Abdominal Ultrasound and Medical Education | Revista Clínica Española

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Abbreviations: ASA, acetylsalicylic acid; AF, atrial fibrillation; CV, cardiovascular; OAC, oral anticoagulants. * For example: With recurrent thrombotic events, stent-carrying patients, research studies. ** Considering factors such as advanced age, poorly controlled hypertension, previous bleeding and concomitant medication." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Castilla-Guerra, M.S. Navas-Alcántara, M.C. Fernández-Moreno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Castilla-Guerra" ] 1 => array:2 [ "nombre" => "M.S." "apellidos" => "Navas-Alcántara" ] 2 => array:2 [ "nombre" => "M.C." 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García de Casasola Sánchez, J. Torres Macho, J.M. Casas Rojo, P. Cubo Romano, J.M. Antón Santos, V. Villena Garrido, R. Diez Lobato" "autores" => array:8 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "García de Casasola Sánchez" "email" => array:1 [ 0 => "ggcasasolaster@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Torres Macho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Casas Rojo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Cubo Romano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J.M." "apellidos" => "Antón Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "V." "apellidos" => "Villena Garrido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "R." "apellidos" => "Diez Lobato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 7 => array:1 [ "colaborador" => "Working Group SEMI Clinical Ultrasound" ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía clínica abdominal y educación médica" ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0005"></elsevierMultimedia>BackgroundIn the medical diagnostic and decision-making process, the first step, and probably the most important, is the performance of an adequate anamnesis (medical history) and physical examination of a patient. However, due to significant technological advances, the interest and expertise of professionals in physical examination has declined substantially in recent decades.A hundred years ago the diagnosis of most diseases was based on the detection of specific signs and symptoms without any additional test. Currently, the diagnosis of numerous processes rests on analytical and imaging tests (ultrasound, CAT, magnetic resonance). Due to the greater availability and accessibility of these tests, physical examination has been relegated to a second tier. However, in the hands of experts, inspection, palpation, percussion and auscultation can be essential for a proper diagnostic approach.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In fact, there are diseases (cellulitis, psoriasis, herpes zoster, amyotrophic lateral sclerosis, Parkinson's disease, Bell's palsy, etc.) whose diagnosis rests exclusively on the physical examination.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Despite the importance of physical examination, we must be aware of its limitations. Thus, for example, the detection of small quantities of ascites or pleural effusion; the size assessment of the spleen, liver and aorta; and the interpretation of a heart murmur can be difficult when using traditional physical examination techniques, especially for less experienced students or doctors.High-quality ultrasound scanners have been developed relatively recently and are relatively affordable. Many of them are portable, thereby enabling bedside examinations. This type of equipment (stethoscope, ophthalmoscope, otoscope and reflex hammer) can be used by any physician and is a perfect complement for improving the cost-effectiveness of physical examinations. Ultrasound helps visualize and objectively measure organs and their potential disorders, which can be difficult to determine in a traditional physical examination.Undergraduate ultrasound training is progressively being implemented in various medical schools, especially in the United States.<a class="elsevierStyleCrossRefs" href="#bib0015">3–11</a> Ultrasound facilitates the learning of anatomy, helps in understanding the physiology and pathophysiology of numerous organs and systems (especially cardiovascular), improves the performance and reliability of physical examinations and facilitates the diagnosis of numerous diseases.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Ultrasound does not attempt to substitute or replace physical examination; it supplements it perfectly and can even help improve our skills in this field.After several years dedicated to the teaching of basic ultrasound to residents and internal medicine specialists, we have become aware of the enormous potential that this technology can have for medical students as a complement to physical examination and the diagnostic approach to patients. We have selected specific aspects of abdominal ultrasound that, based on our experience, are relatively simple to perform and do not involve a steep learning curve. The aim of this pilot study is to attempt to demonstrate that, in a short training period, medical students can adequately perform a basic ultrasound-guided abdominal examination.MethodologyStudentsWe recruited 12 students in their 4th year of medical school, all of whom participated voluntarily in the study. All students were attending the course on clinical practice at the University Hospital Infanta Cristina (Parla, Madrid) at the time of their recruitment. Nine of the students belonged to the Faculty of Medicine of the University Complutense (Madrid) and 3 belonged to the School of Medicine of the University San Pablo CEU (Madrid). None of the students had previous experience with ultrasound.Ultrasound Training PhaseIn small groups of at most 5 participants per team and teacher, the students initially completed a 5-h theoretical and practical training course. The course was taught by two physicians with experience in clinical ultrasound. The syllabus for this course, which was focused on basic abdominal ultrasound examination, was the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Basic ultrasound principles, interpretation of images and fundamental use of ultrasound.</li><li class="elsevierStyleListItem" id="lsti0010">-FAST (“Focused Assessment with Sonography in Trauma”) protocol.</li><li class="elsevierStyleListItem" id="lsti0015">-Detection of free abdominal fluid.</li><li class="elsevierStyleListItem" id="lsti0020">-Detection of hydronephrosis and acute urine retention.</li><li class="elsevierStyleListItem" id="lsti0025">-Assessment of the diameter and degree of collapse of the inferior vena cava and abdominal aorta.</li><li class="elsevierStyleListItem" id="lsti0030">-Gallbladder assessment: detection of cholelithiasis and signs of cholelithiasis.</li></ul>After each section of theory, the students practiced the basic views using their own colleagues as models. All didactic material taught in the course was available for students on the website of the Clinical Ultrasound Workgroup of the Spanish Society of Internal Medicine (SEMI) (www.ecografiaclinica.es).In the second phase, each student performed 20 supervised abdominal ultrasound examinations in a period of no more than 10 calendar days after completing the initial theoretical course. The ultrasound examinations were performed “at the bedside” of patients hospitalized in the Department of Internal Medicine, the Emergency Department and the Department of Gastroenterology of the University Hospital Infanta Cristina (Parla, Madrid). All patients selected in this phase had paradigmatic abdominal ultrasound abnormalities (cholelithiasis, free abdominal fluid, vena cava dilation, etc.) to facilitate their recognition and diagnosis in the assessment phase. For each patient, the student filled out a checklist for the purposes of exploring, in a regulated manner, all points required in the basic abdominal ultrasound.On average, all students received some 15h of supervised training.Knowledge Assessment PhaseIn a period of no more than 5 days after the training phase, the participating students underwent an objective evaluation. Each student had to perform abdominal ultrasound explorations on 5 selected patients who were hospitalized at that time in the University Hospital Infanta Cristina. The students did not have access to the patients’ medical history, and the students were not allowed to interview the patients. At least 3 of the 5 patients selected for each student had a disease susceptible to detection by the participants.In each evaluation, the student was accompanied by a teacher who was an ultrasound expert and who verified in real time the suitability of the ultrasound views obtained and the detection of normality or of abnormalities.Ultrasound EquipmentThe ultrasound examinations were performed with 2 ultrasound machines: Logic e (General Electric) and MyLab 25 Gold (Esaote). Both machines have similar image quality and were equipped with specific carts for transport and internal batteries to facilitate bedside studies. To obtain the views, a low-frequency (<5MHz) convex probe was used. All images were obtained in B mode without using Doppler.Ethical IssuesThe study was approved by the Research Committee of the University Hospital Infanta Cristina. All patients were requested to provide verbal informed consent.Statistical AnalysisStatistical analysis was performed using the SPSS version 17 program (SPSS Inc., Chicago, IL, USA). The data are expressed as means±standard deviation and proportions (percentages). We calculated the sensitivity, specificity and predictive values of the studies performed by the students with their respective confidence intervals. We also determined the overall value or efficiency of the students for each of the ultrasound abnormalities of the patients, defined as the proportion of valid results among the set of results.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>ResultsEach of the 12 students performed the ultrasound assessment phase examining 5 patients (60 abdominal studies on a total of 28 patients). Three patients had undergone cholecystectomy. The teacher-evaluator was unable to visualize the inferior vena cava in 2 patients (due to interposing gases) and the abdominal aorta in 3 patients (due to severe obesity).The percentage of correct identification of the various anatomical views by the students is listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Of the 28 patients whom the students had to examine in the objective assessment test, 9 had cholelithiasis (32.1%), 3 had free intraabdominal fluid (10.7%), 1 had an abdominal aortic aneurysm (3.5%), 4 had splenomegaly (14.26%), 8 had pleural effusion (28.5%), 1 had acute urine retention (3.5%), 3 had mild to moderate pericardial effusion (10.7%) and 3 had significant dilation of the inferior vena cava (10.7%).In the analysis of the cases where the structures were visualized, the overall diagnostic ability of the students for the pathological conditions was the following: sensitivity of 0.9 (95% CI, 0.83–0.98), specificity of 1, positive predictive value of 1 and negative predictive value of 0.98 (95% CI, 0.97–1). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the diagnostic ability by pathological findings.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionIn this study, we were able to verify that the medical students, in a short training period, were able to reliably visualize the selected abdominal ultrasound views that are essential for identifying clinical problems of enormous clinical relevance. This fact is significant because it is more difficult to obtain appropriate views or slices that interpret the images.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>In general, physical examination of the abdomen is considered difficult for students<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and is not simple even for expert clinicians. Thus, for example, although we are able to palpate and measure the distance between the liver edge and costal margin, this assessment has poor agreement with an increase in liver size. This is similar to what happens with the spleen. It is relatively easy to palpate very large spleens (>20cm), but the sensitivity for detecting splenomegaly of 13–18cm is very low (clearly inferior to the 50% in numerous series).<a class="elsevierStyleCrossRefs" href="#bib0010">2,15,16</a> In terms of abdominal aortic aneurysms, if their size is greater than 5cm then the sensitivity for detecting them using palpation can reach 80%, but if their size is between 3cm and 5cm and the patient is overweight, the cost-effectiveness lowers considerably.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The urinary bladder can only be detected, using percussion or tenderness, when it contains more than 500ml of urine.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> When the ascites is less than 1000ml, it is virtually impossible to objectify it through physical examination, and our sensitivity only increases significantly if it exceeds 2000ml.<a class="elsevierStyleCrossRefs" href="#bib0010">2,18</a> The determination of central venous pressure through an inspection of the jugular vein, one of the paradigms of cardiovascular physical examination, is difficult to measure exactly in many patients (even for expert clinicians) for numerous reasons (obesity, short neck, limited collaboration, etc.).<a class="elsevierStyleCrossRef" href="#bib0095">19</a> However, ultrasound assessment of the caliber and degree of collapse of the inferior vena cava is much more reliable.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a>In this study, the students were able to visualize and diagnose the majority of disorders shown by the selected patients in the assessment test (cholelithiasis, abdominal aortic aneurysm, ascites, splenomegaly, acute urine retention, pleural effusion, pericardial effusion). As it happens, the patient with an aneurysm and the patient with acute urine retention were diagnosed “de novo” by the students in the assessment test. The patient with acute urine retention was immediately probed. The patient with the aortic aneurysm was hospitalized for pleural effusion associated with lung cancer, but this finding was irrelevant given their poor prognosis. We observed a greater percentage of errors in the identification of cholelithiasis. The gallbladder can be difficult to observe if it is depleted and, even when detected correctly, it can sometimes be difficult to assess the presence of lithiasis smaller than 1–2mm (biliary microlithiasis and sludge). Independently of the unquestionable usefulness of ultrasound for the diagnosis of certain abdominal problems, it can also be of considerable assistance in improving the expertise of students in abdominal physical examinations, as has been demonstrated in a number of studies.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>A controversial issue is the time required to achieve sufficient training and ability in the use of ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0015">3,23</a> Numerous studies have shown that obtaining specific ultrasound views is an easy task (short learning curve) and can have significant clinical usefulness.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a> This technique is known as objective-focused or selective ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0065">13,26</a> With abdominal ultrasound, for example, the assessment of hepatic or renal masses or the study of the appendix can be truly complex. However, detecting acute urine retention or quantifying spleen or aorta size is relatively simple and has unquestionable clinical usefulness. The paradigm of selective ultrasound is the so-called FAST (“Focused Assessment with Sonography in Trauma”) protocol aimed at detecting intraperitoneal fluid in the context of the multitrauma patient. It is a very simple and easy-to-perform procedure that can also detect ascites or free fluid in various circumstances.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>The main limitations of the study were the participation of a small group of students and the reduced sample size. However, this is a pioneering study for Spain. The teaching of ultrasound to undergraduate students has been very recently introduced, mostly in universities in the United States.<a class="elsevierStyleCrossRefs" href="#bib0015">3–11</a> In a number of these universities, pilot projects similar to ours have been conducted with small numbers of students who were taught basic concepts of clinical ultrasound in courses lasting 10–20h.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Formal ultrasound training was subsequently implemented, but this required the acquisition of various portable ultrasound machines and a number of sufficiently qualified teachers.<a class="elsevierStyleCrossRefs" href="#bib0035">7,10</a> Formal ultrasound training includes the scheduling of ultrasound courses over the entire academic training program. The training addresses issues related to anatomy, physiology, pathophysiology and symptoms.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>For some teachers of medicine, ultrasound will change the method of teaching and learning medicine for the coming decade.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7</a> The main problems in introducing ultrasound to undergraduate medicine in Spain are the lack of available machines, the high number of students in many of our faculties and the scarcity of sufficiently qualified teachers to train them. However, modern ultrasound equipment is increasingly portable and affordable, and its use is spreading among professionals of numerous medical specialties. Without question, these changes can facilitate the introduction of ultrasound in undergraduate programs, although more studies might be needed to endorse its usefulness.In conclusion, we can confirm that, within a relatively short training period, medical students are able to reliably use abdominal ultrasound focused on basic aspects of considerable clinical usefulness. This can improve the cost-effectiveness of the physical abdominal examination and facilitate the bedside diagnosis of certain diseases." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres329536" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Aim" 3 => "Methodology" 4 => "Results" 5 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec311418" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres329535" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Metodología" 4 => "Resultados" 5 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec311417" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0020" "titulo" => "Methodology" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Students" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Ultrasound Training Phase" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Knowledge Assessment Phase" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Ultrasound Equipment" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Ethical Issues" ] 5 => array:2 [ "identificador" => "sec0050" "titulo" => "Statistical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0055" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec311418" "palabras" => array:3 [ 0 => "Ultrasonography" 1 => "Undergraduate medical education" 2 => "Physical examination" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec311417" "palabras" => array:3 [ 0 => "Ecografía" 1 => "Educación médica en pregrado" 2 => "Exploración física" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionUltrasound is a very versatile diagnostic modality that permits real-time visualization of multiple internal organs. It is of invaluable help for the physical examination of the patients. AimTo assess if ultrasound can be incorporated into medical education and if the students can perform a basic abdominal ultrasound examination without the necessity of a long period of training. MethodologyTwelve medical students were trained in basic abdominal ultrasound during a 15-h training program including a 5-h theoretical and practical course and supervised practice in 20 selected patients. Subsequently, we conducted an evaluation test that assessed the ability of students to obtain the ultrasound views and to detect various pathologies in five different patients. ResultsThe students were able to correctly identify the abdominal views more than 90% of the times. This percentage was only lower (80%) in the right subcostal view to locate the gallbladder. The accuracy or global efficiency of the ultrasound for the diagnosis of relevant pathological findings of the patients was greater than 90% (91.1% gallstones, abdominal aortic aneurysm 100%; splenomegaly 98.3%, ascites 100%; dilated inferior vena cava 100%; acute urinary retention 100%). ConclusionThe ultrasound may be a feasible learning tool in medical education. Ultrasound can help students to improve the physical examination." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa ecografía es una técnica muy versátil, que permite en tiempo real visualizar múltiples órganos internos y es de inestimable ayuda para la exploración física de los pacientes. ObjetivoEvaluar si la ecografía puede incorporarse en la enseñanza de la medicina y si los alumnos pueden realizar una exploración ecográfica abdominal básica sin un largo periodo de formación. MetodologíaDoce estudiantes de medicina recibieron formación en ecografía abdominal básica durante un programa formativo de 15h de duración, que incluía un curso teórico-práctico de 5h y prácticas supervisadas en 20 pacientes seleccionados. Posteriormente realizamos una prueba de evaluación objetiva en la que valoramos la capacidad de los alumnos para obtener los planos ecográficos y detectar diversas enfermedades en 5 pacientes distintos. ResultadosLos estudiantes fueron capaces de identificar correctamente los planos abdominales en más del 90% de las ocasiones. Solo en el corte subcostal derecho para localizar la vesícula este porcentaje fue inferior (80%). La precisión o eficiencia global de la ecografía para el diagnóstico de los hallazgos patológicos relevantes de los enfermos fue superior al 90% (colelitiasis 91,1%; aneurisma de aorta abdominal 100%; esplenomegalia 98,3%; ascitis 100%; vena cava inferior dilatada 100%, y retención aguda de orina 100%). ConclusiónLa ecografía puede ser una herramienta formativa en la enseñanza de la medicina y puede ayudar a los alumnos a mejorar la exploración física." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: García de Casasola Sánchez G, Torres Macho J, Casas Rojo JM, Cubo Romano P, Antón Santos JM, Villena Garrido V, et al. Ecografía clínica abdominal y educación médica. Rev Clin Esp. 2013;214:131–136." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound View \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% Identified Correctly \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatorenal recess (Morrison's pouch) Right kidney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(59/60) 98.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Splenorenal recess. Visualization of spleen and left kidney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(59/60) 98.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transversal and longitudinal slice of the urinary bladder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(59/60) 98.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Longitudinal slice of the inferior vena cava \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(49/52) 94.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transversal slice of the abdominal aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(35/39) 89.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right subcostal slice. Visualization of the gallbladder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(45/57) 78.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subxiphoid slice of the heart \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60/60 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab483097.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Degree of Correct Identification of Basic Abdominal Ultrasound Planes." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity (CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Specificity (CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Positive Predictive Value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Negative Predictive Value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Overall Diagnostic Ability (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cholelithiasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 (0.56–0.97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88 (0.76–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal aortic aneurysm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Splenomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 (0.71–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 (0.94–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92 (0.78–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.98 (0.94–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Free abdominal fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dilated inferior vena cava \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute urine retention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab483098.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic Ability of the Ultrasound Performed by the Students Based on the Pathological Findings." ] ] 2 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What we know?Ultrasound is a great help for the approximation diagnosis of patients and tool suitable for the development of exploration physics. There are no studies in our environment that valued training in clinical ultrasound undergraduate studies.What this article provide?This pilot study, conducted with a small number medical students, shows that with a properly trained, supervised and not very extensive, the students learned to locate the principal planes anatomical. Furthermore, a very high percentage detect certain diseases or complications significant abdominal. The work opens a door to more complex studies to determine the role of the teaching of this technical medical future.The Editors" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical examination in the care of medical inpatients: an observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.M. 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Abdominal Ultrasound and Medical Education

Ecografía clínica abdominal y educación médica

G. García de Casasola Sáncheza,

Corresponding author

ggcasasolaster@gmail.com

Corresponding author.

, J. Torres Machoa, J.M. Casas Rojoa, P. Cubo Romanoa, J.M. Antón Santosa, V. Villena Garridob, R. Diez Lobatoc, Working Group SEMI Clinical Ultrasound

a Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain

b Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain

c Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Background</span><p id="par0020" class="elsevierStylePara elsevierViewall">In the medical diagnostic and decision-making process&#44; the first step&#44; and probably the most important&#44; is the performance of an adequate anamnesis &#40;medical history&#41; and physical examination of a patient&#46; However&#44; due to significant technological advances&#44; the interest and expertise of professionals in physical examination has declined substantially in recent decades&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A hundred years ago the diagnosis of most diseases was based on the detection of specific signs and symptoms without any additional test&#46; Currently&#44; the diagnosis of numerous processes rests on analytical and imaging tests &#40;ultrasound&#44; CAT&#44; magnetic resonance&#41;&#46; Due to the greater availability and accessibility of these tests&#44; physical examination has been relegated to a second tier&#46; However&#44; in the hands of experts&#44; inspection&#44; palpation&#44; percussion and auscultation can be essential for a proper diagnostic approach&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In fact&#44; there are diseases &#40;cellulitis&#44; psoriasis&#44; herpes zoster&#44; amyotrophic lateral sclerosis&#44; Parkinson&#39;s disease&#44; Bell&#39;s palsy&#44; etc&#46;&#41; whose diagnosis rests exclusively on the physical examination&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite the importance of physical examination&#44; we must be aware of its limitations&#46; Thus&#44; for example&#44; the detection of small quantities of ascites or pleural effusion&#59; the size assessment of the spleen&#44; liver and aorta&#59; and the interpretation of a heart murmur can be difficult when using traditional physical examination techniques&#44; especially for less experienced students or doctors&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">High-quality ultrasound scanners have been developed relatively recently and are relatively affordable&#46; Many of them are portable&#44; thereby enabling bedside examinations&#46; This type of equipment &#40;stethoscope&#44; ophthalmoscope&#44; otoscope and reflex hammer&#41; can be used by any physician and is a perfect complement for improving the cost-effectiveness of physical examinations&#46; Ultrasound helps visualize and objectively measure organs and their potential disorders&#44; which can be difficult to determine in a traditional physical examination&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Undergraduate ultrasound training is progressively being implemented in various medical schools&#44; especially in the United States&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;11</span></a> Ultrasound facilitates the learning of anatomy&#44; helps in understanding the physiology and pathophysiology of numerous organs and systems &#40;especially cardiovascular&#41;&#44; improves the performance and reliability of physical examinations and facilitates the diagnosis of numerous diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Ultrasound does not attempt to substitute or replace physical examination&#59; it supplements it perfectly and can even help improve our skills in this field&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After several years dedicated to the teaching of basic ultrasound to residents and internal medicine specialists&#44; we have become aware of the enormous potential that this technology can have for medical students as a complement to physical examination and the diagnostic approach to patients&#46; We have selected specific aspects of abdominal ultrasound that&#44; based on our experience&#44; are relatively simple to perform and do not involve a steep learning curve&#46; The aim of this pilot study is to attempt to demonstrate that&#44; in a short training period&#44; medical students can adequately perform a basic ultrasound-guided abdominal examination&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methodology</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Students</span><p id="par0050" class="elsevierStylePara elsevierViewall">We recruited 12 students in their 4th year of medical school&#44; all of whom participated voluntarily in the study&#46; All students were attending the course on clinical practice at the University Hospital Infanta Cristina &#40;Parla&#44; Madrid&#41; at the time of their recruitment&#46; Nine of the students belonged to the Faculty of Medicine of the University Complutense &#40;Madrid&#41; and 3 belonged to the School of Medicine of the University San Pablo CEU &#40;Madrid&#41;&#46; None of the students had previous experience with ultrasound&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ultrasound Training Phase</span><p id="par0055" class="elsevierStylePara elsevierViewall">In small groups of at most 5 participants per team and teacher&#44; the students initially completed a 5-h theoretical and practical training course&#46; The course was taught by two physicians with experience in clinical ultrasound&#46; The syllabus for this course&#44; which was focused on basic abdominal ultrasound examination&#44; was the following&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Basic ultrasound principles&#44; interpretation of images and fundamental use of ultrasound&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">FAST &#40;&#8220;Focused Assessment with Sonography in Trauma&#8221;&#41; protocol&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Detection of free abdominal fluid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Detection of hydronephrosis and acute urine retention&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Assessment of the diameter and degree of collapse of the inferior vena cava and abdominal aorta&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Gallbladder assessment&#58; detection of cholelithiasis and signs of cholelithiasis&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">After each section of theory&#44; the students practiced the basic views using their own colleagues as models&#46; All didactic material taught in the course was available for students on the website of the Clinical Ultrasound Workgroup of the Spanish Society of Internal Medicine &#40;SEMI&#41; &#40;<span class="elsevierStyleUnderline">www&#46;ecografiaclinica&#46;es</span>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the second phase&#44; each student performed 20 supervised abdominal ultrasound examinations in a period of no more than 10 calendar days after completing the initial theoretical course&#46; The ultrasound examinations were performed &#8220;at the bedside&#8221; of patients hospitalized in the Department of Internal Medicine&#44; the Emergency Department and the Department of Gastroenterology of the University Hospital Infanta Cristina &#40;Parla&#44; Madrid&#41;&#46; All patients selected in this phase had paradigmatic abdominal ultrasound abnormalities &#40;cholelithiasis&#44; free abdominal fluid&#44; vena cava dilation&#44; etc&#46;&#41; to facilitate their recognition and diagnosis in the assessment phase&#46; For each patient&#44; the student filled out a checklist for the purposes of exploring&#44; in a regulated manner&#44; all points required in the basic abdominal ultrasound&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">On average&#44; all students received some 15<span class="elsevierStyleHsp" style=""></span>h of supervised training&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Knowledge Assessment Phase</span><p id="par0105" class="elsevierStylePara elsevierViewall">In a period of no more than 5 days after the training phase&#44; the participating students underwent an objective evaluation&#46; Each student had to perform abdominal ultrasound explorations on 5 selected patients who were hospitalized at that time in the University Hospital Infanta Cristina&#46; The students did not have access to the patients&#8217; medical history&#44; and the students were not allowed to interview the patients&#46; At least 3 of the 5 patients selected for each student had a disease susceptible to detection by the participants&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In each evaluation&#44; the student was accompanied by a teacher who was an ultrasound expert and who verified in real time the suitability of the ultrasound views obtained and the detection of normality or of abnormalities&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ultrasound Equipment</span><p id="par0115" class="elsevierStylePara elsevierViewall">The ultrasound examinations were performed with 2 ultrasound machines&#58; Logic e &#40;General Electric&#41; and MyLab 25 Gold &#40;Esaote&#41;&#46; Both machines have similar image quality and were equipped with specific carts for transport and internal batteries to facilitate bedside studies&#46; To obtain the views&#44; a low-frequency &#40;&#60;5<span class="elsevierStyleHsp" style=""></span>MHz&#41; convex probe was used&#46; All images were obtained in B mode without using Doppler&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical Issues</span><p id="par0120" class="elsevierStylePara elsevierViewall">The study was approved by the Research Committee of the University Hospital Infanta Cristina&#46; All patients were requested to provide verbal informed consent&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical Analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the SPSS version 17 program &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; The data are expressed as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation and proportions &#40;percentages&#41;&#46; We calculated the sensitivity&#44; specificity and predictive values of the studies performed by the students with their respective confidence intervals&#46; We also determined the overall value or efficiency of the students for each of the ultrasound abnormalities of the patients&#44; defined as the proportion of valid results among the set of results&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Each of the 12 students performed the ultrasound assessment phase examining 5 patients &#40;60 abdominal studies on a total of 28 patients&#41;&#46; Three patients had undergone cholecystectomy&#46; The teacher-evaluator was unable to visualize the inferior vena cava in 2 patients &#40;due to interposing gases&#41; and the abdominal aorta in 3 patients &#40;due to severe obesity&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The percentage of correct identification of the various anatomical views by the students is listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Of the 28 patients whom the students had to examine in the objective assessment test&#44; 9 had cholelithiasis &#40;32&#46;1&#37;&#41;&#44; 3 had free intraabdominal fluid &#40;10&#46;7&#37;&#41;&#44; 1 had an abdominal aortic aneurysm &#40;3&#46;5&#37;&#41;&#44; 4 had splenomegaly &#40;14&#46;26&#37;&#41;&#44; 8 had pleural effusion &#40;28&#46;5&#37;&#41;&#44; 1 had acute urine retention &#40;3&#46;5&#37;&#41;&#44; 3 had mild to moderate pericardial effusion &#40;10&#46;7&#37;&#41; and 3 had significant dilation of the inferior vena cava &#40;10&#46;7&#37;&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In the analysis of the cases where the structures were visualized&#44; the overall diagnostic ability of the students for the pathological conditions was the following&#58; sensitivity of 0&#46;9 &#40;95&#37; CI&#44; 0&#46;83&#8211;0&#46;98&#41;&#44; specificity of 1&#44; positive predictive value of 1 and negative predictive value of 0&#46;98 &#40;95&#37; CI&#44; 0&#46;97&#8211;1&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the diagnostic ability by pathological findings&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">In this study&#44; we were able to verify that the medical students&#44; in a short training period&#44; were able to reliably visualize the selected abdominal ultrasound views that are essential for identifying clinical problems of enormous clinical relevance&#46; This fact is significant because it is more difficult to obtain appropriate views or slices that interpret the images&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In general&#44; physical examination of the abdomen is considered difficult for students<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and is not simple even for expert clinicians&#46; Thus&#44; for example&#44; although we are able to palpate and measure the distance between the liver edge and costal margin&#44; this assessment has poor agreement with an increase in liver size&#46; This is similar to what happens with the spleen&#46; It is relatively easy to palpate very large spleens &#40;&#62;20<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; but the sensitivity for detecting splenomegaly of 13&#8211;18<span class="elsevierStyleHsp" style=""></span>cm is very low &#40;clearly inferior to the 50&#37; in numerous series&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;15&#44;16</span></a> In terms of abdominal aortic aneurysms&#44; if their size is greater than 5<span class="elsevierStyleHsp" style=""></span>cm then the sensitivity for detecting them using palpation can reach 80&#37;&#44; but if their size is between 3<span class="elsevierStyleHsp" style=""></span>cm and 5<span class="elsevierStyleHsp" style=""></span>cm and the patient is overweight&#44; the cost-effectiveness lowers considerably&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The urinary bladder can only be detected&#44; using percussion or tenderness&#44; when it contains more than 500<span class="elsevierStyleHsp" style=""></span>ml of urine&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> When the ascites is less than 1000<span class="elsevierStyleHsp" style=""></span>ml&#44; it is virtually impossible to objectify it through physical examination&#44; and our sensitivity only increases significantly if it exceeds 2000<span class="elsevierStyleHsp" style=""></span>ml&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;18</span></a> The determination of central venous pressure through an inspection of the jugular vein&#44; one of the paradigms of cardiovascular physical examination&#44; is difficult to measure exactly in many patients &#40;even for expert clinicians&#41; for numerous reasons &#40;obesity&#44; short neck&#44; limited collaboration&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However&#44; ultrasound assessment of the caliber and degree of collapse of the inferior vena cava is much more reliable&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In this study&#44; the students were able to visualize and diagnose the majority of disorders shown by the selected patients in the assessment test &#40;cholelithiasis&#44; abdominal aortic aneurysm&#44; ascites&#44; splenomegaly&#44; acute urine retention&#44; pleural effusion&#44; pericardial effusion&#41;&#46; As it happens&#44; the patient with an aneurysm and the patient with acute urine retention were diagnosed &#8220;de novo&#8221; by the students in the assessment test&#46; The patient with acute urine retention was immediately probed&#46; The patient with the aortic aneurysm was hospitalized for pleural effusion associated with lung cancer&#44; but this finding was irrelevant given their poor prognosis&#46; We observed a greater percentage of errors in the identification of cholelithiasis&#46; The gallbladder can be difficult to observe if it is depleted and&#44; even when detected correctly&#44; it can sometimes be difficult to assess the presence of lithiasis smaller than 1&#8211;2<span class="elsevierStyleHsp" style=""></span>mm &#40;biliary microlithiasis and sludge&#41;&#46; Independently of the unquestionable usefulness of ultrasound for the diagnosis of certain abdominal problems&#44; it can also be of considerable assistance in improving the expertise of students in abdominal physical examinations&#44; as has been demonstrated in a number of studies&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">A controversial issue is the time required to achieve sufficient training and ability in the use of ultrasound&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;23</span></a> Numerous studies have shown that obtaining specific ultrasound views is an easy task &#40;short learning curve&#41; and can have significant clinical usefulness&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> This technique is known as objective-focused or selective ultrasound&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;26</span></a> With abdominal ultrasound&#44; for example&#44; the assessment of hepatic or renal masses or the study of the appendix can be truly complex&#46; However&#44; detecting acute urine retention or quantifying spleen or aorta size is relatively simple and has unquestionable clinical usefulness&#46; The paradigm of selective ultrasound is the so-called FAST &#40;&#8220;Focused Assessment with Sonography in Trauma&#8221;&#41; protocol aimed at detecting intraperitoneal fluid in the context of the multitrauma patient&#46; It is a very simple and easy-to-perform procedure that can also detect ascites or free fluid in various circumstances&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">The main limitations of the study were the participation of a small group of students and the reduced sample size&#46; However&#44; this is a pioneering study for Spain&#46; The teaching of ultrasound to undergraduate students has been very recently introduced&#44; mostly in universities in the United States&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;11</span></a> In a number of these universities&#44; pilot projects similar to ours have been conducted with small numbers of students who were taught basic concepts of clinical ultrasound in courses lasting 10&#8211;20<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Formal ultrasound training was subsequently implemented&#44; but this required the acquisition of various portable ultrasound machines and a number of sufficiently qualified teachers&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;10</span></a> Formal ultrasound training includes the scheduling of ultrasound courses over the entire academic training program&#46; The training addresses issues related to anatomy&#44; physiology&#44; pathophysiology and symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">For some teachers of medicine&#44; ultrasound will change the method of teaching and learning medicine for the coming decade&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7</span></a> The main problems in introducing ultrasound to undergraduate medicine in Spain are the lack of available machines&#44; the high number of students in many of our faculties and the scarcity of sufficiently qualified teachers to train them&#46; However&#44; modern ultrasound equipment is increasingly portable and affordable&#44; and its use is spreading among professionals of numerous medical specialties&#46; Without question&#44; these changes can facilitate the introduction of ultrasound in undergraduate programs&#44; although more studies might be needed to endorse its usefulness&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In conclusion&#44; we can confirm that&#44; within a relatively short training period&#44; medical students are able to reliably use abdominal ultrasound focused on basic aspects of considerable clinical usefulness&#46; This can improve the cost-effectiveness of the physical abdominal examination and facilitate the bedside diagnosis of certain diseases&#46;</p></span></span>"
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    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec311418"
          "palabras" => array:3 [
            0 => "Ultrasonography"
            1 => "Undergraduate medical education"
            2 => "Physical examination"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec311417"
          "palabras" => array:3 [
            0 => "Ecograf&#237;a"
            1 => "Educaci&#243;n m&#233;dica en pregrado"
            2 => "Exploraci&#243;n f&#237;sica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound is a very versatile diagnostic modality that permits real-time visualization of multiple internal organs&#46; It is of invaluable help for the physical examination of the patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess if ultrasound can be incorporated into medical education and if the students can perform a basic abdominal ultrasound examination without the necessity of a long period of training&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methodology</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twelve medical students were trained in basic abdominal ultrasound during a 15-h training program including a 5-h theoretical and practical course and supervised practice in 20 selected patients&#46; Subsequently&#44; we conducted an evaluation test that assessed the ability of students to obtain the ultrasound views and to detect various pathologies in five different patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The students were able to correctly identify the abdominal views more than 90&#37; of the times&#46; This percentage was only lower &#40;80&#37;&#41; in the right subcostal view to locate the gallbladder&#46; The accuracy or global efficiency of the ultrasound for the diagnosis of relevant pathological findings of the patients was greater than 90&#37; &#40;91&#46;1&#37; gallstones&#44; abdominal aortic aneurysm 100&#37;&#59; splenomegaly 98&#46;3&#37;&#44; ascites 100&#37;&#59; dilated inferior vena cava 100&#37;&#59; acute urinary retention 100&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The ultrasound may be a feasible learning tool in medical education&#46; Ultrasound can help students to improve the physical examination&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a es una t&#233;cnica muy vers&#225;til&#44; que permite en tiempo real visualizar m&#250;ltiples &#243;rganos internos y es de inestimable ayuda para la exploraci&#243;n f&#237;sica de los pacientes&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar si la ecograf&#237;a puede incorporarse en la ense&#241;anza de la medicina y si los alumnos pueden realizar una exploraci&#243;n ecogr&#225;fica abdominal b&#225;sica sin un largo periodo de formaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Metodolog&#237;a</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Doce estudiantes de medicina recibieron formaci&#243;n en ecograf&#237;a abdominal b&#225;sica durante un programa formativo de 15<span class="elsevierStyleHsp" style=""></span>h de duraci&#243;n&#44; que inclu&#237;a un curso te&#243;rico-pr&#225;ctico de 5<span class="elsevierStyleHsp" style=""></span>h y pr&#225;cticas supervisadas en 20 pacientes seleccionados&#46; Posteriormente realizamos una prueba de evaluaci&#243;n objetiva en la que valoramos la capacidad de los alumnos para obtener los planos ecogr&#225;ficos y detectar diversas enfermedades en 5 pacientes distintos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los estudiantes fueron capaces de identificar correctamente los planos abdominales en m&#225;s del 90&#37; de las ocasiones&#46; Solo en el corte subcostal derecho para localizar la ves&#237;cula este porcentaje fue inferior &#40;80&#37;&#41;&#46; La precisi&#243;n o eficiencia global de la ecograf&#237;a para el diagn&#243;stico de los hallazgos patol&#243;gicos relevantes de los enfermos fue superior al 90&#37; &#40;colelitiasis 91&#44;1&#37;&#59; aneurisma de aorta abdominal 100&#37;&#59; esplenomegalia 98&#44;3&#37;&#59; ascitis 100&#37;&#59; vena cava inferior dilatada 100&#37;&#44; y retenci&#243;n aguda de orina 100&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a puede ser una herramienta formativa en la ense&#241;anza de la medicina y puede ayudar a los alumnos a mejorar la exploraci&#243;n f&#237;sica&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garc&#237;a de Casasola S&#225;nchez G&#44; Torres Macho J&#44; Casas Rojo JM&#44; Cubo Romano P&#44; Ant&#243;n Santos JM&#44; Villena Garrido V&#44; et al&#46; Ecograf&#237;a cl&#237;nica abdominal y educaci&#243;n m&#233;dica&#46; Rev Clin Esp&#46; 2013&#59;214&#58;131&#8211;136&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound View&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37; Identified Correctly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatorenal recess &#40;Morrison&#39;s pouch&#41; Right kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;59&#47;60&#41; 98&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Splenorenal recess&#46; Visualization of spleen and left kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;59&#47;60&#41; 98&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal and longitudinal slice of the urinary bladder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;59&#47;60&#41; 98&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Longitudinal slice of the inferior vena cava&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;49&#47;52&#41; 94&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transversal slice of the abdominal aorta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;35&#47;39&#41; 89&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right subcostal slice&#46; Visualization of the gallbladder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;45&#47;57&#41; 78&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subxiphoid slice of the heart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#47;60 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab483097.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Degree of Correct Identification of Basic Abdominal Ultrasound Planes&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pathology&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity &#40;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Specificity &#40;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Positive Predictive Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Negative Predictive Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Overall Diagnostic Ability &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Cholelithiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76 &#40;0&#46;56&#8211;0&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88 &#40;0&#46;76&#8211;0&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdominal aortic aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Splenomegaly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;71&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98 &#40;0&#46;94&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92 &#40;0&#46;78&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98 &#40;0&#46;94&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Free abdominal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Pericardial effusion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dilated inferior vena cava&nbsp;\t\t\t\t\t\t\n
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagnostic Ability of the Ultrasound Performed by the Students Based on the Pathological Findings&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">What we know&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound is a great help for the approximation diagnosis of patients and tool suitable for the development of exploration physics&#46; There are no studies in our environment that valued training in clinical ultrasound undergraduate studies&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">What this article provide&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">This pilot study&#44; conducted with a small number medical students&#44; shows that with a properly trained&#44; supervised and not very extensive&#44; the students learned to locate the principal planes anatomical&#46; Furthermore&#44; a very high percentage detect certain diseases or complications significant abdominal&#46; The work opens a door to more complex studies to determine the role of the teaching of this technical medical future&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
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                          "etal" => false
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                      "doi" => "10.1016/S0140-6736(03)14464-9"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14550696"
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                            2 => "L&#46;C&#46; Melo"
                            3 => "M&#46;L&#46; Freeman"
                            4 => "E&#46;J&#46; Ledermann"
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                    0 => array:1 [
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                            0 => "I&#46; Wong"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1743-498X.2010.00416.x"
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                      "titulo" => "Using ultrasonography as a teaching support tool in undergraduate medical education-time to reach a decision"
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                            3 => "D&#46;B&#46; Howe"
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                        0 => array:2 [
                          "etal" => false
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                      "Revista" => array:5 [
                        "tituloSerie" => "JANO"
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                      "titulo" => "Should a hand-carried ultrasound machine become standard equipment for every internist&#63;"
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                        0 => array:2 [
                          "etal" => false
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2013.11.001

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