Gregory Mints | NYU School of Medicine (original) (raw)

Papers by Gregory Mints

Journal of Ultrasound in Medicine, Jun 21, 2019

To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not sh... more To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not show what was intended. From the text of the article, it was meant to show transverse processes (in the median sagittal plane); instead, it shows articular processes (in a paramedian sagittal plane). This is evident by the lack of dropout or the bone shadow in between the processes and a much deeper location (than, for example, their corresponding Figure 1). Examples of images of spinous processes (Figure 1) and articular processes (Figure 2) are shown here. In our experience, it is a common error in the technique. Because the middle of the intervertebral space in the paramedian plane does not correspond to the middle of the interspinous space as seen in the median sagittal plane, this error leads to incorrect choice of a puncture site. We wonder whether the lack of an observed benefit in the study may have been related to the inaccurate identification of structures on imaging by novice operators.

Thrombosis Research, Dec 1, 2020

The New England Journal of Medicine, Apr 5, 2007

Correspondence from The New England Journal of Medicine — Biomarkers for Prediction of Cardiovasc... more Correspondence from The New England Journal of Medicine — Biomarkers for Prediction of Cardiovascular Events.

Neurology, Aug 31, 2020

We read with great interest the case reports about patients with COVID-19 with Miller Fisher synd... more We read with great interest the case reports about patients with COVID-19 with Miller Fisher syndrome and polyneuritis cranialis by Gutiérrez-Ortiz et al., 1 which provided a link between these diseases and the symptom spectrum of SARS-CoV-2 infection. As we know, the Miller Fisher syndrome and polyneuritis cranialis are an autoimmune neuropathy triggered by autoantibodies specific for the polysialogangliosides GQ1b and GT1a in axonal terminals and causes the inflammation and demyelination of the peripheral and cranial nerves. 2 A recent article also proposed that autoimmune injury may be involved in the mechanisms of nervous system symptoms of COVID-19. 3 In addition, Zika virus-another coronavirus-is also associated with autoimmune peripheral neuropathy. 4,5 These thus support the connection of Miller Fisher syndrome and polyneuritis cranialis with SARS-CoV-2 infection. We wonder whether the authors examined the presence of SARS-CoV-2 RNA and antibodies for SARS-CoV-2 in CSF and ruled out the infection by other common viruses in 2 patients with COVID-19? This will

Additional file 1: Table S1. Two-day In-person POCUS Course Agenda. Table S2. Four-week Tele-ultr... more Additional file 1: Table S1. Two-day In-person POCUS Course Agenda. Table S2. Four-week Tele-ultrasound POCUS Course Agenda. Table S3. In-person Course Scanning Session Objectives. Table S4. Tele-ultrasound Course Scanning Session Objectives. File S1. Pre- and Post-course Knowledge Test. File S2. CME Course Evaluation. File S3. Tele-ultrasound Course Evaluation. Table S5. Characteristics of Learners and Faculty. Table S6. Tele-ultrasound Course Evaluations by Learners and Faculty. Table S7. Faculty Evaluation of the Tele-ultrasound Course.

Journal of Ultrasound in Medicine, 2021

To the Editor: We thank Drs Soldati, Smargiassi, Perrone, Torri, Mento, Demi, and Inchingolo for ... more To the Editor: We thank Drs Soldati, Smargiassi, Perrone, Torri, Mento, Demi, and Inchingolo for their comments on our article. Their group pointed to their excellent prior studies, including their work on correlating lung ultrasound (LUS) score with prognosis in 52 patients, as well as their work on elucidating the number of zones necessary to be scanned in order to achieve comparable diagnostic accuracy to their proposed 14-zone protocol in 88 patients. Work such as these contribute to furthering our understanding of LUS use in COVID-19. In our consensus-based recommendations on how LUS should be performed, our group favored a flexible rather than a prescriptive approach, recommending the inclusion of posterior lung zones wherever possible, in addition to the usual lung regions. Our recommendation was based on three primary reasons. First and foremost, we anticipate that the clinical indications for performing LUS will vary. Scans done to rule out specific causes of acute deterioration in a patient may differ from those done as an initial evaluation of a clinically stable patient, which will also differ from a follow-up scan done to assess newly developed symptoms such as focal chest pain. Thus, while existing data have validity evidence to support its use in diagnosis and prognosis, the extension of this evidence may not apply broadly in the clinical setting, especially if the diagnosis or prognosis of COVID-19 is not the clinical question at hand. Second, we anticipate that a multitude of factors must be considered by the clinician when deciding which and how many areas of the lungs to scan. For example, is there time to perform a more extensive evaluation or is the time available or the status of the patient limiting the scanning task to answering only focused questions? While a more extensive scan will typically increase the sensitivity of LUS, this sensitivity may come at a cost of increased time spent and thus increased time exposed to the patient as well. Other factors must also be considered: What additional information influences the focused questions being asked? For example, does the patient have preexisting conditions that must be considered, such as congestive heart failure or interstitial lung disease and so on? Is the patient able to sit up or be placed in a lateral decubitus position, or would posterior findings need to be confined for the time being to the lateral posterior windows? What additional imaging and other diagnostic results are available to the clinician at the time of the LUS? The use of a single protocol across all settings is unlikely prudent, as the task of clinical integration is often complex. Third, it remains unclear at this time how clinical management decisions are to be specifically altered based on LUS findings alone. Our group does not currently endorse patient disposition decisions be made based solely on LUS findings. And while prognostic information may be an additional benefit to performing LUS, how to modify management based on this prognostic information is unknown. We further acknowledge that many clinicians and experts worldwide have extensive experience with standardized LUS protocols. A number of these also have accompanying supportive validity evidence. Thus, existing evidence is not sufficiently compelling to justify the need to endorse a single protocol over another in the clinical setting. Our group continues to endorse a flexible approach, rather than a specific protocol. The majority of members from our group are based in North America; our recommendations are primarily intended for a Canadian internal medicine practice setting and may not apply broadly to other sites. Nonetheless, our recommendation is concordant with a recently published international expert consensus, which comprises of an independent voting expert panel, whose members were different from ours, except for one individual who voted in both panels. Finally, it is important to note that data will continue to evolve and our recommendations will need to be revisited in the future. We greatly appreciate the rigorous research from clinician investigators around the world that contributes to this valuable ongoing dialog.

Thrombosis Research, 2020

The Ultrasound Journal, 2021

Background Lack of training is currently the most common barrier to implementation of point-of-ca... more Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-...

Journal of Hospital Medicine, 2020

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on Marc... more COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on March 11, 2020. Although most patients (81%) develop mild illness, 14% develop severe illness, and 5% develop critical illness, including acute respiratory failure, septic shock, and multiorgan dysfunction.1 Point-of-care ultrasound (POCUS), or bedside ultrasound performed by a clinician caring for the patient, is being used to support the diagnosis and serially monitor patients with COVID-19. We performed a literature search of electronically discoverable peer-reviewed publications on POCUS use in COVID-19 from December 1, 2019, to April 10, 2020. We review key POCUS applications that are most relevant to frontline providers in the care of COVID-19 patients.

Journal of Ultrasound in Medicine, 2020

ObjectivesTo develop a consensus statement on the use of lung ultrasound (LUS) in the assessment ... more ObjectivesTo develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID‐19).MethodsOur LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as “strong,” “weak,” or “do not recommend.” For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered.ResultsOf the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for ...

Neurology, 2020

We read with great interest the case reports about patients with COVID-19 with Miller Fisher synd... more We read with great interest the case reports about patients with COVID-19 with Miller Fisher syndrome and polyneuritis cranialis by Gutiérrez-Ortiz et al., 1 which provided a link between these diseases and the symptom spectrum of SARS-CoV-2 infection. As we know, the Miller Fisher syndrome and polyneuritis cranialis are an autoimmune neuropathy triggered by autoantibodies specific for the polysialogangliosides GQ1b and GT1a in axonal terminals and causes the inflammation and demyelination of the peripheral and cranial nerves. 2 A recent article also proposed that autoimmune injury may be involved in the mechanisms of nervous system symptoms of COVID-19. 3 In addition, Zika virus-another coronavirus-is also associated with autoimmune peripheral neuropathy. 4,5 These thus support the connection of Miller Fisher syndrome and polyneuritis cranialis with SARS-CoV-2 infection. We wonder whether the authors examined the presence of SARS-CoV-2 RNA and antibodies for SARS-CoV-2 in CSF and ruled out the infection by other common viruses in 2 patients with COVID-19? This will

