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Calvo Cebrián A, Alonso Roca R, Sánchez Barrancos IM. Diagnostic Accuracy of Abdominal Point of Care Ultrasound in Primary Care: Study Design and Protocol. POCUS JOURNAL 2024; 9:63-70. [PMID: 38681170 PMCID: PMC11044929 DOI: 10.24908/pocus.v9i1.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.
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Affiliation(s)
| | - Rafael Alonso Roca
- Mar Báltico Primary Care Health-Center. Madrid Health ServiceMadridSpain
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Larsen KL, Kavaliunaite E, Rasmussen LM, Hallas J, Diederichsen A, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Lambrechtsen J, Egstrup K, Lindholt JS. The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies. BMC Cardiovasc Disord 2023; 23:139. [PMID: 36927295 PMCID: PMC10022183 DOI: 10.1186/s12872-023-03160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years. METHODS A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded. RESULTS In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999. CONCLUSION Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population. TRIAL REGISTRATION DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.
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Affiliation(s)
- Katrine Lawaetz Larsen
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.7143.10000 0004 0512 5013The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Egle Kavaliunaite
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jesper Hallas
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.10825.3e0000 0001 0728 0170Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Axel Diederichsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Flemming Hald Steffensen
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Martin Busk
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Jes Sanddal Lindholt
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
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Alfuraih AM, Alqarni MA, Alhuthaili HS, Mubaraki MY, Alotaibi NN, Almusalim FM. Reproducibility and feasibility of a handheld ultrasound device compared to a standard ultrasound machine in muscle thickness measurements. Australas J Ultrasound Med 2023; 26:13-20. [PMID: 36960135 PMCID: PMC10030094 DOI: 10.1002/ajum.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To test the feasibility and reproducibility of a handheld ultrasound device (HUD) compared to a standard ultrasound machine for muscle thickness measurements in healthy participants. Methods A prospective cross-sectional study was designed where two novice operators tested the thickness of the vastus lateralis, rectus femoris, and vastus intermedius muscles on recruited asymptomatic participants with no history of muscle diseases. The anterior-posterior thickness of each muscle was measured three times per operator to evaluate intra-operator reproducibility and using two machines to evaluate inter-system reproducibility. Scanning started using the HUD followed by the standard system. Intraclass correlation coefficients (ICC) and simple linear regression were used to test for reproducibility and proportional bias respectively. Results A total of 33 male participants volunteered to take part in this study with a mean age of 22.7 years (6.8). Intra-operator reproducibility was almost perfect for both operators on both machines (ICC > 0.80). The measurements difference percentage between the machines ranged from 1.8% to 6.6% and inter-system reproducibility ICC ranged from 0.815 to 0.927 showing excellent reproducibility. Inter-operator reproducibility was poor to moderate on both machines (ICC: 0.522-0.849). Regression analysis showed no proportional bias in the measurements. All measurements were completed successfully using the HUD. Conclusion The HUD demonstrated excellent accuracy compared to the standard ultrasound machine for measuring thigh muscle thickness.
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Affiliation(s)
- Abdulrahman M. Alfuraih
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
| | - Mohammed A. Alqarni
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
| | - Hamad S. Alhuthaili
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
| | - Meshal Y. Mubaraki
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
| | - Nader N. Alotaibi
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
| | - Fahad M. Almusalim
- Radiology and Medical Imaging DepartmentCollege of Applied Medical Sciences, Prince Sattam bin Abdulaziz UniversityKharjSaudi Arabia
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Normal Infrarenal Aortic Diameter in Men and Women in a Mediterranean Area. Ann Vasc Surg 2023; 92:163-171. [PMID: 36639098 DOI: 10.1016/j.avsg.2022.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Infrarenal aortic diameter (AD) values currently considered normal are based on measurements from epidemiologic studies performed over 20 years ago. Knowledge of expected normal AD is important for understanding the relevance of abdominal aortic dilatation. The aim of this study was to define contemporary reference values for normal infrarenal AD and build a predictive model based on individual features. METHODS A cross-sectional study of participants in a population-based screening program for abdominal aortic aneurysm (AAA) was performed in a healthcare district with 400,000 inhabitants. Men and women aged 65 years were invited to participate. Cardiovascular (CV) risk factors, family history of AAA, personal history of other aneurysms, CV disease, and anthropometric parameters were evaluated. The largest anteroposterior inner-inner diameter of the infrarenal aorta was measured by ultrasound. Multiple linear regressions were used to determine independent predictors of AD. The best-fit model was obtained by randomly selecting 70% of the sample and validating the results in the remaining 30%. RESULTS A total of 4,730 people (2,089 men and 2,641 women) were invited. The participation rate was 50.4% for men and 44.0% for women. Mean AD (standard deviation, SD) was 16.51 (3.2) mm in the overall group, 17.91 (3.51) mm in men, and 15.25 (2.32) mm in women (P < 0.001). Male sex (P < 0.001), body surface area (P < 0.001), smoking habit (P = 0.012), and history of arterial aneurysms (P = 0.013) were independently associated with increased AD. Dyslipidemia was associated with decreased AD (P < 0.001). The findings were used to build a model for predicting AD based on individual characteristics. CONCLUSIONS ADs in our study population are smaller than those described in classic epidemiological studies. Men have a significantly larger diameter than women and the strongest predictor of increased AD is body surface area. A greater understanding of factors associated with AD will help predict expected sizes in individual members of the population.
