Development of transition metal oxide platforms for aptasensing of PSA in cell cultures.

In this study, a novel aptasensor based on a transition metal oxide-modified pencil graphite electrode (PGE) was developed for the diagnosis of early-stage prostate cancer (PCa) via monitoring the prostate-specific antigen (PSA), which is the main biomarker for PCa. Single-use PGEs modified with pulsed deposited manganese oxide (MnOx) film were used to attach the amino-terminated aptamer specific to the PSA via carbodiimide chemistry. The designed aptasensor was placed in an electrochemical cell containing ferri/ferrocyanide ions as a redox probe to measure the charge transfer resistances (Rct) of the electrode surface by electrochemical impedance spectroscopy (EIS) to follow the response of each modification step. The effect of the medium pH on the ionic structure of the aptamer molecule according to its pI value and, thus, the reversing of the direction of the response (ΔRct) by the pH change was also discussed. The level of PSA secreted from PCa cells was investigated using impedimetric transduction. The specificity of the aptasensor was validated through selectivity studies against non-specific tumor markers like VEGF and different cancer cell lines including breast cancer and androgen-insensitive prostate cancer. The developed system showcases a label-free, fast, specific, and cost-effective approach for PSA detection, highlighting the importance of medium pH and the electrostatic environment on the aptamer's response. Our work emphasizes the potential for such aptasensors in clinical diagnostics and paves the way for further exploration into using transition metal oxides in biosensing applications.

The effects of gestational diabetes on lower urinary tract symptoms of pregnant women: a case-control study.

Gestational diabetes mellitus (GDM) and lower urinary tract symptoms (LUTS) are common health problems in pregnant women. The aim of this case-control study was to evaluate the effects of GDM on LUTS in pregnant women. This study was conducted with 44 pregnant women diagnosed with GDM and 44 pregnant without GDM. Patients with GDM had significantly lower likelihood of experiencing urgency (7.069-fold lower likelihood); whereas they had significantly greater likelihoods for urinary incontinence (UI) during sexual intercourse (OR: 0.185; 5.4-fold higher), need for clothing change due to UI (OR: 0.268; 3.7-fold higher), and adverse effects on daily life due to UI (OR: 0.338; 2.9-fold higher) compared to women without GDM (p < .05 for all). Although pregnant women with GDM appear to have a lower likelihood of urgency, this may be associated with the adverse effects of GDM since the likelihoods for UI-related outcomes were increased and quality of life was reduced among pregnant women with GDM compared to those without GDM.Impact statementWhat is already known on this subject? Lower urinary tract symptoms (LUTS) are very common among pregnant women, and negatively affect social, sexual and working life. There are many risk factors that affect the development of LUTS in pregnant women. It is stated that gestational diabetes mellitus (GDM) may be a predisposing factor in the development of LUTS in women.What do the results of this study add? Women with GDM experienced storage symptoms at a lower frequency (especially urgency) compared to the control group. In addition, we determined worse quality of life among women with GDM who experienced a greater frequency of urinary incontinence.What are the implications of these findings for clinical practice and/or further research? It may be beneficial to provide training on the prevention and management of LUTS to all pregnant women, especially women with GDM, and to increase the sensitivity of health professionals on the subject.

Relationship between menopausal symptoms and sleep quality in women during the climacteric period: a cross-sectional study.

