Prospective comparison of handheld ultrasound devices from different manufacturers with respect to B-scan quality and clinical significance for various abdominal sonography questions

Background: Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. Method: The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). Results: The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p < 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. Conclusion: In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are—while bearing their limitations in mind—an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers

Development and Integration of DOPS as Formative Tests in Head and Neck Ultrasound Education : Proof of Concept Study for Exploration of Perceptions

In Germany, progress assessments in head and neck ultrasonography training have been carried out mainly theoretically and lack standardisation. Thus, quality assurance and comparisons between certified courses from various course providers are difficult. This study aimed to develop and integrate a direct observation of procedural skills (DOPS) in head and neck ultrasound education and explore the perceptions of both participants and examiners. Five DOPS tests oriented towards assessing basic skills were developed for certified head and neck ultrasound courses on national standards. DOPS tests were completed by 76 participants from basic and advanced ultrasound courses (n = 168 documented DOPS tests) and evaluated using a 7-point Likert scale. Ten examiners performed and evaluated the DOPS after detailed training. The variables of “general aspects” (6.0 Scale Points (SP) vs. 5.9 SP; p = 0.71), “test atmosphere” (6.3 SP vs. 6.4 SP; p = 0.92), and “test task setting” (6.2 SP vs. 5.9 SP; p = 0.12) were positively evaluated by all participants and examiners. There were no significant differences between a basic and advanced course in relation to the overall results of DOPS tests (p = 0.81). Regardless of the courses, there were significant differences in the total number of points achieved between individual DOPS tests. DOPS tests are accepted by participants and examiners as an assessment tool in head and neck ultrasound education. In view of the trend toward “competence-based” teaching, this type of test format should be applied and validated in the future

A blended learning approach for teaching thoracic radiology to medical students: a proof-of-concept study

IntroductionThe best way to impart knowledge to medical students is still unclear. Therefore, we designed a blended learning course in thoracic radiology including both “traditional” in-class time as well as online learning modules. The aims were (1) to investigate students’ attitudes toward this blended learning approach; and (2) to test whether it improved their knowledge about thoracic radiology.MethodsA prospective study was conducted at the local medical center; 156 fourth-year medical students completed this study. Before and after the course, students had to complete (1) questionnaires to investigate their attitudes (7-point Likert scale); and (2) an objective test to assess their knowledge (multiple-choice/free text questions; results as % of correct answers).ResultsRegarding (1), the course led to an improvement in all items compared to baseline, exemplary: interest in thoracic radiology (precourse 4.2 vs. 5.4 postcourse) and the fulfillment of students’ expressed requirements regarding the teaching content (4.5 precourse vs. 6.2 postcourse). Furthermore, the great majority (88%) of our participants wished for more online learning offerings in the future. Regarding (2), the course led to improved knowledge on the objective test (precourse: 40% vs. postcourse: 63% correct answers).ConclusionThis feasibility study showed the successful design and implementation of a blended learning approach in thoracic radiology. Furthermore, it revealed medical students’ positive attitudes toward this approach and showed an increased knowledge in thoracic radiology. Thus, such approaches might be used to enrich the teaching armamentarium in medical education and to further enhance interest and knowledge in thoracic diseases among medical students

In vitro Analyse der primären Rotationsstabilität zementfreier Hüftkurzschaftprothesen unter Berücksichtigung einer valgischen Implantatstellung