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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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Olmstead C, Wakabayashi AT, Freeman TR, Cejic SS. Abdominal aortic aneurysm screening in an academic family practice: Short-term impact of guideline changes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:899-904. [PMID: 36515055 PMCID: PMC9796976 DOI: 10.46747/cfp.6812899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate abdominal aortic aneurysm (AAA) screening rates in the 6 months before and after the introduction of updated Canadian Task Force on Preventive Health Care (CTFPHC) guidelines to determine effects on practice patterns, as well as to determine whether certain patient characteristics impact AAA screening rates. DESIGN Retrospective chart review. SETTING Academic family health centre in London, Ont. PARTICIPANTS Male patients between the ages of 65 and 80. MAIN OUTCOME MEASURES Screening rates for AAA before and after the guideline update were compared using the normal approximation of the binomial distribution. Analysis of demographic characteristic effects on screening rates was completed with the Fisher exact test. Number of visits to the clinic with a primary care provider within the study period and imaging type were collected. RESULTS Of the 266 patients included in the study, 160 patients were eligible for screening at the start of the study period, 6 months before publication of the CTFPHC AAA guideline. Individuals eligible for screening visited the clinic an average (SD) of 2.44 (1.82) times in the 6 months before and 2.66 (1.99) times in the 6 months after. Overall, 69 individuals had AAA screening completed and 9 had a discussion of AAA screening without any imaging, for a total uptake rate of 88.5% for those who had screening recommended. The overall imaging rate was 48.9%. There was no statistically significant difference in screening rates between the time periods (P=.337) among those eligible for screening. For demographic characteristics for risk stratification, 7 individuals had a documented family history, of whom 5 had imaging of their abdominal aorta performed, plus 1 additional individual who had screening recommended but not completed. This was not statistically significant relative to the total population (P=.0598). Positive smoking status (active or ex-smoker) was more common, with 135 individuals having a relevant smoking history. Approximately half of these current and former smokers (68 individuals [50.4%]) had any sort of abdominal aortic imaging performed or recommended, which was not statistically significantly different compared with non-smokers (62 of 126 imaging performed or recommended, 49.2%; P=.9016). CONCLUSION Screening practices did not change appreciably with the introduction of the CTFPHC AAA screening guidelines. Further research is needed to improve AAA screening rates. It is worth exploring electronic medical record-based reminders, nursing staff involvement in screening, screening programs via public health, and point-of-care ultrasound screening in a primary care setting.
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Affiliation(s)
- Craig Olmstead
- Adjunct Professor in the Department of Family Medicine at Western University in London, Ont.,Correspondence Dr Craig Olmstead; e-mail
| | | | - Thomas R Freeman
- Professor Emeritus in the Centre for Studies in Family Medicine in the Department of Family Medicine at Western University
| | - Sonny S Cejic
- Associate Professor in the Department of Family Medicine at Western University
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Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12092052. [PMID: 36140454 PMCID: PMC9497677 DOI: 10.3390/diagnostics12092052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Point-of-Care ultrasound (POCUS) is based on target ultrasound that is performed wherever a patient is being treated, and by a non-radiologist directly involved in the patient’s care. It is used either for quick diagnosis or procedural guidance. Abdominal pain is one of the most common complaints in emergency departments, and POCUS can help in the differentiation of patients who need additional diagnostic tests or hospital treatment, which eventually reduces the overall costs of health care. POCUS has high sensitivity and specificity in abdominal pathology, it can be helpful in the evaluation of biliary, intestinal, and urinary tract, and it is especially used in trauma. Additionally, the gold standard for abdominal aortic aneurysm detection, follow up and screening is precisely this diagnostic procedure. Unfortunately, the quality of ultrasound examination can be affected by the experience of the physician performing it and the patient’s body weight. There is no doubt that POCUS is being increasingly recognized, but all motivated physicians should be provided with dedicated tutors and enough time for learning. This would certainly help to implement this diagnostic method as a routine in emergency and critical care departments, and significantly shorten the time until definitive diagnosis.
