American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131434950 Number of Proctored Pediatric Focused Assessment WithSonography for Trauma Exams Required for ProficiencySharon Yellin, 1,2 * Jennifer Chao, 2 Richard Sinert, 2 JohnGullett, 2 Gerardo Chiricolo 1 1 Pediatric Emergency Medicine/EmergencyUltrasound, New York Methodist Hospital,Brooklyn, New York USA; 2 Pediatric Emergency Medicine/Emergency Medicine, Kings County Hospital/State Universityof New York Downstate Medical Center, Brooklyn, New YorkUSAObjectives—To assess the number of proctored focused assessmentwith sonography for trauma (FAST) exams necessary for thenovice sonographer to accurately acquire the 4 views of the exam.Methods—This was a prospective educational interventionstudy of FAST exam mastery by novice third- and fourth-year medicalstudents (MS). Students were excluded if they had formal ultrasound trainingor prior experience. All students received a 2-hour online didacticcourse on basic ultrasound and FAST. Students were then randomized into1 of 3 groups: group 1, students performed 5 proctored exams; group 2,10 exams; and group 3, 15 exams. Proctored exams were designed to givethe students hands-on practice under the guidance of trained sonographers.The proctored exams were administered monthly and limited to 10 minutesto standardize the training sessions. At the end of each month, studentswere tested on the FAST exam with the same 2 standardized patients, eithera male 8 years old (body mass index [BMI] = 16.5 [66th percentile])or a female 12 years old (BMI = 18.8 [60th percentile]). Students had 2minutes to perform the test exam starting from the time they picked upthe probe. The test exams were recorded using video and later reviewedand graded by examiners blinded (to groups) using a standardized datascoring sheet. To pass, the students were required to obtain the standardviews of the organs and/or structures necessary to identify free fluid.Results—Forty-five students consisting of 23 MS3s and 22MS4s, ages 24 to 43 years, were enrolled. Groups were evenly matchedfor MS year, age, and gender. Pass rates were lowest for group 1 (n = 15;6.7%; 95% confidence interval [CI], 0.0%–31.8%) and significantly (P
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131539223 Outcome After Second-Trimester Amniocentesis andFirst-Trimester Chorionic Villus Sampling for PrenatalDiagnosis in Multiple GestationsChristian Enzensberger, 1 * Christina Pulvermacher, 1 JanDegenhardt, 1 Andreaa Kawecki, 1 Ute Germer, 2 Jan Weichert, 3Martin Krapp, 4 Ulrich Gembruch, 5 Roland Axt-Fliedner 11Division of Prenatal Medicine, University of Giessen &Marburg, Giessen, Germany; 2 Center for Prenatal Medicine,Caritas Krankenhaus St Josef, Regensburg, Germany; 3 Divisionof Prenatal Medicine, University of Schleswig-Holstein,Campus Luebeck, Luebeck, Germany; 4 Center for Endocrinology,Reproductive and Prenatal Medicine, Amedes Hamburg,Hamburg, Germany; 5 Division of Prenatal Medicine, Universityof Bonn, Bonn, GermanyObjectives—The purpose of this study was to classify pregnancyloss and fetal loss as well as the influence of maternal risk factorsin multiple pregnancies.Methods—Details of the procedure and pregnancy outcome ofall patients were extracted from the clinical audit databases of 2 tertiarycenters. The files were collected in the time from January 1993 to December2010. The procedure-related pregnancy and fetal loss rates wereclassified as all unplanned abortions without important fetal abnormalitiesor obstetric complications within 14 days after amniocentesis (AC) andchorionic villus sampling (CVS).Results—We had a total of 288 multiple pregnancies with atotal of 637 fetuses. After exclusion of 112 pregnancies with an abnormalkaryotype or fetal abnormalities detected by ultrasound as well as cases ofselective feticide, repeated invasive procedures, and monochorionicmonoamniotic pregnancies, 176 pregnancies and 380 fetuses, respectively,were left for final analysis. Overall, 132 ACs and 44 CVSs were performed.The total pregnancy loss rate was 8.0% (14/176): 6.1% (n = 8) forAC and 13.6% (n = 6) for CVS. The procedure-related pregnancy lossrate was 3.4%: 2.3% after AC (3 cases) and 6.8% after CVS (3 cases).There was no statistical significance between the 2 procedures (P = .15).Conclusions—The procedure-related loss rate of 3.4% can becompared with those in literature. The higher loss rates in multiple pregnanciesthan in singleton pregnancies have to be discussed when counselingparents.1540424 Breaking Bad News During Perinatal Sonography:Practical Aspects of a Novel Educational Pilot Using HighfidelityHybrid SimulationDavid Jackson, 1 * Petar Planinic, 1 James Pennington, 1 GigiGuizado de Nathan, 2 Gwen Shonkwiler, 3 Thomas Abdella 11Maternal-Fetal Medicine, 2 Clinical Simulation Center of LasVegas, University of Nevada School of Medicine, Las Vegas,Nevada USA; 3 Medical Education and Evaluations, Universityof Nevada School of Medicine, Reno, Nevada