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Jensen CG, Dybdahl M, Valtersson J, Mussmann BR, Duus LA, Junker T, Pietersen PI, Lund L, Welch BT, Graumann O. Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2024; 47:453-461. [PMID: 38483602 PMCID: PMC10997531 DOI: 10.1007/s00270-023-03633-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 04/07/2024]
Abstract
PURPOSE Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. MATERIALS AND METHODS Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. RESULTS Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. CONCLUSION This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.
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Affiliation(s)
- Christian Greve Jensen
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Marco Dybdahl
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - John Valtersson
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Bo Redder Mussmann
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Urology, OUH, Odense, Denmark
| | - Pia Iben Pietersen
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense, Denmark
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ole Graumann
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark.
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark.
- Department of Radiology, Aarhus University, Arhus, Denmark.
- Aarhus University, Arhus, Denmark.
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Nielsen AB, Dragsbæk J, Jacobsen N, Laursen CB, Farr A, Slavicky M, Konge L, Pietersen PI. Assessment of Basic Thoracic Ultrasound Skills in Immersive Virtual Reality: Gathering Validity Evidence. Ultrasound Med Biol 2024; 50:467-473. [PMID: 38185537 DOI: 10.1016/j.ultrasmedbio.2023.12.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Operator skills are essential for thoracic ultrasound (TUS) to ensure diagnostic accuracy. Immersive virtual reality (IVR) has shown potential within medical education but never for assessment of TUS skills. This study was aimed at developing an IVR test for assessing TUS skills, gathering validity evidence and establishing a pass/fail score. METHODS An expert panel developed a test based on the TUS protocol by the European Respiratory Society (ERS), including a tutorial and two clinical cases (pleural effusion and interstitial syndrome), using an IVR platform (VitaSim, Odense, Denmark). Four anterior, four lateral and six posterior zones were available for examination and decision of diagnosis. Each correct examination equaled one point. The contrasting groups' method was used to set a pass/fail score. RESULTS Data were collected during the 2022 ERS Congress. We included 13 novices (N, experience: 0 TUS), 22 intermediates (I, 1-50 TUS) and 11 experienced clinicians (E, >50 TUS). Cronbach's α was 0.86. The total mean point scores in case 1 (C1) were (N) 5.0 ± 2.7, (I) 7.3 ± 2.4 and (E) 8.7 ± 1.3, and the scores in case 2 (C2) were (N) 4.5 ± 1.8, (I) 6.7 ± 2.3 and (E) 8.5 ± 2.1. Significant differences were found between N and I for C1 (p = 0.007) and C2 (p = 0.02), I and E for C1 (p = 0.04) and C2 (p = 0.019) and N and E for C1 (p < 0.001) and C2 (p < 0.001). The pass/fail score was 7 points in each case. CONCLUSION We established an IVR test that can distinguish between operators with different TUS skills. This enables a standardized, objective and evidence-based approach to assessment of TUS skills.
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Affiliation(s)
- Anders Bo Nielsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark; SimC Simulation Centre, Odense University Hospital, Odense, Denmark
| | - Jonas Dragsbæk
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Sygehus Lillebælt-Vejle, Vejle, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Amy Farr
- Educational Activities, European Respiratory Society, Lausanne, Switzerland
| | - Marek Slavicky
- Educational Activities, European Respiratory Society, Lausanne, Switzerland
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Svendborg, Denmark; UNIFY-Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Moretti A, Pietersen PI, Hassan M, Shafiek H, Prosch H, Tarnoki AD, Annema JT, Munavvar M, Bonta PI, de Wever W, Juul AD. ERS International Congress 2023: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly. ERJ Open Res 2024; 10:00836-2023. [PMID: 38410712 PMCID: PMC10895430 DOI: 10.1183/23120541.00836-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 02/28/2024] Open
Abstract
The Clinical Techniques, Imaging and Endoscopy Assembly is involved in the diagnosis and treatment of several pulmonary diseases, as demonstrated at the 2023 European Respiratory Society (ERS) International Congress in Milan, Italy. From interventional pulmonology, the congress included several exciting results for the use of bronchoscopy in lung cancer, including augmented fluoroscopy, robotic-assisted bronchoscopy and cryobiopsies. In obstructive lung disease, the latest results on bronchoscopic treatment of emphysema with hyperinflation and chronic bronchitis were presented. Research on using cryobiopsies to diagnose interstitial lung disease was further explored, with the aims of elevating diagnostic yield and minimising risk. For imaging, the latest updates in using artificial intelligence to overcome the increased workload of radiologists were of great interest. Novel imaging in sarcoidosis explored the use of magnetic resonance imaging, photon-counting computed tomography and positron emission tomography/computed tomography in the diagnostic work-up. Lung cancer screening is still a hot topic and new results were presented regarding incorporation of biomarkers, identifying knowledge gaps and improving screening programmes. The use of ultrasound in respiratory medicine is an expanding field, which was demonstrated by the large variety in studies presented at the 2023 ERS Congress. Ultrasound of the diaphragm in patients with amyotrophic lateral sclerosis and myasthenia gravis was used to assess movements and predict respiratory fatigue. Furthermore, studies using ultrasound to diagnose or monitor pulmonary disease were presented. The congress also included studies regarding the training and assessment of competencies as an important part of implementing ultrasound in clinical practice.
