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Amiot F, Delomas T, Laborne FX, Ecolivet T, Macrez R, Benhamed A. Implementation of lung ultrasonography by general practitioners for lower respiratory tract infections: a feasibility study. Scand J Prim Health Care 2024:1-8. [PMID: 38767949 DOI: 10.1080/02813432.2024.2343678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/11/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility of lung ultrasonography (LUS) performed by novice users' general practitioners (GPs) in diagnosing lower respiratory tract infections (LRTIs) in primary health care settings. DESIGN A prospective interventional multicenter study (December 2019-March 2020). SETTINGS AND SUBJECTS Patients aged >3 months, suspected of having LRTI consulting in three different general practices (GPs) (rural, semirural and urban) in France. MAIN OUTCOME MEASURES Feasibility of LUS by GPs was assessed by (1) the proportion of patients where LUS was not performed, (2) technical breakdowns, (3) interpretability of images by GPs, (4) examination duration and (5) patient perception and acceptability. RESULTS A total of 151 patients were recruited, and GPs performed LUS for 111 (73.5%) patients (LUS group). In 99.1% (n = 110) of cases, GPs indicated that they were able to interpret images. The median [IQR] exam duration was 4 [3-5] minutes. LRTI was diagnosed in 70.3% and 60% of patients in the LUS and no-LUS groups, respectively (p = .43). After LUS, GPs changed their diagnosis from 'other' to 'LRTI' in six cases (+5.4%, p < .001), prescribed antibiotics for five patients (+4.5%, p = .164) and complementary chest imaging for 10 patients (+9%, p < .001). Patient stress was reported in 1.8% of cases, 81.7% of patients declared that they better understood the diagnosis, and 82% of patients thought that the GP diagnosis was more reliable after LUS. CONCLUSIONS LUS by GPs using handheld devices is a feasible diagnostic tool in primary health care for LRTI symptoms, demonstrating both effectiveness and positive patient reception. TRIAL REGISTRATION NUMBER Clinicaltrial.gov: NCT04602234, 20/10/2020.
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Affiliation(s)
- Félix Amiot
- Emergency Department-SAMU50, Centre Hospitalier Mémorial Saint-Lô, Saint-Lô, France
| | - Thomas Delomas
- Emergency Department-SAMU50, Centre Hospitalier Mémorial Saint-Lô, Saint-Lô, France
| | | | | | - Richard Macrez
- Normandie University, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain @ Caen-Normandie, Caen, France
- Department of Emergency Medicine, Caen University Hospital, Caen, France
| | - Axel Benhamed
- Emergency Department-SAMU69, Centre Hospitalier Universitaire Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
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Poppleton A, Tsukagoshi S, Vinker S, Heritier F, Frappé P, Dupont F, Sigmund P, Iacob M, Vilaseca J, Ungan M, Aakjær Andersen C, Frese T, Halata D. World Organization of National Colleges, Academies and Academic Associations of General Practitioners and Family Physicians (WONCA) Europe position paper on the use of point-of-care ultrasound (POCUS) in primary care. Prim Health Care Res Dev 2024; 25:e21. [PMID: 38651341 PMCID: PMC11091537 DOI: 10.1017/s1463423624000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/29/2023] [Accepted: 02/17/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
| | | | | | | | - Paul Frappé
- Université Jean Monnet, Saint-Etienne, France
| | | | - Peter Sigmund
- Steirischen Akademie für Allgemeinmedizin, Graz, Austria
| | - Mihai Iacob
- Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Mehmet Ungan
- School of Medicine, Ankara University, Ankara, Turkey
| | | | - Thomas Frese
- University Halle-Wittenberg, Halle (Saale), Germany
- European General Practice Research Network, Halle-Wittenberg, Germany
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Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 2024; 19:803-811. [PMID: 38041765 DOI: 10.1007/s11739-023-03480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI - 2.7 to - 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI - 1.8 to - 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI - 1.7 to - 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Claire Couvreur
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Félix Gendebien
- Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium
| | - Laurent Peyskens
- Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Boris Germeau
- Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium
| | | | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
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Gjessing S, Guldberg TL, Risør T, Skals RG, Kristensen JK. Would you like to be a general practitioner? Baseline findings of a longitudinal survey among Danish medical trainees. BMC MEDICAL EDUCATION 2024; 24:111. [PMID: 38317110 PMCID: PMC10845756 DOI: 10.1186/s12909-024-05074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees' who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life. METHODS The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models. RESULTS Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences. CONCLUSION GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.
