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Article: The Role of Hand-Held Cardiac Ultrasound in Patients with COVID-19.

Dadon, Ziv / Carasso, Shemy / Gottlieb, Shmuel

2023 Volume 11, Issue 2

Abstract: The role of point-of-care ultrasound (POCUS) in patient management has been established in recent years as an important tool. It is increasingly used by multiple medical disciplines in numerous clinical settings, for different applications and diagnostic ...

Abstract	The role of point-of-care ultrasound (POCUS) in patient management has been established in recent years as an important tool. It is increasingly used by multiple medical disciplines in numerous clinical settings, for different applications and diagnostic purposes and in the guidance of procedures. The introduction of small-sized and inexpensive hand-held ultrasound devices (HUDs) has addressed some of the POCUS-related challenges and has thus extended POCUS' applicability. HUD utilization is even more relevant in the COVID-19 setting given the operators' infection risk, excessive workload concerns and general equipment contamination. This review focuses on the available technology, usefulness, feasibility and clinical applications of HUD for echocardiogram assessment in patients with COVID-19.
Language	English
Publishing date	2023-01-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11020239
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Article ; Online: Enterococcal Infective Endocarditis - Post discharge treatment with continuous benzylpenicillin and ceftriaxone: A retrospective cohort study.

Szterenlicht, Yael / Steinmetz, Yoed / Dadon, Ziv / Wiener-Well, Yonit

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

2023 Volume 30, Issue 5, Page(s) 429–433

Abstract: Background: Enterococcal Infective Endocarditis (EIE) is usually treated with the combination of penicillin/ampicillin with gentamicin or ampicillin with ceftriaxone. To enable prolonged outpatient treatment, a combination of benzylpenicillin and ... ...

Abstract	Background: Enterococcal Infective Endocarditis (EIE) is usually treated with the combination of penicillin/ampicillin with gentamicin or ampicillin with ceftriaxone. To enable prolonged outpatient treatment, a combination of benzylpenicillin and ceftriaxone has been suggested. This study aimed to describe the incidence and characteristics of EIE and to determine the outcome of EIE cases treated with benzylpenicillin and ceftriaxone. Methods: This was a retrospective single-center study including all patients diagnosed with infective endocarditis (IE) during 2016-2021, comparing EIE with IE caused by other pathogens. We described the outpatient treatment of patients with EIE, comparing those treated of benzylpenicillin - ceftriaxone with other regimes. Results: Among 222 patients with IE, 44 (20%) were diagnosed with EIE. Those were older, had a male predominance (p = 0.035), and were more disabled (p = 0.004). The incidence of EIE reached 30% towards the last year, becoming the leading etiology. Twenty-six patients received outpatient treatment, five of whom were discharged with benzylpenicillin and ceftriaxone. Adding patients from this cohort to the scarce data available, revealed similar recurrence and mortality rates compared to other treatment regimes. Conclusions: EIE is becoming a more frequent cause of IE, involving older, more disabled patients with male predominance. Our experience and existing literature suggest that the combination of benzylpenicillin and ceftriaxone is as safe as more conventional regimes, although further research is needed.
MeSH term(s)	Humans ; Male ; Female ; Ceftriaxone ; Anti-Bacterial Agents ; Retrospective Studies ; Patient Discharge ; Aftercare ; Enterococcus faecalis ; Drug Therapy, Combination ; Endocarditis, Bacterial/drug therapy ; Endocarditis, Bacterial/epidemiology ; Ampicillin/therapeutic use ; Penicillin G/therapeutic use ; Endocarditis/drug therapy ; Endocarditis/epidemiology ; Enterococcus
Chemical Substances	Ceftriaxone (75J73V1629) ; Anti-Bacterial Agents ; Ampicillin (7C782967RD) ; Penicillin G (Q42T66VG0C)
Language	English
Publishing date	2023-11-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1355399-9
ISSN	1437-7780 ; 1341-321X
ISSN (online)	1437-7780
ISSN	1341-321X
DOI	10.1016/j.jiac.2023.11.018
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Article ; Online: The association between CPR quality of In-hospital resuscitation and sex: A hypothesis generating, prospective observational study.

Dadon, Ziv / Fridel, Tal / Einav, Sharon

Resuscitation plus

2022 Volume 11, Page(s) 100280

Abstract: Introduction: The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the ... ...

