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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Osterwalder J, Tabakovic S, Jenssen C, Dietrich CF, Connolly J, Polyzogopoulou E, Cantisani V, Wüstner M, Jarman B, Hoffmann B. Emergency Point-of-Care Ultrasound Stewardship - A Joint Position Paper by EuSEM and EFSUMB and Endorsed by IFEM and WFUMB. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:379-388. [PMID: 36996862 DOI: 10.1055/a-2041-3302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.
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Affiliation(s)
| | | | - Christian Jenssen
- Department of Internal Medicine, Hospital Märkisch Oderland Strausberg/ Wirzen, Wriezen, Germany
| | - Christoph F Dietrich
- Department of Internal Medicine, Clinics Hirslanden Beau Site, Salem and Permanence, Bern, Switzerland
| | - Jim Connolly
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | | | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Matthias Wüstner
- Department of Central Interdisciplinary Sonography, Bruederkrankenhaus, Trier, Germany
| | - Bob Jarman
- RVI's Great North Trauma and Emergency Centre, Royal Victoria Infirmary, St. Gallen, Seychelles
| | - Beatrice Hoffmann
- Emergency Department, Harvard Medical School Department of Emergency Medicine Beth Israel Deaconess Medical Center, Boston, United States
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Lo H, Eder N, Boten D, Jenssen C, Nuernberg D. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8:E68-E76. [PMID: 36937375 PMCID: PMC10023243 DOI: 10.1055/a-1999-7834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 03/19/2023] Open
Abstract
Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.
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Affiliation(s)
- Hendra Lo
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine – Gastroenterology, Diabetology
and Hepatology, Vivantes Hospital Neukölln, Berlin,
Germany
- Correspondence Mr. Hendra Lo Brandenburg
Medical University Theodor Fontane, Institute for Clinical Ultrasound
(BICUS) and Faculty of Health Sciences Brandenburg, Fehrbelliner
Straße 3816816NeuruppinGermany+ 49
3391 3914710
,
| | - Nicole Eder
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - David Boten
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
| | - Christian Jenssen
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - Dieter Nuernberg
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
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