Tricuspid annular plane of systolic excursion to prognosticate acute pulmonary symptomatic embolism (TAPSEPAPSE study).

INTRODUCTION: The imaging standard for evaluation of acute pulmonary embolism (PE) includes a computed tomography pulmonary angiogram. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE. METHODS: We prospectively enrolled patients who came to the emergency department with suspicion of acute PE. Each patient underwent a point-of-care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. Based on the computed tomography pulmonary angiogram findings, patients were grouped into 3 categories: no acute PE, clinically insignificant acute PE, or clinically significant acute PE. RESULTS: We enrolled 87 patients in this study. Twenty-three (26.4%) of these patients were diagnosed with PE. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. Analysis of mean TAPSE measurements between patients with clinically significant acute PE and those with insignificant or no PE was 15.2 mm and 22.7 mm, respectively (P ≤ .0001). Following receiver operating characteristic curve analysis, optimum TAPSE measurement to identify clinically significant acute PE is 18.2 mm. A cutoff TAPSE measurement of 15.2 mm shows a sensitivity of 53.3% (95% confidence interval, 26.7%-80%) and a specificity of 100% (95% confidence interval, 100%-100%) for the diagnosis of a clinically significant PE. CONCLUSIONS: Our data suggest that TAPSE measurements less than 15.2 mm have a high specificity for identifying clinically significant acute PE.

Legal and Bioethical Educational Module in Saudi Board of Emergency Medicine: A Qualitative Need Assessment".

Purpose: Medical malpractice is a leading cause of morbidity and mortality worldwide, negatively affecting healthcare systems, communities, and providers. Although physicians value legal knowledge, their understanding of medical law is limited. Integrating medical law and ethics into medical school curriculums can develop a practitioner's decision-making skills, critical thinking abilities, and ethical judgment. The Saudi Board of Emergency Medicine (SBEM) is a residency training program governed by the Saudi Commission for Health Specialties (SCFHS), which aims to improve healthcare quality and patient safety in Saudi Arabia. This study explored stakeholders' perceptions regarding implementing a legal and bioethical education module in the SBEM curriculum. Methods: Nineteen participants (seven program directors and 12 trainees) from the different training centers around the kingdom (from Riyadh, Jeddah, and eastern province) have been included in the study. Thirty minutes to one-hour face-to-face and virtual (zoom-based) structured interviews have been done. Each interview was audio-recorded and transcribed verbatim. Then, data have been analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Results: Four themes have emerged from the data, including planning and executing the current bioethical and legal educational activities in the SBEM, the current teaching methods and guiding resources for the bioethical and legal subjects, the assessment methods used to evaluate the trainees' comprehension of bioethical and legal topics and the opinions regarding integrating bioethical and legal education module with the current curriculum of the SBEM. Conclusion: The study found that the current educational initiatives for legal and bioethical topics in SBEM are insufficient. There are no clear learning objectives, study guides, or combined practices for trainees to develop safe approaches when faced with ethical and legal challenges. A comprehensive protocol with required competencies and dedicated educators may help trainees understand Islamic ethics and jurisprudence principles for delivering culturally sensitive and patient-centered care. Further studies and needs assessments are recommended.