Dataset Information

Clinical measurements obtained from point-of-care ultrasound images to assess acquisition skills.

ABSTRACT:

Background

Current methods of assessing competence in acquiring point-of-care ultrasound images are inadequate. They rely upon cumbersome rating systems that do not depend on the actual outcome measured and lack evidence of validity. We describe a new method that uses a rigorous statistical model to assess performance of individual trainees based on the actual task, image acquisition. Measurements obtained from the images acquired (the actual desired outcome) are themselves used to validate effective training and competence acquiring ultrasound images. We enrolled a convenience sample of 21 spontaneously breathing adults from a general medicine ward. In random order, two trainees (A and B) and an instructor contemporaneously acquired point-of-care ultrasound images of the inferior vena cava and the right internal jugular vein from the same patients. Blinded diameter measurements from each ultrasound were analyzed quantitatively using a multilevel model. Consistent mean differences between each trainee's and the instructor's images were ascribed to systematic acquisition errors, indicative of poor measurement technique and a need for further training. Wider variances were attributed to sporadic errors, indicative of inconsistent application of measurement technique across patients. In addition, the instructor recorded qualitative observations of each trainee's performance during image acquisition.

Results

For all four diameters, the means and variances of measurements from trainee A's images differed significantly from the instructor's, whereas those from trainee B's images were comparable. Techniques directly observed by the instructor supported these model-derived findings. For example, mean anteroposterior diameters of the internal jugular vein obtained from trainee A's images were 3.8 mm (90% CI 2.3-5.4) smaller than from the instructor's; this model-derived finding matched the instructor's observation that trainee A compressed the vein during acquisition. Instructor summative assessments agreed with model-derived findings, providing internal validation of the descriptive and quantitative assessments of competence acquiring ultrasound images.

Conclusions

Clinical measurements obtained from point-of-care ultrasound images acquired contemporaneously by trainees and an instructor can be used to quantitatively assess the image acquisition competence of specific trainees. This method may obviate resource-intensive qualitative rating systems that are based on ultrasound image quality and direct observation, while also helping instructors guide remediation.

SUBMITTER: Lucas BP

PROVIDER: S-EPMC6638581 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical measurements obtained from point-of-care ultrasound images to assess acquisition skills.

Lucas Brian P BP D'Addio Antonietta A Block Clay C Manning Harold L HL Remillard Brian B Leiter James C JC

The ultrasound journal 20190222 1

<h4>Background</h4>Current methods of assessing competence in acquiring point-of-care ultrasound images are inadequate. They rely upon cumbersome rating systems that do not depend on the actual outcome measured and lack evidence of validity. We describe a new method that uses a rigorous statistical model to assess performance of individual trainees based on the actual task, image acquisition. Measurements obtained from the images acquired (the actual desired outcome) are themselves used to valid ...[more]

PMID: 31359267

Similar Datasets

Project description:Few studies have compared the effectiveness of brief training courses on point-of-care ultrasound (POCUS) skill acquisition of novice attending physicians vs. trainees. The purpose of this study was to evaluate the change in POCUS image interpretation skills and confidence of novice attending physicians vs. trainees after a 1-day POCUS training course.A 1-day POCUS training course was held in March 2017 in Japan. A standardized training curriculum was developed that included online education, live lectures, and hands-on training. The pre-course assessment tools included a written examination to evaluate baseline knowledge and image interpretation skills, and a physician survey to assess confidence in performing specific ultrasound applications. The same assessment tools were administered post-course, along with a course evaluation. All learners were novices and were categorized as trainees or attending physicians. Data were analyzed using two-way analysis of variance.In total, 60 learners attended the course, and 51 learners (85%) completed all tests and surveys. The 51 novice learners included 29 trainees (4 medical students, 9 PGY 1-2 residents, 16 PGY 3-5 residents) and 22 attending physicians (6 PGY 6-10 physicians, and 16 physicians PGY 11 and higher). The mean pre- and post-course test scores of novice trainees improved from 65.5 to 83.9% while novice attending physicians improved from 66.7 to 81.5% (p?<?0.001). The post-course physician confidence scores in using ultrasound significantly increased in all skill categories for both groups. Both trainees and attending physicians demonstrated similar improvement in their post-course test scores and confidence with no statistically significant differences between the groups. The course evaluation scores for overall satisfaction and satisfaction with faculty members' teaching skills were 4.5 and 4.6 on a 5-point scale, respectively.Both novice trainees and attending physicians showed similar improvement in point-of-care ultrasound image interpretation skills and confidence after a brief training course. Although separate training courses have traditionally been developed for attending physicians and trainees, novice learners of point-of-care ultrasound may acquire skills at similar rates, regardless of their ranking as an attending physician or trainee. Future studies are needed to compare the effectiveness of short training courses on image acquisition skills and determine the ideal course design.

