Assessing the utility of ultrasound in the role 2 hospital setting

2019 ◽  
pp. jramc-2019-001208 ◽  
Author(s):  
Edward Sellon ◽  
S Durdle ◽  
D Bailey
Keyword(s):  
Point Of Care ◽  
Hospital Setting ◽  
Management Plan ◽  
Routine Care ◽  
Tissue Imaging ◽  
Clinical Indication ◽  
Presumptive Diagnosis ◽  
Prospective Data ◽  
Clinical Confidence ◽  
And Training

IntroductionThe usefulness of departmental diagnostic ultrasound in the role 2 setting has not been previously evaluated. This is because role 2 hospital manning does not traditionally include a diagnostic radiologist. This study aims to evaluate the usefulness of this added capability in the deployed role 2 hospital setting.MethodsProspective data were collected using a questionnaire alongside each scan request during the Op TRENTON 3 operational period. This included details of clinical indication and presumptive diagnosis. Scans were acquired and reported as part of routine care. The postscan clinical diagnosis and effect on management plan were determined by the treating clinician and recorded on the questionnaire. Point-of-care and focused assessment with sonography in trauma scans were excluded, as were ultrasound-guided interventional procedures.Results41 diagnostic departmental scans were included over the six-month period. 68% (28/41) of the scans increased clinical confidence in the management plan, while 29% (12/41) led to an alteration in the management plan. Only one examination (3%) was deemed to have had no clinical impact. Overall, the musculoskeletal scans had the greatest impact on patient management.ConclusionsConstraints of manoeuvrability at role 2 currently preclude the availability of body CT and shift the demand for diagnostic soft tissue imaging to ultrasound. This capability is only possible with the deployment of suitably trained individuals. This study highlights the utility of this capability at role 2. Musculoskeletal ultrasound skills were of particular value, and training should be encouraged among physiotherapists and radiographers in lieu of, where necessary, a suitably trained deployable radiologist.

scholarly journals Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040977
Author(s):  
Nga Thi Thuy Do ◽  
Rachel Claire Greer ◽  
Yoel Lubell ◽  
Sabine Dittrich ◽  
Maida Vandendorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Antibiotic Use ◽  
Routine Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

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 “There is no magic bullet.” Considerations for the adoption of molecular chlamydia and gonorrhoea point of care tests into routine care.

2020 ◽  
Author(s):  
Sebastian Fuller ◽  
Emma Harding-Esch
Keyword(s):  
Sexual Health ◽  
Point Of Care ◽  
Clinical Effectiveness ◽  
Routine Care ◽  
Good Evidence ◽  
Magic Bullet ◽  
Value Proposition ◽  
Healthcare Settings ◽  
A Value ◽  
Point Of Care Tests

IntroductionSexually Transmitted Infections (STIs), including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), continue to be a global health problem, with the majority of the disease burden in Low and Middle Income Countries. This could in part be addressed through increased access to rapid point-of-care-tests (POCTs) for infection detection and appropriate clinical management. Guidelines and criteria for the development of STI POCTs have been established, and several POCTs for CT and NG have been brought to market. Yet even those diagnostics with good evidence of clinical effectiveness often fail to be implemented and adopted into routine care. Here we review the current literature for test development and implementation alongside studies of how the Cepheid CT/NG GeneXpert POCT has been utilised in different healthcare settings, to develop a value proposition for CT/NG POCT adoption.MethodsWe review whether the Cepheid CT/NG GeneXpert fulfil the (RE)ASSURED and Target Product Profile (TPP) criteria, and present published literature reporting on the test’s implementation, to demonstrate its range of values in different settings and to a variety of stakeholders. This information is then applied to the value proposition for laboratory medicine, to form the basis of a value proposition for a CT/NG POCT. ResultsThe Cepheid CT/NG GeneXpert did not fulfil all (RE)ASSURED or TPP criteria, however, studies of test implementation showed multiple stakeholder values for the use of the test across various healthcare settings and geographic locations. The majority of values identified were setting specific. Sexual health services and outreach services had the least overlap in values, whereas General Practice and other non-sexual health specialist services served as a “bridge” between the two.ConclusionWe recommend that those wishing to improve CT/NG diagnosis be supported to identify the values most relevant to their settings and context, and prioritise implementation of those tests most closely aligned with those values.

scholarly journals Clinical performance evaluation of SARS-CoV-2 rapid antigen testing in point of care usage in comparison to RT-qPCR

