scholarly journals P010: Emergency department performed renal point-of-care ultrasound (POCUS) for the assessment of obstructive uropathy: Impact of a training curriculum and ongoing educational intervention

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S66
Author(s):  
D. Bastien ◽  
D. Thompson ◽  
F. Myslik ◽  
K. Van Aarsen ◽  
J. Serhan ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Obstructive Uropathy ◽  
Color Doppler ◽  
Training Session ◽  
Breath Holding ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Chi Square ◽  
The Difference

Introduction: Hydronephrosis is the de facto measure of obstructive uropathy (OU) and can be evaluated using renal Point of Care Ultrasound (rPOCUS). This educational initiative aimed to develop an effective one-day rPOCUS curriculum and evaluate if feedback/quality assurance (QA), leads to an improvement in image acquisition and interpretation of hydronephrosis as well as comfort with the technique. Methods: Physicians were randomized into a QA or control group (NQA) and all attended a one day training session which involved acquiring rPOCUS scans with one-on-one instruction. Participants then performed POCUS scans on all ED patients where formal renal US was deemed clinically indicated. The QA group received feedback on every scan from qualified ED physicians. Overall sensitivity and specificity were calculated compared to formal scans using a chi-square test. Written QA was reviewed for future improvements. Crossover occurred at 10 weeks to allow for equal learning opportunity but analyses focused on pre-crossover data. Participants completed surveys at study start and end focusing on initiative effectiveness and barriers/comfort with POCUS measured with a likert scale (Not at all (1)-Very (7)). Results: Fourteen ED physicians participated. The most common cited barrier to utilizing rPOCUS was lack of knowledge/training (78.6%). A total of 63 POCUS scans were reviewed. Common feedback included breath-holding (69.7%), use of color doppler (48.5%) and including a transverse sweep (36.4%). Sensitivity and specificity were better in the QA versus NQA group though the difference was not significant (Se- 75.0% vs 50.0%, 95%CI: −34.0-73.4%; Sp- 89.3% vs 73.9%, 95% CI: 8.2-39.2%). Ten physicians completed the post survey; all reported improved comfort with rPOCUS in assessment of hydronephrosis (median [IQR]: Δ+2 [1-3]). At study end, the comfort rating for using only POCUS and not formal scan remained low (median [IQR]: 3.50 [1.8-4.2]). The training initiative was rated highly with a median [IQR] rating of 5.50 [4.8-7.0]. Conclusion: Although the initiative was rated highly effective and resulted in improved comfort with renal POCUS, physicians did not feel comfortable solely using POCUS without formal scan to diagnose OU. Despite the initiative's success, further educational programs are needed before rPOCUS can be safely used as the primary investigation. In the future, a greater emphasis should be placed on the commonly noted areas of improvement.

scholarly journals LO88: Bedside sonography performed by emergency physicians to detect acute appendicitis in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58
Author(s):  
M. Nicole ◽  
J. Gravel ◽  
M. Desjardins
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Tertiary Care ◽  
Training Session ◽  
Lower Sensitivity ◽  
Point Of Care Ultrasound ◽  
Practical Training ◽  
Emergency Physicians ◽  
Primary Analysis ◽  
Bowel Sonography

