowledge Among Young Gastroenterologists: Results of an Italian Survey. J Clin Med 2025; 14:2693. [PMID: 40283523 PMCID: PMC12027906 DOI: 10.3390/jcm14082693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 02/14/2025] [Accepted: 04/08/2025] [Indexed: 04/29/2025] Open
Abstract
Background: The diagnostic accuracy of abdominal ultrasound (US) is operator-dependent and, therefore, influenced by inadequate training and lack of continuous medical education. To fill this gap, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has developed guidelines to identify minimum training requirements for US. The aim of our survey was to assess the self-reported overall US education level among young Italian gastroenterologists. Methods: The Italian Association of Young Gastroenterologists and Endoscopists (Associazione Giovani Gastroenterologi ed Endoscopisti Italiani, AGGEI) developed a web-based survey with a multiple-choice test with images, based on the EFSUMB recommendations. The survey was distributed via e-mail to AGGEI members. Results: The questionnaire was filled out by 110 participants from all over Italy. Most of the respondents worked in academic hospitals and were gastroenterology residents or PhD students. More than half (58.9%) learned US during their gastroenterology training and 8.2% attended specific courses. During their training participants performed a median number of 320 abdominal USs and 240 bowel USs. Participants receiving a longer training period ranked significantly better in the knowledge questionnaire. Conclusions: Young Italian gastroenterologists show heterogeneous training in residencies across the country. In the future learning and hands-on training courses endorsed by academies are needed to fill this knowledge and skill gap.
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Affiliation(s)
- Fabio Cortellini
- Gastroenteroloy Unit, Azienda Unità Sanitaria Locale (AUSL) della Romagna Ospedale Infermi, 47921 Rimini, Italy;
| | - Anna Fichera
- Gastroenteroloy and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.F.); (A.C.)
| | - Alessia Dalila Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, 80146 Naples, Italy;
| | - Lucrezia Laterza
- Centro Malattie Apparato Digerente (CEMAD) Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.L.); (L.L.)
| | - Luigina Vanessa Alemanni
- Gastroenteroloy Unit, Azienda Unità Sanitaria Locale (AUSL) della Romagna, Ospedale Morgani-Pierantoni, 47121 Forlì, Italy;
| | - Loris Lopetuso
- Centro Malattie Apparato Digerente (CEMAD) Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.L.); (L.L.)
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Andrea Costantino
- Gastroenteroloy and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.F.); (A.C.)
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Sun P, Han H, Sun YK, Wang X, Liu XC, Zhou BY, Wang LF, Zhang YQ, Pan ZG, Huang BJ, Xu HX, Zhao CK. Intelligent handheld ultrasound improving the ability of non-expert general practitioners in carotid examinations for community populations: a prospective and parallel controlled trial. Ultrasonography 2025; 44:112-123. [PMID: 39924719 PMCID: PMC11938801 DOI: 10.14366/usg.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 11/02/2024] [Accepted: 11/14/2024] [Indexed: 02/11/2025] Open
Abstract
PURPOSE The aim of this study was to investigate the feasibility of an intelligent handheld ultrasound (US) device for assisting non-expert general practitioners (GPs) in detecting carotid plaques (CPs) in community populations. METHODS This prospective parallel controlled trial recruited 111 consecutive community residents. All of them underwent examinations by non-expert GPs and specialist doctors using handheld US devices (setting A, setting B, and setting C). The results of setting C with specialist doctors were considered the gold standard. Carotid intima-media thickness (CIMT) and the features of CPs were measured and recorded. The diagnostic performance of GPs in distinguishing CPs was evaluated using a receiver operating characteristic curve. Inter-observer agreement was compared using the intragroup correlation coefficient (ICC). Questionnaires were completed to evaluate clinical benefits. RESULTS Among the 111 community residents, 80, 96, and 112 CPs were detected in settings A, B, and C, respectively. Setting B exhibited better diagnostic performance than setting A for detecting CPs (area under the curve, 0.856 vs. 0.749; P<0.01). Setting B had better consistency with setting C than setting A in CIMT measurement and the assessment of CPs (ICC, 0.731 to 0.923). Moreover, measurements in setting B required less time than the other two settings (44.59 seconds vs. 108.87 seconds vs. 126.13 seconds, both P<0.01). CONCLUSION Using an intelligent handheld US device, GPs can perform CP screening and achieve a diagnostic capability comparable to that of specialist doctors.
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Affiliation(s)
- Pei Sun
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Hong Han
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
- Shanghai Institute of Imaging Medicine, Shanghai, China
| | - Yi-Kang Sun
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
- Shanghai Institute of Imaging Medicine, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Xiao-Chuan Liu
- General Medicine Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bo-Yang Zhou
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Li-Fan Wang
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Ya-Qin Zhang
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Zhi-Gang Pan
- General Medicine Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei-Jian Huang
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
- Shanghai Institute of Imaging Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
- Shanghai Institute of Imaging Medicine, Shanghai, China
| | - Chong-Ke Zhao
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
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Costantino A, Piagnani A, Caccia R, Sorge A, Maggioni M, Perbellini R, Donato F, D'Ambrosio R, Sed NPO, Valenti L, Prati D, Vecchi M, Lampertico P, Fraquelli M. Reproducibility and accuracy of a pocket-size ultrasound device in assessing liver steatosis. Dig Liver Dis 2024; 56:1032-1038. [PMID: 38016894 DOI: 10.1016/j.dld.2023.11.014] [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: 08/25/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND This diagnostic prospective study compared the feasibility and diagnostic accuracy of Pocket-size Ultrasound Devices (PUDs) against standard ultrasound (US) in detecting liver steatosis using the controlled attenuation parameter (CAP) and liver biopsy as reference standards. MATERIALS AND METHODS Consecutive patients with chronic liver diseases were assessed for the presence of steatosis using PUD and US. A CAP cut-off value >275 dB/m was applied to establish ≥S1. A 26-patient subgroup underwent liver biopsy. PUD reproducibility was evaluated using Cohen's k statistic. Diagnostic accuracy of PUD and US was given as Sensibility (Sn), Specificity (Sp), Positive and Negative Predictive Values (PPV, NPV), positive and negative Likelihood Ratio (LR+, LR-). RESULTS 81 consecutive patients (69% males) with multiple etiologies were enroled. PUD inter-observer agreement was good (k 0.77, 95%CI 0.62-0.93). PUD and US identified ≥S1 according to CAP values respectively with Sn 0.87, Sp 0.61, PPV 0.49, NPV 0.91, LR+ 2.04, LR- 0.07, AUROC 0.74 and Sn 0.96, Sp 0.54, PPV 0.47, NPV 0.97, LR+ 2.10, LR- 0.07, AUROC 0.75. CONCLUSIONS PUD shows good reproducibility and diagnostic accuracy in ruling liver steatosis out, representing a useful point-of-care tool to avail of hepatologists interested in excluding NAFLD, but with basic US skills.
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Affiliation(s)
- Andrea Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Piagnani
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Riccardo Caccia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marco Maggioni
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pathology Unit, Milan, Italy
| | - Riccardo Perbellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy
| | - Francesca Donato
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy
| | - Nicole Piazza O Sed
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Translational Medicine, Department of Transfusion Medicine and Hematology, Milan, Italy
| | - Daniele Prati
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Translational Medicine, Department of Transfusion Medicine and Hematology, Milan, Italy
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mirella Fraquelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.
