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1.
Med Sci Monit ; 25: 4104-4109, 2019 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-31154454

RESUMEN

BACKGROUND Point-of-care ultrasound (POCUS) diagnosis, performed by a physician at the patient bedside, is routinely used in emergency medicine and critical care. Although training in ultrasonography has become part of the medical school curriculum, POCUS can be challenging for medical students. This study aimed to assess the effectiveness of a one-day POCUS course in a group of final-year medical students by pre-course and post-course assessment of both diagnostic ability and changes in student confidence levels in making a diagnosis. MATERIAL AND METHODS A prospective study recruited 57 final-year medical students who participated in a one-day POCUS course. Improvement in making decisions and levels of confidence were evaluated before and two weeks after the course, using image-based testing and a self- evaluation questionnaire. RESULTS All 57 final-year medical students attended the course and completed the tests and surveys. The pre-training and post-training test scores of medical students improved from 41.78±12% to 58±13%. Student confidence scores in the post-training assessment significantly increased. The post-training confidence scores were significantly increased compared with the pre-training scores regardless of whether or not the questions were answered correctly (p<0.001). The Dunning-Kruger effect, or cognitive bias, might partially explain this phenomenon. CONCLUSIONS One day of POCUS training integrated into anesthesia curriculum for final-year medical students improved performance in the post-training test scores and improved their confidence scores. Further studies are needed to evaluate this effect and to develop adequate tools to assess medical students.


Asunto(s)
Educación Médica/métodos , Ultrasonografía/métodos , Competencia Clínica , Curriculum , Educación/métodos , Femenino , Humanos , Masculino , Sistemas de Atención de Punto/tendencias , Pruebas en el Punto de Atención/tendencias , Estudios Prospectivos , Facultades de Medicina , Estudiantes de Medicina , Encuestas y Cuestionarios
2.
Anal Bioanal Chem ; 411(29): 7607-7621, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31152226

RESUMEN

Immunological methods are widely applied in medical diagnostics for the detection and quantification of a plethora of analytes. Associated analytical challenges usually require these assays to be performed in a central laboratory. During the last several years, however, the clinical demand for rapid immunodiagnostics to be performed in the immediate proximity of the patient has been constantly increasing. Biosensors constitute one of the key technologies enabling the necessary, yet challenging transition of immunodiagnostic tests from the central laboratory to the point of care. This review is intended to provide insights into the current state of this transition process with a focus on the role of biosensor-based systems. To begin with, an overview on standard immunodiagnostic tests presently employed in the central laboratory and at the point of care is given. The review then moves on to demonstrate how biosensor technologies are reshaping this landscape. Single analyte as well as multiplexed immunosensors applicable to point of care scenarios are presented. A section on the areas of clinical application then creates the bridge to day-to-day diagnostic practice. Finally, the depicted developments are critically weighed and future perspectives discussed in order to give the reader a firm idea on the forthcoming trends to be expected in this diagnostic field.


Asunto(s)
Técnicas Biosensibles/instrumentación , Pruebas Inmunológicas/métodos , Laboratorios/organización & administración , Sistemas de Atención de Punto/tendencias , Humanos
3.
Nurs Leadersh (Tor Ont) ; 32(SP): 42-57, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31099746

RESUMEN

Background: Integrated bedside terminals (IBTs) were implemented at Humber River Hospital with the goal of supporting patient independence and autonomy and improving nursing workflows. The IBTs provide access to a range of convenience and entertainment services as well as access to personal health information. Due to the novelty of the technology, there is a paucity of empirical data on patients' use of, satisfaction with and perceptions of bedside terminals. Aim: The purpose of this study was to evaluate the impact of IBTs on patient empowerment and nursing workflows. Methods: A mixed methods design was employed using a cross-sectional patient survey and semi-structured interviews with nurses. The patient survey assessed patient empowerment and satisfaction with the range of services offered through the IBT. Patient scores were summarized using descriptive statistics. Additionally, face-to-face interviews with nurses were used to illicit feedback regarding the IBTs' impacts on nursing workflows. Results: In total, 113 patients and 11 nurses participated in the study. Analysis of patient satisfaction surveys indicated that the IBTs enhanced the patient experience and increased self-care management. Nurses reported that the IBTs helped patients feel comfortable and entertained and helped enhance the nurse-patient relationship. However, nurses also expressed concern that elderly patients were less inclined to use the IBT. Conclusion: The results from the present study suggest that the IBT system has the potential to empower patients and decrease demands on nurses. Patients' notes incorporated into the IBT may provide the necessary level of involvement to garner a greater sense of patient empowerment. The IBT does not replace the need for nurses to deliver information to patients in a manner that supports their trust.


Asunto(s)
Participación del Paciente/métodos , Sistemas de Atención de Punto/normas , Flujo de Trabajo , Adulto , Anciano , Distribución de Chi-Cuadrado , Terminales de Computador/normas , Terminales de Computador/tendencias , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Atención de Enfermería/métodos , Ontario , Satisfacción del Paciente , Sistemas de Atención de Punto/tendencias , Encuestas y Cuestionarios
4.
Mil Med ; 184(Suppl 1): 78-82, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30901438

RESUMEN

INTRODUCTION: Combat wound infection is a common and serious complication, leading to significant morbidity and mortality. In 2005, a point of injury antimicrobial protocol was published by the Israel Defense Forces, in which Moxifloxacin was chosen. During 2016-2017, a revision of this protocol was performed and concluded with the publication of an updated protocol. The purpose of this report is to present this process and the revised protocol, together with a review of the literature. METHODS: We searched "Medline" and "Google Scholar" for studies dealing with antimicrobial prophylaxis in trauma, for militaries' point of injury antimicrobial protocol protocols and for established surgical antimicrobial prophylaxis protocols. RESULTS: Point of injury antimicrobial protocol is aimed at preventing early infection and its complications. The choice of Moxifloxacin for this purpose may not be optimal since Moxifloxacin spectrum might be overly broad, there is scant evidence supporting it for this indication, and the available preparation does not meet distinctive technical requirements. Contrarily, Ceftriaxone seemed to have suitable microbiological, pharmacological and technical features. CONCLUSION: Point of injury antimicrobial protocol should be used especially when evacuation and definitive surgical treatment are delayed. According to present scientific data and operational needs, Ceftriaxone was chosen for most penetrating injuries, with Metronidazole addition for penetrating abdominal and cranial trauma.


Asunto(s)
Antibacterianos/uso terapéutico , Heridas y Traumatismos/tratamiento farmacológico , Guías como Asunto , Humanos , Israel , Medicina Militar/tendencias , Sistemas de Atención de Punto/tendencias
6.
Sensors (Basel) ; 19(4)2019 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-30781554

RESUMEN

Food safety issues have recently attracted public concern. The deleterious effects of compromised food safety on health have rendered food safety analysis an approach of paramount importance. While conventional techniques such as high-performance liquid chromatography and mass spectrometry have traditionally been utilized for the detection of food contaminants, they are relatively expensive, time-consuming and labor intensive, impeding their use for point-of-care (POC) applications. In addition, accessibility of these tests is limited in developing countries where food-related illnesses are prevalent. There is, therefore, an urgent need to develop simple and robust diagnostic POC devices. POC devices, including paper- and chip-based devices, are typically rapid, cost-effective and user-friendly, offering a tremendous potential for rapid food safety analysis at POC settings. Herein, we discuss the most recent advances in the development of emerging POC devices for food safety analysis. We first provide an overview of common food safety issues and the existing techniques for detecting food contaminants such as foodborne pathogens, chemicals, allergens, and toxins. The importance of rapid food safety analysis along with the beneficial use of miniaturized POC devices are subsequently reviewed. Finally, the existing challenges and future perspectives of developing the miniaturized POC devices for food safety monitoring are briefly discussed.


