Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review.
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ABSTRACT:
SUBMITTER: Shi R
PROVIDER: S-EPMC10548023 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review.
Prehospital and disaster medicine 20230825 5
Ultrasound with remote assistance (tele-ultrasound) may have potential to improve accessibility of ultrasound for prehospital patients. A review of recent literature on this topic has not been done before, and the feasibility of prehospital tele-ultrasound performed by non-physician personnel is unclear. In an effort to address this, the literature was qualitatively analyzed from January 1, 2010 - December 31, 2021 in the MEDLINE, EMBASE, and Cochrane online databases on prehospital, paramedic-a ...[more]
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Project description:IntroductionWhen used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence.MethodsWe evaluated the ultrasound competence of 31 participants using post-course written and practical assessments. Written clinical decision scenarios were administered pre- and post-training. Post-training scenarios included an uninterpreted ultrasound clip to aid decision-making. Scenarios included extended focused assessment with sonography in trauma, pulmonary exam, and focused echocardiography combined with carotid pulse check exams. Correct answers to scenarios were defined as those selected by a veteran emergency physician. Participants also indicated their confidence in each of their decisions using a Likert scale.ResultsTraining yielded a statistically significant increase in both mean scenario score (35.5% absolute increase) and mean participant self-confidence (15.8% relative increase), across all exam/decision types assessed (P ≤ 0.001). The focused pulmonary exam yielded the largest increase in both mean score improvement (59.7% absolute increase) and paramedic confidence in their decisions (28.6% increase).ConclusionTrained paramedics can perform focused ultrasound exams and accurately interpret and apply actionable exam findings in the context of written scenarios. Analysis through our model characterized the theoretical clinical yield of each prehospital ultrasound exam and demonstrated how each exam may provide improved decision accuracy in several specific simulated clinical contexts. These results provide support for growing evidence that focused limited-scope ultrasound may be an effective prehospital diagnostic tool in the hands of trained paramedics.
| S-EPMC11418876 | biostudies-literature
Project description:ObjectivesWith the advent of portable devices, prehospital ultrasound is increasingly available and has the potential to provide clinical and procedural decision support. This scoping review seeks to examine current literature on prehospital ultrasound, including study indications, the level of the health care professionals performing prehospital ultrasound, and reported research outcomes.MethodsWe searched PubMed, Embase, Web of Science, CINAHL, and Cochrane databases for research articles and conference abstracts focused on prehospital ultrasound with scans performed in the field. After title/abstract screening by 2 independent reviewers, a full-text review was performed. We excluded reviews, case reports, letters to the editor, and research published in nonEnglish language. Descriptive statistics were reported.ResultsWe identified 9718 unique articles, and 109 were included after title/abstract review (Kappa 0.68) and full-text analysis. Annual publications increased yearly (P < .01). Nineteen countries were represented, with the United States having the highest number of publications (n = 34, 31.2%). Most studies were prospective (n = 74, 67.9%) with few randomized control trials (n = 6, 5.5%). Feasibility studies comprised 45.9% (n = 50) of the included publications, while clinical outcomes were the primary interest in 18 studies (16.5%). Physicians (n = 58, 53.2%) and paramedics (n = 38, 34.9%) were the most studied prehospital clinicians. The most common indication was trauma (n = 49, 45%) followed by dyspnea (n = 13, 11.9%) and cardiac emergencies (n = 10, 9.2%).ConclusionThere is a growing, heterogeneous body of literature describing the use of prehospital ultrasound. Published literature was primarily prospective and described feasibility trials. Identified gaps include a lack of studies in pediatric patients and research identifying clinical outcomes.
| S-EPMC11915001 | biostudies-literature
Project description:BackgroundResearch examining paramedic care of back pain is limited.ObjectiveTo describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics.MethodsWe included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews.ResultsFrom 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data.ConclusionParamedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.
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Project description:The transition from maternal to zygotic gene expression during zygotic genome activation (ZGA) is tightly associated with chromatin accessibility modulated by maternal transcription factors. However, due to technical limitations, it remains elusive how the chromatin regulatory landscape is established in Xenopus tropicalis ZGA, and let alone DNA binding transcription regulators involved in this process. Here, by developing concanavalin A beads-based nucleus capture followed by Tn5-mediated accessible chromatin assay with sequencing (CANTAC-seq), we generated a first genome-wide map of accessible chromatin in X. tropicalis embryos from early blastula to neurula stage. We found that open chromatin landscape is progressively established at cis-regulatory elements during ZGA. Based on the motif analysis and perturbation experiments, we demostrated E2f1, a well-known transcriptional activator, maintains a repressive chromatin environment preceding minor ZGA. Moreover, we identified another maternal factor Otx1 counteracts the inhibitory function of E2f1. Mechanistically, E2f1 and Otx1 co-regulate a set of genes required for zygotic gene transcription and germ layer differentiation before the midblastula transition (MBT) through a seesaw model. Taken together, our data reveals the dynamic chromatin regulatory landscape that accompanies early development and elaborates on the function of a coupled transcriptional repressor-activator regulating zygotic gene transcription in a classical model organism.
