1
|
Ovesen SH, Clausen AH, Kirkegaard H, Løfgren B, Aagaard R, Skaarup SH, Arvig MD, Lorentzen MH, Kristensen AH, Cartuliares MB, Falster C, Tong L, Rabajoli A, Leth R, Desy J, Ma IWY, Weile J. Point-of-Care Lung Ultrasound in Emergency Medicine: A Scoping Review With an Interactive Database. Chest 2024:S0012-3692(24)00290-3. [PMID: 38458431 DOI: 10.1016/j.chest.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives. RESEARCH QUESTION Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine? STUDY DESIGN AND METHODS We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels. RESULTS A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM_240216/INFO). INTERPRETATION Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits.
Collapse
Affiliation(s)
- Stig Holm Ovesen
- Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Emergency Department, Horsens Regional Hospital, Denmark.
| | | | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital, Denmark; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Denmark
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark
| | - Rasmus Aagaard
- Department of Anesthesiology, Aarhus University Hospital, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | - Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Hjarnø Lorentzen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Anne Heltborg Kristensen
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mariana Bichuette Cartuliares
- Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark
| | - Liting Tong
- Emergency Department, Nykøbing F. Hospital, Zealand Denmark Region
| | - Alessandra Rabajoli
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ronja Leth
- Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Emergency Department, Horsens Regional Hospital, Denmark
| | - Janeve Desy
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary; Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary
| | - Irene W Y Ma
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary
| | - Jesper Weile
- Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Emergency Department, Horsens Regional Hospital, Denmark
| |
Collapse
|
2
|
Brink E, Jakobsen TS, Lassen AT, Weile J, Posth S. Management of medical emergency patients in Danish emergency departments. Dan Med J 2023; 70:A11220727. [PMID: 37622648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
INTRODUCTION In many emergency departments (ED), specialised teams are activated to take care of medical emergency patients (MEP). The aim of this study was to describe the organisation of the management of adult MEPs in Danish EDs. The study examined trigger team activation criteria, training and composition of trigger teams. METHODS This was a cross-sectional descriptive study. A questionnaire was sent to the head of department and head nurse at each Danish ED. They recruited eligible personnel to answer the questionnaire. Data were obtained between 1 October and 15 December 2021. RESULTS We included 23 hospitals and 19 responded (82.6%). Most EDs had a trigger call for MEP (89.5%). In 70.6% of the EDs, trigger calls for MEP were activated > 300 times annually. All EDs used red triage (Danish Emergency Process Triage) as activation criteria for MEP calls. Most respondents received simulation training (82.4%). All respondents felt adequately educated to manage MEP. The MEP trigger teams varied from three to 11 members with great variation with respect to team leaders. CONCLUSION Management of MEP varies greatly in Danish Hospitals. A systematic approach to MEP management in line with management of trauma and stroke patients may potentially serve to improve the quality of care for and outcome of this patient group, but further research is needed. FUNDING None. TRIAL REGISTRATION Not relevant.
Collapse
Affiliation(s)
- Elsi Brink
- Faculty of Health Sciences, University of Southern Denmark
| | | | | | - Jesper Weile
- Department of Emergency Medicine, Regional Hospital Horsens
| | - Stefan Posth
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| |
Collapse
|
3
|
Skaarup SH, Aagaard R, Ovesen SH, Weile J, Kirkegaard H, Espersen C, Lassen MCH, Skaarup KG, Posth S, Laursen CB, Bock A, Dan Arvig M, Biering-Sørensen T. Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19. A multicentre prospective cohort study. ERJ Open Res 2022; 8:00128-2022. [PMID: 36284826 PMCID: PMC9501653 DOI: 10.1183/23120541.00128-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background In this study we aimed to assess if a focused lung ultrasound examination predicts the need for mechanical ventilation, admission to an intensive care unit, high-flow oxygen treatment, death from COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection. Methods A multicentre prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed. Results A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (relative risk 2.44, 95% CI 1.32–5.52), admission to intensive care (relative risk 2.55, 95% CI 1.41–54.59) and high-flow oxygen treatment (relative risk 1.95, 95% CI 1.5–2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in area under the receiver operating characteristic curve between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones. Conclusion Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and the need for high-flow oxygen treatment. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms. Focused lung ultrasound can predict need for intensive care treatment in patients with confirmed or suspected COVID-19. A simple ultrasound examination including only the anterior and lateral sides of the thorax is accurate.https://bit.ly/3CTf3p6
Collapse
|
4
|
Weile J, Nebsbjerg MA, Ovesen SH, Paltved C, Ingeman ML. Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Adv Simul (Lond) 2021; 6:3. [PMID: 33472706 PMCID: PMC7816464 DOI: 10.1186/s41077-021-00154-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of simulation-based team training has increased over the past decades. Simulation-based team training within emergency medicine and critical care contexts is best known for its use by trauma teams and teams involved in cardiac arrest. In the domain of emergency medicine, simulation-based team training is also used for other typical time-critical clinical presentations. We aimed to review the existing literature and current state of evidence pertaining to non-technical skills obtained via simulation-based team training in emergency medicine and critical care contexts, excluding trauma and cardiac arrest contexts. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Before the initiation of the study, the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. We conducted a systematic literature search of 10 years of publications, up to December 17, 2019, in the following databases: PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL. Two authors independently reviewed all the studies and extracted data. RESULTS Of the 456 studies screened, 29 trials were subjected to full-text review, and 13 studies were included in the final review. None of the studies was randomized controlled trials, and no studies compared simulation training to different modalities of training. Studies were heterogeneous; they applied simulation-training concepts of different durations and intensities and used different outcome measures for non-technical skills. Two studies reached Kirkpatrick level 3. Out of the remaining 11 studies, nine reached Kirkpatrick level 2, and two reached Kirkpatrick level 1. CONCLUSIONS The literature on simulation-based team training in emergency medicine is heterogeneous and sparse, but somewhat supports the hypothesis that simulation-based team training is beneficial to teams' knowledge and attitudes toward non-technical skills (Kirkpatrick level 2). Randomized trials are called for to clarify the effect of simulation compared to other modalities of team training. Future research should focus on the transfer of skills and investigate improvements in patient outcomes (Kirkpatrick level 4).
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Horsens, Horsens, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.
| | - Mette Amalie Nebsbjerg
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark
| | - Stig Holm Ovesen
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.,Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark
| | | | - Mads Lind Ingeman
- Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
5
|
Weile J, Frederiksen CA, Laursen CB, Graumann O, Sloth E, Kirkegaard H. Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial. Scand J Trauma Resusc Emerg Med 2020; 28:47. [PMID: 32471452 PMCID: PMC7260768 DOI: 10.1186/s13049-020-00740-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Point-of-Care ultrasound (POCUS) changes the management in specific groups of patients in the Emergency Department (ED). It seems intuitive that POCUS holds an unexploited potential on a wide variety of patients. However, little is known about the effect of ultrasound on the broad spectrum of unselected patients in the ED. This study aimed to identify the effect on the clinical management if POCUS was applied on unselected patients. Secondarily the study aimed to identify predictors of ultrasound changing management. Methods This study was a blinded observational single center trial. A basic whole body POCUS protocol was performed in extension to the physical examination. The blinded treating physicians were interviewed about the presumptive diagnosis and plan for the patient. Subsequently the physicians were unblinded to the POCUS results and asked to choose between five options regarding the benefit from POCUS results. Results A total of 403 patients were enrolled in this study. The treating physicians regarded POCUS examinations influence on the diagnostic workup or treatment as following: 1) No new information: 249 (61.8%), 2) No further action: 45 (11.2%), 3) Further diagnostic workup needed: 52 (12.9%), 4) Presumptive diagnosis confirmed 38 (9.4%), and 5) Immediate treatment needed: 19 (4.7%). Predictors of beneficial ultrasound were: (a) triage > 1, (b) patient comorbidities (cardiac disease, hypertension or lung disease), or (c) patients presenting with abdominal pain, dyspnea, or syncope. Conclusion POCUS was found to be potentially beneficial in 27.0% of all patients. High triage score, known cardiac disease, hypertension, pulmonary diseases, a clinical presentation with abdominal pain, dyspnea, or syncope are predictors of this. Future research should focus on patient-important outcomes when applying POCUS on these patients. Trial registration The trail was registered prior to patient inclusion with the Danish Data Protection Agency (https://www.datatilsynet.dk/ Case no: 1–16–02-603-14) and Clinical Trials (www.clinicaltrials.gov/ Protocol ID: DNVK1305018).
