Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI).

INTRODUCTION: Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS: The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS: A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS: This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.

Principales aplicaciones de la ecografía clínica en cuidados paliativos / Main applications of clinical ultrasound in palliative care

Las personas con enfermedades oncológicas avanzadas padecen procesos clínicos intercurrentes y otras manifestaciones relacionadas con la propia progresión tumoral que generan un gran impacto en su calidad de vida. Los profesionales que trabajan en este campo necesitan incorporar nuevos conocimientos y herramientas de diagnóstico y tratamiento que faciliten el manejo de estas personas, de complejidad tan elevada, de la forma menos invasiva posible1. La ecografía clínica (EC) es una de esas herramientas cuyo desarrollo ha sido excepcional en las últimas décadas. Los avances tecnológicos han permitido disponer de equipos de bolsillo cada vez más sofisticados, asequibles económicamente y que pueden ser utilizados allí donde se encuentre la persona enferma como una extensión de la exploración física2. De esta manera el profesional puede dar respuesta a diferentes situaciones o entidades sindrómicas en las que la rentabilidad de la EC puede ser elevada. La pretensión es evitar, en la medida de lo posible, el traslado del paciente al hospital o a una ubicación intrahospitalaria, lo que redunda en su confort y calidad de vida, además de empoderar al profesional en la toma de decisiones clínicas. (AU)

People with advanced cancer suffer from intercurrent clinical conditions and other tumor progression-related manifestations that can have a great impact on their quality of life. Professionals working in this field need to incorporate new knowledge, as well as diagnostic and treatment tools to facilitate the management of these highly complex patients in the least invasive way possible1. Clinical ultrasound (CU) is one of those tools whose development has been exceptional in recent decades. Technological advances have made it possible to have increasingly sophisticated and affordable pocket equipments available, which can be used wherever the patient is as an extension of physical examination2. In this way, a professional can respond to different situations or syndromic conditions in which CU yield may be high. The aim is to avoid, whenever possible, the transfer of patients to in-hospital facilities, which can result in loss of both comfort and quality of life. In addition, an appropriate use of CU can empower the team charged with making clinical decisions. (AU)

Ecografía clínica en cuidados paliativos. Principios básicos / Clinical ultrasound in palliative care. Basic principles

La ecografía clínica se emplea cada vez por más profesionales sanitarios de diversas disciplinas asistenciales. En cuidados paliativos existen iniciativas que han puesto de manifiesto la utilidad de sus múltiples aplicaciones, permitiendo ofrecer respuestas a cuestiones diversas, tanto en el hospital como en el domicilio. No debe suponer una perturbación del confort del paciente contribuyendo a evitar la percepción por parte de pacientes y familiares de “abandono tecnológico” en las fases más avanzadas de la enfermedad. El avance tecnológico de estos dispositivos permite disponer de opciones que aúnan precio, portabilidad, sencillez de manejo y calidad de imagen suficiente para satisfacer los requisitos para su empleo en las necesidades asistenciales más habituales en cuidados paliativos. La curva de aprendizaje en su manejo es relativamente rápida, esperando que esta serie de publicaciones con material teórico-práctico en la revista Medicina Paliativa contribuyan a establecer una base de conocimiento para los profesionales interesados en este tema, pudiendo continuarse más adelante con un sistema para una adecuada acreditación de competencias. (AU)

Clinical ultrasound is being increasingly used by health professionals from various healthcare disciplines. In Palliative Care some initiatives have revealed the usefulness of its multiple applications, allowing to answer various questions both in the hospital and at home. It should not imply a disturbance of patient wellbeing, and helps avoid the perception, both by patients and relatives, of “technological abandonment” in the most advanced phases of disease. The technological advance of these devices allows having options that combine price, portability, ease of use, and sufficient image quality to satisfy the requirements of use in the most common care settings in Palliative Care. The learning curve in its operation is relatively fast, and we hope that this series of publications with theoretical-practical material in the Palliative Medicine journal will contribute to establishing a knowledge base for professionals interested in this topic, which might be later expanded by providing a system for adequate accreditation of competencies. (AU)

Main applications of point-of-care ultrasound in palliative care.

Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies.

Herniación pleuro-pulmonar como causa de tumoración en la pared torácica de inicio brusco / Pleuro-Pulmonary Herniation as a Cause of Sudden Appearance of Chest Wall Mass

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Eritema multiforme inducido por imiquimod tópico / Erythema multiforme induced by topical imiquimod

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Splenic vein thrombosis: rare cause of abdominal pain.

-An 83-year-old woman with a history of hypertension, diabetes and paroxysmal atrial fibrillation anticoagulated with acenocoumarol was brought to the emergency department due to dyspnoea. At admission, the patient reported a 1-week history of malaise, shortness of breath and non-productive cough. She denied fever but reported pain on the left flank. On examination, auscultation showed arrhythmic tones and crackles in the left lower lung field. Laboratory findings showed leucocytosis of 15.32×103/µL, and the C reactive protein was 177 mg/L. The activated partial thromboplastin time was 54.8 s, and the international normalised ratio was 7.09. A chest X-ray showed left lower lobe consolidation with pleural effusion. Point-of-care ultrasound was performed using a low-frequency curved transducer (2-5 MHz). The probe was placed in the left posterior axillary showing a pulmonary consolidation, but also a hypoechoic lesion in the spleen was found (figure 1).emermed;37/1/30/F1F1F1Figure 1Ultrasound image of the spleen in longitudinal section demonstrating a large, hypoechoic, wedge-shaped lesion. QUESTION: What is the most likely diagnosis?Splenic abscessSubcapsular splenic haematomaSplenic infarctionSplenic hydatid cyst For answer see page 2.

Orina verde después de una rectosigmoidoscopia / Green urine after a rectosigmoidoscopy

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Intoxicación aguda por topiramato con intención suicida / Acute topiraranate toxicity to suic idal attempt

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Sepsis, absceso del psoas y artritis séptica de cadera por Yersinia enterocolitica / Sepsis, psoas abscess and septic arthritis of the hip caused by Yersinia enterocolitica

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