Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Factors Associated With Functional Capacity in Hemodialysis Patients.

Hemodialysis patients have a marked decrease in functional capacity when compared to healthy individuals. We evaluated the factors associated with functional capacity in hemodialysis patients. A total of 102 hemodialysis patients were evaluated. The patients were submitted to a 6-min walk test, peripheral muscle strength tests, and an evaluation of quality of life, anxiety, and depression. The laboratory data were measured. The 6-min walk test distance correlated significantly with age, educational level, hemoglobin, creatinine, number of comorbidities, peripheral muscle strength, and some domains of SF-36 quality of life questionnaire and depression (P < 0.05). Multiple linear regression showed that educational level, hemoglobin, peripheral muscle strength, and depression significantly affected the 6-min walk test distance (P < 0.05). The multiple correlation coefficient was 0.74, and the squared multiple correlation coefficient adjusted was 0.52. In conclusion, functional capacity was significantly associated with educational level, hemoglobin, peripheral muscle strength, and depression in hemodialysis patients.

International consensus conference recommendations on ultrasound education for undergraduate medical students.

OBJECTIVES: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

Point-of-care ultrasonography in nephrology: a cross-sectional national survey among Brazilian nephrologists.

INTRODUCTION: Point-of-care ultrasonography (US) (POCUS) has been used in several specialties, particularly in medical emergency. Despite the confirmation of its numerous benefits, the use of POCUS is still timid in nephrology. In the present study, we aim to investigate the use of POCUS by Brazilian nephrologists. METHODS: A survey carried out among the members of the Brazilian Society of Nephrology, through institutional e-mail, using the SurveyMonkey platform. We included 12 self-administered questions, which answers were given anonymously. RESULTS: It was evident that the majority (64%) of the participants did not have the opportunity to practice US during their nephrological training in their residency, specialization, or even in internships; those with experience with US use the method mainly for implanting central vascular accesses (68%), performing a renal biopsy (58%) and evaluating renal morphology (50%); and the main barriers for nephrologists who do not yet use US are the high price of US machines (26%) and the lack of time to learn about US (23%). Also, POCUS use for examinations of other organs, such as the lung (31%) and heart (18%), which are fundamental in the cardiovascular and volume assessment of patients with kidney diseases, is even more limited. However, 95% of the participants expressed an interest in learning POCUS for use in their medical practice. CONCLUSION: Most of the Brazilian nephrologists interviewed were not trained in US; however, almost all of the research participants expressed an interest in learning to use POCUS in nephrological practice.

Diastolic dysfunction for nephrologists: diagnosis at the point of care.

Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.

Use of artisanal simulators in the ultrasound training for invasive procedures in nephrology: venous access and renal biopsy.

INTRODUCTION: Vascular access and renal biopsy are common procedures in nephrology. In this study, two artisanal simulators of very low cost and excelent image quality are (prented) presented to guide, by ultrasound, the venous access and renal biopsy. METHODS: The simulators are constructed using chicken breast slices, Penrose drain, plastic milk shake straw and pig kidney. RESULTS: Both simulators enable immediate identification of the anatomical structures of interest, vessels and kidney, and enable spatial orientation and hand-eye coordination, essential for the development of the necessary skills to safely carry out invasive procedures. CONCLUSION: The simulators described, were extremely useful for simulating venous access and renal biopsy guided by ultrasonography, enabling training to reduce the failure rate in punctures and the potential complications associated with the described procedures.

Traditional and ultrasound physical examinations: a hybrid approach to improve clinical care.

Point-of-care ultrasonography, which is performed at the bedside by physicians who are not specialists in imaging, has become possible thanks to recent technological advances that have allowed for a device with greater portability while maintaining image quality. The increasing use of point-of-care ultrasonography in different specialties has made it possible to expand physical examinations, make timely decisions about the patients and allows the performance of safer medical procedures. In this review, three cases from our experience are presented that highlight the use of point-of-care ultrasonography by clinicians. Bedside ultrasonography is a convenient modality used in a clinical setting to aid in early diagnosis of several common conditions. It is suggested that a hybrid approach of physical examination and point-of-care ultrasonography in the everyday clinical practice is an inevitable change of paradigm that is improving quality of care in a variety of clinical settings.

Homemade ultrasound phantom for simulation of hydronephrosis.

In this article, we describe the development of a simple and inexpensive simulation phantom as a surrogate of human hydronephrosis for the identification of urinary tract obstruction at bedside to be used in undergraduate training of medical students.

Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students.

OBJECTIVES: To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US). MATERIALS AND METHODS: Six medical students without experience with US were given 4 h of theoretical-practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients. They also simulated a puncture of the IJV at a demarcated point, where a TT was theoretically performed. RESULTS: Adequate images were obtained from 95% of the patients; the IJV, on the right side, was more commonly found in the anterolateral position in relation to the CCA (38%). On the left side, the most commonly position observed was the anterior (36%). The caliber of the IJV relative to the CCA greatly varied. The success rate in the IJV puncture simulation, observed with US, by the TTs was 55%. CONCLUSION: The training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.

Uso da ultrassonografia "point-of-care" na prática nefrológica: Transpondo os limites do trato urinário / Point-of-care ultrasound in the nephrological practice: Beyond the limits of the urinary tract

Introdução: O modelo tradicional de referenciamento ao radiologista para a realização de ultrassonografia ou ecografia tem se modificado nos últimos 25 anos. Com a diminuição do tamanho e do custo dos aparelhos de ultrassom (hoje já existem mais de 10 unidades "handheld" no mercado), cada vez mais médicos de diferentes especialidades estão utilizando a ultrassonografia a beira do leito, como extensão do exame físico. Objetivo: Destacar a importância do uso da ultrassonografia a beira do leito na avaliação objetiva e ampliada dos pacientes renais. Materiais e Métodos:Revisão narrativa com seleção dos estudos e a interpretação das informações baseados na escolha arbitrária dos autores. Resultados: Na nefrologia, a ecografia ainda tem sido pouco utilizada, sendo o seu maior uso na identificação renal e venosa quando da realização da biópsia renal e do acesso vascular, respectivamente. Contudo, o papel fundamental dos rins no controle da volemia e da pressão arterial, eventualmente quando se tornam disfuncionais, demanda avaliações multiorgânicas. Assim, a utilização da ultrassonografia na nefrologia não deveria se restringir aos procedimentos mencionados ou a avaliação da retenção urinária. As ecografias "focadas" dos pulmões, do coração e da veia cava inferior permite o diagnóstico de complicações frequentes observadas nas doenças renais, como por exemplo, congestão pulmonar, derrame pleural, pneumotórax, disfunção sistólica, diastólica, derrame pericárdico e, assim, incorporadas como extensão do exame físico em nefrologia. Conclusão: A multifuncionalidade renal implica em grande número de complicações renais e extra-renais quando os rins são funcionalmente acometidos, o que justifica o uso da POCUS não somente na avaliação do trato urinário, mas também dos pulmões, coração, veia cava inferior, entre outros.

Introduction: The traditional model of reference ultrasound to radiologist has changed over the past 25 years. With the reductions in size and cost of ultrasound devices (today there are more than 10 handheld units on the market), medical specialists are increasingly using bedside ultrasound as an extension of the physical examination. Objective:To highlight the importance of using bedside ultrasound in the objective and expanded evaluation of renal patients. Material and Methods: Narrative review with study selection and interpretation of information based on arbitrary choice of authors. Results: In nephrology, ultrasound has not been widely used, and its major uses are in renal and venous identifications in renal biopsy and vascular access, respectively. However, the fundamental role of the kidneys in controlling body volume and blood pressure, eventually when they become dysfunctional, requires multiorgan evaluations. Thus, the use of ultrasound in nephrology should not be restricted to the procedures mentioned or the assessment of urinary retention. "Focused" ultrasound of the lungs, heart, and inferior vena cava allows the diagnosis of frequent complications observed in renal diseases, such as pulmonary congestion, pleural effusion, pneumothorax, systolic and diastolic dysfunction, pericardial effusion, and thus be incorporated as extension of physical examination in nephrology. In the present review, the authors highlight the importance of using bedside ultrasound in the objective and expanded evaluation of renal patients. Conclusion: Renal multifunctionality implies a large number of renal and extrarenal complications when the kidneys are functionally affected, which justifies the use of POCUS not only in the evaluation of the urinary tract, but also in the lungs, heart, inferior vena cava, among others.

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava? A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist.

BACKGROUND/AIMS: The costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the volemic status in hemodialysis patients. We investigated whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing hemodialysis. METHODS: A cardiologist and a nephrologist consecutively measured the indexed IVC expiratory diameter (VCDi) and the IVC collapsibility index (IVCCI) of 52 patients during hemodialysis sessions. In protocol I, the nephrologist used a regular ultrasound system (RUS) and the cardiologist used a cardiovascular ultrasound equipment; in protocol II, the machines were interchanged. Pearson and kappa coefficients and the interexaminer agreement by the Bland-Altman method were calculated. RESULTS: The VCDi measurements showed a strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was very good in both protocols. CONCLUSIONS: Ultrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients.