scholarly journals The Evaluation Point-of-Care Ultrasound in the Post-Anesthesia Unit–A Multicenter Prospective Observational Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2389
Author(s):  
Davinder Ramsingh ◽  
Sumit Singh ◽  
Cecilia Canales ◽  
Elyse Guran ◽  
Zach Taylor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Acute Care ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Arterial Blood ◽  
Evaluation Point ◽  
Significant Difference ◽  
The Impact

Introduction: Point-of-care ultrasound (POCUS) is the most rapidly growing imaging modality for acute care. Despite increased use, there is still wide variability and less evidence regarding its clinical utility for the perioperative setting compared to other acute care settings. This study sought to demonstrate the impact of POCUS examinations for acute hypoxia and hypotension occurring in the post-anesthesia care unit (PACU) versus traditional bedside examinations. Methods: This study was designed as a multi-center prospective observational study. Adult patients who experienced a reduced mean arterial blood pressure (MAP < 60mmHG) and/or a reduced oxygen saturation (SpO2 < 88%) in the PACU from 7AM to 4PM were targeted. POCUS was available or not for patient assessment based on PACU team training. All providers who performed POCUS exams received standardized training on cardiac and pulmonary POCUS. All POCUS exam findings were recorded on a standardized form and the number of suspected mechanisms to trigger the acute event were captured before and after the POCUS exam. PACU length of stay (minutes) across groups was the primary outcome. Results: In total, 128 patients were included in the study, with 92 patients receiving a POCUS exam. Comparison of PACU time between the POCUS group (median = 96.5 min) and no-POCUS groups (median = 120.5 min) demonstrated a reduction for the POCUS group, p = 0.019. Hospital length of stay and 30-day hospital readmission did not show a significant difference between groups. Finally, there was a reduction in the number of suspected diagnoses from before to after the POCUS examination for both pulmonary and cardiac exams, p-values < 0.001. Conclusions: Implementation of POCUS for assessment of acute hypotension and hypoxia in the PACU setting is associated with a reduced PACU length of stay and a reduction in suspected number of diagnoses.

scholarly journals Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study

Anaesthesia ◽  
2017 ◽  
Vol 73 (1) ◽  
pp. 15-22 ◽  
Author(s):  
L. Zieleskiewicz ◽  
A. Noel ◽  
G. Duclos ◽  
M. Haddam ◽  
A. Delmas ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Spinal Hypotension

scholarly journals Editorial Volume 19 Issue 1 – “Eternal Winter”: Acute Medicine the key to providing longer periods of summer

2020 ◽  
Vol 19 (1) ◽  
pp. 2-3
Author(s):  
Tim Cooksley ◽  
Keyword(s):  
Respiratory Rate ◽  
Ambulatory Care ◽  
Acute Care ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Point Of Care Testing ◽  
Acute Medicine ◽  
Care Services ◽  
Acute Care Services ◽  
The Impact

As another winter season passes, many colleagues will continue to be working under immense pressures striving to provide high quality care for increasingly larger numbers of patients. The work of Acute Medicine teams to keep the “front door” safe are fundamental to the delivery and sustainability of acute care services. The challenges of innovating and enacting positive changes at times of such high service demand are not insignificant; but the specialty is blessed with rapidly expanding driven and dedicated international, national and local leaders. The first winter SAMBA has recently been performed. SAMBA is an increasingly rich data source that will serve both nationally and locally to help improve performance and ultimately patient outcomes.1 Higher quality Acute Medicine is being produced. Acute Physicians are leading in many acute sub-specialties. Pleasingly, there has a been a significant rise in the number of trainees applying to train in Acute Medicine in the UK reflecting the traction the specialty is achieving. Ambulatory care remains a fundamental tenet to the sustainability of acute care services. Point of care testing is a key element in driving efficient performance in this setting and in this issue Verbakel et al. perform an important analysis on the reliability of point of care testing to support community based ambulatory care.2 This work should field the way for further research defining the impact of point of care testing and how it should be implemented in ambulatory clinical practice. The performance of respiratory rate observation remains poorly performed in acute care settings despite its well validated predictive value. Nakitende et al. describe an app that allows respiratory rate to calculated more quickly and accurately by using a touch screen method.3 Technological innovations to improve the recording and accuracy of physiological parameters in acute care, which can also be used in resource poor settings, will be a focus of large quantities of research in the upcoming years. Blessing et al. describe an important modelling study on the impact of integrated radiology units.4 Co-ordination between Acute Medicine and Radiology departments is essential in a high functioning AMU, especially as increasingly Acute Physicians are trained in point of care ultrasound. Lees-Deutsch et al. provide a fascinating insight into the patient’s perspective of discharge lounges.5 Often used to help maintain flow through the hospital, they elucidate that patients and caregivers transferred from AMU do not find this aspect of their journey a positive one. In times of significant organisational pressures, it is important that clinicians continue to examine the impact of flow measures on the quality of patient care and experience.

Point-of-care ultrasound augments physical examination learning by undergraduate medical students

2020 ◽  
Vol 97 (1143) ◽  
pp. 10-15
Author(s):  
Chun Ka Wong ◽  
JoJo Hai ◽  
Kwong Yue Eric Chan ◽  
Ka Chun Un ◽  
Mi Zhou ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Medical Curriculum ◽  
Instant Messaging ◽  
Point Of Care ◽  
Group Discussion ◽  
Point Of Care Ultrasound ◽  
Undergraduate Medical Students ◽  
Significant Difference ◽  
The Impact

BackgroundLittle is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students.MethodsWe describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination.Results210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203).ConclusionThe POCUS programme that included provision of a personal handheld POCUS device improved students’ attitude, confidence and ability to perform a physical examination.

Prospective observational study for the impact of short-term periodic intravenous steroid premedication for gastrointestinal cancer chemotherapy on bone metabolism.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 523-523
Author(s):  
Atsushi Ishiguro ◽  
Michio Nakamura ◽  
Tetsuhito Muranaka ◽  
Satoshi Yuki ◽  
Taichi Murai ◽  
...  
Keyword(s):  
Observational Study ◽  
Bone Turnover ◽  
Bone Metabolism ◽  
Gastrointestinal Cancer ◽  
Prospective Observational Study ◽  
Type I Collagen ◽  
Reduction Rate ◽  
Type I ◽  
Significant Difference ◽  
The Impact

523 Background: Although intravenous glucocorticoid (GC) premedication (GCP) before chemotherapy (CTx) are frequently used to prevent nausea and vomiting for continuing comfortable CTx, the side effects of intermittent GCs on bone health have not yet been reported. So we designed a multicenter, prospective, observational study to evaluate the impact of periodic GCP on bone metabolism in gastrointestinal cancer (GIC) patients (pts). Methods: The eligibility criteria were as the follows: (i) histologically proven GIC. ; (ii) The duration of periodical GCP is weekly, biweekly, and triweekly. More over 4 weeks GC free intervals is not permissible. ; (iii) age over 20. The primary endpoint was to investigate the variations of bone mineral densities (BMD) at lumbar spine measured by dual energy x-ray absorptiometry (DEXA) and bone turnover biomarkers, cross-linked N-telopeptide of type I collagen (NTX) and bone alkaline phosphatase (BAP), between baseline (BL) and 16 weeks after starting CTx (16w). Results: From June 2013 to April 2015, 98 pts were enrolled. Two pts were not proven as GIC histologically. One patient (pt) was not measured on baseline DEXA. One pt was taken bisphosphonates already on BL point. Four pts were not administered CTx or GCP, and 16 pts were not measured BMD on 16w due to several reasons such as pts refusal, discontinuation of CTx, death and so on (74 pts were full analysis set). In 55 pts (74.3 % of FAS), the levels of BMD at 16w were decreased compared with BL and the average amount of BMD reduction rate was 5.83 % (-38.8 % to 31.1 %). Although no significant difference was found in the level of NTX between BL and 16w (p = 0.118), there was the significant increase of BAP level statistically (p = 0.006). There were also significant correlations between percent change in BMD and NTX, BMD and BAP, NTX and BAP (p = 0.037, 0.029, and 0.003, respectively). Conclusions: We found that periodic GCP in GIC pts caused the reduction of BMD and some influences for bone turnover. These results indicate that GCP might generate more serious osteoporosis of GIC pts during CTx. Further studies are necessary to illustrate the need to prevent GC induced osteoporosis in using GCP. Clinical trial information: 000011054.

scholarly journals A Consult Is Just a Page Away: A Prospective Observational Study on the Impact of Jinxing on Call Karma in Neurosurgery

2017 ◽  
Vol 44 (4) ◽  
pp. 420-423
Author(s):  
Holger Joswig ◽  
Lauren Zarnett ◽  
David A. Steven ◽  
Martin N. Stienen
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Study Groups ◽  
Numeric Rating Scale ◽  
Personal Beliefs ◽  
Significant Difference ◽  
Level Of Experience ◽  
The Impact ◽  
Numeric Rating

AbstractObjective: Our aim was to assess the impact of jinxing on “call karma” in neurosurgery. Methods: We conducted a prospective observational study on 15 residents on call for the neurosurgery service, recording the total number of admissions, consults, deaths encountered, surgeries performed, hours of sleep and subjective call rating on a numeric rating scale (NRS) of 0-10 in terms of general awfulness. Results: Some 204 on-call nightshifts were analyzed, of which 61 (29.9%) were jinxed and 143 (70.1%) were nonjinxed. Jinxes seemed to occur in clusters. The baseline parameters (experience, type of call coverage and superstition level) of the study groups were well balanced. A trend toward more surgeries was observed during jinxed nights, where residents slept significantly less (mean 147.8±96.2 vs. 180.9±106.1 min, p=0.037) and rated their on-call experience worse on the NRS (4.4±2.2 vs. 3.5±2.0, p=0.011), while there was no significant difference in number of admissions, consults or deaths. Conclusions: The act of jinxing ought to be avoided in the neurosurgical setting, as it might be potentially harmful to resident call karma, irrespective of level of experience, resources and personal beliefs.

scholarly journals Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study

2015 ◽  
Vol 41 (9) ◽  
pp. 1638-1647 ◽  
Author(s):  
Laurent Zieleskiewicz ◽  
Laurent Muller ◽  
Karim Lakhal ◽  
Zoe Meresse ◽  
Charlotte Arbelot ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Intensive Care Units ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound
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