2021 ◽  
Author(s):  
Isabell Wagenhaeuser ◽  
Kerstin Knies ◽  
Vera Rauschenberger ◽  
Michael Eisenmann ◽  
Miriam McDonogh ◽  
...  
Keyword(s):  
Performance Evaluation ◽  
Viral Load ◽  
Clinical Performance ◽  
Point Of Care ◽  
Hospital Setting ◽  
High Viral Load ◽  
Evaluation Study ◽  
Study Cohort ◽  
Protein Variant ◽  
Atypical Symptoms

Background Antigen rapid diagnostic tests (RDT) for SARS-CoV-2 are fast, broadly available, and inexpensive. Despite this, reliable clinical performance data is sparse. Methods In a prospective performance evaluation study, RDT from three manufacturers (NADAL, Panbio, MEDsan) were compared to quantitative reverse transcription polymerase chain reaction (RT-qPCR) in 5 068 oropharyngeal swabs for detection of SARS-CoV-2 in a hospital setting. Viral load was derived from standardized RT-qPCR Cycle threshold (Ct) values. The data collection period ranged from November 12, 2020 to February 28, 2021. Findings Overall, sensitivity of RDT compared to RT-qPCR was 42.57% (95% CI 33.38%-52.31%), and specificity 99.68% (95% CI 99.48%-99.80%). Sensitivity declined with decreasing viral load from 100% in samples with a deduced viral load of 10^8 SARS-CoV-2 RNA copies per ml to 8.82% in samples with a viral load lower than 104 SARS-CoV-2 RNA copies per ml. No significant differences in sensitivity or specificity could be observed between the three manufacturers, or between samples with and without spike protein variant B.1.1.7. The NPV in the study cohort was 98.84%; the PPV in persons with typical COVID-19 symptoms was 97.37%, and 28.57% in persons without or with atypical symptoms. Interpretation RDT are a reliable method to diagnose SARS-CoV-2 infection in persons with high viral load. RDT are a valuable addition to RT-qPCR testing, as they reliably detect infectious persons with high viral loads before RT-qPCR results are available. Funding German Federal Ministry for Education and Science (BMBF), Free State of Bavaria

scholarly journals Molecular chlamydia and gonorrhoea point of care tests implemented into routine practice: Systematic review and value proposition development

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259593
Author(s):  
Sebastian S. Fuller ◽  
Eleanor Clarke ◽  
Emma M. Harding-Esch
Keyword(s):  
Systematic Review ◽  
Sexual Health ◽  
Point Of Care ◽  
Clinical Effectiveness ◽  
Routine Care ◽  
Routine Practice ◽  
Value Proposition ◽  
Sexually Transmitted ◽  
Conference Abstract ◽  
Point Of Care Tests

Background Sexually Transmitted Infections, including Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), continue to be a global health problem. Increased access to point-of-care-tests (POCTs) could help detect infection and lead to appropriate management of cases and contacts, reducing transmission and development of reproductive health sequelae. Yet diagnostics with good clinical effectiveness evidence can fail to be implemented into routine care. Here we assess values beyond clinical effectiveness for molecular CT/NG POCTs implemented across diverse routine practice settings. Methods We conducted a systematic review of peer-reviewed primary research and conference abstract publications in Medline and Embase reporting on molecular CT/NG POCT implementation in routine clinical practice until 16th February 2021. Results were extracted into EndNote software and initially screened by title and abstract by one author according to the inclusion and exclusion criteria. Articles that met the criteria, or were unclear, were included for full-text assessment by all authors. Results were synthesised to assess the tests against guidance criteria and develop a CT/NG POCT value proposition for multiple stakeholders and settings. Findings The systematic review search returned 440 articles; 28 were included overall. The Cepheid CT/NG GeneXpert was the only molecular CT/NG POCT implemented and evaluated in routine practice. It did not fulfil all test guidance criteria, however, studies of test implementation showed multiple values for test use across various healthcare settings and locations. Our value proposition highlights that the majority of values are setting-specific. Sexual health services and outreach services have the least overlap, with General Practice and other non-sexual health specialist services serving as a “bridge” between the two. Conclusions Those wishing to improve CT/NG diagnosis should be supported to identify the values most relevant to their settings and context, and prioritise implementation of tests that are most closely aligned with those values.

scholarly journals LO85: Development of a competency based assessment tool for emergency department point of care ultrasound

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S38-S39
Author(s):  
C. McKaigney ◽  
C. Bell ◽  
A. Hall
Keyword(s):  
Delphi Method ◽  
Assessment Tool ◽  
Point Of Care ◽  
Image Acquisition ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
Clinical Integration ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Image Optimization

