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Improving Patient Care

Improving Patient Care.

Diagnosing Pleural Effusion: Can Handheld Ultrasound Fill X-ray Gaps?

Pleural effusion is a common problem in many patient groups — in particular, for those in intensive care units and those with underlying cardiovascular issues. Fortunately, handheld ultrasound may aid in diagnosing this condition.

How Does Handheld Ultrasound Play a Role in Diagnosis?
The typical method for diagnosing pleural effusion is by examining the patient with a stethoscope during a physical exam and then requesting a chest X-ray. Listening with a stethoscope provides some clues, and in order for X-ray changes to show, there has to be a significant volume of fluid. This can lead to a chest X-ray underestimating the amount of fluid present. Handheld ultrasound examination, on the other hand, may identify even just a few milliliters of fluid. Using a handheld ultrasound device is a quick way to identify the presence of pleural fluid and, therefore, can help in diagnosing pleural effusion.

As an article in Acta Radiologica identified, "Due to its ease of use and its high diagnostic yield, [hand-carried ultrasound] systems of the latest generation constitute a helpful technique for the primary assessment of [pleural effusion]."

This may be useful not only for acute pleural effusions, but also in the assessment of patients with heart failure. Pleural effusions can present as a part of worsening heart failure, and detecting them may help assess the patient's progress. One study reported in the journal Heart concluded that "[u]ltrasound examinations of the pleural cavities and [inferior vena cava] by nurses may improve diagnostics and patient care in [heart failure] patients at an outpatient clinic," although additional research is needed.

How Long Would It Take to Detect Pleural Effusion?
Learning to use a handheld ultrasound device to detect a pleural effusion is straightforward. The European Journal of Cardiovascular Nursing reported a study that concluded, "After brief training, heart failure nurses can reliably identify pulmonary congestion and pleural effusion with a [pocket-sized ultrasound device]."

Another article in the European Journal of Cardiovascular Nursing concluded the following: "Specialized nurses were, after a dedicated training protocol, able to obtain reliable recordings of both pleural cavities and the inferior vena cava by [a pocket-size imaging device] and interpret the images in a reliable way. Implementing focused ultrasound examinations to assess volume status by nurses in an outpatient heart failure clinic may improve diagnostics, and thus improve therapy."

What Are the Benefits of Fast Detection?
Detecting pleural effusion via handheld ultrasound is a quick process. One study in the European Journal of Echocardiography identified that "[p]ocket- sized echocardiographic examinations of [approximately four minutes], performed at the bedside by experts, offer reliable assessment of cardiac structures, the pleural space and the large abdominal vessels."

Ultimately, identifying a pleural effusion more quickly through handheld ultrasound examination (rather than waiting for a chest X-ray) may enable the delivery of faster patient care. Once quickly diagnosed, prompt management can be implemented — for example, by inserting a chest drain. This also potentially avoids the need for ionizing radiation through a chest X-ray.

Being able to perform quick and reliable bedside tests may lead to improved outcomes for patients. The Scandinavian Cardiovascular Journal reported the following: “Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.”

With all this in mind, it seems that using handheld ultrasound in diagnosing pleural effusions is a fast and accurate option.
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Improving Patient Care.

Handheld Ultrasound for Gallstones Improves Physician Effectiveness

Patients visiting their physician with right upper quadrant (RUQ) pain may have vague symptoms that are difficult to diagnose. A condition that physicians commonly check for is gallstones, but it is difficult to reliably diagnose with a physical exam and review of medical history alone.

Bedside ultrasound is an option for providers who are interested in expanding their ability to diagnose patients who are clinically suspected of having acute calculous cholecystitis.

Why Handheld Ultrasound for Gallstones
According to a piece in the Atlas of Handheld Ultrasound, "Bedside [ultrasound (US)] of the biliary system has been shown to decrease the costs as well as emergency department length of stay in patients with cholelithiasis. Bedside US can detect gallstones, a thickened gallbladder wall, pericholecystic fluid, and a sonographic Murphy sign to assist in diagnosis of acute cholecystitis. Also, point-of- care US for gallbladder disease is a skill that can be learned by physicians at all levels of training."

Pocket-sized mobile ultrasound devices (PUDs) have also been found to be a helpful addition to the physical exam. 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 ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.”

How Handheld Ultrasound Stacks Up
Handheld ultrasound offers clinicians portability and easy point-of-care imaging that ultimately transforms the traditional physical exam and expands its capabilities into areas that were previously only available through slow and expensive testing. According to the Journal of Ultrasound in Medicine, "Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability."

Additionally, a study in the Internal and Emergency Medicine journal noted, “PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short-focused training.”

As diagnostic demands on physicians increase, handheld ultrasound options could be a primary consideration for physician leaders who want to best serve their patients, improve outcomes and increase the effectiveness of individual practitioners.
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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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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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