Cameron Baston

The shoulder may be an effective central site for continuous oxygen saturation (SpO2) monitoring but studies of shoulder-mounted pulse oximetry technology are limited. We hypothesized that an alternative location would be similar in function and user acceptance to a standard FDA-cleared finger-based pulse oximeter. We conducted a quantitative and descriptive pilot study of two prototype biosensor designs in patients with clinical suspicion of hypoxic episodes at an outpatient sleep center. Participants wore two prototype biosensors—the primary a shoulder-mounted adhesive and the secondary a combination ring–bracelet—in addition to a control FDA-approved finger-based pulse oximeter. We assessed the comfort of the devices based on a survey. We monitored 27 patients during an overnight polysomnography study. Participants rated the shoulder-mounted device more highly than the control device on a Likert scale survey of comfort (4.6 out of 5 versus 3.1 out of 5). Open-ended questionnaires showed that the two major criticisms of the control and ring devices were devices falling off and disruption to sleep, while only one participant commented on the shoulder device specifically. We also investigated SpO2 agreement between the primary shoulder-mounted prototype and the control finger-based pulse oximeter. This study confirms that alternative configurations for SpO2 monitoring offer potential as well-tolerated devices with preliminary findings of acceptable agreement. Problems with traditional pulse oximetry, such as false readings of hypoxia due to device removal or noisy data, were encountered less frequently in shoulder-mounted pulse oximetry than in the commercial finger-based device. Future directions include studies of additional populations that are at risk of respiratory collapse and surveys to elicit specific feedback on the configurations, whether positive or negative.

Purpose of Review: This manuscript reviews technical principles, clinical applications, and growing evidence around the use of diaphragmatic ultrasound (DU) as a practical, accurate, and reproducible tool for evaluating diaphragm function — with an emphasis on its role in predicting weaning outcomes from mechanical ventilation. This review outlines the standard techniques for performing DU, including assessing diaphragmatic excursion and thickening fraction. Additionally, we synthesize current literature that utilizes DU as a tool for predicting ventilator weaning success. Recent Findings: DU has utility as a tool to assess diaphragm function. Multiple studies have used DU as a tool to predict successful ventilator weaning. Summary: DU is a versatile, accessible modality that overcomes many limitations of traditional assessments. As evidence continues to expand, adoption of DU will require continued emphasis on training, standardization, and studying clinical integration.

The shoulder may be an effective central site for continuous oxygen saturation (SpO2) monitoring but studies of shoulder-mounted pulse oximetry technology are limited. We hypothesized that a shoulder-based biosensor device would be similar in function and user acceptance to a standard FDA-cleared finger-based pulse oximeter. We conducted a quantitative and descriptive pilot study of two prototype biosensor designs in patients with clinical suspicion of hypoxic episodes at an outpatient sleep center. Participants wore two prototype biosensors–the first a shoulder-mounted adhesive and the second a combination ring-bracelet–in addition to a control FDA-approved finger-based pulse oximeter. We assessed SpO2 agreement among the devices as well as the comfort of the devices based on a survey. We monitored 27 patients during an overnight polysomnography study. The prototype shoulder pulse oximeter SpO2 readings agreed with the control values of the commercial finger-based pulse oximeter with a 0.72% mean absolute error. Participants rated the shoulder-mounted device more highly than the control device on a Likert-scale survey of comfort (4.6 out of 5 versus 3.1 out of 5). Open-ended questionnaires showed that the two major criticisms of the control and ring devices were devices falling off and disruption to sleep while only one participant commented on the shoulder device, specifically. This study confirms that alternative configurations for SpO2 monitoring offer potential as accurate and well-tolerated devices. Problems with traditional pulse oximetry, such as false readings of hypoxia due to device removal or noisy data, were encountered less frequently in shoulder-mounted pulse oximetry than in the commercial finger-based device. Future directions include studies of additional populations that are at risk of respiratory collapse and surveys to elicit specific feedback on the configurations, whether positive or negative.