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Andersen CA, Hedegård HS, Løkkegaard T, Frølund J, Jensen MB. Education of general practitioners in the use of point-of-care ultrasonography: a systematic review. Fam Pract 2021; 38:484-494. [PMID: 33367766 DOI: 10.1093/fampra/cmaa140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To systematically review and synthesize the published literature regarding the education of general practitioners (GPs) and GPs in training (GPTs) in the use of ultrasonography. DESIGN This systematic review was prospectively registered in PROSPERO, conducted according to the Cochrane recommendations. We combined studies identified in a previous systematic review with studies from an updated literature search using the same search string. We searched the following databases: MEDLINE via Pubmed, EMBASE via OVID, Cinahl via Ebsco, Web of Science and Cochrane Register of Controlled Trials using the words 'ultrasonography' and 'general practice'. Two reviewers independently screened articles, extracted data and assessed the quality of included papers according to the Down and Black quality assessment tool. Disagreements were resolved by involving a third reviewer. RESULTS Thirty-three papers were included. Ultrasound training was described to include both theoretical and practical training sessions. Theoretical training was achieved through introductory e-learning and/or didactic lectures. Practical training included focussed hands-on training sessions, while some papers described additional longitudinal practical training through proctored scans during clinical work or through self-study practice with continuous feedback on recorded scans. CONCLUSION There was a large variation in ultrasound training programs for GPs and GPTs, with an overall emphasis on focussed practical training. Few studies included a longitudinal learning process in the training program. However, diagnostic accuracy seemed to improve with hours of practical training, and studies including continuous feedback on scans conducted during clinical patient encounters showed superior results.
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Affiliation(s)
| | | | | | - Joachim Frølund
- Center for Health Sciences Education, Aarhus University, Aarhus, Denmark
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Abstract
Point-of-care ultrasound (POCUS) is currently implemented in various medical fields by clinicians for the bedside examination of patients. Evidence supports the fact that adding an ultrasound technology in daily practice (hand-held ultrasound device), called by some 'stethoscope of the future', improves patient care and allows an earlier diagnosis in a hospital setting. In this article, we reviewed the historical evolution of the use of ultrasound in medicine and the possibilities of using POCUS for hospitalists and general internists based on the existing scientific literature.
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Affiliation(s)
- Xavier Vandemergel
- Department of Internal Medicine, Epicura Baudour, Saint-Ghislain, Belgium
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Fite J, Gayarre-Aguado R, Puig T, Zamora S, Escudero JR, Solà Roca J, Bellmunt-Montoya S. Feasibility and Efficiency Study of a Population-Based Abdominal Aortic Aneurysm Screening Program in Men and Women in Spain. Ann Vasc Surg 2020; 73:429-437. [PMID: 33387620 DOI: 10.1016/j.avsg.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program for AAA, so the aim of our study was to perform a pilot population screening program in our area to assess feasibility and efficiency of an AAA screening program for men and women. METHODS A population AAA screening pilot program was performed in a Barcelona area, including 400,000 inhabitants. According to inclusion criteria, 4,730 individuals aged 65 years at the moment of the trial were invited for screening (2,089 men and 2,641 women). Primary care doctors, trained in duplex ultrasound abdominal evaluations, performed an abdominal aortic measurement. Individuals with a previous diagnosis of AAA, limited life expectancy, or wrong contact data were excluded. Participation data, aortic diameters, AAA prevalence, and related cardiovascular risk factors were analyzed. The results were used in a cost-utility model to assess the efficiency of the screening program. RESULTS Participation was 50.3% in men and 44% in women. Eleven patients were excluded because of previously diagnosed AAA. Five new asymptomatic AAA were detected in 65-year-old men (0.5% prevalence), all being active smokers. When considering patients excluded for previous AAA diagnosis, the prevalence in 65-year-old men reached 1.4%. Global AAA prevalence in smoking men reached 2.67%. No AAA was detected in women. Subaneurysmal aorta prevalence in men was 2.9% (n = 29), and in women, it was 0.08% (n = 2). A cost-utility analysis model on screening versus no screening retrieved 13,664€ per quality-adjusted life years at a 10-year horizon and 39,455€ per quality-adjusted life years at a 30-year horizon. CONCLUSIONS AAA population-based screening by ultrasound evaluation in primary care is logistically feasible in our area. Despite that, AAA prevalence is lower than expected in men, and null in women. Cost-utility model results indicate that a local AAA screening program is only efficient in a 30 years' time horizon. Such inefficient results for a population screening make it necessary to consider other strategies such as opportunistic or subgroup screening in our area.