2025-09-03 | GSE262501 | GEO
Project description:PurposeThis prospective study explored the value of synchronous tele-ultrasound (US) to aid doctors inexperienced in US with breast US examinations.MethodsIn total, 99 patients were enrolled. Two trainee doctors who were inexperienced in US (trainee A [TA] and trainee B [TB]) and one doctor who was an expert in US completed the US examinations sequentially. TA completed the US examinations independently, while TB was instructed by the expert using synchronous tele-US. Subsequently, the expert performed on-site US examinations in person. Separately, they selected the most clinically significant nodule as the target nodule. Consistency with the expert and image quality were compared between TA and TB to evaluate tele-US. Furthermore, TB and the patients evaluated tele-US through questionnaires.ResultsTB demonstrated higher consistency with the expert in terms of target nodule selection than TA (93.3% vs. 63.3%, P<0.001). TB achieved good inter-observer agreement (ICC, >0.75) with the expert on five US features (5/9, 55.6%), while TA only did so for one (1/9, 11.1%) (P=0.046). TB's image quality was higher than TA's in gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (P=0.018, P<0.001, P<0.001, P=0.033, and P=0.006, respectively). The comprehensive assessment score was higher for TB than for TA (3.96±0.82 vs. 3.09±0.87, P<0.001). Tele-US was helpful in 69.7% of US examinations and had a training effect in 68.0%. Furthermore, 63.6% of patients accepted tele-US and 60.6% were willing to pay.ConclusionTele-US can help doctors inexperienced in US to perform breast US examinations.
| S-EPMC8942725 | biostudies-literature
Project description:Cognitive tele-assessment (CTA) adoption has increased considerably recently, in parallel with the maturation of the digital technologies that enable it, and the push to move assessment to the online format during the COVID-19 pandemic in 2019. This mode of assessment stems from remote assessment applications that originated in general tele-medicine, where it was typically used for patient screening as part of an intervention. The development of remote tele-medicine was later adapted for CTA in adult populations in tele-neuropsychiatry and tele-psychology and is increasingly applied in experimental research in cognitive science research with adult and pediatric populations, and for remote academic assessment. Compared to in-person assessment, CTA offers advantages such as decreasing time and logistic costs and facilitating the assessment of remote or special needs populations. However, given the novelty of CTA, its technical, methodological, and ethical issues remain poorly understood, especially in cases where methods for assessment of adults are used in pediatric populations. In the current paper, we provide a scoping review on the evolution of remote tele-assessment from the years 2000 to 2021, to identify its main themes, methodologies, and applications, and then focus on the issues of assessment in pediatric populations. Finally, we present recommendations on how to address the challenges previously mentioned.
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Project description:BackgroundPalliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice.MethodsA qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings.ResultsFour categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist.ConclusionChallenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.
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Project description: Not available
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Project description:Background: Telemedicine, or healthcare delivery from a distance, has evolved over the past 50 years and helped alter health care delivery to patients around the globe. Its integration into numerous domains has permitted high quality care that transcends obstacles of geographic distance, lack of access to health care providers, and cost. Ultrasound is an effective diagnostic tool and its application within telemedicine ("tele-ultrasound") has advanced substantially in recent years, particularly in high-income settings. However, the utility of tele-ultrasound in resource-limited settings is less firmly established. Objective: To determine whether remote tele-ultrasound is a feasible, accurate, and care-altering imaging tool in resource-limited settings. Data Sources: PubMed, MEDLINE, and Embase. Study Eligibility Criteria: Twelve original articles met the following eligibility criteria: full manuscript available, written in English, including a direct patient-care intervention, performed in a resource-limited setting, images sent to a remote expert reader for interpretation and feedback, contained objective data on the impact of tele-ultrasound. Study Appraisal and Synthesis Methods: Abstracts were independently screened by two authors against inclusion criteria for full-text review. Any discrepancies were settled by a senior author. Data was extracted from each study using a modified Cochrane Consumers and Communication Review Group's data extraction template. Study bias was evaluated using the ROBINS-I tool. Results: The study results reflect the diverse applications of tele-ultrasound in low-resource settings. Africa was the most common study location. The specialties of cardiology and obstetrics comprised most studies. Two studies primarily relied on smartphones for image recording and transmission. Real-time, rather than asynchronous, tele-ultrasound image interpretation occurred in five of the 12 studies. The most common outcome measures were image quality, telemedicine system requirements, diagnostic accuracy, and changes in clinical management. Limitations: The studies included were of poor quality with a dearth of randomized control trials and with significant between study heterogeneity which resulted in incomplete data and made cross study comparison difficult. Conclusions and Implications of Key Findings: Low-quality evidence suggests that ultrasound images acquired in resource-limited settings and transmitted using a telemedical platform to an expert interpreter are of satisfactory quality and value for clinical diagnosis and management.
| S-EPMC6738135 | biostudies-literature
Project description:IntroductionThere is evidence to suggest that violence against paramedic personnel is increasing. Several authors report adverse effects linked to exposure to workplace violence. There remain gaps in the knowledge related to specific aspects of workplace violence experienced by paramedics in the prehospital setting.Methods and analysisThis scoping review will consider evidence relating to workplace violence against paramedic personnel. All types of evidence will be considered, including quantitative and qualitative studies, systematic reviews, opinion papers, grey literature, text and papers as well as unpublished materials. This scoping review will be designed and conducted in accordance with the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews will guide the reporting process. Sources will include ERIC, Scopus, PubMed, CINAHL, Cochrane Library, ScienceDirect, Web of Science, Sabinet and the DOAJ as well as OpenGrey (https://opengrey.eu/). All sources published in English will be considered for inclusion and no date limit will be applied. The searching of the databases will begin 16 January 2023 and will be concluded by 30 January 2023. Three independent reviewers will conduct the study selection and data extraction process. In the event of disagreement related to a particular source, this will be resolved by discussion. The findings of the proposed review will be presented in a narrative style that uses diagrams and tables for reporting.Ethics and disseminationThis scoping review will use published literature available in the public domain and will involve no participants, meaning that ethical approval is not required. The findings of the proposed review will be published in topic relevant peer-reviewed journals and will be presented at associated conferences.
| S-EPMC9843223 | biostudies-literature