Portable Ultrasound Equipment Research Articles

Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access

BackgroundUltrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities.ObjectiveTo perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians’ interest in and access to ultrasound training opportunities.MethodsThe survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components.ResultsA total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating ‘Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use.ConclusionsFuture efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

Comparison between transrectal palpation, B-mode and Doppler ultrasonography to assess luteal function in Holstein cattle.

Over the years, the most common methods for monitoring reproductive health in cattle have varied from transrectal palpation to B-mode ultrasonography. Nowadays, some portable ultrasound equipment includes the Doppler mode. Therefore, the aim of this study was to compare the accuracy of the different methods to assess corpus luteum (CL) functionality. In Experiment 1, 53 Holstein lactating cows undergoing a synchronization protocol were examined via transrectal palpation and B-mode scanning. Measurements for the largest diameter (LAD) and subjective size of CL (SCLS) were collected. Data were analyzed using correlation analysis and ROC Curves. In Experiment 2, 30 Holstein non-lactating cows with a CL were administered PGF2α and examined several times after injection, first in B-mode and then with Power Doppler. Measurements for LAD, CL area (CLA) and subjective and objective CL blood flow were collected. Blood samples were taken in both experiments to determine P4 concentration. Data were analyzed using correlation analysis and the GLM repeated measures test. Results for Experiment 1 showed that LAD was more accurate than SCLS. In Experiment 2, CLA was the best measurement to assess CL function, although both subjective and objective CL blood flow offer accurate information 24 h after PGF2α administration. Consequently, ultrasonography provides more accurate information about CL function than transrectal palpation. Although CLA seems to be an earlier indicator of luteal function than blood flow, 24 h after the onset of luteolysis, both parameters are valid.

Deep learning-based classification of adequate sonographic images for self-diagnosing deep vein thrombosis.

Pulmonary thromboembolism is a serious disease that often occurs in disaster victims evacuated to shelters. Deep vein thrombosis is the most common reason for pulmonary thromboembolism, and early prevention is important. Medical technicians often perform ultrasonography as part of mobile medical screenings of disaster victims but reaching all isolated and scattered shelters is difficult. Therefore, deep vein thrombosis medical screening methods that can be easily performed by anyone are needed. The purpose of this study was to develop a method to automatically identify cross-sectional images suitable for deep vein thrombosis diagnosis so disaster victims can self-assess their risk of deep vein thrombosis. Ultrasonographic images of the popliteal vein were acquired in 20 subjects using stationary and portable ultrasound diagnostic equipment. Images were obtained by frame split from video. Images were classified as "Satisfactory," "Moderately satisfactory," and "Unsatisfactory" according to the level of popliteal vein visualization. Fine-tuning and classification were performed using ResNet101, a deep learning model. Acquiring images with portable ultrasound diagnostic equipment resulted in a classification accuracy of 0.76 and an area under the receiver operating characteristic curve of 0.89. Acquiring images with stationary ultrasound diagnostic equipment resulted in a classification accuracy of 0.73 and an area under the receiver operating characteristic curve of 0.88. A method for automatically identifying appropriate diagnostic cross-sectional ultrasonographic images of the popliteal vein was developed. This elemental technology is sufficiently accurate to automatically self-assess the risk of deep vein thrombosis by disaster victims.

OpenCare5G: O-RAN in Private Network for Digital Health Applications

Digital Health is a new way for medicine to work together with computer engineering and ICT to carry out tests and obtain reliable information about the health status of citizens in the most remote places in Brazil in near-real time, applying new technologies and digital tools in the process. InovaHC is the technological innovation core of the Clinics Hospital of the Faculty of Medicine of the University of São Paulo (HCFMUSP). It is the first national medical institution to seek new opportunities offered by 5G technology and test its application in the first private network for Digital Health in the largest hospital complex in Latin America through the OpenCare5G Project. This project uses an Open RAN concept and network disaggregation with lower costs than the traditional concept used by the telecommunications industry. The technological project connected to the 5G network was divided into two phases for proof-of-concept testing: the first with an initial focus on carrying out examinations with portable ultrasound equipment in different locations at HCFMUSP, and the second focusing on carrying out remote examinations with health professionals in other states of Brazil, who will be working in remote areas in other states with little or no ICT infrastructure together with a doctor analyzing exams in real time at HCFMUSP in São Paulo. The objective of the project is to evaluate the connectivity and capacity of the 5G private network in these the proof-of-concept tests for transmitting the volume of data from remote exams with higher speed and lower latency. We are in the first phase of the proof of concept testing to achieve the expected success. This project is a catalyst for innovation in health, connecting resources and entrepreneurs to generate solutions for the innovation ecosystem of organizations. It is coordinated by Deloitte with the participation of the Escola Politécnica da USP (The School of Engineering-University of São Paulo), Airspan, Itaú Bank, Siemens Healthineers, NEC, Telecom Infra Projet, ABDI and IDB. The use of 5G Open RAN technology in public health is concluded to be of extreme social, economic, and fundamental importance for HCFMUSP, citizens, and the development of health research to promote great positive impacts ranging from attracting investment in the country to improving the quality of patient care.

Moving forward with point-of-care ultrasound: An (early) educational effort can (also) strengthen research

The growing availability of portable ultrasound equipment, associated with the rapidity of execution and the perceived benefit on diagnostic accuracy and time-to-diagnosis, has led to an exponential increase in the use of Point-of-Care Ultrasound (POCUS) in everyday practice. However, given the complexity of the impact of the rapid introduction of such a revolution at the patient's bedside, one cannot avoid highlighting which steps are still needed to formally establish the role of POCUS in patient management.

Cardiac Ultrasound for the Nephrologist: Know Thy Heart to Know Thy Kidneys.

Kidney disease patients have a high prevalence of cardiovascular morbidity and mortality. It can be challenging to adequately assess their cardiovascular status based on physical examination alone. Cardiac ultrasound has proven to be a powerful tool to accomplish this objective and is increasingly being adopted by noncardiologists to augment their skills and expedite clinical decision-making. With the advent of inexpensive and portable ultrasound equipment, simplified protocols, and focused training, it is becoming easier to master basic cardiac ultrasound techniques. After a short course of training in focused cardiac ultrasound, nephrologists can quickly and reliably assess ventricular size and function, detect clinically relevant pericardial effusion and volume status in their patients. Additional training in Doppler ultrasound can extend their capability to measure cardiac output, right ventricular systolic pressure, and diastolic dysfunction. This information can be instrumental in effectively managing patients in inpatient, office, and dialysis unit settings. The purpose of this review is to highlight the importance and feasibility of incorporating cardiac ultrasound in nephrology practice, discuss the principles of basic and Doppler ultrasound modalities and their clinical utility from a nephrologist's perspective.

ДІАГНОСТИЧНА СОНОГРАФІЯ ПРИ АБДОМІНАЛЬНІЙ ХІРУРГІЇ У ТВАРИН

У статті представлені матеріали щодо історії розвитку ультрасонографії у ветеринарній практиці, наведений аналіз літератури щодо дослідження печінки, селезінки та підшлункової залози, вказуються перспективи методики дослідження в майбутньому. Ультрасонографія черевної поро-жнини у тварин вперше застосовувалась переважно для діагностики вагітності. На сьогодні зазначена методика є важливою діагностичною технікою у ветеринарній медицині, яка застосовуєтьсядля вивчення більшості нормальних та патологічно змінених структур у тварини, забезпечуючишвидкий, неінвазивний спосіб доповнення інформації, отриманої в результаті клінічного обстеженнята рентгенографії. Ультразвукове дослідження засноване на принципі ехолокації, хвилі, що посила-ються датчиком, проходять крізь тканини організму, відображаються та розшифровуються апа-ратом і перетворюються в зображення, яке дає змогу фахівцю ветеринарної медицини оцінитистан внутрішніх органів, тканин і порожнин. Зі збільшенням застосування ветеринарними лікарямиультрасонографічних досліджень у практиці стає зрозуміло, що УЗД є ц інним з асобом в иявленняураження органів черевної порожнини. Оцінка печінки є однією з головних переваг застосування уль-трасонографії черевної порожнини у тварини. Показання включають гепатомегалію, жовтяницю,асцит, підозру на розрив діафрагми, втрату ваги та можливі метастази в печінку. На сьогодні удо-сконалюються та доповнюються методи сонографічних досліджень. Подальше впровадження упрактику та поглиблене вивчення патологій в зазначеній ділянці за допомогою ультрасонографіїдасть змогу об’єктивно встановити стан черевної порожнини та її органів у тварини і оцінититяжкість перебігу хвороби. Впровадження високоякісних, портативних діагностичних ультразвуко-вих апаратів продовжили цей розвиток і попит на ультрасонографію, зважаючи на його діагности-чну цінність, продовжує зростати. Проведений аналіз літератури та доступних інтернет-джерелдав нам змогу оцінити сучасний стан розвитку сонографії у ветеринарній практиці та перспективиподальшого розвитку діагностики стану печінки, селезінки та підшлункової залози, вказати сферипотенційного розвитку методики в майбутньому.

