Littérature scientifique sur le sujet « Hand-held echo »

Introduction. Echocardiography is a highly operator-dependant technique which requires adequate training and skills that are frequently not present, considering the widespread use of cardiovascular ultrasound. This could particularly be true for hand-held echo devices which made echocardiography more accessible but are frequently used by non-cardiologists and non-experts. Outline of Cases. We present a 45-year-old female and a 37-year-old male with heart murmurs due to atrial and ventricular septal defect, respectively. Congenital septal defects were undiagnosed in both patients during several outpatient examinations due to challenging image acquisition. Careful re-evaluation revealed that, depending on the scanning technique, it was possible to detect or overlook the real cause of the murmur using either hand-held or high-end echo device. Conclusion. Our report underlines the need of adequate knowledge and training of medical professionals performing pocket-size hand-held echocardiography, since potential misdiagnoses may not be related to limited imaging capabilities of pocket-sized echo devices only, but also to inability of insufficiently trained users to obtain good quality images and interpret them adequately.

Background Data about the epidemiology of valvular heart disease (VHD) in the elderly is scarce. Hand-held ultrasound devices (HUDs) enable point-of-care ultrasound scanning (POCUS) but their use in an elderly population has not been reported for VHD screening in primary practice. Methods One hundred consecutive subjects aged >70 years without a VHD diagnosis had 2D and colour Doppler POCUS by an accredited sonographer, using a contemporary HUD (Vscan), in a primary practice setting. Patients with left-sided valve pathology identified by Vscan were referred for formal echo in the local tertiary cardiac centre. Results Mean age (s.d.) was 79.08 (3.74) years (72–92 years); 61 female. By Vscan, we found five patients with ≥moderate aortic stenosis (AS), eight with ≥moderate mitral regurgitation (MR) and none with ≥moderate aortic regurgitation. In the AS and MR groups each, one patient had valve intervention following from the initial diagnosis by Vscan, two and one respectively are under follow-up in the valve clinic, while two and four respectively refused TTE or follow-up. Two patients with moderate MR by Vscan had mild and mild/moderate MR respectively by TTE and were discharged. Total cost for scanning 100 patients was $18,201 – i.e. $182/patient. Conclusions Screening with a hand-held scanner (Vscan), we identified 5/100 elderly subjects who needed valve replacement or follow-up in valve clinic, at a cost of $182/patient. These findings have potential significance for the allocation of resources in the context of an ageing population.

Purpose: We performed ophthalmic examinations, including optical coherence tomography (OCT), on a case diagnosed with hydranencephaly. Case Report: This case involved a female infant born at the gestational age of 35 weeks and 4 days, with the birth weight of 2,152 g, who was one of monochorionic diamniotic twins, and the identical twin died in utero at the gestational age of 24 weeks. After that, examination by fetal echo indicated that she had microcephaly and ventriculomegaly. Postnatal magnetic resonance imaging (MRI) of her head indicated microcephaly and significant enlargement of the lateral ventricle on both sides, with no obvious signs of elevated intracranial pressure. The brain parenchyma of both sides of the frontal lobe, parietal lobe, and occipital lobe had marked thinning, yet that of the temporal lobe, basal ganglia, thalamus, brain stem, and cerebellum had been maintained. Moreover, no obvious hematoma or neoplastic lesions were observed. Ophthalmic examinations indicated that both of her eyes had slight light reflex, attributed to optic nerve atrophy. Examination by use of a hand-held OCT system indicated a layered structure of the retina and thinning of the ganglion cell layer. Flicker electroretinogram (ERG) examination by use of a hand-held ERG system indicated an almost normal wave. However, no clear visual reaction was observed when she was 10 months old. Conclusion: Our findings in this case of hydranencephaly revealed that even though the outer layer functions of the patient’s retina were maintained, extensive damage to her cerebral cortex resulted in poor visual function.

This article analyzes the tensionbetween the active, present body and the absent, passive body in this medical case study, presented by doctor and prosthetist Henry Robert Heather Bigg in his 1885 bookArtificial Limbs and the Amputations which Afford the Most Appropriate Stumps in Civil and Military Surgery. I reproduce Bigg's account in its entirety because, to date,Artificial Limbshas not been digitised, although it is held at around a dozen academic libraries in the UK and USA respectively. Bringing attention to and providing a close reading of a source not previously discussed academically sheds new light on the way the disabled body was read by medical professionals in the second half of the nineteenth century. In addition, I consider Bigg's narrative rendering of this unique case study alongside several contemporary sources, including memoirs, novels, short stories, and journal articles. In doing so, I identify how assumptions made by Bigg about the (disabled, female, privileged) hand mirror and echo those in the wider cultural sphere. The sensing hand is an instrument of will, and the creation of such a prosthesis troubles the dynamics of active and passive, touching and touched that Pamela K. Gilbert has identified as crucial to nineteenth-century discourses surrounding the hand. By designing and making this prosthesis, Bigg exerts his professional and masculine agency to make the woman's body assume the position of something beheld rather than embodied.

