المؤلفون: Dornhofer, Kyle, Farhat, Ahmed, Guan, Kevin, Parker, Erica, Kong, Christina, Kim, Daniel, Nguyen, Thalia, Mogi, Jennifer, Lahham, Shadi, Fox, John C.

المصدر: Journal of Clinical Ultrasound; Mar2020, Vol. 48 Issue 3, p145-151, 7p

مستخلص: Purpose: In the Indonesian health-care system, nurses and midwives often serve as the primary health-care providers due to physician shortages. Seeking to address the need for medical care in resource-limited environments, some have advocated for portable equipment in the hands of health-care providers. We hypothesized that medical students are able to effectively teach point-of-care ultrasound (POCUS) to physicians, nurses, and midwives in rural Indonesia.Methods: We conducted a prospective, observational study using health-care practitioners from a clinic and accredited school for nursing and midwifery in Mojokerto, East Java, Indonesia. Enrolled practitioners took part in a 4-week POCUS course followed by postinstructional testing.Results: A total of 55 health-care practitioners completed the course. This included 19 physicians, 13 nurses, and 19 midwives. Of the 55 clinicians, 43 (72%) passed the course and 12 (28%) failed.Conclusions: Physicians, nurses, and midwives in rural Indonesia showed significant acquisition of ultrasound (US) knowledge and skills following a 4-week US course. Following training, all three groups displayed skills in practical US use during a postcourse practical examination. This is one of the first studies to assess the efficacy of medical students teaching POCUS to midwives and nurses. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Clinical Ultrasound is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Becker, Brent A., Lahham, Shadi, Gonzales, Mark A., Nomura, Jason T., Bui, Michelle K., Truong, Taylor A., Stahlman, Barbara A., Fox, John C., Kehrl, Thompson, Jang, Timothy B.

المصدر: Academic Emergency Medicine; Aug2019, Vol. 26 Issue 8, p921-930, 10p

مصطلحات موضوعية: COMPUTED tomography, CONFIDENCE intervals, GASTROINTESTINAL motility, HOSPITAL emergency services, BOWEL obstructions, LONGITUDINAL method, MEDICAL cooperation, SCIENTIFIC observation, RESEARCH, STATISTICAL sampling, POINT-of-care testing

مستخلص: Objective: The main objective of this study was to evaluate the accuracy of emergency physician‐performed point‐of‐care ultrasound (POCUS) for the diagnosis of small‐bowel obstruction (SBO) compared to computed tomography (CT). Methods: We performed a prospective, multicenter, observational study examining a convenience sample of adult patients with potential SBO presenting to the emergency department (ED) between July 2014 and May 2017. Each POCUS was interpreted at the bedside by the performing emergency physician and retrospectively by an expert reviewer. Test characteristics were calculated for POCUS, blinded expert interpretation, and specific POCUS parameters. Results: A total of 217 subjects were included in the primary analysis with an overall SBO prevalence of 42.9%. For the diagnosis of SBO, POCUS demonstrated an overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 0.88 (95% confidence interval [CI] = 0.80 to 0.94), 0.54 (95% CI = 0.45 to 0.63), 1.92 (95% CI = 1.56 to 2.35), and 0.22 (95% CI = 0.12 to 0.39), respectively. Expert review yielded a similar sensitivity (0.89 [95% CI = 0.81 to 0.95]) with a significantly higher specificity (0.82 [95% CI = 0.74 to 0.88]). The more sensitive sonographic parameters for both POC sonographers and expert reviewers were small‐bowel dilation ≥ 25 mm (0.87 [95% CI = 0.79 to 0.93], 0.87 [95% CI = 0.79 to 0.93]) and abnormal peristalsis (0.82 [95% CI = 0.72 to 0.89], 0.85 [95% CI = 0.76 to 0.87]). The more specific parameters for both groups were transition point (0.82 [95% CI = 0.74 to 0.89], 0.98 [95% CI = 0.94 to 1.00]), intraperitoneal free fluid (0.82 [95% CI = 0.74 to 0.89], 0.93 [95% CI = 0.87 to 0.97]), and bowel wall edema (0.76 [95% CI = 0.67 to 0.83], 0.93 [95% CI = 0.87 to 0.97]). Conclusion: POCUS is moderately sensitive for SBO, although less specific, when performed by a diverse group of emergency physicians across multiple EDs. Interpretation of acquired POCUS images is significantly more accurate when performed by physicians with prior emergency ultrasound fellowship training and familiarity with the sonographic appearance of SBO. [ABSTRACT FROM AUTHOR]

: Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lahham, Shadi, Fox, John C., Thompson, Maxwell, Nakornchai, Tanyaporn, Alruwaili, Badriah, Doman, Ghadeer, May Lee, Shannon, Shafi, Amal, Shniter, Inna, Valdes, Victoria, Zhang, Lishi

المصدر: Journal of Ultrasound in Medicine; Mar2019, Vol. 38 Issue 3, p695-702, 8p

