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Handheld Ultrasound Practice Areas.

How a Handheld Ultrasound Exam Could Help in Three Scenarios

The handheld ultrasound exam offers incredible potential for today's primary care physicians (PCPs) — it can, and should, be used as a key diagnostic tool. According to a study in The World Book of Family Medicine, "Ultrasonography should be a diagnosis tool beside the stethoscope in the general practitioner office ... the two instruments should be considered as complementary."

Further, a study in PLoS One identified that "after a simple and short training course, a pocket-sized ultrasound device examination can be used in addition to a physical examination to improve the answer to ... common clinical questions concerning in- and outpatients and can reduce the need for further testing."

Specifically, a focused ultrasound exam may be used to complement the PCP's physical examination in three common diagnostic areas: right upper quadrant pain; flank pain; and deep vein thrombosis (DVT).

Right Upper Quadrant Pain
Right upper quadrant pain is a common presentation in primary care. The handheld ultrasound exam of the right upper quadrant of the abdomen can look for signs of gross abnormalities of the liver and gallbladder.

Point of care ultrasound may be used to identify the presence of gallstones and to assess for acute cholecystitis by detecting Murphy sign, anterior gallbladder wall thickening and pericholecystic fluid. The handheld ultrasound may also be used to assess potential bile obstruction by measuring the common bile duct diameter. This may help the physician pursue non-gallbladder sources of epigastric discomfort.

Flank Pain
When it comes to flank pain, a handheld ultrasound device may be used to assess the kidneys and, specifically, to look for hydronephrosis, identify renal or ureteral stones and to check the post-void residual bladder volume. This may provide a physician with more context in relation to the physical exam.

A study in Urology noted that a urologist "using handheld-pocket-size device is equivalent to a sonographist-performed ultrasound study using a standard device in most parameters examined. The handheld device can be used in evaluating the upper and lower urinary tract with the exception of renal masses and therefore can be of great assistance in a wide variety of the daily urological practice scenarios."

Deep Vein Thrombosis
There is a potential benefit in using handheld ultrasound devices when dealing with DVT. According to the Journal of the American College of Cardiology: Cardiovascular Imaging, "The accurate and immediate decision-making allowed by the pocket-size ultrasound examination (PUE) has the potential to exert a significant impact on the current diagnostic strategies for DVT. Positive PUE can make other diagnostic or therapeutic procedures available earlier for the patient without standard ultrasound examination."

Handheld ultrasound devices can potentially allow physicians to scan anyone suspected of having DVT without them having to wait for blood test results. A paper in Thrombus stated that "reducing the time to diagnose DVT could potentially avoid the use of self-injected low molecular weight heparin by patients."

Training for Success
As with any technology, getting the proper training is a key component for reaching positive results. An article in the Annals of Internal Medicine encourages "residency training programs to teach PoCUS, practicing hospitalists to incorporate it into daily practice, and hospitals and hospital medicine programs to provide easy access to the necessary technology."

A study in BMC Medical Education concluded that "medical students with minimal training were able to use (a pocket-size imaging device) as a supplement to standard physical examination and successfully acquire acceptable relevant organ images for presentation and correctly interpret these with great accuracy." And, according to the Annals of Internal Medicine study, the "use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process."

By adding handheld ultrasound to the routine examination, PCPs may have the potential to reduce waiting times and ultimately deliver better care to those who need it.
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Handheld Ultrasound Education. Improving Patient Care.

Handheld Point-of-Care Ultrasound: Why Having it is Important

When it comes to the best quality patient care, the physical exam is a fundamental factor. Providers glean a great deal of information this way, but using handheld ultrasound to visualize non-visible parts of the body might be a powerful clinical complement.

In many cases, having handheld ultrasound available might also be the key to accelerated patient care and accurate diagnoses. And, when time is of the essence, point-of-care ultrasound (PoCUS) may be the tool that speeds up your diagnostic capabilities.

Ultimately, using PoCUS, such as GE's Vscan Extend™, increases not only your confidence with your diagnosis, but your patient's comfort with the care you provide.

Inspiring Confidence
When a patient presents with a suspected problem, such as right upper quadrant or flank pain, making a timely diagnosis may be critical. Alongside a physical exam, PoCUS lets you focus immediately on the problem area and see what's invisible to the naked eye, giving you greater confidence in identifying the cause of the symptoms.