The aim of this study was to evaluate the relationship between the menopausal symptoms and sleep quality in women in the climacteric period. This cross-sectional study was conducted on 383 women aged 40-64 years at the Cancer Early Diagnosis Screening and Training Centre. The data were collected with the questionnaire form, Menopause Rating Scale (MRS) and the Pittsburgh Sleep Quality Index (PSQI). The sleep quality was poor in 77.8% of the women in the study. A significant relationship was found between PSQI scores and the somatic and psychological subscale scores of the MRS in the presence of other variables that could affect sleep according to multiple linear regression analysis (p < .05). We recommend training and consulting services provided by health care professionals and further experimental studies on the subject to decrease the negative effects of the somatic and psychological symptoms found to worsen sleep quality in women in the climacteric period. IMPACT STATEMENTWhat is already known on this subject? Sleep problems are a common health problem in women in the climacteric period.What do the results of this study add? The most common menopausal symptoms were joint and muscle problems, physical and emotional fatigue, nervousness, hot flushes, unhappiness, anxiety, and sleep problems in order of frequency. There was a weak positive significant relationship between the total PSQI score and the psychological and urogenital subscale scores of the MRS, in addition to a moderate positive significant relationship between the total PSQI scores and the total and somatic subscale scores of the MRS.What are the implications of these findings for clinical practice and/or further research? We believe effective management of the somatic and psychological symptoms during the climacteric period with health care staff providing training and consultancy services to the women aimed at decreasing the symptoms according to evidence-based procedures could help improve the sleep quality. Conducting multicenter studies with a larger subject group where the effect of menopausal symptoms on sleep quality in addition to that of multifactorial causes are evaluated in depth is recommended.

Accuracy of Emergency Physicians for Detection of Regional Wall Motion Abnormalities in Patients With Chest Pain Without ST-Elevation Myocardial Infarction.

OBJECTIVES: Our aim was to evaluate the accuracy of emergency physicians (EPs) in the detection of regional wall motion abnormalities (RWMAs) using focused cardiac ultrasound (FOCUS) in patients suspected of non-having ST-elevation myocardial infarction. METHODS: We prospectively enrolled patients with chest pain. Three EPs underwent didactics and hands-on-training, of 3 hours each, by an experienced cardiologist, on detecting RWMAs using 2-dimensional echocardiography. They performed a FOCUS examination to evaluate for RWMAs and recorded the echo images. Our reference standard for the detection of RWMAs was accepted as a blinded cardiologist review of the prerecorded video clips. We calculated the corrected sample size and inter-rater agreement between the EPs (82 and 0.83, respectively). The analysis of the study was performed on 89 patients. RESULTS: Eighty-nine patients with chest pain were screened. Emergency physicians demonstrated the detection of RWMAs with good sensitivity and even excellent specificity: 76.9% (95% confidence interval [CI], 56.4%- 91.0%) and 92.1% (95% CI, 82.4%-97.4%), respectively. The accuracy of FOCUS was 87.6% (95% CI, 79.0%-93.7%). The area under the curve from a receiver operating characteristic curve analysis, which evaluated the EPs' rate of detecting the presence or absence of RWMAs, was 0.845 (95% CI, 0.753-0.913). CONCLUSIONS: Our study results suggest that EPs with training in bedside echocardiography can accurately rule in patients with RWMAs in suspected non-ST-elevation myocardial infarction cases.

Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards.

BACKGROUND: Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed. OBJECTIVE: The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users ("why"), content and data ("what"), and analyses and displays ("how" they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards. METHODS: We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question. RESULTS: A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are "close to home"; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues. CONCLUSIONS: COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified.

Post-Traumatic Stress Disorder and Affecting Factors in Pregnant Women in the COVID-19 Pandemic.

BACKGROUND: Post-traumatic stress disorder (PTSD) causes adverse obstetric outcomes in pregnants. COVID-19 pandemic can cause PTSD symptoms in pregnant women. This descriptive study aims to determine the post-traumatic stress disorder and affecting factors in pregnant women in the COVID-19 pandemic. SUBJECTS AND METHODS: A total of 445 pregnant women completed "Data Collection Form" and "DSM-5 Post-Traumatic Stress Disorder Checklist (PCL-5)". RESULTS: The mean total PCL-5 score of the pregnant women was found to be 57.27±17.90. There was a significant difference between PCL-5 and gestational week, parity, the idea that the COVID-19 outbreak would cause a problem in childbirth, the presence of a COVID-19 in one of the family members/a loved one, the status of following COVID-19 - related developments (p<0.05). CONCLUSIONS: It is important for health professionals to evaluate the psychological effects of the pandemic in pregnants during antenatal period.