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Poppleton A, Tsukagoshi S, Vinker S, Heritier F, Frappé P, Dupont F, Sigmund P, Iacob M, Vilaseca J, Ungan M, Aakjær Andersen C, Frese T, Halata D. World Organization of National Colleges, Academies and Academic Associations of General Practitioners and Family Physicians (WONCA) Europe position paper on the use of point-of-care ultrasound (POCUS) in primary care. Prim Health Care Res Dev 2024; 25:e21. [PMID: 38651341 PMCID: PMC11091537 DOI: 10.1017/s1463423624000112] [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: 08/23/2023] [Revised: 11/29/2023] [Accepted: 02/17/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
| | | | | | | | - Paul Frappé
- Université Jean Monnet, Saint-Etienne, France
| | | | - Peter Sigmund
- Steirischen Akademie für Allgemeinmedizin, Graz, Austria
| | - Mihai Iacob
- Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Mehmet Ungan
- School of Medicine, Ankara University, Ankara, Turkey
| | | | - Thomas Frese
- University Halle-Wittenberg, Halle (Saale), Germany
- European General Practice Research Network, Halle-Wittenberg, Germany
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Calvo Cebrián A, Alonso Roca R, Sánchez Barrancos IM. Diagnostic Accuracy of Abdominal Point of Care Ultrasound in Primary Care: Study Design and Protocol. POCUS JOURNAL 2024; 9:63-70. [PMID: 38681170 PMCID: PMC11044929 DOI: 10.24908/pocus.v9i1.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.
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Affiliation(s)
| | - Rafael Alonso Roca
- Mar Báltico Primary Care Health-Center. Madrid Health ServiceMadridSpain
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Gibbons RC, Jaeger DJ, Berger M, Magee M, Shaffer C, Costantino TG. Diagnostic Accuracy of a Handheld Ultrasound vs a Cart-based Model: A Randomized Clinical Trial. West J Emerg Med 2024; 25:268-274. [PMID: 38596929 PMCID: PMC11000544 DOI: 10.5811/westjem.17822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model. Methods This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system. Patients who required a cardiac, lung, renal, aorta, or biliary POCUS were randomized to a portable device or to a cart-based model. We hypothesized that the cart-based model would have a 90% diagnostic accuracy vs 70% for the handheld device. To detect a 20% difference, the sample size was calculated to be 98, with 49 patients randomized to each arm. We used standard 2x2 tables to calculate test characteristics with 95% confidence intervals (CI). Results A total of 110 patients were enrolled, with 56 patients randomized to the cart-based model and 54 to the handheld device. The sensitivity, specificity, and diagnostic accuracy of the cart-based vs handheld were 77.8% (40-97.2) vs 92.9% (66.1-99.8), 91.5% (79.6-97.6) vs 92.3% (79.1-98.4%), and 89.3% (78.1-96) vs 92.5% (81.8-97.9), respectively. Conclusion The diagnostic accuracy of a portable, handheld device is similar to that of a cart-based model.
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Affiliation(s)
- Ryan C. Gibbons
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Daniel J. Jaeger
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Matthew Berger
- Capital Health, Department of Emergency Medicine, Pennington, New Jersey
| | - Mark Magee
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Claire Shaffer
- University of Pittsburgh Medical Center Harrisburg, Department of Emergency Medicine, Harrisburg, Pennsylvania
| | - Thomas G. Costantino
- Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania
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Velarde-Ruiz Velasco J, Tapia Calderón D, Llop Herrera E, Castro Narro G, García Jiménez E, Cerda Reyes E, Higuera de la Tijera F, Cano Contreras A, Moreno Alcántar R, Chávez Ramírez R, Calleja Panero J. Más allá de la exploración física convencional en hepatología: POCUS. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2023; 88:381-391. [DOI: 10.1016/j.rgmx.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2025]
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10
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Velarde-Ruiz Velasco JA, Tapia Calderón DK, Llop Herrera E, Castro Narro G, García Jiménez ES, Cerda Reyes E, Higuera de la Tijera F, Cano Contreras AD, Moreno Alcántar R, Chávez Ramírez RM, Calleja Panero JL. Beyond conventional physical examination in hepatology: POCUS. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:381-391. [PMID: 37833134 DOI: 10.1016/j.rgmxen.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 10/15/2023]
Abstract
Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient's bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures. POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists.
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Affiliation(s)
- J A Velarde-Ruiz Velasco
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico; Departamento de Clínicas Médicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - D K Tapia Calderón
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, IDIPHISA, Ciberhd, Majadahonda, Madrid, Spain.
| | - E Llop Herrera
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, IDIPHISA, Ciberhd, Majadahonda, Madrid, Spain
| | - G Castro Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E S García Jiménez
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - E Cerda Reyes
- Servicio de Gineco-Obstetricia, Hospital Central Militar, Mexico City, Mexico
| | - F Higuera de la Tijera
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - A D Cano Contreras
- Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - R Moreno Alcántar
- Unidad Médica de Alta Especialidad Hospital de Especialidades CMN SXXI, Mexico City, Mexico
| | - R M Chávez Ramírez
- Unidad de Cuidados Intensivos, Hospital de Ginecoobstetricia, UMAE CMNO IMSS, Guadalajara, Jalisco, Mexico
| | - J L Calleja Panero
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, IDIPHISA, Ciberhd, Majadahonda, Madrid, Spain
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Badejoko SO, Nso N, Buhari C, Amr O, Erwin JP. Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States. Cureus 2023; 15:e42997. [PMID: 37671219 PMCID: PMC10476883 DOI: 10.7759/cureus.42997] [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: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.
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Affiliation(s)
- Solomon O Badejoko
- Internal Medicine, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Nso Nso
- Internal Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
| | - Cyrus Buhari
- Cardiology, St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - Omar Amr
- Emergency Medicine (Ultrasound), St. Joseph's Medical Center (Dignity Health), Stockton, USA
| | - John P Erwin
- Medicine/Cardiology, NorthShore University HealthSystem/University of Chicago Pritzker School of Medicine, Illinois, USA
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Hollerieth K, Vo-Cong MT, Preuss S, Kemmner S, Stock KF. Miniaturised ultrasound evaluation at the bedside. World J Urol 2023; 41:635-640. [PMID: 35583830 PMCID: PMC10082701 DOI: 10.1007/s00345-022-04018-y] [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: 01/26/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE "Point-of-Care Ultrasound" (POCUS) is now a familiar term. Although the European Federation of Societies for Ultrasound in Medicine and Biology (ESFUMB) published a position paper about its usage (Nielsen et al. in Ultraschall Med 40(1):30-39. https://doi.org/10.1055/a-0783-2303 , 2019), there has not been much scientific focus on its utility in uro-nephrological clinical practice thus far. The aim of this study was to evaluate the present usage of pocket ultrasound devices at the bedside. METHODS 27 investigators (all medical doctors with at least 6 months of experience in sonography) performed 280 bedside examinations using a pocket ultrasound device for common clinical issues. RESULTS The most frequent indications included evaluation of hydronephrosis (147), volume management including assessment of dimension of the vena cava inferior (IVC) (195), detection of pleural, pericardial and abdominal effusions (113) as well as residual urine (52). In 90%, specific clinical questions were effectively answered by the pocket ultrasound device alone. CONCLUSIONS POCUS can be useful in the uro-nephrological field. In the hands of an experienced investigator, it saves time and, when it is realised that departmental ultrasound is not cheap, there is also an economic benefit with applicability within both inpatient and outpatient clinic settings. While acknowledging its technical limits, pocket ultrasound devices may nevertheless be helpful in targeted situations for triage or for bedside follow-up exams after earlier high-end ultrasound-based diagnosis.