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161 (J 103), 8200, Aarhus, Denmark.
| | | | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erik Sloth
- University of Cape Town, Cape Town, South Africa
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161 (J 103), 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
6
|
Putensen C, Ellger B, Sakka SG, Weyland A, Schmidt K, Zoller M, Weiler N, Kindgen-Milles D, Jaschinski U, Weile J, Lindau S, Kieninger M, Faltlhauser A, Jung N, Teschendorf P, Adamzik M, Gründling M, Wahlers T, Gerlach H, Litty FA. Current clinical use of intravenous fosfomycin in ICU patients in two European countries. Infection 2019; 47:827-836. [PMID: 31190298 DOI: 10.1007/s15010-019-01323-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE In Europe, intravenous fosfomycin (IV) is used particularly in difficult-to-treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life conditions. METHODS Prospective, multi-center, and non-interventional study in patients with bacterial infections from 20 intensive care units (ICU) in Germany and Austria (NCT01173575). RESULTS Overall, 209 patients were included (77 females, 132 males, mean age: 59 ± 16 years), 194 of which were treated in intensive care (APACHE II score at the beginning of fosfomycin therapy: 23 ± 8). Main indications (± bacteremia or sepsis) were infections of the CNS (21.5%), community- (CAP) and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP, 15.3%), bone and joint infections (BJI, 11%), abdominal infections (11%), and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.3%), S. epidermidis (14.2%), Enterococcus spp. (10.8%), E. coli (12.3%) and Klebsiella spp. (7.7%). At least one multidrug-resistant (MDR) pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.7 ± 3.5 g over 12.4 ± 8.6 days, almost exclusively (99%) in combination with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and in 84.8% (39/46) of patients with ≥ 1 MDR pathogen. Noteworthy, 16.3% (34/209) of patients developed at least one, in the majority of cases non-serious, adverse drug reaction during fosfomycin therapy. CONCLUSION Our data suggest that IV fosfomycin is an effective and safe combination partner for the treatment of a broad spectrum of severe bacterial infections in critically ill patients.
Collapse
Affiliation(s)
- C Putensen
- Department of Anesthesiology and Surgical Intensive Care Medicine, Medical School of the University of Bonn, Bonn, Germany
| | - B Ellger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Westfalen GmbH, Dortmund, Germany
| | - S G Sakka
- Department of Anesthesiology and Operative Intensive Care Medicine, Medical Center Cologne-Merheim, University of Witten/Herdecke, Cologne, Germany
| | - A Weyland
- Department of Anesthesiology/Intensive Care Medicine/Emergency Medicine/Pain Therapy, Klinikum Oldenburg GmbH, Oldenburg, Germany
| | - K Schmidt
- Department of Anesthesiology, Charité University Hospital Berlin, Berlin, Germany
| | - M Zoller
- Department of Anesthesiology, University Hospital Munich, Munich, Germany
| | - N Weiler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig- Holstein, Campus Kiel, Kiel, Germany
| | - D Kindgen-Milles
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - U Jaschinski
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - J Weile
- Department of Thorax and Cardiovascular Medicine, Institute of Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - S Lindau
- Department of Anesthesiology/Intensive Care Medicine/Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - M Kieninger
- Department of Anesthesiology and Neurosurgical Intensive Care Unit, University Hospital Regensburg, Regensburg, Germany
| | - A Faltlhauser
- Interdisciplinary Intensive Care Unit, Weiden Hospital, Weiden, Germany
| | - N Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - P Teschendorf
- Department of Anesthesiology and Surgical Intensive Care Medicine, Klinikum Osnabrück GmbH, Osnabrück, Germany
| | - M Adamzik
- Department of Anesthesiology/Intensive Care Medicine/Pain Therapy, Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - M Gründling
- Department of Anesthesiology/Intensive Care Medicine/Emergency Medicine/Pain Therapy, University Hospital Greifswald, Greifswald, Germany
| | - T Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - H Gerlach
- Department of Anesthesiology and Surgical Intensive Care Medicine, Klinikum Neukölln, Berlin, Germany
| | - F-A Litty
- InfectoPharm Arzneimittel und Consilium GmbH, Heppenheim, Germany.
| |
Collapse
|
7
|
Jensen SH, Weile J, Aagaard R, Hansen KM, Jensen TB, Petersen MC, Jensen JJ, Petersen P, Kirkegaard H. Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial. Acta Anaesthesiol Scand 2019; 63:403-409. [PMID: 30328094 DOI: 10.1111/aas.13276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. METHODS We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model. RESULTS In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians. CONCLUSION Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.
Collapse
Affiliation(s)
- Stig H. Jensen
- Research Center for Emergency Medicine, Department of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Emergency Department Regional; Hospital West Jutland; Herning Denmark
| | - Jesper Weile
- Research Center for Emergency Medicine, Department of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Emergency Department Regional; Hospital West Jutland; Herning Denmark
| | - Rasmus Aagaard
- Research Center for Emergency Medicine, Department of Clinical Medicine; Aarhus University; Aarhus N Denmark
- Department of Internal Medicine; Regional Hospital Randers; Randers Denmark
| | - Kåre M. Hansen
- Department of Anesthesiology and Intensive Care; Aalborg University Hospital; Aalborg Denmark
| | - Troels B. Jensen
- Department of Anesthesiology; Regional Hospital West Jutland; Herning Denmark
| | | | - Jacob J. Jensen
- Emergency Department Regional; Hospital West Jutland; Herning Denmark
| | - Poul Petersen
- Emergency Department Regional; Hospital West Jutland; Herning Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Clinical Medicine; Aarhus University; Aarhus N Denmark
| |
Collapse
|
8
|
Faust I, Weile J, Fujita B, Kandolf R, Hendig D, Vollmer T, Stan AC, Kellner U, Kuhn J, Gummert JF, Knabbe C. Heart Transplantation in Systemic Sclerosis: New Impulses for Conventional Scleroderma Transplantation Regimen and Scleroderma Diagnostic Monitoring: 2 Case Reports. Transplant Proc 2019; 51:865-870. [PMID: 30979477 DOI: 10.1016/j.transproceed.2019.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although low (but increasing) rates of lung/lung-heart transplantations of scleroderma (systemic sclerosis [SSc]) patients have been reported, exclusive heart transplantation is a rare approach for treatment of heart failure due to SSc. CASES We report on 2 cases of SSc patients receiving a heart transplantation (HTx) due to severe and progressive right heart failure without pulmonary artery hypertension. One patient received a hepatitis C virus (HCV)-positive donor heart and recovered excellently from viral transmission after administration of a direct-acting antiviral (DAA) regimen. This is the first published case of an SSc patient who underwent HTx using an HCV-positive donor heart. The clinical course of both patients was monitored by different serum SSc biomarkers. Only xylosyltransferase activity proved to be a promising biomarker for disease stage determination and therapeutic monitoring, precisely reflecting fibrotic remodeling and successful organ recovery. CONCLUSIONS Successful implementation of the 2 cases described here demonstrates that HTx is a safe and effective therapeutic option for defined SSc sub-patient groups despite the progressive character of the underlying disease. In the future, xylosyltransferase activity might be conducive to simplify the identification of patients with low systemic involvement but a strong indication for single heart transplantation. Finally, we demonstrate that treatment of HCV viral transmission from HCV-positive donor to organ recipient using DAA gives us new opportunities to consider HCV-positive donor organs for HTx and might reveal new possibilities to ease the lack of donor organs.