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Affiliation(s)
- Joan Fite
- Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Teresa Puig
- Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain.
| | - Silvia Zamora
- General Practitioner in Primary Care Team EAP Dreta Eixample, Barcelona, Spain
| | - Jose Roman Escudero
- Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judit Solà Roca
- Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autònoma de Barcelona, Barcelona, Spain; Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall Hebron, Barcelona, Spain
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Brakel JW, Berendsen TA, Callenbach PMC, van der Burgh J, Hissink RJ, van den Berg M. Screening for aneurysms of the abdominal aorta using a simple screening device. Ultrasound J 2020; 12:46. [PMID: 33175986 PMCID: PMC7658288 DOI: 10.1186/s13089-020-00192-5] [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: 03/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.
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Affiliation(s)
- J W Brakel
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands.
| | - T A Berendsen
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands
| | - P M C Callenbach
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands
| | - J van der Burgh
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands
| | - R J Hissink
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands
| | - M van den Berg
- Department of Surgery, Treant Zorggroep, Boermarkeweg 60, 7824 AA, Emmen, Netherlands
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Miszczuk M, Müller V, Althoff CE, Stroux A, Widhalm D, Dobberstein A, Greiner A, Kuivaniemi H, Hinterseher I. Association of simple renal cysts and chronic kidney disease with large abdominal aortic aneurysm. BMC Nephrol 2020; 21:201. [PMID: 32471416 PMCID: PMC7257207 DOI: 10.1186/s12882-020-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Abdominal aortic aneurysms (AAA) primarily affect men over 65 years old who often have many other diseases, with similar risk factors and pathobiological mechanisms to AAA. The aim of this study was to assess the prevalence of simple renal cysts (SRC), chronic kidney disease (CKD), and other kidney diseases (e.g. nephrolithiasis) among patients presenting with AAA. Methods Two groups of patients (97 AAA and 100 controls), with and without AAA, from the Surgical Clinic Charité, Berlin, Germany, were selected for the study. The control group consisted of patients who were evaluated for a kidney donation (n = 14) and patients who were evaluated for an early detection of a melanoma recurrence (n = 86). The AAA and control groups were matched for age and sex. Medical records were analyzed and computed tomography scans were reviewed for the presence of SRC and nephrolithiasis. Results SRC (74% vs. 57%; p<0.016) and CKD (30% vs. 8%; p<0.001) were both more common among AAA than control group patients. On multivariate analysis, CKD, but not SRC, showed a strong association with AAA. Conclusions Knowledge about pathobiological mechanisms and association between CKD and AAA could provide better diagnostic and therapeutic approaches for these patients.
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Affiliation(s)
- Milena Miszczuk
- Vascular Surgery Clinic, Klinik für Gefäßchirurgie, Campus Charité Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Verena Müller
- Surgical Clinic, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | | | - Andrea Stroux
- Institute of Medical Biometrics and Clinical Epidemiology, Campus Charité Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Daniela Widhalm
- Vascular Surgery Clinic, Klinik für Gefäßchirurgie, Campus Charité Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Andy Dobberstein
- Vascular Surgery Clinic, Klinik für Gefäßchirurgie, Campus Charité Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Andreas Greiner
- Vascular Surgery Clinic, Klinik für Gefäßchirurgie, Campus Charité Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Irene Hinterseher
- Vascular Surgery Clinic, Klinik für Gefäßchirurgie, Campus Charité Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Torres-Macho J, Aro T, Bruckner I, Cogliati C, Gilja OH, Gurghean A, Karlafti E, Krsek M, Monhart Z, Müller-Marbach A, Neves J, Sabio R, Serra C, Smallwood N, Tana C, Uyaroğlu OA, Von Wowern F, Bosch FH. Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine. Eur J Intern Med 2020; 73:67-71. [PMID: 31836177 DOI: 10.1016/j.ejim.2019.11.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
Abstract
Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.
