Yoo J, et al. J Korean Med Sci. 2021 May;36(21):e141. https://doi.org/10.3346/jkms.2021.36.e141

Background and objectives: Ocular ultrasound is a core application of point-of-care ultrasound (POCUS) to assist physicians in promptly identifying various ocular diseases at the bedside; however, hands-on POCUS training is challenging during a pandemic. Materials and Methods: A randomized controlled non-inferiority trial was conducted in an academic emergency department from October 2020 to April 2021. Thirty-two participants were randomly assigned to one of two groups. Group H (hands-on learning group) participated individually in a hands-on session with a standardized patient for 30 min, whereas Group O (online learning group) learned training materials and video clips for 20 min. They scanned four eyeballs of two standardized patients sequentially following the ocular POCUS scan protocol. Repeated POCUS scans were performed 2 weeks later to assess skill maintenance. Both groups completed the pre- and post-surveys and knowledge tests. Two emergency medicine faculty members blindly evaluated the data and assigned a score of 0–25. The primary endpoint was the initial total score of scan quality evaluated using non-inferiority analysis (generalized estimating equation). The secondary endpoints were total scores for scan quality after 2 weeks, scan time, and knowledge test scores. Results: The least squares means of the total scores were 21.7 (0.35) for Group O and 21.3 (0.25) for Group H, and the lower bound of the 95% confidence interval (CI) was greater than the non-inferiority margin of minus 2 (95% CI: −0.48–1.17). The second scan scores were not significantly different from those of the first scan. The groups did not differ in scanning time or knowledge test results; however, Group H showed higher subjective satisfaction with the training method (p < 0.001). Conclusion: This study showed that basic online ocular ultrasound education was not inferior to hands-on education, suggesting that it could be a useful educational approach in the pandemic era.

Background: Atrial functional mitral regurgitation (AFMR) is a newly discovered condition associated with longstanding atrial fibrillation. This retrospective study aimed to analyze the outcomes of the maze procedure and mitral regurgitation (MR) surgery in AFMR and atrial fibrillation in comparison with those in degenerative MR (DMR). Methods: Patients who underwent mitral valve repair/replacement with a maze procedure at a hospital (July 2012–August 2021) were included. We excluded patients aged below 18 years undergoing concomitant coronary artery bypass grafting or atrial septal defect repair and those with MR etiology other than ARMR or DMR. Results: We included 35 patients with AFMR and 50 patients with DMR. Patient characteristics and postoperative outcomes were not significantly different between the two groups. Long-term outcomes revealed no significant differences in the ratio of cardiac mortality, stroke, or hospital readmission. However, after the maze procedure, the sinus rhythm restoration rate was significantly lower (62% vs. 28.5%, p < 0.001), a junctional rhythm state (p < 0.001) and permanent pacemaker insertion for sick sinus syndrome (SSS) (p = 0.03) were significantly more common in AFMR than DMR. On postoperative transthoracic echocardiography (TTE), the pulmonary artery systolic pressure was significantly less decreased in the AFMR group than in the DMR group compared with that on preoperative TTE (p = 0.04). Conclusions: AFMR showed excellent mitral valve surgery outcomes, similar to DMR, but had a significantly higher risk of pacemaker insertion for SSS after the maze procedure.

As point-of-care ultrasound (POCUS) is increasingly being used in clinical settings, ultrasound education is expanding into student curricula. We aimed to determine the status and awareness of POCUS education in Korean medical schools using a nationwide cross-sectional survey. In October 2021, a survey questionnaire consisting of 20 questions was distributed via e-mail to professors in the emergency medicine (EM) departments of Korean medical schools. The questionnaire encompassed 19 multiple-choice questions covering demographics, current education, perceptions, and barriers, and the final question was an open-ended inquiry seeking suggestions for POCUS education. All EM departments of the 40 medical schools responded, of which only 13 (33%) reported providing POCUS education. The implementation of POCUS education primarily occurred in the third and fourth years, with less than 4 hours of dedicated training time. Five schools offered a hands-on education. Among schools offering ultrasound education, POCUS training for trauma cases is the most common. Eight schools had designated professors responsible for POCUS education and only 2 possessed educational ultrasound devices. Of the respondents, 64% expressed the belief that POCUS education for medical students is necessary, whereas 36%, including those with neutral opinions, did not anticipate its importance. The identified barriers to POCUS education included faculty shortages (83%), infrastructure limitations (76%), training time constraints (74%), and a limited awareness of POCUS (29%). POCUS education in Korean medical schools was limited to a minority of EM departments (33%). To successfully implement POCUS education in medical curricula, it is crucial to clarify learning objectives, enhance faculty recognition, and improve the infrastructure. These findings provide valuable insights for advancing ultrasound training in medical schools to ensure the provision of high-quality POCUS education for future healthcare professionals.

