Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination.
TL;DR: The diagnostic accuracy of medical students using an HCU device after brief echocardiographic training to detect valvular disease, left ventricular dysfunction, enlargement, and hypertrophy was superior to that of experienced cardiologists performing cardiac physical examinations.
Abstract: This study compared the accuracy of cardiovascular diagnoses by medical students operating a small hand-carried ultrasound (HCU) device with that of board-certified cardiologists using standard physical examinations. Sixty-one patients (38% women; mean age 70 ± 19 years) with clinically significant cardiac disease had HCU studies performed by 1 of 2 medical students with 18 hours of training in cardiac ultrasound and physical examinations by 1 of 5 cardiologists. Diagnostic accuracy was determined by standard echocardiography. Two-hundred thirty-nine abnormal findings were detected by standard echocardiography. The students correctly identified 75% (180 of 239) of the pathologies, whereas cardiologists found 49% (116 of 239) (p
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TL;DR: This guideline states that FCU should be used as an Adjunct to Physical Examination when Echocardiography is not Promptly Available and when the patient has no alternative source of care.
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
504 citations
Cites methods from "Comparison of effectiveness of hand..."
...When used by physicians without formal echocardiographic training, FCU is superior to physical examination for the detection of cardiac abnormalities, including LV enlargement, LV systolic dysfunction, LA enlargement, LV hypertrophy, pericardial effusion, and RA pressure elevation.(30,39,49,53,58-61) 5....
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King Abdulaziz Medical City1, University of the Witwatersrand2, University of Minnesota3, King Saud University4, Harvard University5, Icahn School of Medicine at Mount Sinai6, University of Belgrade7, Beth Israel Deaconess Medical Center8, Aarhus University Hospital9, University of South Florida10, Scripps Mercy Hospital11, University Hospital of Wales12, Sydney Adventist Hospital13, Peking Union Medical College Hospital14, Apollo Hospitals15, University of South Carolina16, Cornell University17
TL;DR: 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.
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.
397 citations
Cites methods from "Comparison of effectiveness of hand..."
...Visualization of cardiac structure and function is the essence of FoCUS, so it is not surprising that FoCUS is more accurate than the physical examination for assessing LV systolic function and for detecting valvular disease.(128,190,191) Also, there is significant evidence showing that FoCUS is more accurate than ECG for determining mechanical cardiac function(43,149,177,178,183,192,193) (refer to recommendation 34)....
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TL;DR: There was strong agreement among a large cohort of international experts regarding several recommendations for the use of ultrasound in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities.
Abstract: Objective:To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites.Methods:Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the “levels” of quality of evidence into high (A), mod
362 citations
TL;DR: It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.
Abstract: A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.
292 citations
TL;DR: 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.
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.
226 citations
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TL;DR: The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population.
Abstract: The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction,.18±.06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r=.82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure. (JAMA1989;261:884-888)
929 citations
TL;DR: A need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology is suggested.
Abstract: Context. —Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically. Objective, Design, and Setting. —To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area. Participants. —A total of 453 physicians in training and 88 medical students. Interventions. —All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire. Main Outcome Measures. —Scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent. Results. —Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested ( P =.01 and.02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students. Conclusions. —Both Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.
531 citations
TL;DR: This study designed a study that could determine whether cardiac auscultation is still viewed as important for the practicing physician and that could evaluate the proficiency and teaching of cardiacAuscultatory skills.
Abstract: Objectives: To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and phy...
238 citations
TL;DR: Point-of-care echocardiography using a miniaturized echOCardiographic platform substantially improved the detection of important cardiovascular pathology compared with PE.
188 citations
TL;DR: Housestaff had difficulty establishing a correct diagnosis for simulations of three common valvular heart diseases, and teaching housestaff to elicit and interpret a few critical signs accurately may improve their physical diagnosis abilities.
Abstract: ▪Objective:To assess the cardiovascular physical examination skills of internal medicine housestaff. ▪Design:Cross-sectional assessment of housestaff performance on three valvular abnormal...
157 citations