The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey.

PURPOSE: The primary aim of this study was to evaluate the current state of point-of-care ultrasound (POCUS) integration in undergraduate medical education (UME) at MD-granting medical schools in the United States. METHOD: In 2020, 154 clinical ultrasound directors and curricular deans at MD-granting medical schools were surveyed. The 25-question survey collected data about school characteristics, barriers to POCUS training implementation, and POCUS curriculum details. Descriptive analysis was conducted using frequency and percentage distributions. RESULTS: One hundred twenty-two (79%) of 154 schools responded to the survey, of which 36 were multicampus. Sixty-nine (57%) schools had an approved POCUS curriculum, with 10 (8%) offering a longitudinal 4-year curriculum. For a majority of schools, POCUS instruction was required during the first year (86%) and second year (68%). Forty-two (61%) schools were teaching fundamentals, diagnostic, and procedural ultrasound. One hundred fifteen (94%) schools identified barriers to implementing POCUS training in UME, which included lack of trained faculty (63%), lack of time in current curricula (54%), and lack of equipment (44%). Seven (6%) schools identified no barriers. CONCLUSIONS: Over half of the responding medical schools in the United States had integrated POCUS instruction into their UME curricula. Despite this, a very small portion had a longitudinal curriculum and multiple barriers existed for implementation, with the most common being lack of trained faculty. The data from this study can be used by schools planning to add or expand POCUS instruction within their current curricula.

Impact of a clinical pharmacist on ultrasound-guided venous thromboembolism screening in hospitalized COVID-19 patients: a pilot prospective study.

BACKGROUND: The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and the role of the clinical pharmacist in treating these patients. METHODS: We present a prospective pilot program of thirty-one consecutive COVID-19 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record. RESULTS: Nine of the thirty-one patients presented with VTE. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings. CONCLUSION: VTE screening of hospitalized COVID-19 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.

Injury patterns and demographics due to legal intervention seen in US emergency departments.

BACKGROUND: Injury and deaths inflicted by law enforcement are a topic of significant discussion in the US. The purpose of this study was to analyze injuries due to law enforcement activity that presented to emergency departments (ED) across the entire US and correlate the injury patterns with patient demographics. METHODS: The National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data was used for the years 2005 through 2015. Injuries due to legal/law enforcement activity were identified. Statistical analyses were performed with SUDAAN 11.0.01™. A p < 0.05 was considered statistically significant. RESULTS: There were 939,405 ED visits for non-fatal injuries due to law enforcement. The average age was 31.9 years; 84.6% were male. The mechanism of injury was being struck in 69.7%; firearm gunshot wounds accounted for only 1.2%. The most common location of injury was the head and neck (44.0%) followed by the upper extremity (20.2%). The vast majority of the patients (94.9%) were treated and released from the ED. The seven major diagnoses were contusion/abrasion (37.8%), strain/sprain (22.7%), laceration (12.9%), fracture (7.6%), puncture (8.2%), and foreign body (2.5%). The injuries with the highest percentage of hospital admissions were foreign bodies and fractures (11.4% and 11.3% respectively. Although the number of events occurring at schools or sporting venues was 2.0%, those seen at children's hospitals demonstrated a higher percentage at 15.6%. CONCLUSIONS: This data set provides another viewpoint of injuries inflicted by police. It can be used as baseline data for further studies, especially in the US recent sociopolitical environment calling for police reform and improvements in the education and training of police officers.