Ultrasound Journal最新文献

Aim: To identify the core components of obstetric point-of-care ultrasound (POCUS) training programs while simultaneously evaluating the effectiveness of these programs using the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model.

Methods: This systematic review and meta-analysis followed a PROSPERO-registered protocol (CRD42024566260) and adhered to PRISMA2020, Cochrane Handbook, and JBI Manual guidelines. Comprehensive searches from database inception to September 22, 2024, covered international and Chinese databases to identify studies evaluating obstetric POCUS training. Two independent reviewers screened studies, assessed methodological quality with JBI tools, and extracted data on study, participant, intervention, and outcome characteristics. Training content was mapped to the ADDIE instructional design model via thematic and framework analyses. Meta-analyses of comparable quantitative outcomes used random-effects models. Integrating quantitative and qualitative findings, this review systematically evaluated the effectiveness and implementation of obstetric POCUS training programs.

Results: Systematic synthesis showed that obstetric POCUS training significantly improved healthcare providers' competencies, including knowledge, skills, sustained use, and clinical decision-making. Training also increased antenatal care attendance and identification of high-risk pregnancies, while reducing referrals and optimizing resource use. However, limitations were noted in needs assessment, implementation flexibility, and outcome evaluation. Using thematic and framework analyses combined with the ADDIE model, we systematically organized training phases and key components to provide a scientific basis for program improvement and optimization.

Conclusions: Obstetric POCUS training effectively enhances clinical competencies and improves maternal and neonatal health outcomes. Applying the ADDIE model offers a replicable, practical, and sustainable approach for developing standardized training programs. Future obstetric POCUS training should leverage the ADDIE model and adapt to local contexts to improve maternal and neonatal health globally.

Background: Timely diagnosis of acute ischemic stroke can aid optimal treatment. Optic nerve sheath diameter (ONSD) can determine increased intracranial pressure (ICP) in such cases. The purpose of this study is to determine the value of ONSD in estimating the severity of acute ischemic stroke.

Methods: Patients with acute ischemic stroke who were referred to a stroke center were studied. The ONSD of both the right and left sides was measured by ultrasound on the day of admission. Ischemic stroke severity was determined based on the NIHSS.

Results: A strong correlation was found between increased right and left ONSDs and severity of ischemic stroke determined by the initial NIHSS score. Based on ROC curve (receiver operating characteristic curve) analysis, both cut points of 5.65 mm for right ONSD (with 100% sensitivity of and 86% specificity) and 5.75 mm for left ONSD (with a 100% Sensitivity and 88% specificity) were able to predict severe stroke. The value of the right ONSD (Area Under the Curve = 0.959) and the left ONSD (Area Under the Curve = 0.942) indicated a strong predictive value.

Conclusions: Ultrasound as a feasible and non-invasive modality might play a role in determining the severity of an acute ischemic stroke, and could be considered a promising first-line decision making tool.

Background: Patients supported with veno-arterial extracorporeal membrane oxygenation may receive an intra-aortic balloon pump to reduce left ventricular afterload and improve aortic diastolic pressure. However, the effect of this combined mechanical support on cerebral hemodynamics is not uniform and can be influenced by intra-aortic balloon pump timing. Bedside transcranial Doppler offers a rapid, noninvasive way to detect maladaptive cerebral flow patterns and to guide patient-device interaction in real time.

Case presentation: We describe a postcardiotomy adult patient on peripheral veno-arterial extracorporeal membrane oxygenation with concomitant intra-aortic balloon pump assistance (1:1) who developed a reduction in cerebral oximetry. Transcranial Doppler of the middle cerebral artery showed increased pulsatility and reduced diastolic velocity, findings consistent with a transient decrease in cerebral perfusion pressure and compatible with balloon deflation asynchrony. Temporary suspension of balloon assistance improved the waveform. Deflation was then synchronized with the electrocardiogram so that it was completed at the onset of systole. Repeat transcranial Doppler performed minutes later showed restoration of diastolic flow and a lower pulsatility index, while extracorporeal support was maintained unchanged and the patient remained hemodynamically stable.

Conclusions: In patients receiving veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump support, cerebral blood flow may deteriorate if balloon timing is not aligned with the native cardiac cycle. Transcranial Doppler can detect these timing-related neurohemodynamic alterations at the bedside and can confirm their reversibility after simple, ECG-guided optimization of deflation. Integrating transcranial Doppler into multiparametric monitoring may help personalize mechanical circulatory support and protect cerebral perfusion in this high-risk population.

