Progress in lung ultrasound education: An updated systematic review.

Thoracic ultrasound (TUS) is an easy-to-use imaging modality that aids physicians in the differential diagnosis of respiratory diseases. However, no data exist on the TUS findings of acute eosinophilic pneumonia (AEP) or their clinical utility in patients with AEP. Thus, we performed an observational study on TUS findings and their clinical utility for follow-up in patients with AEP. We prospectively screened patients who visited the emergency department for acute respiratory symptoms at the Armed Forces Capital Hospital in South Korea between February 2014 and July 2014. Of them, patients suspected to have AEP underwent an etiological investigation, including flexible bronchoscopy with bronchoalveolar lavage and TUS, and we evaluated TUS findings and serial changes on TUS during the treatment course compared with those from chest radiographs. In total, 22 patients with AEP were identified. The TUS examinations reveled that all patients exhibited multiple diffuse bilateral B-lines and lung sliding, with (n = 5) or without pleural effusion, which was consistent with alveolar-interstitial syndrome. B-line numbers fell during the course of treatment, as the lines became thinner and fainter. A-lines were evident in 19 patients on day 7 of hospitalization, when B-lines had disappeared in 13 patients, and all pleural effusion had resolved. All patients exhibited complete ultrasonic resolution by day 14, along with clinicoradiological improvement. Chest radiographs of five patients taken on day 7 seemed to show complete resolution, but several abnormal B-lines were evident on TUS performed the same day. As a result, our data show common TUS findings of AEP and suggest that AEP may be included as a differential diagnosis when multiple diffuse bilateral B-lines with preserved lung sliding are identified on a TUS examination in patients with acute symptoms, and that TUS is a useful modality for evaluating the treatment response in patients with AEP.

Background: Thoracic ultrasound (TUS) and contrast-enhanced CT (CECT) are integral in pleural empyema diagnosis. Objective: To compare diagnostic yield, accuracy, and clinical utility of TUS vs CECT in confirmed empyema. Methods: Cross-sectional study done on 80 adult patients with suspected empyema presenting to Saraswathi Institute of Medical Sciences, Hapur Casualty, IPD or OPD. Patients underwent TUS and CECT Thorax. Sensitivity/specificity for effusion, septation, loculation, and split pleura sign were calculated. Procedural guidance, safety, cost, and time to intervention were evaluated. Results: TUS detected effusions in 98%, septations in 85%, and loculations in 83%. CECT detected septations in 60% and split pleura in 75%. Sensitivity of TUS vs CECT: effusion (98% vs 90%), septation (85% vs 60%), loculation (83% vs 65%). TUS enabled bedside drainage in 92% and avoided CECT in 60% of patients. Conclusion: TUS demonstrated superior sensitivity for internal septations and loculations and provides real time, radiation free, cost effective bedside guidance. CECT is complementary for anatomical delineation and surgical planning.

BackgroundChest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR.MethodsOut of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay.ResultsTUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer.ConclusionsTUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.

prevalent in 20–57% of stroke patients, visual field defects have been shown to impact quality of life. Studies ([8][1]) have shown increased risk of falling, ambulatory difficulties, impaired reading ability, and feelings of panic in crowded or unfamiliar places in patients with visual field

Students who ride older school buses are often exposed to high levels of exhaust during their commutes, which may adversely affect health and school attendance. As a result, the US Environmental Protection Agency (EPA) has awarded millions of dollars to school districts to replace older, highly polluting school buses with newer, cleaner buses. To leverage the EPA's randomized allocation of funding under the 2012-2016 School Bus Rebate Programs to estimate the association between replacing old, highly polluting buses and changes in district-average standardized test scores. This study examined changes in reading and language arts (RLA) and math test scores among US school district applicants to the EPA's 2012-2016 national School Bus Rebate Programs 1 year before and after each lottery by selection status. Data analysis was conducted from January 15 to July 30, 2023. Selection to receive EPA funding to replace older school buses with newer, cleaner alternatives. School district changes in RLA and math test scores among students in grades 3 through 8 before and after the EPA funding lotteries by selection status were measured using an intention-to-treat approach. This study included 1941 school district applicants to the 2012-2106 EPA School Bus Rebate Programs. These districts had a mean (SD) of 14.6 (33.7) schools per district, 8755 (23 776) students per district, and 41.3% (20.2%) of students with free lunch eligibility. Among the applicants, 209 districts (11%) were selected for the clean bus funding. District-average student test scores did not improve among selected districts overall. In secondary analyses, however, districts replacing the oldest, highest polluting buses (ie, pre-1990) experienced significantly greater improvements in district-average test scores in the year after the lottery for RLA and math (SD improvement in test scores, 0.062 [95% CI, 0.050-0.074] and 0.025 [95% CI, 0.011-0.039], respectively) compared with districts without replacements. In this study, the EPA funding was not associated with student test scores overall, but in secondary analyses, the replacement of the oldest school buses was associated with improved educational performance. These findings support prioritizing clean bus replacement of the oldest buses as an actionable way for improving students' educational performance.