Feature-Guided CNN for Denoising Images From Portable Ultrasound Devices

As a non-invasive medical imaging scanning device, ultrasound has greatly increased the efficiency and accuracy of medical diagnosis. In recent years, portable ultrasound is being more widely used for its convenience and lower cost. Patients and physicians can receive the scanned images on their mobile phones at any time via a wireless network with low latency. However, it is difficult for portable ultrasound devices to capture images with the same quality as standard hospital ultrasound image acquisition systems. Usually, the images captured by portable ultrasound equipment have considerable noise. This noise undoubtedly affects the diagnosis of the physician. It is imperative to develop methods to remove the noise while preserving important information in the image. For this reason, we propose a novel denoising neural network model, called Feature-guided Denoising Convolutional Neural Network (FDCNN), to remove noise while retaining important feature information. In order to achieve high-quality denoising results, we employ a hierarchical denoising framework driven by a feature masking layer for medical images. Furthermore, we propose a feature extraction algorithm based on Explainable Artificial Intelligence (XAI) for medical images. Experimental results show that our medical image feature extraction method outperforms previous methods. Combined with the new denoising neural network architecture, portable ultrasound devices can now achieve better diagnostic performance.

Avaliação do volume urinário: comparação do desempenho do equipamento de ultrassonografia portátil de bexiga Mobissom® com o equipamento de mesa

This study aimed to compare the performance of Mobissom® portable bladder ultrasound equipment with tabletop ultrasound equipment to assess bladder urine volume. 192 images of 16 adult patients who underwent the exam were analyzed. The bladder volumes obtained by the portable equipment were archived in the form of an image and, later, compared with the ultrasound report of the evaluation performed by a tabletop ultrasound device. The results obtained were compared using the paired t test and the differences were graphically distributed using the Bland & Altmann method. In the overall result, there were no significant differences between the two devices. It is concluded that the equipment, despite the limitation in the visualization of other organs, is easy to use and relevant for bedside assessment.

Effect of Dysphagia Rehabilitation Using Kinesiology Taping on Oropharyngeal Muscle Hypertrophy in Post-Stroke Patients: A Double Blind Randomized Placebo-Controlled Trial.

Background: It has recently been shown that suprahyoid muscle exercise using kinesiology taping (KT) increases the activation of the suprahyoid muscle in healthy adults, suggesting a potential therapeutic clinical exercise for dysphagia rehabilitation. This study investigated the effect of dysphagia rehabilitation using KT in stroke patients with dysphagia. Methods: Thirty subjects in South Korea were enrolled in this prospective placebo-controlled double-blind study. Participants were randomly assigned to the experimental and sham groups. In the experimental group, the tape was attached to the hyolaryngeal complex, pulled downward with approximately 70% tension, and then attached to the sternum and the clavicle bilaterally. In the sham group, the tape was applied similarly but without the tension. Both groups performed voluntary swallowing 50 times (10 times swallowing per set, times 5 sets) a day for 4 weeks with KT applied. Outcome measures were assessed using portable ultrasound equipment. The parameter measured was the change in thickness of the tongue muscle, mylohyoid muscle, and the anterior belly of the digastric muscle. Results: The experimental group showed statistically significant changes in the thickness of the tongue muscle, mylohyoid muscle, and anterior belly of the digastric muscle than the sham group (p = 0.007, 0.002, and 0.001). Conclusion: Dysphagia rehabilitation using KT is a technique that may promote oropharyngeal muscle thickness in patients with dysphagia after stroke.

