Basic Ultrasound Training Can Replace Chest Radiography for Safe Tube Thoracostomy Removal

An ultrasound (US) examination can be easily and rapidly performed at the bedside to aide in clinical decisions. Previously we demonstrated that US was safe and as effective as a chest x-ray (CXR) for removal of tube thoracostomy (TT) when performed by experienced sonographers. This study sought to examine if US was as safe and accurate for the evaluation of pneumothorax (PTX) associated with TT removal after basic US training. Patients included had TT managed by the surgical team between October 2012 and May 2013. Bedside US was performed by a variety of members of the trauma team before and after removal. All residents received, at minimum, a 1-hour formal training class in the use of ultrasound. Data were collected from the electronic medical records. We evaluated 61 TTs in 61 patients during the study period. Exclusion of 12 tubes occurred secondary to having incomplete imaging, charting, or death before having TT removed. Of the 49 remaining TT, all were managed with US imaging. Average age of the patients was 40 years and 30 (61%) were male. TT was placed for PTX in 37 (76%), hemothorax in seven (14%), hemopneumothorax in four (8%), or a pleural effusion in one (2%). Two post pull PTXs were correctly identified by residents using US. This was confirmed on CXR with appropriate changes made. US was able to successfully predict the safe TT removal and patient discharge at all residency levels after receiving a basic US training program.

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eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members

The American Surgeon ◽

10.1177/000313481808400228 ◽

2018 ◽

Vol 84 (2) ◽

pp. 220-224 ◽

Cited By ~ 3

Author(s):

Steven Maximus ◽

Cesar Figueroa ◽

Matthew Whealon ◽

Jacqueline Pham ◽

Eric Kuncir ◽

...

Keyword(s):

Real Life ◽

Standard Of Care ◽

Trauma Team ◽

Tube Thoracostomy ◽

Trauma Patients ◽

Team Members ◽

X Ray ◽

Chest X Ray ◽

Level 1 ◽

Clinically Significant

The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultra-sonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical “real-life” application is yet to be investigated. This is a retrospective review of all trauma patients with a diagnosis of PTX, who were treated at a large level 1 urban trauma center from March 2013 through July 2014. Charts were reviewed for results of imaging, which included eFAST, chest X-ray, and CT scan. The requirement of tube thoracostomy and mechanism of injury were also analyzed. A total of 369 patients with a diagnosis of PTX were identified. A total of 69 patients were excluded, as eFASTwas either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.

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CHEST X RAY SCORE AND CLINICAL SEVERITY IN COVID-19 PATIENTS

10.36106/ijsr/2506669 ◽

2021 ◽

pp. 31-32

Author(s):

Sheeba Rana ◽

Vicky Bakshi ◽

Yavini Rawat ◽

Zaid Bin Afroz

Keyword(s):

Retrospective Study ◽

Medical Records ◽

Scoring Systems ◽

Clinical Severity ◽

X Rays ◽

Antigen Test ◽

X Ray ◽

Classi Cation ◽

Chest X Ray ◽

Male Subjects

INTRODUCTION: Various chest X-ray scoring systems have been discovered and are employed to correlate with clinical severity, outcome and progression of diseases. With, the coronavirus outbreak, few chest radiograph classication were formulated, like the BSTI classication and the Brixia chest X-ray score. Brixia CXR scoring is used for assessing the clinical severity and outcome of COVID-19. This study aims to compare the Brixia CXR score with clinical severity of COVID-19 patients. MATERIAL& METHODS:This was a retrospective study in which medical records of patients aged 18 years or above, who tested for RTPCR or st st Rapid Antigen Test (RAT) for COVID positive from 1 February 2021 to 31 July 2021 (6 months) were taken. These subjects were stratied into mild, moderate and severe patients according to the ICMR guidelines. Chest X Rays were obtained and lesions were classied according to Brixia scoring system. RESULTS: Out of these 375 patients, 123 (32.8%) were female and 252 (67.2%) were male subjects. The average brixia score was 11.12. Average Brixia CXR score for mild, moderate and severe diseased subjects were 5.23, 11.20, and 14.43 respectively. DISCUSSION:The extent of chest x-ray involvement is proportional to the clinical severity of the patient. Although, a perplexing nding was that the average Brixia score of the female subjects were slightly higher than their male counterparts in the same clinical groups. CONCLUSION: Brixia CXR score correlates well with the clinical severity of the COVID-19.