Background: Doppler‐based diastolic dysfunction assessment requires optimal apical views and specialized expertise, and up to 30% of evaluations yield indeterminate results. We investigated whether a parasternal long‐axis (PLAX)–only M‐mode scoring system derived from mitral valve anterior leaflet (MVAL) motion could provide clinically useful risk stratification for moderate‐to‐severe left ventricular diastolic dysfunction (LVDD). Methods: This retrospective study analyzed echocardiographic data from 253 patients. Novel M‐mode parameters (EPSS, APSS, EPOL, APOL, and their ratios) were compared with conventional Doppler indices across LVDD severity grades (normal, grade 1, grade 2, grade 3). A logistic regression‐based scoring system combining five M‐mode parameters was developed and internally evaluated using five‐fold cross‐validation with bootstrap confidence intervals. Results: The EPOL/APOL ratio showed moderate correlations with the E/A ratio in both normal‐to‐mild ( r = 0.353, p < 0.001) and moderate‐to‐severe ( r = 0.397, p = 0.001) LVDD groups. The logistic regression–derived scoring system achieved an AUC of 0.754 (95% CI: 0.672–0.825), with 55.7% sensitivity and 85.9% specificity at the optimal cutoff of 63.5. Decision curve analysis demonstrated positive net benefit over default strategies across the clinically plausible threshold probability range of 0.15–0.35. Conclusion: A PLAX‐only M‐mode scoring system provides acceptable discrimination and positive net clinical benefit for risk stratification of moderate‐to‐severe LVDD. External validation in independent populations is required before clinical implementation.

Background and Objectives: Bacteremia is associated with worse outcomes in sepsis, but comparative data between Gram-positive bacteremia (GPB) and Gram-negative bacteremia (GNB) remain scarce. We compared clinical characteristics, empirical antibiotic appropriateness, and outcomes of GPB and GNB in emergency department (ED) patients with sepsis. Materials and Methods: We retrospectively studied ED patients who met the Sepsis-3 criteria with culture-confirmed GPB or GNB from December 2021 to August 2024. The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality, in-hospital mortality, ICU admission, and length of hospital stay. Multivariable logistic regression assessed the association between Gram status and 28-day mortality. Results: Of 493 patients, 96 had GPB and 397 had GNB. GPB was associated with higher 28-day mortality (26.0% vs. 9.3%), 90-day mortality (34.4% vs. 11.8%), in-hospital mortality (26.0% vs. 10.1%), ICU admission (36.5% vs. 24.7%), longer hospital stay (20.5 [11.8–31.0] vs. 14.0 [9.0–20.0] days), and substantially more frequent inappropriate empirical antibiotic therapy (37.5% vs. 12.8%) (all p < 0.05). The independent association between GPB and 28-day mortality was not consistent across adjusted models and was attenuated after accounting for inappropriate empirical antibiotic therapy (aOR, 1.85; 95% CI, 0.92–3.71). In exploratory analyses, GPB was associated with four-fold higher odds of inappropriate empirical antibiotic therapy than GNB (aOR, 4.07; 95% CI, 2.19–7.54). Conclusions: In bacteremic sepsis, GPB was associated with worse observed outcomes and substantially more frequent inappropriate empirical antibiotic therapy than GNB. GPB should be interpreted less as a standalone microbiologic determinant of mortality and more as a marker of a clinically vulnerable and management-challenging profile. Our findings point to a modifiable diagnostic–treatment gap in early ED recognition and empirical antibiotic selection. Prospective multicenter studies should evaluate whether systematic reassessment of clinical features suggestive of GPB and suspected infection source can improve empirical antibiotic appropriateness and ultimately translate into better clinical outcomes.