Collapse
Affiliation(s)
- I Faust
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - J Weile
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - B Fujita
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - R Kandolf
- Abteilung für Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - D Hendig
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - T Vollmer
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - A-C Stan
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - U Kellner
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - J Kuhn
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - J F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - C Knabbe
- Institute for Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
9
|
Weile J, Laursen CB, Frederiksen CA, Graumann O, Sloth E, Kirkegaard H. Point-of-care ultrasound findings in unselected patients in an emergency department -results from a prospective observational trial. BMC Emerg Med 2018; 18:60. [PMID: 30587153 PMCID: PMC6307264 DOI: 10.1186/s12873-018-0211-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) can improve patient management in the emergency department (ED). However, previous studies have focused only on selected groups of patients, such as trauma, shock, dyspnea, or critically ill patients, or patients with an already known diagnosis. Most patients seen in the ED do not match these criteria. We aim to present total prevalence of positive findings when basic POCUS is applied to the broad population of patients seen in an emergency department. Methods We conducted a single-center prospective explorative observational study of 405 unselected patients aged 18 years or over. A structured whole-body ultrasound examination was performed on all patients within 2 h of arrival to the ED. The ultrasound examination consisted of focused cardiac ultrasound, focused abdominal ultrasound, focused assessment with sonography for trauma (FAST), and focused lung ultrasound. Results We managed to perform 94.5% of all planned examinations. The study revealed positive findings in 39.3% of all included patients. This study presents the prevalence of positive findings among subgroups of patients. Divided among the categories of chief complaint, we found 62 positive examinations in 58 (14.3%; 95% CI, 10.9–17.7) unique patients with orthopedic complaints, 77 positive examinations among 59 (14.6%; 95% CI, 11.1–18.0) unique patients with medical complaints, and 55 positive examinations among 42 (10.4%; 95% CI, 7.4–13.3) unique patients with abdominal surgical complaints. Conclusion POCUS revealed positive findings in more than one third of unselected patients in the emergency department. The study presents the findings and distribution among categories of chief complaints. Future investigations are necessary to elucidate the implication of the findings. Electronic supplementary material The online version of this article (10.1186/s12873-018-0211-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Graumann
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Erik Sloth
- University of Cape Town, Cape Town, South Africa
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark
| |
Collapse
|
10
|
Weile J, Brix J, Moellekaer AB. Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound. Crit Ultrasound J 2018; 10:25. [PMID: 30270416 PMCID: PMC6165827 DOI: 10.1186/s13089-018-0106-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/23/2018] [Indexed: 11/14/2022] Open
Abstract
Background Point-of-care ultrasound (PoCUS) is spreading throughout Emergency Medicine, Critical Care and Pre-hospital Care. However, there is an underlying inherited conflict with the established specialties performing comprehensive examinations. It has been stated that PoCUS is disruptive innovation. If this is true the definition might open up for a new perspective on differentiating comprehensive ultrasound from PoCUS. PoCUS in the light of disruptive innovation is a different perspective on ultrasound that has not before been academically scrutinized. Methods In this paper we investigate if PoCUS is in fact disruptive innovation. This is done by comparative analysis with the point of departure in disruptive innovation theory known from the business world. Results We find that a disruptive innovation process is happening. This new knowledge allows us to put forward advice for the stakeholders in the field of ultrasound. It also allows us to challenge the conventional pyramid of expertise used to describe different types of ultrasound. The perspective of this paper is mutual understanding of similarities and differences between conventional and point-of-care ultrasound. Only with this understanding the stakeholders can collaborate and use the full spectrum of ultrasound for the benefit of the patient.
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Jacob Brix
- Department of Learning& Philosophy, Research Group for Evaluation & Capacity Building, Aalborg University, Aalborg, Denmark
| | - Anders Broens Moellekaer
- Emergency Department, Regional Hospital Herning, Herning, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
11
|
Weile J, Nielsen K, Primdahl SC, Frederiksen CA, Laursen CB, Sloth E, Mølgaard O, Knudsen L, Kirkegaard H. Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation. Scand J Trauma Resusc Emerg Med 2018; 26:22. [PMID: 29587862 PMCID: PMC5870211 DOI: 10.1186/s13049-018-0486-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. Methods We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. Results A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. Conclusion The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for. Electronic supplementary material The online version of this article (10.1186/s13049-018-0486-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, building 1B, 8000, Aarhus C, Denmark.
