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Article ; Online: Performance of Comprehensive Transesophageal Echocardiography: Quality Improvement Through Educational Intervention.

Chen, Tiffany / Carlson, Selma / Cheney, Amy / Zwink, Todd / Freeman, Rosario V / Kirkpatrick, James N

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2019 Volume 32, Issue 8, Page(s) 1046–1048

MeSH term(s)	Cardiology/education ; Echocardiography, Transesophageal/standards ; Educational Measurement ; Female ; Humans ; Inservice Training ; Male ; Middle Aged ; Prospective Studies ; Quality Improvement ; Retrospective Studies
Language	English
Publishing date	2019-05-23
Publishing country	United States
Document type	Letter
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2019.03.019
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Article ; Online: Focused cardiac ultrasound training in medical students: Using an independent, simulator-based curriculum to objectively measure skill acquisition and learning curve.

Elison, David M / McConnaughey, Shannon / Freeman, Rosario V / Sheehan, Florence H

Echocardiography (Mount Kisco, N.Y.)

2020 Volume 37, Issue 4, Page(s) 491–496

Abstract: Background: Using simulators built and validated at the University of Washington (UW), the study sought to test whether medical students can learn the basic skills of focused cardiac ultrasound (FoCUS) from an individually paced, simulator-based ... ...

Abstract	Background: Using simulators built and validated at the University of Washington (UW), the study sought to test whether medical students can learn the basic skills of focused cardiac ultrasound (FoCUS) from an individually paced, simulator-based curriculum, how skills improve, and the rate at which these skills are acquired. Methods: The curriculum presented didactic material interspersed with hands-on practice. Psychomotor skill was measured by the angle error of the acquired image view plane relative to the correct image view plane. The rate of learning was assessed at baseline, after 7 practice cases, and after 10 cases. To assess the rate of learning, the same case was repeatedly presented at all three tests. To assess students' ability to apply their learning, a previously unseen post-test was included. Results: A total of 41 students completed the course. Average angle error improved from 43° ± 24 pretraining to 23° ± 16 post-training, with most students falling within one SD of the view angle acquired by sonographers. Regarding learning curve, or the rate of skill acquisition, an angle error of 43 ± 24° (pre) changed to 22 ± 14° (interim test, P < .0001 vs. pretest) and remained at that level for the post-test evaluation on both the repeated case (23 ± 16°) and the new case (26 ± 18°). Conclusions: This study describes the learning curve and technical skill acquisition in FoCUS. A simulator-based curriculum improved medical student's skills in an objective and quantifiable manner. The individually paced curriculum allowed for independent knowledge and skill attainment, without facilitator oversight.
MeSH term(s)	Clinical Competence ; Curriculum ; Educational Measurement ; Humans ; Learning Curve ; Students, Medical
Language	English
Publishing date	2020-03-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.14641
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Article ; Online: Bicuspid aortic valve and aortopathy: see the first, then look at the second.

Freeman, Rosario V / Otto, Catherine M

JACC. Cardiovascular imaging

2013 Volume 6, Issue 2, Page(s) 162–164

MeSH term(s)	Aorta/diagnostic imaging ; Aorta/pathology ; Aortic Valve/abnormalities ; Aortic Valve/diagnostic imaging ; Aortography/methods ; Bicuspid Aortic Valve Disease ; Echocardiography, Doppler ; Female ; Heart Valve Diseases/diagnosis ; Humans ; Male ; Multidetector Computed Tomography
Language	English
Publishing date	2013-03-13
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2013.01.001
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Article ; Online: Left ventricular hypertrophy is a possible biomarker for early mortality after type B aortic dissection.

Taylor, Alexander P / Freeman, Rosario V / Bartek, Matthew A / Shalhub, Sherene

Journal of vascular surgery

2018 Volume 69, Issue 6, Page(s) 1710–1718

Abstract: Objective: Data regarding the cardiac abnormalities associated with Stanford type B aortic dissection (TBAD) and whether these abnormalities are related to outcomes are limited. We describe the prevalence of cardiac abnormalities in patients with TBAD ... ...