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Affiliation(s)
- J Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Complutense University, Spanish Society of Internal Medicine, Madrid, Spain.
| | - T Aro
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Young Internists Subcommittee. European Federation of Internal Medicine. Finnish Society of Internal Medicine
| | - I Bruckner
- Romanian Society of Internal Medicine, Romania
| | - C Cogliati
- Internal Medicine Department. Ospedale Luigi Sacco, ASST-Fbf-Sacco. Italian Society of Internal Medicine, Milan, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Gurghean
- Internal Medicine Department. Cardiology, Coltea Clinical Hospital, University of Medicine and Pharmacy Bucharest, Romanian Society of Internal Medicine, Romania
| | - E Karlafti
- AHEPA University Hospital, Aristotle University of Thessaloniki, Internal Medicine Society of Greece, Greece
| | - M Krsek
- Third Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Czech Society of Internal Medicine, Prague
| | - Z Monhart
- Internal Medicine and Emergency Department, Hospital Znojmo, Czech Society of Internal Medicine, Czech Republic
| | - A Müller-Marbach
- Department of Gastroenterology, Hepatology und Palliative Care. Helios Hospital Niederberg, German Society of Internal Medicine, Velbert, Germany
| | - J Neves
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto, Portuguese Society of Internal Medicine, Porto, Portugal
| | - R Sabio
- Hospital SAMIC de Alta Complejidad, Sociedad Argentina de Medicina (SAM), El Calafate, Argentina
| | - C Serra
- Diagnostic and Interventional Utrasound Unit. Division of Multiorgan Failure Emergency, General Surgery and Transplant Department. S.Orsola-Malpighi University Hospital. Italian Society of Internal Medicine
| | - N Smallwood
- Department of Acute Medicine, East Surrey Hospital. Society for Acute Medicine. United Kingdom
| | - C Tana
- Internal Medicine and Subacute Care Unit, University-Hospital of Parma, Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), Parma, Italy
| | - O A Uyaroğlu
- Internal Medicine Department. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital. Turkish Society of Internal Medicine, Turkey
| | - F Von Wowern
- Department of Internal Medicine, University Hospitals of Skåne - Malmö, Swedish Society of Internal Medicine, Skane, Sweden
| | - F H Bosch
- Department of Internal Medicine, Radboud university medical center, Nijmegen and Rijnstate Hospital, Arnhem, the Netherlands
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Khan MAB, Abu-Zidan FM. Point-of-care ultrasound for the acute abdomen in the primary health care. Turk J Emerg Med 2020; 20:1-11. [PMID: 32355895 PMCID: PMC7189821 DOI: 10.4103/2452-2473.276384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a focused examination, which is performed and interpreted at the bedside by the treating physician answering a specific clinical question. It is currently utilized as an essential adjunct to physical examination in many medical specialties. Recent advances in technology have made POCUS machines portable, affordable, and could be used with minimal training even by nonradiologists. This review aims to cover the fundamental physics of POCUS and its applications for diagnosing the acute abdomen in the primary health care including the most common causes encountered by family physicians. These are acute appendicitis, acute cholecystitis, renal colic, ectopic pregnancy, acute diverticulitis, bowel obstruction, and abdominal aortic aneurysm. We hope to encourage primary care physicians to incorporate POCUS in their routine clinical practice. We also highlight challenges encountered when using POCUS in the primary health care including limited availability and the need for proper training. Furthermore, we review the POCUS results when performed by primary health-care physicians. Integrating POCUS in primary health care empowers primary health-care physicians to provide high-quality, safe, and cost-effective care to the patients.
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Affiliation(s)
- Moien A B Khan
- Department of Family Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Ngetich E, Ward J, Cassimjee I, Lee R, Handa A. Prevalence and Epidemiological Pattern of Abdominal Aortic Aneurysms in Africa: A Systematic Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:3-14. [PMID: 35531585 PMCID: PMC9067630 DOI: 10.4103/jwas.jwas_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
Introduction The incidence of abdominal aortic aneurysms (AAAs) in high-income countries has been declining in the last three decades. However, in most low-income and middle-income countries especially in Africa, little is known about its burden. The absence of screening services for AAA in African countries makes it difficult to detect and promptly manage AAA before rupture, which has significant implications for mortality. This study sought to systematically assess the prevalence of AAA amongst patients visiting hospitals in Africa and evaluate its epidemiological pattern. Materials and Methods A systematic review was performed on the EMBASE, GLOBAL HEALTH, MEDLINE, and PUBMED databases. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement standards and protocol registered with PROSPERO (CRD42020162214). A data extraction tool was used to get relevant information from these studies. Quality assessment and risk of bias were performed using the Newcastle Ottawa Scale for cross-sectional studies. Results were summarised in tables, figures, and a forest plot. A narrative synthesis approach of the articles was taken. Results Two hundred and sixty-one studies were identified and after the exclusion of 246, a final 15 were deemed suitable for analysis. A total of 4012 participants were screened for AAA and of these, 129 cases were identified. The prevalence of AAA in these studies ranged from 0.7 to 6.4%. Male participants accounted for 115 (89.1%) of the cases. There was a wide age range (31-72 years) reflective of both its possible infective and degenerative aetiology. AAA was reported to be associated with hypertension, smoking, advanced age, coronary artery disease, and HIV infection. There was no association between AAA and diabetes. Over 50% of cases were identified incidentally. About one-third (23-54%) of the participants presented aortic rupture with a mortality rate ranging between 65 and 72%. Conclusions AAA prevalence in Africa is probably higher than the current thinking as there is no baseline data to compare with. Aetiologically, AAA was shown to be associated with hypertension, smoking, coronary artery disease, and possibly infectious pathologies like HIV. Large epidemiological studies would help better characterise AAA in this setting. Lastly, efforts targeting the reduction of the risk factors for AAA would go a long way in reducing the burden of AAA.
