Tag Archives: conference

Faculty group photo

SonoSweden 2014 course

At the end of January, Bret Nelson joined an incredible team of international a faculty for the largest SonoSweden course to date. Course director Christofer Muhr hosted this unique, intensive hands-on conference at the scenic Yasuragi hotel in Stockholm, Sweden. Over thirty faculty and one hundred participants took part in this three-day course.

Among the faculty were lung ultrasound pioneer Vicki Noble, Matt Dawson and Mike Mallin (creators of the Ultrasound Podscast) and others from around the globe.

Registration is not yet open for the 2015 course, but check out the SonoSweden website for a countdown timer- there were over 100 people on the waiting list for this year’s course!

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2013 Tri-State Ultrasound Fellow Conference

The first annual Tri-State Ultrasound Fellow Conference kicked off today at Lenox Hill Hospital in New York City. The first day of this two-day course focused on administrative issues in ultrasound, featuring nationally recognized speakers from all around the area.

Bret Nelson from the Icahn School of Medicine at Mount Sinai discussed faculty development, including:

  • Creating a niche
  • The educator portfolio
  • Making connections

Here are a few references from the talk:

 

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ACEP 2012- Ultrasound Management Course

 

The ACEP Emergency Ultrasound Section hosted its annual Ultrasound Management Course on Sunday October 7. This year’s course was organized by Vivek Tayal, Troy Foster and Bret Nelson. Special thanks to ACEP organizers Marilyn Bromley and Julie Williams who were instrumental in putting the course together.

Almost 120 participants registered for this full-day course which served as a whirlwind introduction to the operational aspects of emergency ultrasound. Participants interacted with each other as well as national ultrasound leaders in small group breakout sessions covering topics such as quality assurance, image management systems, reimbursement issues, and others.

Faculty for the course (listed below) hailed from across the United States and brought enormous expertise to bear in their lectures and small group sessions.  We look forward to their continued involvement as the course expands, as well as your suggestions for topics for next year’s course!

Emergency Ultrasound Management Course 2012

Sunday Oct 7th 2012 Denver

Course Agenda

EM US Director M. Blaivas
Introductory Education J. Kendall
Equipment Purchase V. Noble
Hospital Credentialing R. Jones
Quality Improvements P. Hunt
Breakout session All faculty
Politics of EUS P. Sierzenski
Continuing Program Education B. Nelson
EUS Coding/Reimbursement J. Resnick
Essential Software M. Stone
Workflow Solutions M. Byrne
Electronic Medical Record V. Tayal
Machine Maintenance A. Dewitz
Tying it all Together R. Geria

 

Breakout Sessions:

  1. Coding/reimbursement I (J. Resnick)
  2. Coding/reimbursement II (S. Hoffenberg)
  3. Machine purchase/maintenance (A. Dewitz)
  4. Archiving and QA solutions I (M. Stone)
  5. Archiving and QA solutions II (M. Byrne)
  6. The Director’s job- negotiations, pitfalls, strategies (R. Geria)
  7. Politics (local/national), hospital credentialing (V. Noble)
  8. The QA process (R. Lewiss)
  9. Ultrasound Education- training your faculty and yourself (J. Kendall)

2012 Ultrasound CME conference

The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference held on March 22 at the Stern Auditorium.

Faculty, fellows and PAs from a number of institutions took part in our eighth annual conference.

The course was directed by Bret Nelson, MD and topics included ultrasound physics (Leila PoSaw, MD, MPH) and assessment of  airway and breathing (Jim Tsung, MD, MPH), circulation (Daniel Singer, MD), disability/trauma (Phil Andrus, MD) and procedure guidance (Danny Duque, MD).

Great lectures by Sinai’s Emergency Ultrasound faculty were followed by an intensive hands-on scanning session.

AIUM 2012 Preconference

ann2012Banner 500x83 AIUM 2012 PreconferenceThis year AIUM is hosting its annual conference at the JW Marriott Desert Ridge Resort and Spa in Phoenix, AZ. The first offering by the Emergency and Critical Care Community of Practice was a great success. The conference proper hasn’t even started yet and the sessions have already started off with a bang.

Moderator Bret Nelson organized the session which was attended by Emergency Physicians, Intensivists, Sonographers, Perinatologists, and Primary Care physicians:

 

Point-of-care ultrasound in the evaluation and treatment of the unstable patient

  • Bret Nelson
    • Introduction- Ultrasound for airway, breathing and circulation
  •  Srikar Adhikari
    • Ultrasound assessment of airway anatomy and intubation
  • Eitan Dickman
    • Thoracic ultrasound: Beyond pneumothorax
  • Anthony Dean
    • Basic cardiac assessments
  • Chris Moore
    • Advanced cardiac assessments
  • Robert Arntfield
    • Transesophageal echo- practical utility in the critical patient
  • Rajesh Geria
    • Vascular assessment- IVC (volume assessment), aorta (AAA, dissection)
  • Betty Chang
    • Ultrasound guidance for bedside procedures
  •  Jerry Chiricolo
    • Putting it all together- ultrasound use in Resuscitation
  • All Faculty
    • Panel Discussion and wrap up
2011 Ultrasound Management Course Faculty

ACEP 2011- Ultrasound Management Course

2011MGMTFaculty 500x333 ACEP 2011  Ultrasound Management Course

The ACEP Ultrasound Section hosted its annual Ultrasound Management Course on Friday October 14. This year’s course was organized by directors Vivek Tayal and Troy Foster and co-directors Rajesh Geria and Bret Nelson. Special thanks to ACEP organizers Marilyn Bromley and Julie Williams who were instrumental in putting the course together.

Over 125 participants registered for this full-day course which served as a whirlwind introduction to the operational aspects of emergency ultrasound. Participants interacted with each other as well as national ultrasound leader in small group breakout sessions covering topics such as quality assurance, image management systems, reimbursement issues, and others.

Faculty for the course (listed below) hailed from across the United States and brought enormous expertise to bear in their lectures and small group sessions.  We look forward to their continued involvement as the course expands. Planning has already begun for the next Ultrasound Management Course to be held at ACEP in Denver 2012!

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ACEM Bangkok 2011

logo ACEM Bangkok 2011

Here are the references and brief overview of Bret Nelson’s talk at the 2011 ACEM conference in Bangkok, Thailand on July 5.

The Focused Assessment with Sonography in Trauma (FAST) was first described decades ago and hundred of citations exist regarding its use. Although it has become a standard part of the evaluation of the trauma patient, there exists some controversy regarding its use. In 2005 a Cochrane Review was published which concluded:

There is currently insufficient evidence from RCTs [randomized controlled trials] to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

Stengel D, Bauwens K, Sehouli J, Rademacher G, Mutze S, Ekkernkamp A, Porzsolt F. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004446

The review included four RCTs:

  1. Arrillaga A, Graham R, York JW, Miller RS. Increased efficiency and cost-effectiveness in the evaluation of the blunt abdominal trauma patient with the use of ultrasound. The American Surgeon 1999; 65:31-5.
  2. Boulanger BR, McLellan BA, Brenneman FD, Ochoa J, Kirkpatrick AW. Prospective evidence of the superiority of a sonography-based algorithm in the assessment of blunt abdominal injury. Journal of Trauma 1999; 47:632-7.
  3. Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. al. Randomized controlled clinical trial of point-of-care, limited ultrasonography  in the emergency department: the First Sonography Outcomes Assessment Program Trial. Academic Emergency Medicine 2006; 48:227-35.
  4. Rose JS, Levitt A, Porter J, Hutson A, Greenholtz J, Nobay F, Hilty W. Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized controlled trial of ultrasound use in trauma. Journal of Trauma 2001; 51:545-50.

Great debate ensued, including a literal debate between Dr. Melniker (author of study #3 above), Dr. Stengel (author of the Cochrane Review on FAST) and other prominent researchers featured during the opening session at the Second World Congress on Ultrasound in Emergency and Critical Care Medicine in New York in 2006.

Dr. Melniker also published the following rebuttal to the Cochrane Review conclusions:

Melniker LA. The value of focused assessment with sonography in trauma examination for the need for operative intervention in blunt torso trauma: a rebuttal to “emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma (review)”, from the Cochrane Collaboration. Critical Ultrasound Journal. 2009;1:73-84.

Included in the rebuttal was an analysis of FAST literature focusing on cases which required operative intervention. Dr. Melniker found the FAST exam had a false negative rate (ie. patient required operative intervention despite a negative FAST exam) in 5.8% of cases as they were initially published. Upon further review of those false negative cases (and exclusion of inadequate studies, patients who did not go to the OR during at the time of their initial evaluation, etc.) it may be that the actual false negative rate approaches 1.1%.

Thus, it is critically important to define appropriate outcome measures when we evaluate the utility of a diagnostic test. Do we care about the FAST exam’s ability to detect hemoperitoneum? The ability to detect which patients should go to the OR? And to what extent does the clinical picture (ie. mechanism of injury and hemodynamic stability) determine how we proceed? Few would argue that ultrasound has better test characteristics than CT scan; the utility of sonography is non-invasive, repeatable examinations at the point of care.

This type of discussion is incredibly important, and helps clinicians better determine how to employ the appropriate diagnostic tests in their practice. Non-operative management of blunt abdominal injury is becoming more common, and our interpretation of the FAST as well as other diagnostic tests must evolve:

  • Knudson et al. Nonoperative management of solid organ injuries. Past, present, and future. Surg Clin North Am. 1999 Dec;79(6):1357-71.
  • Velmahos et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003 May;138(5):475-80; discussion 480-1.
  • Velmahos et al. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003 Aug;138(8):844-51.
  • Haan et al. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005 Mar;58(3):492-8.
  • Yanar et al. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma. 2008 Apr;64(4):943-8.

Discussions of the utility of trauma ultrasound are valuable because they force us to consider best practices in terms of clinical management of trauma, appropriate use of diagnostic tests, as well as determining appropriate outcomes-based metrics for quality healthcare delivery.

Please comment below or email me with questions.