Innovation Concept: Assessment of residents' Point of Care Ultrasound (PoCUS) competency currently relies on heterogenous and unvalidated methods, such as the completion of a number of proctored studies. Although number of performed studies may be associated with ability, it is not necessarily a surrogate for competence. Our goal was to create a single Ultrasound Competency Assessment Tool (UCAT) using domain-anchored entrustment scoring. Methods: The UCAT was developed as an anchored global assessment score, building on a previously validated simulation-based assessment tool. It was designed to measure performance across the domains of Preparation, Image Acquisition, Image Optimization, and Clinical Integration, in addition to providing a final entrustment score (i.e., OSCORE). A modified Delphi method was used to establish national expert consensus on anchors for each domain. Three surveys were distributed to the CAEP Ultrasound Committee between July-November 2018. The first survey asked members to appraise and modify a list of anchor options created by the authors. Next, collated responses from the first survey were redistributed for a re-appraisal. Finally, anchors obtaining >65% approval from the second survey were condensed and redistributed for final consensus. Curriculum, Tool or Material: Twenty-two, 26, and 22 members responded to the surveys, respectively. Each anchor achieved >90% final agreement. The final anchors for the domains were: Preparation – positioning, initial settings, ensures clean transducer, probe selection, appropriate clinical indication; Image Acquisition – appropriate measurements, hand position, identifies landmarks, visualization of target, efficiency of probe motion, troubleshoots technical limitations; Image Optimization – centers area of interest, overall image quality, troubleshoots patient obstacles, optimizes settings; Clinical Integration – appropriate interpretation, understands limitations, utilizes information appropriately, performs multiple scans if needed, communicates findings, considers false positive and negative causes of findings. Conclusion: The UCAT is a novel assessment tool that has the potential to play a central role in the training and evaluation of residents. Our use of a modified Delphi method, involving key stakeholders in PoCUS education, ensures that the UCAT has a high degree of process and content validity. An important next step in determining its construct validity is to evaluate the use of the UCAT in a multi-centered examination setting.

scholarly journals Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium

2014 ◽  
Vol 13 (4) ◽  
pp. 1005-1011 ◽  
Author(s):  
Gabrielle Silver ◽  
Julia Kearney ◽  
Chani Traube ◽  
Margaret Hertzig
Keyword(s):  
Child Development ◽  
Screening Tool ◽  
Hospital Setting ◽  
Lessons Learned ◽  
Hospitalized Children ◽  
Bedside Nurse ◽  
Symptom Domains ◽  
Anchor Points ◽  
Bedside Nursing ◽  
And Training

AbstractObjective:The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a “developmental anchor points” reference chart, which helps ground clinicians' assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium.Method:During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting.Results:The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children.Significance of Results:The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium.

scholarly journals Introducing point-of-care testing into a rural hospital setting: thematic analysis of interviews with providers

2010 ◽  
Vol 2 (1) ◽  
pp. 54 ◽  
Author(s):  
Katharina Blattner ◽  
Garry Nixon ◽  
Chrystal Jaye ◽  
Susan Dovey
Keyword(s):  
Rural Community ◽  
Thematic Analysis ◽  
Professional Education ◽  
Point Of Care ◽  
Hospital Setting ◽  
Daily Practice ◽  
Care Providers ◽  
Diagnostic Certainty ◽  
Care Systems ◽  
Education Gaps

INTRODUCTION: Hauora Hokianga Enterprises Trust, an integrated Primary Health Organisation (PHO), which provides primary and intermediate/secondary care to a remote rural community, introduced point-of-care (POC) testing at Rawene Hospital in June 2008. Previously, all laboratory tests were undertaken in Whangarei, with a one to three day turn-around for results. This study aimed to identify the perceived impact of POC testing on clinicians and the community. METHOD: Face-to-face interviews were conducted with 13 health professionals working at Rawene Hospital. The qualitative data analysis computer programme Atlas.ti v5.2 was used to assist the thematic analysis. FINDINGS: Three overall themes captured the main issues with introducing POC testing: (1) POC testing increased clinicians’ confidence, certainty and assurance in their daily practice; (2) POC testing improved diagnostic certainty and this impacted on patients and their families/whanau; (3) the challenges associated with POC testing included increased workload, pressure to up-skill, over-testing, and continuing professional education gaps. CONCLUSION: POC testing is an invaluable technological adjunct for improving clinical decisions and culturally safe care provided to a remote rural community, but it brings challenges to care providers in managing higher workloads and pressures to up-skill. POC testing can improve the acute medical care (access and quality) provided to an economically-deprived, predominantly Maori, rural community. KEYWORDS: Hospitals, rural; point-of-care systems; rural health

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