Ultrasound applied to nursing in the Emergency Medical Service (EMS): a scoping review

Background: In recent years, ultrasound has represented a new field of application for nursing. Point of Care UltraSound (POCUS) has been defined as an essential skill in the pre-hospital setting. The primary objective of this scoping review is to describe what are the main ultrasound techniques applied by nurses in the pre-hospital emergency setting. The secondary objective is to identify the different training courses implemented in the various studies selected to learn the necessary ultrasound skills. Methods: We conducted a scoping review. The following databases were consulted: PubMed, Cochrane Library, CINAHL and Google Scholar. For the extraction of useful articles, after identifying the inclusion and exclusion criteria, the PRISMA methodology was used, two authors independently analyzed the identified records, in the event of a conflict a third author intervened. Results: The identified records were initially 815. After the duplicates removal, and screening made by the researcher for inclusion criteria, 6 articles were retrieved for qualitative analysis. The most discussed topic is the recognition of pneumothorax: two studies analyzed a specific educational program on ultrasound for flight nurses, three articles evaluated the us of US to verify the correct insertion of devices, and two explored the skills of nurses in performing ultrasound scans. The first study stated that nurses had 86.4% accuracy, 66.6% sensitivity and 100% specificity in ultrasound using; in the second one, nurses had a sensitivity and specificity of 100% in non-traumatized patients and a sensitivity of 60% and a specificity of 93% in trauma patients. Conclusions: Despite the methodological differences of the selected records, the main ultrasound techniques implemented by nurses in the Emergency Medical Service (EMS) are Focused Assessment with Sonography for Trauma (FAST), Extendend Focused Assessment with Sonography for Trauma (E-FAST), evaluation of pneumothorax and visualization of correct insertion of devices (Endotracheal Tube, Nasogastric Tube). At the level of training in the ultrasound field, on the other hand, a certain heterogeneity is highlighted in the structuring of training courses, both in terms of hours of theory and of controlled practice

Diagnostic Tools in the Detection of Physical Child Abuse: A Systematic Review

Child abuse is a critical social issue. The orthopedic surgeon’s role is essential in noticing signs and symptoms of physical abuse. For this reason, several authors have proposed scoring systems to identify abuse early on and reduce undiagnosed cases. The aim of this systematic review is to overview the screening tools in the literature. In 2021, three independent authors performed a systematic review of two electronic medical databases using the following inclusion criteria: physical child abuse, questionnaire, survey, score, screening tool and predictive tool. Patients who had experienced sexual abuse or emotional abuse were excluded. The risk of bias evaluation of the articles was performed according to the Newcastle–Ottawa Quality Assessment Scale Cohort Studies. Any evidence-level study reporting clinical data and dealing with a physical child abuse diagnosis tool was considered. A total of 217 articles were found. After reading the full texts and checking the reference lists, n = 12 (71,035 patients) articles were selected. A total of seven screening tools were found. However, only some of the seven diagnostic tools included demonstrated a high rate of sensitivity and specificity. The main limits of the studies were the lack of heterogeneity of evidence and samples and the lack of common assessing tools. Despite the multiplicity of questionnaires aimed at detecting validated child abuse, there was not a single worldwide questionnaire for early diagnosis. A combination of more than one test might increase the validity of the investigation

Evolutionary history of the extinct Sardinian dhole

The Sardinian dhole (Cynotherium sardous)1 was an iconic and unique canid species that was endemic to Sardinia and Corsica until it became extinct at the end of the Late Pleistocene.2-5 Given its peculiar dental morphology, small body size, and high level of endemism, several extant canids have been proposed as possible relatives of the Sardinian dhole, including the Asian dhole and African hunting dog ancestor.3,6-9 Morphometric analyses3,6,8-12 have failed to clarify the evolutionary relationship with other canids.We sequenced the genome of a ca-21,100-year-old Sardinian dhole in order to understand its genomic history and clarify its phylogenetic position. We found that it represents a separate taxon from all other living canids from Eurasia, Africa, and North America, and that the Sardinian dhole lineage diverged from the Asian dhole ca 885 ka. We additionally detected historical gene flow between the Sardinian and Asian dhole lineages, which ended approximately 500-300 ka, when the land bridge between Sardinia and mainland Italy was already broken, severing their population connectivity. Our sample showed low genome-wide diversity compared to other extant canids-probably a result of the long-term isolation-that could have contributed to the subsequent extinction of the Sardinian dhole