scholarly journals Establishing a risk assessment framework for point-of-care ultrasound

2021 ◽  
Author(s):  
Thomas W. Conlon ◽  
Nadya Yousef ◽  
Juan Mayordomo-Colunga ◽  
Cecile Tissot ◽  
Maria V. Fraga ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Clinical Care ◽  
Hippocratic Oath ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
International Guidelines ◽  
Portable Ultrasound

AbstractPoint-of-care ultrasound (POCUS) refers to the use of portable ultrasound (US) applications at the bedside, performed directly by the treating physician, for either diagnostic or procedure guidance purposes. It is being rapidly adopted by traditionally non-imaging medical specialties across the globe. Recent international evidence-based guidelines on POCUS for critically ill neonates and children were issued by the POCUS Working Group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Currently there are no standardized national or international guidelines for its implementation into clinical practice or even the training curriculum to monitor quality assurance. Further, there are no definitions or methods of POCUS competency measurement across its varied clinical applications.Conclusion: The Hippocratic Oath suggests medical providers do no harm to their patients. In our continued quest to uphold this value, providers seeking solutions to clinical problems must often weigh the benefit of an intervention with the risk of harm to the patient. Technologies to guide diagnosis and medical management present unique considerations when assessing possible risk to the patient. Frequently risk extends beyond the patient and impacts providers and the institutions in which they practice. POCUS is an emerging technology increasingly incorporated in the care of children across varied clinical specialties. Concerns have been raised by clinical colleagues and regulatory agencies regarding appropriate POCUS use and oversight. We present a framework for assessing the risk of POCUS use in pediatrics and suggest methods of mitigating risk to optimize safety and outcomes for patients, providers, and institutions. What is Known: • The use POCUS by traditionally non-imaging pediatric specialty physicians for both diagnostic and procedural guidance is rapidly increasing. • Although there are international guidelines for its indications, currently there is no standardized guidance on its implementation in clinical practice. What is New: • Although standards for pediatric specialty-specific POCUS curriculum and training to competency have not been defined, POCUS is likely to be most successfully incorporated in clinical care when programmatic infrastructural elements are present. • Risk assessment is a forward-thinking process and requires an imprecise calculus that integrates considerations of the technology, the provider, and the context in which medical care is delivered. Medicolegal considerations vary across countries and frequently change, requiring providers and institutions to understand local regulatory requirements and legal frameworks to mitigate the potential risks of POCUS.

Establishing a Risk Assessment Framework for Point-of-Care Ultrasound

2021 ◽  
Author(s):  
Thomas W. Conlon ◽  
Nadya Yousef ◽  
Juan Mayordomo Colungo ◽  
Cecile Tissot ◽  
Maria V. Fraga ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Hippocratic Oath ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Portable Ultrasound ◽  
Do No Harm ◽  
Critically Ill Neonates ◽  
Procedure Guidance ◽  
Evidence Based Guidelines

Abstract Point of Care Ultrasound (POCUS) refers to the use of portable ultrasound (US) applications at the bedside, performed directly by the treating physician, for either diagnostic or procedure guidance purposes. It is being rapidly adopted by traditionally non-imaging medical specialties across the globe. Recent international evidence-based guidelines on POCUS for critically ill neonates and children were issued by the POCUS Working Group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Currently there are no standardized national or international guidelines for its implementation into clinical practice or even the training curriculum to monitor quality assurance. Further, there are no definitions or methods of POCUS competency measurement across its varied clinical applications.The Hippocratic Oath suggests medical providers do no harm to their patients. In our continued quest to uphold this value, providers seeking solutions to clinical problems must often weigh the benefit of an intervention with the risk of harm to the patient. Technologies to guide diagnosis and medical management present unique considerations when assessing possible risk to the patient. Frequently risk extends beyond the patient and impacts providers and the institutions in which they practice. Point-of-care ultrasound (POCUS) is an emerging technology increasingly incorporated in the care of children across varied clinical specialties. Concerns have been raised by clinical colleagues and regulatory agencies regarding appropriate POCUS use and oversight. We present a framework for assessing the risk of POCUS use in pediatrics and suggest methods of mitigating risk to optimize safety and outcomes for patients, providers and institutions.

scholarly journals Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care?

