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As point-of-care ultrasound (POCUS) invades medical specialties, more students covet earlier ultrasound (US) training programs in medical school. Determining the optimal placement and format in the curriculum remains a challenge. This study uses student perceptions and confidence in interpreting and acquiring images to evaluate the effectiveness of an US curriculum and assesses their performance on US content. A unique US curriculum was incorporated into first-year clinical anatomy at Tufts University School of Medicine (TUSM). Students completed surveys evaluating changes in US confidence and perceptions. Mean ratings on pre- and post-surveys were compared using Mann--Whitney U tests. Performance on US examination questions was evaluated. Two independent evaluators coded narrative responses and NVivo software was used to identify common themes. Two hundred eleven students completed the US curriculum. Students reported higher post-curriculum mean confidence ratings on US comprehension, operation, image acquisition, artifact recognition, and normal image interpretation (P < 0.0001). US reinforced anatomy concepts and clinical correlates (9.56, ±0.97 SD; 9.60, ±1.05). Students disagreed with items stating learning US is too difficult (1.2, ±2.2) and that it interferes with learning anatomy (0.68, ±1.7). Students scored above passing on practical US knowledge questions, supporting survey data, and the relation to learning spatial relationships. Qualitative analysis identified seven major themes and additional subthemes. Limited integration of US breaks barriers in students' perceptions and confidence in performing POCUS. The TUSM US curriculum is a natural marriage of anatomy and POCUS applications, serving as a template for medical schools.

There have been at least 7 separate randomised controlled trials published between 2011 and 2023 that have examined primary care for nonspecific low back pain informed by the STarT Back approach to stratified care based on risk prediction, compared with care not informed by this approach. The results, across 4 countries, have been contrasting—some demonstrating effectiveness and/or efficiency of this approach, others finding no benefits over comparison interventions. This review considers possible explanations for the differences, particularly whether this is related to poor predictive performance of the STarT Back risk-prediction tool or to variable degrees of success in implementing the whole STarT Back approach (subgrouping and matching treatments to predicted risk of poor outcomes) in different healthcare systems. The review concludes that although there is room for improving and expanding the predictive value of the STarT Back tool, its performance in allocating individuals to their appropriate risk categories cannot alone explain the variation in results of the trials to date. Rather, the learning thus far suggests that challenges in implementing stratified care in clinical practice and in changing professional practice largely explain the contrasting trial results. The review makes recommendations for future research, including greater focus on studying facilitators of implementation of stratified care and developing better treatments for patients with nonspecific low back pain at high risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Purpose:There are a variety of commercially made ultrasound training phantoms available for educational purposes. A new concept in phantoms is presented that utilises a low‐cost method to create a reusable phantom. Methods: A closed electric circuit was combined with insulating material to create a novel phantom that can be used to practise needle tracking under ultrasound guidance on repeated occasions. A tricolour light‐emitting diode (LED) illuminates when the needle (under ultrasound gudiance) contacts one of three metal objects embedded in the phatom material. Conclusion: This prototype model provides a simple solution for trianing ultrasound needle guidance is particularly geared towards programmes with a high volume of users. This protoype provides a starting point for a new concept in educational phantom trainers. [ABSTRACT FROM AUTHOR]

back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach. In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients' self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain. We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change. Les lombalgies sont la principale cause d'annees de vie vecues avec une incapacite dans le monde. En 2018, un groupe de travail international a invite l'Organisation mondiale de la Sante a attirer l'attention sur la charge que representent les lombalgies et sur la necessite d'eviter le recours excessif aux solutions medicales. En effet, selon les dernieres recommandations cliniques internationales, de nombreux cas de lombalgie ne necessitent pas ou peu de traitement formel. Lorsqu'un traitement est requis, il est recommande de limiter la prise d'analgesiques, les injections de steroides et la chirurgie rachidienne, et d'encourager plutot les therapeutiques physiques et psychologiques. Tres souvent, les systemes de sante ne sont pas concus pour appliquer cette approche. Dans cet article, nous abordons les raisons pour lesquelles un changement des systemes s'impose si l'on veut prendre en charge les lombalgies suivant les recommandations. Nous detaillons les principales difficultes de la prise en charge des lombalgies dans le cadre des systemes de sante. Il s'agit notamment des interets financiers des laboratoires pharmaceutiques, entre autres; des systemes de paiement obsoletes qui privilegient la prise en charge medicale a l'autogestion par les patients; et de croyances et traditions medicales profondement ancrees parmi les medecins et la population. Nous donnons des exemples internationaux de solutions, de politiques et de pratiques prometteuses pour les systemes de sante confrontes de plus en plus souvent a une prise en charge inefficace des lombalgies. Nous suggerons des politiques qui, sans incidence sur les couts, en transferant les ressources allouees aux soins inutiles vers des soins conformes aux recommandations, pourraient avoir un impact considerable. De petits ajustements des politiques de sante ne suffiront cependant pas. Les systemes des milieux professionnels, les cadres juridiques, les croyances personnelles, les politiques et le contexte societal global dans lequel s'inscrit la sante devront egalement changer. El dolor lumbar es la causa principal de vivir con discapacidad durante anos en todo el mundo. En 2018, un grupo de trabajo internacional pidio a la Organizacion Mundial de la Salud que prestara mas atencion a la carga del dolor lumbar y a la necesidad de evitar soluciones excesivamente medicas. De hecho, las principales directrices clinicas internacionales reconocen ahora que muchas personas con dolor lumbar requieren poco o ningun tratamiento formal. Cuando se requiere tratamiento, el enfoque recomendado es desalentar el uso de analgesicos, inyecciones de esteroides y cirugia de la columna vertebral y, en su lugar, promover las terapias fisicas y psicologicas. Muchos sistemas de salud no estan disenados para apoyar este enfoque. En este documento, se expone por que el cuidado del dolor lumbar de acuerdo con las directrices requiere cambios en todo el sistema. Se detallan los retos clave de la atencion del dolor lumbar en los sistemas de salud. Estos incluyen los intereses financieros de las companias farmaceuticas y de otro tipo, los sistemas de pago obsoletos que favorecen la atencion medica por encima del autocuidado de los pacientes, asi como las tradiciones y las creencias medicas profundamente arraigadas sobre la atencion del dolor de espalda entre los medicos y el publico general. Se presentan ejemplos internacionales de soluciones prometedoras y de politicas y practicas para los sistemas de salud que se enfrentan a una carga cada vez mayor de la atencion ineficaz para el dolor lumbar. Se sugieren politicas que, al desplazar los recursos de la atencion innecesaria a la atencion acorde con las directrices para el dolor lumbar, podrian ser neutras en cuanto a costes y tener un impacto generalizado. Sin embargo, los pequenos ajustes en la politica sanitaria no funcionaran de forma aislada. Los sistemas del lugar de trabajo, los marcos juridicos, las creencias personales, la politica y el contexto social general en el que vivimos la salud tambien tendran que cambiar., Introduction Low back pain is the single biggest cause of years lived with disability worldwide, and a major challenge to international health systems. (1) In 2018, the Lancet Low Back [...]