Abstract	Objective: Data regarding the cardiac abnormalities associated with Stanford type B aortic dissection (TBAD) and whether these abnormalities are related to outcomes are limited. We describe the prevalence of cardiac abnormalities in patients with TBAD as detected by echocardiography. Methods: This retrospective review included patients with TBAD presenting between 1990 and 2016. Echocardiograms performed within 6 weeks of acute TBAD were reviewed. Cardiac function, valve abnormalities, and stigmata of hypertensive heart disease including left ventricular hypertrophy (LVH) were ascertained. Characteristics of patients who did and did not receive echocardiograms were compared. Outcomes of patients with and without evidence of LVH on echocardiography were also compared. Results: Of 239 patients with TBAD, 90 had echocardiograms performed within 6 weeks of acute TBAD (74% male; mean age, 57.8 ± 13.2 years). Echocardiograms were obtained at a median of 2 days (range, 0-41 days) from acute TBAD. Patients who had echocardiograms were more likely to present with malperfusion (28% vs 14%; P < .01) and had a trend toward increased operative repair during the subacute phase (17.4% vs 9.5%; P = .07) compared with patients who did not receive an echocardiogram. A majority of patients (57%) had at least mild LVH, including 39% of patients without a prior diagnosis of hypertension. Fibrocalcific changes associated with hypertension, including aortic sclerosis and mitral annular calcification, were noted in 40% and 11% of the patients, respectively. Among patients with LVH, there was a trend toward higher all-cause mortality (35% vs 23%; P = .21) and a younger age at death (58 ± 14 years vs 66 ± 13 years; P = .19) despite a similar age at TBAD onset. In a multivariable analysis controlling for age, sex, and admission estimated glomerular filtration rate, LVH independently predicted all-cause mortality (hazard ratio, 2.38; 95% confidence interval, 1.02-5.56; P = .04). Conclusions: LVH and other findings of hypertensive heart disease are common in patients with TBAD. LVH predicted all-cause mortality after TBAD in this small group of patients. Further exploration of the relationship between the chronic effects of hypertension and using LVH as an objective biomarker to risk stratify patients with TBAD and long-term outcomes after TBAD is warranted.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/mortality ; Aortic Aneurysm/diagnostic imaging ; Aortic Aneurysm/mortality ; Cause of Death ; Echocardiography ; Female ; Humans ; Hypertrophy, Left Ventricular/diagnostic imaging ; Hypertrophy, Left Ventricular/mortality ; Male ; Middle Aged ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Washington/epidemiology
Language	English
Publishing date	2018-12-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2018.09.050
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Article ; Online: Quantitative Feedback Facilitates Acquisition of Skills in Focused Cardiac Ultrasound.

Skinner, Alisha A / Freeman, Rosario V / Sheehan, Florence H

Simulation in healthcare : journal of the Society for Simulation in Healthcare

2016 Volume 11, Issue 2, Page(s) 134–138

Abstract: Introduction: With the development of portable, affordable ultrasound machines with good image quality, many physicians have adopted focused cardiac ultrasound (FoCUS). To facilitate acquisition of these skills, we developed a simulator-based, self- ... ...

Abstract	Introduction: With the development of portable, affordable ultrasound machines with good image quality, many physicians have adopted focused cardiac ultrasound (FoCUS). To facilitate acquisition of these skills, we developed a simulator-based, self-taught curriculum for FoCUS that provides immediate feedback for rapid performance improvement. Methods: Twenty-two first-year residents participated in the study. The curriculum consisted of instructive modules teaching image acquisition and interpretation of standard echocardiography views and common cardiac pathology, 7 practice cases in which participants scanned a mannequin using a mock transducer, acquired specified views with feedback provided by visual guidance technology, and interpreted these images. Trainees were tested pretraining and posttraining on different cases, without visual guidance assistance or feedback. Previously validated metrics were used to assess psychomotor skill in terms of the angle error in degrees between the planes of the optimal view, defined anatomically, and of the acquired view, as well as cognitive skill in image interpretation. Results: The average error in image acquisition decreased from a median of 81 degrees at the pretest to 28 degrees after training (P < 0.0001). Cognitive skill improved by 29% (21%, P < 0.0001). There was a significant correlation between cognitive and psychomotor skill (r = 0.64, P < 0.001). Discussion: A novel, simulator-based curriculum that provides immediate feedback was effective in teaching both psychomotor and cognitive skills in FoCUS without need for direct expert oversight of the learner. The curriculum's components provide a useful tool that can be applied to improve, assess, and monitor physician skill in FoCUS.
MeSH term(s)	Clinical Competence ; Curriculum ; Formative Feedback ; Heart/diagnostic imaging ; Humans ; Internship and Residency/methods ; Manikins ; Simulation Training/methods
Language	English
Publishing date	2016-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2223429-9
ISSN	1559-713X ; 1559-2332
ISSN (online)	1559-713X
ISSN	1559-2332
DOI	10.1097/SIH.0000000000000132
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Article: Getting to the Heart of the Matter: A 20-Year-Old Man With Fever, Rash, and Chest Pain.

Sabo, Michelle C / Boonyaratanakornkit, Jim / Cybulski, Robert / Kopmar, Noam E / Freeman, Rosario V / Fang, Ferric C / Graham, Susan M

Open forum infectious diseases

2017 Volume 5, Issue 1, Page(s) ofx272

Abstract: Infection ... ...