Introduction: Previous studies have suggested that emergency physicians (EP) highly experienced in point-of-care ultrasound (POCUS) have similar performance to formal ultrasound to identify appendicitis in children. The aim of this study was to evaluate the ability of EP with various levels of POCUS experience to detect appendicitis with POCUS among children visiting a pediatric ED. Methods: A prospective cohort study was conducted in an urban, tertiary care pediatric ED. Children aged 2 to 18 years old who presented to the ED with acute abdominal pain suggesting appendicitis were included. Patients were excluded if they had a history of appendectomy, hemodynamic instability requiring resuscitation, or were transferred with proven diagnosis of appendicitis. Participating EP had various levels of POCUS experience. Four of the 22 physicians were experienced in bowel sonography (EDU 2 level and higher) while the others were inexperienced in bowel sonography (EDU 1). All the participants received a 1-hour didactical and practical training session on appendix ultrasound. The treating physician performed all POCUS following initial physical exam, before further radiological evaluation. Final outcomes were determined by pathology and/or operative reports for surgical cases, and telephone follow-up at 3 weeks for those who did not have surgery. The primary analysis was a simple proportion for sensitivity and specificity for POCUS. Expecting a sensitivity of 80% based on previous studies, we calculated that a sample size of 50 cases would provide a 95%CI ranging from 66 to 90%. Results: We approached 140 patients, of which 121 accepted to participate and were recruited. After excluding 4 patients for missing POCUS data, 117 patients were included in the primary analysis, of which 51 (44%) had appendicitis. Twenty-two EP performed between 1 and 20 POCUS. The POCUS identified 27 out of 51 appendicitis for a sensitivity of 0.53 (95%CI 0.40-0.66). A negative POCUS was reported for 54 out of 66 patients without appendicitis (specificity of 0.82; 95%CI 0.71-0.89). Conclusion: This study shows limited sensitivity and specificity of POCUS when performed by EP with various level of experience for appendicitis in children. While showing lower sensitivity and specificity than previous studies, the inclusion of a large number of physicians solidifies the external validity of our conclusion.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

scholarly journals Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Khushboo Qaim Ali ◽  
Sajid Bashir Soofi ◽  
Ali Shabbir Hussain ◽  
Uzair Ansari ◽  
Shaun Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Health Care Providers ◽  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Training Session ◽  
Technical Skills ◽  
Neonatal Health ◽  
Point Of Care Ultrasound ◽  
Care Providers

Abstract Background Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts. Methods Sixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations. Results The majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = − 1.3; 95% CI: − 1.66 to − 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above. Conclusion We found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings. Trial registration ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

scholarly journals Evaluation of school-based prevention program in Turkey: Results of a 24-month study

2016 ◽  
Vol 10 (02) ◽  
pp. 245-249 ◽  
Author(s):  
Coruh Turksel Dulgergil ◽  
Ertugrul Ercan ◽  
Hakan Colak
Keyword(s):  
Oral Hygiene ◽  
Permanent Teeth ◽  
School Age Children ◽  
Control Group ◽  
Chi Square ◽  
The Difference ◽  
Group 5 ◽  
Group 2 ◽  
Chi Square Analysis ◽  
Provincial Center

ABSTRACT Objective: In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kırıkkale Provincial center were monitored for 2 years after a variety of protective applications. Materials and Methods: Three hundred and twenty-two children at the age of 7–11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) – was given hygiene training only; Group 2 - with medium level cavity activity (2–4 cavities in average) – oral hygiene training + surface restoration applied; Group 3 - children with 2–4 cavities on average – oral hygiene training + professional flour gel applied; Group 4 - children with 2–4 cavities in average – oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) – oral hygiene training + surface restoration + professional flour gel combination applied. Results: At the end of the 2nd year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1–5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01). Conclusion: These findings have showed that, in Kırıkkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.

Seroprevalence of Helicobacter pylori infection in patients with chronic nonspecific pharyngitis: preliminary study

2007 ◽  
Vol 122 (1) ◽  
pp. 61-64 ◽  
Author(s):  
İ Aladag ◽  
Y Bulut ◽  
M Guven ◽  
A Eyibilen ◽  
K Yelken
Keyword(s):  
Helicobacter Pylori ◽  
Treatment Strategies ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Control Groups ◽  
Chi Square ◽  
Control Subjects ◽  
The Difference ◽  
H Pylori ◽  
And Control