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Affiliation(s)
- Antonio Moretti
- Department of Pulmonology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Unit of Respiratory Diseases, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital Svendborg, Svendborg, Denmark
- Research and Innovations Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Hanaa Shafiek
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Adam Domonkos Tarnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, Oncologic Imaging and Invasive Diagnostic Centre, National Institute of Oncology, Budapest, Hungary
| | - Jouke T Annema
- Department of Pulmonology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mohammed Munavvar
- Lancashire Teaching Hospitals and University of Central Lancashire, Preston, UK
| | - Peter I Bonta
- Department of Pulmonology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Walter de Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Amanda Dandanell Juul
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
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Pietersen PI, Konge L, Bhatnagar R, Slavicky M, Rahman NM, Maskell N, Crombag L, Tabin N, Laursen CB, Nielsen AB. The European Respiratory Society led training programme improves self-reported competency and increases the use of thoracic ultrasound. Breathe (Sheff) 2023; 19:230160. [PMID: 38264206 PMCID: PMC10805265 DOI: 10.1183/20734735.0160-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/09/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Thoracic ultrasound has become a well-implemented diagnostic tool for assessment and monitoring of patients with respiratory symptoms or disease. However, ultrasound examinations are user dependent and sufficient competencies are needed. The European Respiratory Society (ERS) hosts a structured and evidence-based training programme in thoracic ultrasound. This study aimed to explore and discuss the self-reported activity and self-reported competency of the participants during the ERS course. Online surveys were sent to the training programme participants before the second part of the course (practical part of the course), and before and 3 months after the third part of the course (final certification exam). A total of 77 participants completed the surveys. The self-reported frequency of thoracic ultrasound examinations increased during the course, and in the final survey more than 90% of the participants used thoracic ultrasound on weekly basis. The self-reported competency (on technical execution of the thoracic ultrasound examination and overall competency) also increased. The ERS thoracic ultrasound training programme forms the basis of broad theoretical knowledge and sufficient practical skills that seem to lead to behavioural changes, whereby a large proportion of the participants implemented ultrasound in their clinical practice.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital – Svendborg, Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Rahul Bhatnagar
- Southmead University Hospital Bristol, Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Marek Slavicky
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine, Oxford NIHR Biomedical Research Centre, Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Laurence Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nathalie Tabin
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense Respiratory Research Unit (ODIN), Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
- SimC Simulation Centre, Odense University Hospital, Odense, Denmark
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Pietersen PI, Hertz P, Olsen RG, Møller LB, Konge L, Bjerrum F. Transfer of skills between laparoscopic and robot-assisted surgery: a systematic review. Surg Endosc 2023; 37:9030-9042. [PMID: 37875694 DOI: 10.1007/s00464-023-10472-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/17/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Robot-assisted surgery is today well-implemented in many surgical specialties, but requires another skill set than laparoscopy. Most often, robot-assisted surgery is considered add-on to laparoscopic skills but very little is known about the transfer of skills. The aim of the study was to examine to what extent surgical skills are transferable between laparoscopic and robot-assisted surgery. METHODS A systematic search was conducted in three databases (Ovid Medline, Embase, and Web of Science). Studies investigating transfer of skills between laparoscopy and robot-assisted surgery in either a phantom-based, simulation-based, animal model, or clinical setting were eligible for inclusion. Quality assessment was done using the Medical education research study quality instrument and educational New Ottawa Scale. RESULTS Of 15,610 studies identified, 89 studies continued to full-text reading, and 37 studies were included. Four studies were found non-comparable and were left out of the results for the primary outcome. All 33 studies explored transfer from laparoscopy to robot-assisted surgery and 17 found a positive transfer whereas 15 did not. Only 11 studies explored transfer from robot-assisted surgery to laparoscopy, of which only three found a positive transfer. CONCLUSION An almost equal number of publications found a positive transfer and no transfer from laparoscopic to robot-assisted surgery. Fewer studies explored the transfer from robot-assisted surgery to laparoscopy. Very little evidence supports that surgeons trained solely in robot-assisted surgery can perform laparoscopy. This must be considered in future training programs as robot-assisted surgery is expected to become the first-in-line modality for many future surgeons.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Entrance 112, 2nd floor, 5000, Odense C, Denmark.
- Simulation Center (SimC), Odense University Hospital, Odense, Denmark.
| | - Peter Hertz
- Department of Surgery, Hospital Lillebaelt, University of Southern Denmark, Kolding, Denmark
| | - Rikke Groth Olsen
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Louise Birch Møller
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Lars Konge
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bjerrum
- Center for HR & Education, The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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Valtersson J, Vogsen M, Graumann O, Pietersen PI. Image-guided percutaneous cryoablation of a solitary subpleural lung metastasis from breast cancer. BMJ Case Rep 2023; 16:e256256. [PMID: 37857535 PMCID: PMC10603477 DOI: 10.1136/bcr-2023-256256] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
This case presents CT-guided percutaneous cryoablation as a treatment option in a patient with oligometastatic breast cancer who previously had received standard-of-care treatment for metastatic breast cancer. Before cryoablation, the patient received two systemic lines of therapy, several surgeries and radiotherapy for oligometastatic disease. The cryoablation was performed in a single 7 mm subpleural oligometastatic lesion 42 months after diagnosis of metastatic breast cancer. It was performed without complications, and the patient experienced no complaints or discomfort after the procedure. A 3-month, 6-month, 9-month and 12-month follow-up fluorodeoxyglucose-positron emission tomography/CT scans showed no sign of disease progression.
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Affiliation(s)
- John Valtersson
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Diederichsen MZ, Weile KS, Christiansen CB, Pietersen PI. Cryoablation following neoadjuvant tyrosine kinase inhibitor as treatment of a T1a renal clear cell carcinoma in a patient with a solitary kidney. BMJ Case Rep 2023; 16:e252800. [PMID: 37567735 PMCID: PMC10423794 DOI: 10.1136/bcr-2022-252800] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
The case is presented of a woman in her 60s with renal cell carcinoma in a solitary kidney with normal renal function. Because of the solitary kidney status, the management strategy described in acknowledged guidelines was not possible. The patient was treated with standard first-line tyrosine kinase inhibitor followed by percutaneous CT-guided cryoablation. Before and after the procedure the patient had normal kidney function. The treatment resulted in local cancer control, but a bone metastasis developed in the thoracic part of the spine.
