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1.
J Appl Clin Med Phys ; 23(4): e13546, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1782551

ABSTRACT

PURPOSE: This study introduced an A-mode portable ultrasound bladder scanner, the Lilium® α-200 (here after Lilium; Lilium Otsuka, Kanagawa, Japan), for the treatment of prostate cancer patients with hypofractionated volumetric modulated arc therapy to improve the reproducibility of bladder volume (BV). MATERIALS AND METHODS: Thirty patients were advised to maintain full BV prior to computed tomography (CT) simulation and daily treatment. Among these, the BV of 15 patients was measured using Lilium until a BV of 80% in the simulation was achieved (with the Lilium group). Daily cone-beam CT (CBCT) was performed for treatment. The correlation between BV measured by CBCT and Lilium was assessed. The differences in the BV and dosimetric parameters of the bladder in the CBCT versus planning CT were compared between the groups with and without Lilium. RESULTS: There was a significantly strong relationship (r = 0.796, p < 0.05) between the BVs measured using CBCT and Lilium. The relative BV ratios to simulation CT < 0.5 and > 2 were observed in 10.3% and 12.7%, respectively, of treatment sessions without Lilium group, while these ratios were 1% and 2.8%, respectively, in the Lilium group. The mean absolute difference in the range of V30Gy to V40Gy without Lilium sessions was significantly larger (p < 0.05) than that in the Lilium group. CONCLUSION: The use of the A-mode portable ultrasound bladder scanner significantly improved the reproducibility of the BV, resulting in few variations in the dosimetric parameters for the bladder.


Subject(s)
Prostatic Neoplasms , Radiotherapy, Intensity-Modulated , Cone-Beam Computed Tomography/methods , Humans , Male , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Intensity-Modulated/methods , Reproducibility of Results , Ultrasonography , Urinary Bladder/diagnostic imaging
2.
Can J Anaesth ; 67(10): 1393-1404, 2020 10.
Article in English | MEDLINE | ID: covidwho-1777843

ABSTRACT

Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.


RéSUMé: Les complications pulmonaires du coronavirus (COVID-19) constituent ses manifestations cliniques les plus fréquentes. De récentes observations cliniques ont fait émerger deux phénotypes : le phénotype à élastance faible ou type L (low), et le phénotype à élastance élevée, ou type H (high). La présentation clinique, la physiopathologie, les mécanismes pulmonaires, ainsi que les observations radiologiques et échographiques de ces deux différents phénotypes sont différents. L'approche thérapeutique variera par conséquent selon le phénotype des patients atteints de COVID-19 souffrant d'insuffisance respiratoire.


Subject(s)
Coronavirus Infections/complications , Lung/diagnostic imaging , Pneumonia, Viral/complications , Respiratory Insufficiency/diagnostic imaging , Ultrasonography , Acute Disease , Algorithms , COVID-19 , Coronavirus Infections/diagnostic imaging , Humans , Lung/physiopathology , Lung/virology , Oxygen/metabolism , Pandemics , Phenotype , Pneumonia, Viral/diagnostic imaging , Point-of-Care Systems , Respiratory Insufficiency/virology , Respiratory Rate/physiology
3.
Front Public Health ; 10: 778253, 2022.
Article in English | MEDLINE | ID: covidwho-1775984

ABSTRACT

Background: Promoting technology diffusion and utilization is a key measure to address the great disparity in technical capacity within integrated health systems. However, even the effectiveness and appropriateness regarding technology has been widely recognized, its diffusion and utilization are still stagnant. The mechanisms that influence the technology from being recognized to being widely applied in practice remain largely unknown. Purpose: Taking hepatic contrast-enhanced ultrasound (CEUS) as an example, this study aimed to investigate the comprehensive influencing mechanism of organizational atmosphere and organizational practice on the knowledge, attitude, and practice toward diffusion and utilization of hepatic CEUS in the medical alliance. Methods: Based on the integration of organizational ready for change (ORC) and knowledge-attitude-practice (KAP), a structured questionnaire was developed. A multistage random sampling method was applied to investigate physicians who directly use CEUS working at the liver disease-related departments of sampled health institutions. Structural equation modeling (SEM) was used to verify the proposed hypotheses, and determine the relationship between the factors. Results: In total, 292 physicians were included. SEM results demonstrated that knowledge influenced both attitude and practice, while attitude positively predicted practice. Organizational practice and organizational atmosphere associated positively with each other. Organizational atmosphere positively affected the physicians' attitude toward CEUS diffusion and utilization (ß = 0.425, p < 0.001), while organizational practice positively affected corresponding knowledge (ß = 0.423, p < 0.001) and practice (ß = 0.275, p < 0.001). Additionally, there was a partial mediating effect between organizational practice and physicians' CEUS diffusion and utilization behavior. Conclusion: By verifying the influencing mechanism of organizational atmosphere and organizational practice on the physicians' KAP of hepatic CEUS diffusion and utilization, this study benefit tailoring strategies for promoting technology diffusion and utilization within medical alliance. It is recommended to develop an organizational atmosphere of advocating technology innovation, establish organizational support mechanism (SM) with multiple concrete supporting countermeasures, and so on.


