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Walsh MH, Balan M, Montague SJ, Butler D, Chan B, Tran A, Viau-Lapointe J, Wiseman J, Traquair H, Yu J, Lépine PA, Desy J, Friesen TB, Gaudreau-Simard M, Kolbenson L, Jayaraman D, Lubbers S, Mayette M, Sattin M, Smyth LM, Sandhu M, Spiegle G, Lacasse A, Lam AW, Wiskar K, Arishenkoff S, Wong J, Ma IWY. Canadian Internal Medicine Ultrasound (CIMUS) consensus statement: recommendations for mandatory ultrasound competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterization. Ultrasound J 2024; 16:21. [PMID: 38519740 PMCID: PMC10959885 DOI: 10.1186/s13089-024-00363-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/11/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES To develop a Canadian Internal Medicine Ultrasound (CIMUS) consensus statement on recommended mandatory point-of-care ultrasound (POCUS) competencies for ultrasound-guided thoracentesis, paracentesis, and central venous catheterizations (CVC) for internal medicine physicians. METHODS The 2022 CIMUS group consists of 27 voting members, with representations from all 17 Canadian academic institutions across 8 provinces. Members voted in 3 rounds on 46 procedural competencies as "mandatory, must include", "optional, could include" or "superfluous, do not include". These 46 competencies included 6 general competencies that apply to all POCUS-guided procedures, 11 competencies for thoracentesis, 10 competencies for paracentesis, and 19 competencies for CVC. RESULTS In the first round, members reached consensus on 27 competencies (5 general, 6 thoracentesis, 8 paracentesis, 8 CVC). In the second round, 10 competencies (1 general, 2 thoracentesis, 1 paracentesis, 6 CVC) reached consensus. In the third round, 2 additional competencies (1 paracentesis, 1 CVC) reached consensus for being mandatory and 3 as optional (1 thoracentesis and 2 CVC). Overall, a total of 28 competencies reached consensus as mandatory, 3 as optional, while 11 competencies reached consensus as superfluous. Four competencies did not reach consensus for either inclusion or exclusion. CONCLUSIONS The CIMUS group recommends 28 competencies be considered mandatory and 3 as optional for internal medicine physicians performing POCUS guided thoracentesis, paracentesis, and CVC placement. National curriculum development and implementation efforts should include training these mandatory competencies.
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Gaudreau-Simard M, Wiskar K, Kilabuk E, Walsh MH, Sattin M, Wong J, Burhani Z, Arishenkoff S, Yu J, Lam AW, Ma IWY. An overview of Internal Medicine Point-of-Care Ultrasound rotations in Canada. Ultrasound J 2022; 14:37. [PMID: 36053334 PMCID: PMC9440170 DOI: 10.1186/s13089-022-00287-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is a growing part of internal medicine training programs. Dedicated POCUS rotations are emerging as a particularly effective tool in POCUS training, allowing for longitudinal learning and emphasizing both psychomotor skills and the nuances of clinical integration. In this descriptive paper, we set out to review the state of POCUS rotations in Canadian Internal Medicine training programs. Results We identify five programs currently offering a POCUS rotation. These rotations are offered over two to thirteen blocks each year, run over one to four weeks and support one to four learners. Across all programs, these rotations are set up as a consultative service that offers POCUS consultation to general internal medicine inpatients, with some extension of scope to the hospitalist service or surgical subspecialties. The funding model for the preceptors of these rotations is predominantly fee-for-service using consultation codes, in addition to concomitant clinical work to supplement income. All but one program has access to hospital-based archiving of POCUS exams. Preceptors dedicate ten to fifty hours to the rotation each week and ensure that all trainee exams are reviewed and documented in the patient’s medical records in the form of a consultation note. Two of the five programs also support a POCUS fellowship. Only two out of five programs have established learner policies. All programs rely on In-Training Evaluation Reports to provide trainee feedback on their performance during the rotation. Conclusions We describe the different elements of the POCUS rotations currently offered in Canadian Internal Medicine training programs. We share some lessons learned around the elements necessary for a sustainable rotation that meets high educational standards. We also identify areas for future growth, which include the expansion of learner policies, as well as the evolution of trainee assessment in the era of competency-based medical education. Our results will help educators that are endeavoring setting up POCUS rotations achieve success.