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Affiliation(s)
- Sofie Gjessing
- Center for General Practice, Aalborg University, Aalborg, Denmark.
| | - Trine Lignell Guldberg
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
| | - Torsten Risør
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Overgaard J, Thilagar BP, Bhuiyan MN. A Clinician's Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice. J Prim Care Community Health 2024; 15:21501319241255576. [PMID: 38773821 PMCID: PMC11113028 DOI: 10.1177/21501319241255576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a valuable clinical tool used at the patient bedside to rapidly assess a wide variety of symptoms and problems which would otherwise take hours or even days. Though it has become the standard of care in Emergency Medicine and is becoming so in hospital internal medicine, less uptake has been appreciated in the outpatient setting despite reported interest from clinicians practicing there. A number of common barriers have been cited to explain this gap in use, which usually include access to equipment, mentorship, and time. In this review we present a proposed framework for clinicians who have an interest in implementing POCUS in their outpatient practice which we hope can mitigate some of these barriers and provide a more streamlined pathway to their desired goals.
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Calderon Martinez E, Diarte E, Othon Martinez D, Rodriguez Reyes L, Aguirre Cano DA, Cantu Navarro C, Ycaza Zurita MG, Arriaga Escamilla D, Choudhari J, Michel G. Point-of-Care Ultrasound for the Diagnosis of Frequent Cardiovascular Diseases: A Review. Cureus 2023; 15:e51032. [PMID: 38264374 PMCID: PMC10805123 DOI: 10.7759/cureus.51032] [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: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Point-of-care ultrasound (POCUS) has emerged as an indispensable diagnostic tool in cardiology, particularly within the emergency department. This narrative synthesis provides a comprehensive exploration of POCUS applications in cardiovascular diseases, elucidating its multifaceted roles and addressing challenges. The review delves into the technical attributes of POCUS, emphasizing its non-invasive nature, radiation-free qualities, and suitability for non-radiologists. It navigates through educational strategies, stressing the importance of structured programs for the seamless integration of POCUS into clinical practice. Highlighting its efficacy, the synthesis discusses POCUS applications in various scenarios such as dyspnea, chest pain, cardiac arrest, aortic dissection, pericardial effusion, and pulmonary embolism. Beyond acute care, the review explores the role of POCUS in outpatient and inpatient settings, focusing on chronic and acute heart failure, valvular heart diseases, and more. Acknowledging operator-dependent challenges and the need for continuous education, the review underscores the transformative potential of POCUS across diverse healthcare settings. This narrative synthesis accentuates POCUS as a valuable and versatile diagnostic tool in cardiology, offering efficiency, safety, and cost-effectiveness. Despite challenges, POCUS stands out as a transformative addition to clinical practices, poised to enhance patient outcomes and reshape the landscape of cardiovascular diagnostics.
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Affiliation(s)
| | - Edna Diarte
- Medicine, Universidad Autónoma de Sinaloa, Culiacán, MEX
| | | | | | | | | | | | | | - Jinal Choudhari
- Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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Motazedian P, Marbach JA, Prosperi-Porta G, Parlow S, Di Santo P, Abdel-Razek O, Jung R, Bradford WB, Tsang M, Hyon M, Pacifici S, Mohanty S, Ramirez FD, Huggins GS, Simard T, Hon S, Hibbert B. Diagnostic accuracy of point-of-care ultrasound with artificial intelligence-assisted assessment of left ventricular ejection fraction. NPJ Digit Med 2023; 6:201. [PMID: 37898711 PMCID: PMC10613290 DOI: 10.1038/s41746-023-00945-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
Focused cardiac ultrasound (FoCUS) is becoming standard practice in a wide spectrum of clinical settings. There is limited data evaluating the real-world use of FoCUS with artificial intelligence (AI). Our objective was to determine the accuracy of FoCUS AI-assisted left ventricular ejection fraction (LVEF) assessment and compare its accuracy between novice and experienced users. In this prospective, multicentre study, participants requiring a transthoracic echocardiogram (TTE) were recruited to have a FoCUS done by a novice or experienced user. The AI-assisted device calculated LVEF at the bedside, which was subsequently compared to TTE. 449 participants were enrolled with 424 studies included in the final analysis. The overall intraclass coefficient was 0.904, and 0.921 in the novice (n = 208) and 0.845 in the experienced (n = 216) cohorts. There was a significant bias of 0.73% towards TTE (p = 0.005) with a level of agreement of 11.2%. Categorical grading of LVEF severity had excellent agreement to TTE (weighted kappa = 0.83). The area under the curve (AUC) was 0.98 for identifying an abnormal LVEF (<50%) with a sensitivity of 92.8%, specificity of 92.3%, negative predictive value (NPV) of 0.97 and a positive predictive value (PPV) of 0.83. In identifying severe dysfunction (<30%) the AUC was 0.99 with a sensitivity of 78.1%, specificity of 98.0%, NPV of 0.98 and PPV of 0.76. Here we report that FoCUS AI-assisted LVEF assessments provide highly reproducible LVEF estimations in comparison to formal TTE. This finding was consistent among senior and novice echocardiographers suggesting applicability in a variety of clinical settings.
