Student ultrasound education - current views and controversies.

As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide, this review presents basic principles of modern medical student ultrasound education and advocates for the establishment of an ultrasound core curriculum embedded both horizontally and vertically in medical studies.

Concepts for exercise therapy in prehabilitation for elderly people with frailty or pre-frailty prior to elective surgery. A scoping review.

BACKGROUND: Frailty is a state of reduced functional capacities in older people that can be reversed through multimodal therapy concepts. The effect of preoperative prehabilitation on frailty has been examined, but the heterogeneity of exercise regimens has prevented conclusive evidence. This scoping review analyses prehabilitation interventions, particularly exercise methods, published in trials for prefrail and frail elderly patients. METHOD: We identified studies evaluating prehabilitation for frail elderly using the framework of Arksey and O'Malley. Five scientific databases were searched until March 2022. Articles were screened by two independent reviewers. Data extraction included, but was not limited to, study design, intervention protocol of the prehabilitation including exercise therapy and additional interventions, and safety of the reported exercise concepts. RESULTS: Nineteen studies were included, offering an insight into the utilized prehabilitation concepts for exercise. All study interventions were based around exercise programs, potentially with complementary interventions. Twelve studies based their exercise programs on a combination of endurance and strength training. Breathing exercises were prescribed in five studies, flexibility routines in five, and one study included balance training. Further interventions included nutritional counselling/supplementation in nine studies, smoking/alcohol cessation in five, in addition to two physiological and three medical/pharmaceutical interventions. DISCUSSION: Prehabilitation for the frail elderly is safe and feasible. The general concept of prehabiliation for frail patients is promising. An exercise program should focus on improving the patient's endurance and strength, considering the positive effects that can be provided by breathing exercises and other additional interventions, such as nutritional support or lifestyle counselling.

The optimal dose of mobilisation therapy in the ICU: a prospective cohort study.

BACKGROUND: This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge. METHODS: Prospective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated. RESULTS: Daily mobilisation ≥ 40 min was identified as an independent predictor of an improved functional status upon ICU discharge. This effect on the primary outcome measure, change of Mobility-Barthel until ICU discharge, was observed in three different models for baseline patient characteristics (average treatment effect (ATE), all three models p < 0.001). When mobilisation parameters like level of mobilisation, were included in the analysis, the average treatment effect disappeared [ATE 1.0 (95% CI - 0.4 to 2.4), p = 0.16]. CONCLUSIONS: A mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels. TRIAL REGISTRATION: Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018-retrospectively registered, https://classic. CLINICALTRIALS: gov/ct2/show/NCT03666286 .

From Videogames to Teaching - Different Camera Perspectives in an Interactive Synchronous Online Tutorial.

The global COVID-19 pandemic has required clinical skills training to be transferred to an online format. An interactive synchronous online tutorial with different camera perspectives was developed. In a survey, 79% of the students preferred the first-person perspective, which allowed students to view the abdominal examination through the examiner's eyes.

Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU.

BACKGROUND: While early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU cohort can provide individualized mobilization recommendations that have a positive impact on the likelihood of being discharged home. METHODS: This study is an analysis of a prospective observational database of two interdisciplinary intensive care units in Munich, Germany. Dosage of mobilization is determined by sessions per day, mean duration, early mobilization as well as average and maximum level achieved. A k-means cluster analysis was conducted including collected parameters at ICU admission to generate clinically definable clusters. RESULTS: Between April 2017 and May 2019, 948 patients were included. Four different clusters were identified, comprising "Young Trauma," "Severely ill & Frail," "Old non-frail" and "Middle-aged" patients. Early mobilization (< 72 h) was the most important factor to be discharged home in "Young Trauma" patients (ORadj 10.0 [2.8 to 44.0], p < 0.001). In the cluster of "Middle-aged" patients, the likelihood to be discharged home increased with each mobilization level, to a maximum 24-fold increased likelihood for ambulating (ORadj 24.0 [7.4 to 86.1], p < 0.001). The likelihood increased significantly when standing or ambulating was achieved in the older, non-frail cluster (ORadj 4.7 [1.2 to 23.2], p = 0.035 and ORadj 8.1 [1.8 to 45.8], p = 0.010). CONCLUSIONS: An artificial intelligence-based learning approach was able to divide a heterogeneous critical care cohort into four clusters, which differed significantly in their clinical characteristics and in their mobilization parameters. Depending on the cluster, different mobilization strategies supported the likelihood of being discharged home enabling an individualized and resource-optimized mobilization approach. TRIAL REGISTRATION: Clinical Trials NCT03666286, retrospectively registered 04 September 2018.

[The Frail Patient in a Fictitious Case Study]. / Der fraile Patient: fiktives Fallbeispiel.

Various limitations in everyday life can indicate a frailty syndrome. These limitations are not always directly visible and result from a wide variety of domains. Fried et al. described these limitations of different domains as frailty syndrome. This syndrome can be acutely worsened by different influencing factors. One major risk factor is an upcoming anesthesia and surgery. Frailty is associated with a significantly increased risk of peri- and postoperative complications. To avoid acute deterioration due to anesthesia and surgery, the concept of prehabilitation was developed. The aim is to specifically address the respective deficits and to develop an individual training concept together with the patient. Prehabilitation can significantly improve the risk of complications and the outcome of frail patients. In this context, it is important to establish routine screening in order to detect a frailty syndrome in everyday clinical practice and to create opportunities for prehabilitation.