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Affiliation(s)
- E Ngetich
- University of Oxford, Department of Surgical Sciences, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom,Address for correspondence: Dr. Elisha Ngetich, Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom. E-mail:
| | - J Ward
- University of Oxford, Department of Surgical Sciences, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom
| | - I Cassimjee
- University of Witwatersrand, Department of Surgery, Private Bag X2600, Houghton, Johannesburg, South Africa
| | - R Lee
- University of Oxford, Department of Surgical Sciences, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom
| | - A Handa
- University of Oxford, Department of Surgical Sciences, John Radcliffe Hospital OX3, 9DU Oxford, United Kingdom
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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Abstract
The use of portable ultrasound (US) devices has increased in recent years and the market has been flourishing. Portable US devices can be subdivided into three groups: laptop-associated devices, hand-carried US, and handheld US devices. Almost all companies we investigated offer at least one portable US device. Portable US can also be associated with the use of different US techniques such as colour Doppler US and pulse wave (PW)-Doppler. Laptop systems will also be available with contrast-enhanced US and high-end cardiac functionality. Portable US devices are effective in the hands of experienced examiners. Imaging quality is predictably inferior to so-called high-end devices. The present paper is focused on portable US devices and clinical applications describing their possible use in different organs and clinical settings, keeping in mind that patient safety must never be compromised. Hence, portable devices must undergo the same decontamination assessment and protocols as the standard equipment, especially smartphones and tablets.
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18
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Faraji F, Gaba RC. Radiologic Modalities and Response Assessment Schemes for Clinical and Preclinical Oncology Imaging. Front Oncol 2019; 9:471. [PMID: 31214510 PMCID: PMC6558006 DOI: 10.3389/fonc.2019.00471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 05/16/2019] [Indexed: 11/29/2022] Open
Abstract
Clinical drug trials for oncology have resulted in universal protocols for medical imaging in order to standardize protocols for image procurement, radiologic interpretation, and therapeutic response assessment. In recent years, there has been increasing interest in using large animal models to study oncologic disease, though few standards currently exist for imaging of large animal models. This article briefly reviews medical imaging modalities, the current state-of-the-art in radiologic diagnostic criteria and response assessment schemes for evaluating therapeutic response and disease progression, and translation of radiologic imaging protocols and standards to large animal models of malignant disease.
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Affiliation(s)
- Farshid Faraji
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Ron C Gaba
- Department of Radiology, University of Illinois Health, Chicago, IL, United States
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19
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Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel) 2019; 9:diagnostics9020061. [PMID: 31208078 PMCID: PMC6628329 DOI: 10.3390/diagnostics9020061] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to review the scientific literature available on the comparison of hand-held ultrasound devices with high-end systems for abdominal and pleural applications. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original research describing hand-held ultrasound devices compared with high-end systems was included and assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2. The search was limited to articles published since 1 January 2012. A total of 2486 articles were found and screened by title and abstract. A total of 16 articles were chosen for final review. All of the included articles showed good overall agreement between hand-held and high-end ultrasound systems. Strong correlations were found when evaluating ascites, hydronephrosis, pleural cavities, in detection of abdominal aortic aneurysms and for use with obstetric and gynaecological patients. Other articles found good agreement for cholelithiasis and for determining the best site for paracentesis. QUADAS-2 analysis suggested few risks of bias and almost no concerns regarding applicability. For distinct clinical questions, hand-held devices may be a valuable supplement to physical examination. However, evidence is inadequate, and more research is needed on the abdominal and pleural use of hand-held ultrasound with more standardised comparisons, using only blinded reviewers.
