Focused Acute Medicine Ultrasound (FAMUS): uptake, completion and barriers to accreditation after two years.

The Society for Acute Medicine launched their ultrasound accreditation in September 2016, involving a practical course alongside completion of scanning competencies. Candidates require a registered supervisor to oversee their training. We present here the results of a survey of attendees of practical courses approximately 2 years after launch. The majority of respondents were Consultants or trainees within AIM. Fourteen of 76 (18.4%) respondents had completed the whole accreditation process, whilst 51 (67.1%) had not completed any of the three individual modules. The biggest barriers to accreditation were seen to be lack of supervisors, and lack of dedicated training time. There was good uptake of available online learning resources with good feedback. These results will be used to help develop the training pathway further and widen access to ultrasound training within the specialty and beyond.

Focused Acute Medicine Ultrasound (FAMUS).

Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a 'knowledge, skills and behaviours' framework and incorporates the GMC's 'Good Medical Practice' (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.

Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS).

Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell.

Differential T helper cell response in tuberculous pleuritis.

PURPOSE: This study was conducted to understand the in vivo and in vitro immune responses and to find whether there exists any difference in the systemic and localized immune responses in tuberculous pleuritis. METHODS: The in vivo levels of IFN-gamma and IL-4 were compared in plasma (BL) and pleural fluid (PF) of 47 tuberculous (TB) and 31 nontuberculous pleuritis (Non-TB) patients. In vitro cytokine response to various mycobacterial antigens was studied in 19 TB patients by ELISA. Both ex vivo and in vitro cytokine responses were further ascertained by intracellular cytokine staining on purified CD4+ T cells from pleural fluid mononuclear cells (PFMC) of 10 TB patients. RESULTS: The ex vivo results showed a significant increase in IFN-gamma levels and higher IFN-gamma + T cells in PF. On the other hand, in vitro results showed simultaneous increase in both IFN-gamma and IL-4 levels in the supernatants of antigen stimulated PFMC. Similarly antigen specific increase was observed in both IFN-gamma + and IL-4+ T cells in all cultured conditions. However, the percentile increase was more in IL-4 secreting T cells, significant for PPD stimulation (P < 0.05), indicating that in vitro cellular response was dominated by Th2 type. CONCLUSIONS: These results showed a differential T-helper response in TB pleuritis suggestive of predominant Th1 in vivo and mixed response (Th1 and Th2) under in vitro conditions.