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Affiliation(s)
- Katharina Hollerieth
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Minh-Truc Vo-Cong
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephanie Preuss
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
- Transplant Centre, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Konrad Friedrich Stock
- Department of Nephrology, School of Medicine, Technical University of Munich, Munich, Germany
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Bisquera OC, Valparaiso AP, Espiritu NT, Ayuste EC, Paloyo SR. Diagnostic Validity of Point-of-Care Breast Ultrasound for Females with Palpable Breast Masses. Clin Breast Cancer 2023; 23:e189-e193. [PMID: 36918315 DOI: 10.1016/j.clbc.2023.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION With breast cancer as one of the frequent causes of cancer mortality today, the importance of ultrasound in its early detection has been apparent. It has been a valuable addition to the surgeon's diagnostic skills, contributing a vital role in clinical practice. We set out to determine the accuracy and value of breast ultrasound for primary imaging in women presenting with a clinically palpable mass in our outpatient clinic. MATERIALS AND METHODS This is a retrospective cross-sectional study of a point-of-care breast ultrasound among patients who consulted at the University of the Philippines-Philippine General Hospital (UP-PGH) Breast Care Clinic for a palpable breast mass without prior histopathologic diagnosis. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Sonographic features were also identified, and multiple logistic regression analysis was performed to determine significant predictors of malignancy. RESULTS Eighty patients were reviewed and compared with their histopathology results. The overall accuracy of a surgeon-performed breast ultrasound was 86.2%, sensitivity of 91.4%, specificity of 82.2%, PPV of 80% and NPV of 92.5%. Indistinct borders, posterior enhancement, unilateral shadowing, heterogeneous echo pattern and deeper than wide anterior-posterior ratio are sonographic features associated with malignancy. CONCLUSION This study showed that a point-of-care ultrasound for a palpable breast mass is reliable with a relatively good accuracy rate. Performing breast ultrasound in the clinic will help the surgeon evaluate the extent of disease preoperatively and be guided as to the optimal surgical management for the patient.
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Affiliation(s)
- Orlino C Bisquera
- Department of Surgery University of the Philippines-Philippine General Hospital, Manila, Philippines; College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Apple P Valparaiso
- Department of Surgery University of the Philippines-Philippine General Hospital, Manila, Philippines; College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Neresito T Espiritu
- Department of Surgery University of the Philippines-Philippine General Hospital, Manila, Philippines; College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Eduardo C Ayuste
- Department of Surgery University of the Philippines-Philippine General Hospital, Manila, Philippines; College of Medicine, University of the Philippines-Manila, Manila, Philippines
| | - Siegfredo R Paloyo
- Department of Surgery University of the Philippines-Philippine General Hospital, Manila, Philippines; College of Medicine, University of the Philippines-Manila, Manila, Philippines.
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Gilja OH, Nylund K. Point-of-care Ultrasound of the Gastrointestinal Tract. J Med Ultrasound 2023; 31:1-7. [PMID: 37180631 PMCID: PMC10173834 DOI: 10.4103/jmu.jmu_5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 05/16/2023] Open
Abstract
The widespread use of portable ultrasound scanners has promoted the concept of point of care ultrasound (POCUS), namely "ultrasound performed bedside and interpreted directly by the clinician." The purpose of this short review is to outline how POCUS can be used in patients with diseases of the gastrointestinal (GI) tract. POCUS is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid diagnosis and efficient work-up and treatment of the patients. There are many indications for doing POCUS of the GI tract, including abdominal pain, diarrhea, palpable masses, and to detect fluid or free air in the abdominal cavity. To improve the visibility of deeper parts of the abdomen, the graded compression technique with the scan head is useful. During POCUS, the operator should look for signs of severe pathology including target lesions, the pseudo-kidney sign, the onion sign, dilated bowel loops, gastric retention, free fluid, and free air, depending on the actual clinical problem. We conclude that POCUS of the GI tract is very useful to provide a rapid diagnosis in many clinical scenarios.
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Affiliation(s)
- Odd Helge Gilja
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Address for correspondence: Prof. Odd Helge Gilja, Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, 5021 Bergen, Norway. E-mail:
| | - Kim Nylund
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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15
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Hulse WN, Bell CR, Roosevelt GE, Sabbadini L, Germano R, Hopkins E, Kendall J, Toney AG. Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents. Pediatr Emerg Care 2022; 38:605-608. [PMID: 36314862 DOI: 10.1097/pec.0000000000002853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents. METHODS The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores. RESULTS Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images. CONCLUSIONS Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.
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Affiliation(s)
- Whitley N Hulse
- From the Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Colin R Bell
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Genie E Roosevelt
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - Linda Sabbadini
- Università degli Studi di Brescia, Facoltà di Medicina e Chirurgia, Spedali Civili di Brescia, Brescia, Italy
| | - Rocco Germano
- Università degli Studi di Brescia, Facoltà di Medicina e Chirurgia, Spedali Civili di Brescia, Brescia, Italy
| | - Emily Hopkins
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - John Kendall
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - Amanda G Toney
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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17
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Costantino A, Piagnani A, Nandi N, Sciola V, Maggioni M, Donato F, Vecchi M, Lampertico P, Casazza G, Fraquelli M. Reproducibility and diagnostic accuracy of pocket-sized ultrasound devices in ruling out compensated cirrhosis of mixed etiology. Eur Radiol 2022; 32:4609-4615. [PMID: 35238968 PMCID: PMC9213370 DOI: 10.1007/s00330-022-08572-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fibrosis is the key prognostic factor in chronic liver disease patients. Liver surface nodularity (LSN) is the ultrasonographic sign with the highest accuracy to detect advanced liver fibrosis. The use of pocket-sized ultrasound devices (PUDs) has been assessed in several clinical settings but never as regards chronic liver disease (CLD) severity. Our study aimed at evaluating the feasibility, reproducibility, and diagnostic accuracy of PUD in LSN identification. METHODS We enrolled all the consecutive adults referred for percutaneous liver biopsy. Two independent operators evaluated LSN by PUD; one sonographer used standard ultrasound (US). Transient elastography (TE) and liver biopsy were performed on all the patients. PUD reproducibility was evaluated by Cohen's k statistic. PUD, standard US, and TE results were compared with histology staging. RESULTS A total of 104 consecutive patients (aged 54 ± 14 years) with mixed-etiology CLD were studied. Assessment by PUD was feasible in all the patients and showed very good inter-observer agreement with Cohen's k = 0.87 (95% CI 0.72-0.95). The diagnostic accuracy estimates for PUD in diagnosing compensated cirrhosis (F = 4) were 87.5% sensitivity, 76.8% specificity, positive likelihood ratio (LR) 3.78, and negative likelihood ratio (LR-) 0.16, while those for standard US and TE (> 12.5 kPa) were, respectively, 87.5% sensitivity, 72.6% specificity, LR+ 3.2, and LR- 0.17, and 87.5% sensitivity, 90.5% specificity, LR + 9.2, and LR- 0.13. CONCLUSIONS PUD reproducibility in assessing LSN was excellent even with operators of different experience. PUD performed very well in excluding advanced CLD. PUD can be used as a first-line tool for screening patients to undergo more invasive techniques, thus shortening the time for clinical decision-making. KEY POINTS • PUD is highly reproducible in assessing the sign of liver surface nodularity. • PUD showed high diagnostic accuracy in excluding the presence of advanced chronic liver disease. • PUD can be used as a first-line tool for screening patients with CLD who should undergo more invasive techniques.
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Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Valentina Sciola
- Gastroenterology and Endoscopy Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Maggioni
- Pathology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Donato
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Lampertico
- Gastroenterology and Hepatology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanni Casazza
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, "L. Sacco" Hospital, University of Milan, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Rispo A, de Sire R, Mainenti PP, Imperatore N, Testa A, Maurea S, Ricciolino S, Nardone OM, Olmo O, Castiglione F. David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2022; 29:563-569. [PMID: 35666249 DOI: 10.1093/ibd/izac116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Diagnosis of Crohn's disease (CD) requires ileo-colonoscopy (IC) and cross-sectional evaluation. Recently, "echoscopy" has been used effectively in several settings, although data about its use for CD diagnosis are still limited. Our aim was to evaluate the diagnostic accuracy of handheld bowel sonography (HHBS) in comparison with magnetic resonance enterography (MRE) for CD diagnosis. METHODS From September 2019 to June 2021, we prospectively recruited consecutive subjects attending our third level IBD Unit for suspected CD. Patients underwent IC, HHBS, and MRE in random order with operators blinded about the result of the other procedures. Bivariate correlation between MRE and HHBS was calculated by Spearman coefficient (r). To test the consistency between MRE and HHBS for CD location and complications, the Cohen's k measure was applied. RESULTS Crohn's disease diagnosis was made in 48 out of 85 subjects (56%). Sensitivity, specificity, positive predictive values, and negative predictive values for CD diagnosis were 87.50%, 91.89%, 93.33%, and 85% for HHBS; and 91.67%, 94.59%, 95.65%, and 89.74% for MRE, without significant differences in terms of diagnostic accuracy (89.41% for HHBS vs 92.94% for MRE, P = NS). Magnetic resonance enterography was superior to HHBS in defining CD extension (r = 0.67; P < .01) with a better diagnostic performance than HHBS for detecting location (k = 0.81; P < .01), strictures (k = 0.75; P < .01), abscesses (k = 0.68; P < .01), and fistulas (k = 0.65; P < .01). CONCLUSION Handheld bowel sonography and MRE are 2 accurate and noninvasive procedures for diagnosis of CD, although MRE is more sensitive in defining extension, location, and complications. Handheld bowel sonography could be used as effective ambulatory (or out-of-office) screening tool for identifying patients to refer for MRE examination due to high probability of CD diagnosis.
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Affiliation(s)
- Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Simone Maurea
- Radiology, Department of Advanced Biochemical Sciences, University Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology, Hospital of Ariano Irpino Sant'Ottone-Frangipane, Avellino, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Oriana Olmo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Lam SHF, Berant R, Chang TP, Friedman L, Gold DL, Kornblith AE, Lin-Martore M, Pade KH, Skaugset LM, Toney AG, Wang-Flores H. The P2Network-Advancing Pediatric Emergency Care With Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:e1014-e1018. [PMID: 34787985 DOI: 10.1097/pec.0000000000002369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Over the last 2 decades, the use of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM) has grown exponentially. In 2014, a group of PEM POCUS leaders met and formed the P2Network. The P2Network provides a platform to build collaborative relationships and share expertise among members from various countries and practice settings. It works with educators and researchers within and outside of the field to advance POCUS practice in PEM. As an organization, the P2Network promotes the evidence-based application of POCUS to facilitate and improve care in the PEM setting and addresses issues related to integration of the PEM POCUS practitioner in this nascent field. The P2Network is building and augmenting its infrastructure for PEM POCUS research and education and has already made some progress in the areas, with published manuscripts and ongoing clinical research studies under its sponsorship. Future goals include developing a PEM POCUS research agenda, formalizing teaching and assessment of PEM POCUS skills, and implementing multicenter research studies on potentially high impact applications.
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Affiliation(s)
- Samuel H F Lam
- From the Sutter Medical Center Sacramento, Sacramento, CA
| | | | - Todd P Chang
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Lucas Friedman
- University of California Riverside School of Medicine, Riverside CA
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Kiritharan S, Johanson MV, Jensen MB, Thomsen JNL, Andersen CA, Jensen CE. A cost-minimisation analysis of performing point-of-care ultrasonography on patients with vaginal bleeding in early pregnancy in general practice: a decision analytical model. BMC Health Serv Res 2022; 22:55. [PMID: 35016655 PMCID: PMC8753911 DOI: 10.1186/s12913-022-07463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Spotting and light vaginal bleeding are common and usually harmless symptoms in early pregnancy. Still, vaginal bleeding may be the first sign of an abortion and often causes distress to pregnant women and leads to an expectation of an ultrasonography examination of the uterus. As point-of-care ultrasonography (POCUS) is increasingly being integrated into general practice, these patients may be clinically evaluated and managed by general practitioners (GPs). This can potentially reduce referrals of patients from the primary to the secondary healthcare sector resulting in societal cost-savings. The primary purpose of this study was to investigate whether the accessibility of POCUS in general practice for patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice where GPs do not have access to POCUS. A secondary purpose of this study was to estimate a remuneration for GPs performing POCUS on these patients in general practice. METHODS A cost-minimisation analysis was based on a decision tree model reflecting the two alternatives: general practice with and without GPs having access to POCUS. The robustness of the model results was investigated using probabilistic sensitivity analysis and the following deterministic sensitivity analyses: one-way analyses for the model input parameters and a scenario analysis with a change from a societal to a healthcare sector perspective. An expected remuneration reflecting the add-on cost of Danish GPs performing POCUS was estimated based on the related costs: cost of an ultrasonography scanner, GP's time consumption, ultrasonography training, and utensils per scanning. RESULTS The difference in average cost between the two alternatives from a societal perspective was estimated to be €110, in favour of general practice with GPs using POCUS. The deterministic sensitivity analyses demonstrated robustness of the results to plausible changes in the input parameters. The expected remuneration for performing POCUS in this specific setting was estimated to be €32 per examination. CONCLUSION Having GPs perform POCUS on patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice. The results should be taken with caution as this study was based on early modelling with uncertainties associated with the input parameters in the model.
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Affiliation(s)
- Swaathi Kiritharan
- The Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg Øst, Denmark.
| | - Mille Vang Johanson
- The Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg Øst, Denmark
| | - Martin Bach Jensen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 1,3, 9220, Aalborg Øst, Denmark
| | | | - Camilla Aakjær Andersen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 1,3, 9220, Aalborg Øst, Denmark
| | - Cathrine Elgaard Jensen
- Department of Clinical Medicine, Aalborg University, Danish Center for Healthcare Improvements, Fredrik Bajers Vej 5, 176, 9220, Aalborg Øst, Denmark
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Magee MA, Au AK, Flashner L, Goodsell K, Huot J, Kalwani RM, Lewiss RE, Risler ZW. The effect of display size on ultrasound interpretation. Am J Emerg Med 2021; 51:285-289. [PMID: 34785484 DOI: 10.1016/j.ajem.2021.10.050] [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: 03/30/2021] [Revised: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Ultrasound (US) is an essential component of emergency department patient care. US machines have become smaller and more affordable. Handheld ultrasound (HUS) machines are even more portable and easy to use at the patient's bedside. However, miniaturization may come with consequences. The ability to accurately interpret ultrasound on a smaller screen is unknown. This pilot study aims to assess how screen size affects the ability of emergency medicine clinicians to accurately interpret US videos. METHODS This pilot study enrolled a prospective convenience sample of emergency medicine physicians. Participants completed a survey and were randomized to interpret US videos starting with either a phone-sized screen or a laptop-sized screen, switching to the other device at the halfway point. 50 unique US videos depicting right upper quadrant (RUQ) views of the Focused Assessment with Sonography in Trauma (FAST) examination were chosen for inclusion in the study. There were 25 US videos per device. All of the images were previously obtained on a cart-based machine (Mindray M9) and preselected by the study authors. Participants answered "Yes" or "No" in response to whether they identified free fluid. The time that each participant took to interpret each video was also recorded. Following the assessment, participants completed a post-interpretation survey. The goal of the pilot was to determine the accuracy of image interpretation on a small screen as compared to a laptop-sized screen. Statistical analyses were performed using MATLAB (The MathWorks, Inc., Natick, MA). Nonparametric statistical tests were utilized to compare subgroups, with a Wilcoxon signed rank test used for paired data and a Wilcoxon rank sum test for unpaired data. RESULTS 52 emergency medicine physicians were enrolled in the study. The median accuracy of US interpretation for phone versus laptop image screen was 88.0% and 87.6% (p = 0.67). The mean time to interpret with phone versus laptop screen was 293 and 290 s (p = 0.66). CONCLUSIONS The study found no statistically significant difference in the accuracy of US interpretation nor time spent interpreting when the pre-selected RUQ videos generated on a cart-based ultrasound machine were reviewed on a phone-sized versus a laptop-sized screen. This pilot study suggests that the accuracy of US interpretation may not be dependent upon the size of the screen utilized.
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Affiliation(s)
- Mark A Magee
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Lillian Flashner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Kelly Goodsell
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Jamie Huot
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Rishi M Kalwani
- Department of Emergency Medicine, Jefferson Health Northeast, Philadelphia, PA, United States of America
| | - Resa E Lewiss
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Zachary W Risler
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, United States of America
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22
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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: 28] [Impact Index Per Article: 7.0] [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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23
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Andersen CA, Hedegård HS, Løkkegaard T, Frølund J, Jensen MB. Education of general practitioners in the use of point-of-care ultrasonography: a systematic review. Fam Pract 2021; 38:484-494. [PMID: 33367766 DOI: 10.1093/fampra/cmaa140] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically review and synthesize the published literature regarding the education of general practitioners (GPs) and GPs in training (GPTs) in the use of ultrasonography. DESIGN This systematic review was prospectively registered in PROSPERO, conducted according to the Cochrane recommendations. We combined studies identified in a previous systematic review with studies from an updated literature search using the same search string. We searched the following databases: MEDLINE via Pubmed, EMBASE via OVID, Cinahl via Ebsco, Web of Science and Cochrane Register of Controlled Trials using the words 'ultrasonography' and 'general practice'. Two reviewers independently screened articles, extracted data and assessed the quality of included papers according to the Down and Black quality assessment tool. Disagreements were resolved by involving a third reviewer. RESULTS Thirty-three papers were included. Ultrasound training was described to include both theoretical and practical training sessions. Theoretical training was achieved through introductory e-learning and/or didactic lectures. Practical training included focussed hands-on training sessions, while some papers described additional longitudinal practical training through proctored scans during clinical work or through self-study practice with continuous feedback on recorded scans. CONCLUSION There was a large variation in ultrasound training programs for GPs and GPTs, with an overall emphasis on focussed practical training. Few studies included a longitudinal learning process in the training program. However, diagnostic accuracy seemed to improve with hours of practical training, and studies including continuous feedback on scans conducted during clinical patient encounters showed superior results.
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Affiliation(s)
| | | | | | - Joachim Frølund
- Center for Health Sciences Education, Aarhus University, Aarhus, Denmark
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24
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Malik AN, Rowland J, Haber BD, Thom S, Jackson B, Volk B, Ehrman RR. The Use of Handheld Ultrasound Devices in Emergency Medicine. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 9:73-81. [PMID: 33996272 PMCID: PMC8112245 DOI: 10.1007/s40138-021-00229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
Purpose of Review Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology. Recent Findings Images obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of "tele-ultrasound" and augmented reality scanning. Summary This review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.
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Affiliation(s)
- Adrienne N Malik
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Jonathan Rowland
- Department of Emergency Medicine, University of California-Irvine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Brian D Haber
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
| | - Stephanie Thom
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bradley Jackson
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bryce Volk
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
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25
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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: 2.5] [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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Andersen CA, Frandsen AK, Valentiner-Branth C, Lykkegaard J, Løkkegaard T, Thomsen JL, Jensen MB, Hansen MP. Introducing point-of-care ultrasound in Danish general practice-elucidating the use through a medical audit. Fam Pract 2021; 38:80-87. [PMID: 32839822 DOI: 10.1093/fampra/cmaa080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Point-of-care ultrasonography (PoCUS) is increasingly used across the medical field. PoCUS is also being implemented in general practice despite a lack of clinical guidelines and training programs for general practitioners (GPs). OBJECTIVES This study aimed to elucidate the employment of PoCUS by Danish GPs following a short training program. METHODS Thirty GPs were enrolled in a short ultrasound training program and taught how to perform 22 selected scanning modalities. In the following 3 months, the GPs registered all performed PoCUS examinations according to the Audit Project Odense method. After 5 months, the GPs were invited to participate in an evaluation seminar, where questionnaires were distributed. RESULTS During the registration period, 1598 patients were examined with PoCUS. A total of 1948 scanning modalities were registered, including 207 examinations outside the taught curriculum. The majority of the ultrasound examinations were performed within 10 minutes (89%), most were considered to be conclusive (87%) and/or to increase diagnostic certainty (67%), whereas one in four examinations entailed a change in patient management. Most GPs attending the evaluation seminar continued to use PoCUS and found the scanning modalities included in the course curriculum relevant in their daily work. CONCLUSION The GPs found several indications for performing PoCUS following the attendance of a 2-day basic training program. The majority of examinations were registered to be conclusive and/or increase diagnostic certainty. However, few GPs used PoCUS on a daily basis and not all examinations were registered to have an impact on patient care.
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Affiliation(s)
| | | | | | - Jesper Lykkegaard
- Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Malene Plejdrup Hansen
- Center for General Practice at Aalborg University, Aalborg.,Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Salmi A, Greco F, Belleri E. Ultrasound-guided insertion of the Elipse ® gastric balloon: technical details, learning curve, and perioperative outcome in 36 cases. J Ultrasound 2020; 23:593-597. [PMID: 32621121 PMCID: PMC7588567 DOI: 10.1007/s40477-020-00499-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Our aim is to demonstrate the feasibility of real-time ultrasound-assisted insertion of the Elipse® intragastric balloon for the treatment of overweight and obese patients. METHODS A plastic gastric phantom filled with water was created to mimic the gastric lumen and to test the operator's ability to recognize the capsule containing the balloon inside. In the clinical phase, we tested the operator's ability to recognize the swallowed capsule and its progressive filling in the gastric lumen by means of ultrasound in 36 consecutive patients with a mean body mass index of 35 in an outpatient setting. RESULTS The ultrasound hyperechoic signal of the capsule in the gastric lumen was visible early on and was confirmed after the injection of a few milliliters of saline solution in the capsule with a cyst-like shape. The insertion of the balloon was successful in all cases at the first attempt, and the complete filling was monitored in real-time without the need for fluoroscopy. Postprocedure symptoms were limited to the first 24-48 h and were controlled by symptomatic therapy; endoscopic removal of the balloon because of painful distal gastric migration was necessary in one case after 3 months. CONCLUSION After a learning curve, we were able to demonstrate the placement of the balloon capsule inside the fundus of the stomach under ultrasound guidance without fluoroscopy in all patients in an outpatient setting.
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Affiliation(s)
- Andrea Salmi
- Medicalspa Outpatient Clinic, Brescia, Italy.
- Liver Unit, San Camillo Hospital, via Turati, 25125, Brescia, Italy.
| | - Francesco Greco
- Medicalspa Outpatient Clinic, Brescia, Italy
- Bariatric and Metabolic Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
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Arenas-Berenguer I, Tung-Chen Y, Alonso González B. Utilidad de la ecografía clínica en el diagnóstico y seguimiento de la sinusitis aguda. Enferm Infecc Microbiol Clin 2020; 38:508-509. [DOI: 10.1016/j.eimc.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
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Aakjær Andersen C, Brodersen J, Davidsen AS, Graumann O, Jensen MBB. Use and impact of point-of-care ultrasonography in general practice: a prospective observational study. BMJ Open 2020; 10:e037664. [PMID: 32948563 PMCID: PMC7500300 DOI: 10.1136/bmjopen-2020-037664] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To describe how general practitioners (GPs) use point-of-care ultrasonography (POCUS) and how it influences the diagnostic process and treatment of patients. DESIGN Prospective observational study using an online questionnaire before and after POCUS. SETTING Office-based general practice. PARTICIPANTS Twenty GPs consecutively recruited all patients examined with POCUS in 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the use of POCUS through the indication for use, the frequency of use, the time consumption, the extent of modification of the examination and the findings.The influence on the diagnostic process was estimated through change in the tentative diagnoses, change in confidence, the ability to produce ultrasound images and the relationship between confidence and organs scanned or tentative diagnoses.The influence of POCUS on patient treatment was estimated through change in plan for the patient, change in patient's treatment and the relationship between such changes and certain findings. RESULTS The GPs included 574 patients in the study. POCUS was used in patient consultations with a median frequency of 8.6% (IQR: 4.9-12.6). Many different organs were scanned covering more than 100 different tentative diagnoses. The median time taken to perform POCUS was 5 min (IQR: 3-8). Across applications and GPs, POCUS entailed a change in diagnoses in 49.4% of patients; increased confidence in a diagnosis in 89.2% of patients; a change in the management plan for 50.9% of patients including an absolute reduction in intended referrals to secondary care from 49.2% to 25.6%; and a change in treatment for 26.5% of patients. CONCLUSIONS The clinical utilisation of POCUS was highly variable among the GPs included in this study in terms of the indication for performing POCUS, examined scanning modalities and frequency of use. Overall, using POCUS altered the GPs' diagnostic process and clinical decision-making in nearly three out of four consultations. TRIAL REGISTRATION NUMBER NCT03375333.
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Affiliation(s)
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Zealand Region, Copenhagen, Denmark
| | - Annette Sofie Davidsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Graumann
- Department of Radiology, Radiological Research and Innovation Unit, Odense University Hospital, Odense, Denmark
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García Moreno R, Noguer Martos R, Tung-Chen Y, Villén Villegas T. Ictericia congestiva desenmascarada con la ecografía clínica. Semergen 2020; 46:434-436. [DOI: 10.1016/j.semerg.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
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Ong AML. Utility of gastrointestinal ultrasound in functional gastrointestinal disorders: A narrative review. World J Meta-Anal 2020; 8:109-118. [DOI: 10.13105/wjma.v8.i2.109] [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: 11/18/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal (GI) ultrasound (GIUS) is valuable in the evaluation of GI diseases such as inflammatory bowel disease, but its use in functional GI disorders (FGIDs) is largely unknown although promising. In order to review the current knowledge on current and potential uses of GIUS in FGIDs, information was obtained via a structured literature search through PubMed, EMBASE and Google Scholar databases with a combination of MESH and keyword search terms: “ultrasound”, “functional GI disorders”, “irritable bowel syndrome”, “functional dyspepsia”, “intestinal ultrasound”, “point of care ultrasonography”, “transabdominal sonography”, “motility”, “faecal loading”, “constipation”. GIUS is currently used for various settings involving upper and lower GI tracts, including excluding organic diseases, evaluating physiology, guiding treatment options and building rapport with patients. GIUS can be potentially used to correlate mechanisms with symptoms, evaluate mechanisms behind treatment efficacy, and investigate further the origin of symptoms in real-time. In conclusion, GIUS is unique in its real-time, interactive and non-invasive nature, with the ability of evaluating several physiological mechanisms with one test, thus making it attractive in the evaluation and management of FGIDs. However, there are still limitations and concerns of operator dependence and lack of validation data for widespread implementation of GIUS in FGIDs.
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Affiliation(s)
- Andrew Ming-Liang Ong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
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Torres-Macho J, Aro T, Bruckner I, Cogliati C, Gilja OH, Gurghean A, Karlafti E, Krsek M, Monhart Z, Müller-Marbach A, Neves J, Sabio R, Serra C, Smallwood N, Tana C, Uyaroğlu OA, Von Wowern F, Bosch FH. Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine. Eur J Intern Med 2020; 73:67-71. [PMID: 31836177 DOI: 10.1016/j.ejim.2019.11.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
Abstract
Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.
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Affiliation(s)
- J Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Complutense University, Spanish Society of Internal Medicine, Madrid, Spain.
| | - T Aro
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Young Internists Subcommittee. European Federation of Internal Medicine. Finnish Society of Internal Medicine
| | - I Bruckner
- Romanian Society of Internal Medicine, Romania
| | - C Cogliati
- Internal Medicine Department. Ospedale Luigi Sacco, ASST-Fbf-Sacco. Italian Society of Internal Medicine, Milan, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Gurghean
- Internal Medicine Department. Cardiology, Coltea Clinical Hospital, University of Medicine and Pharmacy Bucharest, Romanian Society of Internal Medicine, Romania
| | - E Karlafti
- AHEPA University Hospital, Aristotle University of Thessaloniki, Internal Medicine Society of Greece, Greece
| | - M Krsek
- Third Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Czech Society of Internal Medicine, Prague
| | - Z Monhart
- Internal Medicine and Emergency Department, Hospital Znojmo, Czech Society of Internal Medicine, Czech Republic
| | - A Müller-Marbach
- Department of Gastroenterology, Hepatology und Palliative Care. Helios Hospital Niederberg, German Society of Internal Medicine, Velbert, Germany
| | - J Neves
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto, Portuguese Society of Internal Medicine, Porto, Portugal
| | - R Sabio
- Hospital SAMIC de Alta Complejidad, Sociedad Argentina de Medicina (SAM), El Calafate, Argentina
| | - C Serra
- Diagnostic and Interventional Utrasound Unit. Division of Multiorgan Failure Emergency, General Surgery and Transplant Department. S.Orsola-Malpighi University Hospital. Italian Society of Internal Medicine
| | - N Smallwood
- Department of Acute Medicine, East Surrey Hospital. Society for Acute Medicine. United Kingdom
| | - C Tana
- Internal Medicine and Subacute Care Unit, University-Hospital of Parma, Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), Parma, Italy
| | - O A Uyaroğlu
- Internal Medicine Department. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital. Turkish Society of Internal Medicine, Turkey
| | - F Von Wowern
- Department of Internal Medicine, University Hospitals of Skåne - Malmö, Swedish Society of Internal Medicine, Skane, Sweden
| | - F H Bosch
- Department of Internal Medicine, Radboud university medical center, Nijmegen and Rijnstate Hospital, Arnhem, the Netherlands
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Costantino A, Giunta M, Casazza G, Arona S, Colli A, Conte D, Vecchi M, Fraquelli M. Is pocket-size ultrasound a reliable tool for bowel investigation? A study on its feasibility, reproducibility and diagnostic accuracy. Dig Liver Dis 2020; 52:38-43. [PMID: 31409578 DOI: 10.1016/j.dld.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intestinal ultrasound (IUS) examination is a first-line non-invasive imaging procedure for patients with suspicion of bowel diseases. AIM To assess the feasibility, reproducibility and diagnostic accuracy of a pocket-size ultrasound device (PUD) in identifying the presence of intestinal alterations in patients consecutively recruited to undergo IUS examination. METHODS 200 consecutive patients (57% female, 48.8 years) underwent both PUD (two independent investigators) and IUS examination on the same day. Nine ultrasonographic signs were systematically searched for. PUD inter-observer reproducibility was assessed by kappa statistic and ICC. The diagnostic accuracy of PUD as compared to IUS results was assessed by calculating sensitivity, specificity and corresponding positive and negative likelihood ratios. RESULTS PUD and IUS examinations were successful in 100% of the patients. PUD reproducibility was good/excellent at evidencing the presence (ICC 0.84) and length (ICC 0.85) of an intestinal tract with thickened wall and abdominal free fluid (ICC 0.87). The diagnostic accuracy of PUD, compared to traditional IUS, was good with regard to the presence of bowel wall thickening (sensitivity 92%, specificity 95%), the length of the thickened bowel (sensitivity 94%, specificity 95%) and the presence of free fluid (sensitivity 81%, specificity 99%). CONCLUSIONS PUD is a feasible, reproducible and accurate first-line screening tool for the assessment of the gastro-intestinal tract.
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Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | | | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche, Ospedale "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Silvia Arona
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Agostino Colli
- Dipartimento di Medicina Interna, Ospedale "A. Manzoni", Lecco, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy.