Asunto(s)
Análisis de Peligros y Puntos de Control Críticos/métodos , Sistemas de Atención de Punto/tendencias , Técnicas Biosensibles/métodos , Contaminación de Alimentos , Inocuidad de los Alimentos , Humanos
7.
Eur J Clin Microbiol Infect Dis ; 38(6): 1015-1022, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30710202

RESUMEN

The emergence and spread of antimicrobial resistance is one of the major global issues currently threatening the health and wealth of nations, with effective guidelines and intervention strategies urgently required. Such guidelines and interventions should ideally be targeted at individuals, communities, and nations, requiring international coordination for maximum effect. In this respect, the European Joint Programming Initiative on Antimicrobial Resistance Transnational Working Group 'Antimicrobial Resistance - Rapid Diagnostic Tests' (JPIAMR AMR-RDT) is proposing to consider a 'mix-and-match' package for the implementation of point-of-care testing (PoCT), which is described in this publication. The working group was established with the remit of identifying barriers and solutions to the development and implementation of rapid infectious disease PoCT for combatting the global spread of antimicrobial resistance. It constitutes a multi-sectoral collaboration between medical, technological, and industrial opinion leaders involved in in vitro diagnostics development, medical microbiology, and clinical infectious diseases. The mix-and-match implementation package is designed to encourage the implementation of rapid infectious disease and antimicrobial resistance PoCT in transnational medical environments for use in the fight against increasing antimicrobial resistance.


Asunto(s)
Antibacterianos/farmacología , Enfermedades Transmisibles/diagnóstico , Conducta Cooperativa , Farmacorresistencia Bacteriana , Pruebas en el Punto de Atención , Antibacterianos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Pruebas Diagnósticas de Rutina/tendencias , Personal de Salud , Humanos , Sistemas de Atención de Punto/organización & administración , Sistemas de Atención de Punto/tendencias , Pruebas en el Punto de Atención/tendencias , Salud Pública
8.
J Emerg Med ; 56(3): 323-326, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30638648

RESUMEN

BACKGROUND: Internal jugular venous thrombosis (IJVT) is an uncommon condition rarely diagnosed in the outpatient setting. IJVT carries significant morbidity and mortality and must be considered in the differential diagnosis for new-onset neck pain and swelling, especially in the emergency setting. Paget-Schroetter syndrome (PSS), or primary thrombosis secondary to effort, is an uncommon, likely under-recognized etiology of thrombosis. We report a case of PSS extending from the right subclavian vein into the right internal jugular vein, suspected based upon patient history and physical examination and confirmed by point-of-care ultrasound (POCUS). We then review the presentation, causes, and diagnostic standards for PSS. CASE REPORT: We present a case of a 79-year-old man who presented to the Emergency Department with acute right-sided neck pain 1 day after playing the saxophone for 4 h the prior evening. POCUS confirmed Paget-Schroetter syndrome, or primary effort thrombosis of the internal jugular vein. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is the first documented case of PSS resulting from venous stasis with prolonged Valsalva maneuver and vascular trauma with activity of playing the saxophone. The significance of this case is the unusual etiology of a rare presentation and the ability to diagnose this condition quickly and accurately with POCUS.


Asunto(s)
Música , Trombosis Venosa Profunda de la Extremidad Superior/complicaciones , Trombosis de la Vena/etiología , Anciano , Anticoagulantes/uso terapéutico , Servicio de Urgencia en Hospital/organización & administración , Humanos , Venas Yugulares/fisiopatología , Masculino , Sistemas de Atención de Punto/tendencias , Ultrasonografía/métodos , Trombosis Venosa Profunda de la Extremidad Superior/fisiopatología , Trombosis de la Vena/fisiopatología
9.
World J Emerg Surg ; 14: 1, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30636969

RESUMEN

Background: Point-of-Care Ultrasound (POCUS) is a useful diagnostic tool. Nevertheless, it needs proper training to reach its required level of competency. Educators who work in low-income countries find it difficult to purchase expensive training computer-based simulators. We aim in this communication to describe the methods to build up and use an efficient, simple, and cheap simulator which can be used for teaching POCUS globally. Methods: It took our group 2 years to develop the simulator to its current form. The required material for the simulator includes a Kunafa knife, a carton gift box and its cover and colored play dough. The Kunafa knife with its blade is an excellent simulator for the small print convex array probe (3-5 MHz) and its ultrasound sections. It is useful to teach two important principles. First, the three basic hand movements used to control the ultrasound probe (fanning, tilting, and shifting). Second, the thin blade of the knife (1 mm thick) simulates the shape of the two-dimensional ultrasound images. The play dough is used to simulate different organs to be cut in different directions like the aorta and inferior vena cava. Results: The simulator was used to teach 88 fifth year medical students during the period of November 2017 to November 2018 at the College of Medicine and Health Sciences, UAE University. The simulator was valid, simple, portable, and sustainable. The students greatly enjoyed its use. The cost of the simulator is less than 10 US dollars. Conclusions: Surgical educators who work in low-income countries are encouraged to develop their educational tools that are tailored to their own needs. Our simulator can help our colleagues who want to teach POCUS and cannot purchase expensive mannequins and computer-based simulators.


Asunto(s)
Personal de Salud/educación , Entrenamiento Simulado/normas , Estudiantes de Medicina/estadística & datos numéricos , Ultrasonografía/métodos , Curriculum/normas , Curriculum/tendencias , Educación de Pregrado en Medicina/métodos , Educación de Pregrado en Medicina/normas , Evaluación Educacional , Personal de Salud/tendencias , Humanos , Juego e Implementos de Juego , Sistemas de Atención de Punto/normas , Sistemas de Atención de Punto/tendencias , Entrenamiento Simulado/métodos
11.
Chem Soc Rev ; 48(3): 850-884, 2019 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-30565609

RESUMEN

Barcode technology can deliver batched information for patient healthcare. For clinical examinations, barcodes serve as reporters for labeling multiple targets, and meanwhile, facilitate improved sensitivity and specificity, thus enabling barcode as a promising alternative to traditional labels for biomarker identification and signal amplification. However, faced with the stringent claims of point-of-care (POC) bioassays, efforts are needed to advance current technologies toward rapidity, robustness, affordability, and user-friendliness. In the past decades, chemists have succeeded in delicate fabrication of the barcode libraries for encoding. Nevertheless, the decoding technologies remain poorly discussed, especially simplified decoding strategies for POC bioassays. Recent emergence of portable cartridges and miniaturized signal-recording devices has brought a promise to merge barcodes-assisted bioassay with POC testing (POCT). This review provides a comprehensive summary on barcode encoding and decoding, with emphasis on their potential use in POCT, facilitated by improved manufacturing and portable devices. Future directions of barcoded bioassays for POCT and current challenges are also presented. We anticipate that this review will be beneficial to promoting barcodes toward broad applications.


Asunto(s)
Bioensayo/instrumentación , Bioensayo/métodos , Técnicas Biosensibles/instrumentación , Técnicas Biosensibles/métodos , Sistemas de Atención de Punto/tendencias , Animales , Colorantes Fluorescentes/química , Humanos , Aplicaciones Móviles/tendencias , Imagen Óptica/métodos , Medicina de Precisión/métodos , Nanomedicina Teranóstica/métodos
12.
World J Emerg Surg ; 13: 47, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30356808

RESUMEN

The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn's disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.


Asunto(s)
Enfermedades Gastrointestinales/diagnóstico , Ultrasonografía/métodos , Ultrasonografía/tendencias , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico/instrumentación , Examen Físico/métodos , Sistemas de Atención de Punto/normas , Sistemas de Atención de Punto/tendencias
13.
Medicina (Kaunas) ; 54(1)2018 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-30344234

RESUMEN

Human immunodeficiency virus (HIV) is a global health problem. Early diagnosis, rapid antiretroviral therapy (ART) initiation and monitoring of viral load are the key strategies for effective HIV management. Many people in resource limited settings where timely access to medical care is a challenge and healthcare infrastructure is poor have no access to laboratory facilities and diagnosis is dependent on the presence of point of care (POC) devices. POC instruments have shown to be easy to operate, maintain and transport and can easily be operated by less skilled health workers. Additionally, POC tests do not require laboratory technicians to operate. POC devices have resulted in a growing number of people testing for HIV and thereby receiving treatment early. In recent years, there has been great improvement in the development of POC technologies for early HIV diagnosis, HIV viral load and cluster of differentiation 4 (CD4) measurement. This review discusses POC technologies that are currently available and in the pipeline for diagnosing and monitoring HIV. We also give an overview of the technical and commercialization challenges in POC diagnostics for HIV.


