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The ultrasound academy at Capio S:t Göran Hospital in Stockholm.

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Argirios Argiriou:
Translation from Swedish to English and underlining: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

18/10/2017, Läkartidningen (The weekly Swedish Medicine Journal).



The ultrasound academy takes a holistic approach

Set the standard for the entire hospital

Capio S: t Göran Hospital in Stockholm is the first in Sweden with a holistic approach to getting all doctors to work the same way with patient-related ultrasound. In the long run, the goal is for the rest of the country to hook up on the concept.

Here is the lung, says Nina Moeini, as she angled ultrasound probe to look better on the screen before she systematically works through the other protocols of the investigation protocol EFAST on an undamaged volunteer model.

The spleen, liver and right kidney. Diaphragm, bladder and lung bag. And so the heart, just like the EFAST protocol - extended focused assessment with ultrasound in case of trauma - prescribes.

- Nice! Four minutes, where you captured one and a half minutes on a training session, Leo Silvén Möller,registrar doctor in Internal Medicine, coaches when Nina Moeini leaves the probe after she had neither found
free fluid around the organs or fluid in the heartbone.

We are at the introductory course of the S: t Göran ultrasound academy - a project that will not only ensure that all doctors at the hospital who work with patient-related ultrasound have the same education and skills and that only the one who has been certified should use the technology .The aim is also that everyone should start saving images from ultrasound examinations and register the finds of every ultrasound examination that he or she performs.

Patient-related ultrasound simply means that the physician brings the ultrasound to the patient, as part of his clinical assessment or status, for example, at the Emergency Department, Intensive Care Unit or any clinic.

"We usually avoid saying that patient-related ultrasound is stethoscope 2.0. But for a long time, there has not been much happening in the clinical examination of the patient. It is still about squeezing, feeling, talking and listening with the stethoscope. Here's something that is an extension of our fingers so we can see inside the patient. We see this as a revolution, says Leo Silvén Möller, who heads the Ultrasound Academy together with Fredrik Hallgren, specialist in Anaesthesiology and Intensive Care.

They note that the use of patient-related ultrasound has increased explosively in recent years.

At the same time, so far, there has been no requirement for what a clinical doctor should have for education and skills to use the ultrasound.

"This means that you can not rely on being an experienced and competent colleague who has done the ultrasound examination and drew conclusions. There has also been no tradition either of documenting and reporting, "says Fredrik Hallgren.

According to Fredrik Hallgren, there are plenty of courses in patient-related ultrasound, as well as examples of individual clinics in hospitals in Sweden which have developed some standards of education at their own clinic.

- What makes the Ultrasound Academy at St. Göran's Hospital unique in Sweden is the overall approach. That we set a standard for the entire hospital. It does not matter if it's a Surgeon, an Internist or an Anaesthesiologist who has looked at the heart or gall bladder, he says, and continues:

"What makes our education program stand out is what happens after the course itself.

After having basic knowledge of patient-related ultrasound during the two-day introductory course, Nina Moeini and the five other participants will have experienced tutors to speak with when they collect a number of pictures from different ultrasound examinations that they have done.

In order to become certified practitioners of patient-related ultrasound, they are required to save a certain number of correct examinations and have passed a theoretical and practical test.

One key to successful launching such a project is to get along the entire hospital, including Hospital Managers, the Informatics Department of the Hospital, Medical Technicians and Doctors at various clinics, considers Leo Silvén Möller and Fredrik Hallgren.

An important piece is about being clear about the limitations of the patient-related ultrasound and that it is not the question of replacing diagnostic ultrasound that Radiologists and Clinical Physiologists are experts in.

- Internationally there has been resistance from Radiologists. But here there is an understanding that what we do is something completely different. In patient-related ultrasound we work with very clear targeted questions, "says Leo Silvén Möller.

- Is there free fluid around the abdominal organs? Does the heart pump well or bad? Much is about 'rule in'. If we see something there is probably there. But if we do not see anything, that does not mean that it is not there. We have been clear with all this and that has created a trust in the project, he continues.

Jesper Danielsson is a Radiologist and one of the experts who teach the course.

"I'm only positive that ultrasound is spread to the doctors who really need it - that is, those who are at the Emergency Department and Intensive Care Unit. It's great to have this supply, but without education and control it will be a little of an amusement park and not so good. But if you do it in this way that we practice ultrasound in this hospital, I only see benefits, he says.

Concerning resistance, at least from Radiologists from abroad, with releasing ultrasound technology to doctors outside the Radiology and Clinical Physiology Clinics, the Radiologist Jesper Danielsson thinks that, as in many times, it has to do with "territorial" thinking, which does not benefit the patient.

"It is my dream that Emergency Department Physicians and Anaesthesiologists - above all - should be able to use ultrasound, so that patients do not have to wait four hours extra for ultrasound in the Emergency Department. And Intensive Care Unit patients will not have to wait two hours for us to come up and do things.

Following a pilot round this spring, Fredrik Hallgren and Leo Silvén Möller have been informed by the hospital management that the project will run with a training program in the fall and spring.

In the long run, they hope to spread the concept. First locally within the Stockholm region and then, if it succeeds in getting a foothold, to the whole Sweden.

"We have a vision that more hospitals and regions will join this "train" to create what other countries already have: A national standard for the requirements for theoretical and practical training in Ultrasound for Clinical Doctors, for example the number of ultrasound examinations that should be done before a clinician is considered ready to work with patient-related ultrasound, says Fredrik Hallgren.

"We have already noticed a great interest in doing similar things elsewhere in the country," he continues.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

timex:
Δε νομίζω ότι αυτό θα το πει ποτέ κάποιος ακτινολόγος στην Ελλάδα. Οι άνθρωποι είναι πολύ μπροστά!

Argirios Argiriou:
Το παραπάνω άρθρο είναι πολύ ενδιαφέρον, κατά την γνώμη μου, και επίκαιρο. Δημοσιεύθηκε στις 18/10/2017 στο εβδομαδιαίο Περιοδικό του Πανσουηδικού Ιατρικού Συλλόγου ( Läkartidningen). Περιγράφει την προσπάθεια του Νοσοκομείου St Göran στην Στοκχόλμη να ομογενοποιήσει την εκπαίδευση των Κλινικών Ιατρών του Νοσοκομείου αυτού στην Υπερηχογραφία. Πρόκειται κυρίως για τους Ιατρούς που κατεβαίνουν και δουλεύουν στο Τμήμα Επειγόντων Περιστατικών αλλά και σε αυτούς που δουλεύουν στην Μονάδα Εντατικής Θεραπείας. Η ομογενοποίηση γίνεται μέσω πιστοποίησης που λαμβάνουν μετά από θεωρητικές και πρακτικές εξετάσεις αλλά και αφού έχουν πραγματοποιήσει και κάποιον αριθμό πετυχημένων υπερηχογραφιών.

timex:
Αυτό μπορεί να γίνει και στην Ελλάδα όταν γίνει η εξειδίκευση της επείγουσας ιατρικής.
Στο πανευρωπαϊκό συνέδριο επείγουσας ιατρικής υπήρχαν ειδικευόμενοι από Σουηδικά νοσοκομεία, οι οποίοι προσπαθούσαν να βρουν κάποιον από άλλη χώρα για να κάνουν μαθήματα υπερήχων. Βρήκαν ένα πρόγραμμα που γίνεται στη Σλοβενία και θα πήγαιναν να το παρακολουθήσουν. Μάλλον το κατάλαβαν αυτό οι Σουηδοί και αποφάσισαν να το κάνουν στη Σουηδία. Γιατί  η ειδικότητα της επείγουσας ιατρικής είναι κάτι καινούριο εκεί. Αν δεν κάνω λάθος ξεκίνησε πριν 3 χρόνια.

Argirios Argiriou:
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή ΕίσοδοςΑυτό μπορεί να γίνει και στην Ελλάδα όταν γίνει η εξειδίκευση της επείγουσας ιατρικής.
Στο πανευρωπαϊκό συνέδριο επείγουσας ιατρικής υπήρχαν ειδικευόμενοι από Σουηδικά νοσοκομεία, οι οποίοι προσπαθούσαν να βρουν κάποιον από άλλη χώρα για να κάνουν μαθήματα υπερήχων. Βρήκαν ένα πρόγραμμα που γίνεται στη Σλοβενία και θα πήγαιναν να το παρακολουθήσουν. Μάλλον το κατάλαβαν αυτό οι Σουηδοί και αποφάσισαν να το κάνουν στη Σουηδία. Γιατί  η ειδικότητα της επείγουσας ιατρικής είναι κάτι καινούριο εκεί. Αν δεν κάνω λάθος ξεκίνησε πριν 3 χρόνια.

--- Τέλος παράθεσης ---

Μόνο που στο συγκεκριμένο Νοσοκομείο προσπαθούν να δώσουν βασικές γνώσεις υπερηχογραφίας (συγκεκριμένα πράγματα όπως π.χ. το  FAST το eFAST , η εκτίμηση της Αορτής, Αγγειακή προσπέλαση υπό υπερηχογραφική καθοδήγηση και Ηχοκαρδιογραφία στην υποστήριξη της ζωής ( ELS ) σε όλους του Κλινικούς Ιατρούς του Νοσοκομείου που έρχονται σε επαφή με τα ΤΕΠ και την ΜΕΘ.
Οι περισσότεροι Ιατροί που δουλεύουν στα ΤΕΠ στην Σουηδία εξακολουθούν να ΜΗΝ είναι Επειγοντολόγοι.

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