Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

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Torres Macho, F.J. García Sánchez, P. Garmilla Ezquerra, L. Beltrán Romero, J. Canora Lebrato, J.M. Casas Rojo, P. Arribas Arribas, S. López Palmero, S. Pintos Martínez, J.M. Cepeda Rodrigo, D. Luordo, M. Beltrán López, M. Méndez Bailón, E. Rodilla Sala, L. Manzano Espinosa, A. Zapatero Gaviria, G. García de Casasola" "autores" => array:18 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Torres Macho" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "García Sánchez" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Garmilla Ezquerra" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Beltrán Romero" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Canora Lebrato" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Casas Rojo" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Arribas Arribas" ] 7 => array:2 [ "nombre" => "S." "apellidos" => "López Palmero" ] 8 => array:2 [ "nombre" => "S." "apellidos" => "Pintos Martínez" ] 9 => array:2 [ "nombre" => "J.M." 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"apellidos" => "García de Casasola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 17 => array:1 [ "colaborador" => "on behalf of the Sociedad Española de Medicina Interna y de su Grupo de Trabajo de Ecografía Clínica" ] ] "afiliaciones" => array:12 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna-Urgencias, Hospital Universitario Infanta Cristina, Parla (Madrid), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Santa Bárbara, Soria, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Medicina Interna, Hospital de Torrecárdenas, Almería, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Denia, Alicante, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Valencia), Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda (Cádiz), Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Sagunto, Valencia, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna" ] ] "textoCompleto" => "Background and conceptsClinical ultrasonography or point-of-care ultrasound consists of the systematic application of ultrasound as an extension and supplement to conventional physical examinations. The Spanish Society of Cardiology (SEC) also refers to clinical cardiac ultrasonography as echocardiography. Similarly, the concept of multiorgan ultrasonography has been suggested as an instrument for the comprehensive evaluation of various regions of the body. Clinical ultrasonography in no way replaces board-certified evaluations performed in radiology rooms or cardiac imaging laboratories.<a class="elsevierStyleCrossRef" href="#bib0305">1</a>The main purpose of clinical ultrasonography is to rule out a relevant disease (given the technique's high sensitivity and negative predictive value). Given that ultrasonography competence is achieved within a short training period, incorporating ultrasound training within the internal medicine specialty program is feasible. Moreover, the procedure lasts approximately 15min and should therefore be acceptable for the internist's clinical practice. This basic tool offers the following features:Streamlining of the diagnostic process, which can provide a prognostic benefit in some cases.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Screening of numerous diseases.</li><li class="elsevierStyleListItem" id="lsti0010">-Monitoring of certain treatments.</li><li class="elsevierStyleListItem" id="lsti0015">-Implementation of invasive procedures, such as extraction of fluids and cannulation of central venous pathways.</li><li class="elsevierStyleListItem" id="lsti0020">-Assessment of the patient's hemodynamic and congestive state.</li></ul><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the main indications for clinical ultrasonography and the elements that should be assessed.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Key aspects of clinical ultrasonography in internal medicinePatient safetyUltrasonography facilitates the safety of certain procedures. Specifically, the ultrasound-guided cannulation of central pathways markedly decreases associated complications.<a class="elsevierStyleCrossRefs" href="#bib0310">2–7</a> In the hands of nurses, ultrasonography also enables the cannulation of peripheral pathways of complex access, avoiding the need to use central venous catheters.<a class="elsevierStyleCrossRef" href="#bib0340">8</a>Other “interventionist” procedures in which ultrasonography is of considerable assistance include thoracentesis and paracentesis. Reducing the risk of pneumothorax associated with thoracentesis is especially important.<a class="elsevierStyleCrossRefs" href="#bib0345">9,10</a> Performing a blind thoracentesis is therefore considered inappropriate when the center has an ultrasound machine.Another essential point related to patient safety is the promoting of measures that prevent nosocomial infections associated with the use of catheters and tubes. Ultrasonography is useful for detecting acute urine retention and pathological postvoid residue and for monitoring blood volume and central venous pressure. Ultrasonography could help reduce the indications for bladder catheterization in internal medicine departments.<a class="elsevierStyleCrossRef" href="#bib0355">11</a>The increase in ultrasound-guided cannulation of peripheral venous pathways under conditions of difficult venous access decreases the use of central pathways and thereby the infections associated with central catheters.<a class="elsevierStyleCrossRefs" href="#bib0320">4,12–15</a>Clinical ultrasonography as a supplement to physical examinationsPhysical examinations are a subjective diagnostic procedure, whose precision and reliability vary significantly and depend on the physician's ability and patient's characteristics.<a class="elsevierStyleCrossRef" href="#bib0380">16</a>Clinical ultrasonography is an excellent supplement for improving the cost-effectiveness of classical physical examinations.<a class="elsevierStyleCrossRefs" href="#bib0385">17–19</a> Ultrasonography helps visualize and objectively measure the structures and their potential abnormalities. For example, ultrasonography is especially useful for detecting and quantifying pleural effusion, pericardial effusion and ascites, assessing and typing heart murmurs, calculating the central venous pressure and detecting aortic aneurysms, processes that can go unnoticed during conventional physical examinations.<a class="elsevierStyleCrossRef" href="#bib0400">20</a>Clinical ultrasonography in the patient follow-upBoard-certified ultrasonography is useful for accurately assessing patients on an as-needed basis (“freeze frame”) but is obviously not feasible for implementing on a frequent basis. Clinical ultrasonography can be efficiently applied at the point of care in a “serial” or “dynamic” manner to a patient to monitor certain complications (pulmonary congestion, pleural effusion, ascites, blood volume estimation, cholestasis, etc.).In a significant percentage of patients who are admitted to internal medicine departments, a progressive follow-up of multiple medical complications is essential.<a class="elsevierStyleCrossRefs" href="#bib0405">21–27</a>Multiorgan ultrasonographyIn some clinical scenarios, such as patients with dyspnea, shock or suspected thromboembolism disease, the comprehensive ultrasound assessment of various organs is highly useful for the diagnosis and follow-up.<a class="elsevierStyleCrossRefs" href="#bib0400">20,28–31</a> The characteristic specialization of the radiology and cardiology departments limits the implementation of these types of procedures, which can be performed by general practitioners. Moreover, some organs such as the lungs can be considered orphans from the ultrasound viewpoint.<a class="elsevierStyleCrossRefs" href="#bib0430">26,27</a>Limitations of clinical ultrasonographyThe characteristics of patients treated in internal medicine departments frequently hinder the ability to obtain good acoustic windows, a fact that needs to be considered when training internists in the use of ultrasonography. Another limitation is the type of ultrasound, which should be standardized according to the competencies assumed by the practitioner. There are systematic errors that should also be considered when learning clinical ultrasonography, such as obtaining inadequate images and the lack of systemization in the implementation of the study.Settings for the use of clinical ultrasonography in internal medicineEmergency department and hospital wardPoint-of-care ultrasonography is extraordinarily useful as a supplement to physical examinations in these healthcare settings, especially in life-threatening situations.<a class="elsevierStyleCrossRef" href="#bib0460">32</a>Specialized consultationsClinical ultrasonography can be of considerable use in this type of consultation, in which internists can acquire experience and skill in assessing specific aspects of ultrasonography (“limited ultrasonography”), similar or even superior to those performed in other departments. Some examples are listed below:Consultation for cardiovascular riskUltrasonography is essential in detecting subclinical lesions of target organs (carotid, heart, leg arteries, abdominal aorta), which helps improve the estimate of cardiovascular risk and treatment optimization.<a class="elsevierStyleCrossRefs" href="#bib0465">33–40</a>Consultation for heart failureUltrasonography is essential in the diagnosis and follow-up of patients with heart failure. Ultrasonography helps monitor pulmonary congestion (quantifying B-lines, pleural effusion), central venous pressure (size and collapse of the inferior vena cava) and ascites. The tool can also be of value for adjusting the diuretic treatment.<a class="elsevierStyleCrossRefs" href="#bib0410">22,41–43</a>Other consultationsUltrasonography can also be practical in rapid diagnosis consultations, chronic-complex patient consultations and in specialized consultations of systemic autoimmune diseases (detection and monitoring of interstitial lung disease, pulmonary hypertension, joint involvement, etc.).Alternatives to conventional hospitalizationPortable ultrasound machines enable the comprehensive evaluation of patients outside the hospital.<a class="elsevierStyleCrossRefs" href="#bib0460">32,44,45</a> There is sufficient evidence to confirm that ultrasonography can substitute chest radiography for the diagnosis and follow-up of pneumonia and heart failure.<a class="elsevierStyleCrossRefs" href="#bib0530">46,47</a> Ultrasound can therefore be of considerable assistance for palliative medicine and home care physicians, including nursing homes.<a class="elsevierStyleCrossRefs" href="#bib0540">48,49</a>Clinical ultrasonography in undergraduate training and researchUndergraduate trainingThe training of basic clinical ultrasonography does not take long and facilitates training in anatomy, physiology and pathophysiology. Most importantly, the training improves the performance and reliability of the physical examination. Ultrasound training for medical students is implemented progressively in numerous faculties, especially in the United States and Germany.<a class="elsevierStyleCrossRefs" href="#bib0550">50–53</a> This training requires sufficiently qualified teachers, human resources and sufficient materials for the individual training of a large number of students.In recent years, the Clinical Ultrasonography workgroup of the Spanish Society of Internal Medicine (SEMI) has been developing a practical undergraduate teaching system for ultrasonography, based on the integration of students as teachers. Thus, after a small group of students have been trained, these students can in turn teach their classmates (“peer mentoring”).<a class="elsevierStyleCrossRefs" href="#bib0570">54,55</a> This teaching model is easily exportable to any department of internal medicine involved in teaching undergraduate and postgraduate courses.ResearchThe number of publications related to clinical ultrasonography has grown exponentially in recent years. The first example was the development of lung ultrasonography in critical patients, followed by studies on the use of clinical ultrasonography in cardiac arrest, hypotension-shock and the diagnosis of dyspnea. Other lines of research related to the internal medicine field include cardiovascular risk, heart failure and autoimmune diseases.Recommendations on the training of internal medicine residents and specialists in general clinical ultrasonographyThe established rotation model is based on the combination of scientific evidence and the experience of numerous training centers that have been progressively set up in Spain in the past 10 years.<a class="elsevierStyleCrossRefs" href="#bib0580">56–60</a> There is still the need for a common accreditation system, which will come from the inclusion of clinical ultrasonography in the official program of the specialty.ObjectivesThe general objective is to understand the foundations of point-of-care ultrasonography as a supplement to the physical examination. The aspects that students should learn are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> of this document.In addition to a rotation in general clinical ultrasonography, residents may request a rotation in a center that has experience in specific areas of clinical ultrasonography.Duration and number of examinationsThe optimal duration of a training cycling is 4 to 8 weeks. During this time, the resident should perform at least 150 supervised multiorgan ultrasounds on various selected patients. This workload consists of performing 5 examinations per day, which ensures the acquisition of technical skills to optimally view the basic layers of each organ and the application of the technique to an appropriate case mix.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows an approach for the components and learning times of basic ultrasound training, separated into 3 sequential levels according to their difficulty. Undoubtedly, the basic echocardiographic layers are the most complicated to learn.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Ultrasound examination systemEach clinical ultrasound examination should systematically include the pulmonary, cardiac and abdominal assessment. Depending on the medical indication, other structures may be added, such as the carotid territory, deep venous system of the legs and temporal artery.Material resourcesAn ultrasound machine should be available for every 2 internists on rotation and should be portable, for performing point-of-care examinations. The equipment should have at least 2D and color Doppler images.SupervisionUltrasound examinations should be supervised, especially during the first week of rotation. The resident should then perform ultrasonography independently, requesting supervision by the tutor on demand and storing the images for subsequent consultation.Activity recordAll ultrasound activity should be recorded in a patient file in which detected pathological findings are noted. Ultrasounds can thereby be quantified and the findings compared with those from board-certified ultrasounds and other additional tests available to the patient.The results of the supervised ultrasound examinations should be reflected in the patient's medical history in the same way the results of classical physical examinations are reflected.Assessing the level of competenceUpon completion of the rotation period, the tutor will have proof of the number of examinations performed by each resident to qualify the level of acquired competence.SEMI will define, with the advice of the Clinical Ultrasonography workgroup, homogeneous criteria for assessing the level of competence in general clinical ultrasonography and thereby establish specific accreditation. SEMI is also working with the SEC and other scientific societies to develop joint accreditation in echocardiography.ConclusionsSEMI and the Clinical Ultrasonography workgroup recommend the incorporation of clinical ultrasonography into the internist's standard clinical practice. To this end, the training of residents and specialists in internal medicine needs to be promoted and facilitated. To achieve these objectives, ultrasound equipment should be acquired by internal medicine departments. Through the National Committee of Internal Medicine, SEMI will propose the incorporation of clinical ultrasonography in the training program for the specialty.Conflict of interestsThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1022764" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980850" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022765" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980851" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background and concepts" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Key aspects of clinical ultrasonography in internal medicine" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient safety" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical ultrasonography as a supplement to physical examinations" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical ultrasonography in the patient follow-up" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Multiorgan ultrasonography" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Limitations of clinical ultrasonography" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Settings for the use of clinical ultrasonography in internal medicine" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Emergency department and hospital ward" ] 1 => array:3 [ "identificador" => "sec0050" "titulo" => "Specialized consultations" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Consultation for cardiovascular risk" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Consultation for heart failure" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Other consultations" ] ] ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Alternatives to conventional hospitalization" ] ] ] 7 => array:3 [ "identificador" => "sec0075" "titulo" => "Clinical ultrasonography in undergraduate training and research" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Undergraduate training" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Research" ] ] ] 8 => array:3 [ "identificador" => "sec0090" "titulo" => "Recommendations on the training of internal medicine residents and specialists in general clinical ultrasonography" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0095" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "sec0100" "titulo" => "Duration and number of examinations" ] 2 => array:2 [ "identificador" => "sec0105" "titulo" => "Ultrasound examination system" ] 3 => array:2 [ "identificador" => "sec0110" "titulo" => "Material resources" ] 4 => array:2 [ "identificador" => "sec0115" "titulo" => "Supervision" ] 5 => array:2 [ "identificador" => "sec0120" "titulo" => "Activity record" ] 6 => array:2 [ "identificador" => "sec0125" "titulo" => "Assessing the level of competence" ] ] ] 9 => array:2 [ "identificador" => "sec0130" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0135" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack345344" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-15" "fechaAceptado" => "2018-02-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980850" "palabras" => array:4 [ 0 => "Point-of-care ultrasound" 1 => "Ultrasound" 2 => "Internal medicine" 3 => "Training" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980851" "palabras" => array:4 [ 0 => "Ecografía clínica" 1 => "Ultrasonidos" 2 => "Medicina Interna" 3 => "Formación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Este documento de posicionamiento describe los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, desde sus indicaciones fundamentales hasta el período de formación recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la práctica clínica habitual del internista en múltiples escenarios clínicos y ámbitos de actuación (urgencias, planta de hospitalización, consulta general y específica y atención domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolución del profesional, al aumentar su fiabilidad y seguridad diagnóstica, además de proporcionar información pronóstica y evolutiva importante. Además, en los últimos años se ha incorporado como una herramienta en la enseñanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formación estructurada y la adquisición de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Torres Macho J, García Sánchez FJ, Garmilla Ezquerra P, Beltrán Romero L, Canora Lebrato J, Casas Rojo JM, et al. Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna. Rev Clin Esp. 2018;218:192–198." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(a) Abdominal ultrasound: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection of free intraperitoneal fluid, hepatomegaly or splenomegaly, hepatic steatosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Extrahepatic assessment of the gallbladder and bile duct. Cholelithiasis, cholecystitis. Assessment of patients with cholestasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Assessment of patients with chronic liver disease and portal hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(b) Echocardiography: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Estimating the measurements of cardiac cavities (left atrium, interventricular septum, atrium and right ventricle and ascending aorta). Assessment of patients with radiological cardiomegaly \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Assessment of left and right ventricular function. Usefulness of ultrasonography for assessing patients with suspected heart failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection and estimation of severity of pericardial effusion. Diagnosis of tamponade. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Identification of possible significant valvular heart disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Estimation of blood volume and central venous pressure: inferior vena cava, suprahepatic veins \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(c) Urological ultrasonography: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection of hydronephrosis and bladder balloon. Renal diameter and echogenicity. Assessment of patients with renal failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(d) Pulmonary ultrasonography: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Identification of pneumothorax, pleural effusion, interstitial syndrome and pulmonary condensation (pneumonia). Usefulness of pulmonary ultrasonography for assessing patients with dyspnea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(e) Vascular ultrasonography: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection of thoracic and abdominal aortic aneurysm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection of deep vein thrombosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Detection of carotid plaques \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(f) Invasive procedures with ultrasound control: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Cannulation of central and peripheral pathways, thoracentesis, paracentesis and arthrocentesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(g) Multiorgan ultrasonography: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Usefulness of ultrasonography for assessing venous thromboembolism disease. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Assessment of patients in shock. Assessment of patients in shock, in cardiopulmonary arrest or electromechanical dissociation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">- Overall assessment of cardiovascular risk \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1738113.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Competencies and Indications for Clinical Ultrasonography." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "For level 1, at least 20 supervised examinations are needed. For levels 2 and 3, between 30 and 50 examinations are needed." "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Level 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Level 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Level 3 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Detection of free abdominal fluid (FAST) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney and urinary bladder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior vena cava \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gallbladder and bile duct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal aorta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Echocardiography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deep venous system of the lower limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary ultrasonography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1738114.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Difficulty levels of clinical ultrasonography." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:60 [ 0 => array:3 [ "identificador" => "bib0305" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecocardiografía clínica en Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Torres Macho" 1 => "G. Garcia de Casasola" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "138" "paginaInicial" => "567" "paginaFinal" => "569" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0310" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The top patient safety strategies that can be encouraged for adoption now" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G. Shekelle" 1 => "P.J. Pronovost" 2 => "R.M. Wachter" 3 => "K.M. McDonald" 4 => "K. Schoelles" 5 => "S.M. Dy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-158-5-201303051-00001" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2013" "volumen" => "158" "paginaInicial" => "365" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23460091" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0315" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonic locating devices for central venous cannulation: meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Hind" 1 => "N. Calvert" 2 => "R. McWilliams" 3 => "A. Davidson" 4 => "S. Paisley" 5 => "C. Beverley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.327.7411.361" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2003" "volumen" => "327" "paginaInicial" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12919984" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0320" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Lamperti" 1 => "A.R. Bodenham" 2 => "M. Pittiruti" 3 => "M. Blaivas" 4 => "J.G. Augoustides" 5 => "M. Elbarbary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2597-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1105" "paginaFinal" => "1117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0325" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Special articles: Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Troianos" 1 => "G.S. Hartman" 2 => "K.E. Glas" 3 => "N.J. Skubas" 4 => "R.T. Eberhardt" 5 => "J.D. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3182407cd8" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2012" "volumen" => "114" "paginaInicial" => "46" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22127816" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0330" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided vascular access: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Weiner" 1 => "P. Geldard" 2 => "A.J. Mittnacht" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2012.07.007" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "345" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22995457" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0335" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.Y. Wu" 1 => "Q. Ling" 2 => "L.H. Cao" 3 => "J. Wang" 4 => "M.X. Xu" 5 => "W.A. Zeng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e31827bd172" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2013" "volumen" => "118" "paginaInicial" => "361" "paginaFinal" => "375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23249991" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0340" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implementation of a successful registered nurse peripheral ultrasound-guided intravenous catheter program in an emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Miles" 1 => "A. Salcedo" 2 => "D. Spear" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jen.2011.02.011" "Revista" => array:6 [ "tituloSerie" => "J Emerg Nurs" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "353" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21514651" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0345" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographically guided thoracentesis and rate of pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.W. Barnes" 1 => "T.I. Morgenthaler" 2 => "E.J. Olson" 3 => "G.K. Hesley" 4 => "P.A. Decker" 5 => "J.H. Ryu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jcu.20163" "Revista" => array:6 [ "tituloSerie" => "J Clin Ultrasound" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "442" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16281263" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0350" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumothorax following thoracentesis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.E. Gordon" 1 => "D. Feller-Kopman" 2 => "E.M. Balk" 3 => "G.W. Smetana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinternmed.2009.548" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2010" "volumen" => "170" "paginaInicial" => "332" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20177035" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0355" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effectiveness of implementing a bladder ultrasound programme in neurosurgical units" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y.Y. Lee" 1 => "W.L. Tsay" 2 => "M.F. Lou" 3 => "Y.T. Dau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2648.2006.04080.x" "Revista" => array:6 [ "tituloSerie" => "J Adv Nurs" "fecha" => "2007" "volumen" => "57" "paginaInicial" => "192" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17214755" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0360" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.K. Au" 1 => "M.J. Rotte" 2 => "R.J. Grzybowski" 3 => "B.S. Ku" 4 => "J.M. Fields" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2012.04.016" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "1950" "paginaFinal" => "1954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795988" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0365" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided peripheral venous access vs. the external jugular vein as the initial approach to the patient with difficult vascular access" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.G. Costantino" 1 => "J.F. Kirtz" 2 => "W.A. Satz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2009.02.004" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2010" "volumen" => "39" "paginaInicial" => "462" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19303238" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0370" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Egan" 1 => "D. Healy" 2 => "H. O’Neill" 3 => "M. Clarke-Moloney" 4 => "P.A. Grace" 5 => "S.R. Walsh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/emermed-2012-201652" "Revista" => array:6 [ "tituloSerie" => "Emerg Med J" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "521" "paginaFinal" => "526" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22886890" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0375" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Shokoohi" 1 => "K. Boniface" 2 => "M. McCarthy" 3 => "T. Khedir Al-tiae" 4 => "M. Sattarian" 5 => "R. Ding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2012.09.016" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2013" "volumen" => "61" "paginaInicial" => "198" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23141920" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0380" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based physical diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. McGee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "editorial" => "Elsevier Saunders" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0385" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empowering physical examination: the «laying on» of ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.J. Kimura" 1 => "A.N. Demaria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2008.06.004" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2008" "volumen" => "1" "paginaInicial" => "602" "paginaFinal" => "604" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19356488" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0390" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac limited ultrasound examination techniques to augment the bedside cardiac physical examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.J. Kimura" 1 => "D.J. Shaw" 2 => "S.A. Amundson" 3 => "J.N. Phan" 4 => "D.G. Blanchard" 5 => "A.N. DeMaria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.15.14.09002" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "1683" "paginaFinal" => "1690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26269293" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0395" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.M. Stokke" 1 => "V. Ruddox" 2 => "S.I. Sarvari" 3 => "J.E. Otterstad" 4 => "E. Aune" 5 => "T. Edvardsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2014.08.001" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "1238" "paginaFinal" => "1246" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25216765" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0400" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Nazerian" 1 => "S. Vanni" 2 => "G. Volpicelli" 3 => "C. Gigli" 4 => "M. Zanobetti" 5 => "M. Bartolucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.13-1087" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2014" "volumen" => "145" "paginaInicial" => "950" "paginaFinal" => "957" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092475" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0405" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Gargani" 1 => "P.S. Pang" 2 => "F. Frassi" 3 => "M.H. Miglioranza" 4 => "F.L. Dini" 5 => "P. Landi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12947-015-0033-4" "Revista" => array:5 [ "tituloSerie" => "Cardiovasc Ultrasound" "fecha" => "2015" "volumen" => "13" "paginaInicial" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26337295" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0410" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Cubo-Romano" 1 => "J. Torres-Macho" 2 => "N.J. Soni" 3 => "L.F. Reyes" 4 => "A. Rodríguez-Almodóvar" 5 => "J.M. Fernández-Alonso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jhm.2620" "Revista" => array:6 [ "tituloSerie" => "J Hosp Med" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "778" "paginaFinal" => "784" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27264844" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0415" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.N. Goonewardena" 1 => "A. Gemignani" 2 => "A. Ronan" 3 => "S. Vasaiwala" 4 => "J. Blair" 5 => "J.M. Brennan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2008.06.005" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2008" "volumen" => "1" "paginaInicial" => "595" "paginaFinal" => "601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19356487" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0420" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A dilated inferior vena cava is a marker of poor survival" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Nath" 1 => "J.L. Vacek" 2 => "P.A. Heidenreich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2005.04.023" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2006" "volumen" => "151" "paginaInicial" => "730" "paginaFinal" => "735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16504642" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0425" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IVC diameter in patients with chronic heart failure: relationships and prognostic significance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Pellicori" 1 => "V. Carubelli" 2 => "J. Zhang" 3 => "T. Castiello" 4 => "N. Sherwi" 5 => "A.L. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2012.08.012" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "16" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328557" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0430" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Volpicelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "165" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23269722" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0435" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of chest ultrasonography in the management of respiratory diseases: document I" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Zanforlin" 1 => "R. Giannuzzi" 2 => "S. Nardini" 3 => "A. Testa" 4 => "G. Soldati" 5 => "R. Copetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/2049-6958-8-54" "Revista" => array:5 [ "tituloSerie" => "Multidiscip Respir Med" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23937880" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0440" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Al Deeb" 1 => "S. Barbic" 2 => "R. Featherstone" 3 => "J. Dankoff" 4 => "D. Barbic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/acem.12435" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "843" "paginaFinal" => "852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25176151" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0445" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The RUSH exam: rapid ultrasound in shock in the evaluation of the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Perera" 1 => "T. Mailhot" 2 => "D. Riley" 3 => "D. Mandavia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.emc.2009.09.010" "Revista" => array:6 [ "tituloSerie" => "Emerg Med Clin North Am" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "29" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0450" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonography in hypotension and cardiac arrest (SHoC): rates of abnormal findings in undifferentiated hypotension and during cardiac arrest as a basis for consensus on a hierarchical point of care ultrasound protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Milne" 1 => "P. Atkinson" 2 => "D. Lewis" 3 => "J. Fraser" 4 => "L. Diegelmann" 5 => "P. Olszynski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.564" "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "e564" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27190729" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0455" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinically integrated multi-organ point-of-care ultrasound for undifferentiated respiratory difficulty, chest pain, or shock: a critical analytic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.R. Ha" 1 => "H.C. Toh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40560-016-0172-1" "Revista" => array:5 [ "tituloSerie" => "J Intensive Care" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27529030" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0460" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergency ultrasound guidelines" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American College of Emergency Physicians" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2008.12.013" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "550" "paginaFinal" => "570" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19303521" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0465" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk prediction is improved by adding markers of subclinical organ damage to SCORE" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Sehestedt" 1 => "J. Jeppesen" 2 => "T.W. Hansen" 3 => "K. Wachtell" 4 => "H. Ibsen" 5 => "C. Torp-Pedersen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehp546" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "883" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20034972" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0470" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focused vascular ultrasound for the assessment of atherosclerosis: a proof-of-concept study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Johri" 1 => "C.M. Calnan" 2 => "M.F. Matangi" 3 => "J. MacHaalany" 4 => "M.F. Hétu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2016.05.003" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "842" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27342940" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0475" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carotid intima media thickness and its utility as a predictor of cardiovascular disease: a review of evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Carpenter" 1 => "H. Sinclair" 2 => "V. Kunadian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CRD.0000000000000077" "Revista" => array:6 [ "tituloSerie" => "Cardiol Rev" "fecha" => "2016" "volumen" => "24" "paginaInicial" => "70" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26825762" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0480" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of primary care physicians’ use of a pocket ultrasound device to measure left ventricular mass in patients with hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Bornemann" 1 => "J. Johnson" 2 => "S. Tiglao" 3 => "A. Moghul" 4 => "S. Swain" 5 => "G. Bornemann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3122/jabfm.2015.06.140314" "Revista" => array:6 [ "tituloSerie" => "J Am Board Fam Med" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "706" "paginaFinal" => "712" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26546645" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0485" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular hypertrophy, aortic wall thickness, and lifetime predicted risk of cardiovascular disease: the Dallas Heart Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Gupta" 1 => "J.D. Berry" 2 => "C.R. Ayers" 3 => "R.M. Peshock" 4 => "A. Khera" 5 => "J.A. de Lemos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2010.03.005" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "605" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541716" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0490" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diastolic dysfunction and left auricular volume: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.M. Pritchett" 1 => "D.W. Mahoney" 2 => "S.J. Jacobsen" 3 => "R.J. Rodeheffer" 4 => "B.L. Karon" 5 => "M.M. Redfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2004.09.054" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "45" "paginaInicial" => "87" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15629380" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0495" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones de la guía para el diagnóstico y tratamiento del aneurisma de aorta abdominal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lahoz" 1 => "C. Esteban Gracia" 2 => "L. Reinares García" 3 => "S. Bellmunt Montoya" 4 => "Á. Brea Hernando" 5 => "Á. Fernández Heredero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arteri.2015.01.004" "Revista" => array:6 [ "tituloSerie" => "Clin Investig Arterioscler" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "159" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25835613" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0500" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.T. Hirsch" 1 => "Z.J. Haskal" 2 => "N.R. Hertzer" 3 => "C.W. Bakal" 4 => "M.A. Creager" 5 => "J.L. Halperin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.10.009" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "1239" "paginaFinal" => "1312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16545667" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0505" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Platz" 1 => "E.F. Lewis" 2 => "H. Uno" 3 => "J. Peck" 4 => "E. Pivetta" 5 => "A.A. Merz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv745" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "1244" "paginaFinal" => "1251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26819225" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0510" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidad pronóstica de la ecografía pulmonar en el seguimiento ambulatorio de pacientes con insuficiencia cardiaca" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.C. Tojo Villanueva" 1 => "M. Fernández López" 2 => "J. Canora Lebrato" 3 => "J.Á. Satué Bartolomé" 4 => "A. San Martín Prado" 5 => "A. Zapatero Gaviria" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "13" "paginaFinal" => "15" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0515" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galiè" 1 => "M. Humbert" 2 => "J.L. Vachiery" 3 => "S. Gibbs" 4 => "I. Lang" 5 => "A. Torbicki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv317" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "67" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320113" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0520" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adding point of care ultrasound to assess volume status in heart failure patients in a nurse-led outpatient clinic. A randomised study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.H. Gundersen" 1 => "T.M. Norekval" 2 => "H.H. Haug" 3 => "K. Skjetne" 4 => "J.O. Kleinau" 5 => "T. Graven" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2015-307798" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2016" "volumen" => "102" "paginaInicial" => "29" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26438785" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0525" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prehospital evaluation of effusion, pneumothorax, and standstill (PEEPS): point-of-care ultrasound in emergency medical services" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.R. Bhat" 1 => "D.A. Johnson" 2 => "J.E. Pierog" 3 => "B.E. Zaia" 4 => "S.R. Williams" 5 => "L. Gharahbaghian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5811/westjem.2015.5.25414" "Revista" => array:6 [ "tituloSerie" => "West J Emerg Med" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "503" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26265961" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0530" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Nazerian" 1 => "G. Volpicelli" 2 => "S. Vanni" 3 => "C. Gigli" 4 => "L. Betti" 5 => "M. Bartolucci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2015.01.035" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "620" "paginaFinal" => "625" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758182" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0535" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Martindale" 1 => "A. Wakai" 2 => "S.P. Collins" 3 => "P.D. Levy" 4 => "D. Diercks" 5 => "B.C. Hiestand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/acem.12878" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2016" "volumen" => "23" "paginaInicial" => "223" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26910112" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0540" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative ultrasound for home care hospice patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.J. Mariani" 1 => "J.A. Setla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1553-2712.2009.00678.x" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "293" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20370762" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0545" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound-experience in a palliative care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Gishen" 1 => "I. Trotman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Cancer Care (Engl)" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "642" "paginaFinal" => "644" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0550" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The state of ultrasound education in U.S. medical schools: results of a national survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.P. Bahner" 1 => "E. Goldman" 2 => "D. Way" 3 => "N.A. Royall" 4 => "Y.T. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0000000000000414" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2014" "volumen" => "89" "paginaInicial" => "1681" "paginaFinal" => "1686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25099238" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0555" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Hoppmann" 1 => "V.V. Rao" 2 => "M.B. Poston" 3 => "D.B. Howe" 4 => "P.S. Hunt" 5 => "S.D. Fowler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13089-011-0052-9" "Revista" => array:6 [ "tituloSerie" => "Crit Ultrasound J" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21516137" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0560" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful strategies for integrating bedside ultrasound into undergraduate medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.K. Palma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7205/MILMED-D-14-00573" "Revista" => array:6 [ "tituloSerie" => "Mil Med" "fecha" => "2015" "volumen" => "180" "paginaInicial" => "153" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25850144" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0565" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feasibility of a focused ultrasound training programme for medical undergraduate students" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Wong" 1 => "T. Jayatilleke" 2 => "R. Kendall" 3 => "P. Atkinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1743-498X.2010.00416.x" "Revista" => array:6 [ "tituloSerie" => "Clin Teach" "fecha" => "2011" "volumen" => "8" "paginaInicial" => "3" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21324064" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0570" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecografía clínica abdominal y educación médica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Garcia de Casasola Sanchez" 1 => "J. Torres Macho" 2 => "J.M. Casas Rojo" 3 => "P. Cubo Romano" 4 => "J.M. Anton Santos" 5 => "V. Villena Garrido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2013.09.006" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2014" "volumen" => "214" "paginaInicial" => "131" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24168817" "web" => "Medline" ] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0575" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enseñanza de la ecografía clínica en el pregrado: los estudiantes como mentores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. García de Casasola Sánchez" 1 => "D. González Peinado" 2 => "A. Sánchez Gollarte" 3 => "E. Muñoz Aceituno" 4 => "I. Peña Vázquez" 5 => "J. Torres Macho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2014.11.023" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2015" "volumen" => "215" "paginaInicial" => "211" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25583252" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0580" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Internal Medicine point-of-care ultrasound curriculum: consensus recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.W.Y. Ma" 1 => "S. Arishenkoff" 2 => "J. Wiseman" 3 => "J. Desy" 4 => "J. Ailon" 5 => "L. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11606-017-4071-5" "Revista" => array:6 [ "tituloSerie" => "J Gen Intern Med" "fecha" => "2017" "volumen" => "32" "paginaInicial" => "1052" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28497416" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0585" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International Federation of Emergency Medicine point of care ultrasound curriculum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Atkinson" 1 => "J. Bowra" 2 => "M. Lambert" 3 => "H. Lamprecht" 4 => "V. Noble" 5 => "B. Jarman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/cem.2015.8" "Revista" => array:6 [ "tituloSerie" => "CJEM" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "161" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26052968" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0590" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Ailon" 1 => "O. Mourad" 2 => "M. Nadjafi" 3 => "R. Cavalcanti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can Med Educ J" "fecha" => "2016" "volumen" => "7" "paginaInicial" => "e51" "paginaFinal" => "e69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28344709" "web" => "Medline" ] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0595" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Training in critical care echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.H. Mayo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/2110-5820-1-36" "Revista" => array:5 [ "tituloSerie" => "Ann Intensive Care" "fecha" => "2011" "volumen" => "1" "paginaInicial" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21906268" "web" => "Medline" ] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0600" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Learning curves in emergency ultrasound education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.J. Blehar" 1 => "B. Barton" 2 => "R.J. Gaspari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/acem.12653" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "574" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25903780" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack345344" "titulo" => "Acknowledgements" "texto" => "The authors would like to thank Dr. Miquel Aranda for his support in including clinical ultrasonography in the training program of the internal medicine specialty. We would also like to thank the Board of Directors of SEMI and all members of the Clinical Ultrasonography workgroup of SEMI." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000004/v2_201805060420/S2254887418300444/v2_201805060420/en/main.assets" "Apartado" => array:4 [ "identificador" => "3982" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000004/v2_201805060420/S2254887418300444/v2_201805060420/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300444?idApp=WRCEE"]

