Bridging the Technology Divide in the COVID-19 Era: Using Virtual Outreach to Expose Middle and High School Students to Imaging Technology.

Increasing the diversity of students choosing careers in science, technology, engineering, and mathematics (STEM) fields is an area of intense focus across the USA, especially in kindergarten through 12th grade (K-12)-focused pipeline programs in medical schools. A diverse STEM workforce contributes to better problem-solving and equity in health care. Two of the many major barriers for rural students are the lack of sufficient STEM role models and limited access to technology in the classroom. Medical schools often serve as an important resource for students in the local community who can easily gain access to STEM professionals and modern technology through on-campus, sponsored events and STEM outreach to the local classrooms. However, underrepresented minority (URM) students often live in socioeconomically distressed parts of rural states such as Arkansas, where access to STEM role models and technology is limited. Virtual learning in the COVID-19 era has proven that the imaging technology resources of a medical school can be harnessed to reach a wider audience, especially students living in rural areas far from the medical school campus.

The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis.

The diagnostic accuracy of emergency department (ED) ocular ultrasonography may be sufficient for diagnosing retinal detachment. We systematically reviewed the literature to determine the diagnostic accuracy of ED ocular ultrasonography for the diagnosis of retinal detachment. This review conformed to the recommendations from the Meta-analysis of Observational Studies in Epidemiology statement. An experienced medical librarian searched the following databases from their inception, without language restrictions: Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, Emergency Medical Abstracts, and Google Scholar. Content experts were contacted and bibliographies of relevant studies were reviewed to identify additional references. Evidence quality was independently assessed by 2 investigators using the revised Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Discrepancies were resolved by consensus or adjudication by a third reviewer. Diagnostic test characteristics were summarized and reported with 95% confidence intervals. Of 7,771 unique citations identified, 78 were selected for full-text review, resulting in 4 trials assessed for quality. Agreement between authors' QUADAS-2 scoring was good (κ=0.63). Three trials were deemed to have a low risk of bias. They enrolled ED-based patients (N=201) and evaluated clinician-performed bedside ocular ultrasonography, using either a 7.5- or 10-MHz linear-array probe. Two trials included patients who had retinal detachment from trauma. The prevalence of retinal detachment ranged from 15% to 38%. Sensitivity and specificity ranged from 97% to 100% and 83% to 100%, respectively. The results of the bedside ocular ultrasonography were compared with the reference standard of an ophthalmologic evaluation; one trial also included orbital computed tomography findings suggestive of retinal detachment. Bedside ocular ultrasonography has a high degree of accuracy in identifying retinal detachment, according to 3 small prospective investigations. Larger prospective validation of these findings would be valuable.

Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity.

STUDY OBJECTIVE: Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. METHODS: Prospective, single-center study conducted at an urban, academic emergency department (ED). Clinician participants included ED faculty, supervised residents, and midlevel providers who completed a training course for above-calf, 3-point-compression, venous ultrasonography. Patient participants had suspected leg deep venous thrombosis and greater than or equal to 1 predefined sign or symptom. Before any imaging, clinicians classified patients as low (<15%), moderate (15% to 40%), or high (>40%) pretest probability of deep venous thrombosis, followed by emergency clinician-performed ultrasonography. A whole-leg reference venous ultrasonography was then performed and interpreted separately in the radiology department. Patients were followed for 30 days. The criterion standard for deep venous thrombosis(+), required thrombosis of any leg vein on a reference ultrasonograph and clinical plan to treat. RESULTS: We enrolled 183 patients, and 27 (15%) had deep venous thrombosis(+). The sensitivity and specificity emergency clinician-performed ultrasonography was 70% (95% confidence interval [CI] 60% to 80%) and 89% (95% CI 83% to 94%), respectively, with overall diagnostic accuracy of 85% (95% CI 79% to 90%). The posterior probability of deep venous thrombosis(+) among the 88 low-risk patients with a negative emergency clinician-performed ultrasonographic result was 1 of 88, or 1.1% (95% CI 0% to 6%), and the posterior probability of deep venous thrombosis(+) among 14 high-risk patients with a positive emergency clinician-performed ultrasonographic result was 11 of 14, or 79% (95% CI 49% to 95%). CONCLUSION: The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.