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Affiliation(s)
- Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, OR, USA
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Richard Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William B Bradford
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Miranda Tsang
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hyon
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Stefano Pacifici
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Sharanya Mohanty
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gordon S Huggins
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Hon
- Division of Pulmonary and Critical Care Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Andersen CA, Brodersen JB, Graumann O, Davidsen AS, Jensen MB. Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics. BMJ Open 2023; 13:e077702. [PMID: 37848298 PMCID: PMC10582891 DOI: 10.1136/bmjopen-2023-077702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs' concerns related to POCUS use in general practice. DESIGN An online survey was distributed in June 2019. SETTING General practice. PARTICIPANTS GPs working in office-based primary care clinics in Denmark. MAIN OUTCOME MEASURES The questionnaire was developed using mixed methods and included questions about participants' characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs' background characteristics and POCUS use was tested using logistics regression. RESULTS Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future. CONCLUSION Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs' capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.
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Affiliation(s)
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Region Zealand, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette Sofie Davidsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Kornelsen J, Ho H, Robinson V, Frenkel O. Rural family physician use of point-of-care ultrasonography: experiences of primary care providers in British Columbia, Canada. BMC PRIMARY CARE 2023; 24:183. [PMID: 37684568 PMCID: PMC10486031 DOI: 10.1186/s12875-023-02128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In British Columbia (BC), rural and remote areas lack proximal access to radiographic services. Poor access to radiographic services in rural settings presents a challenge to timely diagnosis and screening across many disease states and healthy pregnancies. As a solution to the lack of access to radiographic services in rural settings, the Rural Coordination Centre of BC (RCCbc) supported rural Family Physicians (FPs) wishing to use PoCUS through the Intelligent Network for PoCUS (IN PoCUS) program. This study evaluates FPs' experience and use of PoCUS in their clinical practice. METHODS This qualitative study conducted in-depth virtual interviews with 21 FPs across rural BC. The interview asked participants' motivation to participate in the RCCbc program, the type of training they received, their current use of PoCUS, their experience with the technology, and their experience interacting with specialists in regional centres. Thematic analysis of findings was undertaken. RESULTS This study used Rogers' framework on the five elements of diffusion of innovation to understand the factors that impede and enable the adoption of PoCUS in rural practice. Rural FPs in this study differentiated PoCUS from formal imaging done by specialists. The adoption of PoCUS was viewed as an extension of physical exams and was compatible with their values of providing generalist care. This study found that the use of PoCUS provided additional information that led to better clinical decision-making for triage and allowed FPs to determine the urgency for patient referral and transport to tertiary hospitals. FPs also reported an increase in job satisfaction with PoCUS use. Some barriers to using PoCUS included the time needed to be acquainted with the technology and learning how to integrate it into their clinical flow in a seamless manner. CONCLUSION This study has demonstrated the importance of PoCUS in improving patient care and facilitating timely diagnosis and treatment. As the use of PoCUS among FPs is relatively new in Canada, larger infrastructure support such as improving billing structures, long-term subsidies, educational opportunities, and a quality improvement framework is needed to support the use of PoCUS among rural FPs.
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Affiliation(s)
- Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Hilary Ho
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Virginia Robinson
- Rural Coordination Centre of British Columbia, 1665 West Broadway, Vancouver, BC, V6J 1X1, Canada
| | - Oron Frenkel
- Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Patrick DP, Bradley XG, Wolek C, Anderson B, Grady J, Herbst MK. Minutes matter: Time it takes to perform point-of-care ultrasound. AEM EDUCATION AND TRAINING 2023; 7:e10901. [PMID: 37600853 PMCID: PMC10436032 DOI: 10.1002/aet2.10901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
Background While point-of-care ultrasound (PoCUS) is a safe, versatile tool that can improve patient care, the perceived time investment needed to incorporate PoCUS into clinical care is cited as a barrier to performance. We sought to determine the time it takes to perform a PoCUS examination and whether this time was influenced by training level and prior ultrasound experience. Methods This was a retrospective study looking at time stamps of all emergency medicine (EM) provider-performed PoCUS examinations during clinical shifts from August 10, 2019, to June 7, 2022, at a suburban academic emergency department that is the site for a 3-year EM residency. Our workflow is order-based; when PoCUS is ordered, that patient's information populates the ultrasound machine worklist. Selecting the patient's name from the worklist generates a time-stamped patient information page (PIP). We defined the PIP time stamp as the start of the PoCUS examination. The duration of one PoCUS examination was defined as the time of the last image acquired minus the time of the PIP. General estimating equations were used to estimate differences between training level and between prior scan status using an exchangeable correlation and Tukey adjusted pairwise comparisons. A two-tailed chi-square analysis was used for comparing accuracy according to training level. Results Of 4187 PoCUS examinations abstracted, 2144 met study criteria. The median (IQR) time spent per examination was 6.0 (3-9) min. First-year residents took the longest to perform PoCUS among all providers (p < 0.0001). Residents with fewer than 250 prior scans took longer than residents with 501-800 (p = 0.0002) and >800 (p = 0.0013). Resident accuracy was not significantly different according to training level. Conclusions Overall median time to perform PoCUS was 6.0 min. EM residents became more efficient in performing PoCUS as they advanced from first- to third-year, without compromising accuracy.
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Affiliation(s)
| | - Xenia Gia Bradley
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Caroline Wolek
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Bowen Anderson
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - James Grady
- Department of Public Health SciencesUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Meghan Kelly Herbst
- Department of Emergency MedicineUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
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Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, Miller D, Feletti F, Wełnicki M, Buda N, Skoczylas A, Pomiecko A, Damjanovic D, Olszewski R, Kirkpatrick AW, Breitkreutz R, Mathis G, Soldati G, Smargiassi A, Inchingolo R, Perrone T. New International Guidelines and Consensus on the Use of Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:309-344. [PMID: 35993596 PMCID: PMC10086956 DOI: 10.1002/jum.16088] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/28/2022] [Accepted: 07/31/2022] [Indexed: 05/02/2023]
Abstract
Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.
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Affiliation(s)
- Libertario Demi
- Department of Information Engineering and Computer ScienceUniversity of TrentoTrentoItaly
| | - Frank Wolfram
- Department of Thoracic and Vascular SurgerySRH Wald‐Klinikum GeraGeraGermany
| | - Catherine Klersy
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and BiostatisticsFondazione IRCCS Policlinico S. MatteoPaviaItaly
| | | | - Marie Muller
- Department of Mechanical and Aerospace EngineeringNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Douglas Miller
- Department of RadiologyMichigan MedicineAnn ArborMichiganUSA
| | - Francesco Feletti
- Department of Diagnostic ImagingUnit of Radiology of the Hospital of Ravenna, Ausl RomagnaRavennaItaly
- Department of Translational Medicine and for RomagnaUniversità Degli Studi di FerraraFerraraItaly
| | - Marcin Wełnicki
- 3rd Department of Internal Medicine and CardiologyMedical University of WarsawWarsawPoland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Disease and GeriatricsMedical University of GdanskGdanskPoland
| | - Agnieszka Skoczylas
- Geriatrics DepartmentNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrzej Pomiecko
- Clinic of Pediatrics, Hematology and OncologyUniversity Clinical CenterGdańskPoland
| | - Domagoj Damjanovic
- Heart Center Freiburg University, Department of Cardiovascular Surgery, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Robert Olszewski
- Department of Gerontology, Public Health and DidacticsNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and SurgeryUniversity of Calgary and the TeleMentored Ultrasound Supported Medical Interventions Research GroupCalgaryCanada
| | - Raoul Breitkreutz
- FOM Hochschule für Oekonomie & Management gGmbHDepartment of Health and SocialEssenGermany
| | - Gebhart Mathis
- Emergency UltrasoundAustrian Society for Ultrasound in Medicine and BiologyViennaAustria
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound UnitValledel Serchio General HospitalLuccaItaly
| | - Andrea Smargiassi
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Riccardo Inchingolo
- Pulmonary Medicine Unit, Department of Medical and Surgical SciencesFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
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12
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Akanuwe JN, Siriwardena AN, Bidaut L, Mitchell P, Bird P, Lasserson D, Apenteng P, Lilford R. Practitioners' views on community implementation of point-of-care ultrasound (POCUS) in the UK: a qualitative interview study. BMC Health Serv Res 2023; 23:84. [PMID: 36698100 PMCID: PMC9876652 DOI: 10.1186/s12913-023-09069-4] [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] [Received: 07/01/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK. METHODS We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12. RESULTS We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals. Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience. CONCLUSIONS POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.