Aptamer-based electrochemical biosensing strategy toward human non-small cell lung cancer using polyacrylonitrile/polypyrrole nanofibers.

In the present study, a sensitive electrochemical aptamer-based biosensing strategy for human non-small cell lung cancer (NSCLC) detection was proposed using nanofiber-modified disposable pencil graphite electrodes (PGEs). The composite nanofiber was comprised of polyacrylonitrile (PAN) and polypyrrole (PPy) polymers, and fabrication of the nanofibers was accomplished using electrospinning process onto PGEs. Development of the nanofibers was confirmed using scanning electron microscopy (SEM). The high-affinity 5'-aminohexyl-linked aptamer was immobilized onto a PAN/PPy composite nanofiber-modified sensor surface via covalent bonding strategy. After incubation with NSCLC living cells (A549 cell line) at 37.5 °C, the recognition between aptamer and target cells was monitored by electrochemical impedance spectroscopy (EIS). The selectivity of the aptasensor was evaluated using nonspecific human cervical cancer cells (HeLa) and a nonspecific aptamer sequence. The proposed electrochemical aptasensor showed high sensitivity toward A549 cells with a detection limit of 1.2 × 103 cells/mL. The results indicate that our label-free electrochemical aptasensor has great potential in the design of aptasensors for the diagnostics of other types of cancer cells with broad detection capability in clinical analysis. Graphical abstract.

Aptamer-based electrochemical nanobiosensor for research and monitoring of multiple sclerosis in mice models.

Multiple sclerosis (MS) is a severe progressive autoimmune-inflammatory, demyelinating process in the central nervous system (CNS) with heterogeneous neurological symptoms appearing as a consequence of myelin break down. Myelin basic protein (MBP) makes up to 30 % of the CNS myelin [1] and it is known to be released into the cerebrospinal fluid (CSF) as a bioindicator of MS. Autoimmune encephalomyelitis (EAE) is a mice model of MS widely used for research and development of new treatments [2]. Herein, MBP specific aptamer developed for possible therapeutic purposes in mouse model [3] was applied as a bioreceptor for MBP recognition. A nanobiosensor for MBP detection and monitoring was developed by using graphene oxide (GO) nanoparticles integrated onto the screen-printed carbon electrodes (SPCE) and aptamer immobilized to create a bioactive layer on the sensor surface for MBP binding. The measurements were carried out using electrochemical impedance spectrometry (EIS). Validation studies were carried out in a biological matrix (artificial CSF) containing MBP, and MSA. The aptasensor had LOD in artificial CSF 0.01 ng/mL and showed its usability in the concentration range of 0.01 … 64 ng/mL.

Simultaneous detection of ovarian cancer related miRNA biomarkers with carboxylated graphene oxide modified electrochemical biosensor platform.

Ovarian cancer, known as "silent killer", is a gynocological cancer with high mortality that usually diagnosed in the late stages. Gold standard immunoassay technique is evaluation of CA-125 levels which is not merely specific to ovarian cancer. Therefore, there is a need for sensitive determination of more specific biomarkers. miR-200 family is RNA nucleic acids that known to be upregulated in the presence of ovarian cancer. Since diagnosis based on a single biomarker is prone to generate misleading results, it is important to develop point-of-care systems that allow diagnosis of multiple miRNAs. Herein, an electrochemical nanobiosensor platform was developed for the multiplexed and simultaneous detection of miR-200c and miR-141. Biorecognition part was constitutued of methylene blue and ferrocene labeled hairpin DNA probes immobilized onto carboxylated graphene oxide modified pencil graphite electrodes. Their hybridization with miRNAs were examined upon "signal-off" approach using Square Wave Voltammetry. The platform demonstrated a linear detection range of 0.1 pM to 10 nM for both miR-141 and miR-200c, with low detection limits of 0.029 pM and 0.026 pM, respectively. We assume that the developed biosensor platform may pave the way in early diagnosis of the disease and the development of more effective treatment strategies.

