Ethical Implications for Potential Placebo Effects of Point of Care Ultrasound.

Anecdotally, practitioners of point of care ultrasound (POCUS) describe instances where patients appear to experience a placebo-like response after the examination, also described as a positive care effect. Extensive study of therapeutic ultrasound has yet to reveal differences between intervention and placebo, both of which respond to therapy. Indeed, POCUS is exemplary in incorporating many components known to modulate placebo-like effects. Patient expectations, ritualistic aspects of hands-on care, symbolic power of sophisticated medical instruments, the power of real-time POCUS images, therapeutic practitioner-patient communication, and the effect of cultural and linguistic concordance all have significant potential to modulate positive or negative care effects of POCUS. Drawing from complementary and alternative medicine's discussion of characteristic and incidental factors, this review argues that POCUS should be studied as a complex medical intervention intertwined with and inextricable from diagnostic and care processes in the hospital setting. Since POCUS is a diagnostic tool with care effect potential, its similarity to the physical exam can guide preliminary ethical guidance on disclosure of potential placebo effects or efforts to maximize that potential effect. However, more data is needed to balance the benefits and risks of effective diagnosis and overdiagnosis, respectively.

Ecografía clínica: ¿prueba complementaria o una parte más de la exploración rutinaria? / Clinical ultrasound: a diagnostic test or a part of the routine exam?

La ecografía ha sido considerada una prueba complementaria que deben realizar los especialistas en imagen. Desde su inicio, determinados especialistas como obstetras o cardiólogos la han utilizado en su campo con grandes resultados. En los últimos años, los médicos generales y de otras especialidades se van acercando a la técnica, que es rápida, inocua, accesible, barata y que, sobre todo, permite completar en tiempo real la exploración del paciente. Muchos son los países y las sociedades donde los médicos no especialistas en Radiología realizan ecografía a diario y cada vez más estudios muestran la utilidad de la misma en la práctica clínica habitual (AU)

Ultrasound has been considered an additional test to be carried out by specialists in image. Since its inception some specialists as obstetricians or cardiologists have used it in its field with great results. Now, the general practitioners and other specialties are approaching this technique which is quick, safe, accessible, inexpensive, and above all allows you to complete real-time exploration of the patient. Many are beginning to be the countries and societies where the non-specialist physicians in the field of radiology ultrasound performed on a daily basis and more and more studies show the utility of the same in normal clinical practice (AU)

Medicine and the holistic understanding of the human being: ultrasound examination as dialog.

Ultrasound can capture the living nature of a person. This capturing of life depends greatly on experience as well as sense of touch, intuition, sense of speech, and not least a sense for the distinctiveness of every person. Performing ultrasound is not simply the application of a technique but rather a merging of man and technology in the framework of an interpersonal encounter. Therefore, as much should be invested in the interpersonal nature of the encounter as in the development of the technical principles of the ultrasound probe. To effectively perform ultrasound, it is necessary to avoid viewing ultrasound from a purely technical view and to always remember the importance of the relationship to the patient, particularly during the technical examination.

La responsabilidad en la ultrasonografía / Responsability on ultrasonography

Descripción de diferentes causales de responsabilidad en el campo de la ultrasonografía y del diagnóstico por imágenes

Ecografía en rehabilitación / Ultrasonography in rehabilitation

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Intervencionismo guiado por ecografía: lo que todo radiólogo debe conocer / US-guided interventional procedures: what a radiologist needs to know

La ecografía presenta importantes ventajas como guía de procedimientos: es barata, disponible, móvil, no utiliza radiaciones ionizantes, y requiere menos tiempo que otras técnicas. La guía ecográfica puede realizarse usando dispositivos adaptados a las sondas o mediante la técnica de manos libres (sosteniendo la aguja con una mano y la sonda con la otra). La realización de procedimientos guiados por ecografía requiere una planificación previa cuidadosa, tener una hemostasia suficiente o que la zona de punción sea directamente compresible, obtener el consentimiento informado del paciente, y medidas de asepsia y anestesia apropiadas. La técnica de los procedimientos supone introducir la aguja o el catéter a través del plano de corte del ecógrafo. El avance se controla en tiempo real, pudiendo dirigir la aguja. Los transductores ideales para realizar intervenciones en tejidos superficiales son los lineales de alta resolución, aunque en lesiones profundas es necesario utilizar sondas de 3,5MHz. Los procedimientos más habituales incluyen biopsias, drenajes e inyecciones percutáneas. Las biopsias pueden realizarse usando técnicas de punción con aguja fina (PAF), para citología, o gruesa, para obtener muestras histológicas. Esta última presenta mayor sensibilidad y especificidad con una tasa baja de complicaciones. El drenaje supone casi siempre colocar un catéter en una colección. Puede hacerse usando las técnicas de Seldinger, trócar o mediante catéteres de tipo pleural. Las inyecciones percutáneas con control ecográfico se pueden usar para inyectar sustancias en lesiones infecciosas, neoplásicas, en plexos nerviosos o en patología musculoesquelética sobre todo (AU)

US has important advantages in guiding interventional procedures: it is economical and widely available, it does not use ionizing radiation, and it requires less time than other techniques. US guidance can be provided using devices adapted to probes or using the freehand technique (holding the needle in one hand and the probe in the other). US-guided procedures require careful planning, adequate hemostasis or a directly compressible puncture site, the patient's informed consent, and appropriate measures to ensure asepsis and anesthesia. The technique involves introducing the needle or catheter through the plane of the US slice. The advance of the needle is controlled in real time. High resolution linear probes are ideal for interventional procedures in superficial tissues, but 3.5MHz probes are required for procedures in deep tissues. The most common procedures include biopsies, drainages, and percutaneous injections. Biopsies can be carried out using fine needles to obtain material for cytological study (fine-needle aspiration cytology) or using large needles to obtain specimens for histologic study (core biopsy). Core biopsy is more sensitive and more specific, and it has a low rate of complications. Drainage almost always involves placing a catheter in a fluid collection; it can be done using the Seldinger techniques, trocars, or pleural catheters. US-guided percutaneous injections can be used to inject substances into infectious lesions, tumors, or nerve plexuses, and they are especially useful in musculoskeletal disease (AU)

El camino de la ecografía / The course of ultrasonography

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Ultrasound and the IRB.

The purpose of this paper is to assist researchers in writing their research protocols and subject consent forms so that both the Institutional Review Board (IRB) and subjects are assured of the minimal risk associated with diagnostic B-scan ultrasound as it is used in speech research. There have been numerous epidemiological studies on fetal ultrasound and laboratory studies on the effects of ultrasound on various types of tissue, and the American Institute of Ultrasound in Medicine and the World Federation for Ultrasound in Medicine and Biology have concluded that B-scan diagnostic ultrasound procedures are safe if conducted in a prudent manner. To this end, this paper will present a list of potential risks associated with diagnostic ultrasound so that researchers can explain to the IRB and subjects why diagnostic ultrasound, and B-scan in particular, is minimal risk.

Betwixt and between: ritual and the management of an ultrasound waiting list.

Hospital waiting lists are a feature of publicly funded health services that results when demand appears to exceed supply. While much has been written about hospital waiting lists, little is known about the dynamics of diagnostic waiting lists, or more generally why hospital waiting lists behave in perverse and often counter-intuitive ways. This paper attempts to address this gap by applying a recent development in critical systems thinking called boundary critique to understand how a particular ultrasound waiting list was managed. A new waiting list metaphor based on waiting lists as ritual forms is proposed.