scholarly journals ULTRASIM: Ultrasound in trauma simulation

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 125-128
Author(s):  
Devon McLean ◽  
Leanne Hewitson ◽  
Paul Atkinson ◽  
David Lewis ◽  
Jacqueline Fraser ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Performance ◽  
Low Cost ◽  
Primary Diagnosis ◽  
High Fidelity ◽  
Ultrasound Simulation ◽  
Diagnosis Accuracy ◽  
Diagnostic Capabilities ◽  
Ultrasound Simulator ◽  
Attending Physicians

ABSTRACTObjectiveThis study sought to assess the effectiveness of ultrasound simulation as a component of high-fidelity trauma simulation, in training diagnostic capabilities of resident and attending physicians participating in simulated trauma scenarios.MethodsTwelve residents and 20 attending physicians participated in 114 trauma simulations. Participants generated a ranked differential diagnosis list after a physical exam and subsequently after a simulated extended focused assessment with sonography for trauma (E-FAST) ultrasound scan. We compared reports to determine whether the addition of ultrasound improved diagnostic performance.ResultsThe primary diagnosis accuracy improved significantly with the addition of simulated ultrasound (p<0.0001). Median diagnostic ranking scores also improved (p<0.0001). Further, participants reported a higher confidence in their diagnoses (p<0.0001) and narrowed their differential diagnosis list (p<0.0001).ConclusionWe demonstrated that a low-cost ultrasound simulator can be successfully integrated into trauma simulations, resulting in an associated improvement in measures of diagnostic accuracy, confidence, and precision for participating resident and attending physicians.

scholarly journals P089: Does the use of ultrasound improve diagnosis during simulated trauma scenarios?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S108
Author(s):  
D. McLean ◽  
L. Hewitson ◽  
D. Lewis ◽  
J. Fraser ◽  
J. Mekwan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Performance ◽  
Statistical Tests ◽  
Correct Diagnosis ◽  
Primary Diagnosis ◽  
Point Of Care Ultrasound ◽  
Trauma Patients ◽  
Diagnostic Capabilities ◽  
Attending Physicians ◽  
The Impact

Introduction: Point of care ultrasound (US) is a key adjunct in the management of trauma patients, in the form of the extended focused assessment with sonography in trauma (E-FAST) scan. This study assessed the impact of adding an edus2 ultrasound simulator on the diagnostic capabilities of resident and attending physicians participating in simulated trauma scenarios. Methods: 12 residents and 20 attending physicians participated in 114 trauma simulations utilizing a Laerdal 3G mannequin. Participants generated a ranked differential diagnosis list after a standard assessment, and again after completing a simulated US scan for each scenario. We compared reports to determine if US improved diagnostic performance over a physical exam alone. Standard statistical tests (χ2 and Student t tests) were performed. The research team was independent of the edus2 designers. Results: Primary diagnosis improved significantly from 53 (46%) to 97 (85%) correct diagnoses with the addition of simulated US (χ2=37.7, 1df; p=&lt;0.0001). Of the 61 scenarios where an incorrect top ranked diagnosis was given, 51 (84%) improved following US. Participants were assigned a score from 1 to 5 based on where the correct diagnosis was ranked, with a 5 indicating a correct primary diagnosis. Median scores significantly increased from 3.8 (IQR 3, 4.9) to 5 (IQR 4.7, 5; W=219, p&lt;0.0001).Participants were significantly more confident in their diagnoses after using the US simulator, as shown by the increase in their mean confidence in the correct diagnosis from 53.1% (SD 22.8) to 83.5% (SD 19.1; t=9.0; p&lt;0.0001)Additionally, participants significantly narrowed their differential diagnosis lists from an initial medium count of 3.5 (IQR 2.9, 4.4) possible diagnoses to 2.4 (IQR 1.9, 3; W=-378, p&lt;0.0001) following US. The performance of residents was compared to that of attending physicians for each of the above analyses. No differences in performance were detected. Conclusion: This study showed that the addition of ultrasound to simulated trauma scenarios improved the diagnostic capabilities of resident and attending physicians. Specifically, participants improved in diagnostic accuracy, diagnostic confidence, and diagnostic precision. Additionally, we have shown that the edus2 simulator can be integrated into high fidelity simulation in a way that improves diagnostic performance.

A low-cost high-fidelity ultrasound simulator with the inertial tracking of the probe pose

2017 ◽  
Vol 59 ◽  
pp. 183-193 ◽  
Author(s):  
Saverio Farsoni ◽  
Marcello Bonfè ◽  
Luca Astolfi
Keyword(s):  
Low Cost ◽  
High Fidelity ◽  
Ultrasound Simulator

Assessing the diagnostic capabilities of the app DemDx in an acute care setting (Preprint)

2018 ◽  
Author(s):  
Cian Murphy
Keyword(s):  
Differential Diagnosis ◽  
Care Setting ◽  
Medical Student Education ◽  
Initial Assessment ◽  
Junior Doctors ◽  
Doctor Who ◽  
Clinical Accuracy ◽  
Education Tool ◽  
Clinical Records ◽  
Diagnostic Capabilities

UNSTRUCTURED DemDx is a differential diagnosis app for students and junior doctors. Starting with a patient’s presenting complaint the app goes through a step-by-process through history, examination and investigation findings to an increasingly refined differential diagnosis list until a single most likely diagnosis is reached. The aim of this project was to assess the accuracy of DemDx in an Emergency Department (ED) setting. Anonymised clinical records for 100 patients were retrospectively obtained from the ED in Beth Israel, Boston, USA. This contained the differential diagnoses from the clerking doctor, who performed the initial assessment (D1). The discharge diagnosis was used as the gold standard diagnosis (D2). D1 agreed with D2 in 74.44% of cases while DemDx agreed with D2 in 85.56% of cases (p=0.0003716). When the first, and thus most likely, differential was taken from D1 and DemDx, they agreed with D2 in 20 and 18.8% of cases, respectively (p=0.1428). This demonstration of the clinical accuracy of the app highlights how it can be a useful medical student education tool.

scholarly journals Diagnostic Capabilities of a Smartphone- Based Low-Cost Microscope

2020 ◽  
Vol 6 (3) ◽  
pp. 522-525
Author(s):  
Dorina Hasselbeck ◽  
Max B. Schäfer ◽  
Kent W. Stewart ◽  
Peter P. Pott
Keyword(s):  
Low Cost ◽  
Field Of View ◽  
Parasitic Diseases ◽  
Optical Parameters ◽  
Trade Off ◽  
Resource Limited ◽  
Wide Range ◽  
Diagnostic Applications ◽  
Diagnostic Capabilities

AbstractMicroscopy enables fast and effective diagnostics. However, in resource-limited regions microscopy is not accessible to everyone. Smartphone-based low-cost microscopes could be a powerful tool for diagnostic and educational purposes. In this paper, the imaging quality of a smartphone-based microscope with four different optical parameters is presented and a systematic overview of the resulting diagnostic applications is given. With the chosen configuration, aiming for a reasonable trade-off, an average resolution of 1.23 μm and a field of view of 1.12 mm2 was achieved. This enables a wide range of diagnostic applications such as the diagnosis of Malaria and other parasitic diseases.

scholarly journals Can Hematological Parameters Play a Role in the Differential Diagnosis of Adrenal Tumors?

Uro ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 39-44
Author(s):  
Mehmet Gürkan Arıkan ◽  
Göktan Altuğ Öz ◽  
Nur Gülce İşkan ◽  
Necdet Süt ◽  
İlkan Yüksel ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Inflammatory Markers ◽  
Blood Count ◽  
Complete Blood Count ◽  
Low Cost ◽  
Easy Access ◽  
Adrenal Tumors ◽  
Tumor Diameter ◽  
Lymphocyte Ratio ◽  
Significant Difference

There have been few studies reported with conflicting results in the use of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), redcell-distribution-width (RDW), etc. for predicting prognosis and differential diagnosis of adrenal tumors. The aim of this study is to investigate the role of inflammatory markers through a complete blood count, which is an easy access low-cost method, for the differential diagnosis of adrenocortical adenoma (ACA), adrenocortical carcinoma (ACC), and pheochromocytoma. The data of patients who underwent adrenalectomy between the years of 2010–2020 were retrospectively analyzed. Systemic hematologic inflammatory markers based on a complete blood count such as neutrophil ratio (NR), lymphocyte ratio (LR), NLR, PLR, RDW, mean platelet volume (MPV), and maximum tumor diameter (MTD) were compared between the groups. A statistically significant difference was found between the three groups in terms of PLR, RDW, and MTD. With post-hoc tests, a statistically significant difference was found in PLR and MTD between the ACA and ACC groups. A statistically significant difference was found between the ACA and pheochromocytoma groups in PLR and RDW values. In conclusion, it could be possible to plan a more accurate medical and surgical approach using PLR and RDW, which are easily calculated through an easy access low-cost method such as a complete blood count, together with MTD in the differential diagnosis of ACC, ACA, and pheochromocytoma.

scholarly journals Validation of Differentially Expressed Immune Biomarkers in Latent and Active Tuberculosis by Real-Time PCR

2021 ◽  
Vol 11 ◽  
Author(s):  
Prem Perumal ◽  
Mohamed Bilal Abdullatif ◽  
Harriet N. Garlant ◽  
Isobella Honeyborne ◽  
Marc Lipman ◽  
...  
Keyword(s):  
Low Cost ◽  
Peripheral Blood Leukocyte ◽  
Primary Diagnosis ◽  
Diagnostic Methods ◽  
World Health ◽  
Molecular Diagnostic ◽  
Roc Curve Analysis ◽  
Simple Arithmetic ◽  
Immune Biomarkers ◽  
The Uk

Tuberculosis (TB) remains a major global threat and diagnosis of active TB ((ATB) both extra-pulmonary (EPTB), pulmonary (PTB)) and latent TB (LTBI) infection remains challenging, particularly in high-burden countries which still rely heavily on conventional methods. Although molecular diagnostic methods are available, e.g., Cepheid GeneXpert, they are not universally available in all high TB burden countries. There is intense focus on immune biomarkers for use in TB diagnosis, which could provide alternative low-cost, rapid diagnostic solutions. In our previous gene expression studies, we identified peripheral blood leukocyte (PBL) mRNA biomarkers in a non-human primate TB aerosol-challenge model. Here, we describe a study to further validate select mRNA biomarkers from this prior study in new cohorts of patients and controls, as a prerequisite for further development. Whole blood mRNA was purified from ATB patients recruited in the UK and India, LTBI and two groups of controls from the UK (i) a low TB incidence region (CNTRLA) and (ii) individuals variably-domiciled in the UK and Asia ((CNTRLB), the latter TB high incidence regions). Seventy-two mRNA biomarker gene targets were analyzed by qPCR using the Roche Lightcycler 480 qPCR platform and data analyzed using GeneSpring™ 14.9 bioinformatics software. Differential expression of fifty-three biomarkers was confirmed between MTB infected, LTBI groups and controls, seventeen of which were significant using analysis of variance (ANOVA): CALCOCO2, CD52, GBP1, GBP2, GBP5, HLA-B, IFIT3, IFITM3, IRF1, LOC400759 (GBP1P1), NCF1C, PF4V1, SAMD9L, S100A11, TAF10, TAPBP, and TRIM25. These were analyzed using receiver operating characteristic (ROC) curve analysis. Single biomarkers and biomarker combinations were further assessed using simple arithmetic algorithms. Minimal combination biomarker panels were delineated for primary diagnosis of ATB (both PTB and EPTB), LTBI and identifying LTBI individuals at high risk of progression which showed good performance characteristics. These were assessed for suitability for progression against the standards for new TB diagnostic tests delineated in the published World Health Organization (WHO) technology product profiles (TPPs).

scholarly journals Contrast-Enhanced Ultrasound in the Differential Diagnosis of Primary Thyroid Lymphoma and Nodular Hashimoto’s Thyroiditis in a Background of Heterogeneous Parenchyma

2021 ◽  
Vol 10 ◽  
Author(s):  
Lulu Yang ◽  
Haina Zhao ◽  
Yushuang He ◽  
Xianglan Zhu ◽  
Can Yue ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Hashimoto’S Thyroiditis ◽  
Diagnostic Performance ◽  
Roc Curves ◽  
Hashimoto's Thyroiditis ◽  
Imaging Features ◽  
Contrast Enhanced Ultrasound ◽  
Thyroid Lymphoma ◽  
Contrast Enhanced ◽  
Primary Thyroid Lymphoma

ObjectiveTo investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the differentiation of primary thyroid lymphoma (PTL) and nodular Hashimoto’s thyroiditis (NHT) in patients with background of heterogeneous diffuse Hashimoto’s thyroiditis (HT).MethodsSixty HT patients with 64 thyroid nodules (31 PTL and 33 NHT) who had undergone CEUS examination were included in this study. With histopathological results as the reference, we evaluated the imaging features of each nodule on both conventional ultrasonography (US) and CEUS. Quantitative CEUS parameters including peak intensity (PI), time to peak (TTP), and area under the time–intensity curve (AUC) were gathered in the nodule and background parenchyma. The ratio indexes of theses parameters were calculated by the ratio of the lesion and the corresponding thyroid parenchyma. Logistic regression and receiver operating characteristic (ROC) curves analyses of valuable US indicators were further preformed to evaluate the diagnostic capability of CEUS in discrimination of PTL and NHT.ResultsAmong all the observed US imaging features and CEUS parameters, 10 indicators showed significant differences between PTL and NHT (all P &lt; 0.05). All the significant indicators were ranked according to the odds ratios (ORs). Eight of them were CEUS associated including imaging features of enhancement pattern, degree, homogeneity, and quantification parameters of PI, AUC, ratios of PI, AUC, and TTP, while indicators on conventional US, including vascularity and size ranked the last two with ORs less than 3. The five single CEUS parameters showed good diagnostic performance in diagnosis of PTL with areas under ROC curves of 0.72–0.83 and accuracies of 70.3–75.0%. The combination of CEUS imaging features and the ratios of PI, AUC, and TTP demonstrated excellent diagnostic efficiency and achieved area under ROC curve of 0.92, which was significantly higher than any of the five single parameters (all P &lt; 0.05), with a sensitivity of 83.9%, specificity of 87.9%, and accuracy of 85.9%.ConclusionsCEUS is an efficient diagnostic tool in the differential diagnosis of PTL and NHT for patients with diffuse HT. Conjoint analysis of CEUS imaging features and quantification parameters could improve the diagnostic values.

scholarly journals Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 940
Author(s):  
Joanna Haynes ◽  
Peder Bjorland ◽  
Øystein Gomo ◽  
Anastasia Ushakova ◽  
Siren Rettedal ◽  
...  
Keyword(s):  
Skill Acquisition ◽  
Low Cost ◽  
Negative Relationship ◽  
Real Life ◽  
Neonatal Resuscitation ◽  
Healthcare Personnel ◽  
Positive Pressure ◽  
High Fidelity ◽  
High Resource ◽  
Clinical Conditions

Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.

scholarly journals A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery

2019 ◽  
Vol 130 (5) ◽  
pp. 1663-1671
Author(s):  
Ulas Cikla ◽  
Balkan Sahin ◽  
Sahin Hanalioglu ◽  
Azam S. Ahmed ◽  
David Niemann ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Low Cost ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
High Fidelity ◽  
Skin Closure ◽  
Neurosurgical Training ◽  
Training Simulator ◽  
Live Animal

OBJECTIVECerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e.g., cadaver, live animal, placenta models). The aim of the present study was to design a readily accessible, realistic, easy-to-build, reusable, and high-fidelity simulator to train neurosurgeons or trainees on vascular anastomosis techniques even in the operating room.METHODSThe authors used an anatomical skull and brain model, artificial vessels, and a water pump to simulate both extracranial and intracranial circulations. They demonstrated the step-by-step preparation of the bypass simulator using readily available and affordable equipment and consumables.RESULTSAll necessary steps of a superficial temporal artery–middle cerebral artery bypass surgery (from skin opening to skin closure) were performed on the simulator under a surgical microscope. The simulator was used by both experienced neurosurgeons and trainees. Feedback survey results from the participants of the microsurgery course suggested that the model is superior to existing microanastomosis training kits in simulating real surgery conditions (e.g., depth, blood flow, anatomical constraints) and holds promise for widespread use in neurosurgical training.CONCLUSIONSWith no requirement for specialized laboratory facilities and regulations, this novel, low-cost, reusable, high-fidelity simulator can be readily constructed and used for neurosurgical training with various scenarios and modifications.

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