Journal of the Academy of Consultation-Liaison Psychiatry, 2020

Abstract Introduction Buprenorphine in the treatment of opioid use disorder (OUD) has several ben... more Abstract Introduction Buprenorphine in the treatment of opioid use disorder (OUD) has several benefits including better long-term treatment adherence (1) and is a safer option for many patients due to buprenorphine’s limited potential to cause respiratory depression (4). In comparison to standard buprenorphine induction, induction via micro-dosing does not require a period of withdrawal and dramatically shortens the time required to complete induction. Prior micro-dosing protocols using sublingual (SL) (7-10) and transdermal forms (11) have been reported. We present a case of buprenorphine induction using a novel inpatient intravenous micro-dosing 4-day protocol in a patient on methadone. Case Presentation A 62-year-old man with chronic obstructive pulmonary disease (COPD) on chronic methadone 80mg daily for OUD presented with respiratory failure and was diagnosed with opioid overdose. He was transitioned from a naloxone infusion to intravenous micro-doses of buprenorphine and low dose methadone without experiencing significant withdrawal, and he was discharged on buprenorphine/naloxone SL. Discussion This case demonstrates a successful and well tolerated buprenorphine induction without interruption of methadone treatment or precipitation of significant opioid withdrawal. To the best of our knowledge, this is the first report describing micro-induction with intravenous buprenorphine.

Neurology, 2020

Neurological complications of COVID-19 are not well described. We report two patients who were di... more Neurological complications of COVID-19 are not well described. We report two patients who were diagnosed with COVID-19 after presenting with diplopia and ophthalmoparesis.

Journal of Hospital Medicine, 2019

Many hospitalists incorporate point‐of‐care ultrasound (POCUS) into their daily practice to answe... more Many hospitalists incorporate point‐of‐care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision‐making processes surrounding POCUS program mana...

Journal of Ultrasound in Medicine, 2019

To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not sh... more To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not show what was intended. From the text of the article, it was meant to show transverse processes (in the median sagittal plane); instead, it shows articular processes (in a paramedian sagittal plane). This is evident by the lack of dropout or the bone shadow in between the processes and a much deeper location (than, for example, their corresponding Figure 1). Examples of images of spinous processes (Figure 1) and articular processes (Figure 2) are shown here. In our experience, it is a common error in the technique. Because the middle of the intervertebral space in the paramedian plane does not correspond to the middle of the interspinous space as seen in the median sagittal plane, this error leads to incorrect choice of a puncture site. We wonder whether the lack of an observed benefit in the study may have been related to the inaccurate identification of structures on imaging by novice operators.

Journal of Ultrasound in Medicine, Jun 21, 2019

To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not sh... more To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not show what was intended. From the text of the article, it was meant to show transverse processes (in the median sagittal plane); instead, it shows articular processes (in a paramedian sagittal plane). This is evident by the lack of dropout or the bone shadow in between the processes and a much deeper location (than, for example, their corresponding Figure 1). Examples of images of spinous processes (Figure 1) and articular processes (Figure 2) are shown here. In our experience, it is a common error in the technique. Because the middle of the intervertebral space in the paramedian plane does not correspond to the middle of the interspinous space as seen in the median sagittal plane, this error leads to incorrect choice of a puncture site. We wonder whether the lack of an observed benefit in the study may have been related to the inaccurate identification of structures on imaging by novice operators.

Thrombosis Research, Dec 1, 2020

The New England Journal of Medicine, Apr 5, 2007

Correspondence from The New England Journal of Medicine — Biomarkers for Prediction of Cardiovasc... more Correspondence from The New England Journal of Medicine — Biomarkers for Prediction of Cardiovascular Events.

Neurology, Aug 31, 2020

We read with great interest the case reports about patients with COVID-19 with Miller Fisher synd... more We read with great interest the case reports about patients with COVID-19 with Miller Fisher syndrome and polyneuritis cranialis by Gutiérrez-Ortiz et al., 1 which provided a link between these diseases and the symptom spectrum of SARS-CoV-2 infection. As we know, the Miller Fisher syndrome and polyneuritis cranialis are an autoimmune neuropathy triggered by autoantibodies specific for the polysialogangliosides GQ1b and GT1a in axonal terminals and causes the inflammation and demyelination of the peripheral and cranial nerves. 2 A recent article also proposed that autoimmune injury may be involved in the mechanisms of nervous system symptoms of COVID-19. 3 In addition, Zika virus-another coronavirus-is also associated with autoimmune peripheral neuropathy. 4,5 These thus support the connection of Miller Fisher syndrome and polyneuritis cranialis with SARS-CoV-2 infection. We wonder whether the authors examined the presence of SARS-CoV-2 RNA and antibodies for SARS-CoV-2 in CSF and ruled out the infection by other common viruses in 2 patients with COVID-19? This will