Abstract	Introduction: The relationship between sex and cardiopulmonary resuscitation (CPR) outcomes remains unclear. Particularly, questions remain regarding the potential contribution of unmeasured confounders. We aimed to examine the differences in the quality of chest compression delivered to men and women. Methods: Prospective study of observational data recorded during consecutive resuscitations occurring in a single tertiary center (Feb-1-2015 to Dec-31-2018) with real-time follow-up to hospital discharge. The studied variables included time in CPR, no-flow-time and fraction, compression rate and depth and release velocity. The primary study endpoint was the unadjusted association between patient sex and the chest compression quality (depth and rate). The secondary endpoint was the association between the various components of chest compression quality, sex, and survival to hospital discharge/neurologically intact survival. Results: Overall 260 in-hospital resuscitations (57.7% male patients) were included. Among these 100 (38.5%) achieved return of spontaneous circulation (ROSC) and 35 (13.5%) survived to hospital discharge. Female patients were significantly older. Ischemic heart disease and ventricular arrhythmias were more prevalent among males. Compression depth was greater in female vs male patients (54.9 ± 11.3 vs 51.7 ± 10.9 mm; Discussion: Women received deeper chest compressions during in-hospital CPR. Our findings require corroboration in larger cohorts but nonetheless underscore the need to maintain high-quality CPR in all patients using real-time feedback devices. Future studies should also include data on ventilation rates and volumes which may contribute to survival outcomes.
Language	English
Publishing date	2022-07-27
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2022.100280
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Article: Artificial Intelligence-Based Left Ventricular Ejection Fraction by Medical Students for Mortality and Readmission Prediction.

Dadon, Ziv / Rav Acha, Moshe / Orlev, Amir / Carasso, Shemy / Glikson, Michael / Gottlieb, Shmuel / Alpert, Evan Avraham

Diagnostics (Basel, Switzerland)

2024 Volume 14, Issue 7

Abstract: Introduction: Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making.: Aim: To assess the association of reduced (<50%) left-ventricular ... ...

Abstract	Introduction: Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. Aim: To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students using an artificial intelligence (AI) tool and 1-year primary composite outcome, including mortality and readmission for cardiovascular-related causes. Methods: Eight trained medical students used a hand-held ultrasound device (HUD) equipped with an AI-based tool for automatic evaluation of the LVEF of non-selected patients hospitalized in a cardiology department from March 2019 through March 2020. Results: The study included 82 patients (72 males aged 58.5 ± 16.8 years), of whom 34 (41.5%) were diagnosed with AI-based reduced LVEF. The rates of the composite outcome were higher among patients with reduced systolic function compared to those with preserved LVEF (41.2% vs. 16.7%, Conclusion: AI-based assessment of reduced systolic function in the hands of medical students, independently predicted 1-year mortality and cardiovascular-related readmission and was associated with unfavorable in-hospital outcomes. AI utilization by novice users may be an important tool for risk stratification for hospitalized patients.
Language	English
Publishing date	2024-04-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics14070767
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Article ; Online: Utilizing Advanced Telecommunication Strategies to Enhance the Response of Emergency Medical Services Volunteers.

Dadon, Ziv / Alpert, Evan Avraham / Jaffe, Eli

Disaster medicine and public health preparedness

2020 Volume 15, Issue 1, Page(s) 86–91

Abstract: Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with ... ...

Abstract	Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with advanced telecommunication strategies to activate and direct them in order to improve these processes. The volunteers include local high school students, international college students, emergency medical technicians, on-call volunteers, motorcyclists, and Life Guardian first responders. The telecommunication strategies include pagers, push-to-talk over cellular, and sophisticated smartphone-based software applications. These are monitored and directed via a central command and control station. Such processes, both on an organizational as well as technical level, can be adapted to improve prehospital emergency care.
MeSH term(s)	Emergency Medical Services ; Emergency Responders ; Humans ; Israel ; Telecommunications ; Volunteers
Language	English
Publishing date	2020-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2019.126
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Article ; Online: Use of artificial intelligence as a didactic tool to improve ejection fraction assessment in the emergency department: A randomized controlled pilot study.

Dadon, Ziv / Butnaru, Adi / Rosenmann, David / Alper-Suissa, Liat / Glikson, Michael / Alpert, Evan A

AEM education and training

2022 Volume 6, Issue 2, Page(s) e10738

Abstract: Objectives: Incorporating artificial intelligence (AI) into echocardiography operated by clinicians working in the emergency department to accurately assess left-ventricular ejection fraction (LVEF) may lead to better diagnostic decisions. This ... ...