Virtual Reality Simulation Facilitates Resident Training in Total Hip Arthroplasty: A Randomized Controlled Trial

Genetics and health of children born from cryopreserved oocytes

Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B₁₂, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

Pilot Study of a Web-Based Antibiotic Decision Management Guide

Non-expandable lung (NEL) occurs when the lung fails to fully re-expand after pleural fluid drainage, complicating management and limiting therapeutic options. Diagnosis, based on clinical symptoms, pleural manometry, and traditional imaging, is often delayed to the peri- or post-procedural stages, leading to improper management, complications, and higher healthcare costs. Therefore, early, pre-procedural diagnostic methods are needed. Thoracic ultrasound (TUS) has emerged as a non-invasive tool with the potential to enhance diagnostic accuracy and guide clinical decisions, yet, it remains inadequately studied within the context of NEL. We conducted a non-systematic narrative review using a structured methodology, including a comprehensive database search, predefined inclusion criteria, and QUADAS-2 quality assessment. This approach ensured a rigorous synthesis of evidence on TUS in NEL, with the aim of identifying knowledge gaps and guiding future studies. Non-invasive, real-time, bedside M-mode TUS has demonstrated efficacy in predicting NEL prior to thoracentesis by detecting an absent sinusoidal sign and reduced atelectatic lung movement. Emerging experimental techniques, including 2D shear wave elastography (SWE), speckle tracking imaging (STI) strain analysis, the lung/liver echogenicity (LLE) ratio, TUS assessment of dynamic air bronchograms, and pleural thickening evaluation, show additional potential to enhance pre-procedural NEL detection. However, all these methods have significant limitations that require further comprehensive investigation. Despite their significant promise, TUS modalities for early NEL detection still require rigorous validation and standardization before broad clinical use. A multimodal diagnostic approach, combining clinical manifestations, pleural manometry, radiologic and ultrasonographic findings, along with emerging techniques (once fully validated), may provide the most extensive framework for NEL. Regardless of advancements, patient-centered care and shared decision-making remain essential. Further research is needed to improve outcomes, reduce healthcare costs, and enhance long-term treatment strategies.

Neuropsychological tests are widely used not only to assess the degree of dysfunction following a brain injury, but also to assess the effectiveness of rehabilitation procedures in improving cognitive functioning. As yet, however, there is little evidence bearing upon whether any cognitive gains during rehabilitation relate to psychosocial aspects of the patient's subsequent daily life. In the present study 55 non-aphasic brain-injured adult patients were tested, as part of a standard procedure, with a short battery of neuropsychological tests before and after an intensive post-acute rehabilitation programme of about 4–5 months duration. There were significant but small improvements in most test scores after rehabilitation. At a period of between 18 months and 5 years after completion of the programme, a follow-up of the patients was conducted to establish outcomes in terms of whether or not they were actively employed or pursuing an education. This was true in almost 60% of cases. Neuropsychological test scores, in particular before rehabilitation, were generally related to outcome as thus defined, although some of this relationship may have been mediated by age effects. A notable finding was that there was, however, no evidence that improvements in test scores from pre- to post-programme were associated with a positive later outcome. The results suggest that whereas better neuropsychological test results are predictive of a positive outcome, cognitive improvements during rehabilitation as measured by such tests may be only modest and, importantly, they may have little bearing on subsequent return to employment or education. It is suggested that positive outcome in this regard may therefore depend upon other factors.

Fibrosing interstitial lung diseases (F-ILD), which include idiopathic pulmonary fibrosis (IPF) and other ILDs conferring risk for progressive pulmonary fibrosis (PPF), are a heterogeneous group of diseases with multiple subtypes. A multidisciplinary team discussion (MDD) incorporating HRCT is considered the gold standard for diagnosing and quantifying pulmonary fibrosis. However, repeated HRCTs are associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) has emerged as a potential radiation-free method for diagnosing and monitoring disease severity in F-ILD. However, consistent knowledge regarding the use of TUS in patients with F-ILD remains limited. This systematic review aimed to evaluate existing literature on the applicability of TUS in patients with F-ILD. We performed a systematic review according to PRISMA guidelines. MEDLINE, Embase, CINAHL, and Cochrane library databases were searched. Prospective, cross-sectional, and retrospective studies were considered. Risk of bias was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2). Six studies met the inclusion criteria. All examined patients had IPF, and two had other F-ILD subtypes. The most frequently evaluated TUS findings were B-lines and pleural line irregularities (PI). However, there was marked heterogeneity in TUS methodology and protocols, precluding meta-analysis. Although the preliminary findings in this review suggest TUS may have potential utility in this patient group, available data on TUS in F-ILD are sparse and heterogeneous, highlighting the need for further research.

