Implementation of a Liver Transplant-Specific TEE Guide to Expand TEE Utilization and Improve Workflow During Orthotopic Liver Transplantation.

OBJECTIVES: Transesophageal echocardiography (TEE) is being increasingly utilized during orthotopic liver transplantation to guide perioperative management. Obstacles of improving TEE utilization include the challenge of becoming familiar with the TEE machine, optimizing TEE images, and translating skills acquired in didactic or simulator center-based training into clinical use. METHODS: In an effort to expand TEE utilization and improve workflow among the liver transplantation (LT) anesthesiologists at our institution, a LT-specific TEE guide was created to serve as a reference and educational tool during LT. A 26-question survey was distributed to all LT anesthesiologists before and 6 months after implementation of the LT-specific TEE guide. RESULTS: All seven LT anesthesiologists completed the survey questions during the study period. No statistically significant difference was detected in participant-reported confidence in optimizing targeted TEE views, performing technical aspects of the exam, navigating the knobs on the TEE machine, or in ability to identify abnormal cardiac pathology during the study period. One participant became basic-TEE certified during the study period. CONCLUSIONS: Implementing a liver transplant-specific TEE guide is a strategy to expand TEE utilization, encourage longitudinal TEE education and reinforce concepts learned from hands-on education sessions; however, we did not detect a difference in participant-reported confidence of performing a TEE exam, ability to identify abnormal cardiac pathology or altering workflow. Further studies with larger sample sizes will be needed to evaluate the effectiveness of a LT-specific TEE guide.

Optimización de la exploración eco Doppler mediante la manipulación de los controles del equipo (knobology); segunda parte / Doppler ultrasound exploration optimization by manipulating the controls of the equipment: knobology; part two

La ecografía Doppler es una modalidad diagnóstica que depende de un operador indispensable por disponibilidad, eficacia, coste y no invasividad. Además de conocimientos anatómicos y clínicos, exige un mínimo conocimiento de sus principios físicos y tecnológicos. Este artículo intenta repasar y esquematizar cómo ajustar las principales aplicaciones del equipo en la exploración Doppler mediante los botones y los controles (knobology). Complementa a la primera parte ya editada, en la que se explicaban los ajustes en la exploración en modo B. Realizar una exploración con una postura adecuada, que evite lesiones en el explorador (ergonomía), permite también aumentar nuestro rendimiento laboral. Conocer, entrenar y ajustar las funciones del eco Doppler de forma ordenada teniendo en cuenta al paciente y el estudio indicado hará que nuestras exploraciones sean más sencillas, rápidas, seguras y precisas.(AU)

Doppler ultrasound is an operator-dependent diagnostic modality, essential due to availability, efficacy, costs and non-invasive test. In addition to anatomical and clinical knowledge, it requires a minimum knowledge of its physical and technological principles. This article attempts to review and outline how to adjust the main applications of the equipment in Doppler scanning, using the buttons and controls (knobology). It complements the first part already edited, where the adjustments in the exploration in B mode were explained.Carrying out an examination with a suitable posture, which avoids injuries to the explorer (ergonomics), also allows us to increase our work performance. Knowing, training and adjusting the echo Doppler functions in an orderly manner, considering the patient and the indicated study, will make our examinations easier, faster, safer and more precise.(AU)

Optimización de la exploración eco Doppler mediante la manipulación de los controles del equipo (knobology); primera parte / Doppler ultrasound exploration optimization by manipulating the controls of the equipment: knobology; part one

La ecografía Doppler es una modalidad diagnóstica dependiente de un operador indispensable por disponibilidad, eficacia y costes. además de conocimientos anatómicos y clínicos, exige un mínimo conocimiento de sus principios físicos y tecnológicos. Conocer, practicar, ajustar las funciones del eco Doppler de forma ordenada y en función del paciente y de la exploración indicada harán que nuestras exploraciones sean más sencillas, rápidas, seguras y precisas. este artículo de formación intenta repasar y esquematizar cómo ajustar las principales aplicaciones del equipo mediante los botones y controles del dispositivo ("knobology").(AU)

doppler ultrasound is an operator-dependent diagnostic modality, essential due to its availability, efficacy and costs.in addition to anatomical and clinical knowledge, it requires a minimum knowledge of its physical and technologicalprinciples. the knowledge, training, and set up the functions of the duplex scan in a properly way depending onthe patient and kind of exploration, will make our examinations easier, faster, safer, and more precise. this papertries to review and outline how to adjust the main applications of the equipment using the buttons and controlsof the device (knobology).(AU)

Medical Student Ultrasound Education: A WFUMB Position Paper, Part I.

The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.

An introduction to ultrasound equipment and knobology.

The use of ultrasonography in medical practice has evolved dramatically over the last few decades and will continue to improve as technological advances are incorporated into daily medical practice. Although ultrasound machine size and equipment have evolved, the basic principles and fundamental functions have remained essentially the same. This article reviews the general ultrasound apparatus design, the most common probe types available, and the system controls used to manipulate the images obtained. Becoming familiar with the machine and the controls used for image generation optimizes the scans being performed and enhances the use of ultrasound in patient care.

Ultrasound: Basic understanding and learning the language.

Ultrasound (US) use has rapidly entered the field of acute pain medicine and regional anesthesia and interventional pain medicine over the last decade, and it may even become the standard of practice. The advantages of US guidance over conventional techniques include the ability to both view the targeted structure and visualize, in real time, the distribution of the injected medication, and the capacity to control its distribution by readjusting the needle position, if needed. US guidance should plausibly improve the success rate of the procedures, their safety and speed. This article provides basic information on musculoskeletal US techniques, with an emphasis on the principles and practical aspects. We stress that for the best use of US, one should venture beyond the "pattern recognition" mode to the more advanced systematic approach and use US as a tool to visualize structures beyond the skin (sonoanatomy mode). We discuss the sonographic appearance of different tissues, introduce the reader to commonly used US-related terminology, cover basic machine "knobology" and fundamentals of US probe selection and manipulation. At the end, we discuss US-guided needle advancement. We only briefly touch on topics dealing with physics, artifacts, or sonopathology, which are available elsewhere in the medical literature.