scholarly journals Point‐of‐care respiratory muscle ultrasound in a child with medical complexity

2021 ◽  
Author(s):  
Sigmund J. Kharasch ◽  
Lauren Selame ◽  
Helene Dumas ◽  
Hamid Shokoohi ◽  
Andrew Liteplo ◽  
...  
Keyword(s):  
Respiratory Muscle ◽  
Point Of Care ◽  
Medical Complexity ◽  
Muscle Ultrasound

scholarly journals Point-of-Care Ultrasound (POCUS) in the Field of Diabetology

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
X. Vandemergel
Keyword(s):  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Clinical Examination ◽  
Carotid Arteries ◽  
Point Of Care ◽  
Intima Media Thickness ◽  
Point Of Care Ultrasound ◽  
Promising Tool ◽  
Ultrasonic Evaluation ◽  
Muscle Ultrasound

Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).

scholarly journals Point-of-Care Respiratory Muscle Ultrasound in a Child with Medical Complexity

2021 ◽  
Author(s):  
Sigmund Kharasch ◽  
LAUREN SELAME ◽  
Helene Dumas ◽  
Hamid Shokoohi ◽  
Andrew Liteplo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Adverse Effects ◽  
Point Of Care ◽  
Spontaneous Breathing Trial ◽  
Point Of Care Ultrasound ◽  
Lateral Abdominal Wall ◽  
High Resource ◽  
Weaning Failure ◽  
Medical Complexity ◽  
Expiratory Muscles

Point-of-care ultrasound of the diaphragm is a simple, noninvasive, dynamic bedside evaluation of diaphragm function that involves no ionizing radiation, does not require patient transport, and enables the serial evaluation of diaphragmatic function over time. Adverse effects on the diaphragm attributed to ventilator-induced diaphragm dysfunction include longer weaning times, ventilation time and weaning failure. Recent investigations of point-of-care ultrasound evaluating the expiratory muscles of the lateral abdominal wall have found similar adverse effects of mechanical ventilation on these important respiratory muscles resulting in weaning difficulty as well as impaired airway clearance. Children with medical complexity have significant chronic health conditions that may involve multisystem disease (congenital or acquired), high medical fragility, functional and psychosocial impairment, technology dependence (tracheostomies, mechanical ventilation, feeding tubes) and high resource utilization (frequent and/or prolonged hospitalizations). Weaning children dependent on mechanical ventilation is a common rehabilitation goal that has beneficial effects on the quality of life, ease of care, and functionality for transitioning to home care. We present a case of weaning difficulty in a child with medical complexity and the important role of point-of-care ultrasound in the evaluation of the diaphragm and expiratory muscles during a spontaneous breathing trial.

scholarly journals Point of Care Quantitative Assessment of Muscle Health in Older Individuals: An Investigation of Quantitative Muscle Ultrasound and Electrical Impedance Myography Techniques

Geriatrics ◽  
2018 ◽  
Vol 3 (4) ◽  
pp. 92 ◽  
Author(s):  
Lisa Hobson-Webb ◽  
Paul Zwelling ◽  
Ashley Pifer ◽  
Carrie Killelea ◽  
Mallory Faherty ◽  
...  
Keyword(s):  
Electrical Impedance ◽  
Point Of Care ◽  
Clinical Care ◽  
Critical Role ◽  
Knee Extensor ◽  
Well Being ◽  
Older Individuals ◽  
Rater Reliability ◽  
Muscle Health ◽  
Muscle Ultrasound