USAObjectives—Few issues are as predictably inevitable as badnews occurring during fetal sonography. There are currently no standardson how to teach this essential communication skill. A pilot program usinghigh-fidelity hybrid standardized patient (SP) encounters for the deliveryof bad news in perinatal imaging is presented.Methods—The budget for the project was $7200. Four residents(25% of our program) experienced 2 simulations each. A live videofeed allowed additional medical and sonography students to observe in aclassroom setting. Transvaginal simulation of an anembryonic gestationand transabdominal simulation of severe fetal hydrocephalus were presented.Resident sonographers were unaware of the impending scenariooutcome. The transvaginal exam used a MedaPhor virtual reality “realfeel”haptic simulator placed between the actor’s legs (covered by a sheet).The transabdominal exam used a linear video played on the screen of anultrasound machine. Following the simulation, faculty gave immediatefeedback on verbal and nonverbal mannerisms by sharing observationsfrom the recorded video. SPs then provided additional insight on perceivedcommunication skills. The exercise was completed with a classroom didacticon evidence-based techniques for breaking bad news followed byfaculty and participant group discussion.Results—Residents and medical students enthusiastically reportedthat the simulation should be part of any future curricula. Postgraduateyear 1 was designated as the year to begin. Despite varying levelsof training, both residents and medical students rated the experience aslevel appropriate. The simulation was rated 5 overall (with 5 as excellent).Individual segments were rated as: didactic (5), faculty feedback (5), videoreview (4.9), SP feedback (4.75), and viewing in the classroom (4.7).Conclusions—High-fidelity hybrid simulation allows neededskill training in communicating bad news during perinatal sonography. Actorsimulation, faculty video feedback, and a classroom didactic with group discussionare valued components. The use of simulation-based training for allsonographers in communicating bad news is an area for future study.1525554 Coronal Measurement of Fetal Lateral Ventricles: A CrosssectionalUltrasonographic StudyEldad Katorza, 1 * Nir Duvdevani, 1 Jeffrey-Michael Jacobson, 2Yinon Gilboa, 1 Chen Hoffmann, 2 Reuven Achiron 11Obstetrics and Gynecology, 2 Radiology, Sheba Medical Center,Tel Hashomer, IsraelObjectives—The aim of this study was to compare the diameterof the lateral cerebral ventricles measured on a traditional axial viewwith measurements obtained in an unconventional coronal plane.Methods—We conducted a prospective study of 144 fetuses inwhich 2D sonographic measurements of the lateral ventricles in both axialand coronal planes were performed at 19 to 38 weeks of gestation. Seventy-sevenfetuses were evaluated as part of a routine fetal scan (routinegroup), and 67 were referred for a dedicated scan (referral group). Foreach fetus, only the distal lateral ventricle’s diameter was able to be measuredby the “classic” transventricular axial plane, whereas both ventricleswere visible in the posterior coronal plane at the level of the atria using atranscerebellar approach.Results—The mean gestational age was 27.7 ± 4.6 weeks.Good visualization of both ventricles was achieved in 91% of the casesusing the coronal plane. For the entire study group, the mean width of thedistal lateral ventricle on the axial plane was 7.9 ± 1.9 mm vs 8.2 ± 1.9 mmon the coronal plane (P < .001). The mean axial width was 6.6 ± 1.1 mmin the routine group vs 9.3 ± 1.6 mm in the referral group (P < .001). Coronalmeasurements yielded similar results. In addition, slight asymmetryof the ventricles was detected in the routine group (0.2 mm), and the asymmetrywas even more significant in the referral group (1.6 mm; P < .001).Conclusions—Measurement of both proximal and distal ventriclesis very important in the diagnosis of ventriculomegaly and essentialin measuring ventricular asymmetry, both of which can be associatedwith a bad prognosis. Our study showed that coronal measurement of bothproximal and distal ventricles is feasible, an advantage over the axial viewin which only the distal ventricle is clearly visible and measurable.1537200 Feasibility of an Automated Modified Myocardial PerformanceIndex System: A Novel Technique for Automated Measurementof a Modified Fetal Myocardial Performance IndexMi-Young Lee, 1 * Hye-Sung Won, 1 Eun-Jin Jeon, 1 Jae-YoonShim, 1 Hee-Chul Yoon, 2 Jin-Young Choi, 3 Soon-Jae Hong 31Maternal-Fetal Medicine, Asan Medical Center, Seoul, Korea;2Digital Media City Research and Development Center,3Reserch and Development Team, Health and Medical EquipmentBusiness Team, Samsung Electronics Co, Ltd, Suwon, KoreaObjectives—To evaluate the reliability and reproducibility ofthe fetal left modified myocardial performance index (Mod-MPI) meas-S80
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