domenica 11 agosto 2013
domenica 4 agosto 2013
Ho sentito parlare a lungo dell'applicazione dell'ecografia FAST sul territorio ma ho sempre espresso riserve in quanto, secondo me e per la mia esperienza di emergenza territoriale e ospedaliera, non sono in numero sufficiente i "mentori" che hanno reali abilità ed esperienza sulla strada. Un conto è imparare in una sala chiusa un conto è l'esecuzione con la confusione, con il sole a picco o la pioggia, un conto è darsi una tempistica per l'esecuzione mentre un altro è lasciarsi trasportare dall'esame e farlo durare ben oltre una decina di minuti...(passano più velocemente di quanto si possa pensare)
Questa potrebbe essere una soluzione ed è la naturale continuazione del post precedente.
Telemed J E Health. 2012 Dec;18(10):807-9. doi: 10.1089/tmj.2012.0038. Epub 2012 Oct 26.
Just-in-time cost-effective off-the-shelf remote telementoring of paramedical personnel in bedside lung sonography-a technical case study.
Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta, Canada.
Remote telementored ultrasound (RTMUS) is a new discipline that allows a remote expert to guide variably experienced clinical responders through focused ultrasound examinations. We used the examination of the pleural spaces after tube thoracostomy (TT) removal by anurse with no prior ultrasound experience as an illustrative but highly accurate example of the technique using a simple cost-effective system.
MATERIALS AND METHODS:
The image outputs of a handheld ultrasound machine and a head-mounted Web camera were input into a customized graphical user interface and streamed over a freely available voice over Internet protocol system that allowed two-way audio and visual communication between the novice examiner and the remote expert. The bedside nurse was then guided to examine the anterior chest of a patient who had recently had bilateral TTs removed. The team sought to determine the presence or absence of any recurrent pneumothoraces using the standard criteria for theultrasound diagnosis of post-removal pneumothorax (PTXs). An upright chest radiograph (CXR) was obtained immediately after the RTMUS examination.
The RTMUS system enabled the novice user to learn how to hold the ultrasound probe, where to place it on the chest, and thereafter to diagnose a subtle unilateral PTX characterized as "tiny" on the subsequent formal CXR report.
As ultrasound has almost limitless clinical utility, using simple but advanced informatics and communication technologies has potential to improve worldwide healthcare delivery. RTMUS could be used both to enhance the information content as well as to digitally document important physiologic findings in any clinical encounter wherever a portable ultrasound and Internet connectivity are available.
- [PubMed - in process]
Certamente quest'articolo potrebbe essere uno spunto di riflessione per una futuro monitoraggio delle tecniche ecografiche a distanza con un costo esiguo.
Crit Ultrasound J. 2013 Jun 27;5(1):5. [Epub ahead of print]
The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - 'a remote virtual mentor'
Biegler N, McBeth PB, Tiruta C, Hamilton DR, Xiao Z, Crawford I, Tevez-Molina M, Miletic N, Ball CG, Pian L, Kirkpatrick AW.
Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic 'off-the-shelf' technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal.
The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted.
Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination.
Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
- [PubMed - as supplied by publisher]