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Wiskar K, Chan B, Arishenkoff S. A 78-Year-Old Male With Acute on Chronic Kidney Injury. Chest 2022; 161:e55-e58. [DOI: 10.1016/j.chest.2021.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
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Madden KM, Feldman B, Arishenkoff S, Meneilly GS. Bedside tests of muscle mass in older adults with Type 2 diabetes. AIMSMEDS 2022. [DOI: 10.3934/medsci.2022022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
<abstract><sec>
<title>Objective</title>
<p>Diabetes and sarcopenia often coexist in older adults, suggesting a possible bidirectional association. Available bedside measures of muscle mass consist of bedside ultrasound (MT, quadriceps muscle thickness) and Bioelectrical Impedance Analysis (BIA). We examined the association between ultrasound measures and BIA measures of muscle in older adults with measures of strength, performance and frailty in older adults with diabetes.</p>
</sec><sec>
<title>Design</title>
<p>Cross-sectional study.</p>
</sec><sec>
<title>Methods</title>
<p>81 subjects (age ≥ 65; mean age 80.8 ± 0.6 years, 27 women, 53 men) were recruited sequentially from geriatric medicine clinics. Each subject had Lean Body Mass (LBM, by BIA, in kg), grip strength, gait speed, Cardiovascular Health Study index (frailty) and MT (in cm) measured. All initial models were adjusted for biological sex.</p>
</sec><sec>
<title>Results</title>
<p>In our final parsimonious models, only MT (as opposed to LBM) showed a significant correlation with grip strength (Standardized β = 0.217 ± 0.078; p = 0.007) and frailty (Standardized β = 0.276 ± 0.109; p = 0.013). Neither MT or LBM showed a significant association with subject performance (gait speed).</p>
</sec><sec>
<title>Conclusions</title>
<p>Unlike BIA, bedside ultrasound measures of muscle thickness showed strong associations with both grip strength and frailty in the older adult population with diabetes, suggesting that bedside measures of MT might be a more clinically useful modality to assess muscularity in this patient population. Neither BIA or MT measures of subject muscularity showed any association with our performance indicator (gait speed).</p>
</sec></abstract>
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Affiliation(s)
- Kenneth M. Madden
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Feldman
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S. Meneilly
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ma IWY, Noble VE, Mints G, Wong T, Tonelli AC, Hussain A, Liu RB, Hergott CA, Dumoulin E, Chee A, Miller DJ, Walker B, Buchanan B, Wagner M, Arishenkoff S, Liteplo AS. On Recommending Specific Lung Ultrasound Protocols in the Assessment of Medical Inpatients with Known or Suspected Coronavirus Disease-19 Reply. J Ultrasound Med 2021; 40:2785-2786. [PMID: 33555607 PMCID: PMC8013807 DOI: 10.1002/jum.15650] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 05/15/2023]
Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of Emergency Ultrasound, Department of Emergency MedicineMassachusetts General Hospital, Boston, Harvard Medical SchoolBostonMassachusettsUSA
| | - Vicki E. Noble
- Department of Emergency MedicineUniversity Hospitals, Cleveland Medical Center, Case Western Reserve School of MedicineClevelandOhioUSA
| | - Gregory Mints
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Tanping Wong
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Ana Claudia Tonelli
- Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of MedicineUnisinos UniversitySão LeopoldoRSBrazil
| | - Arif Hussain
- Division of Cardiac Critical Care, Department of Cardiac SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Rachel B. Liu
- Section of Emergency Ultrasound, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Christopher A. Hergott
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Alex Chee
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Daniel J. Miller
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Brandie Walker
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryAlbertaCanada
| | - Brian Buchanan
- Department of Critical CareUniversity of AlbertaEdmontonAlbertaCanada
| | - Michael Wagner
- Division of Hospital Medicine, Department of MedicinePrisma Health‐UpstateGreenvilleSouth CarolinaUSA
| | - Shane Arishenkoff
- Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Andrew S. Liteplo
- Division of Emergency Ultrasound, Department of Emergency MedicineMassachusetts General Hospital, Boston, Harvard Medical SchoolBostonMassachusettsUSA
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Ma IWY, Hussain A, Wagner M, Walker B, Chee A, Arishenkoff S, Buchanan B, Liu RB, Mints G, Wong T, Noble V, Tonelli AC, Dumoulin E, Miller DJ, Hergott CA, Liteplo AS. Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the Use of Lung Ultrasound for the Assessment of Medical Inpatients With Known or Suspected Coronavirus Disease 2019. J Ultrasound Med 2021; 40:1879-1892. [PMID: 33274782 PMCID: PMC8451849 DOI: 10.1002/jum.15571] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 08/28/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Arif Hussain
- Division of Cardiac Critical Care, Department of Cardiac SciencesKing Abdulaziz Medical CityRiyadhSaudi Arabia
| | - Michael Wagner
- Division of Hospital Medicine, Department of MedicinePrisma Health–UpstateGreenvilleSouth CarolinaUSA