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Affiliation(s)
- Alexander Rykkje
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med 2019; 17:61-69. [PMID: 30670398 PMCID: PMC6342599 DOI: 10.1370/afm.2330] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners. METHODS We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting. CONCLUSIONS POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners.
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Affiliation(s)
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Aalborg East, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan Vela
- Department of Rheumatology, Aalborg University Hospital, Aalborg North, Denmark
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Altobelli E, Rapacchietta L, Profeta VF, Fagnano R. Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122805. [PMID: 30544688 PMCID: PMC6313801 DOI: 10.3390/ijerph15122805] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, coronary artery disease and family history of AAA. Respect to a previous a meta-analysis we added the funnel plot to examine the effect sizes estimated from individual studies as measure of their precision; sensitivity analysis to check the stability of study findings and estimate how the overall effect size would be modified by removal of one study; cumulative analysis to evaluate the trend between studies in relation to publication year. Abdominal aortic aneurysm prevalence is higher in smokers and in males. On the other hand, while diabetes is a risk factor for many cardiovascular diseases, it is not a risk factor for AAA. In addition, it is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It could avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
- Epidemiology and Biostatistics Unit, Local Health Unit, 64100 Teramo, Italy.
| | | | - Valerio F Profeta
- Department of community Health, Local Health Unit, 64100 Teramo, Italy.
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular. Rev Clin Esp 2018; 218:461-467. [DOI: 10.1016/j.rce.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 01/27/2023]
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Michon A, Jammal S, Passeron A, De Luna G, Bomahou C, Jullien V, Pouchot J, Arlet JB, Ranque B. [Use of pocket-sized ultrasound in internal medicine (hospitalist) practice: Feedback and perspectives]. Rev Med Interne 2018; 40:220-225. [PMID: 30078545 DOI: 10.1016/j.revmed.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department. The device used was a Vscan Dual Probe, GE, whose two probes and presets allow for cardiac, abdominal, pulmonary, obstetric, vascular, pulmonary, and superficial soft tissue exploration. One physician of the ward received a course for POCUS that was initially dedicated for emergency physicians. This study reports on the results of the examinations made between January and September 2015. For each examination performed, clinical usefulness was assessed at the time of patient discharge, by two independent physicians who reviewed the clinical course and the results of conventional imaging and rated their evaluation on a Likert scale. RESULTS One hundred and four examinations were evaluated. The mean duration of the ultrasound examination was 9±5minutes. The POCUS conclusions were corrected by disease course or the results of conventional imaging in 10 (9.6%) cases. The presets of the device: heart, soft tissue, lung, abdomen and vascular were used respectively in 32, 30, 21, 12 and 5% of the examinations. The main indications of POCUS examination were for identification of pleural, pericardial or peritoneal effusion, and to assess the central venous pressure by inferior vena cava examination. Eighteen examinations were performed for puncture of effusion. The retrospectively evaluated clinical benefit was clearly demonstrated in 78% of cases. The agreement between the two blinded assessors was good (kappa coefficient at 0.82). CONCLUSION Pocket-sized ultrasound device could be used in internal medicine wards. However, its limited performance compared to more sophisticated echography limits the possible explorations and their reliability, which encourages caution and makes critical the question of the initial training of doctors and medical students.
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Affiliation(s)
- A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - S Jammal
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - G De Luna
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Bomahou
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - V Jullien
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
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Chen J, Li J, Ding X, Chang C, Wang X, Ta D. Automated Identification and Localization of the Inferior Vena Cava Using Ultrasound: An Animal Study. ULTRASONIC IMAGING 2018; 40:232-244. [PMID: 29862931 DOI: 10.1177/0161734618777262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound measurement of the inferior vena cava (IVC) is widely implemented in the clinic. However, the process is time consuming and labor intensive, because the IVC diameter is continuously changing with respiration. In addition, artificial errors and intra-operator variations are always considerable, making the measurement inconsistent. Research efforts were recently devoted to developing semiautomated methods. But most required an initial identification of the IVC manually. As a first step toward fully automated IVC measurement, in this paper, we present an intelligent technique for automated IVC identification and localization. Forty-eight ultrasound data sets were collected from eight pigs, each of which included two frames in B-mode and color mode (C-mode) collected at the inspiration, and two cine loops in B-mode and C-mode. Static and dynamic automation algorithms were applied to the data sets for identifying and localizing the IVC. The results were evaluated by comparing with the manual measurement of experienced clinicians. The automated approaches successfully identified the IVC in 47 cases (success rate: 97.9%). The automated localization of the IVC is close to the manual counterpart, with the difference within one diameter. The automatically measured diameters are close to those measured manually, with most differences below 15%. It is revealed that the proposed method can automatically identify the IVC with high success rate and localize the IVC with high accuracy. But the study with high accuracy was conducted under good control and without considering difficult cases, which deserve future explorations. The method is a first step toward fully automated IVC measurement, which is suitable for point-of-care applications.