The current mechanisms in the United States to research and develop novel reversal agents for substances that can lead to overdose are restricted by regulations placed on the pharmaceutical industry. While there are many forms of harm reduction critical to saving lives that require increased investment and research, it is proven that reversal agents, such as naloxone, help prevent overdose morbidity and mortality. In the setting of an evolving crisis of illicit substance use and related overdose with new, increasingly potent substances appearing in communities nationwide, it is essential to implement a structured approach to rapidly develop and deploy efficacious harm reduction tools to save lives. In this article, we review the history of US scheduled drug regulation which aims to mitigate substance use but also paradoxically hinders research into treatments for drug overdose. We also discuss the regulation of drug reversal agents in the context of changing patterns in illicit substance use as well as barriers to the rapid development of medical devices associated with drug reversal agents that address immense public health needs. The overdose epidemic is a national crisis that requires technological solutions in addition to sociopolitical reform. Even if a reversal agent or medication is approved for an emerging substance, the existing regulatory landscape for drug delivery devices discourages the development, access, and widespread adoption of potentially lifesaving treatments. A systematic approach to monitoring the evolution of illicit drugs and a more streamlined regulatory pathway is urgently needed to facilitate the development and deployment of effective harm reduction tools.

Point of care ultrasound of the lungs has emerged as a crucial tool in the evaluation of hypoxemia in critical care and hospital medicine settings. The ability to distinguish the horizontal A-line artifact from other lung pathology is essential for guiding clinical decision making. Typically, ribs and their acoustic shadows are used as anchoring anatomy to ensure visualization of pleura and parenchyma. We present a case of horizontal reverberation artifacts incidentally observed over a rib during a point of care lung ultrasound (LUS) in a 77-year-old patient with persistent hypoxic respiratory failure. Describing these reverberation artifacts caused by ribs is important to decrease the chance of misinterpretation.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: For over a decade, drug overdose has been the leading cause of injury and accidental death in the United States. Most fatal overdoses involve opioids and occur during solitary drug use events when no one is available to initiate lifesaving responses (e.g., naloxone).​ While there is a growing interest in devices providing early overdose detection and automated response, little research has engaged end users in a device design process.​ Objective: To describe user experience, perceived harms and benefits, and the acceptability of a shoulder-mounted wearable sensor among people who inject drugs who wore a device prototype for seven days, and to explore real-time responses that could be incorporated into a next generation sensor. Methods: Individuals ≥18 years reporting past week injection drug use were recruited from a walk-in substance use disorder clinic in Camden, NJ, USA. Participants completed a brief survey assessing socio-demographics and recent drug use and were assigned a sensor prototype that they were asked to wear near-continuously for seven days. At endline, they completed semi-structured interviews exploring acceptability, usability, and form and function preferences for next-generation devices with integrated automated response options. Structured field notes and transcripts were analyzed to identify key themes and design considerations. Results: Participants (n=23) had a median age of 41 years. Most were primarily non-Hispanic White (65%) males (61%), experiencing homelessness (57%) who reported daily injection drug use (74%) within 3-months and receipt of opioid use disorder medication within a month (74%). Sixteen completed an exit interview. They found the concept of a shoulder-mounted overdose detection device acceptable and unanimously endorsed the need for long-lasting discreet devices. They emphasized the importance of having multiple response options that wearers could tailor to their individual circumstances and preferences, noting some might prefer an automatic call to emergency services, while others might prefer to alert a peer. Participants expressed a preference for solutions that alert first responders over automated biomedical solutions, such as naloxone injection, because of concerns about device error (e.g., false positives) leading to precipitated withdrawal. Conclusions: After wearing a shoulder-mounted protype, this small group of participants found the idea acceptable and provided feedback to improve usability and design. Data suggest that a variety of devices with differing functions, size, and capacity will be needed to meet user needs and increase the likelihood of adoption once devices come to market.

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Objectives: Despite growing use of point of care ultrasound (POCUS), there remains a paucity of data about familiarity with POCUS among educators who dictate curricular content in undergraduate medical education. This paper aims to longitudinally characterize the level of comfort and frequency of POCUS use among faculty involved in undergraduate clerkship education. Methods: A web-based cross-sectional survey assessing comfort, frequency of use, and awareness of indications for POCUS among faculty involved in Internal Medicine, Family Medicine, and Surgery undergraduate clerkship education in a single urban academic medical center in 2016 and again in 2022. Results: A total of 45 responses from 2016 and 30 responses from 2022 are included. The percentage of faculty “not comfortable” with performing POCUS decreased from 78% to 46%, although the overall change in comfort was not statistically significant. Comfort interpreting POCUS images, frequency of POCUS use, and familiarity with the clinical applications of POCUS all improved. Faculty identified multiple barriers to more frequent POCUS use. Conclusions: Over a six-year period at one urban, academic medical center, comfort with POCUS and frequency of use have increased slightly but remain low among core faculty responsible for clerkship education. There are still large gaps in knowledge and very regularly use POCUS, which can be attributed to multiple different barriers.