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Affiliation(s)
| | | | | | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Syddanmark, Denmark
- Research and Innovation Unit of Radiology - UNIFY, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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Jensen J, Graumann O, Jensen RO, Gade SKK, Thielsen MG, Most W, Pietersen PI. Using virtual reality simulation for training practical skills in musculoskeletal wrist X-ray - A pilot study. J Clin Imaging Sci 2023; 13:20. [PMID: 37559875 PMCID: PMC10408651 DOI: 10.25259/jcis_45_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Using virtual reality (VR), students of radiography can practice acquisition and positioning of musculoskeletal radiographs and get immediate feedback on their performance within the simulator. The purpose of this study was to assess usability of a newly developed VR simulator and to explore self-perceived clinical readiness (SPCR) of radiography students before and after training acquisition of wrist radiographs in the VR simulator. MATERIAL AND METHODS A prospective methodology was applied where the students (n = 10) estimated their own SPCR in regard to acquisition of wrist radiographs pre- and post-VR training. A questionnaire on usability, realism, and educational value of the simulator was answered post-VR training. Usability and SPCR scores were calculated. The student's paired t-test was applied to explore the impact of VR training on SPCR. RESULTS The students (90%) reported that the simulator was realistic and they thought that it could contribute to learning. The pre- and post-SPCR scores were 75 (95% confidence interval [CI]: 54-96) and 77 (95% CI: 59-95), respectively. There was no significant difference (P = 0.4574) between the pre- and post-SPCR scores. CONCLUSION Results indicated that the concept of training acquisition and positioning of wrist radiographs in a VR simulator is feasible with positive feedback from the students. The SPCR scores improved slightly, although not statistically significant, after completion of the training session.
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Affiliation(s)
- Janni Jensen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rune Overgaard Jensen
- Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Signe K. K. Gade
- Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Grabau Thielsen
- Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Winnie Most
- Department of Radiography, University College UCL, Odense, Denmark
| | - Pia Iben Pietersen
- Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Pietersen PI, Bhatnagar R, Rahman NM, Maskell N, Wrightson JM, Annema J, Crombag L, Farr A, Tabin N, Slavicky M, Skaarup SH, Konge L, Laursen CB. Evidence-based training and certification: the ERS thoracic ultrasound training programme. Breathe (Sheff) 2023; 19:230053. [PMID: 37492346 PMCID: PMC10365077 DOI: 10.1183/20734735.0053-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023] Open
Abstract
Thoracic ultrasound has developed into an integral part of the respiratory physician's diagnostic and therapeutic toolbox, with high diagnostic accuracy for many diseases causing acute or chronic respiratory symptoms. However, it is vitally important that the operator has received the appropriate education and training to ensure a systematic and thorough examination, correct image interpretation, and that they then have the appropriate skills to integrate all the findings for patient benefit. In this review, we present the new European Respiratory Society thoracic ultrasound training programme, including a discussion of curriculum development, its implementation, and trainee evaluation. This programme enables participants to gain competence in thoracic ultrasound through structured, evidence-based training with robustly validated assessments and certification. The training programme consists of three components: an online, theoretical part (part 1), which is accessible all year; a practical course (part 2), with four courses held each year (two online courses and two on-site courses); and an examination (part 3) comprising an objective structured clinical examination (OSCE), which is hosted each year at the European Respiratory Society Congress.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital – Svendborg, UNIFY – Research and Innovation Unit of Radiology, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, SimC – Simulation Center, Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib M. Rahman
- University of Oxford, Oxford NIHR Biomedical Research Centre, Oxford Centre for Respiratory Medicine, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - John M. Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jouke Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Laurence Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Amy Farr
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Nathalie Tabin
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Marek Slavicky
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Cuk P, Simonsen RM, Sherzai S, Buchbjerg T, Andersen PV, Salomon S, Pietersen PI, Möller S, Al-Najami I, Ellebaek MB. Surgical efficacy and learning curves of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: A retrospective two-center cohort study. J Surg Oncol 2023; 127:1152-1159. [PMID: 36933189 DOI: 10.1002/jso.27230] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/18/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND There is a potential benefit on long-term outcomes following complete mesocolic excision (CME) for right-sided colon cancer when compared to conventional colectomy. This study aims to analyze the learning curve and short-term outcomes of laparoscopic CME with intracorporeal anastomosis (ICA) for right-sided colon cancer in the hands of experienced colorectal surgeons. METHODS A two-center cohort study of consecutive patients undergoing right-sided colectomy from September 2021 to May 2022 at two tertiary colorectal centers in Denmark. Learning curves of surgical time were estimated using a cumulative sum analysis (CUSUM). RESULTS A total of 61 patients were included. According to the CUSUM analysis, 32 cases were needed to obtain a peak in operative time, resulting in a decrease in time consumption (group 1/learning phase: 217.2 min [SD 53.6] and group 2/plateau phase 191.6 min [SD 45.1], p = 0.05). There was a nonsignificant reduction in the rates of severe surgical complications (Clavien-Dindo > 3) (13% vs. 7%, p = 0.67) between the two groups, while the length of hospital stay remained constant (median 3.0 days, interquartile range, IQR [2.0; 4.0]). CONCLUSION The learning curve of laparoscopic CME with ICA for right-sided colon cancer demonstrated that 32 cases were needed to obtain a plateau phase expressed by operative time.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Selab Sherzai
- Surgical Department, Hospital of South West Jutland, Esbjerg, Denmark
| | - Thomas Buchbjerg
- Surgical Department, Odense University Hospital, Odense C, Denmark
| | | | - Søren Salomon
- Surgical Department, Odense University Hospital, Odense C, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital-Svendborg, Odense, Denmark.,Department of Radiology, Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,OPEN-Open Patient data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Issam Al-Najami
- Surgical Department, Odense University Hospital, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Mark Bremholm Ellebaek
- Surgical Department, Odense University Hospital, Odense C, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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11
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Pietersen PI, Bhatnagar R, Andreasen F, Konge L, Laursen CB, Rahman N, Nielsen AB. Objective structured clinical examination in basic thoracic ultrasound: a European study of validity evidence. BMC Pulm Med 2023; 23:15. [PMID: 36639627 PMCID: PMC9837899 DOI: 10.1186/s12890-022-02285-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Basic thoracic ultrasound is being used more frequently by clinicians in several settings due to its high diagnostic accuracy for many common causes of respiratory failure and dyspnoea. However, ultrasound examinations are operator-dependent, and sufficient competences are needed to obtain high sensitivity and specificity of examinations. Additionally, it is crucial for ultrasound operators to perceive the competence to interpret the images and integrate them into the patient history and other examinations. This study aims to explore and gather validity evidence for an objective structured clinical examination test of basic thoracic ultrasound competences and establish a pass/fail score. METHODS An expert panel created the test which included two theoretical and five practical stations representing cases with different diagnoses that cause respiratory symptoms and which are possible to establish by basic thoracic ultrasound. Twenty-five participants with different levels of experience in basic thoracic ultrasound completed the test. Data of the test scores were used for item analysis, and exploring validity evidence was done according to Messick's framework which is recommended. The contrasting groups' standard setting method was used to establish a pass/fail score. RESULTS The summarised internal consistency reliability was high with a Cronbach's alpha of 0.87. The novice group (n = 4) had a mean test score of 42 ± 10.1 points, the intermediate group (n = 8) scored 79.1 ± 8.1 points, and the experienced group (n = 13) 89.0 ± 6.2 points (one-way ANOVA, p < 0.001). A pass/fail score of 71 points was thus derived (maximum test score = 105 points). CONCLUSION We developed a test for the assessment of clinical competences in basic thoracic ultrasound with solid validity evidence, and a pass/fail standard with no false positives or false negatives.
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Affiliation(s)
- Pia Iben Pietersen
- grid.7143.10000 0004 0512 5013Department of Radiology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Entrance 112, 2nd Floor, 5000 Odense C, Denmark ,grid.7143.10000 0004 0512 5013SimC - Simulation Centre, Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- grid.416201.00000 0004 0417 1173Respiratory Medicine Department, North Bristol NHS Trust, Southmead Hospital, Bristol, UK ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, ODIN - Odense Respiratory Research Unit, University of Southern Denmark, Odense C, Denmark ,grid.5337.20000 0004 1936 7603Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Freja Andreasen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, ODIN - Odense Respiratory Research Unit, University of Southern Denmark, Odense C, Denmark ,grid.7143.10000 0004 0512 5013Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Konge
- grid.489450.4CAMES - Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | - Christian Borbjerg Laursen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, ODIN - Odense Respiratory Research Unit, University of Southern Denmark, Odense C, Denmark ,grid.7143.10000 0004 0512 5013Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Najib Rahman
- grid.454382.c0000 0004 7871 7212Oxford Centre for Respiratory Medicine, Oxford NIHR Biomedical Research Centre, Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Anders Bo Nielsen
- grid.7143.10000 0004 0512 5013SimC - Simulation Centre, Odense University Hospital, Odense, Denmark
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12
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Pietersen PI, Lynggård Bo Madsen J, Asmussen J, Lund L, Nielsen TK, Pedersen M, Engvad B, Graumann O. Multiparametric magnetic resonance imaging for characterizing renal tumors: A validation study of the algorithm presented by Cornelis et al. J Clin Imaging Sci 2023; 13:7. [PMID: 36908585 PMCID: PMC9992978 DOI: 10.25259/jcis_124_2022] [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: 10/15/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives In the last decade, the incidence of renal cell carcinoma (RCC) has been rising, with the greatest increase observed for solid tumors. Magnetic resonance imaging (MRI) protocols and algorithms have recently been available for classifying RCC subtypes and benign subtypes. The objective of this study was to prospectively validate the MRI algorithm presented by Cornelis et al. for RCC classification. Material and Methods Over a 7-month period, 38 patients with 44 renal tumors were prospectively included in the study and received an MRI examination in addition to the conventional investigation program. The MRI sequences were: T2-weighted, dual chemical shift MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced T1-weighted in wash-in and wash-out phases. The images were evaluated according to the algorithm by two experienced, blinded radiologists, and the histopathological diagnosis served as the gold standard. Results Of 44 tumors in 38 patients, only 8 tumors (18.2%) received the same MRI diagnosis according to the algorithm as the histopathological diagnosis. MRI diagnosed 16 angiomyolipoma, 14 clear cell RCC (ccRCC), 12 chromophobe RCC (chRCC), and two papillary RCC (pRCC), while histopathological examination diagnosed 24 ccRCC, four pRCC, one chRCC, and one mixed tumor of both pRCC and chRCC. Malignant tumors were statistically significantly larger than the benign (3.16 ± 1.34 cm vs. 2.00 ± 1.04 cm, P = 0.006). Conclusion This prospective study could not reproduce Cornelis et al.'s results and does not support differentiating renal masses using multiparametric MRI without percutaneous biopsy in the future. The MRI algorithm showed few promising results to categorize renal tumors, indicating histopathology for clinical decisions and follow-up regimes of renal masses are still required.