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ACR Appropriateness Criteria® Palpable Abdominal Mass-Suspected Neoplasm. J Am Coll Radiol 2019; 16:S384-S391. [DOI: 10.1016/j.jacr.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 01/13/2023]
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Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel) 2019; 9:diagnostics9020061. [PMID: 31208078 PMCID: PMC6628329 DOI: 10.3390/diagnostics9020061] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to review the scientific literature available on the comparison of hand-held ultrasound devices with high-end systems for abdominal and pleural applications. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original research describing hand-held ultrasound devices compared with high-end systems was included and assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2. The search was limited to articles published since 1 January 2012. A total of 2486 articles were found and screened by title and abstract. A total of 16 articles were chosen for final review. All of the included articles showed good overall agreement between hand-held and high-end ultrasound systems. Strong correlations were found when evaluating ascites, hydronephrosis, pleural cavities, in detection of abdominal aortic aneurysms and for use with obstetric and gynaecological patients. Other articles found good agreement for cholelithiasis and for determining the best site for paracentesis. QUADAS-2 analysis suggested few risks of bias and almost no concerns regarding applicability. For distinct clinical questions, hand-held devices may be a valuable supplement to physical examination. However, evidence is inadequate, and more research is needed on the abdominal and pleural use of hand-held ultrasound with more standardised comparisons, using only blinded reviewers.
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Affiliation(s)
- Alexander Rykkje
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med 2019; 17:61-69. [PMID: 30670398 PMCID: PMC6342599 DOI: 10.1370/afm.2330] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners. METHODS We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting. CONCLUSIONS POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners.
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Affiliation(s)
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Aalborg East, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan Vela
- Department of Rheumatology, Aalborg University Hospital, Aalborg North, Denmark
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Chetioui A, Masia T, Claret PG, Markarian T, Muller L, Lefrant JY, de La Coussaye JE, Roger C, Bobbia X. Pocket-sized ultrasound device for internal jugular puncture: A randomized study of performance on a simulation model. J Vasc Access 2018; 20:404-408. [DOI: 10.1177/1129729818812733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Adrien Chetioui
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaud Masia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Pierre-Géraud Claret
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Thibaut Markarian
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
| | - Laurent Muller
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Yves Lefrant
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Claire Roger
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
| | - Xavier Bobbia
- Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France
- Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France
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Del Medico M, Altieri A, Carnevale-Maffè G, Formagnana P, Casella F, Barchiesi M, Bergonzi M, Vattiato C, Casazza G, Cogliati C. Pocket-size ultrasound device in cholelithiasis: diagnostic accuracy and efficacy of short-term training. Intern Emerg Med 2018; 13:1121-1126. [PMID: 29982876 DOI: 10.1007/s11739-018-1901-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
Abstract
Pocket-size ultrasound devices (PSUD) are now widely available becoming a useful tool for diagnostic and therapeutic purposes. We aim to investigate the accuracy of PSUD in diagnosing cholelithiasis as compared to traditional ultrasonography. Moreover, we tested the reliability of PSUD when performed by inexperienced internal medicine residents after a short-term training. We consecutively enrolled inpatients and outpatients referred to undergo abdominal ultrasonography for signs or symptoms of gallbladder diseases in two different hospitals. Every patient underwent two independent examinations with PSUD by both expert (EXPPSUD) and nonexpert operators (N-EXPPSUD), and a conventional examination with traditional abdominal ultrasound (AUS). Every naive operator underwent a short-term training with a 2-h theoretical lesson, and a practical training focused on gallbladder under expert operator supervision. Overall, 146 patients were consecutively enrolled. Considering conventional AUS as the reference standard, sensitivity and specificity of EXPPSUD were, respectively, 93.75 and 100%. Sensitivity and specificity of N-EXPPSUD were, respectively, 75 and 91.25%. Nevertheless, when considering outpatients, PSUD has a high diagnostic accuracy even when performed by N-EXPPSUD with sensitivity of 93% and specificity of 88%. PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short focussed training.
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Affiliation(s)
- Marta Del Medico
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Alessandra Altieri
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Gabriella Carnevale-Maffè
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Pietro Formagnana
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Casella
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy.
| | - Marco Barchiesi
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Manuela Bergonzi
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Claudia Vattiato
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Chiara Cogliati
- Department of Internal Medicine, L.Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
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Wagner M, Shen-Wagner J, Zhang KX, Flynn T, Bergman K. Point-of-Care Ultrasound Applications in the Outpatient Clinic. South Med J 2018; 111:404-410. [DOI: 10.14423/smj.0000000000000835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kameda T, Uebayashi K, Wagai K, Kawai F, Taniguchi N. Assessment of the renal collecting system using a pocket-sized ultrasound device. J Med Ultrason (2001) 2018; 45:577-581. [PMID: 29721640 DOI: 10.1007/s10396-018-0881-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the performance of a pocket-sized ultrasound device (PUD) for evaluating dilatation of the renal collecting system with high-end ultrasound devices (HUDs) as a reference standard. METHODS One sonographer examined both kidneys using a PUD to evaluate dilatation of the collecting system. The grading of the dilatation ranged from 0 to 4. Immediately after the examination, another sonographer blinded to the previous results performed a formal examination with a HUD. RESULTS Two hundred kidneys in 100 patients were included in the analysis. The agreement of grades between the PUD and HUDs was excellent (weighted kappa = 0.83; P < 0.001). When hydronephrosis was defined as grade 1 or higher, the test characteristics of the PUD were as follows: sensitivity 91% (95% confidence interval (CI) 79-97%), positive predictive value 73% (95% CI 60-83%), and negative predictive value 96% (95% CI 92-99%). When hydronephrosis was defined as grade 2 or higher, the test characteristics were as follows: sensitivity 88% (95% CI 73-97%), positive predictive value 75% (95% CI 59-87%), and negative predictive value 98% (95% CI 94-99%). CONCLUSION Ultrasound using a PUD is useful for evaluating dilatation of the collecting system, especially for ruling out its presence.
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Affiliation(s)
- Toru Kameda
- Department of Clinical Laboratory Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi, 321-0974, Japan.
| | - Kumiko Uebayashi
- Department of Clinical Laboratory Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Kazuko Wagai
- Department of Clinical Laboratory, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Fukiko Kawai
- Department of Clinical Laboratory Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke, Japan
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Saranteas T, Igoumenou VG, Megaloikonomos PD, Mavrogenis AF. Ultrasonography in Trauma: Physics, Practice, and Training. JBJS Rev 2018; 6:e12. [PMID: 29688910 DOI: 10.2106/jbjs.rvw.17.00132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology (T.S.) and First Department of Orthopaedics (V.G.I., P.D.M., and A.F.M.), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Calvo Cebrián A, López García-Franco A, Short Apellaniz J. [Point of Care Ultrasound in Primary Care. Is it a high resolution tool?]. Aten Primaria 2018; 50:500-508. [PMID: 29609871 PMCID: PMC6837135 DOI: 10.1016/j.aprim.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023] Open
Abstract
El modelo «Point of Care Ultrasound» es una forma de hacer ecografía clínica rápida con un fin: responder a una cuestión clínica de forma inmediata. No es hacer ecografía de modo sistemático como la que hacen los radiólogos, ni pretende sustituirla. Es útil en alguna forma de cribado (aneurisma de aorta abdominal) y es de especial interés en procedimientos ecoguiados (infiltraciones articulares). Permite adecuar las derivaciones, minimizando la incertidumbre y descartando determinadas enfermedades por su elevada precisión diagnóstica. Pero puede llevarnos al sobrediágnostico si las exploraciones que realizamos son no limitadas a los órganos sobre los que está fundamentada nuestra sospecha clínica. La ecografía es una herramienta más del proceso diagnóstico, pero que debe ser limitada en su utilización a determinadas situaciones clínicas. Su uso en la detección precoz de enfermedades prevalentes en Atención Primaria deberá ser convenientemente evaluado.Y, por otra parte, con gran evidencia de alta precisión diagnóstica en un gran elenco de entidades patológicas.