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1098
Author(s):  
J. Lauren Ruoss ◽  
Catalina Bazacliu ◽  
Nicole Cacho ◽  
Daniele De Luca
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Clinical Care ◽  
Neonatal Intensive Care Units ◽  
Point Of Care Ultrasound ◽  
Predictive Tool ◽  
Neonatal Lung ◽  
Respiratory Conditions

A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe

2020 ◽  
Vol 21 (9) ◽  
pp. e716-e722
Author(s):  
Martien H. Humblet ◽  
Yogen Singh ◽  
Cecile Tissot ◽  
Daniele De Luca ◽  
Piet L. Leroy
Keyword(s):  
Clinical Practice ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Current Clinical Practice

scholarly journals Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

2016 ◽  
Vol 38 (04) ◽  
pp. 279-283
Author(s):  
Daniel Damiani ◽  
Durval Damiani
Keyword(s):  
Intracranial Pressure ◽  
Randomized Trials ◽  
Point Of Care ◽  
Current Data ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Non Invasive ◽  
Nerve Sheath ◽  
Invasive Method ◽  
Point Of Care Ultrasonography

AbstractPoint-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

scholarly journals Merits and perils of targeted neonatal echocardiography-based hemodynamic research: a position statement

2019 ◽  
Vol 97 (3) ◽  
pp. 183-186 ◽  
Author(s):  
Ashraf Kharrat ◽  
Patrick J. McNamara ◽  
Dany Weisz ◽  
Amish Jain
Keyword(s):  
Neonatal Intensive Care ◽  
Heart Function ◽  
Point Of Care ◽  
Position Statement ◽  
Neonatal Intensive Care Units ◽  
Point Of Care Ultrasound ◽  
First Time ◽  
Neonatal Echocardiography ◽  
Clinical Problems ◽  
Time Assessment

In the neonatal setting, point-of-care ultrasound is increasingly being used to help clinicians with the evaluation of heart function. Practices in neonatology, particularly with regard to acute and chronic hemodynamic managements, were traditionally more driven on dogma and predefined thresholds and not always supported by demonstrable physiology. For the first time, targeted neonatal echocardiography (TNE) provided neonatal intensivists with a bedside tool that made real-time assessment of neonatal hemodynamics status feasible in even the tiniest of babies. This opened the door towards more targeted physiological driven practices, allowing us to test historical approaches to clinical problems in a more precise way. Despite the standardization of TNE training and the creation of a formalized curriculum, little attention has been paid to the establishment of an empirical framework to adjudicate scientific investigation. In this position statement, we reflect on the evolution of TNE in Canadian neonatal intensive care units, appraise its strengths and limitations, and suggest guiding principles for clinicians and researchers to consider as they take this field forward.

scholarly journals Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS)

2018 ◽  
Vol 17 (3) ◽  
pp. 168-168
Author(s):  
Karim Fouad Alber ◽  
◽  
Martin Dachsel ◽  
Alastair Gilmore ◽  
Philip Lawrenson ◽  
...  
Keyword(s):  
Focused Ultrasound ◽  
Point Of Care ◽  
Evidence Base ◽  
Response To Treatment ◽  
Point Of Care Ultrasound ◽  
Curriculum Mapping ◽  
Acute Medicine ◽  
Portable Ultrasound ◽  
Sonographic Assessment ◽  
Radiology Training

Dear sir/madam, Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell. Focused Acute Medicine Ultrasound (FAMUS) is the point of care ultrasound curriculum created to aid the management of the acutely unwell adult patient. Following a survey of trainees and consultants, it was apparent that there was a strong desire for Acute Medics to be able to use point of care ultrasound to aid their clinical diagnostic skills. The FAMUS committee was set up to develop competencies using the evidence base available. FAMUS stands in contrast to traditional radiology training modules, which focus on carrying out comprehensive assessments of anatomy and pathology. Instead, FAMUS delivers a syndrome-based sonographic assessment with the aim of ruling out gross pathology and interrogating underlying physiology. It serves as a useful adjunct to history and clinical examination by way of providing key information quickly and non-invasively. Furthermore, it provides a feasible way to monitor response to treatment or progression of disease and thereby providing useful dynamic information quickly and safely. The accreditation in FAMUS involves the sonographic assessment of three systems: lung, abdomen and the deep veins of the lower-limb. Accrediting in each one involves theoretical learning, a formal course attendance and achieving a set number of supervised and mentored scans. As well as technical skills, the candidate must demonstrate competence in recognising key pathology and drawing appropriate conclusions about each scan, including when to refer for departmental imaging. FAMUS was met with enthusiasm by trainees and consultants in acute medicine, and its popularity rises as more courses are becoming available for accreditation paired with increasing access to portable ultrasound units. It is envisioned that this will continue to grow and formal ‘train the trainer’ courses have been held in order to increase the pool of available supervisors. Currently, FAMUS is endorsed by the Society for Acute Medicine and recognised by the AIM training committee as a specialist skill that can be undertaken during specialist training. It has been proposed that FAMUS should be considered for integration into the acute internal medicine (AIM) curriculum, which will be re-written for 2022 in line with the GMC’s revised standards for curriculum and assessment. Thus we present in this letter, a curriculum mapping exercise that utilises a ‘knowledge, skills, behaviours’ framework in order to be considered for the AIM curriculum rewrite. We believe this will provide a standard and framework to integrate focused ultrasound in AIM training programmes with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.

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