scholarly journals Point-of-Care Cardiac Ultrasound in COVID-19 Intensive Care Unit

2020 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Rosanna Carmela De Rosa ◽  
Antonio Romanelli ◽  
Roberto Colonna ◽  
Annunziata Minale ◽  
Antonio Corcione
Keyword(s):  
Intensive Care Unit ◽  
Length Of Stay ◽  
Wall Motion ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Case Series ◽  
Clinical Decision ◽  
Cor Pulmonale ◽  
Cardiac Ultrasound ◽  
Clinical Conditions

(1) Background: Coronavirus disease 2019 (COVID-19) is associated with the development of Acute COVID-19 Cardiovascular Syndrome (ACovCS) in critically ill patients. In this case series, we evaluated the incidence of ACovCS by ultrasound in critically COVID-19 ill patients. (2) Methods: This case series included all patients with confirmed COVID-19 requiring admission to the ICU at Monaldi Hospital (AORN Ospedale dei Colli, Naples), between March 14th, 2020, and May 1st, 2020. On admission, in stable clinical conditions, an experienced and certified intensivist performed Point-Of-Care Cardiac Ultrasound (POC-CU). The exam was performed daily in every patient and repeated according to clinical evolution and intensivist’s judgment during the length of stay. Ex-Novo ACovCS echocardiographic patterns were noted. (3) Results: POC-CU evaluation performed on 19 patients revealed that, on admission, five patients (26.3%) presented an echocardiographic pattern like cor pulmonale. During the length of stay, seven patients (36.8%) presented ex-Novo echocardiographic alterations, suggesting ACovCS. Pericardial effusion (26.3%), acute right impairment due to pulmonary embolism (5.3%) and acute left impairment by wall motion alteration (5.3%) were the most common findings. (4) Conclusions: Ex-Novo cardiac abnormalities shown by POC-CU were common in patients with severe COVID-19. Competence in POC-CU is essential in identifying ACovCS in COVID-ICU and clinical decision-making.

Transducer-based comparisons of the prosthetic feet used by transtibial amputees for different walking activities: a pilot study

2012 ◽  
Vol 36 (2) ◽  
pp. 203-216 ◽  
Author(s):  
Edward Schreiber Neumann ◽  
Kartheek Yalamanchili ◽  
Justin Brink ◽  
Joon S Lee
Keyword(s):  
Clinical Decision Making ◽  
Research Question ◽  
Case Series ◽  
Clinical Decision ◽  
Residual Limb ◽  
Convenience Sample ◽  
Loading Patterns ◽  
Prosthetic Feet ◽  
Transtibial Amputees ◽  
Resultant Forces

Background: Knowledge of transtibial residual limb force and moment loading during gait can be clinically useful. The research question was whether a transducer attached between the socket and pylon can be used to detect differences in loading patterns created by prosthetic feet of different design and different walking activities in real-world environments outside the gait lab. Objectives: To develop methods for obtaining, processing, analyzing and interpreting transducer measurements and examining their clinical usefulness. Study Design: Case series design. Methods: A convenience sample of four K3-K4 transtibial amputees and a wireless tri-axial transducer mounted distal to the socket. Activities included self-selected comfortable speed walking, and ascending and descending ramps and steps. Measurements taken about three orthogonal axes were processed to produce plots of normalized resultant force versus normalized resultant moment. Within-subject differences in peak resultant forces and moments were tested. Results: Loading patterns between feet and subjects and among the activities were distinctly different. Optimal loading of peak resultant forces tentatively might occur around 25% and 69% to73% of stance during self-selected comfortable walking. Ascending and descending ramps is useful for examining heel and forefoot response. Conclusions: Force-moment plots obtained from transducer data may assist clinical decision making. Clinical relevance A pylon-mounted transducer distal to the socket reveals the moments and forces transmitted to the residual limb and can be used to evaluate the loading patterns on the residual limb associated with different foot designs and different everyday activities outside the gait lab.

POCT errors can lead to false potassium results

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Antonio Buño ◽  
Paloma Oliver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Clinical Intervention ◽  
Clinical Decision ◽  
Whole Process ◽  
Severe Hyperkalemia ◽  
Wrong Diagnosis ◽  
Critical Patients

Abstract Point-of-care-testing (POCT) facilitates rapid availability of results that allows prompt clinical decision making. These results must be reliable and the whole process must not compromise its quality. Blood gas analyzers are one of the most used methods for POCT tests in Emergency Departments (ED) and in critical patients. Whole blood is the preferred sample, and we must be aware that hemolysis can occur. These devices cannot detect the presence of hemolysis in the sample, and because of the characteristics of the sample, we cannot visually detect it either. Hemolysis can alter the result of different parameters, including potassium with abnormal high results or masking low levels (hypokalemia) when reporting normal concentrations. Severe hyperkalemia is associated with the risk of potentially fatal cardiac arrhythmia and demands emergency clinical intervention. Hemolysis can be considered the most frequent cause of pseudohyperkalemia (spurious hyperkalemia) or pseudonormokalemia and can be accompanied by a wrong diagnosis and an ensuing inappropriate clinical decision making. A complete review of the potential causes of falsely elevated potassium concentrations in blood is presented in this article. POCT programs properly led and organized by the clinical laboratory can help to prevent errors and their impact on patient care.

scholarly journals Manipulative and Manual Therapies in the Management of Patients with Prior Lumbar Surgery: A Systematic Review

2020 ◽  
Author(s):  
Clinton J Daniels ◽  
Zachary A. Cupler ◽  
Jordan A Gliedt ◽  
Sheryl Walters ◽  
Alec L Schielke ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Clinical Decision ◽  
Manual Therapies ◽  
Lumbar Surgery ◽  
Pilot Studies ◽  
Surgical Interventions

Abstract BackgroundThe purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery.MethodsThe review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality.ResultsLiterature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. ConclusionThe findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.Trial registrationProspectively registered with PROSPERO (#CRD42020137314). Registered 24 January 2020.

scholarly journals Point-of-Care Testing-the Key in the Battle against SARS-CoV-2 Pandemic

Micromachines ◽  
2021 ◽  
Vol 12 (12) ◽  
pp. 1464
Author(s):  
Florina Silvia Iliescu ◽  
Ana Maria Ionescu ◽  
Larisa Gogianu ◽  
Monica Simion ◽  
Violeta Dediu ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Point Of Care ◽  
Low Cost ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Rapid Screening ◽  
Diagnostic Tools ◽  
Point Of Care Testing ◽  
Qrt Pcr ◽  
User Friendly

The deleterious effects of the coronavirus disease 2019 (COVID-19) pandemic urged the development of diagnostic tools to manage the spread of disease. Currently, the “gold standard” involves the use of quantitative real-time polymerase chain reaction (qRT-PCR) for SARS-CoV-2 detection. Even though it is sensitive, specific and applicable for large batches of samples, qRT-PCR is labour-intensive, time-consuming, requires trained personnel and is not available in remote settings. This review summarizes and compares the available strategies for COVID-19: serological testing, Point-of-Care Testing, nanotechnology-based approaches and biosensors. Last but not least, we address the advantages and limitations of these methods as well as perspectives in COVID-19 diagnostics. The effort is constantly focused on understanding the quickly changing landscape of available diagnostic testing of COVID-19 at the clinical levels and introducing reliable and rapid screening point of care testing. The last approach is key to aid the clinical decision-making process for infection control, enhancing an appropriate treatment strategy and prompt isolation of asymptomatic/mild cases. As a viable alternative, Point-of-Care Testing (POCT) is typically low-cost and user-friendly, hence harbouring tremendous potential for rapid COVID-19 diagnosis.

Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device

2019 ◽  
Vol 41 (03) ◽  
pp. 308-316 ◽  
Author(s):  
Eckhart Fröhlich ◽  
Katharina Beller ◽  
Reinhold Muller ◽  
Maria Herrmann ◽  
Ines Debove ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Patients ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
False Negative ◽  
Clinical Decision ◽  
Point Of Care Ultrasound ◽  
Handheld Device ◽  
Ultrasound Device ◽  
Handheld Ultrasound

Abstract Purpose The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard. Materials and Methods Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications. Results The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an “overall sensitivity” of 89.5 %. The respective “overall specificity” was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed. Conclusion The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.

scholarly journals Early Multi-organ Point-of-Care Ultrasound Evaluation of Respiratory Distress During SARS-CoV-2 Outbreak: Case Report

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Robert Farrow ◽  
Graham Becherer-Bailey ◽  
Daniel Mantuani ◽  
Arun Nagdev
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Case Series ◽  
Disease Process ◽  
Point Of Care Ultrasound ◽  
Care Assessment

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several case series from Italy and China have highlighted the lung ultrasound findings of this disease process and may demonstrate its clinical utility during the current pandemic. Case Report: We present a case of a COVID-19 patient who presented to the emergency department twice within a 24-hour period with rapidly progressing illness. A multi-organ point-of-care ultrasound (POCUS) evaluation was used on the return visit and assisted clinical decision-making. Discussion: A multi-organ POCUS exam allows for quick assessment of acute dyspnea in the emergency department. As the lung involvement of COVID-19 is primarily a peripheral process it is readily identifiable via lung ultrasound. We believe that when applied efficiently and safely a POCUS exam can reduce clinical uncertainty and potentially limit the use of other imaging modalities when treating patients with COVID-19. Conclusion: This case highlights the utility of an early multiorgan point-of-care assessment for patients presenting with moderate respiratory distress during the severe SARS-CoV-2 pandemic.

scholarly journals Factors affecting clinical decision-making in inflammatory bowel disease and the role of point-of-care calprotectin

2018 ◽  
Vol 11 ◽  
pp. 1756283X1774473 ◽  
Author(s):  
Yannick Derwa ◽  
Christopher J.M. Williams ◽  
Ruchit Sood ◽  
Saqib Mumtaz ◽  
M. Hassan Bholah ◽  
...  
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Mucosal Inflammation ◽  
Inflammatory Bowel

Objectives: Patient-reported symptoms correlate poorly with mucosal inflammation. Clinical decision-making may, therefore, not be based on objective evidence of disease activity. We conducted a study to determine factors associated with clinical decision-making in a secondary care inflammatory bowel disease (IBD) population, using a cross-sectional design. Methods: Decisions to request investigations or escalate medical therapy were recorded from outpatient clinic encounters in a cohort of 276 patients with ulcerative colitis (UC) or Crohn’s disease (CD). Disease activity was assessed using clinical indices, self-reported flare and faecal calprotectin ≥ 250 µg/g. Demographic, disease-related and psychological factors were assessed using validated questionnaires. Logistic regression was performed to determine the association between clinical decision-making and symptoms, mucosal inflammation and psychological comorbidity. Results: Self-reported flare was associated with requesting investigations in CD [odds ratio (OR) 5.57; 95% confidence interval (CI) 1.84–17.0] and UC (OR 10.8; 95% CI 1.8–64.3), but mucosal inflammation was not (OR 1.62; 95% CI 0.49–5.39; and OR 0.21; 95% CI 0.21–1.05, respectively). Self-reported flare (OR 7.96; 95% CI 1.84–34.4), but not mucosal inflammation (OR 1.67; 95% CI 0.46–6.13) in CD, and clinical disease activity (OR 10.36; 95% CI 2.47–43.5) and mucosal inflammation (OR 4.26; 95% CI 1.28–14.2) in UC were associated with escalation of medical therapy. Almost 60% of patients referred for investigation had no evidence of mucosal inflammation. Conclusions: Apart from escalation of medical therapy in UC, clinical decision-making was not associated with mucosal inflammation in IBD. The use of point-of-care calprotectin testing may aid clinical decision-making, improve resource allocation and reduce costs in IBD.

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