Effect of Suprahyoid Muscle Resistance Exercise Using Kinesio Taping on Suprahyoid Muscle Thickness in Patients with Dysphagia after Subacute Stroke

Background: Recently, a new method of dysphagia rehabilitation using Kinesio taping (KT) has been attempted and demonstrated an immediate increase in the activation of the suprahyoid muscle during swallowing in healthy adults. Objectives: To investigate the effect of dysphagia rehabilitation using KT on the thickness change of the suprahyoid muscle in patients with dysphagia after stroke. Design: Two-group pre-post design. Methods: In this study, 20 patients with dysphagia after stroke were enrolled and assigned to the experimental and control groups. The experimental group applied KT to the front of the neck and repeatedly swallowed against the tension of the tape. On the other hand, the control group performed repeated swallowing without applying KT. Patients in both groups had swallowed 50 times a day/5 times a week for 4 weeks. For evaluation, the volume of the geniohyoid, mylohyoid, and digastric muscle was measured before and after the intervention using portable ultrasound equipment. Results: As a result of comparing the two groups after the intervention, the experimental group showed more volume increase in mylohyoid (P<.05) and digastric muscle (P<.05) than the control group. Conclusion: This study proved that suprahyoid muscle resistance exercise using KT is effective in increasing the volume of the suprahyoid muscle.

Hand-Held Portable Versus Conventional Cart-Based Ultrasound in Musculoskeletal Imaging.

Background:Portable ultrasound machines are now common, used for point-of-care applications and needle guidance for percutaneous procedures; however, the effectiveness of portable ultrasound in evaluation of the musculoskeletal system has not been fully assessed.Purpose:To prospectively evaluate the use of portable hand-held ultrasound in comparison with conventional cart-based ultrasound in evaluation of the musculoskeletal system.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:In this institutional review board–approved, prospective study, 100 consecutive patients with informed consent were imaged through use of both portable and cart-based ultrasound equipment using 12-5 MHz linear transducers. Agreement in ultrasound diagnosis was documented along with expected clinical changes in management if there was disagreement (definitely no, probably no, uncertain, probably yes, definitely yes). Imaging details of disagreement cases were recorded, and descriptive statistics were calculated.Results:There were 42 male and 58 female patients (mean ± SD age, 53 ± 13 years) imaged over a time period of 20 months. Anatomic areas scanned were the shoulder (n = 30), elbow (n = 11), hand and wrist (n = 15), hip (n = 10), knee (n = 11), foot and ankle (n = 12), and others (n = 11). Scanning with conventional ultrasound revealed abnormality in 92% of patients. Agreement in diagnosis made between portable versus cart-based ultrasound was found in 65% of patients. In the 35% of patients with discordant results, the change in diagnosis resulted in no change in clinical management in 46%, probably no change in 29%, uncertain change in 14%, probable change in 11%, and definite change in 0%. The diagnoses changing management (4%; 4/100) included nondetection of a satellite nodule (n = 1), ganglion cyst (n = 1), hernia (n = 1), and underestimated tendon tear (n = 1).Conclusion:When compared with conventional cart-based ultrasound, a musculoskeletal diagnosis using portable hand-held ultrasound was concordant or was discordant without clinical relevance in 96% (96/100) of patients. Knowledge of benefits and limitations of portable hand-held ultrasound will help determine areas where specific types of ultrasound equipment can be used.

Strengthen application research of ultrasound technology in perioperative and pain medicine

The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine. ultrasound is primarily used to evaluate blood volume and volume responsiveness, airway, lung and stomach volume, as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics. Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy, pathology and cardiac function. It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound, left auricular thrombosis, infective endocarditis, aortic dissection, intraoperative monitoring, etc. The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment, and improves the quality of perioperative and pain medical treatment. Key words: Ultrasonography; Perioperative period; Anesthesia; Pain

PO 8409 SERUM HYALURONIC ACID: A POTENTIAL DIAGNOSTIC MARKER FOR SCHISTOSOMAL PERIPORTAL FIBROSIS IN SCHISTOSOMA MANSONI-ENDEMIC AREAS