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Affiliation(s)
- Joseph N.A Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Aloysius Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Luc Bidaut
- grid.36511.300000 0004 0420 4262School of Computer Science, College of Science, University of Lincoln, Lincoln, England
| | - Pauline Mitchell
- grid.36511.300000 0004 0420 4262School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Paul Bird
- grid.412563.70000 0004 0376 6589Institute for Translational Medicine Research & Development, University Hospitals Birmingham NHS Foundation Trust, West Midlands Academic Health Science Network, Birmingham, England
| | - Daniel Lasserson
- grid.7372.10000 0000 8809 1613Warwick Medical School, University of Warwick, Coventry, England ,grid.410556.30000 0001 0440 1440Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, England
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13
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Halata D, Zhoř D, Kulec RS. Implementation of Point‑of‑Care ultrasound examination in general practice. VNITRNI LEKARSTVI 2023; 69:237-241. [PMID: 37468291 DOI: 10.36290/vnl.2023.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Point-of-Care ultrasonography (POCUS) is a method defined as a targeted ultrasound examination of patients with acute symptoms or syndromes that can be diagnosed by a healthcare worker at a site. The aim is to answer a specific diagnostic or therapeutic question or to ease the therapeutic procedure. Recently in Europe, there has been an increase in implementing POCUS in many medical fields including primary health care. The Czech Society of General Practice (SVL ČLS JEP) has for several years been watching the use of POCUS in primary care in many European countries. In August 2020, the committee of the Czech Society of General Practice charged the Working Group for ultrasound in primary care to start a project POCUS iGP - POCUS Implementation in General Practice aiming for the implementation of POCUS into daily practice in general medicine. An ultrasound device is required, as well as setting up the education and training courses with follow up courses and a consensual curriculum of skills, securing quality control mechanisms, proving with scientific evidence the reliability of POCUS when provided by GPs and setting up the final rules of competency and payment for performance. The current international trend of patient centred care in primary health settings and increasing competencies of GPs emphasises a need to implement new point of care diagnostic methods. One of which is point of care ultrasonography. Scientific outcomes and published data from primary care and other fields of medicine show that even doctors who do not work in radiology departments are after a relatively short course able to independently provide POCUS examinations with high reliability. Establishment of the Czech Multidisciplinary Task Force Group for standards, education and research in Pointof- Care ultrasound support development of the POCUS implementation.
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14
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Conangla-Ferrin L, Guirado-Vila P, Solanes-Cabús M, Teixidó-Gimeno D, Díez-García L, Pujol-Salud J, Evangelista-Robleda L, Bertran-Culla J, Ortega-Vila Y, Canal-Casals V, Sisó-Almirall A. Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study. Eur J Gen Pract 2022; 28:253-259. [PMID: 36503353 DOI: 10.1080/13814788.2022.2150163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills. OBJECTIVES To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies. METHODS A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan. RESULTS The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice). CONCLUSION Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.
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Affiliation(s)
- Laura Conangla-Ferrin
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Pere Guirado-Vila
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Mònica Solanes-Cabús
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - David Teixidó-Gimeno
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Lorena Díez-García
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Jesus Pujol-Salud
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | | | - Josefa Bertran-Culla
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Yolanda Ortega-Vila
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Vicenç Canal-Casals
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Catalan Society of Family and Community Medicine (CAMFiC), EcoAP Network, Barcelona, Spain
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15
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Andersen CA, Guetterman TC, Fetters MD, Brodersen J, Davidsen AS, Graumann O, Jensen MB. General Practitioners' Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study. Ann Fam Med 2022; 20:211-219. [PMID: 35606122 PMCID: PMC9199035 DOI: 10.1370/afm.2795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Researchers aimed to describe general practitioners' understanding of appropriate ultrasound use, to record actual scanning practices of early adopters in general practice, and to identify differences between attitudes and actual practice via a mixed methods analysis. METHODS This study was part of a larger multistage mixed methods research framework exploring the use of ultrasound in general practice in Denmark. We used an exploratory sequential approach in the data collection with initial qualitative findings from an interview study applied to building a quantitative questionnaire utilized in a cohort study. In addition, we merged the qualitative and quantitative data using joint display analysis to compare and contrast the results from the 2 stages of the study. RESULTS In the interviews, general practitioners described appropriate ultrasound use as point-of-care examinations with a clear purpose and limited to predefined specific conditions within delimited anatomic areas. They stated that general practitioners should receive formalized ultrasound training and be skilled in the examinations they perform. In the cohort study, general practitioners performed ultrasound examinations of anatomic areas with or without a defined clinical suspicion. Some performed ultrasound examinations for which they had no previous training or skills. CONCLUSIONS We found a difference between the ideas about the appropriate uses for ultrasound in general practice and the actual use by early adopters in clinical practice. Our findings suggest a need for evidence-based guidelines to support general practitioners in choosing which examinations to perform and strategies for developing and maintaining scanning competency.