Abstract	Objectives: Incorporating artificial intelligence (AI) into echocardiography operated by clinicians working in the emergency department to accurately assess left-ventricular ejection fraction (LVEF) may lead to better diagnostic decisions. This randomized controlled pilot study aimed to evaluate AI use as a didactic tool to improve noncardiologist clinicians' assessment of LVEF from the apical 4-chamber (A4ch) view. Methods: This prospective randomized controlled pilot study tested the feasibility and acceptability of the incorporation of AI as a didactic tool by comparing the ability of 16 clinicians who work in the emergency department to assess LVEF before and after the introduction of an AI-based ultrasound application. Following a brief didactic course, participants were randomly equally divided into an intervention and a control group. In each of the first and second sessions, both groups were shown 10 echocardiography A4ch clips and asked to assess LVEF. Following each clip assessment, only the intervention group was shown the results of the AI-based tool. For the final session, both groups were presented with a new set of 40 clips and asked to evaluate the LVEF. Results: In the "normal-abnormal" category evaluation, as related to own baseline accuracy assessment, the intervention group had an improvement in accuracy on 50 consecutive clip assessments compared with a decline in the control group (0.10 vs. -0.12, respectively, Conclusions: A study involving AI incorporation as a didactic tool for clinicians working in the emergency department appears feasible and acceptable. The introduction of an AI-based tool to clinicians working in the emergency department improved the assessment accuracy of LVEF as compared to the control group.
Language	English
Publishing date	2022-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2472-5390
ISSN (online)	2472-5390
DOI	10.1002/aet2.10738
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Article ; Online: Empowering Medical Students: Harnessing Artificial Intelligence for Precision Point-of-Care Echocardiography Assessment of Left Ventricular Ejection Fraction.

Dadon, Ziv / Orlev, Amir / Butnaru, Adi / Rosenmann, David / Glikson, Michael / Gottlieb, Shmuel / Alpert, Evan Avraham

International journal of clinical practice

2023 Volume 2023, Page(s) 5225872

Abstract: Introduction: Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making.: Aim: To evaluate the ... ...

Abstract	Introduction: Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making. Aim: To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for assessing the left ventricular ejection fraction (LVEF) of patients admitted to a cardiology department. Methods: Eight students underwent a 6-hour didactic and hands-on training session. Participants used a hand-held ultrasound device (HUD) equipped with an AI-based tool for the automatic evaluation of LVEF. The clips were assessed for LVEF by three methods: visually by the students, by students + the AI-based tool, and by the cardiologists. All LVEF measurements were compared to formal echocardiography completed within 24 hours and were evaluated for LVEF using the Simpson method and eyeballing assessment by expert echocardiographers. Results: The study included 88 patients (aged 58.3 ± 16.3 years). The AI-based tool measurement was unsuccessful in 6 cases. Comparing LVEF reported by students' visual evaluation and students + AI vs. cardiologists revealed a correlation of 0.51 and 0.83, respectively. Comparing these three evaluation methods with the echocardiographers revealed a moderate/substantial agreement for the students + AI and cardiologists but only a fair agreement for the students' visual evaluation. Conclusion: Medical students' utilization of an AI-based tool with a HUD for LVEF assessment achieved a level of accuracy similar to that of cardiologists. Furthermore, the use of AI by the students achieved moderate to substantial inter-rater reliability with expert echocardiographers' evaluation.
MeSH term(s)	Humans ; Ventricular Function, Left ; Stroke Volume ; Artificial Intelligence ; Students, Medical ; Point-of-Care Systems ; Reproducibility of Results ; Echocardiography/methods ; Power, Psychological
Language	English
Publishing date	2023-11-29
Publishing country	India
Document type	Journal Article
ZDB-ID	1386246-7
ISSN	1742-1241 ; 1368-5031
ISSN (online)	1742-1241
ISSN	1368-5031
DOI	10.1155/2023/5225872
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Article ; Online: Enhancing early response to out-of-hospital cardiac arrest.

Dadon, Ziv / Alpert, Evan Avraham / Jaffe, Eli

The American journal of emergency medicine

2019 Volume 38, Issue 1, Page(s) 155

MeSH term(s)	Ambulances ; Cardiopulmonary Resuscitation ; Humans ; Out-of-Hospital Cardiac Arrest ; Reaction Time
Language	English
Publishing date	2019-05-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2019.05.055
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Article ; Online: Wisdom of the Crowd in Saving Lives: The Life Guardians App.

Jaffe, Eli / Dadon, Ziv / Alpert, Evan Avraham

Prehospital and disaster medicine

2018 Volume 33, Issue 5, Page(s) 550–552

Abstract: Multi-casualty incidents (MCIs) continue to occur throughout the world, whether they be mass shootings or natural disasters. Prehospital emergency services have done a professional job at stabilizing and transporting the victims to local hospitals. When ... ...