The Theater Is always Dying traces the resilience of live theatrical performance in the face of competing performative forms like cinema, television and contemporary streaming services on personal, hand-held devices and focuses on theater’s ability to continue as a significant cultural, community and intellectual force in the face of such competition. To echo Beckett, we might suggest, then, that theater may be at its best at its dying since its extended demise seems self-regenerating. Whether or not you “go out of the theatre more human than when you went in”, as Ariane Mnouchkin suggests, or whether you’ve had a sense that you’ve been part of, participated in a community ritual, a Dionysia, or whether or not you’ve felt that you’ve been affected by a performative, an embodied intellectual and emotional human experience may determine how you judge the state of contemporary theater. You may not always know the answer to those questions immediately after the theatrical encounter, or ever deliberately or consciously, but something, nonetheless, may have been taking its course. You may emerge “more human than when you went in”.

Il primo scopo del lavoro è stato quello di analizzare retrospettivamente l’impatto organizzativo, economico e clinico dell’esecuzione degli esami ecocardiografici in reparto di degenza al letto del paziente utilizzando un ecocardiografo portatile e un sonographer con la lettura centralizzata degli esami da parte di medici ecocardiografisti esperti rispetto al modello organizzativo che prevede il trasporto dei pazienti presso il Laboratorio per l’esecuzione dell’esame ecocardiografico. Il secondo scopo è stato quello di valutare prospetticamente l’impatto clinico ed organizzativo di ecografi ultra-mobili di ultima generazione che sono stati adottati da parte da cardiologi nell’ambito delle visite di consulenza a pazienti degenti. METODI Sono stati analizzati dati storici sulla modalità e sui tempi di trasporto dei pazienti al Laboratorio di Ecocardiografia. Questo modello è stato confrontato in termini economici e di impatto clinico con quello che prevedeva gli esami al letto del paziente, registrati dal sonographer. Sono state raccolte anche informazioni quali la necessità di ripetizione e/o di completamento presso il Laboratorio registrando le eventuali discordanze. Per il secondo scopo sono state registrate prospetticamente nell’arco di 2 mesi tutte le consulenze cardiologiche effettuate in reparti internistici. Successivamente i cardiologi che espletavano le consulenze cardiologiche sono stati dotati di un ecografo ultra-mobile e per 5 mesi ne è stata registrata la modalità di utilizzo, la ricaduta nella gestione del paziente e quali fossero le condizioni cliniche che invece necessitavano comunque l’esecuzione di un ecocardiogramma completo da parte del sonographer o presso il Laboratorio. Sì è infine stimato il risparmio in termini di giornate di degenza e di impatto economico di tale gestione per l’Ospedale, in quanto la consulenza cardiologica poteva essere finalizzata sul momento. RISULTATI La durata media dei trasporti da parte di pedoni di pazienti degenti nello stesso padiglione del Laboratorio è stata pari a 26 ± 8 minuti. Per i trasporti in autoambulanza la durata media dei trasporti da parte dei lettighieri di pazienti degenti in altri padiglioni rispetto al Laboratorio è stata pari a 50 ± 11 minuti, con una assenza media del paziente dal reparto pari a 178±77 minuti. Nel corso dell’anno di rilevazione dell’attività del sonographer, sono stati eseguiti dal sonographer al letto del paziente 1.611 esami, di cui 26 (1,6%) sono stati ripetuti in Laboratorio per incompletezza o insufficiente qualità delle immagini acquisite dal sonographer, senza impatto sul decorso clinico del paziente. Calcolando i costi del personale medico e di trasporto, il risparmio con l’introduzione del sonographer è stato di € 72.624,46/anno. Nella rilevazione della durata di 2 mesi sono state richieste 95 consulenze cardiologiche che hanno necessitato l’informazione ecocardiografica e che hanno richiesto una mediana di tempo di 4 giorni per essere concluse. Delle 187 consulenze cardiologiche richieste comprensive di informazione ecografica nel periodo di adozione del nuovo ecografo, 66 (35%) sono state evase sul momento utilizzando l’ecografo ultra-mobile. L’analisi eseguita dal controllo di gestione dell’Ospedale ha determinato un costo medio di giornata di degenza in un reparto di Medicina Interna pari a € 574,96. Avere una latenza di circa 4 giorni stimata sul gruppo di controllo per la risposta ad un quesito clinico comporterebbe l’allungamento della degenza, se vincolata unicamente alla risoluzione del quesito cardiologico, pari a un costo evitabile di € 2300. CONCLUSIONI Il modello gestionale del sonographer e l'implementazione durante consulenze cardiologiche di una valutazione con ecografo ultra-mobile mirata al quesito clinico ha dimostrato di essere efficace dal punto di vista economico e clinico.
The first purpose of the work was to retrospectively analyze the organizational, economic and clinical impact of performing echocardiographic examinations in the hospital ward at the patient's bed using a portable echocardiograph and a certified sonographer with centralized reading of the exams by expert echocardiographers with respect to the organizational model that requires the transport of patients to the Echocardiography Laboratory for the execution of the echocardiographic examination. The second purpose was to prospectively assess the clinical and organizational impact of the latest generation ultra-mobile ultrasound scanners that have been adopted by cardiologists as part of consulting visits to inpatient patients. METHODS Historical data on the modality and time of transport of patients to the Echocardiography Laboratory were analyzed. This model was compared in economic terms and in clinical impact with the one involving bedside examinations, recorded by the sonographer. Information was also collected such as the need for repetition and / or completion at the Laboratory, recording any discrepancies or the added value of the examination carried out at the Laboratory. For the second purpose, cardiological consultations carried out in internist departments were recorded prospectively over a period of 2 months. Subsequently, the cardiologists who carried out the cardiological consultations were equipped with an ultra-mobile ultrasound system and for 5 months were recorded the method of use, the relapse in the management of the patient and what were the clinical conditions that instead required the execution of a complete echocardiogram by the sonographer or at the Laboratory. Finally, the savings in terms of hospitalization days and the economic impact of this management for the hospital are estimated, as the cardiological consultancy could be finalized on the spot. RESULTS The average duration of transport by operators of patients staying in the same hall of the Laboratory was equal to 26 ± 8 minutes. For transport by ambulance, the average duration of transport by the hospitalized patients in other pavilions with respect to the Laboratory was equal to 50 ± 11 minutes, with an average absence of the patient from the ward equal to 178 ± 77 minutes. During the year of observation of the sonographer's activity, 1,611 examinations were performed by the sonographer at the patient's bed, of which 26 (1.6%) were repeated in the Laboratory due to incompleteness or insufficient quality of the images acquired by the sonographer, without impact on the patient's clinical course. Calculating the costs of medical personnel and transport, the savings with the introduction of the sonographer were € 72,624.46 / year. In the 2-month survey, 95 cardiological consultations were requested which required echocardiographic information and which required a median of 4 days to be completed. Of the 187 cardiological consultations required including ultrasound information during the adoption period of the new ultrasound system, 66 (35%) were fulfilled on the spot using the ultra-mobile ultrasound system. The analysis performed by the hospital management control determined an average cost per day of hospitalization in an Internal Medicine ward of € 574.96. Having an estimated latency of about 4 days on the control group for the answer to a clinical question would lead to lengthening of the hospital stay, if limited only to the resolution of the cardiological question, equal to an avoidable cost of about € 2300. CONCLUSIONS The management model of the sonographer and the implementation during cardiological consultations of an evaluation with an ultra-mobile ultrasound system aimed at the clinical question has proved to be effective from an economic and clinical point of view.