Demyelination detection in CSF based on electrochemical monitoring of myelin basic protein in comparison between Apta vs. Immuno sensing strategies.

Multiple sclerosis (MS) is a recurrent inflammatory, demyelinating disease of the white matter in central nervous system (CNS). The number of MS patients is increasing, but the diagnostic process is still quite difficult, costly and requires combination of several methods. Myelin basic protein (MBP) makes up to 30 % of the myelin in CNS. It is known that MBP is released into the cerebrospinal fluid (CSF) as MS bioindicator. Herein, myelin specific DNA aptamer earlier developed for possible therapeutic purposes and anti-MBP antibody were applied as bioreceptors for MBP recognition on the same nanomodified sensor surfaces and their performances were compared. Biosensors were developed by using graphene oxide (GO) nanoparticles integrated onto pencil graphite electrodes (PGE) and bioreceptor molecules immobilized to create a bioactive layer for MBP binding. The measurements were run with electrochemical impedance spectroscopy (EIS). Selectivity of the biosensors was evaluated using human serum albumin (HSA). After optimization of binding parameters, biosensors were validated in artificial CSF. It was shown that LJM-5708 based aptasensor had LOD 0.65 ng/mL that was comparable to immunosensor LOD (0.36 ng/mL) in artificial CSF and showed its applicability in the clinical concentration range between 1 and 128 ng/mL.

Ultrasonography of jugular vein as a marker of hypovolemia in healthy volunteers.

BACKGROUND: Our aim in this study was to use ultrasonography of internal jugular vein (IJV) instead of visual estimation by eye and to get more precise estimation of central venous pressure at supine position for estimating blood loss in healthy volunteers. METHODS: The values of the sonographic IJV collapse index and corrected IJV longitudinal length (cIJV LL) (vertical height of the jugular vein from the sternal angle of Louis plus 5 cm) were compared before and after blood donation. The correlations between the mean arterial pressure, pulse rate, IJV collapse index, and cIJV LL were analyzed using SPSS version 15.0 (SPSS, Chicago, IL) and G*Power version 3.1.2. (Franz Faul, Universitat Kiel, Germany) was used for power and sample size analysis. RESULTS: A total of 80 volunteers were enrolled in the study. The medians of cIJV LLs before and after blood donation were 6.67 (95% confidence interval [CI], 6.72-7.07) and 5.98 (95% CI, 6.09-6.40), respectively. The medians of IJV collapse indices before and after blood donation were 32.74 (95% CI, 32.73-39.50) and 38.88 (95% CI, 35.54-42.95), respectively. Preliminary results of our study revealed that cIJV LL and IJV collapse index were not well correlated (Spearman ρ correlation coefficient, 0.257; r = 0.128). CONCLUSION: Although, the IJV collapse index was not found to be a useful parameter for evaluation of hypovolemia, cIJV LL is more valuable marker for the detection of blood loss at bedside.

Neuroprotective effects of progesterone in spinal cord ischemia in rabbits.

BACKGROUND: This experimental study was performed to investigate the neuroprotective effects of progesterone on spinal cord ischemia in rabbits. METHODS: Eighteen female New Zealand white rabbits were used in this study. Rabbits were randomized into 3 groups. Spinal cord ischemia was induced by clamping the abdominal aorta from a point just inferior to the left renal artery to the aortic bifurcation for a period of 30 minutes. Group 1 served as the control group, and groups 2 and 3 received intraperitoneal progesterone immediately after the onset of reperfusion, at a dose of 8 mg/kg. Two hours after reperfusion, the animals in group 1 were killed. Four hours after reperfusion, the animals in group 2 were killed, and 6 hours after reperfusion, the group 3 rabbits were killed. Spinal cords were removed and fixed in 10% formalin in a phosphate buffer. Neuronal injury was evaluated by a pathologist who was blinded to the treatment groups, and 5 sections per animal were evaluated. The number of intact large motor neuron cells in the ventral grey matter region was counted. RESULTS: The analysis revealed that the average mean arterial pressure for group 1 was significantly higher than that for group 2, and the mean sacrificed pressure value for group 1 was significantly higher than that for group 3 (P < .05). The number of intact neurons in group 1 was significantly lower than the number of intact neurons found in both groups 2 and 3 (P < .05). No other statistically significant differences were found between the groups. CONCLUSION: The findings from the present study indicate that progesterone effectively protects the spinal cord tissues against ischemic damage in the setting of decreased perfusion.

Biosensing strategies (approaches) for diagnosis and monitoring of multiple sclerosis.

Multiple sclerosis is a recurrent and progressive inflammatory autoimmune disease causing demyelination in the central nervous system. Nowadays, the number of MS patients is increasing, but the diagnostic process and disease management are still quite difficult and costly and time consuming. The combination of methods used for clinical MS diagnosis mainly relies on MRI, that cannot be used as routine analysis. Classical methods of biological liquids analysis used for disease diagnosis and monitoring, include electrophoretic and labeled antibody-based techniques requiring professional personnel for analysis performing and results interpretation. In line with that, there is a need for reliable, sensitive and cost-effective methods that would be easier to take for both the staff and the patient. Biosensors application for MS biomarkers detection would provide such advantages. This review aimed to summarize studies carried out in this field available at the literature so far, evaluate current situation and emphasize possible perspectives for research and clinical application. Since this is multidisciplinary area of research, including development of biosensors, their use in clinical practice and making diagnostic clues, this review is expected to help different specialists, medical doctors, engineers, biochemists to use the results of each other's work for common good. Possible transition to the use biosensors in clinical practice may be associated with some difficulties that must be taken into account were either considered.

Limited bedside echocardiography by emergency physicians for diagnosis of diastolic heart failure.

INTRODUCTION: The identification of diastolic heart failure (DHF) is important for determining the prognosis of congestive heart failure patients. This study attempted to determine the accuracy of emergency physicians who performed bedside echocardiography (BECH) in patients with diastolic dysfunction. METHODS: Three attending emergency physicians underwent 3 h of didactic and 3 h of hands-on training taught by a cardiology specialist for the echocardiographic diagnostic criteria of DHF. Between February and April 2010, the emergency physicians performed BECH for patients presenting with dyspnoea, and echocardiographic views were recorded. Our gold standard for the diagnosis of diastolic dysfunction was the cardiologists' echocardiography report. Results were compared with χ(2) testing. RESULTS: Of the 69 enrolled patients, 51 were diagnosed as having diastolic dysfunction by emergency physicians. The sensitivity of BECH was 89% (77-95) and specificity was 80% (51-95) with 95% CI. The accuracy of the emergency physicians' echocardiographic diagnosis was 87%. CONCLUSION: BECH performed by emergency physicians may serve as an objective, rapid, non-invasive tool in the assessment of patients presenting with dyspnoea in ED.

Ability of emergency physicians to detect early ischemic changes of acute ischemic stroke on cranial computed tomography.

OBJECTIVE: The objective of this study was to evaluate the ability of emergency physicians (EPs) to diagnose early ischemic changes due acute ischemic stroke on cranial computed tomography (CT). SUBJECTS AND METHODS: Three EPs interpreted CT scans obtained within 3 h of symptom onset in 50 patients with acute stroke. The CT scans were interpreted by the EPs and compared to official neuroradiologist reports as a gold standard. ĸ statistics were calculated to determine agreement among the three readers. Sensitivities and specificities were analyzed for each reader. RESULTS: The EPs' sensitivities were 50, 45.5, and 45.5%, and specificities were 64.3, 82.1, and 64.3%, respectively. Focal parenchymal hypodensity was the criterion for which the EPs were the most sensitive (77.3%). The ability of EPs to recognize early ischemic changes on CT scans in acute ischemic stroke was moderate based on sensitivities. CONCLUSION: Based on this study, EPs must be trained especially for recognizing early ischemic changes in acute ischemic stroke to improve their accuracy of interpretation.

Composite measures of quality of health care: Evidence mapping of methodology and reporting.

BACKGROUND: Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators. OBJECTIVE: To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications. METHODS: We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s). RESULTS: A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure. CONCLUSION: Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low. DISCUSSION: Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.

Perception and readiness for inter-professional education of health discipline students: A cross-sectional study.

BACKGROUND: Interprofessional education (IPE) is a concept focusing on the improvement of a good teamwork environment bringing professionals from diffferent professions together to obtain high-quality health care and improve health outcomes. Determining health discipline students' IPE perceptions and readiness is important to develop, implement and maintain effective IPE programs. OBJECTIVES: This study aims to determine perception and readiness for interprofessional education of health discipline students. DESIGN: This study utilized a descriptive and cross-sectional design. SETTINGS: A public university in Turkey. The study was conducted with students enrolled in Faculty of Health Sciences, Medical Faculty, Faculty of Dentistry, or Vocational School of Health Services. PARTICIPANTS: The participants included 646 health discipline students who were enrolled in nursing, midwifery, medical, dentistry, medical imaging technology, first and emergency aid, and elderly care departments. METHODS: Data were collected through the "Data Collection Form", the "Interdisciplinary Education Perception Scale (IEPS-TR)" and the "Readiness for Inter-professional Learning Scale (RIPLS)". RESULTS: The participants' IEPS-TR and RIPLS total mean scores were found 65.81 ± 19.86 and 67.90 ± 13.53, respectively. The IEPS-TR and RIPLS mean scores and the variables such as choosing the department willingly and being satisfied with the department indicated a statistically significant correlation (p < 0.05). In addition, RIPLS mean scores and the variables such as age, and willingness to take classes with other healthcare students indicated a statistically significant correlation (p < 0.05). However, no statistically significant correlation was found between the IEPS-TR and RIPLS total mean scores and department-related variables (p > 0.05). The participants' IEPS-TR and RIPLS mean scores demonstrated a positive and significant relationship (r = 0.314, p < 0.001). CONCLUSIONS: This study showed that health discipline students had a high level of perception of interdisciplinary education and were ready for interprofessional education. The study also demonstrated that students' perception of interdisciplinary education increased with the increase in their readiness for this education.

Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the emergency department.

BACKGROUND: Our objective was to evaluate the accuracy of paramedic-performed Focused Assessment with Sonography in Trauma (PFAST) for detection of free fluid in patients admitted to the Emergency Department (ED) following trauma. METHODS: After four hours of didactic and four hours of hands-on training, four paramedics prospectively evaluated trauma patients. Our gold standard was the official radiologist reports of ultrasonography and computerized abdominal tomography (CAT). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were calculated and analyzed using SPSS 15.0 with ?2 testing. RESULTS: One hundred and twenty-seven patients were evaluated by the paramedics. Fourteen patients had positive free fluid in the abdomen. Of these, 11 were corroborated by radiology reports and CAT (true positives), and three were found to be negative (false positives). In 113 cases, PFAST was negative for free fluid. Of these, 111 were determined not to have free fluid (true negatives), whereas free fluid was detected by CAT in 2 (false negatives). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were 84.62, 97.37, 32.15, 0.16, and 203.50, respectively. CONCLUSION: Our study shows that paramedics can perform FAST in hospital Eds with a high degree of accuracy.