Vi Đinh - Academia.edu (original) (raw)

Papers by Vi Đinh

Research paper thumbnail of Predicting treatment Response based on Dual assessment of magnetic resonance Imaging kinetics and Circulating Tumor cells in patients with Head and Neck cancer (PREDICT-HN): matching 'liquid biopsy' and quantitative tumor modeling

BMC cancer, Jan 19, 2018

Magnetic resonance imaging (MRI) has improved capacity to visualize tumor and soft tissue involve... more Magnetic resonance imaging (MRI) has improved capacity to visualize tumor and soft tissue involvement in head and neck cancers. Using advanced MRI, we can interrogate cell density using diffusion weighted imaging, a quantitative imaging that can be used during radiotherapy, when diffuse inflammatory reaction precludes PET imaging, and can assist with target delineation as well. Correlation of circulating tumor cells (CTCs) measurements with 3D quantitative tumor characterization could potentially allow selective, patient-specific response-adapted escalation or de-escalation of local therapy, and improve the therapeutic ratio, curing the greatest number of patients with the least toxicity. The proposed study is designed as a prospective observational study and will collect pretreatment CT, MRI and PET/CT images, weekly serial MR imaging during RT and post treatment CT, MRI and PET/CT images. In addition, blood sample will be collected for biomarker analysis at those time intervals. C...

Research paper thumbnail of Patient-Centered Structured Interdisciplinary Bedside Rounds in the Medical ICU

Critical care medicine, 2018

We examined the effects of introducing patient-centered structured interdisciplinary bedside roun... more We examined the effects of introducing patient-centered structured interdisciplinary bedside rounds in the medical ICU with respect to rounding efficiency, provider satisfaction, and patient/family satisfaction. A prospective, nonblinded, nonrandomized, parallel group study from June 21, 2016, to August 15, 2016. The medical ICU at a tertiary care academic medical center. A consecutive sample of adult patients, family members, and healthcare providers. The patients and healthcare providers were arbitrarily assigned to either the patient-centered structured interdisciplinary bedside rounds or nonstructured interdisciplinary bedside round care team. Healthcare providers on the patient-centered structured interdisciplinary bedside rounds team were educated about their respective roles and the information they were expected to discuss on rounds each day. Rounds completion data and satisfaction questionnaires from healthcare providers, patients, and family members were obtained from both...

Research paper thumbnail of PD11-04 Conventional Versus Computer Assisted Stereoscopic Ultrasound Needle Guidance for Renal Access: A Randomized Bench-Top Crossover Trial

The Journal of Urology, 2017

Research paper thumbnail of Effects of Student-Performed Point-of-Care Ultrasound on Physician Diagnosis and Management of Patients in the Emergency Department

The Journal of emergency medicine, Jan 3, 2017

Despite the increasing integration of ultrasound training into medical education, there is an ina... more Despite the increasing integration of ultrasound training into medical education, there is an inadequate body of research demonstrating the benefits and practicality of medical student-performed point-of-care ultrasound (SP-POCUS) in the clinical setting. The primary purpose of this study was to evaluate the effects that SP-POCUS can have on physician diagnosis and management of patients in the emergency department, with a secondary purpose of evaluating the diagnostic accuracy of SP-POCUS. SP-POCUS examinations were performed in the emergency department by medical students who completed year one of a 4-year medical school curriculum with integrated ultrasound training. Scans were evaluated by an emergency physician who then completed a survey to record any changes in diagnosis and management. A total of 641 scans were performed on the 482 patients enrolled in this study. SP-POCUS resulted in a change in management in 17.3% of scans performed. For 12.4% of scans, SP-POCUS discovered...

Research paper thumbnail of Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship

Journal of surgical education, Jan 4, 2017

To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended f... more To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship. A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online ...

Research paper thumbnail of Ultrasound Integration in Undergraduate Medical Education: Comparison of Ultrasound Proficiency Between Trained and Untrained Medical Students

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The benefit of formal ultrasound implementation in undergraduate medical education remains unclea... more The benefit of formal ultrasound implementation in undergraduate medical education remains unclear. The goal of this study was to evaluate the effectiveness of ultrasound curriculum implementation during year 1 medical student physical examination teaching on the ultrasound proficiency of medical students. An ultrasound curriculum was formally implemented at our institution in August 2012 and since then has successfully trained 2 classes of medical students (year 1 and year 2). Year 3 and year 4 medical students did not receive any formal ultrasound training, as the curriculum had not yet been implemented during their preclinical years. With the use of a 22-point ultrasound objective structured clinical examination (US-OSCE), trained medical students were compared to untrained medical students. The US-OSCE tested image acquisition and interpretation of the following systems: ocular, neck, vascular, pulmonary, cardiovascular, and abdominal. Emergency medicine (EM) residents formally ...