Additional file 1: Table S1. Two-day In-person POCUS Course Agenda. Table S2. Four-week Tele-ultr... more Additional file 1: Table S1. Two-day In-person POCUS Course Agenda. Table S2. Four-week Tele-ultrasound POCUS Course Agenda. Table S3. In-person Course Scanning Session Objectives. Table S4. Tele-ultrasound Course Scanning Session Objectives. File S1. Pre- and Post-course Knowledge Test. File S2. CME Course Evaluation. File S3. Tele-ultrasound Course Evaluation. Table S5. Characteristics of Learners and Faculty. Table S6. Tele-ultrasound Course Evaluations by Learners and Faculty. Table S7. Faculty Evaluation of the Tele-ultrasound Course.

Journal of Ultrasound in Medicine, 2021

To the Editor: We thank Drs Soldati, Smargiassi, Perrone, Torri, Mento, Demi, and Inchingolo for ... more To the Editor: We thank Drs Soldati, Smargiassi, Perrone, Torri, Mento, Demi, and Inchingolo for their comments on our article. Their group pointed to their excellent prior studies, including their work on correlating lung ultrasound (LUS) score with prognosis in 52 patients, as well as their work on elucidating the number of zones necessary to be scanned in order to achieve comparable diagnostic accuracy to their proposed 14-zone protocol in 88 patients. Work such as these contribute to furthering our understanding of LUS use in COVID-19. In our consensus-based recommendations on how LUS should be performed, our group favored a flexible rather than a prescriptive approach, recommending the inclusion of posterior lung zones wherever possible, in addition to the usual lung regions. Our recommendation was based on three primary reasons. First and foremost, we anticipate that the clinical indications for performing LUS will vary. Scans done to rule out specific causes of acute deterioration in a patient may differ from those done as an initial evaluation of a clinically stable patient, which will also differ from a follow-up scan done to assess newly developed symptoms such as focal chest pain. Thus, while existing data have validity evidence to support its use in diagnosis and prognosis, the extension of this evidence may not apply broadly in the clinical setting, especially if the diagnosis or prognosis of COVID-19 is not the clinical question at hand. Second, we anticipate that a multitude of factors must be considered by the clinician when deciding which and how many areas of the lungs to scan. For example, is there time to perform a more extensive evaluation or is the time available or the status of the patient limiting the scanning task to answering only focused questions? While a more extensive scan will typically increase the sensitivity of LUS, this sensitivity may come at a cost of increased time spent and thus increased time exposed to the patient as well. Other factors must also be considered: What additional information influences the focused questions being asked? For example, does the patient have preexisting conditions that must be considered, such as congestive heart failure or interstitial lung disease and so on? Is the patient able to sit up or be placed in a lateral decubitus position, or would posterior findings need to be confined for the time being to the lateral posterior windows? What additional imaging and other diagnostic results are available to the clinician at the time of the LUS? The use of a single protocol across all settings is unlikely prudent, as the task of clinical integration is often complex. Third, it remains unclear at this time how clinical management decisions are to be specifically altered based on LUS findings alone. Our group does not currently endorse patient disposition decisions be made based solely on LUS findings. And while prognostic information may be an additional benefit to performing LUS, how to modify management based on this prognostic information is unknown. We further acknowledge that many clinicians and experts worldwide have extensive experience with standardized LUS protocols. A number of these also have accompanying supportive validity evidence. Thus, existing evidence is not sufficiently compelling to justify the need to endorse a single protocol over another in the clinical setting. Our group continues to endorse a flexible approach, rather than a specific protocol. The majority of members from our group are based in North America; our recommendations are primarily intended for a Canadian internal medicine practice setting and may not apply broadly to other sites. Nonetheless, our recommendation is concordant with a recently published international expert consensus, which comprises of an independent voting expert panel, whose members were different from ours, except for one individual who voted in both panels. Finally, it is important to note that data will continue to evolve and our recommendations will need to be revisited in the future. We greatly appreciate the rigorous research from clinician investigators around the world that contributes to this valuable ongoing dialog.

Thrombosis Research, 2020

The Ultrasound Journal, 2021

Background Lack of training is currently the most common barrier to implementation of point-of-ca... more Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-...