| | - Brandie Walker
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alex Chee
- Division of Thoracic Surgery and Interventional PulmonologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Shane Arishenkoff
- Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Brian Buchanan
- Department of Critical CareUniversity of AlbertaEdmontonAlbertaCanada
| | - Rachel B. Liu
- Section of Emergency Ultrasound, Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Gregory Mints
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Tanping Wong
- Section of Hospital Medicine, Division of General Internal Medicine, Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Vicki Noble
- Department of Emergency Medicine, University Hospitals, Cleveland Medical CenterCase Western Reserve School of MedicineClevelandOhioUSA
| | - Ana Claudia Tonelli
- Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of MedicineUnisinos UniversitySão LeopoldoBrazil
| | - Elaine Dumoulin
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Daniel J. Miller
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Christopher A. Hergott
- Division of Respiratory Medicine, Department of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Andrew S. Liteplo
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Madden KM, Feldman B, Arishenkoff S, Meneilly GS. A rapid point-of-care ultrasound marker for muscle mass and muscle strength in older adults. Age Ageing 2021; 50:505-510. [PMID: 32909032 PMCID: PMC7936023 DOI: 10.1093/ageing/afaa163] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is defined as the gradual age-associated loss of both muscle quantity and strength in older adults, and is associated with increased mortality, falls, fractures and hospitalisations. Current sarcopenia criteria use dual-energy X-ray absorptiometry (DXA) measures of muscle mass, a test that cannot be performed at the bedside, unlike point-of-care ultrasound (PoCUS). We examined the association between ultrasonic measures of muscle thickness (MT, vastus medialis muscle thickness) and measures of muscle quantity and strength in older adults. METHODS A total of 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited sequentially from geriatric medicine clinics. Each subject had lean body mass (LBM, by bioimpedance assay), grip strength, mid-arm biceps circumference (MABC), gait speed and MT measured. All initial models were adjusted for biological sex. RESULTS In our final parsimonious models, MT showed a strong significant correlation with all measures of muscle mass, including LBM (Standardised β = 0.204 ± 0.058, R2 = 0.577, P < 0.001) and MABC (Standardised β = 0.141 ± 0.067, R2 = 0.417, P = 0.038). With respect to measures of muscle quality, there was a strong significant correlation with grip strength (Standardised β = 0.118 ± 0.115, R2 = 0.511, P < 0.001) but not with subject performance (gait speed). CONCLUSIONS MT showed strong correlations with both measures of muscle mass (LBM and MABC) and with muscle strength (grip strength). Although more work needs to be done, PoCUS shows potential as a screening tool for sarcopenia in older adults.
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Affiliation(s)
- Kenneth M Madden
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Feldman
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Wong JSH, Nikoo M, Westenberg JN, Suen JG, Wong JYC, Krausz RM, Schütz CG, Vogel M, Sidhu JA, Moe J, Arishenkoff S, Griesdale D, Mathew N, Azar P. Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: protocol for an open-label, parallel-group, superiority, randomized controlled trial. Addict Sci Clin Pract 2021; 16:11. [PMID: 33579359 PMCID: PMC7881636 DOI: 10.1186/s13722-021-00220-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Buprenorphine/naloxone (Suboxone) is a current first-line treatment for opioid use disorder (OUD). The standard induction method of buprenorphine/naloxone requires patients to be abstinent from opioids and therefore experience withdrawal symptoms prior to induction, which can be a barrier in starting treatment. Rapid micro-induction (micro-dosing) involves the administration of small, frequent does of buprenorphine/naloxone and removes the need for a period of withdrawal prior to the start of treatment. This study aims to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone in patients with OUD. METHODS This is a randomized, open-label, two-arm, superiority, controlled trial comparing the safety and effectiveness of rapid micro-induction versus standard induction of buprenorphine/naloxone for the treatment of OUD. A total of 50 participants with OUD will be randomized at one Canadian hospital. The primary outcome is the completion of buprenorphine/naloxone induction with low levels of withdrawal. Secondary outcomes are treatment retention, illicit drug use, self-reported drug use behaviour, craving, pain, physical health, safety, and client satisfaction. DISCUSSION This is the first randomized controlled trial to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone. This study will thereby generate evidence for a novel induction method which eliminates substantial barriers to the use of buprenorphine/naloxone in the midst of the ongoing opioid crisis. Trial registration ClinicalTrials.gov, NCT04234191; date of registration: January 21, 2020; https://clinicaltrials.gov/ct2/show/NCT04234191.
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Affiliation(s)
- James S H Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada.
| | - Mohammadali Nikoo
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jean N Westenberg
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Janet G Suen
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Y C Wong
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Reinhard M Krausz
- Addictions and Concurrent Disorders Research Group, Institute of Mental Health, Department of Psychiatry, The University of British Columbia, 430-5950, David Strangway Building, Vancouver, BC, V6T 1Z3, Canada
| | - Christian G Schütz
- Behavioral Reward Affect + Impulsivity Neuroscience Lab, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Division of Addictive Disorders, University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jesse A Sidhu
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
| | - Nickie Mathew
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, University of British Columbia & Vancouver General Hospital, Vancouver, BC, Canada
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Madden K, Feldman B, Arishenkoff S, Meneilly G. Bedside Ultrasound Measures of Muscle Mass and Frailty Measures in Community-Dwelling Older Adults. Innov Aging 2020. [PMCID: PMC7741053 DOI: 10.1093/geroni/igaa057.861] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The age-associated loss of muscle mass and strength in older adults is called sarcopenia, and it is associated with increased rates of falls, fractures, hospitalizations and death. Sarcopenia is one of the most common physical etiologies for increased frailty in older adults, and some recent work has suggested the use of Point-of care ultrasound (PoCUS) measures as a potential measure of muscle mass. The objective of this study was to examine the association of PoCUS measures of muscle thickness (MT) with measures of frailty in community-dwelling older adults. We recruited 150 older adults (age >= 65; mean age 80.0±0.5 years, 66 women, 84 men) sequentially from 5 geriatric medicine clinics (Vancouver General Hospital). We measured lean muscle mass (LMM, by bioimpedance assay) and an ultrasonic measure of muscle quantity (MT, vastus medialis muscle thickness) in all subjects, as well as two outcome measures of frailty (FFI, Fried Frailty Index; RCFS, Rockwood Clinical Frailty Scale). In our models, MT showed an inverse correlation with the FFI (Standardized β=-0.2320±0.107, p=0.032) but no significant correlation with the RCFS (Standardized β = -0.025±0.086, p=0.776). LMM showed no significant association with either FFI (Standardized β=-0.232±0.120, p=0.055) or RCFS (Standardized β = -0.043±0.119, p=0.719). Our findings indicate that PoCUS measures show potential as a way to screen for physical manifestations of frailty and might be superior to other bedside methods such as bioimpedance assay. However, PoCUS measures of muscle thickness will likely miss patients showing frailty in the much broader context captured by the RCFS.
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Affiliation(s)
- Kenneth Madden
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Feldman
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Graydon Meneilly
- University of British Columbia, Vancouver, British Columbia, Canada
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10
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Madden KM, Feldman B, Arishenkoff S, Meneilly GS. Point-of-care ultrasound measures of muscle and frailty measures. Eur Geriatr Med 2020; 12:161-166. [PMID: 32960448 DOI: 10.1007/s41999-020-00401-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/11/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Frailty is defined as a syndrome of increased vulnerability due to both age and disease that leads to an inability to cope with acute stressors. There has been growing interest in the surgical and emergency medicine literature in the potential use of Point-of-Care ultrasonic (PoCUS) measures of muscle mass to assess frailty in older adults. Our study examined the association between a simple ultrasonic measure of muscle thickness (MT, vastus medialis muscle thickness) and commonly used frailty measures (Cardiovascular Health Study, CHS; Rockwood Clinical Frailty Scale, RCFS) in older adults. METHODS Participants were recruited sequentially from ambulatory geriatric medicine clinics in an academic medical centre (Vancouver General Hospital, Vancouver, Canada). Each subject had MT measured by PoCUS, as well as the CHS index and Rockwood Clinical Frailty Scale. RESULTS 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited. In our final parsimonious models, MT showed a weak inverse association with the CHS index (Standardized β = - 0.180 ± 0.080, R2 = 0.06, p = 0.027) and no association with the RCFS (p = 0.776). Within the CHS index, most of the association was due to grip strength in men (Standardized β = - 0.326 ± 0.099, R2 = 0.26, p = 0.001). CONCLUSION Frailty is a multifactorial syndrome, and caution must be used in trying to screen for this condition with a single ultrasonic measure. Further work might indicate associations with a more restricted syndrome, such as sarcopenia.