Research paper thumbnail of Integration of Ultrasound in Medical Education at United States Medical Schools: A National Survey of Directors' Experiences

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the impleme... more Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the implementation of such curricula in medical schools. No studies to date have surveyed individuals who are successfully championing USMED programs. This study aimed to investigate the experiences with ultrasound integration as perceived by active USMED directors across the United States. In 2014, all allopathic and osteopathic medical schools in the United States were contacted regarding their status with ultrasound education. For schools with required point-of-care ultrasound curricula, we identified the USMED directors in charge of the ultrasound programs and sent them a 27-question survey. The survey included background information about the directors, ultrasound program details, the barriers directors faced toward implementation, and the directors' attitudes toward ultrasound education. One-hundred seventy-three medical schools were contacted, and 48 (27.7%) reported having a formal USME...

Research paper thumbnail of Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Many medical schools are implementing point-of-care ultrasound in their curricula to help augment... more Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. Th...

Research paper thumbnail of Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Since the first medical student ultrasound electives became available more than a decade ago, ult... more Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound ...

Research paper thumbnail of A Cost-effective, Gelatin-Based Phantom Model for Learning Ultrasound-Guided Fine-Needle Aspiration Procedures of the Head and Neck

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The rise in popularity of ultrasound imaging has seen a corresponding increase in demand for effe... more The rise in popularity of ultrasound imaging has seen a corresponding increase in demand for effective training tools such as phantom models. They are especially useful for teaching and practice of invasive procedures, such as fine-needle aspiration of lesions of the head and neck. We have created 2 gelatin models out of inexpensive, commonly available materials that can be used in sequence to learn head and neck fine-needle aspiration. Fundamental skills can be learned first on the flat, rectangular model, whereas the second, cylindrical model more closely represents human anatomy and can be used to develop more advanced technique.

Research paper thumbnail of Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall ef... more Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall effects of ultrasound curriculum implementation on the traditional physical examination skills of medical students are still unknown. We studied the effects on the Objective Standardized Clinical Examination (OSCE) scores of year 1 medical students before and after ultrasound curriculum implementation. An ultrasound curriculum was incorporated into the physical diagnosis course for year 1 medical students in the 2012-2013 academic year. We performed a prospective observational study comparing traditional OSCE scores of year 1 medical students exposed to the ultrasound curriculum (post-ultrasound) versus historic year 1 medical student controls (pre-ultrasound) with no ultrasound exposure. Questionnaire data were also obtained from year 1 medical students and physical diagnosis faculty to assess attitudes toward ultrasound implementation. The final overall OSCE scores were graded with a 5-p...

Research paper thumbnail of Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

Critical Care Research and Practice, 2015

Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CC... more Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows.Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course.Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after t...

Research paper thumbnail of Head and Neck Ultrasound Education-A Multimodal Educational Approach in the Predoctoral Setting: A Pilot Study

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

With the increased implementation of ultrasound in medical education, it is important to continua... more With the increased implementation of ultrasound in medical education, it is important to continually improve instructional methods. In this study, we demonstrate that by augmenting the traditional methods of instructor demonstration and student practice on a healthy volunteer with additional modalities, such as didactic presentation, simulated pathologic cases, and simulated procedures, students gain a more comprehensive understanding of and confidence in ultrasound technique and pathology. A multimodal curriculum was developed and applied to head and neck ultrasound sessions of our institution's Ultrasound Symposium. Participants were asked to fill out surveys rating each instructional modality as well as preinstructional and postinstructional confidence. The survey results were divided into a group of first- and second-year medical students who had previous ultrasound training and a group of third- and fourth-year students who were ultrasound "naïve." The survey show...