Journal of Hospital Medicine, 2020

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on Marc... more COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on March 11, 2020. Although most patients (81%) develop mild illness, 14% develop severe illness, and 5% develop critical illness, including acute respiratory failure, septic shock, and multiorgan dysfunction.1 Point-of-care ultrasound (POCUS), or bedside ultrasound performed by a clinician caring for the patient, is being used to support the diagnosis and serially monitor patients with COVID-19. We performed a literature search of electronically discoverable peer-reviewed publications on POCUS use in COVID-19 from December 1, 2019, to April 10, 2020. We review key POCUS applications that are most relevant to frontline providers in the care of COVID-19 patients.

Journal of Ultrasound in Medicine, 2020

ObjectivesTo develop a consensus statement on the use of lung ultrasound (LUS) in the assessment ... more ObjectivesTo develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID‐19).MethodsOur LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as “strong,” “weak,” or “do not recommend.” For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered.ResultsOf the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for ...

Neurology, 2020

We read with great interest the case reports about patients with COVID-19 with Miller Fisher synd... more We read with great interest the case reports about patients with COVID-19 with Miller Fisher syndrome and polyneuritis cranialis by Gutiérrez-Ortiz et al., 1 which provided a link between these diseases and the symptom spectrum of SARS-CoV-2 infection. As we know, the Miller Fisher syndrome and polyneuritis cranialis are an autoimmune neuropathy triggered by autoantibodies specific for the polysialogangliosides GQ1b and GT1a in axonal terminals and causes the inflammation and demyelination of the peripheral and cranial nerves. 2 A recent article also proposed that autoimmune injury may be involved in the mechanisms of nervous system symptoms of COVID-19. 3 In addition, Zika virus-another coronavirus-is also associated with autoimmune peripheral neuropathy. 4,5 These thus support the connection of Miller Fisher syndrome and polyneuritis cranialis with SARS-CoV-2 infection. We wonder whether the authors examined the presence of SARS-CoV-2 RNA and antibodies for SARS-CoV-2 in CSF and ruled out the infection by other common viruses in 2 patients with COVID-19? This will

Journal of the Academy of Consultation-Liaison Psychiatry, 2020

Abstract Introduction Buprenorphine in the treatment of opioid use disorder (OUD) has several ben... more Abstract Introduction Buprenorphine in the treatment of opioid use disorder (OUD) has several benefits including better long-term treatment adherence (1) and is a safer option for many patients due to buprenorphine’s limited potential to cause respiratory depression (4). In comparison to standard buprenorphine induction, induction via micro-dosing does not require a period of withdrawal and dramatically shortens the time required to complete induction. Prior micro-dosing protocols using sublingual (SL) (7-10) and transdermal forms (11) have been reported. We present a case of buprenorphine induction using a novel inpatient intravenous micro-dosing 4-day protocol in a patient on methadone. Case Presentation A 62-year-old man with chronic obstructive pulmonary disease (COPD) on chronic methadone 80mg daily for OUD presented with respiratory failure and was diagnosed with opioid overdose. He was transitioned from a naloxone infusion to intravenous micro-doses of buprenorphine and low dose methadone without experiencing significant withdrawal, and he was discharged on buprenorphine/naloxone SL. Discussion This case demonstrates a successful and well tolerated buprenorphine induction without interruption of methadone treatment or precipitation of significant opioid withdrawal. To the best of our knowledge, this is the first report describing micro-induction with intravenous buprenorphine.

Neurology, 2020

Neurological complications of COVID-19 are not well described. We report two patients who were di... more Neurological complications of COVID-19 are not well described. We report two patients who were diagnosed with COVID-19 after presenting with diplopia and ophthalmoparesis.

Journal of Hospital Medicine, 2019

Many hospitalists incorporate point‐of‐care ultrasound (POCUS) into their daily practice to answe... more Many hospitalists incorporate point‐of‐care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision‐making processes surrounding POCUS program mana...

Journal of Ultrasound in Medicine, 2019

To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not sh... more To the Editor: We believe that Figure 3 in the recent article by Evans and colleagues does not show what was intended. From the text of the article, it was meant to show transverse processes (in the median sagittal plane); instead, it shows articular processes (in a paramedian sagittal plane). This is evident by the lack of dropout or the bone shadow in between the processes and a much deeper location (than, for example, their corresponding Figure 1). Examples of images of spinous processes (Figure 1) and articular processes (Figure 2) are shown here. In our experience, it is a common error in the technique. Because the middle of the intervertebral space in the paramedian plane does not correspond to the middle of the interspinous space as seen in the median sagittal plane, this error leads to incorrect choice of a puncture site. We wonder whether the lack of an observed benefit in the study may have been related to the inaccurate identification of structures on imaging by novice operators.