Pocket-size hand-held echocardiography (PHE) is low cost, portable, user friendly, and battery powered. Studies using PHE do not replace conventional echo studies and do not provide a complete diagnostic echocardiographic examination. PHE should be used for goal-oriented studies that include assessment of left ventricular (LV) cavity size, LV systolic function, detection of pericardial effusion, and haemodynamic compromise. Examinations using PHE have been demonstrated to be feasible and provide additional information to the physical examination. For potential users other than cardiology experts in echocardiography the accuracy of PHE data highly depends on training and competency. Emphasis must be placed on acquisition of good quality images and knowledge of pitfalls and limitations. The challenge is providing efficient training programmes to ensure competency in performing focused studies and have recognition of an appropriate threshold for seeking expert advice and full echo examination. PHE is a useful teaching tool and provides important complementary information for medical education.

Abstract This paper describes an engineering education attempt in a synthesis class during the 4th year. Since the Kochi University of Technology was inaugurated in April, 1997, engineering education trials had been conducted in the past 4 years. In 1997, 3 student teams participated in an eco-power race held in Kochi, Japan, with hand-made ecological vehicles. In the summer, 1998, three teams participated in the Shikoku Electric Vehicle Rally using light weight vehicles converted into electric cars. The synthesis class was performed based on such past engineering activities out of class. In order to provide an active learning opportunity, a synthetic learning environment is needed rather than just teaching in classes. Manufacturing is also considered to be of great importance for mechanical engineering as well as the basic sciences such as mathematics and physics. As a capstone learning course, a team of four students in the laboratory tried to design and manufacture a hand-made small-sized electric vehicle.