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Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna

J. Torres Machoa,

Corresponding author

jtorresmacho@gmail.com

Corresponding author.

, F.J. García Sáncheza, P. Garmilla Ezquerrab, L. Beltrán Romeroc, J. Canora Lebratod, J.M. Casas Rojoa, P. Arribas Arribase, S. López Palmerof, S. Pintos Martínezg, J.M. Cepeda Rodrigoh, D. Luordoa, M. Beltrán Lópezi, M. Méndez Bailónj, E. Rodilla Salak, L. Manzano Espinosal, A. Zapatero Gaviriad, G. García de Casasolaa, on behalf of the Sociedad Española de Medicina Interna y de su Grupo de Trabajo de Ecografía Clínica

a Servicio de Medicina Interna-Urgencias, Hospital Universitario Infanta Cristina, Parla (Madrid), Spain

b Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Spain

c Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain

d Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain

e Servicio de Medicina Interna, Hospital de Santa Bárbara, Soria, Spain

f Unidad de Gestión Clínica de Medicina Interna, Hospital de Torrecárdenas, Almería, Spain

g Servicio de Medicina Interna, Hospital de Denia, Alicante, Spain

h Servicio de Medicina Interna, Hospital Vega Baja, Orihuela (Valencia), Spain

i Servicio de Medicina Interna, Hospital Virgen del Camino, Sanlúcar de Barrameda (Cádiz), Spain

j Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Madrid, Spain

k Servicio de Medicina Interna, Hospital de Sagunto, Valencia, Spain

l Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain

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Given that ultrasonography competence is achieved within a short training period&#44; incorporating ultrasound training within the internal medicine specialty program is feasible&#46; Moreover&#44; the procedure lasts approximately 15<span class="elsevierStyleHsp" style=""></span>min and should therefore be acceptable for the internist&#39;s clinical practice&#46; This basic tool offers the following features&#58;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Streamlining of the diagnostic process&#44; which can provide a prognostic benefit in some cases&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">Screening of numerous diseases&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Monitoring of certain treatments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Implementation of invasive procedures&#44; such as extraction of fluids and cannulation of central venous pathways&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Assessment of the patient&#39;s hemodynamic and congestive state&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the main indications for clinical ultrasonography and the elements that should be assessed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Key aspects of clinical ultrasonography in internal medicine</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Patient safety</span><p id="par0045" class="elsevierStylePara elsevierViewall">Ultrasonography facilitates the safety of certain procedures&#46; Specifically&#44; the ultrasound-guided cannulation of central pathways markedly decreases associated complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">2&#8211;7</span></a> In the hands of nurses&#44; ultrasonography also enables the cannulation of peripheral pathways of complex access&#44; avoiding the need to use central venous catheters&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Other &#8220;interventionist&#8221; procedures in which ultrasonography is of considerable assistance include thoracentesis and paracentesis&#46; Reducing the risk of pneumothorax associated with thoracentesis is especially important&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">9&#44;10</span></a> Performing a blind thoracentesis is therefore considered inappropriate when the center has an ultrasound machine&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Another essential point related to patient safety is the promoting of measures that prevent nosocomial infections associated with the use of catheters and tubes&#46; Ultrasonography is useful for detecting acute urine retention and pathological postvoid residue and for monitoring blood volume and central venous pressure&#46; Ultrasonography could help reduce the indications for bladder catheterization in internal medicine departments&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The increase in ultrasound-guided cannulation of peripheral venous pathways under conditions of difficult venous access decreases the use of central pathways and thereby the infections associated with central catheters&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">4&#44;12&#8211;15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical ultrasonography as a supplement to physical examinations</span><p id="par0065" class="elsevierStylePara elsevierViewall">Physical examinations are a subjective diagnostic procedure&#44; whose precision and reliability vary significantly and depend on the physician&#39;s ability and patient&#39;s characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Clinical ultrasonography is an excellent supplement for improving the cost-effectiveness of classical physical examinations&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">17&#8211;19</span></a> Ultrasonography helps visualize and objectively measure the structures and their potential abnormalities&#46; For example&#44; ultrasonography is especially useful for detecting and quantifying pleural effusion&#44; pericardial effusion and ascites&#44; assessing and typing heart murmurs&#44; calculating the central venous pressure and detecting aortic aneurysms&#44; processes that can go unnoticed during conventional physical examinations&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinical ultrasonography in the patient follow-up</span><p id="par0075" class="elsevierStylePara elsevierViewall">Board-certified ultrasonography is useful for accurately assessing patients on an as-needed basis &#40;&#8220;freeze frame&#8221;&#41; but is obviously not feasible for implementing on a frequent basis&#46; Clinical ultrasonography can be efficiently applied at the point of care in a &#8220;serial&#8221; or &#8220;dynamic&#8221; manner to a patient to monitor certain complications &#40;pulmonary congestion&#44; pleural effusion&#44; ascites&#44; blood volume estimation&#44; cholestasis&#44; etc&#46;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In a significant percentage of patients who are admitted to internal medicine departments&#44; a progressive follow-up of multiple medical complications is essential&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">21&#8211;27</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Multiorgan ultrasonography</span><p id="par0085" class="elsevierStylePara elsevierViewall">In some clinical scenarios&#44; such as patients with dyspnea&#44; shock or suspected thromboembolism disease&#44; the comprehensive ultrasound assessment of various organs is highly useful for the diagnosis and follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">20&#44;28&#8211;31</span></a> The characteristic specialization of the radiology and cardiology departments limits the implementation of these types of procedures&#44; which can be performed by general practitioners&#46; Moreover&#44; some organs such as the lungs can be considered orphans from the ultrasound viewpoint&#46;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">26&#44;27</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Limitations of clinical ultrasonography</span><p id="par0090" class="elsevierStylePara elsevierViewall">The characteristics of patients treated in internal medicine departments frequently hinder the ability to obtain good acoustic windows&#44; a fact that needs to be considered when training internists in the use of ultrasonography&#46; Another limitation is the type of ultrasound&#44; which should be standardized according to the competencies assumed by the practitioner&#46; There are systematic errors that should also be considered when learning clinical ultrasonography&#44; such as obtaining inadequate images and the lack of systemization in the implementation of the study&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Settings for the use of clinical ultrasonography in internal medicine</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Emergency department and hospital ward</span><p id="par0095" class="elsevierStylePara elsevierViewall">Point-of-care ultrasonography is extraordinarily useful as a supplement to physical examinations in these healthcare settings&#44; especially in life-threatening situations&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Specialized consultations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Clinical ultrasonography can be of considerable use in this type of consultation&#44; in which internists can acquire experience and skill in assessing specific aspects of ultrasonography &#40;&#8220;limited ultrasonography&#8221;&#41;&#44; similar or even superior to those performed in other departments&#46; Some examples are listed below&#58;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Consultation for cardiovascular risk</span><p id="par0105" class="elsevierStylePara elsevierViewall">Ultrasonography is essential in detecting subclinical lesions of target organs &#40;carotid&#44; heart&#44; leg arteries&#44; abdominal aorta&#41;&#44; which helps improve the estimate of cardiovascular risk and treatment optimization&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">33&#8211;40</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Consultation for heart failure</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ultrasonography is essential in the diagnosis and follow-up of patients with heart failure&#46; Ultrasonography helps monitor pulmonary congestion &#40;quantifying B-lines&#44; pleural effusion&#41;&#44; central venous pressure &#40;size and collapse of the inferior vena cava&#41; and ascites&#46; The tool can also be of value for adjusting the diuretic treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">22&#44;41&#8211;43</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Other consultations</span><p id="par0115" class="elsevierStylePara elsevierViewall">Ultrasonography can also be practical in rapid diagnosis consultations&#44; chronic-complex patient consultations and in specialized consultations of systemic autoimmune diseases &#40;detection and monitoring of interstitial lung disease&#44; pulmonary hypertension&#44; joint involvement&#44; etc&#46;&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Alternatives to conventional hospitalization</span><p id="par0120" class="elsevierStylePara elsevierViewall">Portable ultrasound machines enable the comprehensive evaluation of patients outside the hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">32&#44;44&#44;45</span></a> There is sufficient evidence to confirm that ultrasonography can substitute chest radiography for the diagnosis and follow-up of pneumonia and heart failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">46&#44;47</span></a> Ultrasound can therefore be of considerable assistance for palliative medicine and home care physicians&#44; including nursing homes&#46;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">48&#44;49</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical ultrasonography in undergraduate training and research</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Undergraduate training</span><p id="par0125" class="elsevierStylePara elsevierViewall">The training of basic clinical ultrasonography does not take long and facilitates training in anatomy&#44; physiology and pathophysiology&#46; Most importantly&#44; the training improves the performance and reliability of the physical examination&#46; Ultrasound training for medical students is implemented progressively in numerous faculties&#44; especially in the United States and Germany&#46;<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">50&#8211;53</span></a> This training requires sufficiently qualified teachers&#44; human resources and sufficient materials for the individual training of a large number of students&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In recent years&#44; the Clinical Ultrasonography workgroup of the Spanish Society of Internal Medicine &#40;SEMI&#41; has been developing a practical undergraduate teaching system for ultrasonography&#44; based on the integration of students as teachers&#46; Thus&#44; after a small group of students have been trained&#44; these students can in turn teach their classmates &#40;&#8220;peer mentoring&#8221;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">54&#44;55</span></a> This teaching model is easily exportable to any department of internal medicine involved in teaching undergraduate and postgraduate courses&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Research</span><p id="par0135" class="elsevierStylePara elsevierViewall">The number of publications related to clinical ultrasonography has grown exponentially in recent years&#46; The first example was the development of lung ultrasonography in critical patients&#44; followed by studies on the use of clinical ultrasonography in cardiac arrest&#44; hypotension-shock and the diagnosis of dyspnea&#46; Other lines of research related to the internal medicine field include cardiovascular risk&#44; heart failure and autoimmune diseases&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Recommendations on the training of internal medicine residents and specialists in general clinical ultrasonography</span><p id="par0140" class="elsevierStylePara elsevierViewall">The established rotation model is based on the combination of scientific evidence and the experience of numerous training centers that have been progressively set up in Spain in the past 10 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">56&#8211;60</span></a> There is still the need for a common accreditation system&#44; which will come from the inclusion of clinical ultrasonography in the official program of the specialty&#46;</p><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Objectives</span><p id="par0145" class="elsevierStylePara elsevierViewall">The general objective is to understand the foundations of point-of-care ultrasonography as a supplement to the physical examination&#46; The aspects that students should learn are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> of this document&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In addition to a rotation in general clinical ultrasonography&#44; residents may request a rotation in a center that has experience in specific areas of clinical ultrasonography&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Duration and number of examinations</span><p id="par0155" class="elsevierStylePara elsevierViewall">The optimal duration of a training cycling is 4 to 8 weeks&#46; During this time&#44; the resident should perform at least 150 supervised multiorgan ultrasounds on various selected patients&#46; This workload consists of performing 5 examinations per day&#44; which ensures the acquisition of technical skills to optimally view the basic layers of each organ and the application of the technique to an appropriate case mix&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows an approach for the components and learning times of basic ultrasound training&#44; separated into 3 sequential levels according to their difficulty&#46; Undoubtedly&#44; the basic echocardiographic layers are the most complicated to learn&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ultrasound examination system</span><p id="par0165" class="elsevierStylePara elsevierViewall">Each clinical ultrasound examination should systematically include the pulmonary&#44; cardiac and abdominal assessment&#46; Depending on the medical indication&#44; other structures may be added&#44; such as the carotid territory&#44; deep venous system of the legs and temporal artery&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Material resources</span><p id="par0170" class="elsevierStylePara elsevierViewall">An ultrasound machine should be available for every 2 internists on rotation and should be portable&#44; for performing point-of-care examinations&#46; The equipment should have at least 2D and color Doppler images&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Supervision</span><p id="par0175" class="elsevierStylePara elsevierViewall">Ultrasound examinations should be supervised&#44; especially during the first week of rotation&#46; The resident should then perform ultrasonography independently&#44; requesting supervision by the tutor on demand and storing the images for subsequent consultation&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Activity record</span><p id="par0180" class="elsevierStylePara elsevierViewall">All