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A comparison of handheld and standard ultrasound in Swiss medical students

World Journal of Emergency Medicine 2022年第2期13卷 85-90页

作者： Mark Slader Hayley Young Margot Barker Kylie Prentice Katherine Bogaard Charlene Yuan Soheil Saadat shadi lahham School of Medicine University of CaliforniaIrvine 92617USA Department of Emergency Medicine University of CaliforniaIrvine 92868USA

BACKGROUND:The use of ultrasound(US)within healthcare has inspired the development of new US technology.There have been few studies comparing the use of handheld US to standard US for medical education.This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine.METHODS:Over two days of instruction,participants were taught and evaluated on core US fundamentals.The standard group received instruction on standard US machines,while the handheld group received instruction on handheld US devices.Participants completed a qualitative survey regarding their experience.Six hundred and four images were obtained and graded by two emergency medicine physicians.RESULTS:A total of 119 Swiss medical students were enrolled in our study.There was no statistically significant difference in the US assessment measurements,except for faster endpoint septal separation(EPSS)vascular setup time in the handheld group(P=0.001).There was no statistically significant difference in participants’perceived difficulty of US learning(P=0.198),comfort level(P=0.188),or self-estimated capability to perform US in the future(P=0.442).There was no statistically significant difference in the percentage of correctly obtained images(P=0.211)or images that were clinically useful(P=0.256).The median quality score of images obtained by the standard group was eight compared to seven in handheld group(P<0.01).CONCLUSION:Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality.

关键词： Handheld ultrasound Ultrasound education Switzerland Medical education

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Can an 8^(th) grade student learn point of care ultrasound?

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World Journal of Emergency Medicine 2019年第2期10卷 109-113页

作者： Alexander S.Kwon shadi lahham John C.Fox Sage Hill School Department of Emergency Medicine UC Irvine Medical Center UC Irvine School of Medicine

BACKGROUND: Point-of-care ultrasound has gained widespread use in developing countries due to decreased cost and improved telemedicine capabilities. Ultrasound training, specifi cally image acquisition skills, is occurring with more frequency in non-medical personnel with varying educational levels in these underdeveloped areas. This study evaluates if students without a high school education can be trained to acquire useful FAST images, and to determine if an 8^(th) grade student can teach peers these skills.METHODS: The 8^(th) grade students at a small middle school were divided into two groups. One group received training by a certified medical sonographer, while the other group received training by a peer 8^(th) grade student trainer who had previously received training by the sonographer. After training, each student was independently tested by scanning the four FAST locations. A blinded ultrasound expert evaluated these images and deemed each image adequate or inadequate for clinical use.RESULTS: Eighty video image clips were obtained. The overall image adequacy rate was 74%. The splenorenal window had the highest rate at 95%, followed by retrovesical at 90%, hepatorenal at 75%, and subxiphoid cardiac at 35%. The adequacy rate of the sonographer-trained group was 78%, while the adequacy rate of the student-trained group was 70%. The difference in image adequacy rate between the two groups was not signifi cant(P-value 0.459).CONCLUSION: The majority of 8^(th) graders obtained clinically adequate FAST images after minimal training. Additionally, the student-trained group performed as well as the sonographer-trained group.

关键词： Point of care ultrasound FAST Image acquisition Training

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Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center

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World Journal of Emergency Medicine 2020年第1期11卷 12-17页

作者： Samantha Shwe Lauren Witchey shadi lahham Ethan Kunstadt Inna Shniter John C.Fox School of Medicine University of CaliforniaIrvine 92697USA Department of Emergency Medicine University of CaliforniaIrvineOrangeCA 92868USA

BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.

关键词： Point-of-care ultrasound Emergency medicine Focused assessment withsonography in trauma Trauma activation Blunt trauma

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A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students

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World Journal of Emergency Medicine 2019年第3期10卷 169-176页

作者： Sagar Shah Steven Tohmasi Emily Frisch Amanda Anderson Roy Almog shadi lahham Roland Bingisser John C. Fox School of Medicine University of California Irvine USA Department of Emergency Medicine University of California Irvine Irvine USA University Hospital Basel Basel Switzerland

BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean precourse ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3%(P<0.01). The didactic group also showed statistically signifi cant improvement on the physiology exam, improving from 59.3% to 70.0%(P<0.01). CONCLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically signifi cant improvement in physiology learning when compared to standard didactic curriculum.

关键词： Ultrasound education POCUS Switzerland Medical education

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Procedural simulation:medical student preference and value of three task trainers for ultrasound guided regional anesthesia

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World Journal of Emergency Medicine 2017年第4期8卷 287-291页

作者： shadi lahham Taylaur Smith Jessa Baker Amanda Purdy Erica Frumin Bret Winners Sean P.Wilson Abdulatif Gari John C.Fox Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA UC Irvine School of Medicine IrvineCaliforniaUSA

BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks.METHODS: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device.RESULTS: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin model.CONCLUSION: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.

关键词： Ultrasound guided nerve block Task trainer Regional anesthesia

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Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam(ROUTE)in rural Panama

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World Journal of Emergency Medicine 2018年第3期9卷 216-222页

作者： Annasha Vyas Katherine Moran Joshua Livingston Savannah Gonzales Marlene Torres Ali Duffens Carina Mireles Romo Gnevieve Mazza Briana Livingston shadi lahham John Christian Fox School of Medicine University of California IrvineIrvineCA 92697USA Department of Obstetrics and Gynecology University of California IrvineOrangeCA 92868USA Department of Emergency Medicine University of California IrvineOrangeCA 92868USA

BACKGROUND:Maternal and infant mortality rates reported in rural Panama are greater than those in urban regions.Bocas del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health care.Portable ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic imaging.The goal of this study is to determine the feasibility of teaching firstyear medical students the Rural Obstetrical Ultrasound Triage Exam(ROUTE)to help identify pathology in pregnant women of the Bocas del Toro region of Panama.METHODS:Eight first-year medical students completed ROUTE training sessions.After training,the students were compared to professional sonographers to evaluate their accuracy in performing the ROUTE.Students then performed the ROUTE in mobile clinics within Bocas del Toro.They enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter,head circumference,amniotic fluid index,fetal lie and placental position.Any abnormal measurement would be further analyzed by the lead physician for a potential hospital referral.RESULTS:A total of 60 women were enrolled in the study.Four women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further evaluation.CONCLUSION:Based on our data,first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural Panama.Additional studies are required to determine the optimal amount of training required for proficiency.

关键词： Point of care ultrasound Ultrasound education Rural Panama Obstetrics ultrasound

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Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

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World Journal of Emergency Medicine 2019年第1期10卷 46-50页

作者： Genevieve Mazza Carina Mireles Romo Marlene Torres Ali Duffens Annasha Vyas Katherine Moran Joshua Livingston Savannah Gonzales shadi lahham Inna Shniter Maxwell Thompson John Christian Fox School of Medicine University of California Irvine Department of Emergency Medicine University of California Irvine

BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava(IVC) to the aorta(Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half(n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half(n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8.CONCLUSION: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

关键词：小学英语课外阅读阅读材料

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Simpli?ed point-of-care ultrasound protocol to con?rm central venous catheter placement:A prospective study

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World Journal of Emergency Medicine 2017年第1期8卷 25-28页

作者： Scan P.Wilson Samer Assaf shadi lahham Mohammad Subeh Alan Chiem Craig Anderson Samantha Shwe Ryan Nguyen John C.Fox Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA Department of Emergency Medicine University of CaliforniaSylmarLos AngelesCalifornia 91342USA

BACKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(CVC) placement is with plain ? lm chest radiography(CXR). We hypothesized that a simple point-of-care ultrasound(POCUS) protocol could effectively con? rm placement and reduce time to con? rmation.METHODS: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC.RESULTS: Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8%(95%CI 77.1%–93.5%) and speci? city of 100%(95%CI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), respectively.CONCLUSION: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory CXR.