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Affiliation(s)
| | - Timothy C Guetterman
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Mixed Methods Program and Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Copenhagen, Denmark
| | - Annette Sofie Davidsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Graumann
- Department of Radiology, Radiological Research and Innovation Unit, Odense University Hospital, Odense, Denmark
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16
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Andersen CA, Espersen M, Brodersen J, Thomsen JL, Jensen MB, Davidsen AS. Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study. Scand J Prim Health Care 2022; 40:67-77. [PMID: 35166178 PMCID: PMC9090417 DOI: 10.1080/02813432.2022.2036483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). AIM To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. DESIGN AND SETTING Qualitative study conducted in office-based general practice in Denmark. METHODS Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. RESULTS The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. CONCLUSION This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.Key pointsLittle is known about the educational needs of general practitioners striving to achieve ultrasound competences.General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills.Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.
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Affiliation(s)
- Camilla Aakjaer Andersen
- Center for General Practice at Aalborg University, Aalborg, Denmark
- CONTACT Camilla Aakjaer Andersen Center for General Practice at Aalborg University, Fyrkildevej 7, 9220, Aalborg Øst, Denmark
| | - Marie Espersen
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - John Brodersen
- Department of Public Health, Faculty of Health Sciences, Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | | | | | - Annette Sofie Davidsen
- Department of Public Health, Faculty of Health Sciences, Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
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17
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Kiritharan S, Johanson MV, Jensen MB, Thomsen JNL, Andersen CA, Jensen CE. A cost-minimisation analysis of performing point-of-care ultrasonography on patients with vaginal bleeding in early pregnancy in general practice: a decision analytical model. BMC Health Serv Res 2022; 22:55. [PMID: 35016655 PMCID: PMC8753911 DOI: 10.1186/s12913-022-07463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Spotting and light vaginal bleeding are common and usually harmless symptoms in early pregnancy. Still, vaginal bleeding may be the first sign of an abortion and often causes distress to pregnant women and leads to an expectation of an ultrasonography examination of the uterus. As point-of-care ultrasonography (POCUS) is increasingly being integrated into general practice, these patients may be clinically evaluated and managed by general practitioners (GPs). This can potentially reduce referrals of patients from the primary to the secondary healthcare sector resulting in societal cost-savings. The primary purpose of this study was to investigate whether the accessibility of POCUS in general practice for patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice where GPs do not have access to POCUS. A secondary purpose of this study was to estimate a remuneration for GPs performing POCUS on these patients in general practice. METHODS A cost-minimisation analysis was based on a decision tree model reflecting the two alternatives: general practice with and without GPs having access to POCUS. The robustness of the model results was investigated using probabilistic sensitivity analysis and the following deterministic sensitivity analyses: one-way analyses for the model input parameters and a scenario analysis with a change from a societal to a healthcare sector perspective. An expected remuneration reflecting the add-on cost of Danish GPs performing POCUS was estimated based on the related costs: cost of an ultrasonography scanner, GP's time consumption, ultrasonography training, and utensils per scanning. RESULTS The difference in average cost between the two alternatives from a societal perspective was estimated to be €110, in favour of general practice with GPs using POCUS. The deterministic sensitivity analyses demonstrated robustness of the results to plausible changes in the input parameters. The expected remuneration for performing POCUS in this specific setting was estimated to be €32 per examination. CONCLUSION Having GPs perform POCUS on patients with vaginal bleeding in early pregnancy is cost-saving compared to usual practice. The results should be taken with caution as this study was based on early modelling with uncertainties associated with the input parameters in the model.
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Affiliation(s)
- Swaathi Kiritharan
- The Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg Øst, Denmark.
| | - Mille Vang Johanson
- The Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg Øst, Denmark
| | - Martin Bach Jensen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 1,3, 9220, Aalborg Øst, Denmark
| | | | - Camilla Aakjær Andersen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 1,3, 9220, Aalborg Øst, Denmark
| | - Cathrine Elgaard Jensen
- Department of Clinical Medicine, Aalborg University, Danish Center for Healthcare Improvements, Fredrik Bajers Vej 5, 176, 9220, Aalborg Øst, Denmark
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18
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Heldeweg MLA, Vermue L, Kant M, Brouwer M, Girbes ARJ, Haaksma ME, Heunks LMA, Mousa A, Smit JM, Smits TW, Paulus F, Ket JCF, Schultz MJ, Tuinman PR. The impact of lung ultrasound on clinical-decision making across departments: a systematic review. Ultrasound J 2022; 14:5. [PMID: 35006383 PMCID: PMC8748548 DOI: 10.1186/s13089-021-00253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background Lung ultrasound has established itself as an accurate diagnostic tool in different clinical settings. However, its effects on clinical-decision making are insufficiently described. This systematic review aims to investigate the impact of lung ultrasound, exclusively or as part of an integrated thoracic ultrasound examination, on clinical-decision making in different departments, especially the emergency department (ED), intensive care unit (ICU), and general ward (GW). Methods This systematic review was registered at PROSPERO (CRD42021242977). PubMed, EMBASE, and Web of Science were searched for original studies reporting changes in clinical-decision making (e.g. diagnosis, management, or therapy) after using lung ultrasound. Inclusion criteria were a recorded change of management (in percentage of cases) and with a clinical presentation to the ED, ICU, or GW. Studies were excluded if examinations were beyond the scope of thoracic ultrasound or to guide procedures. Mean changes with range (%) in clinical-decision making were reported. Methodological data on lung ultrasound were also collected. Study quality was scored using the Newcastle–Ottawa scale. Results A total of 13 studies were included: five studies on the ED (546 patients), five studies on the ICU (504 patients), two studies on the GW (1150 patients), and one study across all three wards (41 patients). Lung ultrasound changed the diagnosis in mean 33% (15–44%) and 44% (34–58%) of patients in the ED and ICU, respectively. Lung ultrasound changed the management in mean 48% (20–80%), 42% (30–68%) and 48% (48–48%) of patients in the ED, in the ICU and in the GW, respectively. Changes in management were non-invasive in 92% and 51% of patients in the ED and ICU, respectively. Lung ultrasound methodology was heterogeneous across studies. Risk of bias was moderate to high in all studies. Conclusions Lung ultrasound, exclusively or as a part of thoracic ultrasound, has substantial impact on clinical-decision making by changing diagnosis and management in the EDs, ICUs, and GWs. The current evidence level and methodological heterogeneity underline the necessity for well-designed trials and standardization of methodology. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00253-3.
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Affiliation(s)
- Micah L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands. .,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.
| | - Lian Vermue
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Max Kant
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Michelle Brouwer
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Amne Mousa
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Jasper M Smit
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
| | - Thomas W Smits
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Johannes C F Ket
- Medical Library, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pieter Roel Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, location VUmc, Postbox 7507, 1007MB, Amsterdam, The Netherlands.,Amsterdam Leiden IC Echography (ALIFE), Amsterdam, The Netherlands
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19
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Declerck C, Mahieu R, Sanderink D, de la Chapelle M, Abgueguen P, Vandamme YM, Dubée V. Implementation of point-of-care ultrasonography in an infectious disease ward. Infect Dis Now 2021; 52:87-92. [PMID: 34896661 DOI: 10.1016/j.idnow.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) has emerged as an essential supplement to physical examination in many specialties. In contrast, its use by infectious diseases (ID) specialists remains anecdotal. Here, we report on the acquisition of an ultrasonography device in a French ID ward, and we describe its everyday use. METHODS A preliminary audit was conducted to evaluate the potential impact of the acquisition of an ultrasonography device. A second audit was performed during the first year following the acquisition of the device to quantify its everyday use. We also evaluated the impact of POCUS implementation on medical imaging requests by comparing the number of intra-hospital transports before and after the acquisition. RESULTS According to the first audit, 81 of the 199 (41%) imaging examinations that were prescribed during a two-month period could have been replaced by POCUS. During the first year following the acquisition of the ultrasonography device, POCUS was performed 240 times by 31 different operators. The operators were a senior physician, an intern, and a medical student in 94 (39%), 135 (57%), and 11 (5%) cases, respectively. The organs most frequently explored were the genito-urinary tract (n=74), the joints (n=35), and the lungs/pleura (n=35). Acquisition of the device was followed by a significant decrease in the number of transports to the ultrasonography room, whereas the total number of transports to the medical imaging ward did not change. CONCLUSION Opportunities to use POCUS in the ID ward are numerous. POCUS training should be part of the ID specialist's curriculum.
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Affiliation(s)
- C Declerck
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France.
| | - R Mahieu
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - D Sanderink
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - M de la Chapelle
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - P Abgueguen
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - Y M Vandamme
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - V Dubée
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
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20
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Varrias D, Palaiodimos L, Balasubramanian P, Barrera CA, Nauka P, Melainis AA, Zamora C, Zavras P, Napolitano M, Gulani P, Ntaios G, Faillace RT, Galen B. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med 2021; 10:3903. [PMID: 34501350 PMCID: PMC8432124 DOI: 10.3390/jcm10173903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Prasanth Balasubramanian
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian A Barrera
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Peter Nauka
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Angelos Arfaras Melainis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian Zamora
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Phaedon Zavras
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Marzio Napolitano
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Perminder Gulani
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - George Ntaios
- Department of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Benjamin Galen
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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21
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Ienghong K, Suzuki T, Tiamkao S, Gaysonsiri D, Bhudhisawasdi V, Apiratwarakul K. Point of Care Ultrasound Use by Interns in Emergency Department. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Point of care ultrasound (POCUS) is required for use in many instances on a daily basis in the hospital, especially in the emergency department and other specialty treatment areas. While interns play a crucial role in running emergency services in Thailand, the POCUS usage of interns has not been well studied.
METHODS: This was a retrospective observational study of the interns who worked at the Department of Emergency Medicine, a tertiary university hospital in Khon Kaen, Thailand between July 2020 and April 2021. The seven questions survey about participants’ experiences performing POCUS examinations was conceived and carried out by the research team. The primary aim of this study is to identify the frequency of POCUS examinations performed by interns in this or any other given rotation.
RESULTS: The response rate was 81.25% with the frequency of POCUS examinations per physician coming in at 2.5 per shift. It should be noted that examinations occurred primarily during the morning shift (79%) and were for diagnostic purposes (100%). The highest POCUS use cases (80%) were found to take place for abdominal examinations and the most commonly used POCUS application was the FAST (Focused Assessment with Sonography for Trauma) examination (92%). The confidence level was rated as 3/5. The primary barrier to performing POCUS was lack of knowledge or ultrasound training (47%).
CONCLUSIONS: POCUS is often used by interns though less than in some other specialties. The type of POCUS application employed was limited due to lack of training and the primary obstacle for POCUS use in the emergency department was patient overcrowding.
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Andersen CA, Brodersen J, Rudbæk TR, Jensen MB. Patients' experiences of the use of point-of-care ultrasound in general practice - a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:116. [PMID: 34144701 PMCID: PMC8214303 DOI: 10.1186/s12875-021-01459-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/10/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of point-of-care ultrasonography (POCUS) performed by general practitioners (GPs) in primary care settings is increasing. Previous studies have focused on GP-reported outcomes and little is known about patients' perspectives on the use of POCUS technology within the general practice consultation. The purpose of this study was to examine patients' experiences with POCUS in general practice within the areas where GPs have indicated that POCUS affected aspects of the consultation. METHODS A questionnaire was developed using a mixed methods sequential design. Analytical themes from interviews with GPs were converted into items in a questionnaire by the research team. The questionnaire was then further developed in several rounds of pilot tests involving both patients and GPs. The final questionnaire was used in a cohort study conducted in 18 Danish office-based general practice clinics from January 2018 to August 2018. All patients examined with POCUS were asked to complete the questionnaire on tablets immediately after their consultation. RESULTS Out of 691 patients examined, 564 (81.6%) questionnaires were available for analysis. The patients reported that they were well informed about the purpose (98%) and the results (97%) of the POCUS examination; however, 29% reported that they were not informed about the difference between POCUS and an imaging-specialist's ultrasound examination. Almost all patients (99%) reported that POCUS was integrated naturally into the consultation, and 45% reported that POCUS improved the doctor-patient relationship. The majority of patients felt that they had been more thoroughly examined (92%) and taken more seriously (58%) when POCUS was part of the consultation. They felt POCUS gave them a better understanding of their health problem (82%), made them feel more secure (86%) and increased their trust in the physician's assessment (65%). Moreover, the patients reported that POCUS use improved the level of service (95%) they experienced and the quality of care (94%) in general practice. CONCLUSION We found that an examination including POCUS in general practice was a positive experience overall for the majority of patients. Future research should further explore reasons for patient confidence in POCUS and whether or not the reassuring value of POCUS is valid. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03416608.
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Affiliation(s)
- Camilla Aakjær Andersen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark.
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, P. O. Box 2099, DK-1014, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | | | - Martin Bach Jensen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark
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23
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Cameron E, Istrail L. Diagnosing Early Cardiac Tamponade in Patient with JAK2+ Myeloproliferative Syndrome with Point of Care Ultrasound. POCUS JOURNAL 2021; 6:13-15. [PMID: 36895498 PMCID: PMC9979924 DOI: 10.24908/pocus.v6i1.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Point of care ultrasound (POCUS) is a diagnostic modality growing in popularity and use in medicine in both the acute and chronic management settings. Its utility lies in its non-invasive application, direct user interface, and portability, especially in handheld devices, allowing for quick assessment and triage. Herein is a case of POCUS diagnosing life threatening cardiac tamponade in a patient with a new diagnosis of JAK2+ myeloproliferative syndrome prompting urgent intervention with pericardiocentesis. This case illustrates the utility of POCUS through its ability to serve as a quick diagnostic tool that can hasten intervention for potentially life-threatening conditions.
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Affiliation(s)
- Evan Cameron
- Department of Medicine, Inova Fairfax Medical Campus Falls Church, Virginia
| | - Lawrence Istrail
- Department of Medicine, Inova Fairfax Medical Campus Falls Church, Virginia
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