Research paper thumbnail of Diagnosis of Mondor’s Disease in the Emergency Department with Bedside Ultrasound

Case Reports in Emergency Medicine, 2015

Mondor’s disease is a rare condition characterized by a superficial thrombophlebitis that can occ... more Mondor’s disease is a rare condition characterized by a superficial thrombophlebitis that can occur in the thoracoabdominal and genital areas. Findings with ultrasound in penile Mondor’s disease are readily measurable: a noncompressible penile vein without flow and absence of tears of the corpus cavernosum or tunica albuginea, hematoma, or evidence of fracture of the penis. We present a case of Mondor’s disease, diagnosed with bedside ultrasound, in the emergency department. Ultrasonography is readily available within the emergency department, and we suggest its use in aiding diagnosis of genitourinary disorders such as Mondor’s disease.

Research paper thumbnail of Diagnosis of Necrotizing Faciitis with Bedside Ultrasound: the STAFF Exam

Western Journal of Emergency Medicine, 2014

The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic... more The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

Research paper thumbnail of 2089700 Integration Of Ultrasound In Medical Education In United States Medical Schools: A National Survey Of Directors

Ultrasound in Medicine & Biology, 2015

AS 4.4) and physical exam courses (91% agreement, AS 4.5). They agreed that learning US would enh... more AS 4.4) and physical exam courses (91% agreement, AS 4.5). They agreed that learning US would enhance their medical education (100% agreement, AS 4.7). Following workshops, 100% of subjects agreed that US would enhance their medical education (AS 4.8) and that they wanted more US in their medical curriculum (AS 4.7). Subjects agreed that the student-sponsored US workshops were worthwhile (100% agreement, AS 4.8), taught them something they could not have learn elsewhere in their medical education (99% agreement, AS 4.8), and added something valuable to their medical education (99% agreement, AS 4.6). Subjects agreed that they learned something relevant to their pre-clinical coursework (91% agreement, AS 4.5), which they could use in their future clinical practice (100% agreement, AS 4.8). Nearly all subjects planned to attend future USIG workshops (96% agreement, AS 4.7) and wanted to learn more US after their experience (99% agreement, AS 4.6). Conclusions: Medical students with limited ultrasound in their medical curriculums want to learn ultrasound. They feel ultrasound should be incorporated into their undergraduate medical education and will seek it out if not provided for them. USIGs are a great method to provide immediate access to ultrasound education that is worthwhile and not found elsewhere in the medical curriculum.

Research paper thumbnail of 2073972 Ultrasound Integration into Medical School Curriculum: A Comparison Between Trained and Untrained Medical Students

Ultrasound in Medicine & Biology, 2015

Research paper thumbnail of Developing a percutaneous dilatational tracheostomy service by medical intensivists: Experience at one academic Institution

Journal of Critical Care, 2015

Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compa... more Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compared with open surgical tracheostomy, for patients requiring chronic ventilatory assistance. Little is known regarding the process involved to incorporate PDT as a standard service in the medical intensive care unit. In this report, we describe our experience developing a "PDT service" led by medical intensivists. With support from our leadership and surgical colleagues, we developed a credentialing and training process for medical intensivists, formulated a bedside team to perform PDT, refined our technique, and maintained a patient data registry for quality improvement. To date, our service includes 4 medical intensivists with PDT privileges. Over a 4-year period, we performed 171 PDTs for patients in the medical intensive care unit after 12.1 ± 8.2 days of mechanical ventilation. Our procedure-related complication rates are similar to other reports. No patient required emergent open surgical tracheostomy, and there were no deaths related to PDT. We required minimal to no backup support from our surgical colleagues in performing PDT. We successfully developed a medical intensivist-driven PDT service, sharing our unique successes and challenges, to facilitate the care of our patients requiring prolonged ventilator support.

Research paper thumbnail of Percutaneous Tracheostomy Performed by Medical Intensivists: Implementation and Outcomes

Research paper thumbnail of Real-time sonographically guided percutaneous dilatational tracheostomy using a long-axis approach compared to the landmark technique

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014

Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (... more Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (PDT) has been shown to predict PDT success. In this study, we compared the real-time, long-axis, in-plane approach to the traditional bronchoscopically guided landmark technique. Data were analyzed from a prospectively maintained PDT database at a university tertiary care medical intensive care unit. A convenience sample of adult patients requiring PDT for prolonged mechanical ventilation dependence was enrolled. Critical care fellows, under direct supervision of an attending intensivist, performed all PDTs. Tracheostomy performance from the sonographically guided and landmark techniques was compared. Twenty-three patients were enrolled: 11 in the sonography group and 12 in the landmark group. Initial midline introducer needle puncture was achieved in 72.7% in the sonography group compared to 8.3% in the landmark group (P< .001). The mean number of introducer needle punctures ± SD was...