In fact, point-of-care ultrasound could increase how detailed your exam can be, adding valuable information to the patient's electronic health record. In a short amount of time, PoCUS may capture multiple clear images to give you a more robust picture. According to the concluding findings of a 2016 report from The World Book of Family Medicine, "because of a significant number of advantages, ultrasonography should be a diagnosis tool" used with a stethoscope in medical offices.

If needed, this level of detail lets you refer your patients for the right test or diagnostic treatment, reducing the likelihood they will go through unnecessary doctor visits or unneeded additional imaging.

Saving Time
PoCUS images may also help you save time whether you're an emergency department (ED) physician or a general practitioner.

In the ED, having access to a handheld ultrasound device may determine if and how you triage your patients. For example, if an individual has symptoms of cardiac distress, PoCUS may reveal information at the bedside in real time.

A PoCUS exam may also pave the way for rapid diagnosis during a regular doctor's visit. During an appointment, you may make an immediate decision whether your patient needs to see a specialist or be hospitalized. Not having to wait for another provider's analysis may fast-track needed therapy and reduce any stress patients might have about their symptoms.

Shortening Diagnosis Time
As you use PoCUS more often and fine-tune your skills, you're likely to become more confident in your findings. Over time, it's possible that you'll be able to render your bedside diagnoses and offer guidance more quickly.

A 2011 European Journal of Echocardiography study tested the diagnostic efficiency of PoCUS and high-end echocardiography and concluded that "pocket-sized echocardiographic examinations of approximately four-minute length, performed at the bedside by experts, offers reliable assessment of cardiac structures, the pleural space and the large abdominal vessels."

Improving Relationships
As a hand-held device, PoCUS gives you the opportunity to have more face time with your patients. In many cases, they watch as you conduct the exams and can ask questions. Getting real-time information from ultrasound images may increase the patient's confidence in your diagnosis and the treatment you'll prescribe. For example, PoCUS at the bedside may provide a pregnant woman with the immediate visual confirmation that her unborn baby is healthy.

Additionally, according to a 2018 Annals of Internal Medicine study, PoCUS may also offer high ultrasound imaging quality, and the authors concluded that they "believe that use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process." Bedside testing may lead to decreased lengths of stay, a reduction in resource utilization and lower costs.

PoCUS vs. Other Modalities
In many instances, PoCUS may provide better ultrasound image quality than the other modalities you employ with your patients. For example, according to the conclusions of a 2013 Clinical Cardiology study, "the pocket-sized (portable transthoracic echocardiography) provides accurate detection of cardiac structural and functional abnormalities beyond the ECG." These findings may boost your confidence that you'll catch a problem earlier.

In addition, research has also shown PoCUS is a strong alternative to chest X-ray when diagnosing pericardial (PE) and pleural effusions (PLE). A 2015 Scandanavian Cardiovascular Journal article that observed nurses using ultrasound concluded that "Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused ultrasound."

Overall, in today's healthcare environment, PoCUS may play a significant role in providing additional clues during physical exams to make a diagnosis. By employing PoCUS, you may be able to gather these images much faster than you possibly could with other options. And, as you become more proficient with the hand-held technology, you may become more confident with your real-time diagnosis, potentially improving patient care.

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Technology and Innovation. Handheld Ultrasound Practice Areas.

Building the Doctor-Patient Relationship With Practical Visualization Tools

The doctor-patient relationship relies on strong communication, just like every other relationship in healthcare. Between providers, communication failure, not a lack of provider skill, has been identified as the root cause of approximately 80 percent of serious adverse events in healthcare settings. The implications of failures in doctor-patient communications should be taken just as seriously.

Medical schools are stepping up to the plate and putting more emphasis on relationships and communication, but more practical steps are needed. Thankfully, a new class of portable tools is emerging to address those gaps.

Better Outcomes Start With Physician Empowerment
Often, the discussion around outcome improvement centers on patient empowerment. Of course, patient-centered health matters, but a large portion of it rests in the hands of physicians.

Physicians have an amazing opportunity to be catalysts in revolutionizing the patient experience, simply by being willing and enthusiastic agents of patient empowerment.

At the same time, the benefits of an improved doctor-patient relationship flow both ways. Having confused, irritated patients might lead to poor outcomes, which may directly impact a physician's feelings of job fulfillment — a dynamic that can't be ignored as we face the public health crisis of physician burnout.
 
Technology That's Improving the Doctor-Patient Relationship
The relationship between doctors and patients is dynamic and relies on direct communication. However, it's also filtered through the overall patient experience. Breakthroughs in technology have been made that not only improve care, but also open up new channels of communication for physicians.

Advances in digital devices allow 4D ultrasound allow doctors to not only share digital images almost immediately with expectant parents with one click, but also enable instantaneous collaboration with other clinicians in addressing any issues. The cloud-based system Tricefy™ allows immediate commentary from physicians and facilitates dialog from practically anywhere.

Enhancing clinical relationships requires not only better communication skills, but also tools that close the gap between diagnosis and patient understanding through a more educational and interactive experience. Patients can not only see what their doctors see, but also get more precise information, like the exact location of an issue. This is where portable technology, such as handheld ultrasound, gives teeth to initiatives attempting to improve the doctor-patient relationship.

Understanding the Power of Handheld Ultrasound
Handheld ultrasound has led the way to a new level of accessibility for providers, with some units being the size of a smartphone, while still providing quality images. According to the conclusion of a study published in The Acta Anaesthesiologica Scandinavica that compared the Vscan and the Vivid-i systems, "the Vscan displays image quality interchangeable with larger and more expensive systems. The apparatus is well-suited for performing a (focus-assessed transthoracic echocardiography) examination in a one-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness."

The simple nature of their portability can help doctors at the bedside, as well. Authors of a study published in The Annals of Internal Medicine concluded "that the use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process."

Consider the fact that the use of pocket mobile ultrasound devices (PUDs) has been found to actually spare patients the negative and often costly experience of unnecessary exams. According to a study published in PLOS One, "after a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to 10 common clinical questions concerning in- and outpatients, and can reduce the need for further testing."

Clinical settings, though, are just the beginning. Organizations such as Doctors To You are meeting patients where they are and leveraging technology like Vscan Extend™ to expand the reach of house calls. We're also entering a period where more employers are offering healthcare services in the workplace. Companies including Disney, Apple, Boeing, Cisco and Goldman Sachs now provide on-site clinics for their employees, further increasing the potential for portability and accessibility in diagnostic modalities like handheld ultrasound, and opening up an entirely new venue for the doctor-patient relationship.

Initiatives around improving outcomes and the patient experience can easily remain abstract without serious discussions about the technology that pulls them into clinical realities. Forward-thinking healthcare leaders should keep an eye out for developments like handheld ultrasound as foundational tools in improving doctor-patient communications.
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Improving Patient Care. Handheld Ultrasound Trends. Technology and Innovation.

Inside Africa’s Floating Hospital

Dr. Leo Cheng, a maxillofacial reconstructive surgeon with the UK National Health Service, spends two to three weeks of his leave each year volunteering on board the Africa Mercy, the world’s largest charitable floating hospital run by international charity Mercy Ships. His patients suffer from large benign tumours on the face and neck. Many of them have never received any kind of healthcare before they meet him.

Earlier this year, Dr. Cheng joined the Africa Mercy to travel to Tamatave in Madagascar, where more than 90% of the population live on less than a dollar a day. For every 10,000 residents, there are only two physicians and three hospital beds available.

The Africa Mercy has five state-of-the-art operating rooms and advanced equipment to help make fast and accurate diagnoses. Dr. Cheng and the ship’s team are always on the lookout for new methods and technologies that can improve the work they do while aboard.

 
“Ahead of this latest journey, I initially inquired about a laptop-style ultrasound machine. Once I found out about the Vscan with Dual Probe, I immediately felt that I must introduce this to the ship clinicians,” Dr. Cheng said.

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Improving Patient Care. Handheld Ultrasound Trends. Technology and Innovation.

Massive Storm, Small Technology

On September 9, Jeff Hersh, a doctor, watched the northbound lanes of Interstate 75 in Florida fill with carloads of people fleeing the path of Hurricane Irma.

Jeff was on the other side of the highway, driving south and intentionally heading into the oncoming storm.

Irma struck northern Caribbean islands as well as the U.S. mainland and is blamed for dozens of deaths as well as power outages to millions of homes and businesses.

Jeff is among the 36 members of the Boston Strong MA1 Disaster Medical Assist Team (DMAT), which was activated as part of the United States Health and Human Service’s National Disaster Medical System (NDMS) response to Hurricane Irma.

In its 30-year history, NDMS has participated in more than 300 deployments to disasters domestically. It’s is made up of civilian, disaster-response trained people who become intermittent federal employees, serving as boots on the ground when and where they’re needed.

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