关键词： Point-of-care ultrasound Emergency ultrasound Central venous access

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Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by fi rst-year medical students

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World Journal of Emergency Medicine 2017年第4期8卷 281-286页

作者： Jonathan B.Lee Christina Tse Thomas Keown Michael Louthan Christopher Gabriel Alexander Anshus Bima Hasjim Katrina Lee Esther Kim Luke Yu Allen Yu shadi lahham Steven Bunch Maili Alvarado Abdulatif Gari John C.Fox School of Medicine University of CaliforniaIrvineUSA Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA

BACKGROUND: The purpose of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by American first-year medical students to general practitioners working in public health care clinics, or puskesmas, in Bandung, Indonesia.METHODS: We performed a prospective, observational study of Indonesian health care practitioners from public clinics in Bandung, Indonesia. These practitioners were enrolled in a 4-week ultrasound training course taught by first-year American medical students. A total of six sessions were held comprising of 38 ultrasound milestones. A pre-course and post-course written exam and practical exam was taken by each participant.RESULTS: We enrolled 41 clinicians in the course. The average pre-course exam score was 35.2% with a 2.4% pass rate, whereas the average post-course exam score was 82.0% with a 92.7% pass rate. The average practical score at the completion of the course was 83.2%(SD=0.145) with 82.9% of the class passing(score above 75.0%).CONCLUSION: Our data suggests that first-year medical students can effectively teach ultrasound to physicians in Indonesia using a 4-week intensive ultrasound training course. Future studies are needed to determine the amount of training required for proficiency and to evaluate the physicians' perceptions of the student-instructors' depth of knowledge and skill in point of care ultrasound.

关键词： Ultrasound education Ultrasound teaching Indonesia

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Ultrasound curriculum taught by first-year medical students： A four-year experience in Tanzania

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World Journal of Emergency Medicine 2018年第1期9卷 33-40页

作者： Scan P. Denny William B. Mintccr Rcccc T.H. Fcnning Sahil Aggarwal Dcbora H. Lee Shclla K. Raja Kaavya R. Raman Allison O. Farfcl Priya A. Patcl MarkLicbcr Mcgan E. Bcrnstcin shadi lahham John C. Fox School of Medicine University of California Irvine Orange California 92868 USA Department of EmergencyMedicine University of California Irvine Orange California 92868 USA

BACKGROUND: Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries(LMICs) such as Tanzania. The introduction of ultrasound can significantly impact treatment in these countries due to its portability, low cost, safety, and usefulness in various medical assessments. This study reviews the implementation of a four-week ultrasound course administered annually from 2013–2016 in a healthcare professional school in Mwanza, Tanzania by first-year allopathic US medical students.METHODS: Participants(n=582, over 4 years) were recruited from the Tandabui Institute of Health Sciences and Technology to take the ultrasound course. Subjects were predominantly clinical officer students, but other participants included other healthcare professional students, practicing healthcare professionals, and school employees. Data collected includes pre-course examination scores, post-course examination scores, course quiz scores, demographic surveys, and postcourse feedback surveys. Data was analyzed using two-tailed t-tests and the single factor analysis of variance(ANOVA).RESULTS: For all participants who completed both the pre-and post-course examinations(n=229, 39.1% of the total recruited), there was a significant mean improvement in their ultrasound knowledge of 42.5%, P<0.01.CONCLUSION: Our data suggests that trained first-year medical students can effectively teach a point of care ultrasound course to healthcare professional students within four weeks in Tanzania. Future investigation into the level of long-term knowledge retention, impact of ultrasound training on knowledge of human anatomy and diagnostic capabilities, and how expansion of an ultrasound curriculum has impacted access to care in rural Tanzania is warranted.

关键词： Point of care ultrasound Ultrasound education Tanzania

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