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Affiliation(s)
- Kenneth M Madden
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Chair in Geriatric Medicine, Gordon and Leslie Diamond Health Care Centre, Room 7185, 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada.
| | - Boris Feldman
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Graydon S Meneilly
- Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Watson K, Lam A, Arishenkoff S, Halman S, Gibson NE, Yu J, Myers K, Mintz M, Ma IWY. Point of care ultrasound training for internal medicine: a Canadian multi-centre learner needs assessment study. BMC Med Educ 2018; 18:217. [PMID: 30236101 PMCID: PMC6149066 DOI: 10.1186/s12909-018-1326-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/03/2018] [Accepted: 09/11/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND Significant gaps currently exist in the Canadian internal medicine point-of-care ultrasound (POCUS) curriculum. From a learner's perspective, it remains unknown what key POCUS skills should be prioritized. This needs assessment study seeks to establish educational priorities for POCUS for internal medicine residents at five Canadian residency training programs. METHODS All internal medicine trainees [postgraduate year (PGY) 1-5] from five internal medicine residency training programs in Canada (n = 598) were invited to complete an online survey on 15 diagnostic POCUS applications, 9 bedside procedures, and 18 POCUS knowledge items. For POCUS applications and procedures, participants were asked how applicable they are to patient care in internal medicine and the participants' reported skills in those domains. Self-reported knowledge and skills were rated on a 5-point Likert scale, where 1 = very poor and 5 = very good. Applicability was rated, where 1 = not at all applicable and 5 = very applicable. RESULTS A total of 253 of 598 residents (42%) participated in our study. Data from one centre (n = 15) was removed because of low response rate (15%) and significant baseline differences between those trainees and the remaining participants. Of the remaining analyzable data from four training programs (n = 238), participants reported highest applicability to internal medicine for the following applications and procedures: identifying ascites/free fluid [mean applicability score of 4.9 ± standard deviation (SD) 0.4]; gross left ventricular function (mean 4.8 ± SD 0.5) and pericardial effusion (mean 4.7 ± SD 0.5); thoracentesis (mean score 4.9 ± SD 0.3), central line insertion (mean 4.9 ± SD 0.3), and paracentesis (mean 4.9 ± SD 0.3), respectively. Overall reported knowledge/skills was low, with skill gaps being the highest for identifying deep vein thrombosis (mean gap 2.7 ± SD 1.1), right ventricular strain (mean 2.7 ± SD 1.1), and gross left ventricular function (mean 2.7 ± SD 1.0). CONCLUSIONS Many POCUS applications and procedures were felt to be applicable to the practice of internal medicine. Significant skill gaps exist in the four Canadian training programs included in the study. POCUS curriculum development efforts should target training based on these perceived skill gaps.
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Affiliation(s)
- Kathryn Watson
- Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Ada Lam
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Shane Arishenkoff
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Samantha Halman
- Department of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Neil E. Gibson
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Jeffrey Yu
- Department of Medicine, Western University, London, ON Canada
| | - Kathryn Myers
- Department of Medicine, Western University, London, ON Canada
| | - Marcy Mintz
- Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Irene W. Y. Ma
- Department of Medicine, University of Calgary, Calgary, AB Canada
- W21C, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
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Cessford T, Meneilly GS, Arishenkoff S, Eddy C, Chen LYC, Kim DJ, Ma IWY. Comparing Physical Examination With Sonographic Versions of the Same Examination Techniques for Splenomegaly. J Ultrasound Med 2018; 37:1621-1629. [PMID: 29219201 DOI: 10.1002/jum.14506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/11/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, Castell's method (Ann Intern Med 1967; 67:1265-1267), the sonographic Castell's method, spleen tip palpation, and the sonographic spleen tip technique were compared with reference measurements. METHODS Two clinicians trained in bedside sonography patients recruited from an urban hematology clinic. Each patient was examined for splenomegaly using conventional percussion and palpation techniques (Castell's method and spleen tip palpation, respectively), as well as the sonographic versions of these maneuvers (sonographic Castell's method and sonographic spleen tip technique). Results were compared with a reference standard based on professional sonographer measurements. RESULTS The sonographic Castell's method had greater sensitivity (91.7% [95% confidence interval, 61.5% to 99.8%]) than the traditional Castell's method (83.3% [95% confidence interval, 51.6% to 97.9%]) but took longer to perform [mean ± SD, 28.8 ± 18.6 versus 18.8 ± 8.1 seconds; P = .01). Palpable and positive sonographic spleen tip results were both 100% specific, but the sonographic spleen tip method was more sensitive (58.3% [95% confidence interval, 27.7% to 84.8%] versus 33.3% [95% confidence interval, 9.9% to 65.1%]). CONCLUSIONS Sonographic versions of traditional physical examination maneuvers have greater diagnostic accuracy than the physical examination maneuvers from which they are derived but may take longer to perform. We recommend a combination of traditional physical examination and sonographic techniques when evaluating for splenomegaly at the bedside.
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Affiliation(s)
- Tara Cessford
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane Arishenkoff
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Eddy
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke Y C Chen
- Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel J Kim
- Departments of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Irene W Y Ma
- Department of Medicine and W21C Research and Innovation Center, University of Calgary, Calgary, Alberta, Canada
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Ma IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L, Otremba M, Halman S, Willemot P, Blouw M. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2017; 32:1052-1057. [PMID: 28497416 PMCID: PMC5570740 DOI: 10.1007/s11606-017-4071-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/05/2017] [Accepted: 04/13/2017] [Indexed: 11/29/2022]
Abstract
Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.
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Affiliation(s)
- Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- W21C, University of Calgary, Calgary, AB, Canada.
| | | | | | - Janeve Desy
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Arishenkoff S, Eddy C, Roberts JM, Chen L, Chang S, Nair P, Hatala R, Eva KW, Meneilly GS. Accuracy of Spleen Measurement by Medical Residents Using Hand-Carried Ultrasound. J Ultrasound Med 2015; 34:2203-2207. [PMID: 26507695 DOI: 10.7863/ultra.15.02022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 02/10/2015] [Accepted: 03/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Easily palpable splenomegaly can be identified on physical examination, but it is difficult to detect lesser degrees of splenomegaly. Rapid bedside assessment can be conducted with hand-carried ultrasound. We performed this study to determine whether medical residents could reliably assess spleen size using hand-carried ultrasound after a brief educational intervention. METHODS Postgraduate year 1 internal medicine residents were shown a brief (45-minute) presentation on ultrasound basics, the use of hand-carried ultrasound, and principles of splenic ultrasound imaging. They practiced on each other, using hand-carried ultrasound to assess spleen size, for 1 hour in the presence of an instructor. Patients with varying degrees of splenomegaly and hospital staff were recruited at Vancouver General Hospital. A sonographer measured spleen size in each participant using conventional ultrasound. Subsequently, the trained residents scanned the participants using hand-carried ultrasound, blinded to the sonographer's measurements and the participants' diagnoses. The instructor was not present during scanning. RESULTS Twelve first-year residents (8 male and 4 female; mean age ± SEM, 28 ± 1 years; all with limited prior ultrasound training) and 19 patients and staff members (10 male and 9 female; mean age, 60 ± 4 years; body mass index, 24 ± 2 kg/m(2)) were recruited. The greatest longitudinal measurements were 14.0 ± 0.7 cm with conventional ultrasound administered by the sonographer and 13.2 ± 0.9 cm with hand-carried ultrasound administered by the residents (P > .05, not significant). The correlation between conventional and hand-carried ultrasound was r = 0.81 (P < .001). CONCLUSIONS Internal medicine residents can reliably assess spleen size at the point of care using hand-carried ultrasound with minimal training. Our findings, if replicated in other centers and in different clinical scenarios, may change the way that clinicians examine the spleen.
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Affiliation(s)
- Shane Arishenkoff
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Eddy
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark Roberts
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Luke Chen
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Silvia Chang
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Parvathy Nair
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose Hatala
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin W Eva
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Graydon S Meneilly
- Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
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