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Therapeutic effect of cycloserine combined with anti-tuberculosis drugs in the treatment of multidrug-resistant tuberculosis

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v20i2.28 ◽

2022 ◽

Vol 20 (2) ◽

pp. 419-424

Author(s):

Yang Zhao ◽

Mabin Si ◽

Zhihui Li ◽

Xiulei Yu

Keyword(s):

Ct Scan ◽

Multidrug Resistant ◽

Chest Ct ◽

Case Detection Rate ◽

X Ray ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Before And After ◽

Mdr Tb ◽

Chest X Ray

Purpose: The present study analyzes the comprehensive therapeutic effect of cycloserine, in combination with anti-tuberculosis drugs using chest X-ray and chest CT (computed tomography) scan techniques. Methods: A total of 90 patients, diagnosed with multidrug resistant tuberculosis (MDR TB) were subjected to chest x-ray and CT scan before and after treatment in the two groups. Different views such as sagittal, coronal, lung window and multiplanar imaging of mediastinal window were taken. Some parameters such as case detection rate (CDR) in chest X-ray and CT scan and comprehensive curative effect were observed in two groups. Further, the changes in chest CT signs in addition to absorption of focus, cavity closure and changes in CT extra pulmonary signs were also observed. Results: The clinical profile of the patients and the course of disease were statistically insignificant (p > 0.05). Total effectiveness rate and case detection rate (CDR) values exhibited a significant difference between the groups (p < 0.05). Lung consolidation, nodules and cavities significantly improved in both groups before and after the treatment (p < 0.05). Both groups showed significant improvements in extrapulmonary signs in CT scan (p < 0.05) after the treatment. Conclusion: Based on the study outcomes, the CT scan method has good potentials for diagnosing and treating MDR TB at the early stages. Further, it can clarify the signs and outcomes of the disease at early stages, thus providing the medical fraternity a great opportunity to cure the disease.

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Abstract P18: Report on the Treatment Process and Impact of Mechanical Thrombectomy Before and After Coronavirus Disease in a Newly Opened Hospital of South Korea

Stroke ◽

10.1161/str.52.suppl_1.p18 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jin EUN ◽

Hae-Kwan Park

Keyword(s):

Emergency Treatment ◽

Treatment Process ◽

Mechanical Thrombectomy ◽

X Ray ◽

X Ray Imaging ◽

New Process ◽

Before And After ◽

Portable Chest ◽

Chest X Ray ◽

Adequate Management

Introduction: The difficulty neurointernvetionists face in keeping “Time is brain” in the middle of the COVID-19 pandemic are inevitable. Our health system began shutting down entire hospital for two weeks after a transport agent was diagnosed with COVID-19. It took an additional two weeks to establish the process of emergency treatment. We intend to introduce our protocols and report on their progress so far. Post-COVID-19 Protocol (Figure 1) Methods: A total of 52 patients underwent mechanical thrombectomy at Eunpyeong St. Mary’s Hospital before the Covid-19 outbreak. For 18 patients who underwent mechanical thrombectomy through a new process after COVID-19, door-to-image time, door-to-puncture time, and TICI grade were compared. Results: For the treatment of all patients, portable chest x-ray imaging was performed, but the door-to-initial-brain-image time (min) was 15.5 vs. 15 (before COVID-19 vs. after COVID-19) (p=0.265). Door-to-needle-time (min) showed a delay of 9 minutes, from 144.5 to 153.5, but it was not statistically significant (p=0.299). Up to 95.2% of patients before COVID-19 achieved TICI grade 2b or higher, and 100% of patients after COVID-19 have achieved TICI grade 2b or 3. (Table 1) Conclusions: Overall, there was a slight increase in the door-to-needle time, but clear protocols and guidelines for management and collaboration with the clinical workforce have been able to reduce delays and ensure timely and adequate management. When referring to the protocol implemented while preparing for infectious diseases, it will be a reference not only for COVID-19, but also for other diseases that may occur in the future.

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Recurrent spontaneous pneumothorax in pregnancy-a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20214390 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3449

Author(s):

Muhammad S. Shafique ◽

Fatima Rauf ◽

Hamza W. Bhatti ◽

Noman A. Chaudhary ◽

Muhammad Hanif

Keyword(s):

Case Report ◽

Spontaneous Pneumothorax ◽

Respiratory Illness ◽

Tube Thoracostomy ◽

Shortness Of Breath ◽

Past Medical History ◽

Pleuritic Chest Pain ◽

X Ray ◽

Chest X Ray ◽

In Pregnancy

Spontaneous pneumothorax during pregnancy is a rare but a serious condition. The typical symptoms of spontaneous pneumothorax include pleuritic chest pain and shortness of breath. Diagnosis is usually made on chest X-ray with abdominal shielding. Management differs according to severity and no specific guidelines are described for management of spontaneous pneumothorax in pregnancy. We report a case of a 27-year-old multigravida, with insignificant past medical history for any respiratory illness, presenting with recurrent, left sided spontaneous pneumothorax during a single pregnancy. It was managed by chest tube thoracostomy each time and patient was discharged with tube till the delivery of the fetus.

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Profil hasil pemeriksaan foto toraks pada pasien pneumotoraks di Bagian / SMF Radiologi FK Unsrat RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2015 – Agustus 2016

e-CliniC ◽

10.35790/ecl.4.2.2016.14397 ◽

2016 ◽

Vol 4 (2) ◽

Author(s):

Windy D.P. Masengi ◽

Elvie Loho ◽

Vonny Tubagus

Keyword(s):

Medical Records ◽

Spontaneous Pneumothorax ◽

Pleural Cavity ◽

Secondary Data ◽

Descriptive Study ◽

Age Group ◽

X Ray ◽

Secondary Spontaneous Pneumothorax ◽

Chest X Ray ◽

The Right

Abstract: Radiology examination especially chest x-ray can enforce various kinds of pulmonary diseases inter alia pneumothorax. Pneumothorax is defined as the presence of air in the pleural cavity. The causes of pneumothorax are very diverse ranging from idiopathic, infection, trauma, and iatrogenic. This study was aimed to obtain the profile of chest x-ray in patients with pneumothorax. This was a retrospective descriptive study by using secondary data from the medical records at the Department of Radiology Prof. Dr. R. D. Kandou Hospital Manado from January 2015 to August 2016. Samples were the medical records of patients that were radiologically diagnosed as pneumothorax. There were 41 patients that were diagnosed radiologically as pneumothorax. The majority of cases were male (90.2%), age group >50 years (36.6%), location of lesion in the right hemithorax (53.7%), and secondary spontaneous pneumothorax as the etiology (43,9 %). Conclusion: In this study, pneumothorax was more common among males, age group of ≥50 years, and secondary spontaneous pneumothorax as the etiology of pneumothorax.Keywords: pneumothorax, radiology, chest x-ray Abstrak: Pemeriksaan radiologi khususnya foto toraks dapat menegakkan berbagai macam diagnosis penyakit paru, salah satunya ialah pneumotoraks. Pneumotoraks adalah terdapatnya udara bebas didalam rongga pleura dengan penyebab yang sangat beragam mulai dari idiopatik, infeksi, trauma, maupun iatrogenik. Penelitian ini bertujuan untuk mengetahui profil hasil pemeriksaan foto toraks pada pasien pneumotoraks. Jenis penelitian ialah deskriptif retrospektif dengan pengambilan data di Bagian Radiologi RSUP Prof. Dr. R. D. Kandou Manado pada bulan Januari 2015 sampai dengan Agustus 2016. Sampel yaitu data rekam medik pasien yang didiagnosis pneumotoraks secara radiologis sebanyak 41 pasien. Yang tersering ditemukan ialah pasien laki-laki sebanyak 37 orang (90,2%), kelompok usia >50 tahun sebanyak 15 orang (36,6%), lokasi lesi hemitoraks deksra sebanyak 22 kasus (53,7%), serta etiologi pneumotoraks spontan sekunder sebanyak 18 kasus (43,9%). Simpulan: Pada penelitian ini didapatkan pneumotoraks paling banyak pada laki-laki, kelompok usia ≥50 tahun, dengan pneumotoraks spontan sekunder sebagai etiologi tersering. Kata kunci: pneumotoraks, radiologi, foto toraks

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GAMBARAN FOTO TORAKS PADA PENDERITA BATUK KRONIK DI BAGIAN/SMF RADIOLOGI FK UNSRAT/RSUP PROF. DR. R.D. KANDOU MANADO PERIODE JULI – SEPTEMBER 2015

e-CliniC ◽

10.35790/ecl.4.1.2016.10955 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Divertt Tamaweol ◽

Ramli H. Ali ◽

Martin L. Simanjuntak

Keyword(s):

Chronic Cough ◽

Medical Records ◽

Smoking Habit ◽

Radiological Diagnosis ◽

Radiology Department ◽

Common Symptom ◽

Inclusion Criteria ◽

X Ray ◽

X Ray Imaging ◽

Chest X Ray

Abstract: Chronic cough is defined as cough that lasts 8 weeks or more. Chronic cough itself is not a disease, but a symptom of other diseases. Chronic cough is the most common symptom that occurs among outpatients and is the main cause of morbidity which was reported by 3-40% population. Chronic cough can be caused by some diseases such as pneumonia, tuberculosis, asthma, chronic bronchitis, emphysema, and lung fibrosis. Chronic cough is closely associated with smoking habit which is one of the predisposing factors. Chest x-ray is one of the seed examination for chronic cough because it is very helpful in diagnosing diseases especially pulmonary diseases and others that may cause chronic cough. Objective: To identify the chest x-ray imaging in chronic cough patients. Methods: This study using retrospective description data in November 2015. Sample is obtained from all the medical records of patients with radiological diagnosis chronic cough who undertook a chest x-ray examination in the Radiology Department of the Medical Faculty of Sam Ratulangi University / Prof. Dr. R. D. Kandou Central General Hospital Manado during July – September 2015. Data was collected from chest x-ray request form and the results show 178 cases of chronic cough that fit the inclusion criteria. The results showed that there was 178 cases of chronic cough based on the radiological diagnosis. The most frequent cases were chronic cough caused by pulmonary tuberculosis (97 patients; 54.49%). Most patients were male (107 patients; 60.11%), and the most frequent age group was 20-49 years (60 patients; 33.71%). Keywords: chronic cough, chest x-ray Abstrak: Batuk kronik adalah batuk yang berlangsung selama 8 minggu atau lebih. Batuk kronik sendiri bukanlah penyakit, tetapi merupakan suatu gejala dari penyakit-penyakit lain. Batuk kronik merupakan gejala yang paling umum terdapat pada orang dewasa yang melakukan pengobatan rawat jalan dan penyebab utama morbiditas yang dilaporkan oleh 3-40% populasi. Batuk kronik dapat disebabkan oleh beberapa penyakit seperti pneumonia, tuberculosis, asma, bronchitis kronik, emfisema, dan fibrosis paru. Batuk kronik erat hubungannya dengan kebiasaan merokok dimana merokok merupakan salah satu faktor predisposisi. Foto toraks adalah salah satu pemeriksaan pilihan untuk batuk kronik karena sangat bermanfaat dalam mendiagnosis penyakit terutama penyakit paru dan gangguan lain yang dapat menyebabkan batuk kronik. Penelitian ini bertujuan untuk mengetahui gambaran foto toraks pada penderita batuk kronik. Penelitian ini menggunakan metode deskriptif retropektif yang dilakukan pada bulan November 2015. Sampel diambil dari semua data catatan medik pasien dengan diagnosis radiologis batuk kronik yang melakukan foto toraks di Bagian/SMF Radiologi FK Unsrat/RSUP Prof. Dr. R. D. Kandou Manado periode Juli – September 2015. Data diperoleh melalui lembaran permintaan pemeriksaan foto toraks dan didapatkan sebanyak 178 kasus batuk kronik yang masuk dalam kriteria inklusi. Hasil penelitian memperlihatkan 178 kasus batuk kronik berdasarkan diagnosis radiologis. Kasus terbanyak ialah batuk kronik akibat tuberkulosis paru sebanyak 97 orang (54,49%), penderita terbanyak ialah laki-laki yaitu 107 orang (60,11%), dan golongan umur terbanyak ialah 20-49 tahun yaitu 60 penderita (33,71%). Kata kunci: batuk kronik, foto toraks

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COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice

Pneumologie ◽

10.1055/a-1266-6602 ◽

2020 ◽

Author(s):

T. Greulich ◽

V. Töpfer ◽

M. Hennig ◽

C. C. Orehounig ◽

K. Ams ◽

...

Keyword(s):

Medical Records ◽

Eosinophil Count ◽

Initial Diagnosis ◽

Blood Eosinophil ◽

Body Plethysmography ◽

Blood Eosinophil Count ◽

X Ray ◽

Diagnostic Measures ◽

Chest X Ray ◽

Eosinophil Counts

Abstract Background Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists. Methods A questionnaire evaluating doctors’ opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures. Results Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor’s questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients’ medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %. Conclusions In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians’ increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.

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Clinical Course and Disease`s Outcome Aspects of COVID-19 Pediatric Patients in Ibn Al-Khateeb Isolation Hospital

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v17i2.251 ◽

2021 ◽

Vol 17 (2) ◽

pp. 84-90

Author(s):

Abbas Oweid Oleiw ◽

Kholod Dhaher Habib ◽

Kadhim Abed Mohammed ◽

Oday Yassen Abbas ◽

Zainab Ali Jaber

Keyword(s):

Medical Records ◽

Pediatric Patients ◽

Virus Disease ◽

Communicable Disease ◽

Imaging Techniques ◽

Demographic Data ◽

White Blood Cells ◽

Age Group ◽

X Ray ◽

Chest X Ray

Background: Corona virus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, leading to an ongoing pandemic. Aim of study: to review the clinical, lab investigation and imaging techniques, in pediatric age group affected COVID-19 to help medical experts better understand and supply timely diagnosis and treatment. Subjects and methods: this study is a retrospective descriptive clinical study. The medical records of patients were analyzed. Information’s recorded include demographic data, exposure history, symptoms, signs, laboratory findings, chest x- ray, and chest computed tomographic (CT) scans. Data were obtained with data collection forms from paper medical records. Results: there were 76 COVID-19 pediatric patients, 46.1% of those patients were within the age group 6 -10 years. The female to male ratio was 1:1, and 92.1% of them were living within the urbane area. About 60.5% of patients were pupils. Seventy-one (93.4%) patients of them had no comorbidity. Twenty (26.3%) patients were asymptomatic. Regarding the duration of hospital stay, 39(51.31) patients had <7 days. All of the patients were nonsmokers. All patients had recovered and discharged from hospital after 2 negative real technique-polymerase chain reaction (RT-PCR) tests, no death was reported. Only 16(21.1%) patients had severe symptoms. Conclusions: the most common symptoms were fever, Cough, Loss of appetite, Shortness of breath & Fatigue. There was a statistically significant association between white blood cells counts, neutrophil number, Chest X-Ray results, with case severity and a statistically significant association between form of treatment in patients who received Oxygen, Oseltamivir, Azithromycin, Paracetamol, Dexamethasone, and case severity.

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A Residency Professional Identity Curriculum and a Longitudinal Measure of Empathy

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v1i4.1353 ◽

2018 ◽

Vol 1 (4) ◽

Author(s):

William J. Crump ◽

Craig H. Ziegler ◽

R. Steve Fricker

Keyword(s):

Professional Identity ◽

Electronic Medical Records ◽

Medical Records ◽

Reflective Writing ◽

Training Level ◽

Conflicts Of Interests ◽

Longitudinal Measure ◽

Curriculum Intervention ◽

Before And After ◽

Academic Year

BACKGROUND AND OBJECTIVES Empathy measures were used before and after implementation of a structured professional identity curriculum to determine the effect among a group of family medicine residents. METHODS The Jefferson Scale of Empathy was completed by 18 residents at all three years of training before, immediately after a six month professional identity curriculum intervention, and six months after the curriculum was completed. The curriculum included one hour luncheon sessions on concepts of profession, burnout, and cynicism as well as thoughtful use of electronic medical records, prevention and management of burnout, mindfulness techniques and reflective writing and drawing. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interests. RESULTS Similar to previous publications, a decline in empathy across the academic year was found, with a significant decline six months after the end of the curriculum. Residents who attended more sessions showed a non-significant smaller decline, and there were large standard deviations among each training level with some individual residents showing little change across the year. Evaluations of the curriculum were largely positive. CONCLUSIONS This professional identity curriculum in this group of residents may have temporarily mitigated the decline in measured empathy that has been described among residents. Results support some aspects of empathy as a trait in some residents rather than a state that is amenable to a training effect. Further study in this residency including longitudinal empathy measurements and focus groups is ongoing. Other programs’ experience with these issues is needed to add to sample size and diversity of training environments to discern which changes are significant and generalizable.

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