Abstract	Multi-casualty incidents (MCIs) continue to occur throughout the world, whether they be mass shootings or natural disasters. Prehospital emergency services have done a professional job at stabilizing and transporting the victims to local hospitals. When there are multiple casualties, there may not be enough professional responders to care for the injured. Bystanders and organized volunteer first responders have often helped in extricating the victims, stopping the bleeding, and aiding in the evacuation of the victims. Magen David Adom (MDA translated as "Red Shield of David"), the national Emergency Medical Services (EMS) provider for Israel, has successfully introduced a program for volunteer first responders that includes both a mobile-phone-based application and appropriate life-saving equipment. Most of the responders, known as Life Guardians, are already medical professionals such as physicians, nurses, or off-duty medics. They are notified by a global positioning system application if there is a nearby life-threatening incident such as respiratory or cardiac arrest, major trauma, or an MCI. They are given a kit that includes a bag-valve mask device, oropharyngeal airways, tourniquets, and bandages. There are currently 17,000 Life Guardians, and in the first-half of 2017, they responded to 253 events.The Life Guardians are essentially an out-of-hospital manpower multiplier using a simple crowdsourcing application who have the necessary skills and equipment to treat those in cardiopulmonary arrest, or victims of trauma, including MCIs. Such a model can be integrated into other systems throughout the world to save lives. JaffeE, DadonZ, AlpertEA. Wisdom of the crowd in saving lives: the Life Guardians app. Prehosp Disaster Med. 2018;33(5):550-552.
MeSH term(s)	Crowdsourcing ; Disaster Planning ; Emergency Medical Service Communication Systems ; Emergency Responders ; Humans ; Israel ; Mass Casualty Incidents/prevention & control ; Mobile Applications
Language	English
Publishing date	2018-09-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025975-2
ISSN	1945-1938 ; 1049-023X
ISSN (online)	1945-1938
ISSN	1049-023X
DOI	10.1017/S1049023X18000754
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Article ; Online: The quality, safety, feasibility, and interpretive accuracy of echocardiographic and lung ultrasound assessment of COVID-19 patients using a hand-held ultrasound.

Dadon, Ziv / Levi, Nir / Alpert, Evan Avraham / Orlev, Amir / Belman, Daniel / Glikson, Michael / Butnaru, Adi / Gottlieb, Shmuel

Echocardiography (Mount Kisco, N.Y.)

2022 Volume 39, Issue 7, Page(s) 886–894

Abstract: Background: The association between COVID-19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point-of-care cardiac and lung ultrasound using a hand- ...

Abstract	Background: The association between COVID-19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point-of-care cardiac and lung ultrasound using a hand-held device in these patients is scarce. Aims: To investigate the safety, technical aspects, quality indices, and interpretive accuracy of a hand-held echocardiogram in patients with COVID-19. Methods: From April-28 through July-27, 2020, consecutive patients with COVID-19 underwent hand-held echocardiogram and lung ultrasound evaluation (Vscan Extend™; GE Healthcare) within 48-h of admission. The operators recorded a series of technical parameters and graded individual experiences. The examinations were further analyzed by a blinded fellowship-trained echocardiographer for general quality, proper acquisition, and right ventricular (RV) demonstration. Results: Among 103 patients, 66 (64.1%) were male. Twenty-nine (28.2%) patients could not turn on their left side and 23 (22.3%) could not maintain effective communication. The mean length of each echocardiogram study was 8.5 ± 2.9 min, battery usage was 14 ± 5%, and mean operator-to-patient proximity was 59 ± 11 cm. Ninety-five (92.2%) examinations were graded as fair/good quality. A fair agreement was demonstrated between the operator and the echocardiographer for general ultrasound quality (Kappa = 0.329, p < 0.001). A fair-good correlation (r = 0.679, p < 0.001) and substantial agreement (Kappa = 0.612, p < 0.001) were demonstrated between the operator and echocardiographer for left ventricular ejection fraction (LVEF), whereas a fair agreement was demonstrated for RV systolic function (Kappa = 0.308, p = 0.002). LVEF agreement was also assessed using the Bland-Altman analysis revealing a mean bias of -0.96 (95% limits of agreement 9.43 to -11.35; p = 0.075). Conclusions: Among patients with COVID-19, echocardiography with a hand-held ultrasound is a safe and reasonable alternative for a complete formal study (<10% poor-quality indices). Echocardiogram assessment by the operators during the exam acquisition is reliable for LVEF, while RV systolic function should be subsequently offline reassessed.
MeSH term(s)	COVID-19 ; Echocardiography ; Feasibility Studies ; Female ; Humans ; Lung/diagnostic imaging ; Male ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	843645-9
ISSN	1540-8175 ; 0742-2822
ISSN (online)	1540-8175
ISSN	0742-2822
DOI	10.1111/echo.15372
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