scholarly journals Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach

2019 ◽  
Vol 6 (1) ◽  
pp. 29-41
Author(s):  
Karen Strike ◽  
Anthony Chan ◽  
Monica R. Maly ◽  
Patricia Solomon
Keyword(s):  
Physical Examination ◽  
Point Of Care ◽  
Healthcare Organisation ◽  
Knowledge To Action ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Treatment Centre ◽  
Diagnostic Modalities ◽  
Point Of Care Ultrasonography ◽  
Inner Setting

Abstract Background: In patients with haemophilia, evidence suggests that the physical examination alone is not sensitive enough to detect small amounts of blood within a joint. Attention has shifted to methods of improving the sensitivity of the physical examination through adding diagnostic modalities such as point-of-care ultrasonography (POC-US). Proficiency with the physical examination and understanding of the role of POC-US are important competencies for physiotherapists. Despite training, implementation of POC-US by physiotherapists in haemophilia treatment centres in Canada has been mixed. Aim: Using a theory-based approach, the aim of the current study is to achieve expert consensus regarding the barriers to physiotherapy performed POC-US in haemophilia treatment centres in Canada using a modified Delphi approach. Materials and Methods: Using the Knowledge-to-Action Framework and the Consolidated Framework for Implementation Research (CFIR), a modified Delphi approach was completed using the Modified BARRIERS Scale (MBS). Participants were blinded and consensus was reached over three rounds at the Canadian Hemophilia Society’s annual three-day conference. Results: Twenty-two physiotherapists participated; 20 participants completed Round 1, and 21 completed Rounds 2 and 3. Four items of the MBS reached consensus: 1) The physiotherapist does not have time to read research related to POC-US; 2) The physiotherapist is isolated from knowledgeable colleagues with whom to discuss POC-US; 3) Administration will not allow POC-US implementation; 4) There is insufficient time on the job to implement new ideas. All four consensus items can be mapped to one domain of the CFIR: the inner setting. Conclusion: The haemophilia treatment centre within a healthcare organisation appears to be an important target for addressing barriers to the implementation of physiotherapy performed POC-US.

scholarly journals LO042: Sonography in Hypotension and Cardiac Arrest (SHoC) - Hypotension: derivation of an evidence-based consensus algorithm for the integration of point of care ultrasound into resuscitation of hypotensive patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S44-S44 ◽  
Author(s):  
P. Atkinson ◽  
J. Bowra ◽  
J. Milne ◽  
M. Lambert ◽  
B. Jarman ◽  
...  
Keyword(s):  
Point Of Care ◽  
Disease Incidence ◽  
Left Ventricular ◽  
Consensus Algorithm ◽  
Professional Organizations ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi ◽  
Delphi Approach

Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.

scholarly journals POCUS for Nephrologists - Basic Principles and a General Approach

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002482021
Author(s):  
Abhilash Koratala ◽  
Nathaniel Reisinger
Keyword(s):  
Physical Examination ◽  
Point Of Care ◽  
Basic Principles ◽  
Medical Specialties ◽  
Case Examples ◽  
Fluid Status ◽  
Valuable Adjunct ◽  
Point Of Care Ultrasonography ◽  
Fragmentation Of Care

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 multi-organ POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. While the need for further imaging studies is obviated in selected cases, POCUS is not meant to serve as an alternative to consultative imaging. In addition, utility of POCUS depends on the skills and experience of the operator, which in turn depends on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss case 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.

scholarly journals Point-of-care ultrasonography for the diagnosis of testicular torsion: a practical resident curriculum

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
Leandra Stringer ◽  
Sarah Cocco ◽  
Alex Jiang ◽  
Ernest Pang Chan ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Testicular Torsion ◽  
Point Of Care ◽  
Modified Delphi ◽  
Likert Score ◽  
Hands On ◽  
Before And After ◽  
Point Of Care Ultrasonography ◽  
Teaching Modules ◽  
Didactic Curriculum

Background: Prompt Doppler ultrasonography to aid in diagnosis is often key to managing testicular torsion, but there may be delays in access; a faster, more widely available alternative is point-of-care ultrasonography (POCUS). The purpose of this study was to develop and evaluate a scrotal POCUS curriculum for urology and emergency medicine residents. Methods: Content experts in urology, emergency medicine and diagnostic imaging collaborated in a modified Delphi method to design a practical didactic curriculum for scrotal POCUS for the identification of testicular torsion. Training included 3 online video teaching modules and a 1-hour hands-on teaching session with standardized adult patients. We evaluated participants’ competency in scrotal POCUS using a validated scale. We assessed participants’ knowledge, comfort and confidence in performing scrotal POCUS before and after the intervention and at 3 months. Results: Twenty-four urology (n = 12) and emergency medicine (n = 12) residents participated in the curriculum. After hands-on practice, 23 participants (96%) were deemed competent at scrotal POCUS. Pre–post testing showed significant improvement in knowledge (mean score 63% v. 80%, p < 0.001), comfort (mean Likert score 0.6 v. 3.6, p < 0.001) and confidence (mean Likert score 1.0 v. 2.1, p < 0.001) after the intervention. These effects were maintained at the 3-month assessment. Conclusion: The scrotal POCUS curriculum was effective and acceptable to both urology and emergency medicine residents. The findings suggest that scrotal POCUS can be learned effectively through a short hands-on session and didactic instruction.