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Affiliation(s)
| | - Janni Lynggård Bo Madsen
- Research and Innovation Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jon Asmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
| | | | - Michael Pedersen
- Department of Clinical Medicine - Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | - Birte Engvad
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
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13
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Jacobsen N, Pietersen PI, Nolsoe CP, Konge L, Graumann O, Laursen CB. Response to Letter to Editor on the Article: "Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review" by Jacobsen N et al. Ultraschall Med 2022; 43:308-309. [PMID: 32736398 DOI: 10.1055/a-1219-7675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian Pállson Nolsoe
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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14
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Pietersen PI, Konge L, Jørgensen R, Stolz D, Farr A, Laursen CB. Pulmonologists’ work and clinical life during the COVID-19 pandemic: a society-led survey. Breathe (Sheff) 2022; 18:220001. [PMID: 36338252 PMCID: PMC9584574 DOI: 10.1183/20734735.0001-2022] [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: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
The continuous and ongoing coronavirus disease 2019 (COVID-19) pandemic has highly affected pulmonologists and pulmonology residents worldwide. To identify where additional work and resources must be focused, it is important to explore on what parameters the pulmonologists and residents are challenged. We present the results of a society-led survey on pulmonologists’ and pulmonology residents’ work and clinical life during the pandemic. A total of 579 pulmonologists and pulmonology residents completed the survey (5.9% of the European Respiratory Society's physician members) and most respondents answered that they have had sufficient training on how to handle patients with COVID-19 (e.g. how to handle patients to prevent virus spread). However, more than a third of the respondents (n=210, 36.3%) had performed procedures they did not feel competent in due to the pandemic and, for example, relocation to COVID-19 units. We must strive for investment in research on medical education and potentially simulation-based training in technical procedures to ensure competence and decrease the insecurity about new procedures, especially in the setting of worldwide pandemics or acute critical situations. Pulmonologists and pulmonology residents are highly affected by the COVID-19 pandemic. More than a third have performed procedures they did not feel competent in. Investment in medical education research is necessary to counter future crises and pandemics.https://bit.ly/3tiOVh0
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15
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Jacobsen N, Pietersen PI, Nolsoe C, Konge L, Graumann O, Laursen CB. Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review. Ultraschall Med 2022; 43:72-81. [PMID: 32259873 DOI: 10.1055/a-1143-3141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Contrast-enhanced ultrasound is utilized in an increasing array of medical fields, including thoracic medicine. However, the technique is still relatively new and only sporadically mentioned in current guidelines and recommendations. The aim of this systematic review is to provide a literature overview and to critically appraise the current clinical applications of contrast-enhanced thoracic ultrasound (CETUS). MATERIALS AND METHODS A systematic literature search using major electronic databases and in accordance with PRISMA guidelines was performed. Studies with a primary focus on CETUS of thoracic disorders compared to a standard reference test were included. The QUADAS-2 tool was used for quality assessment of the studies. RESULTS The search identified 43 articles: 1 randomized controlled study, 6 non-randomized controlled studies, 16 non-randomized non-controlled studies, 5 case series, 10 single case reports, and 5 animal studies. The overall risk of bias was judged to be high. Diagnostic accuracy measurements of noninvasive applications of CETUS were only reported in a few studies and they were too dissimilar for meta-analysis. Six studies compared CETUS-guided versus ultrasound-guided transthoracic needle biopsy of thoracic masses. They individually reported a significant increase in diagnostic accuracy in favor of CETUS guidance but were too heterogeneous for meta-analysis. CONCLUSION The current literature on CETUS is overall heterogeneous with a few high evidence level studies, small study populations and a high risk of bias. CETUS-guided biopsy is the most frequent clinical application and increases diagnostic accuracy compared to ultrasound guidance by an average of 14.6 percentage points.
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Affiliation(s)
- Niels Jacobsen
- Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Pia Iben Pietersen
- Regional Center for Technical Simulation (TechSim), Odense University Hospital, Odense C, Denmark
| | - Christian Nolsoe
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense C, Denmark
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16
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Jørgensen R, Laursen CB, Konge L, Pietersen PI. Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:83. [PMID: 34176508 PMCID: PMC8237454 DOI: 10.1186/s13049-021-00897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark
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17
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Pietersen PI, Jørgensen GM, Christiansen A. Systemic vascular air embolus following CT-guided transthoracic needle biopsy: a potentially fatal complication. BMJ Case Rep 2021; 14:14/5/e240406. [PMID: 33980551 PMCID: PMC8118070 DOI: 10.1136/bcr-2020-240406] [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] [Indexed: 11/04/2022] Open
Abstract
Following an uncomplicated CT-guided transthoracic biopsy, a patient becomes unconscious and subsequently dies despite immediate cardiac resuscitation. The patient felt well during the procedure but started complaining about dizziness and chest pain when he sat up. When he again was put in a supine position, cardiac arrest was noted. A CT scan performed when the symptoms initiated was afterwards rigorously reviewed by the team and revealed air located in the left ventricle, aorta and right coronary artery.We present a rare but potentially lethal complication following CT-guided transthoracic needle biopsy-systemic vascular air embolus. Knowledge and evidence about the complication are sparse because of low incidence and varying presentation. However, immediate initiation of treatment can save a life, and awareness of the complication is therefore crucial.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University, Odense, Denmark .,Simulation Center (SimC), Odense University Hospital, Odense, Denmark
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18
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Riishede M, Lassen AT, Baatrup G, Pietersen PI, Jacobsen N, Jeschke KN, Laursen CB. Point-of-care ultrasound of the heart and lungs in patients with respiratory failure: a pragmatic randomized controlled multicenter trial. Scand J Trauma Resusc Emerg Med 2021; 29:60. [PMID: 33902667 PMCID: PMC8073910 DOI: 10.1186/s13049-021-00872-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/12/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound is a focus oriented tool for differentiating among cardiopulmonary diseases. Its value in the hands of emergency physicians, with various ultrasound experience, remains uncertain. We tested the hypothesis that, in emergency department patients with signs of respiratory failure, a point-of-care cardiopulmonary ultrasound along with standard clinical examination, performed by emergency physicians with various ultrasound experience would increase the proportion of patients with presumptive diagnoses in agreement with final diagnoses at four hours after admission compared to standard clinical examination alone. METHODS In this prospective multicenter superiority trial in Danish emergency departments we randomly assigned patients presenting with acute signs of respiratory failure to intervention or control in a 1:1 ratio by block randomization. Patients received point-of-care cardiopulmonary ultrasound examination within four hours from admission. Ultrasound results were unblinded for the treating emergency physician in the intervention group. Final diagnoses and treatment were determined by blinded review of the medical record after the patients´ discharge. RESULTS From October 9, 2015 to April 5, 2017, we randomized 218 patients and included 211 in the final analyses. At four hours we found; no change in the proportion of patients with presumptive diagnoses in agreement with final diagnoses; intervention 79·25% (95% CI 70·3-86·0), control 77·1% (95% CI 68·0-84·3), an increased proportion of appropriate treatment prescribed; intervention 79·3% (95% CI 70·3-86·0), control 65·7% (95% CI 56·0-74·3) and of patients who spent less than 1 day in hospital; intervention n = 42 (39·6%, 25·8 38·4), control n = 25 (23·8%, 16·5-33·0). No adverse events were reported. CONCLUSIONS Focused cardiopulmonary ultrasound added to standard clinical examination in patients with signs of respiratory failure had no impact on the diagnostic accuracy, but significantly increased the proportion of appropriate treatment prescribed and the proportion of patients who spent less than 1 day in hospital. TRIAL REGISTRATION https://clinicaltrials.gov/ , number NCT02550184 .
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Affiliation(s)
- M Riishede
- Department of Surgery, Odense University Hospital, 5700, Svendborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark. .,Department of Internal Medicine & Emergency Medicine (M/FAM), Odense University Hospital, Valdemarsgade 53, 5700, Svendborg, Denmark. .,OPEN, Open Patient data Explorative Network, Odense University Hospital, 5000, Odense, Denmark.
| | - A T Lassen
- Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark.,Department of Emergency Medicine, Odense University Hospital, 5000, Odense, Denmark
| | - G Baatrup
- Department of Surgery, Odense University Hospital, 5700, Svendborg, Denmark.,Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark
| | - P I Pietersen
- Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, 5000, Odense, Denmark.,Regional Center for Technical Simulation (TechSim), Odense University Hospital, 5000, Odense, Denmark
| | - N Jacobsen
- Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, 5000, Odense, Denmark.,Regional Center for Technical Simulation (TechSim), Odense University Hospital, 5000, Odense, Denmark
| | - K N Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital, 2650, Hvidovre, Denmark
| | - C B Laursen
- Department of Clinical Research, University of Southern Denmark, SDU-Odense, 5000, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, 5000, Odense, Denmark
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Pietersen PI, Klap B, Hersch N, Laursen CB, Walsh S, Annema J, Gompelmann D. ERS International Congress 2020: highlights from the Clinical Techniques, Imaging and Endoscopy assembly. ERJ Open Res 2021; 7:00118-2021. [PMID: 34084779 PMCID: PMC8165368 DOI: 10.1183/23120541.00118-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022] Open
Abstract
The European Respiratory Society congress in the year 2020, a year dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, was the first virtual congress planned with an innovative and interactive congress programme upfront. It was a large, novel platform for scientific discussion and presentations of cutting-edge innovative developments. This article summarises a selection of the scientific highlights from the Clinical Techniques, Imaging and Endoscopy assembly (assembly 14). In addition to presentations on the important role of bronchoscopy, imaging and ultrasound techniques in the field of SARS-CoV-2 infection, novel diagnostic approaches and innovative therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases were discussed.
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Affiliation(s)
- Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Bibi Klap
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole Hersch
- Dept of Respiratory Medicine, St George Hospital, Sydney, Australia
| | - Christian B. Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jouke Annema
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Gompelmann
- Dept of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
- Division of Thoracic Surgery, Medial University of Vienna, Vienna, Austria
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20
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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21
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Abstract
Within the last decade, the number of technical procedures in respiratory medicine and thoracic surgery has grown and created a higher demand for effective and evidence-based education. Today, trainees are often allowed to perform procedures unsupervised on patients after obtaining a course certificate from a theoretic course and having performed a fixed number of supervised procedures. However, these methods do not ensure adequate competence. Well-structured and effective educational programmes including validated tests are needed to reduce economic expenses, optimize time spend, and ensure patient safety. The aim of this article is to summarize current state of educational strategies for technical procedures within respiratory medicine and thoracic surgery. Thus, to discuss future recommendations for curriculum development and assessment of competences based on Kern’s framework. The approach by Kern consists of six topics, which needs to be considered and evaluated and in order to educate physicians and surgeons most effective and evidence-based. We present a practical guide contributing to future educators’ considerations on (I) problem identification and general needs assessment, (II) targeted needs assessment, (III) goals and objectives, (IV) educational strategies, (V) implementation, and finally (VI) evaluation and feedback.
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Affiliation(s)
- Pia Iben Pietersen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark
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Pietersen PI, Mikkelsen S, Lassen AT, Helmerik S, Jørgensen G, Nadim G, Christensen HM, Wittrock D, Laursen CB. Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study. Scand J Trauma Resusc Emerg Med 2021; 29:40. [PMID: 33632276 PMCID: PMC7908705 DOI: 10.1186/s13049-021-00856-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a prehospital setting, the severity of respiratory symptoms in patients calling for an ambulance differ. The initial evaluation, diagnosing, and thereby management can be challenging because respiratory symptoms can be caused by disease in many organs. Ultrasound examinations can contribute with important information and support the clinical decision-making. However, ultrasound is user-dependent and requires sufficient knowledge and training. The aim of this study was to explore the quality of thoracic ultrasound examinations performed on patients by emergency medical technicians and paramedics in a prehospital, clinical setting. METHODS From November 2018 - April 2020, Danish emergency medical technicians and paramedics (n = 100) performed thoracic ultrasound examinations on patients with respiratory symptoms using a portable ultrasound device. The ultrasound examinations were stored and retrospectively assessed by a reviewer blinded to the patients' symptoms and history, as well as the emergency medical technicians' and paramedics' findings. The image quality was scored from 1 to 5. The findings determined by the reviewer was then correlated with a questionnaire filled out by the emergency medical technicians and paramedics regarding ultrasonic findings and potential change in treatment or management of the patient. The agreement in percentage and as Cohen's kappa was explored. RESULTS A total of 590 ultrasound examinations were assessed, resulting in a median image quality score of 3 (IQ1 = 4, IQ3 = 3). The overall agreement in percentage between the emergency medical technicians and paramedics and reviewer was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, and 96.3% for pleural effusion). Cohen's kappa varied from 0.01 for possible pneumothorax to 0.69 for pleural effusion. Based on the questionnaires (n = 406), the ultrasound examination entailed a change in treatment or visitation in 48 cases (11.7%) which in this study population encompasses a number-needed-to-scan of 8.5. CONCLUSION Emergency medical technicians and paramedics perform focused thoracic ultrasound examinations with adequate image quality sufficient to determine if pathology is present or not. The emergency medical technicians' and paramedics' assessment correlates to some extent with an experienced reviewer and their findings are most reliable for the inclusion of a normal scan or inclusion of pleural effusion. Implementation could possibly impact the number of patients receiving correct prehospital treatment and optimal choice of receiving facility.
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Affiliation(s)
- Pia Iben Pietersen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark.
- Regional Center for Technical Simulation, Odense University Hospital, 5000, Odense C, Denmark.
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense C, Denmark
| | - Annmarie T Lassen
- Department of Emergency Medicine, Odense University Hospital, 5000, Odense C, Denmark
| | - Simon Helmerik
- Department of Quality & Education, Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Gitte Jørgensen
- Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Giti Nadim
- Department of Emergency Medicine, Odense University Hospital, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
| | - Helle Marie Christensen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark
- Department of Respiratory Medicine, Odense University Hospital, 5000, Odense C, Denmark
| | - Daniel Wittrock
- Department of Quality & Education, Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Christian B Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark
- Department of Respiratory Medicine, Odense University Hospital, 5000, Odense C, Denmark
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Pietersen PI, Jørgensen R, Graumann O, Konge L, Skaarup SH, Lawaetz Schultz HH, Laursen CB. Training Thoracic Ultrasound Skills: A Randomized Controlled Trial of Simulation-Based Training versus Training on Healthy Volunteers. Respiration 2021; 100:34-43. [PMID: 33454705 DOI: 10.1159/000509298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. OBJECTIVES The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. METHOD A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. RESULTS Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups' performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; p = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (p = 0.009). CONCLUSIONS The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark, .,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark, .,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark, .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark,
| | - Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine, Aarhus University Hospital, Aarhus, Denmark.,MidtSim, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Henrik Lawaetz Schultz
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark.,Department of Cardiothoracic Surgery, Unit of Lung transplantation, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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d'Hooghe J, Alvarez Martinez H, Pietersen PI, Laursen CB, Hersch N, Tárnoki ÁD, Walsh S, Annema J, Gompelmann D. ERS International Congress, Madrid, 2019: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly. ERJ Open Res 2020; 6:00116-2020. [PMID: 32714969 PMCID: PMC7369474 DOI: 10.1183/23120541.00116-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/30/2020] [Indexed: 12/29/2022] Open
Abstract
This manuscript summarises the highlights from Assembly 14, "Clinical techniques, imaging and endoscopy", which were presented at the 2019 European Respiratory Society (ERS) International Congress in Madrid, Spain. Novel diagnostic approaches and innovative therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases are discussed. The authors from the different Assembly 14 subgroups focus on the key take-home messages given new study results, and place them in the context of current knowledge in these areas. At the 2019 ERS International Congress, encouraging results of numerous trials in the field of interventional pulmonology, imaging and ultrasound were presented. Key topics included novel diagnostic and therapeutic approaches in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases.
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Affiliation(s)
- Julia d'Hooghe
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Haizea Alvarez Martinez
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Christian B. Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Nicole Hersch
- Dept of Respiratory Medicine, St George Hospital, Sydney, Australia
| | - Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Dept of Radiology, Oncologic Imaging Diagnostic Center, National Institute of Oncology, Budapest, Hungary
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jouke Annema
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Gompelmann
- Dept of Pneumology and Critical Care Medicine, Thoraxklink University Heidelberg, Heidelberg, Germany
- Dept of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
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25
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Pietersen PI, Konge L, Madsen KR, Bendixen M, Maskell NA, Rahman N, Graumann O, Laursen CB. Development of and Gathering Validity Evidence for a Theoretical Test in Thoracic Ultrasound. Respiration 2019; 98:221-229. [PMID: 31137031 DOI: 10.1159/000500146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thoracic ultrasound (TUS) has a high diagnostic accuracy for many common pulmonary diseases, but theoretic knowledge in sonographic physics, thoracic anatomy and physiology, and sonopathologic patterns is required to develop competence. OBJECTIVES The aims of the study were to develop and gather validity evidence for a theoretical test in TUS and to establish a pass/fail standard. METHODS Content was provided based on expert interviews, leading to the creation of 113 initial multiple-choice question (MCQ) items. Consensus was reached on 92 proceeding items through a Delphi process, and items were presented to physicians with different knowledge and experience in TUS. Answers were used for item statistics in order to select the items with the most optimal item discrimination and difficulty (i.e., level I items) to be included in the final test. Mean scores of the novice, intermediate and experienced groups were compared, and a pass/fail score was established using the contrasting groups' standard setting method. RESULTS Item statistics revealed 38 level I items, of which 30 were selected to be included in the final test. The internal consistency was high (Cronbach's alpha = 0.88). Differences in mean scores were 8.6 points (p < 0.001), 6.3 points (p = 0.01), and 14.9 points (p < 0.001) between novices and intermediates, intermediates and experienced, and novices and experienced, respectively. A pass/fail standard of 20 points was established. CONCLUSION The established MCQ test can distinguish between physicians with different levels of competence in TUS and enables an objective, evidence-based approach for assessing the theoretical knowledge of trainees undergoing an educational programme in TUS.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark,
- Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark,
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Kristian Rørbæk Madsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Najib Rahman
- Oxford Pleural Unit and NIHR Biomedical Research Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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26
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Christiansen IS, Clementsen PF, Bodtger U, Naur TMH, Pietersen PI, Laursen CB. Transthoracic ultrasound-guided biopsy in the hands of chest physicians - a stepwise approach. Eur Clin Respir J 2019; 6:1579632. [PMID: 30815241 PMCID: PMC6383606 DOI: 10.1080/20018525.2019.1579632] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark.,TechSim - Regional Center of Technical Simulation, Odense University Hospital, Odense & Region of Southern, Denmark
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Pietersen PI, Konge L, Graumann O, Nielsen BU, Laursen CB. Developing and Gathering Validity Evidence for a Simulation-Based Test of Competencies in Lung Ultrasound. Respiration 2018; 97:329-336. [PMID: 30404101 DOI: 10.1159/000493758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 08/14/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical lung ultrasound (LUS) is a fast bedside diagnostic tool which can assist clinicians in decisions regarding the treatment and monitoring of patients with respiratory symptoms. LUS training and education differ widely, and is often done in a clinical setting, with potential risks for patients if decisions are made based on the wrong interpretations. No clear guidelines or recommendations for objective and standardized assessment of LUS skills exist, and those that do are often based on a fixed time-frame or an arbitrary number of examinations performed; this does not ensure adequate competencies. OBJECTIVES The study aimed to develop and gather validity evidence for a practical, simulation-based test in LUS. METHODS Nine cases were developed in collaboration with 3D Systems Healthcare, Littleton, CO, USA, representing the most common diagnosis and sonographic findings in patients with respiratory symptoms. Thirty-six participants with different levels of competence in LUS, completed the test. The participants were divided into groups, i.e., novices, intermediates, and experienced, according to their experience with LUS, the number of examinations they had performed, and any research they had conducted. Their answers were used for item analyses. RESULTS The intraclass correlation coefficient, Cronbachs' α, was 0.69 summarized, and there was a statistically significant difference (p < 0.001) between the novices and the trained participants (intermediates and experienced). A pass/fail score of 16 points was calculated according to the contrasting-groups method. CONCLUSION We developed a test for the assessment of clinical competencies in LUS. The test proved solid validity evidence, and a pass/fail standard without any false-negatives, and only 2 explained false-positives.
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Affiliation(s)
- Pia Iben Pietersen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark, .,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark, .,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Central Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Bjørn Ulrik Nielsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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Pietersen PI, Madsen KR, Graumann O, Konge L, Nielsen BU, Laursen CB. Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training. Crit Ultrasound J 2018; 10:23. [PMID: 30175392 PMCID: PMC6119680 DOI: 10.1186/s13089-018-0103-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 03/16/2018] [Accepted: 07/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Clinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification. Methods According to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment. Results Of 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants’ hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%). Conclusion All educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. .,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.
| | - Kristian Rørbæk Madsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Bjørn Ulrik Nielsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Christian Borbjerg Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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29
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Naur TMH, Nilsson PM, Pietersen PI, Clementsen PF, Konge L. Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Systematic Review. Respiration 2017; 93:355-362. [PMID: 28343219 DOI: 10.1159/000464331] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of simulators in a training programme for technically challenging procedures has the advantages of lowering the risk of patient complications while helping the trainees with the initial part of their learning curve. OBJECTIVES The aim of this study was to perform a systematic review of simulation-based training in flexible bronchoscopy and endobronchial ultrasound (EBUS). METHODS We identified 1,006 publications in the PubMed database and included publications on flexible bronchoscopy below the carina and EBUS involving hands-on simulation-based training. Publications were excluded if they were written in languages other than English, if paediatric airways were involved or if they were not journal articles. The screening process was performed by 2 individuals, and a third reviewer made the final decision in case of disagreement. RESULTS We included 30 publications. The studies included participants of varying experience and most commonly used a virtual reality simulator as a training modality. Assessment of the participants' skills was based on simulator metrics or on an assessment tool. Some studies included performance on patients for assessment of the operator after training on a simulator. CONCLUSIONS Simulation-based training was demonstrated to be more efficient than the traditional apprenticeship model. Physical models and virtual reality simulators complement each other. Simulation-based education should be based on a mastery learning approach and structured as directed self-regulated learning in a distributed training programme.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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Abdullah OB, Grand J, Sijapati A, Nimskov P, Nielsen FE, Schmidt JC, Pérez N, Kirkegaard T, Fløjstrup M, Brabrand M, Galthen-Sørensen M, Ramoskiene R, Arshad A, Lassen A, Teglbjærg LS, Andersen O, Jørgensen LM, Sivertsen DM, Kirk JW, Petersen J, Klausen HH, Bodilsen AC, Petersen J, Bandholm T, Haupt T, Sivertsen DM, Andersen O, Hansen CS, Pottegård A, Ekelund U, Forberg JL, Jensen HK, Lassen AT, Madsen JLB, Graumann O, Posth S, Pietersen PI, Konge L, Laursen CB, Madsen JLB, Hansen SN, Jensen KM, Brabrand M, Hasselbalch RB, Pries-Heje M, Ravn L, Lind M, Rasmussen LS, Jensen BN, Havshøj U, Henriksen DP, Brabrand M, Lassen AT, Nygaard HH, Maschmann C, Skjøt-Arkil H, Mogensen CB, Hansen LH, Wittenhoff L, Mogensen CB, Skjøt-Arkil H, Duvald I, Duvald I, Rasmussen LJH, Ladelund S, Haupt TH, Ellekilde G, Eugen-Olsen J, Andersen O, Betzer M, Lyngby R, Elkjær M, Jørgensen C, Brabrand M, Gram B, Pries-Heje MM, Hasselbalch RB, Ravn L, Lind MN, Boel T, Ulriksen PS, Jensen NH, Jensen KM, Mølleskov E, Fog IØ, Kristensen MR, Jensen E. Meeting abstracts from the 7th Danish Emergency Medicine Conference. Scand J Trauma Resusc Emerg Med 2017. [PMCID: PMC5374601 DOI: 10.1186/s13049-017-0364-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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