Research paper thumbnail of Predicting treatment Response based on Dual assessment of magnetic resonance Imaging kinetics and Circulating Tumor cells in patients with Head and Neck cancer (PREDICT-HN): matching 'liquid biopsy' and quantitative tumor modeling

BMC cancer, Jan 19, 2018

Magnetic resonance imaging (MRI) has improved capacity to visualize tumor and soft tissue involve... more Magnetic resonance imaging (MRI) has improved capacity to visualize tumor and soft tissue involvement in head and neck cancers. Using advanced MRI, we can interrogate cell density using diffusion weighted imaging, a quantitative imaging that can be used during radiotherapy, when diffuse inflammatory reaction precludes PET imaging, and can assist with target delineation as well. Correlation of circulating tumor cells (CTCs) measurements with 3D quantitative tumor characterization could potentially allow selective, patient-specific response-adapted escalation or de-escalation of local therapy, and improve the therapeutic ratio, curing the greatest number of patients with the least toxicity. The proposed study is designed as a prospective observational study and will collect pretreatment CT, MRI and PET/CT images, weekly serial MR imaging during RT and post treatment CT, MRI and PET/CT images. In addition, blood sample will be collected for biomarker analysis at those time intervals. C...

Research paper thumbnail of Patient-Centered Structured Interdisciplinary Bedside Rounds in the Medical ICU

Critical care medicine, 2018

We examined the effects of introducing patient-centered structured interdisciplinary bedside roun... more We examined the effects of introducing patient-centered structured interdisciplinary bedside rounds in the medical ICU with respect to rounding efficiency, provider satisfaction, and patient/family satisfaction. A prospective, nonblinded, nonrandomized, parallel group study from June 21, 2016, to August 15, 2016. The medical ICU at a tertiary care academic medical center. A consecutive sample of adult patients, family members, and healthcare providers. The patients and healthcare providers were arbitrarily assigned to either the patient-centered structured interdisciplinary bedside rounds or nonstructured interdisciplinary bedside round care team. Healthcare providers on the patient-centered structured interdisciplinary bedside rounds team were educated about their respective roles and the information they were expected to discuss on rounds each day. Rounds completion data and satisfaction questionnaires from healthcare providers, patients, and family members were obtained from both...

Research paper thumbnail of PD11-04 Conventional Versus Computer Assisted Stereoscopic Ultrasound Needle Guidance for Renal Access: A Randomized Bench-Top Crossover Trial

The Journal of Urology, 2017

Research paper thumbnail of Effects of Student-Performed Point-of-Care Ultrasound on Physician Diagnosis and Management of Patients in the Emergency Department

The Journal of emergency medicine, Jan 3, 2017

Despite the increasing integration of ultrasound training into medical education, there is an ina... more Despite the increasing integration of ultrasound training into medical education, there is an inadequate body of research demonstrating the benefits and practicality of medical student-performed point-of-care ultrasound (SP-POCUS) in the clinical setting. The primary purpose of this study was to evaluate the effects that SP-POCUS can have on physician diagnosis and management of patients in the emergency department, with a secondary purpose of evaluating the diagnostic accuracy of SP-POCUS. SP-POCUS examinations were performed in the emergency department by medical students who completed year one of a 4-year medical school curriculum with integrated ultrasound training. Scans were evaluated by an emergency physician who then completed a survey to record any changes in diagnosis and management. A total of 641 scans were performed on the 482 patients enrolled in this study. SP-POCUS resulted in a change in management in 17.3% of scans performed. For 12.4% of scans, SP-POCUS discovered...

Research paper thumbnail of Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship

Journal of surgical education, Jan 4, 2017

To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended f... more To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship. A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online ...

Research paper thumbnail of Ultrasound Integration in Undergraduate Medical Education: Comparison of Ultrasound Proficiency Between Trained and Untrained Medical Students

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The benefit of formal ultrasound implementation in undergraduate medical education remains unclea... more The benefit of formal ultrasound implementation in undergraduate medical education remains unclear. The goal of this study was to evaluate the effectiveness of ultrasound curriculum implementation during year 1 medical student physical examination teaching on the ultrasound proficiency of medical students. An ultrasound curriculum was formally implemented at our institution in August 2012 and since then has successfully trained 2 classes of medical students (year 1 and year 2). Year 3 and year 4 medical students did not receive any formal ultrasound training, as the curriculum had not yet been implemented during their preclinical years. With the use of a 22-point ultrasound objective structured clinical examination (US-OSCE), trained medical students were compared to untrained medical students. The US-OSCE tested image acquisition and interpretation of the following systems: ocular, neck, vascular, pulmonary, cardiovascular, and abdominal. Emergency medicine (EM) residents formally ...