Subject(s)
Health Knowledge, Attitudes, Practice , Liver/diagnostic imaging , Physicians , Ultrasonography , Atmosphere , Contrast Media , Humans , Surveys and Questionnaires
4.
J Neuroimaging ; 32(1): 104-110, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1769736

ABSTRACT

BACKGROUND AND PURPOSE: Treatment of elevated intracranial pressure (ICP) is central to neurocritical care, but not all patients are eligible for invasive ICP-monitoring. A promising noninvasive option is ultrasound measurement of the optic nerve sheath diameter (ONSD). However, meta-analyses of ONSD for elevated ICP show wide confidence intervals. This might be due to baseline variations, inter-rater variability, and varying measurement methods. No standardized protocol has been validated. Corrections for eyeball diameter (ED) and optic nerve diameter (OND) may compensate for baseline variations. We evaluated a protocol and compared two different measurement methods for ONSD ultrasound. METHODS: Two operators, blinded to each other's measurements, measured ONSD, ED, and OND twice in 20 patients. ONSD was measured with two different methods in use: internal (ONSDint) or external (ONSDext) of the dura mater. Intra-class correlation (ICC) was calculated for inter-rater and intra-rater reliability. RESULTS: ICCs for inter-rater reliability of ONSDext and ONSDint (95% confidence interval) were 0.96 (0.93, 0.98) and 0.88 (0.79, 0.94), respectively. ICCs for intra-rater reliability of ONSDext and ONSDint were 0.97 (0.94, 0.99) and 0.93 (0.87, 0.96), respectively. There was no significant bias or difference in intra-rater reliability between operators. CONCLUSIONS: ONSD can be measured with an excellent inter- and intra-rater reliability and low risk of inter-rater bias, when using this protocol. ONSDext yields a higher inter- and intra-rater reliability than ONSDint. Corrections for ED and OND can be performed reliably.


Subject(s)
Intracranial Hypertension , Central Nervous System , Humans , Intracranial Hypertension/diagnostic imaging , Intracranial Pressure/physiology , Optic Nerve/diagnostic imaging , Reproducibility of Results , Ultrasonography/methods
5.
Chin Med J (Engl) ; 134(11): 1286-1288, 2021 Feb 15.
Article in English | MEDLINE | ID: covidwho-1769418
6.
J Urol ; 207(1): 152-160, 2022 01.
Article in English | MEDLINE | ID: covidwho-1769451

ABSTRACT

PURPOSE: Urologists will benefit from an imaging modality which can assess intra and extraluminal characteristics of urethral strictures. We conducted a prospective pilot study evaluating the utility of contrast-enhanced ultrasound and shear wave elastography for the evaluation of bulbar urethral stricture disease. MATERIALS AND METHODS: Patients with a single, bulbar urethral stricture were prospectively recruited. Contrast-enhanced ultrasound and shear wave elastography were performed at the time of surgical repair and at 4 months' followup using an Aplio i800 scanner (Canon Medical Systems, Tustin, California) with an i8CX1 transducer. Sulfur hexafluoride lipid-type A microsphere ultrasound contrast (Lumason®, Bracco Imaging, Princeton, New Jersey) was injected retrograde through the urethra. Stiffness of the corpus spongiosum was measured at and adjacent to the stricture site. Stricture lengths based on retrograde urethrogram, grayscale ultrasound and contrast-enhanced ultrasound were correlated with measured intraoperative stricture length. RESULTS: Thirty men were enrolled. Contrast-enhanced ultrasound (R2=0.709) showed the best correlation with intraoperative measured stricture length compared to retrograde urethrogram (R2=0.016) or grayscale ultrasound (R2=0.471). Stiffness of the spongiosum was greater at the site of the stricture (32.6±5.4 vs 27.3±5.8 kPa, p=0.044) and in narrower caliber strictures (p=0.044) but did not differ by stricture length (p=0.182). At followup (4.3±1.1 months) contrast-enhanced ultrasound detected stricture recurrence with 80% sensitivity, 100% specificity, and 93% accuracy compared to cystoscopy. CONCLUSIONS: This pilot study demonstrates the ability of contrast-enhanced ultrasound and shear wave elastography to become safe, accurate, and potentially efficacious modalities for assessing bulbar urethral strictures and spongiofibrosis.


Subject(s)
Contrast Media , Elasticity Imaging Techniques , Urethral Stricture/diagnostic imaging , Adult , Aged , Humans , Male , Microspheres , Middle Aged , Pilot Projects , Prospective Studies , Ultrasonography/methods
7.
Acute Med ; 21(1): 56-58, 2022.
Article in English | MEDLINE | ID: covidwho-1766397

ABSTRACT

We read with interest the paper from Knight et al in Acute Medicine1 in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.


Subject(s)
COVID-19 , COVID-19/diagnostic imaging , Humans , Lung/diagnostic imaging , Prognosis , Retrospective Studies , Ultrasonography
8.
Rev. Col. Bras. Cir ; 49: e20223202, 2022. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1760016

ABSTRACT

ABSTRACT Percutaneous tracheostomy has been considered the standard method today, the bronchoscopy-guided technique being the most frequently performed. A safe alternative is ultrasound-guided percutaneous tracheostomy, which can be carried out by the surgeon, avoiding the logistical difficulties of having a specialist in bronchoscopy. Studies prove that the efficacy and safety of the ultrasound-guided technique are similar when compared to the bronchoscopy-guided one. Thus, it is of paramount importance that surgeons have ultrasound-guided percutaneous tracheostomy as a viable and beneficial alternative to the open procedure. In this article, we describe eight main steps in performing ultrasound-guided percutaneous tracheostomy, highlighting essential technical points that can reduce the risk of complications from the procedure. Furthermore, we detail some precautions that one must observe to reduce the risk of aerosolization and contamination of the team when percutaneous tracheostomy is indicated in patients with COVID-19.


RESUMO A traqueostomia percutânea tem sido considerada o método padrão atualmente, sendo a técnica guiada por broncoscopia a mais realizada. Uma alternativa segura é a traqueostomia percutânea guiada por ultrassonografia, que pode ser feita pelo próprio cirurgião, evitando-se as dificuldades logísticas de disponibilidade de um especialista em broncoscopia. Estudos comprovam que a eficácia e a segurança da técnica guiada por ultrassonografia, comparada à guiada por broncoscopia, são semelhantes. Assim, é de suma importância que os cirurgiões tenham a traqueostomia percutânea guiada por ultrassonografia como alternativa viável e benéfica em relação ao procedimento aberto. Neste artigo, descrevemos oito passos principais da realização da traqueostomia percutânea ecoguiada, destacando pontos técnicos essenciais que podem reduzir o risco de complicações do procedimento. Ainda, detalhamos alguns cuidados que devem ser observados, com o intuito de reduzir o risco de aerolização e contaminação da equipe, quando a traqueostomia percutânea é indicada no paciente com COVID-19.


Subject(s)
Humans , Tracheostomy/methods , COVID-19 , Bronchoscopy/methods , Ultrasonography , Ultrasonography, Interventional/methods
9.
Wien Klin Wochenschr ; 133(23-24): 1298-1309, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1748480

ABSTRACT

Hundreds of millions got infected, and millions have died worldwide and still the number of cases is rising.Chest radiographs and computed tomography (CT) are useful for imaging the lung but their use in infectious diseases is limited due to hygiene and availability.Lung ultrasound has been shown to be useful in the context of the pandemic, providing clinicians with valuable insights and helping identify complications such as pleural effusion in heart failure or bacterial superinfections. Moreover, lung ultrasound is useful for identifying possible complications of procedures, in particular, pneumothorax.Associations between coronavirus disease 2019 (COVID-19) and cardiac complications, such as acute myocardial infarction and myocarditis, have been reported. As such, point of care echocardiography as well as a comprehensive approach in later stages of the disease provide important information for optimally diagnosing and treating complications of COVID-19.In our experience, lung ultrasound in combination with echocardiography, has a great impact on treatment decisions. In the acute state as well as in the follow-up setting after a severe or critical state of COVID-19, ultrasound can be of great impact to monitor the progression and regression of disease.


Subject(s)
COVID-19 , Critical Illness , Echocardiography , Humans , Lung/diagnostic imaging , Point-of-Care Systems , SARS-CoV-2 , Ultrasonography
10.
Med Ultrason ; 24(1): 5-6, 2022 Feb 16.
Article in English | MEDLINE | ID: covidwho-1744622

ABSTRACT

.


Subject(s)
Lung , Thorax , Humans , Lung/diagnostic imaging , Ultrasonography
11.
Ultrasound Med Biol ; 48(5): 945-953, 2022 May.
Article in English | MEDLINE | ID: covidwho-1740249

ABSTRACT

Recent research has revealed that COVID-19 pneumonia is often accompanied by pulmonary edema. Pulmonary edema is a manifestation of acute lung injury (ALI), and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS), which have higher mortality. Precise classification of the degree of pulmonary edema in patients is of great significance in choosing a treatment plan and improving the chance of survival. Here we propose a deep learning neural network named Non-local Channel Attention ResNet to analyze the lung ultrasound images and automatically score the degree of pulmonary edema of patients with COVID-19 pneumonia. The proposed method was designed by combining the ResNet with the non-local module and the channel attention mechanism. The non-local module was used to extract the information on characteristics of A-lines and B-lines, on the basis of which the degree of pulmonary edema could be defined. The channel attention mechanism was used to assign weights to decisive channels. The data set contains 2220 lung ultrasound images provided by Huoshenshan Hospital, Wuhan, China, of which 2062 effective images with accurate scores assigned by two experienced clinicians were used in the experiment. The experimental results indicated that our method achieved high accuracy in classifying the degree of pulmonary edema in patients with COVID-19 pneumonia by comparison with previous deep learning methods, indicating its potential to monitor patients with COVID-19 pneumonia.


Subject(s)
COVID-19 , Pulmonary Edema , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/diagnostic imaging , Humans , Lung/diagnostic imaging , Pulmonary Edema/complications , Pulmonary Edema/diagnostic imaging , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/diagnostic imaging , Ultrasonography
12.
BMJ Sex Reprod Health ; 48(1): 22-27, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1736080

ABSTRACT

INTRODUCTION: Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service. METHODS: Retrospective case record review of women requesting abortion over a 5-year period (2015-2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings. RESULTS: Only 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy. CONCLUSIONS: Ectopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.


Subject(s)
Abortion, Induced , Abortion, Spontaneous , Pregnancy, Ectopic , Abortion, Induced/adverse effects , Abortion, Spontaneous/diagnostic imaging , Abortion, Spontaneous/epidemiology , Female , Humans , Pregnancy , Pregnancy, Ectopic/diagnostic imaging , Pregnancy, Ectopic/epidemiology , Retrospective Studies , Ultrasonography
13.
Front Endocrinol (Lausanne) ; 13: 801133, 2022.
Article in English | MEDLINE | ID: covidwho-1731766

ABSTRACT

Background: acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients. Methods: cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality. Results: two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004). Discussion: we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.


Subject(s)
COVID-19/epidemiology , Muscle Strength/physiology , Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Survivors , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/pathology , Cross-Sectional Studies , Extremities/diagnostic imaging , Extremities/physiopathology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscular Diseases/etiology , Muscular Diseases/pathology , Muscular Diseases/physiopathology , Organ Size , SARS-CoV-2/physiology , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Sarcopenia/etiology , Survivors/statistics & numerical data , Ultrasonography
14.
Eur J Radiol ; 146: 110066, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1719668

ABSTRACT

PURPOSE: In this study we aimed to leverage deep learning to develop a computer aided diagnosis (CAD) system toward helping radiologists in the diagnosis of SARS-CoV-2 virus syndrome on Lung ultrasonography (LUS). METHOD: A CAD system is developed based on a transfer learning of a residual network (ResNet) to extract features on LUS and help radiologists to distinguish SARS-CoV-2 virus syndrome from healthy and non-SARS-CoV-2 pneumonia. A publicly available LUS dataset for SARS-CoV-2 virus syndrome consisting of 3909 images has been employed. Six radiologists with different experiences participated in the experiment. A comprehensive LUS data set was constructed and employed to train and verify the proposed method. Several metrics such as accuracy, recall, precision, and F1-score, are used to evaluate the performance of the proposed CAD approach. The performances of the radiologists with and without the help of CAD are also evaluated quantitively. The p-values of the t-test shows that with the help of the CAD system, both junior and senior radiologists significantly improve their diagnosis performance on both balanced and unbalanced datasets. RESULTS: Experimental results indicate the proposed CAD approach and the machine features from it can significantly improve the radiologists' performance in the SARS-CoV-2 virus syndrome diagnosis. With the help of the proposed CAD system, the junior and senior radiologists achieved F1-score values of 91.33% and 95.79% on balanced dataset and 94.20% and 96.43% on unbalanced dataset. The proposed approach is verified on an independent test dataset and reports promising performance. CONCLUSIONS: The proposed CAD system reports promising performance in facilitating radiologists' diagnosis SARS-CoV-2 virus syndrome and might assist the development of a fast, accessible screening method for pulmonary diseases.


Subject(s)
COVID-19 , SARS-CoV-2 , Computers , Diagnosis, Computer-Assisted , Humans , Ultrasonography
15.
J Clin Ultrasound ; 50(3): 326-338, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1712112

ABSTRACT

COVID-19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID-19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID-19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID-19 in the lungs, heart and liver.


Subject(s)
COVID-19 , Humans , Lung/diagnostic imaging , Lung/pathology , Pandemics , SARS-CoV-2 , Ultrasonography
16.
Med Ultrason ; 24(1): 3591, 2022 Feb 16.
Article in English | MEDLINE | ID: covidwho-1689798

ABSTRACT

To EditorWe have read this article with great interest, where a pattern of correlation is established between lung ultrasound findings and the degree of respiratory failure and prognosis in patients with Coronavirus disease 2019. However, we think that some aspects of this study can be better analyzed.


Subject(s)
COVID-19 , Humans , Lung/diagnostic imaging , Prospective Studies , SARS-CoV-2 , Ultrasonography/methods
18.
ANZ J Surg ; 92(3): 385-389, 2022 03.
Article in English | MEDLINE | ID: covidwho-1672962

ABSTRACT

BACKGROUND: Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by the risk of aerosolised SARS-Cov-2 during endoscopy of the aerodigestive tract. Translaryngeal ultrasound (TLUS) to assess the vocal cords has been proposed as a safe, non-invasive and sensitive alternative. The aim of this review was to verify TLUS as a viable tool for perioperative laryngeal assessment. METHOD: A literature review was performed using Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials and Scopus with the following search strategy: (vocal cord OR vocal fold OR glottic OR glottis OR vocal ligaments OR rima glottidis) AND (ultras* OR sonograph* OR echography OR echotomography). RESULTS: Fifteen studies were included in this review. All studies compared TLUS to IDL in visualizing the vocal cords in adults. Ten studies compared pre-operative TLUS to IDL where 50.6-100% of vocal cords were successfully visualized. Nine studies compared post-operative TLUS to IDL and reported visualization between 39.6% and 100%. Pre- and post-operative negative predictive values ranged from 60% to 100%. CONCLUSION: Whilst promising, successful visualization of the cords is limited by inter-user variability, older age and male gender. Thus, we see the role of TLUS as an alternative to IDL in the post-operative setting in the young patient following uncomplicated surgery with a normal voice on clinical examination, to confirm recurrent laryngeal nerve integrity while minimizing the risk of aerosolization.


Subject(s)
COVID-19 , Vocal Cord Paralysis , Adult , Humans , Laryngoscopy/methods , Male , SARS-CoV-2 , Systematic Reviews as Topic , Thyroid Gland , Thyroidectomy/adverse effects , Ultrasonography/methods , Vocal Cord Paralysis/diagnostic imaging , Vocal Cord Paralysis/etiology , Vocal Cords/diagnostic imaging
20.
Medicina (Kaunas) ; 58(2)2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1667240

ABSTRACT

Background and Objectives: Point-of-care ultrasound (POCUS) is a useful tool that helps clinicians properly treat patients in emergency department (ED). This study aimed to evaluate the impact of specific interventions on the use of POCUS in the ED. Materials and Methods: This retrospective study used an interrupted time series analysis to assess how interventions changed the use of POCUS in the emergency department of a tertiary medical institute in South Korea from October 2016 to February 2021. We chose two main interventions-expansion of benefit coverage of the National Health Insurance (NHI) for emergency ultrasound (EUS) and annual ultrasound educational workshops. The primary variable was the EUS rate, defined as the number of EUS scans per 1000 eligible patients per month. We compared the level and slope of EUS rates before and after interventions. Results: A total of 5188 scanned records were included. Before interventions, the EUS rate had increased gradually. After interventions, except for the first workshop, the EUS rate immediately increased significantly (p < 0.05). The difference in the EUS rate according to the expansion of the NHI was estimated to be the largest (p < 0.001). However, the change in slope significantly decreased after the third workshop during the coronavirus disease 2019 pandemic (p = 0.004). The EUS rate increased significantly in the presence of physicians participating in intensive POCUS training (p < 0.001). Conclusion: This study found that expansion of insurance coverage for EUS and ultrasound education led to a significant and immediate increase in the use of POCUS, suggesting that POCUS use can be increased by improving education and insurance benefits.


Subject(s)
COVID-19 , Point-of-Care Systems , Emergency Service, Hospital , Humans , Insurance Benefits , Interrupted Time Series Analysis , Retrospective Studies , SARS-CoV-2 , Ultrasonography
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