Background: Muscle health is recognized for its critical role in the functionality and well-being of older adults. Readily accessible, reliable, and inexpensive methods of measuring muscle health are needed to advance research and clinical care. Methods: In this prospective, blinded study, 27 patients underwent quantitative muscle ultrasound (QMUS), standard electrical impedance myography (sEIM), and handheld electrical impedance myography (hEIM) of the anterior thigh musculature by two independent examiners. Subjects also had dual-energy X-ray absorptiometry (DEXA) scans and standardized tests of physical function and strength. Data were analyzed for intra- and inter-rater reliability, along with correlations with DEXA and physical measures. Results: Measures of intra- and inter-rater reliability were excellent (>0.90) for all QMUS, sEIM, and hEIM parameters except intra-rater reliability of rectus femoris echointensity (0.87–0.89). There were moderate, inverse correlations between QMUS, sEIM, and hEIM parameters and measures of knee extensor strength. Moderate to strong correlations (0.57–0.81) were noted between investigational measures and DEXA-measured fat mass. Conclusions: QMUS, sEIM and hEIM were highly reliable in a controlled, same-day testing protocol. Multiple correlations with measures of strength and body composition were noted for each method. Point-of-care technologies may provide an alternative means of measuring health.

scholarly journals Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity

2020 ◽  
Vol 11 (1) ◽  
pp. 44-51
Author(s):  
Victoria Parente ◽  
Lisa Parnell ◽  
Julie Childers ◽  
Tracy Spears ◽  
Valerie Jarrett ◽  
...  
Keyword(s):  
Point Of Care ◽  
Children With Medical Complexity ◽  
Screening Algorithm ◽  
Medical Complexity

scholarly journals Point-of-Care Ultrasound Training Among Intensivists in Singapore: A Multicentre Survey

2020 ◽  
Vol 49 (9) ◽  
pp. 630-642
Author(s):  
Yie Hui Lau ◽  
Chee Hong Loh ◽  
Wee Kim Fong ◽  
Shahla Siddiqui ◽  
Chee Keat Tan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Online Survey ◽  
Point Of Care ◽  
Unmet Need ◽  
Training Programme ◽  
Diaphragm Muscle ◽  
Teaching Hospitals ◽  
Learning Needs ◽  
Point Of Care Ultrasound ◽  
Muscle Ultrasound

Introduction: Point of care ultrasound (POCUS) has become essential in the management of critically ill patients. Multiple POCUS training courses exist, but are not widely adopted in Singapore. Given the discordance between training supply and demand, we aimed to uncover the learning needs and barriers among intensive care medicine (ICM) doctors locally. Materials and Methods: An anonymous online survey was carried out from January to April 2019 among ICM doctors from 6 major teaching hospitals in Singapore. Results: 66 out of 160 ICM specialists and trainees responded (41.3%). Although only 6% of respondents had current formal POCUS accreditation, the majority were already using critical care echocardiography (CCE) and pleural/ lung ultrasound. 93% supported having a local training programme. More than 50% of trainees wanted training in CCE, diaphragm/muscle ultrasound, airway ultrasound and ultrasound for neurological disease. More than 50% of specialists wanted training in diaphragm/muscle ultrasound, with mixed interests in other topics. The top 2 obstacles hindering POCUS training were lack of supervisors and locally based programmes. Conclusions: ICM doctors who responded were supportive of a local POCUS training programme. The programme’s curriculum should address the learning needs of the majority of learners, with diaphragm/muscle ultrasound being the top unmet need. The programme would need to develop supervisors and be as affordable as possible. Keywords: Continuing medical education, Cross-sectional survey, Intensive Care, Ultrasound

“Aspirin - resistance”? A few critical considerations on definition, terminology, diagnosis, clinical value, natural course of atherosclerotic disease, and therapeutic consequences

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 429-438 ◽  
Author(s):  
Berent ◽  
Sinzinger
Keyword(s):  
Platelet Function ◽  
Point Of Care ◽  
Aspirin Resistance ◽  
Point Of View ◽  
Evidence Based ◽  
Platelet Function Tests ◽  
Clinical Value ◽  
Vascular Events ◽  
Therapeutic Consequences ◽  
Function Tests

Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term “aspirin resistance” was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Intertest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Therefore, it may be more appropriate to speak about “treatment failure” to aspirin therapy than using the term “aspirin resistance”. There is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term “aspirin resistance” should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended.

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