| | - Klaus Nielsen
- Department of Medicine, Section of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, Denmark
| | - Stine C Primdahl
- Emergency Department, Regional Hospital Herning, Herning, Denmark
| | | | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Erik Sloth
- University of Cape Town, Cape Town, South Africa
| | - Ole Mølgaard
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Knudsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, building 1B, 8000, Aarhus C, Denmark
| |
Collapse
|
12
|
Abstract
Evidence-based standards in proficiency are needed for ultrasound-guided peripheral intravenous access. In this study, we explored the validity of the Peripheral Ultrasound-Guided Vascular Access (P-UGVA) Rating Scale.We recruited 3 groups of physicians (5 novices, 5 intermediates, and 5 experts) of increasing proficiency in peripheral ultrasound-guided intravenous access. All participants performed 3 peripheral ultrasound-guided intravenous accesses on three different patients. Performance was video-recorded by 3 cameras and the ultrasound image. Synchronized and anonymized split-screen film clips were rated using the P-UGVA rating scale by 2 assessors, which also assessed overall performance on a 1-5 Likert-scale. Evidence of validity was explored using the contemporary validity framework by Messick (content, response process, internal structure, relations to other variables, and consequences).Content and response process was ensured in the development of the rating scale and validity study. Internal consistency of the P-UGVA rating scale was excellent and sufficient high for certification purposes (Cronbach's alpha = 0.91). Proficiency groups were successfully discriminated by the UPGIVA rating scale (P = .029, one-way ANOVA), and the P-UGVA rating scale scores also correlated strongly with the overall performance evaluations (rho = 0.87, P < .001, Pearson correlation). We calculated a pass/fail score of 29, which lead to a theoretical false positive rate of 26.5% and false negative rate of 8.5%.We present validity evidence for the P-UGVA rating scale and an evidence-based standard in proficiency for ultrasound-guided peripheral intravenous access.
Collapse
Affiliation(s)
- Stine C. Primdahl
- Department of Emergency Medicine, Regional Hospital West Jutland, Herning
- Aarhus University, Aarhus
| | - Jesper Weile
- Department of Emergency Medicine, Regional Hospital West Jutland, Herning
- Research Center for Emergency Medicine, Aarhus University Hospital
| | - Louise Clemmesen
- Department of Anaesthesiology, Regional Hospital Central Jutland, Silkeborg
| | - Kristian R. Madsen
- Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, Odense
| | - Yousif Subhi
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
- Department of Ophthalmology, Zealand University Hospital, Roskilde
| | - Poul Petersen
- Department of Emergency Medicine, Regional Hospital West Jutland, Herning
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense
- Institute of Clinical Medicine, Aarhus University, Aarhus, Demark
- Institute of Clinical Medicine, Odense University, Odense, Demark
| |
Collapse
|
13
|
Abstract
BACKGROUND The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark. METHODS We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation of existing guidelines, and the second phase was a series of structured interviews of orthopedic surgeons, anesthesiologists, and radiologists on call in all hospitals receiving traumatized patients in Denmark. RESULTS Guidelines were obtained from all 22 hospitals receiving traumatized patients in Denmark. Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST indications varied between circulatory instability n = 8 (36.4%), team leader's discretion n = 6 (27.3%), abdominal trauma n = 3 (13.6%), and not specified n = 6 (27.3%). Telephone interviews revealed that exams were always n = 8 (36.4%) or often n = 4 (18.2%) registered in the patients' charts. The remaining n = 10 (45.5%) facilities either never registered n = 2 (9.1%), it was not possible to register n = 1 (4.5%), or unknown by the trauma leaders n = 7 (31.8%). Images were often stored in n = 1 (4.5%), never stored in n = 10 (45.5%), not possible to store in n = 2 (9.1%), and unknown in n = 9 (40.9%) facilities. CONCLUSION Ultrasonography was used in a non-uniform fashion by multiple specialties in Danish trauma facilities. Very few images from FAST examinations were stored and documentation was scanty. National guidelines on application and documentation of ultrasonography in trauma are called for.