Abstract	Infection with
Language	English
Publishing date	2017-12-22
Publishing country	United States
Document type	Case Reports
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofx272
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Article: Echo simulator with novel training and competency testing tools.

Sheehan, Florence H / Otto, Catherine M / Freeman, Rosario V

Studies in health technology and informatics

2013 Volume 184, Page(s) 397–403

Abstract: We developed and validated an echo simulator with three novel tools that facilitate training and enable quantitative and objective measurement of psychomotor as well as cognitive skill. First, the trainee can see original patient images - not synthetic ... ...

Abstract	We developed and validated an echo simulator with three novel tools that facilitate training and enable quantitative and objective measurement of psychomotor as well as cognitive skill. First, the trainee can see original patient images - not synthetic or simulated images - that morph in real time as the mock transducer is manipulated on the mannequin. Second, augmented reality is used for Visual Guidance, a tool that assists the trainee in scanning by displaying the target organ in 3-dimensions (3D) together with the location of the current view plane and the plane of the anatomically correct view. Third, we introduce Image Matching, a tool that leverages the aptitude of the human brain for recognizing similarities and differences to help trainees learn to perform visual assessment of ultrasound images. Psychomotor competence is measured in terms of the view plane angle error. The construct validity of the simulator for competency testing was established by demonstrating its ability to discriminate novices vs. experts.
MeSH term(s)	Cardiology/education ; Computer-Assisted Instruction/methods ; Echocardiography/instrumentation ; Echocardiography/methods ; Educational Measurement/methods ; Equipment Design ; Equipment Failure Analysis ; Humans ; Manikins ; Professional Competence ; User-Computer Interface
Language	English
Publishing date	2013
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	0926-9630
ISSN	0926-9630
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Article ; Online: Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies.

Freeman, Rosario V / Otto, Catherine M

Circulation

2005 Volume 111, Issue 24, Page(s) 3316–3326

MeSH term(s)	Aortic Valve/pathology ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/etiology ; Aortic Valve Stenosis/pathology ; Calcinosis/etiology ; Calcinosis/pathology ; Disease Progression ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/etiology ; Heart Valve Diseases/pathology ; Humans ; Inflammation/pathology ; Risk Factors ; Sclerosis/diagnosis ; Sclerosis/etiology ; Sclerosis/pathology
Language	English
Publishing date	2005-06-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.104.486738
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Article: Management of asymptomatic valvular aortic stenosis.

Freeman, Rosario V / Otto, Catherine M

Indian heart journal

2002 Volume 54, Issue 1, Page(s) 31–38

MeSH term(s)	Age Factors ; Aortic Valve Stenosis/etiology ; Aortic Valve Stenosis/physiopathology ; Aortic Valve Stenosis/therapy ; Death, Sudden, Cardiac/etiology ; Disease Progression ; Echocardiography ; Exercise Test ; Female ; Hemodynamics/physiology ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Treatment Outcome
Language	English
Publishing date	2002-01
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	604366-5
ISSN	0019-4832
ISSN	0019-4832
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Article ; Online: Total Artificial Heart as Bridge to Transplantation for Severe Culture-Negative Prosthetic Valve Endocarditis Due to Gemella haemolysans.

Ramchandani, Meena S / Rakita, Robert M / Freeman, Rosario V / Levy, Wayne C / Von Homeyer, Peter / Mokadam, Nahush A

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2014 Volume 60, Issue 4, Page(s) 479–481

Abstract: We report a rare case of a patient with prosthetic valve endocarditis (PVE) requiring implantation of a total artificial heart (TAH) as a bridge to heart transplantation. Gemella haemolysans, an unusual cause of PVE, was identified as the organism ... ...

Abstract	We report a rare case of a patient with prosthetic valve endocarditis (PVE) requiring implantation of a total artificial heart (TAH) as a bridge to heart transplantation. Gemella haemolysans, an unusual cause of PVE, was identified as the organism responsible only by 16s rRNA polymerase chain reaction analysis of surgical tissue samples. We also describe one of the first uses of combined TAH and veno-venous extracorporeal membrane oxygenation therapy in the setting of severe respiratory and cardiac failure. Implantation of a TAH may be considered in situations where more traditional reconstructive methods are not feasible.
MeSH term(s)	Endocarditis/complications ; Extracorporeal Membrane Oxygenation ; Female ; Gemella ; Gram-Positive Bacterial Infections/complications ; Heart Transplantation ; Heart Valve Prosthesis/microbiology ; Heart, Artificial ; Humans ; Middle Aged
Language	English
Publishing date	2014-04-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000000080
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