ultrasound activity should be recorded in a patient file in which detected pathological findings are noted&#46; Ultrasounds can thereby be quantified and the findings compared with those from board-certified ultrasounds and other additional tests available to the patient&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The results of the supervised ultrasound examinations should be reflected in the patient&#39;s medical history in the same way the results of classical physical examinations are reflected&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Assessing the level of competence</span><p id="par0190" class="elsevierStylePara elsevierViewall">Upon completion of the rotation period&#44; the tutor will have proof of the number of examinations performed by each resident to qualify the level of acquired competence&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">SEMI will define&#44; with the advice of the Clinical Ultrasonography workgroup&#44; homogeneous criteria for assessing the level of competence in general clinical ultrasonography and thereby establish specific accreditation&#46; SEMI is also working with the SEC and other scientific societies to develop joint accreditation in echocardiography&#46;</p></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">SEMI and the Clinical Ultrasonography workgroup recommend the incorporation of clinical ultrasonography into the internist&#39;s standard clinical practice&#46; To this end&#44; the training of residents and specialists in internal medicine needs to be promoted and facilitated&#46; To achieve these objectives&#44; ultrasound equipment should be acquired by internal medicine departments&#46; Through the National Committee of Internal Medicine&#44; SEMI will propose the incorporation of clinical ultrasonography in the training program for the specialty&#46;</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting&#44; from its fundamental indications to the recommended training period&#46; There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings &#40;emergencies&#44; hospital ward&#44; general and specific consultations and home care&#41;&#46; Ultrasonography has a relevant impact on the practitioner&#39;s ability to resolve issues&#44; increasing diagnostic reliability and safety and providing important information on the prognosis and progression&#46; In recent years&#44; ultrasonography has been incorporated as a tool in undergraduate teaching&#44; with excellent results&#46; The use of ultrasonography needs to be widespread&#46; To accomplish this&#44; we must encourage structured training and the acquisition of equipment&#46; This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Este documento de posicionamiento describe los aspectos m&#225;s importantes de la ecograf&#237;a cl&#237;nica en el &#225;mbito de la Medicina Interna&#44; desde sus indicaciones fundamentales hasta el per&#237;odo de formaci&#243;n recomendado&#46; Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la pr&#225;ctica cl&#237;nica habitual del internista en m&#250;ltiples escenarios cl&#237;nicos y &#225;mbitos de actuaci&#243;n &#40;urgencias&#44; planta de hospitalizaci&#243;n&#44; consulta general y espec&#237;fica y atenci&#243;n domiciliaria&#41;&#46; Su uso tiene un impacto relevante en la capacidad de resoluci&#243;n del profesional&#44; al aumentar su fiabilidad y seguridad diagn&#243;stica&#44; adem&#225;s de proporcionar informaci&#243;n pron&#243;stica y evolutiva importante&#46; Adem&#225;s&#44; en los &#250;ltimos a&#241;os se ha incorporado como una herramienta en la ense&#241;anza pregrado con excelentes resultados&#46; Por tanto&#44; es necesario generalizar su uso y para ello se debe fomentar la formaci&#243;n estructurada y la adquisici&#243;n de equipos&#46; El documento ha sido elaborado por el Grupo de Trabajo de Ecograf&#237;a Cl&#237;nica y avalado por la Sociedad Espa&#241;ola de Medicina Interna&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Torres Macho J&#44; Garc&#237;a S&#225;nchez FJ&#44; Garmilla Ezquerra P&#44; Beltr&#225;n Romero L&#44; Canora Lebrato J&#44; Casas Rojo JM&#44; et al&#46; Documento de posicionamiento sobre la incorporaci&#243;n de la ecograf&#237;a cl&#237;nica en los servicios de Medicina Interna&#46; Rev Clin Esp&#46; 2018&#59;218&#58;192&#8211;198&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Extrahepatic assessment of the gallbladder and bile duct&#46; Cholelithiasis&#44; cholecystitis&#46; Assessment of patients with cholestasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Assessment of patients with chronic liver disease and portal hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;b&#41; Echocardiography&#58;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Detection and estimation of severity of pericardial effusion&#46; Diagnosis of tamponade&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Identification of possible significant valvular heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Estimation of blood volume and central venous pressure&#58; inferior vena cava&#44; suprahepatic veins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;c&#41; Urological ultrasonography&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Detection of hydronephrosis and bladder balloon&#46; Renal diameter and echogenicity&#46; Assessment of patients with renal failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;d&#41; Pulmonary ultrasonography&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Identification of pneumothorax&#44; pleural effusion&#44; interstitial syndrome and pulmonary condensation &#40;pneumonia&#41;&#46; Usefulness of pulmonary ultrasonography for assessing patients with dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;e&#41; Vascular ultrasonography&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Detection of thoracic and abdominal aortic aneurysm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Detection of deep vein thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Detection of carotid plaques&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;f&#41; Invasive procedures with ultrasound control&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Cannulation of central and peripheral pathways&#44; thoracentesis&#44; paracentesis and arthrocentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#40;g&#41; Multiorgan ultrasonography&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Usefulness of ultrasonography for assessing venous thromboembolism disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Assessment of patients in shock&#46; Assessment of patients in shock&#44; in cardiopulmonary arrest or electromechanical dissociation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>- Overall assessment of cardiovascular risk&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Level 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney and urinary bladder&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Echocardiography&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deep venous system of the lower limbs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary ultrasonography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ecocardiograf&#237;a cl&#237;nica en Medicina Interna"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Torres Macho"
                            1 => "G&#46; Garcia de Casasola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2012"
                        "volumen" => "138"
                        "paginaInicial" => "567"
                        "paginaFinal" => "569"
                      ]
                    ]
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              "identificador" => "bib0310"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The top patient safety strategies that can be encouraged for adoption now"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;G&#46; Shekelle"
                            1 => "P&#46;J&#46; Pronovost"
                            2 => "R&#46;M&#46; Wachter"
                            3 => "K&#46;M&#46; McDonald"
                            4 => "K&#46; Schoelles"
                            5 => "S&#46;M&#46; Dy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-158-5-201303051-00001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2013"
                        "volumen" => "158"
                        "paginaInicial" => "365"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23460091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0315"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasonic locating devices for central venous cannulation&#58; meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Hind"
                            1 => "N&#46; Calvert"
                            2 => "R&#46; McWilliams"
                            3 => "A&#46; Davidson"
                            4 => "S&#46; Paisley"
                            5 => "C&#46; Beverley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.327.7411.361"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "327"
                        "paginaInicial" => "361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12919984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lamperti"
                            1 => "A&#46;R&#46; Bodenham"
                            2 => "M&#46; Pittiruti"
                            3 => "M&#46; Blaivas"
                            4 => "J&#46;G&#46; Augoustides"
                            5 => "M&#46; Elbarbary"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2597-x"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241"
                            "web" => "Medline"
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              "identificador" => "bib0325"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Special articles&#58; Guidelines for performing ultrasound guided vascular cannulation&#58; recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
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                            1 => "G&#46;S&#46; Hartman"
                            2 => "K&#46;E&#46; Glas"
                            3 => "N&#46;J&#46; Skubas"
                            4 => "R&#46;T&#46; Eberhardt"
                            5 => "J&#46;D&#46; Walker"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1213/ANE.0b013e3182407cd8"
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                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2012"
                        "volumen" => "114"
                        "paginaInicial" => "46"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22127816"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Ultrasound-guided vascular access&#58; a comprehensive review"
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                          "autores" => array:3 [
                            0 => "M&#46;M&#46; Weiner"
                            1 => "P&#46; Geldard"
                            2 => "A&#46;J&#46; Mittnacht"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jvca.2012.07.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiothorac Vasc Anesth"
                        "fecha" => "2013"
                        "volumen" => "27"
                        "paginaInicial" => "345"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22995457"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
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                      "titulo" => "Real-time two-dimensional ultrasound guidance for central venous cannulation&#58; a meta-analysis"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Wu"
                            1 => "Q&#46; Ling"
                            2 => "L&#46;H&#46; Cao"
                            3 => "J&#46; Wang"
                            4 => "M&#46;X&#46; Xu"
                            5 => "W&#46;A&#46; Zeng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e31827bd172"
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                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2013"
                        "volumen" => "118"
                        "paginaInicial" => "361"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23249991"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0340"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implementation of a successful registered nurse peripheral ultrasound-guided intravenous catheter program in an emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Miles"
                            1 => "A&#46; Salcedo"
                            2 => "D&#46; Spear"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jen.2011.02.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Nurs"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "353"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21514651"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0345"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sonographically guided thoracentesis and rate of pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;W&#46; Barnes"
                            1 => "T&#46;I&#46; Morgenthaler"
                            2 => "E&#46;J&#46; Olson"
                            3 => "G&#46;K&#46; Hesley"
                            4 => "P&#46;A&#46; Decker"
                            5 => "J&#46;H&#46; Ryu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jcu.20163"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Ultrasound"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "paginaInicial" => "442"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16281263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumothorax following thoracentesis&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;E&#46; Gordon"
                            1 => "D&#46; Feller-Kopman"
                            2 => "E&#46;M&#46; Balk"
                            3 => "G&#46;W&#46; Smetana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinternmed.2009.548"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2010"
                        "volumen" => "170"
                        "paginaInicial" => "332"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20177035"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effectiveness of implementing a bladder ultrasound programme in neurosurgical units"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46;Y&#46; Lee"
                            1 => "W&#46;L&#46; Tsay"
                            2 => "M&#46;F&#46; Lou"
                            3 => "Y&#46;T&#46; Dau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2648.2006.04080.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Adv Nurs"
                        "fecha" => "2007"
                        "volumen" => "57"
                        "paginaInicial" => "192"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17214755"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0360"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;K&#46; Au"
                            1 => "M&#46;J&#46; Rotte"
                            2 => "R&#46;J&#46; Grzybowski"
                            3 => "B&#46;S&#46; Ku"
                            4 => "J&#46;M&#46; Fields"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2012.04.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "1950"
                        "paginaFinal" => "1954"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795988"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0365"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided peripheral venous access vs&#46; the external jugular vein as the initial approach to the patient with difficult vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;G&#46; Costantino"
