Accuracy of Bedside Lung Ultrasound in Emergency (BLUE) Protocol to Diagnose the Cause of Acute Respiratory Distress Syndrome (ARDS): A Meta-Analysis

Background: There is a stigma that ultrasound cannot be used to see abnormalities in the air-filled organs makes ultrasound rarely used to identify lung abnormalities. This study purpose comparing diagnostic accuracy of BLUE protocol with gold standard for each diagnosis causing acute respiratory failure. Methods: Systematic search was done in 6 databases (Pubmed/MEDLINE, Embase, Cochrane Central, Scopus, Ebscohost/CINAHL dan Proquest) and multiple grey-literature sources for cross-sectional studies. We manually extracted the data from eligible studies and calculated pooled sensitivity, pooled specificity, likelihood ratio (LR) and diagnostic odds ratio (DOR). We follow PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline throughout these processes. Results: Four studies has been picked from total 509 studies involved. The results yield parameters indicating BLUE protocol as a reliable modality to diagnose pneumonia with pooled sensitivity 84% (95% CI, 76-89%),  pooled specificity 98%  (95% CI, 93-99%), LR+ 42 (95% CI, 12-147), LR- 0.12 (95% CI, 0.07-0.2) and DOR 252 (95% CI, 81-788), respectively. It also considerably applicable to diagnose pulmonary oedema with pooled sensitivity 89% (95% CI, 81-93%), pooled specificity 94% (95% CI, 89-96%), LR+ 14 (95% CI, 8-25), LR- 0.165 (95% CI, 0.11-0.24), and DOR 116 (95% CI, 42-320), respectively. Conclusion: BLUE protocol has good diagnostic accuracy to diagnose pneumonia and pulmonary oedema. We recommend implementing BLUE protocol as a tool in evaluating cause of ARF

Internal Medicine Residents’ Perceptions of Point-of-Care Ultrasound in Residency Program: Highlighting the Unmet Needs

Background: Point-of-care ultrasound (POCUS) is increasingly used in internal medicine   field. Ultrasound training has been part of the training provided in the Internal Medicine Residency Program (IMRP). The aim of this study is to examine the residents’ needs and perceptions regarding their competency and needs of POCUS. Methods: We conducted a cross-sectional descriptive study using secondary data from a survey  among internal medicine residents at the Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital. The survey was conducted to evaluate and improve the curriculum in IMRP. Results: A total of 175 out of 197 residents (88.8%) completed the questionnaire. Almost all the residents (99.4%) agreed that POCUS is a beneficial must-have skill during residency. Nevertheless, only 40% of residents identified themselves as competent in POCUS. Sixty-two percent residents reckoned that the training received during the residency program is insufficient. They indicated that the most useful skills are US of hepatobiliary, lungs, heart, kidneys, and US-guided procedures. Conclusion: This study confirms that there is a need for POCUS training for   IM residents, as the majority perceived themselves as unable to perform US. It is necessary to optimize the training provided to ensure proficiency