CEUS cardiac exam protocols International Contrast Ultrasound Society (ICUS) recommendations.

The present CEUS Cardiac Exam Protocols represent the first effort to promulgate a standard set of protocols for optimal administration of ultrasound enhancing agents (UEAs) in echocardiography, based on more than two decades of experience in the use of UEAs for cardiac imaging. The protocols reflect current clinical CEUS practice in many modern echocardiography laboratories throughout the world. Specific attention is given to preparation and dosing of three UEAs that have been approved by the United States Food and Drug Administration (FDA) and additional regulatory bodies in Europe, the Americas and Asia-Pacific. Consistent with professional society guidelines (J Am Soc Echocardiogr 31:241-274, 2018; J Am Soc Echocardiogr 27:797-810, 2014; Eur Heart J Cardiovasc Imaging 18:1205, 2017), these protocols cover unapproved "off-label" uses of UEAs-including stress echocardiography and myocardial perfusion imaging-in addition to approved uses. Accordingly, these protocols may differ from information provided in product labels, which are generally based on studies performed prior to product approval and may not always reflect state of the art clinical practice or guidelines.

Predictors of Delayed Accreditation of Echocardiography Laboratories: An Analysis of the Intersocietal Accreditation Commission Database.

BACKGROUND: Intersocietal Accreditation Commission Echocardiography accreditation involves a broad-based evaluation of a given echocardiography facility's daily operation. An in-depth analysis of the most frequent noncompliant accreditation items provides learning opportunities for improvement of echocardiographic practice and facilities. METHODS: Data from 3,260 facilities applying for accreditation from 2011 to 2013 were analyzed to assess five key elements, each including multiple variables. The key elements included staff qualifications, imaging protocols, image quality, reporting, and documentation of quality improvement activities. Site characteristics for each facility were also analyzed. RESULTS: Sixty-two percent of facilities (n = 2,020) demonstrated deficiencies resulting in delayed accreditation. Deficiencies were less frequently observed at hospital-based facilities, facilities applying for reaccreditation, and facilities with credentialed sonographers. The most frequent deficiencies were related to reports (48%), followed by staff qualifications (46%), quality improvement (45%), image quality (44%), and protocols (43%). Both reports and image quality had the highest average numbers of deficiencies per facility, with 2.0 ± 1.0 and 1.83 ± 0.82, respectively. The most common deficient variables were lack of documented continuing medical education (25%), incomplete protocols (36%), incomplete interrogation of aortic stenosis from multiple views (34%), incomplete reports (36%), and insufficient annual summary of quality improvement activities (45%). CONCLUSIONS: Accreditation is delayed for a majority of facilities seeking Intersocietal Accreditation Commission Echocardiography accreditation because of major deficiencies or noncompliance. By focusing on staff continuing medical education, adoption and implementation of standard imaging protocols, ensuring acceptable image quality, using standards in reporting, and implementing quality improvement programs, echocardiography facility performance and quality as compared with the Intersocietal Accreditation Commission Echocardiography standards may be improved.

Reconsidering culturally competent approaches to American Indian healing and well-being.

There is an urgent need to eliminate mental health disparities experienced by American Indians and Alaska Natives (AI/ANs). Service providers and researchers often address these disparities by focusing on low rates of participation in Western mental health services. In part, this reflects limited understandings of the sociopolitical and historical context of AI/AN mental health problems. Furthermore, this emphasis fails to recognize the importance of emic understandings of locally resonant coping strategies, healing, and treatment. In this article, we describe (a) a study designed to address these gaps, (b) findings related to the importance of land and place, and (c) a community-university collaboration to translate these findings into meaningful change within one Diné community. Connections to the land were an important cultural strength on which to build efforts to promote mental health. Thus, effective treatment might involve more in-depth understanding of cultural processes through which healing occurs and well-being is maintained.

"We're still in a struggle": Diné resilience, survival, historical trauma, and healing.

As part of a community/university collaborative effort to promote the mental health and well-being of Diné (Navajo) youth, we explored the relevance of addressing historical trauma and current structural stressors, and of building on individual and community strengths through healing and social transformation at multiple levels. Qualitative analyses of 74 ethnographic interviews with 37 Diné youth, parents, and grandparents suggested that a focus on historical trauma as a conceptual frame for behavioral health inequities, understood within the context of resilience and survival, is appropriate. Our findings also highlight the salience of current stressors such as poverty and violence exposure. We explore the fit of an historical trauma healing framework and present implications for intervention and transformation through revitalization of traditional knowledge, culturally based healing practices, intergenerational education, and social change strategies designed to eliminate social inequities.

Echocardiographic findings in classical and hypermobile Ehlers-Danlos syndromes.

Structural cardiovascular alterations in the classical and hypermobile forms of Ehlers-Danlos syndrome(EDS) warrant investigation. We have examined a cohort of 38 patients with hypermobile and classical EDSs using two-dimensional echocardiography. The cohort includes 7 males and 31 females, with an age range from 12-60 years. Altered echocardiographic parameters were seen in the initial cross-sectional data analysis in 24/38 patients. Five of the 38 participants had mildly dilated aortic root (AR) or sinuses of Valsalva (SV), and an additional 7 patients had an abnormal pouching of the SV, although the absolute dimensions did not exceed the normal range. Ten patients had mild mitral, tricuspid, or aortic regurgitation, and only one patient had mitral valve prolapse (MVP). Three patients had low normal systolic function; three had evidence of mildly elevated pulmonary pressures, and two patients had mild concentric left ventricular hypertrophy (LVH). Five patients had evidence of impaired left ventricular relaxation (LVR) based on mitral valve E to A velocity ratio. Interestingly, 26/38 subjects demonstrated a prominent right coronary artery (RCA) easily visualized by trans-thoracic echocardiography, and 10/38 had an elongated cardiac silhouette on the 4-chamber apical views. The "pouching" shape of the SV was more common in hypermobile type than in the classical type of EDS. The study is ongoing and will accrue longitudinal data on 100 subjects with classical and hypermobile EDSs at 2-year intervals.