Background Adverse events related to thoracentesis and chest tube insertion are common. International guidelines recommend improved procedural training and mandatory use of ultrasound (US). A particular problem can arise when managing a malignant pleural effusion. If lung entrapment is present, this changes the optimal treatment strategy. Aims To increase the safety and therapeutic efficacy of pleural procedures, by improving training and extending the utility of US and pleural manometry to guide these procedures. Methods The aims will be achieved through three study arms. 1. Assessment tools: Objective tools to assess the competency of physician-performed chest tube insertion (the Chest Tube Insertion Competency Test: TUBE-iCOMPT) and thoracic US (the Ultrasound-Guided Skills and Tasks Assessment Test: UG-STAT) were written in line with international evidence-based guidelines. The reliability and accuracy of the tools was demonstrated by applying them to assess a cohort of doctors performing thoracic US and chest tube insertion. 2. US of the intercostal artery (ICA): A method to visualise the ICA with US was initially developed on a cohort of patients undergoing routine thoracic ultrasound prior to thoracentesis. The sensitivity and specificity of US to screen for a vulnerable intercostal artery was then assessed in a second study, by comparing the position of the ICA found by US with that on computed tomography (CT) chest examination. 3i. Pleural manometry: A new method for continuous pleural manometry during thoracentesis (compared with the traditional intermittent method) was developed. By transducing pleural pressures from an epidural catheter sitting within the pleural effusion, pressure measurements can be made without halting the flow of fluid through the drainage catheter. On a cohort of patients undergoing thoracentesis, pleural manometry was performed simultaneously using the traditional and the new method. Differences in opening pressure and pleural elastance derived from each technique were compared, before demonstrating the feasibility of fully automated pleural manometry allowed by the new technique, by connecting the system to a urodynamics machine. 3ii. US and entrapped lung: A method to identify malignant entrapped lung with US prior to pleural effusion drainage was developed and assessed. Thoracic US with an echocardiogram machine was performed on a cohort of patients prior to thoracentesis. The displacement (mm) and deformation (%) of the atelectatic lower lobe due to the transmitted cardiac impulse, was measured using motion mode (M Mode) and speckle-tracking imaging (STI) respectively. The gold standard diagnosis of lower lobe entrapment was made according to post-drainage radiology. Data was randomly divided into a development and validation set. Data from the development set was used to construct receiver-operating curves (ROC), which described the ability of US to identify lung entrapment. Optimal diagnostic cut-offs selected from the ROC curves were then applied to the validation set, and diagnostic indices calculated. Results 1. Both the TUBE-iCOMPT and UG-STAT showed a high degree of test-retest and inter-tester reliability, and were able to appropriately separate participants into beginner, intermediate and advanced groups. 2. Ultrasound was able to identify a vulnerable intercostal artery with a sensitivity of 86% and specificity of 30%. The performance of a high-end machine was not significantly better than a mobile machine, and an appropriately trained respiratory physician was as good as an experienced radiographer. 3i. There was no statistical difference in opening pressures (p=0.49) or pleural elastance (p>0.10) derived from each technique. The new technique allowed for fully automated real-time display of pleural pressures, drainage volumes and pleural elastance. 3ii. Motion analysis with US showed good diagnostic power to identify malignant entrapped lung prior to pleural effusion drainage, with an area under the ROC of 0.79 for M Mode and 0.86 for STI. The sensitivity and specificity were 50% and 85% for M Mode and 71% and 85% for STI respectively. Conclusions This PhD thesis has produced studies that will have a real impact on clinical practice. It has developed objective assessment tools with initial pilot studies demonstrating their validity. They could now provide the impetus for further studies to develop and refine such methods for procedural competency assessment. While these studies are underway individual hospitals could use the tools to track an individual’s progress through training and use these assessments as feedback opportunities. It has also produced novel extensions to the current use of ultrasound by the pulmonologist, documenting for the first time the possible use of US to identify a vulnerable ICA prior to chest drainage procedures and prospectively identify malignant lung entrapment. It has refined the current technique of pleural manometry, simplifying the practice for clinicians and allowing for fully automated recording and calculation of relevant parameters. These novel tools now provide the stimulus to further clinical study as outlined above. In time it is hoped these tools may improve outcomes and reduce adverse events suffered by our patients.

Piloting the global capacity education e-tool: can capacity be taught to health care professionals across different international jurisdictions?

The purpose of this study was to evaluate Children's Village, a life safety education facility for children. The study took place in Washington County, Maryland, a rural county. Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program. Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive. Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs.