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Olgers TJ, van Os JM, Bouma HR, ter Maaten JC. The validation of a serious game for teaching ultrasound skills. Ultrasound J 2022; 14:29. [PMID: 35870092 PMCID: PMC9308840 DOI: 10.1186/s13089-022-00280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is an important bedside diagnostic tool and is being taught in several specialties. However, mastering the required psychomotor skills takes time and learning curves are different between students. Especially learning to make the right probe movements with the corresponding changes of the ultrasound image on screen, and integrating it into a 3D mental model takes time. This precious bedside-time of trainers and physicians may be reduced using other learning methods for mastering the psychomotor skills, for example the use of serious games. Such a game is under development but it needs to be validated before widespread use can be advised. In this article we describe the development and the first three steps in the validation of a serious game for ultrasound skills. Results We have included 18 ultrasound experts and 24 ultrasound novices who played the serious game ‘Underwater” and provided feedback. They concluded that “underwater” is fun to play and that movement of the 3D-printed probe resembled real ultrasound probe movements. Participants highly valued the potential of the game for training eye–hand coordination and stability of probe handling, two very important skills in performing ultrasound in real practice. Although we compared several in-game parameters such as distance and speed, no difference was observed between novices and experts. This means that content- and face validity of the serious game is demonstrated but optimal parameters to measure differences between novices and experts still have to be determined. Conclusions Our study shows solid content- and face validity of the serious game “UnderWater” for training ultrasound skills, although construct validity could not be demonstrated yet. The game is appreciated as a promising serious game for training eye–hand coordination and learning ultrasound, which may reduce expensive bed-side teaching. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00280-8.
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Olgers TJ, Lieveld AWE, Kok B, Heijmans J, Salet D, Assman NL, Postma DF, Bauer MP, Nanayakkara PWB, Meijer K, Bosch FH, Kooistra H. Screening for asymptomatic deep vein thrombosis in COVID-19 patients admitted to the medical ward: a cross-sectional study. J Ultrasound 2022; 26:163-168. [PMID: 35567703 PMCID: PMC9107005 DOI: 10.1007/s40477-022-00689-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Patients with COVID-19 have an increased risk for venous thrombo-embolism (VTE), especially pulmonary embolism. The exact prevalence of asymptomatic DVT is not known, as is the usefulness of screening for DVT in patients admitted to ward with COVID-19. We have studied the prevalence of asymptomatic DVT. Methods We performed a cross-sectional observational multi-center study at four university medical centers in The Netherlands. All adult patients admitted with COVID-19 to a medical ward were eligible for inclusion, including patients who were transferred back from the ICU to the ward. The study protocol consisted of weekly cross-sectional rounds of compression ultrasound. Results In total, 125 patients were included in the study. A significant proportion of patients (N = 34 (27%)) had developed a VTE during their admission for COVID-19 before the study ultrasound was performed. In most VTE cases (N = 27 (79%)) this concerned pulmonary embolism. A new asymptomatic DVT was found in 5 of 125 patients (4.0%; 95% CI 1.3–9.1%) (Table 2). Nine patients (7.2%; 95% CI 3.3–13.2%) developed a VTE (all PE) diagnosed within 28 days after the screening US was performed. Conclusion We have shown a low prevalence (4%) of newly discovered asymptomatic DVT outside the ICU-setting in COVID-19 patients. Despite this low prevalence, nine patients developed PE (7%) within 28 days after ultrasound. This favors the hypothesis of local thrombus formation in the lungs. Based on our findings and literature, we do not recommend US-screening of asymptomatic patients with COVID-19 admitted to the ward.
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Affiliation(s)
- T J Olgers
- Department of Internal Medicine, Section Acute Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 970 RD, Groningen, The Netherlands.
| | - A W E Lieveld
- General and Acute Internal Medicine Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - B Kok
- Section Acute Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Heijmans
- General and Acute Internal Medicine Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D Salet
- General and Acute Internal Medicine Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - N L Assman
- Section Acute Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D F Postma
- Department of Internal Medicine, Infectious Diseases Service, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M P Bauer
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - P W B Nanayakkara
- General and Acute Internal Medicine Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - K Meijer
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F H Bosch
- Section Acute Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Kooistra
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Olgers TJ, Azizi N, Bouma HR, Ter Maaten JC. Life after a point-of-care ultrasound course: setting up the right conditions! Ultrasound J 2020; 12:43. [PMID: 32893335 PMCID: PMC7475055 DOI: 10.1186/s13089-020-00190-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Point-of-care Ultrasound (POCUS) is becoming an important diagnostic tool for internal medicine and ultrasound educational programs are being developed. An ultrasound course is often included in such a curriculum. We have performed a prospective observational questionnaire-based cohort study consisting of participants of a POCUS course for internal medicine in the Netherlands in a 2-year period. We investigated the usefulness of an ultrasound course and barriers participants encountered after the course. Results 55 participants (49%) completed the pre-course questionnaire, 29 (26%) completed the post-course questionnaire, 11 participants (10%) finalized the third questionnaire. The number of participants who performs POCUS was almost doubled after the course (from 34.5 to 65.5%). Almost all participants felt insufficiently skilled before the course which declined to 34.4% after the course. The majority (N = 26 [89.7%]) stated that this 2-day ultrasound course was sufficient enough to perform POCUS in daily practice but also changed daily practice. The most important barriers withholding them from performing ultrasound are lack of experts for supervision, insufficient practice time and absence of an ultrasound machine. Conclusions This study shows that a 2-day hands-on ultrasound course seems a sufficient first step in an ultrasound curriculum for internal medicine physicians to obtain enough knowledge and skills to perform POCUS in clinical practice but it also changes clinical practice. However, there are barriers in the transfer to clinical practice that should be addressed which may improve curriculum designing.
