Rachel L. Israel

Bio: Rachel L. Israel is an academic researcher. The author has contributed to research in topics: Inferior vena cava & Outpatient clinic. The author has an hindex of 1, co-authored 1 publications receiving 136 citations.

Is pocket mobile echocardiography the next-generation stethoscope? A cross-sectional comparison of rapidly acquired images with standard transthoracic echocardiography.

Abstract: Background A pocket mobile echocardiography (PME) device is commercially available for clinical use, but public data documenting its accuracy compared with standard transthoracic echocardiography (TTE) are not available. Objective To compare the accuracy of rapidly acquired PME images with those acquired by standard TTE. Design Cross-sectional study. At the time of referral for TTE, ultrasonographers acquired PME images first in 5 minutes or less. Ultrasonographers were not blinded to the clinical indication for imaging or to the PME image results when obtaining standard TTE images. Two experienced echocardiographers and 2 cardiology fellows who were blinded to the indication for the study and TTE results but not to the device source interpreted the PME images. Setting Scripps Clinic Torrey Pines and Scripps Green Hospital, La Jolla, California. Patients Convenience sample of 97 patients consecutively referred for echocardiography. Measurements Visualizability and accuracy (the sum of proportions of true-positive and true-negative readings and observer variability) for ejection fraction, wall-motion abnormalities, left ventricular end-diastolic dimension, inferior vena cava size, aortic and mitral valve pathology, and pericardial effusion. Results Physician-readers could visualize some but not all echocardiographic measurements obtained with the PME device in every patient (highest proportions were for ejection fraction and left ventricular end-diastolic dimension [95% each]; the lowest proportion was for inferior vena cava size [75%]). Accuracy also varied by measurement (aortic valve was 96% [highest] and inferior vena cava size was 78% [lowest]) and decreased when nonvisualizability was accounted for (aortic valve was 91% and inferior vena cava size was 58%). Observer agreement was fair to moderate for some measurements among less-experienced readers. Limitation The study was conducted at a single setting, there was no formal estimate of accuracy given the small convenience sample of patients, and few abnormal echocardiographic measurements occurred. Conclusion The rapid acquisition of images by skilled ultrasonographers who use PME yields accurate assessments of ejection fraction and some but not all cardiac structures in many patients. Further testing of the device in larger patient cohorts with diverse cardiac abnormalities and with untrained clinicians obtaining and interpreting images is required before wide dissemination of its use can be recommended. Primary funding source National Institutes of Health.

Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.

Abstract: 1. Why is a guideline needed? 567 2. Definitions 568 a. What is FCU? 568 b. Terminology 568 3. Differentiation of FCU and ‘‘Limited TTE’’ 568 a. Examination Expectations 569 b. Equipment 570 c. Image Acquisition 570 d. Image Interpretation 570 e. Billing 571 4. Considerations for Successful Use of FCU as an Adjunct to Physical Examination 571 a. Personnel 571 b. Equipment 571 c. Potential Limitations of FCU 572 5. FCU Scope of Practice 573 a. FCU When Echocardiography is Not Promptly Available 573 b. FCU When Echocardiography is Not Practical 574

International Evidence-Based Recommendations for Focused Cardiac Ultrasound

Abstract: Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.

Point-of-care ultrasound in medical education--stop listening and look.

Abstract: With some clinical studies indicating that diagnostic ultrasonography can be superior to the physical exam, several U.S. medical schools now offer ultrasound training early in the undergraduate curriculum — though not everyone agrees on the wisdom of that approach.

Novel Wireless Devices for Cardiac Monitoring

Abstract: The digital revolution and the rapid development of smartphones, mobile connectivity, and social networking have changed the way we live. The average American is constantly connected via high bandwidth to a vast network of data and sophisticated digital platforms, with >90% of American adults owning a cell phone and 55% having a smartphone.1 The digital revolution has transformed virtually every industry and every facet of our personal lives but has been conspicuously absent from the world of medicine. Physicians and healthcare networks have been slow to adopt electronic medical records and to integrate medical data with the ubiquitous mobile device. Recently, however, novel devices for wireless monitoring have emerged and begun to be integrated with the care of the cardiac patient. We believe that the evolution of these wireless cardiac monitoring devices will mark a new era in medicine and a transition from population-level health care to individualized medicine in which suitable patients are equipped with advanced biosensors that, in turn, have their data processed through sophisticated algorithms to predict events before they occur. This review is meant to be a comprehensive overview of the novel wireless cardiac monitoring devices that are available, as well as the technologies that are currently under development and poised to revolutionize the way we practice cardiology. A comprehensive list of a number of devices that are currently available or under development is given in the Table for reference. View this table: Table. Comprehensive Overview of Existing Wireless Cardiac Monitoring Devices Cardiac arrhythmias such as atrial fibrillation are common and can be associated with adverse outcomes such as embolic stroke. Less common but more malignant rhythm disorders such as ventricular tachycardia can herald sudden cardiac death.2 The identification and management of arrhythmias in the patient with palpitations, syncope, a history of arrhythmia, or high risk for sudden …