scholarly journals Development of Core Contents of Point-of-Care Ultrasound Curriculum for Pediatric Emergency Medicine Physician Training: A Modified Delphi Survey

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 757
Author(s):  
Jae-Hyun Kwon ◽  
Jin-Hee Lee ◽  
Young-Rock Ha ◽  
June-Dong Park ◽  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Modified Delphi ◽  
Experience Teaching ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Point Of Care Ultrasonography

Background: As the frequency of ultrasound use in pediatric emergency departments increases, it is necessary to train pediatric emergency medicine (PEM) physicians on pediatric point-of-care ultrasonography (POCUS). We discussed the core content of POCUS applications and proposed a POCUS training curriculum for PEM physicians in South Korea. Methods: Twenty-three experts were included if had performed over 1500 POCUS scans, had at least three years of experience teaching POCUS to physicians, were POCUS instructors or had completed a certified pediatric POCUS program. Experts rated 61 possible POCUS applications in terms of the importance of their inclusion in a PEM POCUS curriculum using the modified Delphi technique. Results: In round one, twelve (52.2%) out of 23 experts responded to the email. Eleven experts satisfied the inclusion criteria. Eleven experts participated in round one of a survey and agreed on 27 (44.3%) out of a total of 61 items. In round two, all 11 experts participated in the survey; they agreed on two (5.9%) of the remaining 34 items, and no items were excluded. Conclusion: Using the Delphi method, 61 applications were discussed, and a consensus was reached on 29 core applications.

scholarly journals Albumin Infusion in Patients with Cirrhosis: Time for POCUS-Enhanced Physical Examination

2021 ◽  
pp. 1-5
Author(s):  
Abhilash Koratala ◽  
Claudio Ronco ◽  
Amir Kazory
Keyword(s):  
Physical Examination ◽  
Hepatorenal Syndrome ◽  
Point Of Care ◽  
Objective Assessment ◽  
Objective Evaluation ◽  
Pulmonary Complications ◽  
Complex Disorders ◽  
Point Of Care Ultrasonography ◽  
The Impact

Objective assessment of fluid status is of utmost significance in the management of patients with complex disorders involving hemodynamics and multi-organ crosstalk such as cardiorenal or hepatorenal syndrome. The role of volume expansion using intravenous albumin in the setting of hepatorenal syndrome has been an everlasting debate among clinicians. With the accumulating evidence on the deleterious consequences of iatrogenic fluid overload, empiric albumin administration in these patients has been the focus of much attention, and the findings of recent studies suggest a higher incidence of pulmonary complications with albumin. Poor sensitivity of conventional physical examination has led to an interest in the utility of novel noninvasive bedside tools such as point-of-care ultrasonography (POCUS) to evaluate hemodynamics more precisely. Once confined to specialties such as obstetrics and emergency medicine, the scope of diagnostic POCUS is rapidly expanding in other fields including internal medicine and nephrology. Herein, we offer our perspective on the emerging role of POCUS for objective evaluation of patients with suspected hepatorenal physiology based on our experience. We propose that future clinical trials consider incorporating this strategy and explore the impact of POCUS-guided therapy on the outcomes.

Point-of-Care Ultrasonography for Objective Volume Management in End-Stage Renal Disease

2019 ◽  
Vol 49 (1-2) ◽  
pp. 132-136 ◽  
Author(s):  
Abhilash Koratala ◽  
Gajapathiraju Chamarthi ◽  
Amir Kazory
Keyword(s):  
Renal Disease ◽  
Physical Examination ◽  
End Stage Renal Disease ◽  
Point Of Care ◽  
Esrd Patient ◽  
Vena Cava ◽  
Volume Status ◽  
Point Of Care Ultrasonography ◽  
Stage Renal Disease ◽  
End Stage

Focused ultrasonography or point-of-care ultrasonography (POCUS) is increasingly considered as an essential bedside diagnostic tool. In patients with end-stage renal disease (ESRD) treated with hemodialysis, it can be used as an adjunct to physical examination to objectively assess the volume status and guide the rate and amount of ultrafiltration. Herein, we describe the case of an ESRD patient presenting with hypertensive urgency where POCUS disclosed the presence of hypervolemia despite unremarkable physical examination. The sonographic findings of the inferior vena cava, heart, and lungs guided fluid extraction during hemodialysis therapy, and the actual ultrafiltration volume was significantly higher than what was anticipated based on clinical findings. This case highlights the importance of using ­POCUS as a tool for objective and precise assessment of volume status in patients with ESRD.

scholarly journals The Master Clinician’s Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine

POCUS Journal ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 13-19
Author(s):  
Maria Gabriela Frank MD ◽  
Cason Pierce MD ◽  
Noelle Northcutt MD ◽  
Joseph Walker Keach MD ◽  
Gerard Salame MD ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Physical Examination ◽  
Clinical Medicine ◽  
Point Of Care ◽  
Physical Exam ◽  
Inpatient Setting ◽  
Point Of Care Ultrasound ◽  
Evidence Based ◽  
Post Test ◽  
Point Of Care Ultrasonography

Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program’s aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents’ knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.

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