Asunto(s)
Tecnología Biomédica/tendencias , Infecciones por VIH/diagnóstico , Sistemas de Atención de Punto/tendencias , Recursos en Salud , Accesibilidad a los Servicios de Salud , Humanos
14.
Radiother Oncol ; 129(3): 479-485, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30314717

RESUMEN

PURPOSE: To evaluate the feasibility of image-guided adaptive proton therapy (IGAPT) with a mobile helical-CT without rails. METHOD: CT images were acquired with a 32-slice mobile CT (mCT) scanning through a 6 degree-of-freedom robotic couch rotated isocentrically 90 degrees from an initial setup position. The relationship between the treatment isocenter and the mCT imaging isocenter was established by a stereotactic reference frame attached to the treatment couch. Imaging quality, geometric integrity and localization accuracy were evaluated according to AAPM TG-66. Accuracy of relative stopping power ratio (RSPR) was evaluated by comparing water equivalent distance (WED) and dose calculations on anthropomorphic phantoms to that of planning CT (pCT). Feasibility of image-guided adaptive proton therapy was demonstrated on fractional images acquired with the mCT scanner. RESULTS: mCT images showed slightly lower spatial resolution and a higher contrast-to-noise ratio compared to pCT images from the standard helical CT scanner. The geometric accuracy of the mCT was <1 mm. Localization accuracy was <0.4 mm and <0.3° with respect to 2DkV/kV matching. WED differences between mCT and pCT images were negligible, with discrepancies of 0.8 ±â€¯0.6 mm and 1.3 ±â€¯0.9 mm for brain and lung phantoms respectively. 3D gamma analysis (3% and 3 mm) passing rate was >95% on dose computed on mCT, with respect to dose calculation on pCT. CONCLUSION: Our study has demonstrated that the geometric integrity, image quality and RSPR accuracy of the mCT are sufficient for IGAPT.


Asunto(s)
Terapia de Protones/instrumentación , Tomografía Computarizada Espiral/instrumentación , Diseño de Equipo , Estudios de Factibilidad , Humanos , Fantasmas de Imagen , Sistemas de Atención de Punto/tendencias , Terapia de Protones/métodos , Terapia de Protones/tendencias , Protones , Tomógrafos Computarizados por Rayos X , Tomografía Computarizada Espiral/tendencias
16.
Future Microbiol ; 13: 1157-1164, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30113214

RESUMEN

General practitioners stand at the front line of healthcare provision and have a pivotal role in the fight against increasing antibiotic resistance. In this respect, targeted antibiotic prescribing by general practitioners would help reduce the unnecessary use of antibiotics, leading to reduced treatment failures, fewer side-effects for patients and a reduction in the (global) spread of antibiotic resistances. Current 'gold standard' antibiotic resistance detection strategies tend to be slow, taking up to 48 h to obtain a result, although the implementation of point-of-care testing by general practitioners could help achieve the goal of targeted antibiotic prescribing practices. However, deciding on which antibiotic resistances to include in a point-of-care diagnostic is not a trivial task, as outlined in this publication.