                            1 => "J&#46;F&#46; Kirtz"
                            2 => "W&#46;A&#46; Satz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2009.02.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "462"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19303238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound guidance for difficult peripheral venous access&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Egan"
                            1 => "D&#46; Healy"
                            2 => "H&#46; O&#8217;Neill"
                            3 => "M&#46; Clarke-Moloney"
                            4 => "P&#46;A&#46; Grace"
                            5 => "S&#46;R&#46; Walsh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/emermed-2012-201652"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "521"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22886890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0375"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Shokoohi"
                            1 => "K&#46; Boniface"
                            2 => "M&#46; McCarthy"
                            3 => "T&#46; Khedir Al-tiae"
                            4 => "M&#46; Sattarian"
                            5 => "R&#46; Ding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.annemergmed.2012.09.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "198"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23141920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0380"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based physical diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; McGee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "Elsevier Saunders"
                        "editorialLocalizacion" => "Philadelphia"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0385"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empowering physical examination&#58; the &#171;laying on&#187; of ultrasound"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;J&#46; Kimura"
                            1 => "A&#46;N&#46; Demaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2008.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2008"
                        "volumen" => "1"
                        "paginaInicial" => "602"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19356488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac limited ultrasound examination techniques to augment the bedside cardiac physical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;J&#46; Kimura"
                            1 => "D&#46;J&#46; Shaw"
                            2 => "S&#46;A&#46; Amundson"
                            3 => "J&#46;N&#46; Phan"
                            4 => "D&#46;G&#46; Blanchard"
                            5 => "A&#46;N&#46; DeMaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7863/ultra.15.14.09002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "1683"
                        "paginaFinal" => "1690"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26269293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0395"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;M&#46; Stokke"
                            1 => "V&#46; Ruddox"
                            2 => "S&#46;I&#46; Sarvari"
                            3 => "J&#46;E&#46; Otterstad"
                            4 => "E&#46; Aune"
                            5 => "T&#46; Edvardsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2014.08.001"
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                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2014"
                        "volumen" => "27"
                        "paginaInicial" => "1238"
                        "paginaFinal" => "1246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25216765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0400"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Nazerian"
                            1 => "S&#46; Vanni"
                            2 => "G&#46; Volpicelli"
                            3 => "C&#46; Gigli"
                            4 => "M&#46; Zanobetti"
                            5 => "M&#46; Bartolucci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.13-1087"
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                        "tituloSerie" => "Chest"
                        "fecha" => "2014"
                        "volumen" => "145"
                        "paginaInicial" => "950"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure&#58; a lung ultrasound study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Gargani"
                            1 => "P&#46;S&#46; Pang"
                            2 => "F&#46; Frassi"
                            3 => "M&#46;H&#46; Miglioranza"
                            4 => "F&#46;L&#46; Dini"
                            5 => "P&#46; Landi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12947-015-0033-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cardiovasc Ultrasound"
                        "fecha" => "2015"
                        "volumen" => "13"
                        "paginaInicial" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26337295"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Cubo-Romano"
                            1 => "J&#46; Torres-Macho"
                            2 => "N&#46;J&#46; Soni"
                            3 => "L&#46;F&#46; Reyes"
                            4 => "A&#46; Rodr&#237;guez-Almod&#243;var"
                            5 => "J&#46;M&#46; Fern&#225;ndez-Alonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jhm.2620"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Med"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "paginaInicial" => "778"
                        "paginaFinal" => "784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27264844"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "S&#46;N&#46; Goonewardena"
                            1 => "A&#46; Gemignani"
                            2 => "A&#46; Ronan"
                            3 => "S&#46; Vasaiwala"
                            4 => "J&#46; Blair"
                            5 => "J&#46;M&#46; Brennan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2008.06.005"
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                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2008"
                        "volumen" => "1"
                        "paginaInicial" => "595"
                        "paginaFinal" => "601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19356487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0420"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A dilated inferior vena cava is a marker of poor survival"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Nath"
                            1 => "J&#46;L&#46; Vacek"
                            2 => "P&#46;A&#46; Heidenreich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2005.04.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2006"
                        "volumen" => "151"
                        "paginaInicial" => "730"
                        "paginaFinal" => "735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16504642"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0425"
              "etiqueta" => "25"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "IVC diameter in patients with chronic heart failure&#58; relationships and prognostic significance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Pellicori"
                            1 => "V&#46; Carubelli"
                            2 => "J&#46; Zhang"
                            3 => "T&#46; Castiello"
                            4 => "N&#46; Sherwi"
                            5 => "A&#46;L&#46; Clark"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2012.08.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "16"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung sonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Volpicelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "165"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23269722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            26 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of chest ultrasonography in the management of respiratory diseases&#58; document I"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Zanforlin"
                            1 => "R&#46; Giannuzzi"
                            2 => "S&#46; Nardini"
                            3 => "A&#46; Testa"
                            4 => "G&#46; Soldati"
                            5 => "R&#46; Copetti"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/2049-6958-8-54"
                      "Revista" => array:5 [
                        "tituloSerie" => "Multidiscip Respir Med"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23937880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0440"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Al Deeb"
                            1 => "S&#46; Barbic"
                            2 => "R&#46; Featherstone"
                            3 => "J&#46; Dankoff"
                            4 => "D&#46; Barbic"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/acem.12435"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "843"
                        "paginaFinal" => "852"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25176151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            28 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RUSH exam&#58; rapid ultrasound in shock in the evaluation of the critically ill"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Perera"
                            1 => "T&#46; Mailhot"
                            2 => "D&#46; Riley"
                            3 => "D&#46; Mandavia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.emc.2009.09.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med Clin North Am"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "29"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            29 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sonography in hypotension and cardiac arrest &#40;SHoC&#41;&#58; rates of abnormal findings in undifferentiated hypotension and during cardiac arrest as a basis for consensus on a hierarchical point of care ultrasound protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Milne"
                            1 => "P&#46; Atkinson"
                            2 => "D&#46; Lewis"
                            3 => "J&#46; Fraser"
                            4 => "L&#46; Diegelmann"
                            5 => "P&#46; Olszynski"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7759/cureus.564"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cureus"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "paginaInicial" => "e564"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27190729"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0455"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinically integrated multi-organ point-of-care ultrasound for undifferentiated respiratory difficulty&#44; chest pain&#44; or shock&#58; a critical analytic review"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "H&#46;C&#46; Toh"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40560-016-0172-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Intensive Care"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "paginaInicial" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27529030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergency ultrasound guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American College of Emergency Physicians"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.annemergmed.2008.12.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "550"
                        "paginaFinal" => "570"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19303521"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0465"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk prediction is improved by adding markers of subclinical organ damage to SCORE"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Sehestedt"
                            1 => "J&#46; Jeppesen"
                            2 => "T&#46;W&#46; Hansen"
                            3 => "K&#46; Wachtell"
                            4 => "H&#46; Ibsen"
                            5 => "C&#46; Torp-Pedersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehp546"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "883"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20034972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0470"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Focused vascular ultrasound for the assessment of atherosclerosis&#58; a proof-of-concept study"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;M&#46; Johri"
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                            2 => "M&#46;F&#46; Matangi"
                            3 => "J&#46; MacHaalany"
                            4 => "M&#46;F&#46; H&#233;tu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2016.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2016"
                        "volumen" => "29"
                        "paginaInicial" => "842"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27342940"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0475"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Carotid intima media thickness and its utility as a predictor of cardiovascular disease&#58; a review of evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "H&#46; Sinclair"
                            2 => "V&#46; Kunadian"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CRD.0000000000000077"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiol Rev"
                        "fecha" => "2016"
                        "volumen" => "24"
                        "paginaInicial" => "70"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26825762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            35 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of primary care physicians&#8217; use of a pocket ultrasound device to measure left ventricular mass in patients with hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46; Johnson"
                            2 => "S&#46; Tiglao"
                            3 => "A&#46; Moghul"
                            4 => "S&#46; Swain"
                            5 => "G&#46; Bornemann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3122/jabfm.2015.06.140314"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Board Fam Med"
                        "fecha" => "2015"
                        "volumen" => "28"
                        "paginaInicial" => "706"
                        "paginaFinal" => "712"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26546645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            36 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Left ventricular hypertrophy&#44; aortic wall thickness&#44; and lifetime predicted risk of cardiovascular disease&#58; the Dallas Heart Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46;D&#46; Berry"
                            2 => "C&#46;R&#46; Ayers"
                            3 => "R&#46;M&#46; Peshock"
                            4 => "A&#46; Khera"
                            5 => "J&#46;A&#46; de Lemos"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2010.03.005"
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                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2010"
                        "volumen" => "3"
                        "paginaInicial" => "605"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541716"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diastolic dysfunction and left auricular volume&#58; a population-based study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Pritchett"
                            1 => "D&#46;W&#46; Mahoney"
                            2 => "S&#46;J&#46; Jacobsen"
                            3 => "R&#46;J&#46; Rodeheffer"
                            4 => "B&#46;L&#46; Karon"
                            5 => "M&#46;M&#46; Redfield"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2004.09.054"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "87"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15629380"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones de la gu&#237;a para el diagn&#243;stico y tratamiento del aneurisma de aorta abdominal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Lahoz"
                            1 => "C&#46; Esteban Gracia"
                            2 => "L&#46; Reinares Garc&#237;a"
                            3 => "S&#46; Bellmunt Montoya"
                            4 => "&#193;&#46; Brea Hernando"
                            5 => "&#193;&#46; Fern&#225;ndez Heredero"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arteri.2015.01.004"
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                        "tituloSerie" => "Clin Investig Arterioscler"
                        "fecha" => "2015"
                        "volumen" => "27"
                        "paginaInicial" => "159"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25835613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC&#47;AHA 2005 guidelines for the management of patients with peripheral arterial disease &#40;lower extremity&#44; renal&#44; mesenteric&#44; and abdominal aortic&#41;&#58; executive summary a collaborative report from the American Association for Vascular Surgery&#47;Society for Vascular Surgery&#44; Society for Cardiovascular Angiography and Interventions&#44; Society for Vascular Medicine and Biology&#44; Society of Interventional Radiology&#44; and the ACC&#47;AHA Task Force on Practice Guidelines &#40;Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease&#41; endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation&#59; National Heart&#44; Lung&#44; and Blood Institute&#59; Society for Vascular Nursing&#59; TransAtlantic Inter-Society Consensus&#59; and Vascular Disease Foundation"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "Z&#46;J&#46; Haskal"
                            2 => "N&#46;R&#46; Hertzer"
                            3 => "C&#46;W&#46; Bakal"
                            4 => "M&#46;A&#46; Creager"
                            5 => "J&#46;L&#46; Halperin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.10.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "1239"
                        "paginaFinal" => "1312"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16545667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0505"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Platz"
                            1 => "E&#46;F&#46; Lewis"
                            2 => "H&#46; Uno"
                            3 => "J&#46; Peck"
                            4 => "E&#46; Pivetta"
                            5 => "A&#46;A&#46; Merz"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "2015 ESC&#47;ERS Guidelines for the diagnosis and treatment of pulmonary hypertension&#58; The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology &#40;ESC&#41; and the European Respiratory Society &#40;ERS&#41;&#58; Endorsed by&#58; Association for European Paediatric and Congenital Cardiology &#40;AEPC&#41;&#44; International Society for Heart and Lung Transplantation &#40;ISHLT&#41;"
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                            3 => "S&#46; Gibbs"
                            4 => "I&#46; Lang"
                            5 => "A&#46; Torbicki"
                          ]
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                        "paginaInicial" => "67"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26320113"
                            "web" => "Medline"
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                0 => array:2 [
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                            3 => "K&#46; Skjetne"
                            4 => "J&#46;O&#46; Kleinau"
                            5 => "T&#46; Graven"
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                      ]
                    ]
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                        "link" => array:1 [
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                            "web" => "Medline"
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                          "etal" => false
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                            1 => "D&#46;A&#46; Johnson"
                            2 => "J&#46;E&#46; Pierog"
                            3 => "B&#46;E&#46; Zaia"
                            4 => "S&#46;R&#46; Williams"
                            5 => "L&#46; Gharahbaghian"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "West J Emerg Med"
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                        "paginaInicial" => "503"
                        "paginaFinal" => "509"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26265961"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography"
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                            3 => "C&#46; Gigli"
                            4 => "L&#46; Betti"
                            5 => "M&#46; Bartolucci"
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Emerg Med"
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                        "paginaInicial" => "620"
                        "paginaFinal" => "625"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758182"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0535"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosing acute heart failure in the emergency department&#58; a systematic review and meta-analysis"
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                            1 => "A&#46; Wakai"
                            2 => "S&#46;P&#46; Collins"
                            3 => "P&#46;D&#46; Levy"
                            4 => "D&#46; Diercks"
                            5 => "B&#46;C&#46; Hiestand"
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                    0 => array:2 [
                      "doi" => "10.1111/acem.12878"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2016"
                        "volumen" => "23"
                        "paginaInicial" => "223"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26910112"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Palliative ultrasound for home care hospice patients"
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                            1 => "J&#46;A&#46; Setla"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1553-2712.2009.00678.x"
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                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "293"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20370762"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Bedside ultrasound-experience in a palliative care unit"
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                            1 => "I&#46; Trotman"
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                        "tituloSerie" => "Eur J Cancer Care &#40;Engl&#41;"
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                        "volumen" => "18"
                        "paginaInicial" => "642"
                        "paginaFinal" => "644"
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                    ]
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                      "titulo" => "The state of ultrasound education in U&#46;S&#46; medical schools&#58; results of a national survey"
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                          "etal" => false
                          "autores" => array:5 [
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                            2 => "D&#46; Way"
                            3 => "N&#46;A&#46; Royall"
                            4 => "Y&#46;T&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACM.0000000000000414"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Med"
                        "fecha" => "2014"
                        "volumen" => "89"
                        "paginaInicial" => "1681"
                        "paginaFinal" => "1686"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25099238"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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              "etiqueta" => "51"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "An integrated ultrasound curriculum &#40;iUSC&#41; for medical students&#58; 4-year experience"
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                          "etal" => true
                          "autores" => array:6 [
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                            3 => "D&#46;B&#46; Howe"
                            4 => "P&#46;S&#46; Hunt"
                            5 => "S&#46;D&#46; Fowler"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13089-011-0052-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Ultrasound J"
                        "fecha" => "2011"
                        "volumen" => "3"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21516137"
                            "web" => "Medline"
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              "identificador" => "bib0560"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Successful strategies for integrating bedside ultrasound into undergraduate medical education"
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                          "autores" => array:1 [
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                    0 => array:2 [
                      "doi" => "10.7205/MILMED-D-14-00573"
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                        "tituloSerie" => "Mil Med"
                        "fecha" => "2015"
                        "volumen" => "180"
                        "paginaInicial" => "153"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25850144"
                            "web" => "Medline"
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              "etiqueta" => "53"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Feasibility of a focused ultrasound training programme for medical undergraduate students"
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                          "etal" => false
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                      "doi" => "10.1111/j.1743-498X.2010.00416.x"
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                        "tituloSerie" => "Clin Teach"
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                        "paginaInicial" => "3"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                    0 => array:2 [
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                            2 => "J&#46;M&#46; Casas Rojo"
                            3 => "P&#46; Cubo Romano"
                            4 => "J&#46;M&#46; Anton Santos"
                            5 => "V&#46; Villena Garrido"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2013.09.006"
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                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2014"
                        "volumen" => "214"
                        "paginaInicial" => "131"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24168817"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Ense&#241;anza de la ecograf&#237;a cl&#237;nica en el pregrado&#58; los estudiantes como mentores"
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                            3 => "E&#46; Mu&#241;oz Aceituno"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "fecha" => "2015"
                        "volumen" => "215"
                        "paginaInicial" => "211"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25583252"
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                      "titulo" => "Internal Medicine point-of-care ultrasound curriculum&#58; consensus recommendations from the Canadian Internal Medicine Ultrasound &#40;CIMUS&#41; Group"
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                        0 => array:2 [
                          "etal" => true
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                            3 => "J&#46; Desy"
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                        "tituloSerie" => "J Gen Intern Med"
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                        "paginaFinal" => "1057"
                        "link" => array:1 [
                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "International Federation of Emergency Medicine point of care ultrasound curriculum"
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                            4 => "V&#46; Noble"
                            5 => "B&#46; Jarman"
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                        "tituloSerie" => "CJEM"
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                        "paginaInicial" => "161"
                        "paginaFinal" => "170"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26052968"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0590"
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
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                            2 => "M&#46; Nadjafi"
                            3 => "R&#46; Cavalcanti"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Med Educ J"
                        "fecha" => "2016"
                        "volumen" => "7"
                        "paginaInicial" => "e51"
                        "paginaFinal" => "e69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28344709"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0595"
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        "texto" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The authors would like to thank Dr&#46; Miquel Aranda for his support in including clinical ultrasonography in the training program of the internal medicine specialty&#46; We would also like to thank the Board of Directors of SEMI and all members of the Clinical Ultrasonography workgroup of SEMI&#46;</p>"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2018.02.004

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2023 March	13	4	17
2020 September	0	1	1
2019 April	1	2	3
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2018 May	0	2	2
2018 April	0	2	2

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