مصطلحات موضوعية: TRICUSPID valve, PULMONARY embolism, ADULT respiratory distress syndrome, SYSTOLIC blood pressure, SPECTROGRAMS

مستخلص: Introduction: The imaging standard for evaluation of acute pulmonary embolism (PE) includes a computed tomography pulmonary angiogram. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE. Methods: We prospectively enrolled patients who came to the emergency department with suspicion of acute PE. Each patient underwent a point‐of‐care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. Based on the computed tomography pulmonary angiogram findings, patients were grouped into 3 categories: no acute PE, clinically insignificant acute PE, or clinically significant acute PE. Results: We enrolled 87 patients in this study. Twenty‐three (26.4%) of these patients were diagnosed with PE. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. Analysis of mean TAPSE measurements between patients with clinically significant acute PE and those with insignificant or no PE was 15.2 mm and 22.7 mm, respectively (P ≤ .0001). Following receiver operating characteristic curve analysis, optimum TAPSE measurement to identify clinically significant acute PE is 18.2 mm. A cutoff TAPSE measurement of 15.2 mm shows a sensitivity of 53.3% (95% confidence interval, 26.7%–80%) and a specificity of 100% (95% confidence interval, 100%–100%) for the diagnosis of a clinically significant PE. Conclusions: Our data suggest that TAPSE measurements less than 15.2 mm have a high specificity for identifying clinically significant acute PE. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Ultrasound in Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lahham, Shadi, Baydoun, Jamie, Bailey, James, Sandoval, Sandra, Wilson, Sean P., Fox, John C., Slattery, David E.

المصدر: Journal of Ultrasound in Medicine; Oct2017, Vol. 36 Issue 10, p2079-2085, 7p

مصطلحات موضوعية: TRACHEA intubation, DIAGNOSTIC ultrasonic imaging, ENDOTRACHEAL tubes, RESIDENTS (Medicine), EMERGENCY medicine

مستخلص: Objectives Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. Methods We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. Results Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. Conclusions A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Ultrasound in Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Wilson, Sean P., Mefford, Jason M., Lahham, Shadi, Lotfipour, Shahram, Subeh, Mohammad, Maldonado, Gracie, Spann, Sophie, Fox, John C.

المصدر: Journal of Ultrasound in Medicine; Feb2017, Vol. 36 Issue 2, p321-325, 5p

مستخلص: Objectives The established benefits of point-of-care ultrasound have given rise to multiple new and innovative curriculums to incorporate ultrasound teaching into medical education. This study sought to measure the educational success of a comprehensive and integrated 4-year point-of-care ultrasound curriculum. Methods We integrated a curriculum consisting of traditional didactics combined with asynchronous learning modules and hands-on practice on live models with skilled sonographers into all 4 years of education at a Liaison Committee on Medical Education-accredited US Medical School. Each graduating student was administered an exit examination with 48 questions that corresponded to ultrasound milestones. Results Ninety-five percent (n = 84) of fourth-year medical students completed the exit examination. The mean score was 79.5% (SD, 10.2%), with mean scores on the ultrasound physics and anatomy subsections being 77.1% (SD, 11.0%) and 85.9% (SD, 21.0%), respectively. Conclusions A comprehensive 4-year point-of-care ultrasound curriculum integrated into medical school may successfully equip graduating medical students with a fundamental understanding of ultrasound physics, anatomy, and disease recognition. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Ultrasound in Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Langdorf, Mark I., Fox, John C., Marwah, Rakesh S., Montague, Brian J., Hart, Michael M.

المصدر: Academic Emergency Medicine; Nov2000, Vol. 7 Issue 11, p1321-1329, 9p

المؤلفون: Fox, John C., Lahham, Shadi, Maldonado, Graciela, Klaus, Suzi, Sylwanowicz, Lauren V., Yanuck, Justin, Wilson, Sean P., Shieh, Mason, Anderson, Craig L., English, Carter, Mayer, Ryan, Aish, Bassil, Mohan, Uthara R.

المصدر: Journal of Ultrasound in Medicine; Jun2018, Vol. 37 Issue 6, p1576-1576, 1p

مصطلحات موضوعية: HYPERTROPHIC cardiomyopathy, ULTRASONIC imaging

المؤلفون: FOX, JOHN C.¹, KENKARE, SONYA², PETRONIC-ROSIC, VESNA¹, SOLTANI, KEYOUMARS¹, SETHI, AISHA¹

المصدر: Pediatric Dermatology. Sep/Oct2010, Vol. 27 Issue 5, p537-539. 2p. 2 Color Photographs.

مصطلحات موضوعية: *CASE studies, *BLISTERS, *DISEASE remission, *LEUCOCYTOSIS, *MYCOPHENOLIC acid, *IMMUNOFLUORESCENCE, *PATIENTS

مستخلص: Bullous pemphigoid is an acquired subepidermal vesiculobullous disease most commonly seen in the elderly. We report a 16-year-old girl with bullous pemphigoid who achieved disease remission with mycophenolate mofetil as an adjuvant therapy. [ABSTRACT FROM AUTHOR]