Project description:BackgroundRehabilitation is the key to management of patients with subacromial impingement syndrome to prevent disability and loss of function. While point-of-care musculoskeletal ultrasound aids clinical diagnosis of subacromial impingement syndrome, many patients do not demonstrate the classic findings of dynamic supraspinatus tendon impingement beneath the acromion on ultrasound. The objective of this study was to establish the most reliable shoulder ultrasound measurements for subacromial impingement, by evaluating the intra-rater and inter-rater reliability of measurements in asymptomatic participants.MethodsEighteen participants (9 women, 9 men, mean ± standard deviation: 34.6 ± 7.9 years of age) underwent bilateral shoulder ultrasound evaluations with measurements for subacromial impingement (acromiohumeral distance, acromion-greater tuberosity distance, supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness) performed by two sports medicine physicians. Intra-class coefficients were calculated to determine the intra- and inter-rater reliability of shoulder ultrasound images and measurements.ResultsIntra-rater reliability for acromiohumeral distance (0.76-0.79), supraspinatus tendon (0.91-0.95), subacromial-subdeltoid bursa (0.76-0.84), and subacromial-subdeltoid bursal fluid thickness (0.75-0.81) was found to be good to excellent, whereas inter-rater reliability ranged from poor to moderate.ConclusionsAcromiohumeral distance in neutral position and short axis ultrasound measurements of supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness in the modified Crass position were the most reliable for subacromial impingement in asymptomatic participants. We recommend validation of these measurements in a symptomatic population to aid diagnosis and direct rehabilitation of patients with suspected subacromial impingement, and to increase point-of-care ultrasound uptake, availability, and training among rehabilitation professionals across health systems.

Project description:BackgroundPainful arthropathy is a long-term complication in patients with hemophilia (PWH), affecting mobility and quality of life. A major barrier for the appraisal of joint health is the absence of point-of-care (POC) imaging modalities to promptly identify and manage arthropathic changes. Accordingly, we developed the Joint tissue Activity and Damage Exam (JADE) POC musculoskeletal ultrasound (MSKUS) protocol. JADE is validated for haemophilic joint tissue recognition with high intra/inter-rater and inter-operator reliability.AimsEvaluate associations of JADE with clinical (Hemophilia Joint Health Score, [HJHS]) and functional (total arc [combined flexion and extension range of motion [ROM]]) parameters.MethodologyIn this multi-centre prospective study, we recruited PWH A or B with at least one arthropathic joint. We evaluated joint health (both elbows, knees, and ankles) by comparing JADE measurements (soft tissue and cartilage thickness, and osteochondral alterations) with HJHS and total arc.ResultsOf 44 PWH, most had hemophilia A (35/44), were severe (36/44) and had a median age of 36 years. Increasing HJHSs and declining total arc, indicating worsening arthropathy, were associated with JADE measurements in the expected direction, including (1) increasing length of osteochondral alterations, (2) diminished cartilage thickness, and (3) greater soft tissue expansion. The ankles had the highest proportion of joints without measurable (missing) cartilage. In multivariable models MSKUS measurements explained 68% and 71% of the variation in HJHS and total arc respectively for the elbow, 55% and 29% respectively for the knee, and 50% and 73% for the ankle.ConclusionsThis study highlights the associations of direct intra-articular ultrasonography measurements using the JADE protocol with clinical and functional parameters. Our findings underscore the clinical value of POC MSKUS using the JADE protocol as a complementary instrument for the diagnosis and management of haemophilic arthropathy.