BackgroundSchistosoma mansoni-induced infection is one of the most prevalent infections worldwide with serious public health and economic impact. Morbidity and mortality associated with S. mansoni is mainly the result of periportal fibrosis (PPF) which can be diagnosed using ultrasonography. As ultrasound equipment is not readily available in S. mansoni-endemic areas, serum markers like hyaluronic acid (HA) have been used as an alternative means of diagnosing PPF.MethodsA cross-sectional study was conducted with the aim of determining the importance of serum HA as a marker for schistosomal PPF in in 55 patients found in S. mansoni-endemic areas in northeastern Ethiopia and 20 non-endemic controls. PPF was determined using portable ultrasound equipment and graded according to the ‘Niamey protocol’. Serum HA concentration was determined using commercially available ELISA kit.ResultsThe mean concentration of HA in the sera of the cases was significantly higher than the controls (p&lt;0.001). The concentration of HA also increased significantly as the pattern of PPF became severe while serum HA concentration positively correlated with PPF scores (ρ=0.6438, p&lt;0.001). HA concentration of 27.9 µg/liter of serum differentiated moderate cases of PPF from advanced cases with a sensitivity, specificity, positive predictive value and negative predictive value of 85.71%, 75.61%, 60.5%, 93.9%, respectively (p&lt;0.001). In conclusion, serum HA concentrations could be used as a potential marker for schistosomal PPF and to assess its severity in patients found in S. mansoni-endemic areas.ConclusionBased on our results, serum HA concentrations could be used as an alternative, non-invasive potential marker for schistosomal PPF and to assess its severity in patients found in S. mansoni-endemic areas.

Use of Non-Destructive Methods in Structural Analysis of Petrous Materials - Ultrasonic Testing and Ground Penetrating Radar (GPR)

In the extractive and transformation processing industry of ornamental rocks, the presence of discontinuities, grain size, porosity and textural anisotropies in the explored blocks is an economic risk factor. This study aims the identification and possible quantification of these elements. The existence of a low-cost, non-intrusive and fast inspection method for the evaluation of blocks would facilitate their use avoiding their wastage. For this purpose, two nondestructive methods (“P” Wave Ultrasonic Testing and the Ground Penetration Radar (GPR)) were tested on a limestone rock block and compared the models obtained. The portable ultrasound equipment used was a Proceq Pundit Lab (Portable Ultrasonic Non-Destructive Digital Indicating Tester) which is based on the pulse rate method with 54 KHz to provide information about the uniformity, cavities, cracks and defects of the material concerned by the measurement of the ultrasonic wave time and the measurement of the pulse rate. The equipment used for the GPR data acquisition was a PULSEEKKO GPR (SENSORS & SOFTWARE), with a system of two bistatic antennas (transmitter and receiver) with a frequency of 1 GHz, using the reflection method with a common offset and with an antenna separation of 0,15 meters [m]. To make a comparison of the results valid and representative, both tests were performed with 0,10 m spacing between measurements, according to a pre-defined and common grid. In the case of the ultrasonic test, velocity color maps were created based on the results of the measurements, and through this colors differences it was possible to detect and locate some of the individual and visible fractures, but also not visible fractures on the surface of the tested face. By increasing the distance between transducers, the measurement depth also increases, creating maps of the same face at different depths. This method allows us to create several GPR profiles (radargrams) were obtained because of the processing, and were used to create 2, 2,5 and 3D models to identify the existing structures, their vertical and horizontal limits and spatial relationships between them.

Normative Thyroid Volume by Ultrasonography in a Nigerian Pediatric Population

The objective was to establish normal thyroid volume in healthy infants and children, in a select Nigerian population. Using a portable ultrasound equipment with a 7.5-MHz transducer, 500 apparently healthy pediatric patients were sonographically evaluated. The volume for each thyroid lobe was obtained, as well as the summation of both left and right thyroid volumes, which represented the total volume. The mean and median thyroid volumes for the subgroups were 0.69 ± 0.38 cm3/0.7 cm3 (&lt;1 year), 1.50 ± 0.68 cm3/1.4 cm3 (1–5 years), 2.75 ± 0.94 cm3/2.6 cm3 (6–10 years), 4.47 ± 2.83 cm3/3.7 cm3 (11–15 years), and 7.47 ± 4.81 cm3/5.9 cm3 (16 and 17 years). There was a significant difference ( P = .000) between the population studied and the World Health Organization/International Council for Control of Iodine Deficiency Disorders reference values. The baseline values derived for thyroid dimensions may form the basis for thyroid screening in these asymptomatic children.

