Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility.
ELASTOGRAPHY; NAFLD; Shear wave elastography; Liver stiffness; NASH; MANAGEMENT; Attenuation coefficient; Shear wave dispersion; FIBROSIS; GUIDELINES; HEPATIC STEATOSIS; RADIATION FORCE IMPULSE; RADIOLOGISTS; SOCIETY; STIFFNESS
PURPOSE: To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance. METHODS: 110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was placed 2 cm below the liver capsule. The study included patients with NAFLD/NASH (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5), alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values were obtained. Comparison of less experienced sonographers (LES) and more experienced sonographers (MES) were evaluated through Student's t test for independent data. Pearson coefficient r of correlation among quantitative variables was calculated. RESULTS: The mean time to perform the exam was 129.7 ± 62.1 s. There was a statistically significant difference between LES and MES. The mean IQR/M for LS was 12.3 ± 5.5% m/s. Overall, in a cohort of difficult patients, 4.5% of LS values were not reliable. Fat quantification using attenuation imaging had a mean value of 0.60 ± 0.15 dB/cm/MHz (range 0.35-0.98 cm/dB/MHz) with an IQR/M of 14.7 ± 9.2%. Less reliable measurements of steatosis were obtained in 4.5% of patients. The mean shear wave dispersion slope was 12.74 ± 4.05 (m/s)/kHz (range 7.7-27.5 (m/s)/kHz) with an IQR/M of 38.7 ± 20.2% (range 3-131%). 20.9% of patients had values suggestive of compensated advanced chronic liver disease (cACLD). CONCLUSION: Multiparametric US can provide assessment of CLD in less than 3 min in most patients and identify patients at risk for cACLD.
Aitharaju V; De Silvestri A; Barr RG
Abdominal Radiology
2021
2021-07-25
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s00261-021-03225-2" target="_blank" rel="noreferrer noopener">10.1007/s00261-021-03225-2</a>
Comparison of narrow-versus broad-spectrum antibiotics in elderly patients with acute exacerbations of chronic obstructive pulmonary disease
elderly; pneumonia; adults; chronic obstructive pulmonary disease; society; antibiotics; exacerbations; neutrophil
Background Little evidence is available regarding the choice of empiric antibiotic therapy in elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The primary objective of this study is to compare the outcomes of elderly patients receiving broad- versus narrow-spectrum antibiotics during hospitalization for AECOPD. Design A multicenter, retrospective, cohort analysis was performed. Inpatients 65 years and older with a primary discharge diagnosis of AECOPD who received >= 48 hours of antibiotic therapy were included in the study population. Patients were compared based on the spectrum of their antibiotic therapy. Narrow-spectrum antibiotics included: azithromycin, doxycycline, sulfamethoxazole/trimethoprim, or aminopenicillin. The primary outcome was a composite of mechanical ventilation 48 hours after admission, transfer to the intensive care unit 48 hours after admission, 30-day chronic obstructive pulmonary disease (COPD) readmission, and oxygen saturation less than 90% on room air or increased oxygen requirements from baseline 48 hours after admission. Results Two hundred fifty-three patients were included in this analysis; 127 patients were included in the narrow-spectrum group, and 126 patients were included in the broad-spectrum group. Patient demographics and comorbid conditions were similarly distributed in each group. The incidence of the primary composite outcome occurred in 50 (39.3%) and 60 (47.6%) of patients in the narrow- and broad-spectrum groups, respectively (P= .19). Conclusions and Relevance No difference was found in the primary outcome in inpatients aged >= 65 years with AECOPD who received empiric broad-spectrum or narrow-spectrum antibiotics.
Joyner KR; Walkerly A; Seidel K; Walsh N; Damshekan N; Perry T; Soric MM
Journal of Pharmacy Practice
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/0897190020938190" target="_blank" rel="noreferrer noopener">10.1177/0897190020938190</a>
Telepresent mechanical ventilation training versus traditional instruction: a simulation-based pilot study
critical care; education; telepresence; simulation; Health Care Sciences & Services; telementoring; mechanical ventilation; society; critical-care medicine; DASH
Background Mechanical ventilation is a complex topic that requires an in-depth understanding of the cardiopulmonary system, its associated pathophysiology and comprehensive knowledge of equipment capabilities. Introduction The use of telepresent faculty to train providers in the use of mechanical ventilation using medical simulation as a teaching methodology is not well established. The aim of this study was to compare the efficacy of telepresent faculty versus traditional in-person instruction to teach mechanical ventilation to medical students. Materials and methods Medical students for this small cohort pilot study were instructed using either in-person instruction or telementoring. Initiation and management of mechanical ventilation were reviewed. Effectiveness was evaluated by pre- and post-multiple choice tests, confidence surveys and summative simulation scenarios. Students evaluated faculty debriefing using the Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV). Results A 3-day pilot curriculum demonstrated significant improvement in the confidence (in person P<0.001; telementoring P=0.001), knowledge (in person P<0.001; telementoring P=0.022) and performance (in person P<0.001; telementoring P<0.002) of medical students in their ability to manage a critically ill patient on mechanical ventilation. Participants favoured the in-person curriculum over telepresent education, however, resultant mean DASH-SV scores rated both approaches as consistently to extremely effective. Discussion While in-person learners demonstrated larger confidence and knowledge gains than telementored learners, improvement was seen in both cases. Learners rated both methods to be effective. Technological issues may have contributed to students providing a more favourable rating of the in-person curriculum. Conclusions Telementoring is a viable option to provide medical education to medical students on the fundamentals of ventilator management at institutions that may not have content experts readily available.
Ciullo A; Yee J; Frey J A; Gothard M D; Benner A; Hammond J; Ballas D; Ahmed R A
Bmj Simulation & Technology Enhanced Learning
2019
2019-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1136/bmjstel-2017-000254" target="_blank" rel="noreferrer noopener">10.1136/bmjstel-2017-000254</a>
ASPEN - Past, present, and future
clinical nutrition; e.-rhoads-lecture; enteral nutrition; medicine; nitrogen-metabolism; Nutrition & Dietetics; obesity; perspective; presidential-address; society; specialized nutrition support
It is a privilege and an honor for met to have the opportunity to serve as the 31st president of the American Society for Parental and Enteral Nutrition (A.S.P.E.N.) and to deliver the 2008 Presidential Address. I will review how our Society was started and how it has progressed, share where our Society is today, and, most important, project what I see as the future of our Society.
Vanek V W
Journal of Parenteral and Enteral Nutrition
2008
2008-09
Journal Article
<a href="http://doi.org/10.1177/0148607108321711" target="_blank" rel="noreferrer noopener">10.1177/0148607108321711</a>
A Clinical Study Comparing the Diagnostic Performance of Assist Strain Ratio Against Manual Strain Ratio in Ultrasound Breast Elastography
breast cancer; elastography; cancer; guidelines; Radiology; elasticity; strain; Nuclear Medicine & Medical Imaging; us; recommendations; society; strain ratio; fat-to-lesion ratio; FLR
Objective Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with an expert sonologist. Methods Ninety-one patients scheduled for breast biopsy were included in this institutional review board-approved/Health Insurance Portability and Accountability Act-compliant study. For manual strain ratio (MSR), fat and lesion were manually outlined, whereas for ASR, the clinician indicated the lesion center and the fat-to-lesion ratio is computed automatically. Three measurements were obtained for each lesion. The same raw data were used to calculate the MSR and ASR. Results The SR thresholds to differentiate benign from malignant tumors were determined using the Youden index. For MSR, the cutoff was 2.7, and for ASR was 2.8. The MSR showed a sensitivity of 88%, specificity of 64%, accuracy of 77%, positive predictive value of 72%, and negative predictive value of 92.1%. Corresponding ASR showed a sensitivity of 86%, specificity of 76%, accuracy of 81%, positive predictive value of 79%, and negative predictive value of 84%. The areas under the curve for the MSR and ASR were 0.83 and 0.85, respectively. The average coefficients of variation for the MSR and ASR measurements were 43% and 30%, respectively. Conclusion Assist strain ratio demonstrated similar diagnostic performance compared with MSR. In addition, the coefficient of variation of ASR is lower, implying lower intraoperator dependency. Thus, ASR may aid less-experienced scanners in obtaining improved results.
Barr R G; Managuli R A
Ultrasound Quarterly
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ruq.0000000000000398" target="_blank" rel="noreferrer noopener">10.1097/ruq.0000000000000398</a>