Background: Pneumonia is the leading cause of death from infectious diseases worldwide. Lung ultrasound (LUS) is highly accurate for chest infections diagnosis, yet its correlation with causative pathogens remains unclear. Respiratory cultures, combined with molecular techniques represent the gold standard, achieving etiological diagnosis in 90-95% of cases. We compared LUS findings with bronchoalveolar lavage (BAL) sample analyses; to our knowledge, no prior studies have investigated this in the emergency department (ED).

Materials and methods: Bronchoalveolar lavage (BAL)-LUS is a prospective observational non-profit study conducted in the ED, aiming to assess whether there is a correlation between the LUS sonographic appearance, assessed blindly across 12 lung fields, and the etiopathogenetic agent of pneumonia (bacterial and viral) detected with molecular syndromic panels (MSPs) and respiratory cultures obtained with BAL.

Results: 64 patients were enrolled (mean age 73.3 ± 14.6) with 11 diagnosed as viral pneumonia and 53 as bacterial pneumonia. Bacterial pneumonias were more commonly associated with consolidation (2.9 ± 2.2 vs. 1.5 ± 0.9, p < 0.01) and a higher incidence of pleural effusion (0.9 ± 1.3 vs. 0.3 ± 0.6, p < 0.01). Viral pneumonias were more often associated with interstitial syndrome (4.9 ± 3.3 vs. 0.5 ± 1.3, p < 0.01) and small subpleural consolidations (0.9 ± 1.8 vs. 0.2 ± 0.6, p = 0.01). The mean LUS score was significantly higher in bacterial than in viral pneumonia with a AUC of 0.81 (95% CI 0.68-0.93).

Conclusions: Viral pneumonia is usually associated with interstitial syndrome and small subpleural consolidations; on the other hand, bacterial pneumonia is usually associated with consolidation, and pleural effusion.

Background: Focused cardiac ultrasound (FCU) is increasingly used as an extension of physical examination to aid diagnosis and clinical decision-making. Emerging educational technologies such as artificial intelligence (AI)-enabled ultrasound devices and virtual reality (VR) simulators offer novel, cost-effective and self-directed approaches for FCU skill acquisition training. Prior studies suggest that VR-based training may be non-inferior to traditional teaching, while AI offers real-time feedback to enhance learning.

Objective: This study aimed to evaluate the effectiveness and non-inferiority of AI and VR-assisted training compared to Traditional in-person instruction in achieving competency in FCU image acquisition. Secondary outcomes included time to acquire an optimal apical 4 chamber (A4C) view and self-reported confidence in image acquisition, assessed immediately post-training and at 3-month follow up.

Methods: In this single-blind, randomized controlled pilot trial, 66 local medical students with no prior FCU experience were randomised into 3 arms: (1) AI-enabled ultrasound training using the Kosmos system, (2) VR-based stimulator (Vimedix), and (3) Traditional instructor-led teaching. All sessions were 60 min long. Image acquisition of 5 standard FCU views was assessed by blinded evaluators using the Rapid Assessment of Competency in Echocardiography (RACE) score at both time points.

Results: Two participants were lost to follow-up (one each from the AI and VR groups). In the first assessment, the Traditional group achieved the highest mean RACE score (15.77), followed by AI (13.39) and VR (13.23). Non-inferiority testing confirmed that both AI (95% CI -∞ to 3.60; p < 0.001) and VR (95% CI -∞ to 3.58; p < 0.001) methods were non-inferior to Traditional instruction. The AI group achieved the shortest mean time to acquire an optimal A4C view (158 ± 99.1 s), followed by the VR (189 ± 94.7 s), and traditional (199 ± 115.1 s), though differences were not statistically significant (p = 0.591). Confidence levels were initially highest in the Traditional group, while the VR group showed higher confidence at 3-month follow-up, particularly in parasternal long-axis view acquisition.

Conclusions: AI and VR-based training methods were non-inferior to traditional instruction for FCU skill acquisition. Both modalities show promise as scalable, technology-enabled alternatives in ultrasound education. Trial registration This trial was registered on Clinicaltrials.gov (NCT06355557).

Background: The primary aim of this study was to evaluate the feasibility of adding point-of-care ultrasound (POCUS) during the Emergency Department (ED) triage process. This prospective study enrolled two cohorts of adult patients presenting to the ED for a selected group of acute symptoms, previously selected on the basis of the presumed utility of POCUS during triage evaluation. The ED triage process was performed as recommended by the hospital guidelines or by including a nurse-performed POCUS evaluation. Only urgent or less codes were considered eligible for the study. The timing of all evaluations was recorded along with the opinion of the nurses involved in the study on the impact of POCUS results on the triage process. After ED discharge, the most appropriate triage code was determined by independent review of the triage data.

Results: A total of 312 patients were enrolled, 101 of whom were evaluated with the hospital standard triage process. Nine nurses with expertise in both ED triage and POCUS were involved in the study. The majority of the enrolled patients were deferrable or minor urgency (about 60% in both groups). The median time needed for the triage evaluation was 180 seconds (range 540), 90 seconds longer in the POCUS group than in the standard triage group (p < 0.01). Net reclassification index of POCUS-implemented compared with standard triage protocol was 8% and 5% for urgent and less urgent cases.

Conclusions: This small single site study suggests that POCUS is feasible during the ED triage and it is potentially useful by triage nurses. However, future studies are needed to confirm POCUS potential usefulness for a more accurate triage process.

Background: While conventional imaging provides excellent structural detail of the spine, it cannot assess the mechanical properties of spinal tissue in real time. Ultrasound elastography (USE) is an emerging modality that quantifies tissue stiffness, offering a potential solution to this diagnostic gap. This review synthesizes the current evidence for the use of USE in spinal pathology.

Main body: A systematic review of the PubMed, Cochrane, and Web of Science databases was conducted in accordance with PRISMA guidelines, yielding seven primary studies, three clinical and four preclinical, published between 2015 and 2024. These studies, comprising preclinical and clinical data, demonstrate USE's ability to provide real-time, quantitative feedback. Key applications identified include quantifying tension relief in tethered cord syndrome, differentiating spinal tumors from healthy tissue based on stiffness values, and assessing the biomechanical severity of acute and chronic spinal cord injury. Shear wave elastography (SWE) was the predominant modality, proving superior to strain elastography (SE) for spinal applications.

Conclusion: USE is a powerful adjunct to traditional spinal imaging, providing unique functional data that can enhance intraoperative surgical precision and decision-making. While challenges such as depth penetration and operator standardization remain, continued research and technological innovation position USE to significantly improve diagnostic accuracy and surgical outcomes in spinal disease management.

Background: Medical education commonly utilizes the "see one, do one" two-step approach for teaching psychomotor skills; however, recent evidence suggests that Peyton's four-step method leads to superior learning. There is limited evidence, and almost no high-quality studies, specifically evaluating the effect of Peyton's Four‑Step method on long-term retention of ultrasound/POCUS procedural skills. The purpose of this research project was to evaluate the effectiveness of Peyton's four-step method on teaching the POCUS psychomotor skills of image acquisition to novice learners. Additionally, this research project assessed the influence of Peyton's four-step method at three different points in time during the skill acquisition phase, in the setting of ongoing deliberate skill practice.

Methods: A single-blinded, repeated measures interventional study based on experimental design was completed. Physician Assistant students from one large academic medical center were randomized into a control group (using the two-step method) and intervention group (using Peyton's four-step method). Students were taught POCUS of the aorta, bladder, heart, lungs, and kidneys. Students' POCUS skills were assessed during the immediate, intermediate, and delayed learning phases. At each assessment, an organ-specific score and a total score were obtained. Scores were compared using a Wilcoxon rank sum test. An ordinal logistic regression analysis was performed using a generalized linear mixed model with a multinomial distribution and cumulative logit link function to assess the overall effect of Peyton's four-step method.

Results: Students who were taught using Peyton's method were found to have an increased likelihood of higher total scores compared to those taught using usual instruction (OR = 4.2, p = 0.003). Peyton's method was found to have increased likelihood of higher scores for cardiac (OR = 2.3, p = 0.032), lung (OR = 2.5, p = 0.034), and kidney (OR = 3.0, p = 0.015). Student performance statistically improved with Peyton's four-step method during the immediate (p = 0.031) and delayed (p = 0.011) skill acquisition phases, but not in the intermediate phase.

Conclusion: Peyton's four-step method improves overall psychomotor skill acquisition for POCUS. Peyton's four-step method specifically improved psychomotor skills in the immediate skill acquisition phase and the delayed skill acquisition phase. The benefit of Peyton's four-step method was more prominent in POCUS applications with higher complexity.