Die Implantation von Hüftgelenksendoprothesen zählt zu den häufigsten Operationen der Orthopädischen Chirurgie. Der Erfolg einer stabilen Verankerung zementfrei eingebrachter Prothesenschäfte ist maßgeblich von dem Ausmaß der Mikrorelativbewegungen an der Implantat-Knochen-Grenzfläche abhängig. Eine ausreichend vorhandene primäre Rotationsstabilität ist dabei ein wichtiger Prognosefaktor für eine erfolgreiche Osteointegration und Funktion. Ein epidemiologisch-demographisch bedingter Anstieg von Revisions- und Wechseloperationen führte in den vergangenen Jahren zu einer rasanten Weiterentwicklung und Nachfrage knochensparender Kurzschaftsysteme.Ziel dieses Forschungsprojektes ist es daher, aktuell verwendete Hüftkurzschaftendoprothesen experimentell auf ihre Primärstabilität zu prüfen, sowie den Einfluss einer von der Norm abweichenden valgischen Implantatstellung auf das jeweilige Verankerungsverhalten zu untersuchen.Drei Hüftkurzschaftsysteme (AIDA, Metha, MiniHip) wurden untersucht und dabei sowohl in neutraler als auch in valgischer Schaftposition nach einem standardisierten Protokoll in jeweils fünf Kunststoffemora implantiert. Anschließend erfolgte die Einleitung von rückwirkungsfreien Drehmomenten in stufenlosen Intervallen von ± 7Nm in die Implantate. Als zentrale statistische Methode wurden Varianzanalysen als gemischtes Modell bei einem auf p < 0,05 festgelegtem Signifikanzniveau angewand. Die Hauptverankerungszone frei von der Schaftposition befindet sich bei allen Kurzschaftmodellen im meta-/diaphysären Übergangsbereich. Dennoch besitzen die Prothesen ein vorrangig proximales Verankerungsverhalten. Eine die Osteointegration gefährdende Überschreitung des kritischen Grenzwertes der Mikrorelativbewegungen von 150 mikrometer im Prothesen-Knochen-Verbund zeigte lediglich das valgisch implantierte MiniHip-Kurzschaftsystem.Das Fehlen einer ausreichenden lateralen Schaftanlage in Verbindung mit einem ovalen Flächenquerschnitt verhindert eine suffiziente Primärstabilität. Bei der Weiterentwicklung von Kurzschaftsystemen sollte daher auf ein mehrkonisches, kurviertes Prothesendesign mit eher zirkulo-trapeziodalem Querschnitt und sich nach distal verjüngendem Schaft geachtet werden, um unphysiologisch hohe Bewegungen im distalen Prothesen-Knochenverbund zu verringern, und um eine von der Norm abweichende valgische Implantatstellung besser kompensieren zu können.The implantation of hip endoprostheses is one of the most common operations in orthopaedic surgery. The success of a stable anchorage of cementless prosthesis shafts largely depends on the extent of the micro-relative movements at the implant-bone interface. A sufficient primary rotational stability is an important prognostic factor for successful osteointegration and function. In recent years, the demographically induced increase in revision and replacement operations leads to a rapid development of and demand for bone-saving short shaft systems.The aim of this project is to analyze short hip-stem prosthesis experimentally regarding to their primary stability. The project also investigates the influence of a deviating valgus implant position to the bending behaviour of the prosthesis models.Three hip short shaft systems (AIDA®, Metha®, MiniHipTM) were investigated and each prosthesis was implanted in five plastic femora in both neutral and valgus shaft stem position according to a standardized protocol. Subsequently torques were applied to the prosthesis at a stepless interval of ± 7Nm. As the central statistical method of this study variance analyses are applied as a mixed model with a significance level fixed at p < 0.05.The main anchoring zone - independent of the stem position - is located in the meta/diaphyseal transition area in all prosthesis-systems, but the prostheses still exhibit a mainly proximal anchoring behavior. Only the valgically implanted MiniHipTM exceeds the critical limit of microrelative movements of 150 micrometer between prosthesis and bone, that endangered osteointegration.A lack of lateral shaft contact in combination with an oval cross-sectional area prevents sufficient primary stability. In the further development of short shaft systems attention should therefore be paid to a multi-conical curved prosthesis design with a more circolotrapeziodal cross-sectional area and a shaft, that tapers distally to reduce unphysiologically high movements in the distal prosthesis-bone connection to compensate a deviating valgus implant position better

Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions

Background: Handheld ultrasound (HHUS) devices have chiefly been deployed in emergency medicine, where they are considered a valid tool. The data situation is less clear in the case of internal questions in abdominal sonography. In our study, we investigate whether HHUS devices from different manufacturers differ in their B-scan quality, and whether any differences are relevant for the significance of an internal ultrasound examination. Method: The study incorporated eight HHUS devices from different manufacturers. Ultrasound videos of seven defined sonographic questions were recorded with all of the devices. The analogue recording of the same findings with a conventional high-end ultrasound (HEUS) device served as an evaluation criterion. Then, the corresponding findings were played side by side and evaluated by fourteen ultrasound experts using a point scale (5 points = very good; 1 point = insufficient). Results: The HHUS devices achieved relatively good results in terms of both the B-scan quality assessment and the ability to answer the clinical question, regardless of the manufacturer. One of the tested HHUS devices even achieved a significantly (p &lt; 0.05) higher average points score in both the evaluation of B-scan quality and in the evaluation of clinical significance than the other devices. Regardless of the manufacturer, the HHUS devices performed best when determining the status/inferior vena cava volume and in the representation of ascites/free fluid. Conclusion: In various clinical abdominal sonography questions, HHUS systems can reliably reproduce findings, and are&mdash;while bearing their limitations in mind&mdash;an acceptable alternative to conventional HEUS systems. Irrespective of this, the present study demonstrated relevant differences in the B-scan quality of HHUS devices from different manufacturers

Increasing effort without noticing : A randomized controlled pilot study about the ergogenic placebo effect in endurance athletes and the role of supplement salience

PURPOSE:Previous research shows that endurance performance can be enhanced by placebo ergogenic aids. This study investigates the ergogenic placebo response, which we define as an increase in objective and physiological effort without an increase in subjective effort, in competitive cyclists. The primary objective of this study is to explore the role of supplement salience in the ergogenic placebo response, while the secondary aim is to assess whether believing to have taken an inactive placebo supplement attenuates the desired ergogenic effect. METHODS:We employed a double-blind placebo-controlled study design and compared a high salience (pudding) to a low salience (capsules) ergogenic placebo supplement and to a no treatment control group. Thirty-four male athletes (30.0 ± 5.7 years) performed two self-regulated time trials on an isokinetic cycling ergometer, one without intervention serving as a baseline and one with intervention according to group assignment. At both time trials, power output (objective effort), blood lactate (physiological effort) and the rating of perceived exertion (subjective effort) were measured. RESULTS:Receiving a high salience supplement can increase physiological and objective effort without a proportional rise in subjective effort, suggesting a decoupling of perceived exertion and endurance performance. Low salience and control group both showed no such ergogenic placebo response. Athletes' belief concerning the true nature of the ergogenic aid (inactive placebo vs. ergogenic supplement) did not influence the ergogenic placebo response. CONCLUSION:High salience placebo ergogenic aids can elicit enhanced performance without the athlete noticing (exertion), and deception of athletes seems unnecessary as even believing to have received an inactive placebo supplement maintains the ergogenic placebo response

Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany : a prospective observational study and comparison

Background: Point-of-care ultrasound (POCUS) is steadily growing in use in prehospital emergency medicine. While currently used primarily by emergency physicians, POCUS could also be employed by paramedics to support diagnosis and decision-making. Yet to date, no paramedicine-targeted POCUS curricula exist in Germany. Furthermore, given time and resource constraints in paramedic training, it is unclear whether paramedics could feasibly learn POCUS for prehospital deployment. Hence, this study outlines the development and implementation of a comprehensive POCUS curriculum for paramedics. Through this curriculum, we investigate whether paramedics can attain proficiency in POCUS comparable to other user groups. Methods: In this prospective observational study, we first developed a blended learning-based POCUS curriculum specifically for paramedics, focusing on basic principles, the RUSH-Protocol and ultrasound guided procedures. Participants underwent digital tests to measure their theoretical competence before (T1) and after the digital preparation phase (T2), as well as at the end of the on-site phase (T3). At time point T3, we additionally measured practical competence using healthy subjects and simulators. We compared the theoretical competence and the practical competence on a simulator with those of physicians and medical students who had also completed ultrasound training. Furthermore, we carried out self-assessment evaluations, as well as evaluations of motivation and curriculum satisfaction. Results: The paramedic study group comprised n = 72 participants. In the theoretical test, the group showed significant improvement between T1 and T2 (p < 0.001) and between T2 and T3 (p < 0.001). In the practical test on healthy subjects at T3, the group achieved high results (87.0% ± 5.6). In the practical test on a simulator at T3, paramedics (83.8% ± 6.6) achieved a lower result than physicians (p < 0.001), but a comparable result to medical students (p = 0.18). The results of the study group’s theoretical tests (82.9% ± 9.2) at time point T3 were comparable to that of physicians (p = 0.18) and better than that of medical students (p < 0.01). The motivation and attitude of paramedics towards the prehospital use of POCUS as well as their self-assessment significantly improved from T1 to T3 (p < 0.001). The overall assessment of the curriculum was positive (92.1 ± 8.5). Conclusion: With our tailored curriculum, German paramedics were able to develop skills in POCUS comparable to those of other POCUS learners. Integration of POCUS into paramedics’ training curricula offers opportunities and should be further studied

Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices&mdash;A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive Care

Background: the use of handheld ultrasonography (HHUS) devices is well established in prehospital emergency diagnostics, as well as in intensive care settings. This is based on several studies in which HHUS devices were compared to conventional high-end ultrasonography (HEUS) devices. Nonetheless, there is limited evidence regarding potential variations in B-scan quality among HHUS devices from various manufacturers, and regarding whether any such differences hold clinical significance in intensive care medicine settings. Methods: this study included the evaluation of eight HHUS devices sourced from diverse manufacturers. Ultrasound videos of five previously defined sonographic questions (volume status/inferior vena cava, pleural effusion, pulmonary B-lines, gallbladder, and needle tracking in situ) were recorded with all devices. The analogue recording of the same pathologies with a HEUS device served as gold standard. The corresponding findings (HHUS and HEUS) were then played side by side and evaluated by sixteen intensive care physicians experienced in sonography. The B-scan quality and the clinical significance of the HHUS were assessed using a five-point Likert scale (5 points = very good; 1 point = insufficient). Results: both in assessing the quality of B-scans and in their ability to answer clinical questions, the HHUS achieved convincing results&mdash;regardless of the manufacturer. For example, only 8.6% (B-scan quality) and 9.8% (clinical question) of all submitted assessments received an &ldquo;insufficient&rdquo; rating. One HHUS device showed a significantly higher (p &lt; 0.01) average points score in the assessment of B-scan quality (3.9 &plusmn; 0.65 points) and in the evaluation of clinical significance (4.03 &plusmn; 0.73 points), compared to the other devices. Conclusions: HHUS systems are able to reliably answer various clinical intensive care questions and are&mdash;while bearing their limitations in mind&mdash;an acceptable alternative to conventional HEUS devices. Irrespective of this, the present study was able to demonstrate relevant differences in the B-scan quality of HHUS devices from different manufacturers