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Affiliation(s)
- Jiangang Chen
- 1 Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Jiawei Li
- 2 Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China
- 3 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Ding
- 4 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cai Chang
- 2 Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China
- 3 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoting Wang
- 4 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dean Ta
- 5 Department of Electronic Engineering, Fudan University, Shanghai, China
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26
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Gianfagna F, Veronesi G, Tozzi M, Tarallo A, Borchini R, Ferrario MM, Bertù L, Montonati A, Castelli P, Castelli P, Tozzi M, Ferrario MM, Gianfagna F, Veronesi G, Bertù L, Mara L, Montonati A, Tarallo A, Franchin M, Angrisano A, Tadiello M, Quarti LM, Tagliabue I, Buscarini E, Farioli V, Sala G, Agrusti S, Colombo A, Ferraro S, Rivolta N, Piffaretti G, Borchini R, Conti M, Maio RC, Andreotta U, Ruspa M, Turetta L, Abate T, Rossi S, Ghiringhelli M, Quadrini F, Facchinetti N, Dashi O, Mombelli S, Mazzoleni D, Martignoni MP, Caravati G, De Luca G. Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study. Eur J Vasc Endovasc Surg 2018; 55:633-639. [DOI: 10.1016/j.ejvs.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/10/2018] [Indexed: 02/08/2023]
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27
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Calvo Cebrián A, López García-Franco A, Short Apellaniz J. [Point of Care Ultrasound in Primary Care. Is it a high resolution tool?]. Aten Primaria 2018; 50:500-508. [PMID: 29609871 PMCID: PMC6837135 DOI: 10.1016/j.aprim.2017.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023] Open
Abstract
El modelo «Point of Care Ultrasound» es una forma de hacer ecografía clínica rápida con un fin: responder a una cuestión clínica de forma inmediata. No es hacer ecografía de modo sistemático como la que hacen los radiólogos, ni pretende sustituirla. Es útil en alguna forma de cribado (aneurisma de aorta abdominal) y es de especial interés en procedimientos ecoguiados (infiltraciones articulares). Permite adecuar las derivaciones, minimizando la incertidumbre y descartando determinadas enfermedades por su elevada precisión diagnóstica. Pero puede llevarnos al sobrediágnostico si las exploraciones que realizamos son no limitadas a los órganos sobre los que está fundamentada nuestra sospecha clínica. La ecografía es una herramienta más del proceso diagnóstico, pero que debe ser limitada en su utilización a determinadas situaciones clínicas. Su uso en la detección precoz de enfermedades prevalentes en Atención Primaria deberá ser convenientemente evaluado.Y, por otra parte, con gran evidencia de alta precisión diagnóstica en un gran elenco de entidades patológicas.
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Affiliation(s)
- Antonio Calvo Cebrián
- Médico de Familia, CS Galapagar, Grupo de Trabajo Ecografía SoMaMFyC, Galapagar, Madrid, España.
| | - Alberto López García-Franco
- Médico de Familia, CS Dr. Mendiguchía Carriche, Grupo de Trabajo Ecografía SoMaMFyC, Leganés, Madrid, España
| | - Jorge Short Apellaniz
- Médico de Familia, Servicio de Urgencias Fundación Jiménez Díaz, Grupo de Trabajo Ecografía SoMaMFyC, Madrid, España
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28
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Pavy B, Merle E, Darchis J, Caillon M. [Abdominal aorta aneurysms discovered in cardiac rehabilitation]. Ann Cardiol Angeiol (Paris) 2017; 66:335-337. [PMID: 29050743 DOI: 10.1016/j.ancard.2017.09.009] [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: 07/11/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
We reported two cases of unusual discovery of asymptomatic surgical abdominal aortic aneurysm (AAA) after a coronary artery bypass graft and a valve surgery. Attending cardiac rehabilitation, the patients were transferred for prompt surgery. Beyond these observations, it is of great importance that screening of AAA could be done during echocardiography.
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Affiliation(s)
- B Pavy
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France.
| | - E Merle
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France; Cardiocéan réadaptation cardiaque, 25, allée de la Tourtillière, 17138 Puilboreau, France
| | - J Darchis
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
| | - M Caillon
- Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, boulevard des Régents, 44270 Machecoul, France
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