AbstractBackground and objectives:Chronic nonspecific pharyngitis is a chronic inflammation of the pharynx. It is found worldwide, and treatment is difficult. The underlying aetiopathogenesis is still controversial. The aim of this study was to investigate Helicobacter pylori seroprevalence in chronic nonspecific pharyngitis patients without other possible causative factors for chronic pharyngeal irritation and without H pylori gastric mucosal infection.Materials and methods:Forty-one patients with symptoms of chronic nonspecific pharyngitis and 30 healthy control subjects were enrolled in this prospective, controlled, clinical study. In both study and control groups, selected patients were shown to have gastric mucosa uninfected by H pylori, as demonstrated by the 14C-urea breath test. Comprehensive otorhinolaryngological examination did not elicit any factor contributing to the chronic pharyngeal complaint. Serum H pylori immunoglobulin G antibody titres were assayed using serum enzyme-linked immunosorbent assay. The difference between the study and control groups was analysed by the chi-square test (the likelihood ratio was used).Results:Thirty-two of the 41 patients (78 per cent) and 14 of the 30 control subjects (46.7 per cent) were found to be H pylori positive. Patients with chronic nonspecific pharyngitis were found to have a significantly higher rate of H pylori seropositivity than the control group (p = 0.016).Conclusion:These data may be important in developing future treatment strategies for chronic nonspecific pharyngitis.

scholarly journals Effectiveness of a Novel Device in the Reduction of Cesarean Deliveries

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Daniel A. Burns
Keyword(s):  
Cesarean Delivery ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Control Group ◽  
Chi Square ◽  
Novel Device ◽  
Second Stage ◽  
Cesarean Deliveries ◽  
The Difference ◽  
Second Stage Labor

Objective. To test the hypothesis that the use of the HEM-AVERT Perianal Stabilizer will result in a reduction of cesarean births and shorter duration of second-stage labor. Study Design. In a prospective controlled trial, 102 women scheduled for vaginal delivery were randomized to either the HEM-AVERT investigational device or control group. Ninety eight (98) patients completed the study. A chi-square test was used to evaluate the difference in the number of cesarean deliveries between the investigational and control groups. Duration of second-stage labor was assessed as a secondary outcome. Results. Six (6) of the 50 patients in the investigational group (12%) failed to deliver vaginally and required cesarean delivery. Comparatively, 19 of the 48 control patients (39.6%) required cesarean delivery. Duration of second-stage labor was shorter in the investigational group, but the difference was not statistically significant. Results from 4 patients were excluded due to protocol violations. Conclusion. The HEM-AVERT device effectively reduced the incidence rate of cesarean deliveries in the investigational group when compared to women who delivered without use of the device. This trial is registered with ClinicalTrials.gov NCT01739543.

scholarly journals Cryotherapy as A Prophylaxis of Mucositis in Children with Cancer Undergoing Chemotherapy at Dr. M. Djamil General Hospital

2021 ◽  
Vol 15 (4) ◽  
pp. 183
Author(s):  
Hidayatul Hasni ◽  
Mayetti Mayetti ◽  
Dwi Novrianda
Keyword(s):  
Intervention Group ◽  
Wilcoxon Test ◽  
Control Group ◽  
Children With Cancer ◽  
Chi Square ◽  
Control Group Design ◽  
Severe Problem ◽  
Oral Cryotherapy ◽  
Before And After ◽  
The Difference

