Applications of Ocular Point-of-Care Ultrasound for Optic Nerve Sheath Assessment in the Emergency Setting: A Systematic Review.

Objective: To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department. Methods: A comprehensive literature search was conducted on SCOPUS, Web of Science, MEDLINE, and Cochrane CENTRAL. Inclusion criteria included studies written in English only and primary clinical studies involving ocular POCUS scans in an emergency department setting. Exclusion criteria included non-primary studies (e.g. reviews or case reports), studies written in a non-English language, non-human studies, studies performed in a non-emergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published outside of the last decade. Data extraction was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Results: The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met inclusion criteria. These 24 included studies encompassed 2448 patients across prospective, retrospective, cross sectional, and case series study designs. We found that a majority of included studies focus on the use of POCUS in the emergency department to measure ONSD as a proxy for papilledema and metabolic aberrations, while a minority use ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology. Conclusion: The vast majority of articles investigating the use of ocular POCUS in recent years emphasize its utility in measuring ONSD and fluctuations in intracranial pressure, though additional outcomes of interest include posterior segment, orbit, and globe pathology.

Artificial Intelligence (AI) Applications for Point of Care Ultrasound (POCUS) in Low-Resource Settings: A Scoping Review.

Advancements in artificial intelligence (AI) for point-of-care ultrasound (POCUS) have ushered in new possibilities for medical diagnostics in low-resource settings. This review explores the current landscape of AI applications in POCUS across these environments, analyzing studies sourced from three databases-SCOPUS, PUBMED, and Google Scholars. Initially, 1196 records were identified, of which 1167 articles were excluded after a two-stage screening, leaving 29 unique studies for review. The majority of studies focused on deep learning algorithms to facilitate POCUS operations and interpretation in resource-constrained settings. Various types of low-resource settings were targeted, with a significant emphasis on low- and middle-income countries (LMICs), rural/remote areas, and emergency contexts. Notable limitations identified include challenges in generalizability, dataset availability, regional disparities in research, patient compliance, and ethical considerations. Additionally, the lack of standardization in POCUS devices, protocols, and algorithms emerged as a significant barrier to AI implementation. The diversity of POCUS AI applications in different domains (e.g., lung, hip, heart, etc.) illustrates the challenges of having to tailor to the specific needs of each application. By separating out the analysis by application area, researchers will better understand the distinct impacts and limitations of AI, aligning research and development efforts with the unique characteristics of each clinical condition. Despite these challenges, POCUS AI systems show promise in bridging gaps in healthcare delivery by aiding clinicians in low-resource settings. Future research endeavors should prioritize addressing the gaps identified in this review to enhance the feasibility and effectiveness of POCUS AI applications to improve healthcare outcomes in resource-constrained environments.

Erector spinae plane block (ESPB) for intractable, non-surgical abdominal pain: a scoping review.

Abdominal pain is one of the most common presenting chief complaints in the emergency department (ED). Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of non-surgical abdominal pain has not yet been characterized. Our scoping review aims to review the current literature on the safety and efficacy of ESPB in the management of patients experiencing intractable, non-surgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for non-surgical abdominal pain. Reviewers screened 30 titles and abstracts that met the predefined inclusion and exclusion criteria. Following initial screening, 24 articles underwent full-text review. Two reviewers also screened references included in each study. A total of 14 journal articles were reviewed, including 12 case-based studies, one systematic review, and one narrative review of ESPB in the treatment of non-surgical abdominal pain. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and each case reported no complications. This scoping review provides support for ESPB in the management of intractable, non-surgical abdominal pain. ESPB demonstrates efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Development and feasibility of randomized trial to reduce urinary bisphenols in women with obesity.

BACKGROUND: Bisphenol exposure is widespread and correlated with diabetes and cardiovascular disease. Previous intervention studies have successfully lowered bisphenol exposure among women of normal weight. The primary objective of this study was to develop and test the feasibility of a 3-week behavioral change intervention, rooted in social cognitive theory, to lower a broad range of bisphenols (BPA, BPS, and BPF) in women with obesity. METHODS: Thirty women with obesity (31.1 ± 5.6 kg/m2, 21.1 ± 3.1 years) were randomly assigned to an intervention or control. The intervention included weekly face-to-face meetings to reduce bisphenol exposures from food, cosmetics, and packaged products. Fasting urinary bisphenols, creatinine, and weight were assessed at study entry and after 3 weeks. RESULTS: The intervention was evaluated as feasible (100% of enrollment and recruitment, 96% of retention and attendance at lesson plan visits, and 96% of a collection of urine samples). Adherence to the intervention was estimated based on completion of self-monitoring records; the number of daily records completed was 7.7 ± 1.3 (mean ± SD) after week 1, 7.1 ± 1.5 after week 2, and 4.4 ± 0.9 after week 3. In secondary analysis, there was a significant treatment × time effect on creatinine-corrected urinary BPS (- 1.42 µg/g creatinine in the intervention vs. - 0.09 µg/g creatinine in the control group). CONCLUSION: In women with obesity, the 3-week intervention was considered feasible with promising preliminary results of decreasing BPS concentrations. These data warrant future large-scale clinical trial interventions to reduce bisphenol exposure and determine whether reductions in bisphenols positively impact diabetes and cardiovascular disease risk markers. This study was retroactively registered at ClinicalTrial.gov Identifier NCT03440307.