The recovery of post-burn hypertrophic scar in a monitored pressure therapy intervention programme and the timing of intervention

IntroductionPressure therapy used to be considered as the mainstay non-invasive treatment of hypertrophic scar. However, the maturation process of hypertrophic scar during pressure therapy process has seldom be reported. Moreover, although early application of pressure therapy after burn injuries is reco6mmended, minimal evidence exists to support it. This study aimed to examine the maturation trajectory of post-burn hypertrophic scars in a 6-month monitored pressure therapy intervention programme and investigate the difference in the trajectory between patients receiving early intervention and patients receiving late intervention. MethodsThirty-four patients with sixty-five post-burn hypertrophic scar samples were recruited for the study. All the subjects were treated with a 6-month pressure therapy programme with the pressure dosage regulated using a newly developed pressure therapy system, the Smart Pressure Monitored Suits. The selected scars were assessed with MiniScan XE Spectrocolorimeter on scar pigmentation, and Terason t3000 portable ultrasound imaging equipment on scar thickness. The Vancouver Scar Scale (VSS) was used to evaluate pigmentation, pliability, vascularity and height of the scars. Subjects’ report of pain and itch was documented. Assessments were conducted before treatment began and then monthly during the 6 month-intervention process. Patients were further divided into two groups according to the time of intervention post-burn injuries to review differences in the maturation trajectory between those who received early versus late treatment (early intervention group, prescribed within 60days after injuries; late intervention group, prescribed after 61 days). The changes of scar features were recorded to formulate the recovery trajectory of scar, and the outcomes of intervention between the early and the late groups were compared. ResultsPre- and post-treatment comparison demonstrated significant improvement in scar pigmentation, thickness, VSS scores and scores of pain and itch (p<0.01) for the early intervention group. For the later intervention, only scar lightness, yellowness, VSS scores and scores of pain and itch was found with significant improvement (p<0.01). The improvement in these scar characteristics was sustained over time during the treatment process. The early group demonstrated superior effect in improving scar lightness, yellowness (p<0.01), thickness (p<0.01), pigmentation score (p<0.05) and pain score (p<0.01) than the late group in comparison between the two groups at similar post-burn timing. ConclusionsHypertrophic scars appeared to undergo continuous improvement in the appearance, pain and itch over time during the process of a monitored pressure intervention programme. Early application of pressure therapy after burn injury may contribute to better outcomes as shown by their faster recovery than those with late intervention. In order to achieve the best outcomes, regular evaluation and adjustment for optimal interface pressure is necessary.

Ultrasound application in point of care by palliative medicine physicians: Initial experience of oncology palliative medicine consultation in two rural area hospitals in Costa Rica.

254 Background: Point of care Ultrasonography (POCUS)—that is ultrasonography performed and interpreted by the clinician at the bedside—is a method of clinical focused evaluation assisted by ultrasound equipment which gives the health provider in limited resources conditions, a prompt and accurate diagnosis for a limited number of pathologies. Development of portable ultrasound equipment with accessible technologies in terms of health investment, allows developing such practice in non-conventional resource-limited settings as patient homes. Our proposal is to show point of care ultrasonography (POCUS) experiences by two Palliative Care specialist doctors with in government-managed Social Security service (CCSS) in rural areas in Costa Rica. Methods: Limited diagnosis examinations were performed both at the hospital as well as at out of hospital sites in rural areas of Turrialba, and San Carlos, Costa Rica. Percutaneous procedures took place at the hospital following monitoring and aseptic standards, using two different units (Contec CMS600P2B, Phillips Clearvue 550). Results: Each brief case presented in this article shows effective Point of Care Ultrasound uses for patients with life-limiting conditions in resource-limited settings. Use of this technology by palliative medicine specialists in these cases helped patients and their families by accelerating right diagnosis, limiting unnecessary hospital transportation or by helping making safer procedures. Conclusions: Point of care ultrasound usage by palliative medicine specialists is an innovation breaking paradigms that has shown in our case to be a successful help as an evaluation strategy in a limited-resources rural environment, with a frail population.

Pleural ultrasound for clinicians

Pleural ultrasonography is useful for identifying and characterizing pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety.