ABSTRACT
INTRODUCTION: Heart exploration is an essential clinical competence that requires continuous training and exposure. Low availability and accessibility to patients with heart disease constitutes a barrier to acquiring this competence. Inadequate cardiac auscultation skills in medical students, residents, and graduate physicians have been documented. OBJECTIVE: To develop and validate a low-cost, high-fidelity simulator for heart exploration. METHODS: A low-cost, high-fidelity heart examination simulator capable of reproducing normal cardiac sounds was designed and developed. Subsequently, the simulator was validated by a group of experts who gave their opinion according to a Likert scale. RESULTS: Ninety-four percent agreed that the simulator motivates the learning of heart exploration, and 92 % considered it to be a realistic model; 91 % considered that the simulator is an attractive tool to reinforce learning and 98 % recommended its further use. CONCLUSIONS: The use of the simulator facilitates the acquisition of skills and stimulates learning in the student, which can be attributed to repeated practice, longer exposure time and cognitive interaction.
INTRODUCCIÓN: La exploración cardiaca es una competencia clínica fundamental que requiere exposición o entrenamiento continuo. La baja disponibilidad y accesibilidad de pacientes con patología cardiaca constituye una barrera para adquirir esta competencia. Se han documentado inadecuadas habilidades de auscultación cardiaca en estudiantes de medicina, residentes y médicos graduados. OBJETIVO: Elaborar y validar un simulador de alta fidelidad y bajo costo para exploración cardiaca. MÉTODOS: Se diseñó y elaboró un simulador para exploración cardiaca, realista y de bajo costo capaz de reproducir ruidos cardiacos normales. Posteriormente se realizó la validación del simulador por un grupo de expertos que emitieron su opinión de acuerdo con una escala tipo Likert. RESULTADOS: El 94 % afirmó que el simulador motiva el aprendizaje de la exploración cardiaca y 92 % lo consideró un modelo realista; 91 % consideró que el simulador es una herramienta atractiva para fortalecer el aprendizaje y 98 % recomendó seguir utilizándolo. CONCLUSIONES: El uso del simulador facilita la adquisición de competencias y estimula el aprendizaje en el estudiante, lo cual puede ser atribuido a la práctica deliberada, a un mayor tiempo de exposición y a la interacción cognitiva.
Subject(s)
Equipment Design , Heart Sounds , High Fidelity Simulation Training/methods , Phonocardiography/instrumentation , Equipment Design/economics , High Fidelity Simulation Training/economics , Humans , Phonocardiography/economics , Reproducibility of ResultsABSTRACT
Resumen Introducción: La exploración cardiaca es una competencia clínica fundamental que requiere exposición o entrenamiento continuo. La baja disponibilidad y accesibilidad de pacientes con patología cardiaca constituye una barrera para adquirir esta competencia. Se han documentado inadecuadas habilidades de auscultación cardiaca en estudiantes de medicina, residentes y médicos graduados. Objetivo: Elaborar y validar un simulador de alta fidelidad y bajo costo para exploración cardiaca. Métodos: Se diseñó y elaboró un simulador para exploración cardiaca, realista y de bajo costo capaz de reproducir ruidos cardiacos normales. Posteriormente se realizó la validación del simulador por un grupo de expertos que emitieron su opinión de acuerdo con una escala tipo Likert. Resultados: El 94 % afirmó que el simulador motiva el aprendizaje de la exploración cardiaca y 92 % lo consideró un modelo realista; 91 % consideró que el simulador es una herramienta atractiva para fortalecer el aprendizaje y 98 % recomendó seguir utilizándolo. Conclusiones: El uso del simulador facilita la adquisición de competencias y estimula el aprendizaje en el estudiante, lo cual puede ser atribuido a la práctica deliberada, a un mayor tiempo de exposición y a la interacción cognitiva.
Abstract Introduction: Heart exploration is an essential clinical competence that requires continuous training and exposure. Low availability and accessibility to patients with heart disease constitutes a barrier to acquiring this competence. Inadequate cardiac auscultation skills in medical students, residents, and graduate physicians have been documented. Objective: To develop and validate a low-cost, high-fidelity simulator for heart exploration. Methods: A low-cost, high-fidelity heart examination simulator capable of reproducing normal cardiac sounds was designed and developed. Subsequently, the simulator was validated by a group of experts who gave their opinion according to a Likert scale. Results: Ninety-four percent agreed that the simulator motivates the learning of heart exploration, and 92 % considered it to be a realistic model; 91 % considered that the simulator is an attractive tool to reinforce learning and 98 % recommended its further use. Conclusions: The use of the simulator facilitates the acquisition of skills and stimulates learning in the student, which can be attributed to repeated practice, longer exposure time and cognitive interaction.
Subject(s)
Humans , Phonocardiography/instrumentation , Heart Sounds , Equipment Design/economics , High Fidelity Simulation Training/methods , Phonocardiography/economics , Reproducibility of Results , High Fidelity Simulation Training/economicsABSTRACT
To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15-85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.
Subject(s)
Coronary Artery Disease/diagnosis , Coronary Stenosis/diagnosis , Heart Sounds , Phonocardiography , Adult , Aged , Aged, 80 and over , Algorithms , Coronary Angiography , Coronary Artery Disease/classification , Coronary Artery Disease/economics , Coronary Artery Disease/physiopathology , Coronary Stenosis/classification , Coronary Stenosis/economics , Coronary Stenosis/physiopathology , Cost Savings , Cost-Benefit Analysis , Decision Support Techniques , Female , Health Care Costs , Humans , Male , Middle Aged , Phonocardiography/economics , Phonocardiography/instrumentation , Predictive Value of Tests , Prognosis , Reproducibility of Results , Retrospective Studies , Severity of Illness Index , Young AdultSubject(s)
Aortic Valve Stenosis/diagnosis , Phonocardiography/methods , Algorithms , Aortic Valve Stenosis/diagnostic imaging , Decision Support Systems, Clinical , Echocardiography/methods , Heart Sounds/physiology , Humans , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/diagnostic imaging , Phonocardiography/economics , Primary Health Care , Reproducibility of Results , Severity of Illness Index , Stethoscopes , Systolic Murmurs/diagnosisABSTRACT
The value of phonomechanographic recordings has been contested in recent years. This seems to be the result of the upsurge in other non-invasive methods of investigating cardiac diseases and left ventricular function such as those based on ultrasound, pulsed Doppler or radioisotopes. Far from opposing these techniques, phonocardiography has benefited from their comparison and association which have validated the systolic time and amplitude indices previously used empirically. This validation justifies maintaining and developing phonomechanographic recordings. Whilst recognising their limits, five of their main advantages are emphasised. As a true extension of our senses and complementary to the human ear phonomechanography is, foremost, the continuation of clinical examination and an unique and ideal instrument for teaching cardiac auscultation. By confirming and explaining the nature of an auscultatory abnormality, recording the morphology and timing of the arterial and venous pulses and of the apex beat, phonomechanography participates in the positive and etiological diagnosis of various conditions and even provides a semiquantitative assessment in some diseases. Left ventricular function may be assessed by measuring the systolic time intervals and by quantifying the systolic apical impulse. This appreciation based on the period of isovolumic contraction is complementary to echocardiographic assessments of LV function which are calculated during the ejection period. Only by combining the various non-invasive methods can the weakness and practical limitations of each particular method be avoided. Finally, as the reliability of systolic time and amplitude indices have been validated, the relative ease of their determination and their economic advantages must be emphasised.(ABSTRACT TRUNCATED AT 250 WORDS)