Collapse
Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, Building 1B, 8000, Aarhus C, Denmark.
| | - Klaus Nielsen
- Department of Medicine, Section of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, Denmark
| | | | | | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Erik Sloth
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
14
|
Foss KT, Subhi Y, Aagaard R, Bessmann EL, Bøtker MT, Graumann O, Laursen CB, Weile J, Todsen T. Developing an emergency ultrasound app - a collaborative project between clinicians from different universities. Scand J Trauma Resusc Emerg Med 2015; 23:47. [PMID: 26092581 PMCID: PMC4473832 DOI: 10.1186/s13049-015-0130-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022] Open
Abstract
Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.
Collapse
Affiliation(s)
- Kim Thestrup Foss
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark. .,Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark.
| | - Yousif Subhi
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Clinical Eye Research Unit, Copenhagen University Hospital Roskilde, Roskilde, Denmark
| | - Rasmus Aagaard
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Department of Anesthesia, Randers Regional Hospital, Randers, Denmark
| | - Ebbe Lahn Bessmann
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesia, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Morten Thingemann Bøtker
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Research Department, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Ole Graumann
- Center of Clinical Ultrasound, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Research, Aarhus University, Aarhus, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper Weile
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark.,Department of Emergency Medicine, Regional Hospital Herning, Herning, Denmark
| | - Tobias Todsen
- Centre for Clinical Education, Centre for HR, Capital Region of Denmark & University of Copenhagen, Copenhagen, Denmark.,Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
| |
Collapse
|
15
|
Weile J, Due-Rasmussen D, Hørlyk UG. [Adder bites]. Ugeskr Laeger 2014; 176:V08130509. [PMID: 25096840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Correct treatment of adder bites can reduce morbidity. We aim at creating an evidence-based guideline on pre- and in-hospital treatment of bites by the European adder (Vipera berus). Pre-hospital treatment consists of reassurance, immobilisation, elevation and paracetamol for pain. Icepacks, oral suction and tourniquets should be avoided. In-hospital treatment includes tetanus prophylaxis, paracetamol or opioids, antiemetics and the monovalent ovine immunoglobulin Fab fragment ViperaTAb. We strongly advise emergency departments to carry up-to-date guidelines regarding bites from the European adder.
Collapse
|
16
|
Laursen CB, Nielsen K, Riishede M, Tiwald G, Møllekær A, Aagaard R, Posth S, Weile J. A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine. Scand J Trauma Resusc Emerg Med 2014; 22:25. [PMID: 24731411 PMCID: PMC3989792 DOI: 10.1186/1757-7241-22-25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/28/2014] [Indexed: 11/10/2022] Open
Abstract
The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies, quality assurance, collaboration and research in the field of clinical US used in an ED.
Collapse
Affiliation(s)
- Christian B Laursen
- Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Sdr, Boulevard 29, 5000 Odense C, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Weile J, Due-Rasmussen D, Hørlyk UG. 10 European adder bites in Western Denmark - a case-report on the management in the emergency department. Scand J Trauma Resusc Emerg Med 2012. [DOI: 10.1186/1757-7241-19-s2-p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
18
|
Weile J, Due-Rasmussen D, Hørlyk U. 10 European adder bites in Western Denmark - a case-report on the management in the emergency department. Scand J Trauma Resusc Emerg Med 2012. [PMCID: PMC3327046 DOI: 10.1186/1757-7241-20-s2-p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Zaiss NH, Weile J, Ackermann G, Kuijper E, Witte W, Nüebel U. A case of Clostridium difficile-associated disease due to the highly virulent clone of Clostridium difficile PCR ribotype 027, March 2007 in Germany. ACTA ACUST UNITED AC 2007; 12:E071115.1. [PMID: 18005641 DOI: 10.2807/esw.12.46.03306-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Here, we report the isolation of C. difficile PCR ribotype 027 from a patient suffering from pseudomembranous colitis in Germany in March 2007. The strain was identified during a retrospective PCR ribotyping survey of stored isolates.
Collapse
Affiliation(s)
- N H Zaiss
- Robert Koch Institute, Wernigerode, Germany
| | | | | | | | | | | |
Collapse
|