Research paper thumbnail of Integration of Ultrasound in Medical Education at United States Medical Schools: A National Survey of Directors' Experiences

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the impleme... more Despite the rise of ultrasound in medical education (USMED), multiple barriers impede the implementation of such curricula in medical schools. No studies to date have surveyed individuals who are successfully championing USMED programs. This study aimed to investigate the experiences with ultrasound integration as perceived by active USMED directors across the United States. In 2014, all allopathic and osteopathic medical schools in the United States were contacted regarding their status with ultrasound education. For schools with required point-of-care ultrasound curricula, we identified the USMED directors in charge of the ultrasound programs and sent them a 27-question survey. The survey included background information about the directors, ultrasound program details, the barriers directors faced toward implementation, and the directors' attitudes toward ultrasound education. One-hundred seventy-three medical schools were contacted, and 48 (27.7%) reported having a formal USME...

Research paper thumbnail of Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Many medical schools are implementing point-of-care ultrasound in their curricula to help augment... more Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. Th...

Research paper thumbnail of Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Since the first medical student ultrasound electives became available more than a decade ago, ult... more Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound ...

Research paper thumbnail of A Cost-effective, Gelatin-Based Phantom Model for Learning Ultrasound-Guided Fine-Needle Aspiration Procedures of the Head and Neck

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

The rise in popularity of ultrasound imaging has seen a corresponding increase in demand for effe... more The rise in popularity of ultrasound imaging has seen a corresponding increase in demand for effective training tools such as phantom models. They are especially useful for teaching and practice of invasive procedures, such as fine-needle aspiration of lesions of the head and neck. We have created 2 gelatin models out of inexpensive, commonly available materials that can be used in sequence to learn head and neck fine-needle aspiration. Fundamental skills can be learned first on the flat, rectangular model, whereas the second, cylindrical model more closely represents human anatomy and can be used to develop more advanced technique.

Research paper thumbnail of Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall ef... more Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall effects of ultrasound curriculum implementation on the traditional physical examination skills of medical students are still unknown. We studied the effects on the Objective Standardized Clinical Examination (OSCE) scores of year 1 medical students before and after ultrasound curriculum implementation. An ultrasound curriculum was incorporated into the physical diagnosis course for year 1 medical students in the 2012-2013 academic year. We performed a prospective observational study comparing traditional OSCE scores of year 1 medical students exposed to the ultrasound curriculum (post-ultrasound) versus historic year 1 medical student controls (pre-ultrasound) with no ultrasound exposure. Questionnaire data were also obtained from year 1 medical students and physical diagnosis faculty to assess attitudes toward ultrasound implementation. The final overall OSCE scores were graded with a 5-p...

Research paper thumbnail of Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

Critical Care Research and Practice, 2015

Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CC... more Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows.Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course.Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after t...

Research paper thumbnail of Head and Neck Ultrasound Education-A Multimodal Educational Approach in the Predoctoral Setting: A Pilot Study

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015

With the increased implementation of ultrasound in medical education, it is important to continua... more With the increased implementation of ultrasound in medical education, it is important to continually improve instructional methods. In this study, we demonstrate that by augmenting the traditional methods of instructor demonstration and student practice on a healthy volunteer with additional modalities, such as didactic presentation, simulated pathologic cases, and simulated procedures, students gain a more comprehensive understanding of and confidence in ultrasound technique and pathology. A multimodal curriculum was developed and applied to head and neck ultrasound sessions of our institution's Ultrasound Symposium. Participants were asked to fill out surveys rating each instructional modality as well as preinstructional and postinstructional confidence. The survey results were divided into a group of first- and second-year medical students who had previous ultrasound training and a group of third- and fourth-year students who were ultrasound "naïve." The survey show...