Project description:BackgroundLimited studies have evaluated the use of ultrasound for detection of intracerebral hemorrhage (ICH) using diagnostic ultrasound Transcranial Doppler machines in adults. The feasibility of ICH detection using Point of care Ultrasound (POCUS) machines has not been explored. We evaluated the feasibility of using cranial POCUS B mode imaging performed using intensive care unit (ICU) POCUS device for ICH detection with a secondary goal of mapping optimal imaging technique and brain topography likely to affect sensitivity and specificity of ICH detection with POCUS.Materials and methodsAfter obtaining IRB approval, a blinded investigator performed cranial ultrasound (Fujifilm, Sonosite® Xporte, transcranial and abdominal presets) through temporal windows on 11 patients with intracerebral pathology within 72 h of last CT/MRI (computed tomography scan/magnetic resonance imaging) brain after being admitted to a neurocritical care unit in Aug 2020 and Nov 2020-Mar 2021. Images were then compared to patient's CT/MRI to inform topography. Inferential statistics were reported.ResultsMean age was 57 (28-77 years) and 6/11 were female. Six patients were diagnosed with ICH, 3 with ischemic stroke, 1 subarachnoid hemorrhage, and 1 brain tumor. The sensitivity and specificity of point of care diagnosis of ICH compared to CT/MRI brain was 100% and 50%, respectively. Mean time between ultrasound scan and CT/MRI was 13.3 h (21 min-39 h). Falx cerebri, choroid calcification and midbrain-related artifacts were the most reproducible hyperechoic signals. Abdominal preset on high gain yielded less artifact than Transcranial Doppler preset for cranial B mode imaging. False positive ICH diagnosis was attributed to intracerebral tumor and midbrain-related artifact.ConclusionsOur exploratory analysis yielded preliminary data on use of point of care cranial ultrasound for ICH diagnosis to inform imaging techniques, cranial topography on B mode and sample size estimation for future studies to evaluate sensitivity and specificity of cranial POCUS in adult patients. This pilot study is limited by small sample size and over representation of ICH in the study. Cranial POCUS is feasible using POCUS machines and may have potential as a screening tool if validated in adequately powered studies.

Project description:BackgroundIn Japan, the nurse practitioner (NP) system has only been in place for a short time, and there is no ultrasound (US) simulation course for NPs. Therefore, NPs may have to attend US simulation courses for physicians. We evaluated whether US simulation course for physicians lead to improved image acquisition and interpretation amongst NPs and, if so, if these changes would be maintained over time.MethodsA 2-day point-of-care ultrasound (POCUS) course designed for physicians in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners (JNP) and JNP trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence.ResultsThirty-three participants from 21 facilities completed the program. Before and immediately after the course, test scores of the image interpretation test, image acquisition test, and confidence increased significantly (37.1, 72.6: P < 0.001), (13.7, 53.6: P < 0.001), and (15.8, 35.7: P < 0.001), respectively. Comparing the follow-up tests immediately after the course and 4 months later, there was no decrease in scores on the image interpretation test, the image acquisition test, or confidence (72.6, 71.8: P = 1.00) (53.6, 52.9: p = 1.00) (35.7, 33.0: P = 0.34). There was a statistically significant increase (P < 0.001) in both the total number of ultrasound examinations and in the number of ultrasound examinations by category (cardiac, lung, lower extremity DVT, and abdominal) in the 3 months before and 3 months after the course.ConclusionsThe POCUS simulation course for physicians is useful for JNPs to acquire US examination skills even if it is not arranged for JNPs. Image interpretation skill, image acquisition skill, and confidence improved significantly and were maintained even after 4 months of the course. It leads to behavioral changes such as increasing the number of US examinations in daily practice after the course.

Dataset Information

Clinical measurements obtained from point-of-care ultrasound images to assess acquisition skills.

Background

Results

Conclusions

Publications

Clinical measurements obtained from point-of-care ultrasound images to assess acquisition skills.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets