Development and Validation of a Mixed-Reality Simulator for Reducing Biopsy Core Deviation During Simulated Freehand Systematic Prostate Biopsy.

INTRODUCTION: We describe the development and validation of a mixed-reality prostate biopsy (PBx) simulator with built-in guidance aids and real-time 3-dimensional visualization. METHODS: We evaluated our simulator during one-on-one training sessions with urology residents and attendings from 2018 to 2022. Participants performed freehand, side-fire, double-sextant transrectal ultrasound-guided systematic prostate biopsy (sPBx). After a baseline assessment (first set of 12 biopsy cores), participants trained for 25 minutes with visualization and cognitive aids activated. Training was followed by an exit set of 12 biopsy cores without visualization or cognitive aids and afterward, subjective assessment by trainees of the simulator. Deviation is the shortest distance of the center of a core from its intended template location. RESULTS: Baseline deviations (mean ± SD) for residents (n = 24) and attendings (n = 4) were 13.4 ± 8.9 mm and 8.5 ± 3.6 mm ( P < 0.001), respectively. Posttraining deviations were 8.7 ± 6.6 mm and 7.6 ± 3.7 mm ( P = 0.271), respectively. Deviations between baseline and exit were decreased significantly for residents ( P < 0.001) but not for attendings ( P = 0.093). Overall feedback from participants was positive. Confidence in performing a PBx increased in novices after training ( P = 0.011) and did not change among attendings ( P = 0.180). CONCLUSIONS: A new PBx simulator can quantify and improve accuracy during simulated freehand sPBx while providing visualization and graphical feedback. Improved simulated sPBx accuracy could lead to more even distribution of biopsy cores within the prostate when performed in clinical settings, possibly reducing the high risk of missing an existing lesion and thus decreasing the time to initiating treatment, if indicated.

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Features of patients with upper gastrointestinal bleeding and factors affecting the re-bleeding risk.

BACKGROUND: The risk of re-bleeding in upper gastrointestinal bleeding (UGIB) is a major complication that can be mortal. In this study, we aimed to determine the factors that can predict the risk of re-bleeding in UGIB patients. METHODS: We retrospectively screened UGIB patients admitted in adult intensive care. Along with age and gender, complaints of admission, vital signs, comorbidities, laboratory findings, medications, endoscopy status, and re-bleeding status were recorded. According to these findings, Glasgow-Blatchford and AIMS65 scores of the patients were calculated. All statistical tests were performed with the Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL). RESULTS: A total of 241 patients were included in the study. Mean age of patients was 57.58±19.31, years and 176 (73.0%) of them were male. A total of 117 (48.5%) patients were Helicobacter pylori positive and re-bleeding occurred in 77 (32.0%) patients. Sclerotherapy was applied in 103 (42.7%) patients, while 5 (2.1%) underwent electrocoagulation, and 4 (1.7%) underwent hemoclips. There was a significant difference between patients with and without endoscopic intervention for re-bleeding (p<0.001). Hematocrit, urea values, Glasgow-Blatchford, and AIMS65 scores were statistically significant different between the groups with and without re-bleeding (p=<0.001, <0.001, <0.001, and 0.008, respectively). In the ROC analysis of Glasgow-Blatchford and AIMS65 scoring systems area, under the curve values were 0.700 (p=<0.001, 95% CI: 0.626-0.775), and 0.557 (p=0.194, CI 95%: 0.469-0.645), respectively. Mortality rate was 2.1% (n=5) among study population. CONCLUSION: Hematocrit and urea values seem beneficial among studied laboratory values, however, Glasgow-Blatchford scoring system performed better than AIMS65 in the prediction of re-bleeding risk in UGIB. The authors concluded that more specific predictive markers may be useful for clinicians.

Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study.

OBJECTIVES: To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer. PARTICIPANTS AND METHODS: Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm. RESULTS: All results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double-sextant sets. There was no difference in time to perform a double-sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39). CONCLUSION: A pitch-neutral side-fire technique reduced template deviation during simulated freehand TRUS-guided sPBx, suggesting it may also reduce PBx false-negatives in patients in a future clinical trial. This pitch-neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.

Assessment of endotracheal intubation procedures following inadvertent esophageal intubation. A randomized crossover manikin trial.

OBJECTIVE: To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation.. METHODS: The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E- getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22. RESULTS: There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05±9.65 and for E- it was 17.55±11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85±12.66 seconds and E- had 16.75±8.66. With video laryngoscope, E+ group had a mean completion time of 16.75±8.66 seconds, while E- had it 14.60±8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p>0.05). CONCLUSIONS: In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type.

12th WINFOCUS world congress on ultrasound in emergency and critical care.

TABLE OF CONTENTS: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Catic Cuti, Stanko Belina, Tihomir Vancina, Idriz KovacevicA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Catic Cuti, Nadan RustemovicA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Curcic, Ena Pritisanac, Ivo Planinc, Marijana Grgic Medic, Radovan RadonicA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgic Medic, Ivan Tomic, Radovan RadonicA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Maciuliene, Almantas Maleckas, Algimantas Krisciukaitis, Vytautas Maciulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MozinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolic, Jan Hansel, Rok Petrovcic, Una Mrsic, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovsek, Bostjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Simulation Manikin Modifications for High-Fidelity Training of Advanced Airway Procedures.

Thoracic anesthesia procedures are challenging to master during anesthesia training. A Laerdal ALS Simulator® manikin was modified by adding a bronchial tree module to create fidelity to the fourth generation. After modification, placement of endotracheal tubes up to 8.0 mm is possible by direct laryngoscopy, video laryngoscopy, and fiberoptically; in addition, it allows fiberoptically guided insertion of endobronchial blockers. Insertion of left and right 35-Fr double-lumen tubes permits double- and single-lung ventilation with continuous positive airway pressure and positive end-expiratory pressure. This anatomical modification created a high-fidelity training tool for thoracic anesthesia that has been incorporated into educational curricula for anesthesia.

How reliable are electrolyte and metabolite results measured by a blood gas analyzer in the ED?

INTRODUCTION: Blood gas analysis is a frequently ordered test in emergency departments for many indications. It is a rapid technique that can analyze electrolyte and metabolites in addition to pH and blood gases. The aim of this study was to investigate the correlation of electrolyte and metabolite results measured by blood gas and core laboratory analyzers. METHODS: This was a prospective, single-center observational study conducted in a tertiary care center's emergency department. All adult patients requiring arterial/venous blood gas analysis and core laboratory tests together for any purpose were consecutively included in the study between April 2014 and July 2015. Patients younger than 16 years, having any intravenous infusion or blood transfusion prior to sampling, or who were pregnant were excluded. RESULTS: A total of 1094 patients' (male = 547, female = 547) paired blood samples were analyzed. The mean age was 58.10 ± 21.35 years, and there was no difference between arterial and venous sampling groups by age, pH, or sex (P = .93, .56, and .41, respectively). Correlation coefficients for hemoglobin, hematocrit, glucose, potassium, sodium, and chloride levels measured by blood gas analyzer and core laboratory analyzers were 0.922, 0.896, 0.964, 0.823, 0.854, and 0.791, respectively. CONCLUSION: Blood gas analysis results were strongly correlated for hemoglobin, hematocrit, glucose, potassium, and sodium levels but were only moderately correlated for chloride levels. These parameters as measured by a blood gas analyzer seem reliable in critical decision making but must be validated by core laboratory results.

[Contribution of Turkish Emergency Medicine to the international literature: evaluation of 15 years]. / Türk acil tibbinin uluslararasi literatüre katkisi: 15 yilin degerlendirilmesi.

BACKGROUND: The aim of this study was to present characteristics of internationally published articles originating from Turkish Emergency Medicine (EM) departments over the last 15 years. METHODS: The PubMed database was searched for all articles published from 1995 to 2010 that originated from Turkish EM departments. RESULTS A total of 514 articles were included. Of all articles, 77% (n=396) were published in the last five years. Publications were detected to increase at a rate of 6.2 articles per year. 58.7% (n=302) of the articles were published in non-EM journals. Advances in Therapy in the non-EM group, with 27 articles, and the Turkish Journal of Trauma & Emergency Surgery in the EM group, with 48 articles, were the preferred journals. The most popular subjects were toxicology, at 26% (n=134), followed by trauma, at 16% (n=86). 7.7% (n=40) of all articles were animal studies and 6% (n=31) were randomized controlled trials. CONCLUSION: Significant publication growth was detected related with the development of EM in Turkey. The preference for non- EM journals, toxicology as the most popular subject and the effect of university hospitals were the interesting results of this study. The low number of multicenter, randomized controlled trials and of published articles in high impact factor journals have led us to consider the importance of publication quality, which requires additional effort.