Research paper thumbnail of Diagnosis of Mondor’s Disease in the Emergency Department with Bedside Ultrasound

Case Reports in Emergency Medicine, 2015

Mondor’s disease is a rare condition characterized by a superficial thrombophlebitis that can occ... more Mondor’s disease is a rare condition characterized by a superficial thrombophlebitis that can occur in the thoracoabdominal and genital areas. Findings with ultrasound in penile Mondor’s disease are readily measurable: a noncompressible penile vein without flow and absence of tears of the corpus cavernosum or tunica albuginea, hematoma, or evidence of fracture of the penis. We present a case of Mondor’s disease, diagnosed with bedside ultrasound, in the emergency department. Ultrasonography is readily available within the emergency department, and we suggest its use in aiding diagnosis of genitourinary disorders such as Mondor’s disease.

Research paper thumbnail of Diagnosis of Necrotizing Faciitis with Bedside Ultrasound: the STAFF Exam

Western Journal of Emergency Medicine, 2014

The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic... more The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

Research paper thumbnail of 2089700 Integration Of Ultrasound In Medical Education In United States Medical Schools: A National Survey Of Directors

Ultrasound in Medicine & Biology, 2015

AS 4.4) and physical exam courses (91% agreement, AS 4.5). They agreed that learning US would enh... more AS 4.4) and physical exam courses (91% agreement, AS 4.5). They agreed that learning US would enhance their medical education (100% agreement, AS 4.7). Following workshops, 100% of subjects agreed that US would enhance their medical education (AS 4.8) and that they wanted more US in their medical curriculum (AS 4.7). Subjects agreed that the student-sponsored US workshops were worthwhile (100% agreement, AS 4.8), taught them something they could not have learn elsewhere in their medical education (99% agreement, AS 4.8), and added something valuable to their medical education (99% agreement, AS 4.6). Subjects agreed that they learned something relevant to their pre-clinical coursework (91% agreement, AS 4.5), which they could use in their future clinical practice (100% agreement, AS 4.8). Nearly all subjects planned to attend future USIG workshops (96% agreement, AS 4.7) and wanted to learn more US after their experience (99% agreement, AS 4.6). Conclusions: Medical students with limited ultrasound in their medical curriculums want to learn ultrasound. They feel ultrasound should be incorporated into their undergraduate medical education and will seek it out if not provided for them. USIGs are a great method to provide immediate access to ultrasound education that is worthwhile and not found elsewhere in the medical curriculum.

Research paper thumbnail of 2073972 Ultrasound Integration into Medical School Curriculum: A Comparison Between Trained and Untrained Medical Students

Ultrasound in Medicine & Biology, 2015

Research paper thumbnail of Developing a percutaneous dilatational tracheostomy service by medical intensivists: Experience at one academic Institution

Journal of Critical Care, 2015

Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compa... more Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compared with open surgical tracheostomy, for patients requiring chronic ventilatory assistance. Little is known regarding the process involved to incorporate PDT as a standard service in the medical intensive care unit. In this report, we describe our experience developing a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;PDT service&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; led by medical intensivists. With support from our leadership and surgical colleagues, we developed a credentialing and training process for medical intensivists, formulated a bedside team to perform PDT, refined our technique, and maintained a patient data registry for quality improvement. To date, our service includes 4 medical intensivists with PDT privileges. Over a 4-year period, we performed 171 PDTs for patients in the medical intensive care unit after 12.1 ± 8.2 days of mechanical ventilation. Our procedure-related complication rates are similar to other reports. No patient required emergent open surgical tracheostomy, and there were no deaths related to PDT. We required minimal to no backup support from our surgical colleagues in performing PDT. We successfully developed a medical intensivist-driven PDT service, sharing our unique successes and challenges, to facilitate the care of our patients requiring prolonged ventilator support.

Research paper thumbnail of Percutaneous Tracheostomy Performed by Medical Intensivists: Implementation and Outcomes

Research paper thumbnail of Real-time sonographically guided percutaneous dilatational tracheostomy using a long-axis approach compared to the landmark technique

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014

Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (... more Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (PDT) has been shown to predict PDT success. In this study, we compared the real-time, long-axis, in-plane approach to the traditional bronchoscopically guided landmark technique. Data were analyzed from a prospectively maintained PDT database at a university tertiary care medical intensive care unit. A convenience sample of adult patients requiring PDT for prolonged mechanical ventilation dependence was enrolled. Critical care fellows, under direct supervision of an attending intensivist, performed all PDTs. Tracheostomy performance from the sonographically guided and landmark techniques was compared. Twenty-three patients were enrolled: 11 in the sonography group and 12 in the landmark group. Initial midline introducer needle puncture was achieved in 72.7% in the sonography group compared to 8.3% in the landmark group (P< .001). The mean number of introducer needle punctures ± SD was...