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Affiliation(s)
- T J Olgers
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands.
| | - N Azizi
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
| | - H R Bouma
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands.,Dept of Clinical Pharmacy and Pharmacology, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
| | - J C Ter Maaten
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
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Olgers TJ, Azizi N, Blans MJ, Bosch FH, Gans ROB, Ter Maaten JC. Point-of-care Ultrasound (PoCUS) for the internist in Acute Medicine: a uniform curriculum. Neth J Med 2019; 77:168-176. [PMID: 31264587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The use of Point-of-care Ultrasound (PoCUS) is rapidly increasing in internal medicine as it is useful in the primary assessment of acutely ill internal medicine patients for enhanced diagnostics and resuscitation. PoCUS can be taught in a modular fashion including basic core applications and advanced applications which can be combined for a symptom-based approach. Several PoCUS curriculum guidelines, especially for emergency medicine, exist throughout the world but a clear Dutch guideline for internists has not been developed. In this review we propose 'core' ultrasound competencies for internists that may also be incorporated into the European Training Requirements Internal Medicine. We suggest the use of an Entrustable Professional Activities (EPA) competencybased training system with EPAs specifically designed for ultrasound.
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Affiliation(s)
- T J Olgers
- Department of Internal Medicine, University Medical Center Groningen, the Netherlands
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Olgers TJ, Dijkstra RS, Drost-de Klerck AM, Ter Maaten JC. The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study. Neth J Med 2017; 75:106-111. [PMID: 28469050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Competency in the Airway Breathing Circulation Disability Exposure (ABCDE) approach is required for working in the emergency department. There is limited knowledge on how often and how completely the ABCDE approach is applied to medical patients. The objectives of this study were to assess the frequency with which the ABCDE approach was used in potentially unstable patients and to determine factors influencing the choice of whether or not to use the ABCDE approach. METHODS This observational pilot study included 270 medical patients admitted to the emergency department and it was observed if and how completely the ABCDE approach was performed. We registered several factors possibly determining its use. RESULTS Of the 270 patients included, 206 were identified as possibly unstable patients based on their triage code. The ABCDE approach was used in a minority of these patients (33%). When the ABCDE approach was used, it was done rapidly (generally within 10 minutes) and highly completely (> 80% of needed items). The choice not to use the ABCDE approach was frequently based on a first clinical impression and/or vital signs obtained during triage. The ABCDE approach was used more often with a higher triage code. CONCLUSIONS We show that the emergency department staff are capable of performing the ABCDE approach rather completely (83%), but it was only used in the minority of potentially unstable patients. Important factors determining this choice were the vital signs on triage and a quick first impression. Whether this adequately selects patients in need for an ABCDE approach is not clear yet.
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Affiliation(s)
- T J Olgers
- Department of Internal Medicine, Emergency Department, University Medical Centre Groningen, UMCG, Groningen, the Netherlands
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Olgers TJ, Tulleken JE, Monteban-Kooistra WE, Ligtenberg JJM, Meertens JH, Zijlstra JG. [Serious intoxication with hydroxychloroquine, with haemodynamic instability: a case report supporting treatment with diazepam]. Ned Tijdschr Geneeskd 2008; 152:509-512. [PMID: 18389886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 37-year-old woman was admitted to the emergency room because of an autointoxication with hydroxychloroquine, leading to haemodynamic instability. Treatment consisted of the rapid administration of intravenous diazepam, after which the hypotension recovered rapidly even though no vasoactive medication was given. Treatment with diazepam has been advised in the Netherlands for many years in case of severe hydroxychloroquine intoxication, despite the fact that convincing evidence for its use is lacking. On the basis of the experience with the relevant cases, the administration of diazepam, 2 mg/kg initially followed by 2 mg/kg/24 hours as a continuous infusion, should certainly be considered for supportive treatment in the ICU in case of severe haemodynamic instability.
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Affiliation(s)
- T J Olgers
- Universitair Medisch Centrum Groningen, afd. Intensive Care, Postbus 30.001, 9700 RB Groningen
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