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Affiliation(s)
- Antonio Calvo Cebrián
- Médico de Familia, CS Galapagar, Grupo de Trabajo Ecografía SoMaMFyC, Galapagar, Madrid, España.
| | - Alberto López García-Franco
- Médico de Familia, CS Dr. Mendiguchía Carriche, Grupo de Trabajo Ecografía SoMaMFyC, Leganés, Madrid, España
| | - Jorge Short Apellaniz
- Médico de Familia, Servicio de Urgencias Fundación Jiménez Díaz, Grupo de Trabajo Ecografía SoMaMFyC, Madrid, España
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Li S, Su L, Lv G, Zhao W, Chen J. Transabdominal ultrasonography of the pancreas is superior to that of the liver for detection of ectopic fat deposits resulting from metabolic syndrome. Medicine (Baltimore) 2017; 96:e8060. [PMID: 28906401 PMCID: PMC5604670 DOI: 10.1097/md.0000000000008060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of our study was to investigate the rate of nonalcoholic fatty pancreas disease (NAFPD) in the south China province of Fujian and its relationship to nonalcoholic fatty liver disease (NAFLD) and metabolic parameters.NAFPD is frequently identified on transabdominal ultrasound examination. The incidence of NAFPD varies from 16% to 69.7% depending on the country.A total of 256 subjects were recruited. Each was assessed by abdominal sonography to diagnose NAFLD and NAFPD. The ages, sexes, heights, weights, blood pressure, and detection of peripheral blood biochemical indices (cholesterol, triglycerides, high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], and glucose) were recorded. The relationships among metabolic parameters and NAFPD or NAFLD were evaluated, and the positive rates of NAFLD and NAFPD in the general population were compared.The age, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), cholesterol, triglycerides, HDL, LDL, and glucose were significantly associated with NAFPD and NAFLD but the positive rate of NAFPD was significantly higher than that of NAFLD. The BMI, age, and NAFLD were the independent risk factors of NAFPD. The sex distribution, weight, SBP, DBP, BMI, LDL, HDL, triglycerides, glucose, cholesterol, NAFPD, and NAFLD were different significantly between metabolic syndrome and normal subjects.NAFPD and NAFLD can reflect the body metabolism, but NAFPD has a higher detection rate.
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Snelling PJ, Tessaro M. Paediatric emergency medicine point-of-care ultrasound: Fundamental or fad? Emerg Med Australas 2017; 29:486-489. [PMID: 28845599 DOI: 10.1111/1742-6723.12848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Snelling
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Tessaro
- Emergency Department, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Kobal SL, Lior Y, Ben-Sasson A, Liel-Cohen N, Galante O, Fuchs L. The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum. BMC MEDICAL EDUCATION 2017; 17:94. [PMID: 28558692 PMCID: PMC5450418 DOI: 10.1186/s12909-017-0928-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. METHODS Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students' proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. RESULTS Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. CONCLUSIONS Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies.
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Affiliation(s)
- Sergio L Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alon Ben-Sasson
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Teaching echoscopy for the early diagnosis of ascites in cirrhosis: assessment of an objective structured clinical examination (OSCE). J Ultrasound 2017; 20:123-126. [PMID: 28593001 DOI: 10.1007/s40477-017-0250-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 04/21/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION We assessed the efficacy of a brief, 8-h teaching program, using an objective structured clinical examination (OSCE) for the use of a pocket ultrasound device (echoscope) focused on bed side diagnosis of subclinical ascites in chronic liver disease. PATIENTS AND METHODS Ten cirrhotic patients, five with subclinical ascites and five without, were selected during ultrasound examination performed with a high performance equipment for screening of hepatocellular carcinoma. Five post graduate medical doctors residents in Gastroenterology or Internal Medicine underwent a brief, 8-h theoretical and hands-on examinations training. The methodology to assess the correct competence consisted in two phases defined by actions and answers to questions. RESULTS The evaluation of the technical efficacy was positive in all five students. The diagnostic efficacy for the ten patients examined consisted in no false positive diagnosis of ascites and one false negative. CONCLUSIONS In this preliminary experience, the use of a pocket ultrasound device (echoscope) for diagnosis of subclinical ascites in the context of a short structured teaching program and examination was efficient.
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Hew M, Tay TR. The efficacy of bedside chest ultrasound: from accuracy to outcomes. Eur Respir Rev 2017; 25:230-46. [PMID: 27581823 DOI: 10.1183/16000617.0047-2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/05/2016] [Indexed: 12/12/2022] Open
Abstract
For many respiratory physicians, point-of-care chest ultrasound is now an integral part of clinical practice. The diagnostic accuracy of ultrasound to detect abnormalities of the pleura, the lung parenchyma and the thoracic musculoskeletal system is well described. However, the efficacy of a test extends beyond just diagnostic accuracy. The true value of a test depends on the degree to which diagnostic accuracy efficacy influences decision-making efficacy, and the subsequent extent to which this impacts health outcome efficacy. We therefore reviewed the demonstrable levels of test efficacy for bedside ultrasound of the pleura, lung parenchyma and thoracic musculoskeletal system.For bedside ultrasound of the pleura, there is evidence supporting diagnostic accuracy efficacy, decision-making efficacy and health outcome efficacy, predominantly in guiding pleural interventions. For the lung parenchyma, chest ultrasound has an impact on diagnostic accuracy and decision-making for patients presenting with acute respiratory failure or breathlessness, but there are no data as yet on actual health outcomes. For ultrasound of the thoracic musculoskeletal system, there is robust evidence only for diagnostic accuracy efficacy.We therefore outline avenues to further validate bedside chest ultrasound beyond diagnostic accuracy, with an emphasis on confirming enhanced health outcomes.
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Affiliation(s)
- Mark Hew
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tunn Ren Tay
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia Dept of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Filipiak-Strzecka D, Kasprzak JD, Szymczyk E, Wejner-Mik P, Lipiec P. Bedside screening with the use of pocket-size imaging device can be useful for ruling out carotid artery stenosis in patients scheduled for cardiac surgery. Echocardiography 2017; 34:716-722. [PMID: 28299809 DOI: 10.1111/echo.13507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients (pts) scheduled for coronary artery bypass grafting, burdened with high risk of carotid stenosis, are recommended to undergo duplex ultrasonography (DUS) of carotid arteries. PURPOSE To validate pocket-size imaging device (PSID) equipped with linear probe as an easily accessible tool enabling bedside screening for carotid artery stenosis (CAS). METHODS A total of 100 pts (60 men, mean age 69±11 years) with multivessel coronary artery disease underwent bedside DUS of carotid arteries with the use of PSID performed by a cardiology resident trained in DUS. Subsequently, DUS with the use of stationary high-end ultrasound system was performed in all pts to verify findings of PSID examination. RESULTS Initial diagnosis of atherosclerotic plaque presence obtained with PSID in 59 patients was confirmed by high-end ultrasound system examination in all cases. There was a statistically significant correlation of intima-media thickness measurements between PSID and stationary system (r=.58; 95% CI: 0.48-0.66; P<.0001), but the coefficient of agreement (κ) between the two methods in classification of intima-media as normal or thickened (>0.9 mm) was only .38 (95% CI: 0.299-0.459). During PSID examination, turbulent flow was observed in 21 pts-CAS was confirmed in all these pts-5 pts were diagnosed with significant CAS, the rest with CAS ranging from 30% to 70%. CONCLUSIONS Pocket-size imaging device equipped with linear probe allows for identification of patients with atherosclerotic plaques and turbulent flow in carotid arteries; however, the degree of CAS cannot be reliably determined. The measurement accuracy of intima-media thickness is insufficient for a diagnostic purpose.
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Affiliation(s)
| | - Jarosław D Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Ewa Szymczyk
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Paulina Wejner-Mik
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Piotr Lipiec
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
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