Asunto(s)
Farmacorresistencia Microbiana , Medicina General/tendencias , Sistemas de Atención de Punto/tendencias , Antibacterianos/uso terapéutico , Pruebas Diagnósticas de Rutina/normas , Pruebas Diagnósticas de Rutina/tendencias , Farmacorresistencia Microbiana/genética , Medicina General/normas , Humanos , Prescripción Inadecuada/prevención & control , Microbiota/genética , Relaciones Médico-Paciente , Sistemas de Atención de Punto/normas , Pruebas en el Punto de Atención/normas
18.
An. sist. sanit. Navar ; 41(2): 161-169, mayo-ago. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-173594

RESUMEN

Fundamento: El objetivo de este estudio es conocer el grado de implantación, las características y la formación de la ecografía a pie de cama, realizada por médicos de urgencias (MU), en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Método: Estudio descriptivo basado en una encuesta realizada a los responsables de los SUH públicos de Cataluña y estructurada en tres bloques: dificultad de implementación de la técnica y motivos percibidos en dicha dificultad, aparataje disponible en urgencias y su uso, y formación de los MU. Resultados: Contestaron la encuesta el 96,3% de los SUH públicos. En el 63,5% los MU realizan ecografía a pie de cama. El 86,5% manifestaron un elevado grado de dificultad para implementar la ecografía y el 78,8% disponen de ecógrafo propio. El uso más frecuente es la exploración abdominal (87,9%), torácica (72,7%) o vascular periférica (69,7%). Es escasa la presencia de protocolos y registros de la actividad. La formación no es uniforme entre médicos de plantilla y de guardia. No se encontraron diferencias significativas en función del tipo de hospital, del grado de actividad o de la presencia de radiólogo las 24 horas del día, excepto para el protocolo FAST, más empleado en hospitales comarcales que en el resto (89,5% vs. 42,9%; p=0,007). Conclusiones: La ecografía a pie de cama hecha por MU se usa en más de la mitad de los SUH públicos catalanes. Es necesario que el uso de la ecografía en el SUH se extienda, sea más reglado, registrado de manera adecuada y que participen de él todos los médicos que trabajan en urgencias


Background: The aim of this study was to determine the degree of implantation, the characteristics and the formation of point-of-care ultrasonography, performed by emergency physicians in the public hospital emergency department (ED) of Catalonia. Methods: Descriptive study based on a survey conducted with those responsible for the public ED in Catalonia and structured in three blocks: difficulty of implementing the technique and perceived reasons for this difficulty, equipment available in the emergency room and its use, and training of emergency physicians. Results: The survey was answered by 96.3% of public ED; in 63.5% of them the emergency physicians performed point-ofcare ultrasonography. Implementing ultrasonography was considered to have a high degree of difficulty in 86.5%, and 78.8% had their own ultrasound. The most frequent use is abdominal (87.9%), thoracic (72.7%) and peripheral vascular (69.7%). The presence of protocols and registers of the activity is scarce. The training is not uniform between staff doctors and those on call. No significant differences were found according to the type of hospital, the degree of activity or the presence of a radiologist 24 hours a day, the exception being the FAST protocol, which was more used in regional hospitals (89.5% vs. 42.9%; p=0.007). Conclusions. Point-of-care ultrasonography done by emergency physicians is used in more than half of the Catalan public ED. There is a need for extending the use of ultrasound in the ED, it should be more regulated, appropriately registered and involve all physicians working in the emergency department


Asunto(s)
Humanos , Sistemas de Atención de Punto/tendencias , Ultrasonografía , Tratamiento de Urgencia/métodos , Pruebas Diagnósticas de Rutina/tendencias , Servicio de Urgencia en Hospital/organización & administración , Calidad de la Atención de Salud , Encuestas de Atención de la Salud/estadística & datos numéricos , Epidemiología Descriptiva
19.
Reg Anesth Pain Med ; 43(7): 689-698, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30052550

RESUMEN

This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.


Asunto(s)
Anestesia de Conducción/métodos , Anestesiólogos , Contenido Digestivo/diagnóstico por imagen , Manejo del Dolor/métodos , Especialización , Estómago/diagnóstico por imagen , Anestesia de Conducción/tendencias , Anestesiólogos/tendencias , Humanos , Manejo del Dolor/tendencias , Sistemas de Atención de Punto/tendencias , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/tendencias , Especialización/tendencias , Ultrasonografía/métodos , Ultrasonografía/tendencias
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