Background: Mucositis is one of the side effects of chemotherapy, which can be a severe problem for children with cancer. Cryotherapy can cause vasoconstriction and decrease blood flow to the oral mucosa, resulting in lower concentrations of chemotherapy agents to prevent mucositis. This study aims at determining the effectiveness of oral cryotherapy as prophylaxis mucositis in children with cancer undergoing chemotherapy.Methods: This quasi-experiment study with a pretest-posttest control-group design involved 45 respondents (22 in the intervention group and 23 in the control group) selected using consecutive sampling. The data collection instrument was the WHO mucositis scale. Results: Of the 45 children undergoing chemotherapy, 24 (53.3%) were of school age, 25 (55.6%) were male, 33 (73.3%) had good nutritional status, and 17 (37.8%) had mild neutropenia before undergoing chemotherapy. All respondents (100%) did not experience mucositis, but after chemotherapy, 9 children (40.9%) in the intervention group had mucositis, and 19 children (82.6%) experienced mucositis in the control group. The data were analyzed using the Wilcoxon test to see the difference between the intervention group and the control group and the Chi-Square test with Yates’s correction to see the effect of cryotherapy on the prevention of mucositis. The results showed that there was a difference in the incidence of mucositis between before and after intervention in the intervention group (p = 0.003) and the control group (p = 0.000), and cryotherapy was effective in preventing mucositis (p = 0.01).Conclusions: Cryotherapy is effective against the prevention of mucositis. Nurses and families need to be able to apply oral cryotherapy and other evidence-based treatment as a method to prevent mucositis 

scholarly journals Measurement of the Applicability of Abdominal Point-of-Care Ultrasound to the Practice of Medicine in Saudi Arabia and the Current Skill Gaps

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 36-41
Author(s):  
Rajkumar Rajendram ◽  
Mamdouh Souleymane ◽  
Naveed Mahmood ◽  
Rakan Sambas ◽  
Yousuf M.S. Kharal
Keyword(s):  
Saudi Arabia ◽  
Medical Practice ◽  
Point Of Care ◽  
Perceived Usefulness ◽  
Point Of Care Ultrasound ◽  
Skill Gaps ◽  
Validated Questionnaire ◽  
Internal Medicine Residents ◽  
Practice Of Medicine ◽  
The Difference

Background: Renal, gastrointestinal, and hepatic pathology, and the resources available for their management vary internationally. Whilst abdominal point-of-care ultrasound (APOCUS) should enhance management, uptake by physicians, worldwide, has been poor. So, the aim of this study was to explore the applicability of APOCUS to medical practice in Saudi Arabia, residents’ current ability to perform APOCUS, and the skill gaps. Methods: A validated questionnaire was distributed to the internal medicine residents at our institution to determine their ability to perform APOCUS (self-reported), and obtain their opinions on its applicability for the detection of hepatomegaly, splenomegaly, hydronephrosis, and ascites. Statistical analysis: Standard descriptive statistical techniques were used. Categorical data, presented as frequency, were compared using the χ2 test. The Likert scale responses, presented as mean ± standard deviation, were compared with a t test or analysis of variance. Results: Ninety-eight residents participated (response rate 90.7%). Abdominal POCUS is very applicable to their practice. The use of APOCUS to detect ascites was the most applicable (mean 4.61 ± SD 0.69). However, proficiency in APOCUS was poor (mean 1.65 ± SD 1.11). Conclusions: The difference between internists’ self-reported ability to perform APOCUS and its perceived usefulness demonstrates a skill gap. Thus, whilst APOCUS is applicable to medical practice in Saudi Arabia, significant skill gaps exist.

scholarly journals Role of High Dose Calcium in the Prevention of Preeclampsia

2016 ◽  
Vol 28 (2) ◽  
pp. 66-70 ◽  
Author(s):  
Aparna Khan ◽  
Susil Kumar Mandal ◽  
Amitava Pal
Keyword(s):  
Preterm Delivery ◽  
Final Analysis ◽  
Analysis Data ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
Study Group ◽  
Chi Square ◽  
The Difference ◽  
Lost To Follow Up

Objectives: To assess the effect of supplementation of high dose of calcium(2gm) in prevention of preeclampsia.Materials & Methods: A randomized controlled clinical trial on 272 healthy nulliparous woman were randomly allocated into two groups by means of a computer generation randomization list. From 20 weeks of gestation until delivery who received 2gm of oral elemental calcium per day (n=127 )were assigned to high dose calcium group or the study group and 145 women were assigned to low dose calcium or control group , receiving 500 mg of calcium per day. Ten women (3.67%) were lost to follow up after randomization (4 in the study group and 6 in the control group) . Thus a total of 123 woman in the study group and 139 in the control group were included in the final analysis. Data was collected by standard questionnaire, clinical examination and investigations and statistical analysis was performed by student’s t-test, chi square tests. P<0.05 was statistically significant.Results: Preeclampsia developed in Study Group were 5.7% and Control Group 13.7% and the difference was statistically significant (Chi-squares - 4.65, df =1, p = 0.031). There were 2.43% (3 of 123 women) preterm delivery in the study group and 7.91% (11 of 39 women) in the control group. So, there was a significantly lower risk of preterm delivery in the study group ( p = 0.049). Intrauterine growth retardation (IUGR) was found in 3.25% and 9.35% of women in the study and the control groups respectively. The incidence is higher in the control group when compared to the study group (p = 0.045).Conclusion: Calcium intake is beneficial for both pregnant women and her unborn child. Daily supplementation with 2 grams of calcium during pregnancy significantly reduced the risk of preeclampsia, preterm labor and IUGR. So, high dose calcium should be supplemented to all women during pregnancy in developing countries where preeclampsia and preeclampsia related morbidities and mortality are quite high.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(2) : 66-70

scholarly journals EVALUATION OF INTRARENAL RESISTIVE INDEX BY DUPLEX COLOR DOPPLER ULTRASONOGRAPHY IN PATIENTS WITH DIABETIC NEPHROPATHY – COMPARISON BETWEEN HEALTHY ADULT CONTROL SUBJECTS

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
MSI Tipu Chowdhury ◽  
Sadia Sultana ◽  
Md. Fakhrul Islam Khaled ◽  
Khaled Md. Iqbal ◽  
Sharmin Easmin
Keyword(s):  
Diabetic Nephropathy ◽  
Doppler Ultrasonography ◽  
Early Stage ◽  
Color Doppler ◽  
Left Kidney ◽  
Resistive Index ◽  
Control Group ◽  
Control Subjects ◽  
The Difference

Background: Renal Doppler Ultrasonography (USG) has become a useful adjunct to gray scale sonography in the evaluation of renal function in various pathophysiological conditions like diabetic nephropathy. We can diagnose diabetic nephropathy by serum creatinine level and creatinine clearance rate. But early stage diagnosis of diabetic nephropathy is not always possible. In this study we have focused on resistive index of interlobar arteries of kidney to see changes of renal parenchyma for early stage diagnosis of diabetic nephropathy. Objectives: To observe the difference between values of intrarenal resistive  index measured by duplex color Doppler USG in type 2 diabetic  patients having diabetic nephropathy and in healthy adult control subjects. Materials and methods: This cross sectional observational study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 65 diabetic nephropathy patients were taken as study group and 65 healthy subjects were included as healthy control subjects. Duplex Color Doppler Ultrasonography of interlobar artery was carried out in both groups to measure the peak systolic velocity, the end diastolic velocity and arterial Resistive Index. Results: The Resistive Index of interlobar artery of left kidney in control group was 0.58±0.08 and the mean RI of interlobar artery of left kidney in diabetic nephropathy patients was 0.74±0.53. The difference of Resistive index of interlobar artery of left kidney in the two groups were statistically significant and the RI of right kidney of control & that of case groups were 0.60±0.09 and 0.76±0.03 respectively. In between control and case groups the RI of right kidney were statistically significant. So, resistive index of interlobar artery was increased in type 2 diabetic nrphropathy patients compared to control group. Conclusion: It can be concluded in present study that resistive index remains significantly higher in patients with diabetic nephropathy than in controls. Thus Duplex Doppler ultrasonography allows the rapid, noninvasive evaluation of the intrarenal vasculature and can be used as an easily available parameter of the evolution and a predictor in patients with clinical diabetic nephropathy. Keywords: Doppler Ultrasonography, Intrarenal Resistive Index, Diabetic Nephropathy

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