Abstract Introduction/Purpose Increasing demand for training in focused cardiac ultrasound (FCU) is constrained by availability of supervisors to supervise training on patients. We designed and tested the feasibility of a cloud‐based (internet) system that enables remote supervision and monitoring of the learning curve of image quality and interpretative accuracy for one novice learner. Methods After initial training in FCU (iHeartScan and FCU TTE Course, University of Melbourne), a novice submitted the images and interpretation of 30 practice FCU examinations on hospitalised patients to a supervisor via a cloud‐based portal. Electronic feedback was provided by the supervisor prior to the novice performing each FCU examination, which included image quality score (for each view) and interpretation errors. The primary outcome of the study was the number of FCU scans required for two consecutive scans to score: (i) above the lower limit of acceptable total image quality score (64%), and (ii) below the upper limit of acceptable interpretive errors (15%). Results The number of FCU practice examinations required to meet adequate image quality and interpretation error standard was 10 and 13, respectively. Improvement in image acquisition continued, remaining within limits of acceptable image quality. Conversely, interpretive in‐accuracy (error > 15%) continued. Conclusion This electronic FCU mentoring system circumvents (but should not replace) the requirement for bed‐side supervision, which may increase the capacity of supervision of physicians learning FCU. The system also allows real‐time tracking of their progress and identifies weaknesses that may assist in guiding further training.
Ultrasound simulation allows students to virtually explore internal anatomy by producing accurate, moving, color, three-dimensional rendered slices from any angle or approach leaving the organs and their relationships intact without requirement for consumables. The aim was to determine the feasibility and efficacy of self-directed learning of cardiac anatomy with an ultrasound simulator compared to cadavers and plastic models. After a single cardiac anatomy lecture, fifty university anatomy students participated in a three-hour supervised self-directed learning exposure in groups of five, randomized to an ultrasound simulator or human cadaveric specimens and plastic models. Pre- and post-tests were conducted using pictorial and non-pictorial multiple-choice questions (MCQs). Simulator students completed a survey on their experience. Four simulator and seven cadaver group students did not attend after randomization. Simulator use in groups of five students was feasible and feedback from participants was very positive. Baseline test scores were similar (P = 0.9) between groups. After the learning intervention, there was no difference between groups in change in total test score (P = 0.37), whether they were pictorial (P = 0.6) or non-pictorial (P = 0.21). In both groups there was an increase in total test scores (simulator +19.8 ±12.4%% and cadaver: +16.4% ± 10.2, P < 0.0001), pictorial question scores (+22.9 ±18.0%, 19.7 ±19.3%, P < 0.001) and non-pictorial question scores (+16.7 ±18.2%, +13 ±15.4%, P = 0.002). The ultrasound simulator appears equivalent to human cadaveric prosections for learning cardiac anatomy.
expertise (diagnostic versus focused) was highest in TTE (32 %) compared with TOE (22 %) and LU (12 %). The proportions of intensivists untrained in TTE and LU was 41 % and 30 %, respectively. Perceived barriers included lack of organized training (38 %) and time for training (25 %). Other barriers included a perceived lack of need for training (18 %), insufficient equipment (14 %), and resistance from other ultrasound providers (4 %). The most commonly reported training programs were tertiary courses, such as provided by the Australasian Society of Ultrasound in Medicine (68 %) and University of Melbourne (59 %), rather than board examinations or hands-on workshops. We conclude that although TTE and LU are used frequently in Australasian teaching ICUs, many ICU physicians are yet to be trained due to lack of ICU training programs and time for training. Although tertiary courses are popular and provide training to diagnostic level, they are lengthy and depend on trainers and patient caseload and are not, therefore, scalable. An attractive alternative is to begin training in medical school and to train more physicians in basic ultrasound with shorter, more efficient, and hands-on courses utilizing the internet and ultrasound simulators [1], advancing to a diagnostic level only if required.
Abstract Introduction: Mild cognitive impairment is considered a precursor to dementia and significantly impacts upon quality of life. The prevalence of mild cognitive impairment is higher in the post-surgical cardiac population than the general population, with older age and co-morbidities further increasing the risk of cognitive decline. This significantly impacts upon quality of life. Exercise improves neurogenesis, synaptic plasticity and inflammatory and neurotrophic factor pathways, which may help to augment the effects of cognitive decline. However, the effects of resistance training on cognitive, functional and overall patient-reported recovery have not been investigated in the surgical cardiac population. This study aims to determine the safety and feasibility of early moderate intensity resistance training in people undergoing cardiac surgery via a median sternotomy, compared to standard care. The effect of this exercise program on cognitive and functional recovery will also be examined. Methods: This study will be a prospective, pragmatic, pilot randomised controlled trial comparing a standard care group (low-intensity aerobic exercise) and a moderate-intensity resistance training group. Participants aged 18 years and older with coronary artery and/or valve disease requiring surgical intervention will be recruited pre-operatively and randomised 1:1 to either the resistance training or standard care group post-operatively. Feasibility and safety will be assessed through recruitment and retention rates; exercise program adherence; dropout rate; exercise and session stoppages due to pain, any adverse event or incident; and, any major adverse cardiac and cerebral events. Secondary measures include cognitive function, muscular strength, physical function, multiple-domain recovery, balance and patient satisfaction. Assessments will be conducted at baseline (pre-operatively) and post-operatively at 2 weeks, 8 weeks, 14 weeks and 6 months. Discussion: The results of this study will inform the safety and feasibility of early intervention resistance training for patients following cardiac surgery. In addition, this study will provide insights into the effect of resistance training on postoperative cognitive recovery to inform rehabilitation guidelines. Trial registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ID: ACTRN12617001430325p. Registered on 9 October 2017. Universal Trial Number (UTN):U1111-1203-2131. Keywords: Median sternotomy, resistance training, cognition, cardiac surgery, recovery, rehabilitation, exercise
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