***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims To study the feasibility and reliability of pocket-size h and -held echocardiography ( PHHE ) by medical residents with limited experience in ultrasound . Methods and results A total of 199 patients admitted to a non-university medical department were examined with PHHE .  Six out of 14 medical residents were r and omized to use a focused protocol and examine the heart , pericardium , pleural space , and abdominal large vessels . Diagnostic corrections were made and findings were confirmed by st and ard diagnostics . The median time consumption for the examination was 5.7 min . Each resident performed a median of 27 examinations . The left ventricle was assessed to satisfaction in 97 % and the pericardium in all patients . The aortic and atrioventricular valves were assessed in at least 76 % and the abdominal aorta in 50 % , respectively . Global left-ventricular function , pleural , and pericardial effusion showed very strong correlation with reference method ( Spearman 's r ≥ 0.8 ) . Quantification of aortic stenosis and regurgitation showed strong correlation with r = 0.7 . Regurgitations in the atrioventricular valves showed moderate correlations , r = 0.5 and r = 0.6 for mitral and tricuspid regurgitation , respectively , similar to dilatation of the left atrium ( r = 0.6 ) and detection of regional dysfunction ( r = 0.6 ) . Quantification of the abdominal aorta ( aneurysmatic or not ) showed strong correlation , r = 0.7 , while the inferior vena cava diameter correlated moderately , r = 0.5 . Conclusion By adding a PHHE examination to st and ard care , medical residents were able to obtain reliable information of important cardiovascular structures in patients admitted to a medical department . Thus , focused examinations with PHHE performed by residents after a training period have the potential to improve in-hospital diagnostic procedures STUDY OBJECTIVE To compare the sensitivity , specificity , and accuracy of ultrasonography with those of the initial plain chest radiograph for detection of hemothorax in trauma patients . METHODS Data from a prior prospect i ve study of trauma ultrasonography at a Level I trauma center were retrospectively analyzed . The medical records of a convenience sample of adult patients who presented with major blunt or penetrating torso trauma during a 17-month period were review ed . Emergency physicians performed a trauma ultrasound examination , which included evaluation for pleural fluid . Ultrasound interpretations were recorded before other diagnostic tests were obtained and were not used in patient management decisions . Records of the study patients were review ed for confirmation of the presence or absence of hemothorax by other diagnostic and therapeutic interventions . The chest radiograph and computed tomography ( CT ) scan interpretations were performed by attending radiologists who were not blinded to patient outcome . RESULTS Five of the 245 patients enrolled in the study were excluded because tube thoracostomy was performed before the ultrasound examination was done . Altogether , 26 of the 240 study patients had hemothorax , as confirmed by tube thoracostomy or CT . Both ultrasound examination and the initial chest radiograph result ed in 0 false-positive , 1 false-negative , 25 true-positive , and 214 true-negative findings . Overall , both modailties were 96.2 % sensitive , 100 % specific , and 99.6 % accurate . CONCLUSION Ultrasonography is comparable to the initial chest radiograph for accuracy in detection of hemothorax and may expedite the diagnosis and treatment of this condition for patients with major trauma Background Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome ( ARDS ) . Clinical experience suggests that the diagnostic accuracy of these procedures is poor . Methods This prospect i ve study of 32 patients with ARDS and 10 healthy volunteers was performed to compare the diagnostic accuracy of auscultation , bedside chest radiography , and lung ultrasonography with that of thoracic computed tomography . Three pathologic entities were evaluated in 384 lung regions ( 12 per patient ) : pleural effusion , alveolar consolidation , and alveolar-interstitial syndrome . Results Auscultation had a diagnostic accuracy of 61 % for pleural effusion , 36 % for alveolar consolidation , and 55 % for alveolar-interstitial syndrome . Bedside chest radiography had a diagnostic accuracy of 47 % for pleural effusion , 75 % for alveolar consolidation , and 72 % for alveolar-interstitial syndrome . Lung ultrasonography had a diagnostic accuracy of 93 % for pleural effusion , 97 % for alveolar consolidation , and 95 % for alveolar-interstitial syndrome . Lung ultrasonography , in contrast to auscultation and chest radiography , could quantify the extent of lung injury . Interobserver agreement for the ultrasound findings as assessed by the & kgr ; statistic was satisfactory : 0.74 , 0.77 , and 0.73 for detection of alveolar-interstitial syndrome , alveolar consolidation , and pleural effusion , respectively . Conclusions At the bedside , lung ultrasonography is highly sensitive , specific , and reproducible for diagnosing the main lung pathologic entities in patients with ARDS and can be considered an attractive alternative to bedside chest radiography and thoracic computed tomography OBJECTIVE The objective of our prospect i ve study was to evaluate the value of various operator-dependent techniques that allow grade d compression sonography to detect normal or abnormal vermiform appendix . SUBJECTS AND METHODS A total of 877 subjects were included in this study . This sample population consisted of two groups : 202 control subjects and 675 patients who were suspected of having acute appendicitis . If detection of the appendix failed after a sufficient number of trials using grade d compression scanning , appropriate operator-dependent techniques were used to help grade d compression scanning to increase the detectability of the appendix further . The detection rate for the appendix in both groups and the diagnostic accuracy for acute appendicitis were obtained . RESULTS The initial grade d compression sonography examination depicted the appendix in 170 ( 84 % ) of 202 subjects in the control group and 601 ( 89 % ) of the 675 patients in the patient group . We then added operator-dependent techniques to grade d compression sonography for the remaining patients in whom the appendix could not be detected . The additional use of the posterior manual compression technique , low-frequency convex transducer , upward grade d compression technique , or left oblique lateral decubitus change of body position allowed grade d compression sonography to depict the appendix in an additional 10 , eight , six , and four patients in the control group , respectively , and in an additional 27 , 23 , 11 , and seven patients in the patient group . The number of identified appendixes was increased to 198 ( 98 % ) of the 202 patients in the control group and to 669 ( 99 % ) of the 675 patients in the patient group . Grade d compression sonography with operator-dependent techniques in the patient group yielded a sensitivity of 99 % ( 319/321 patients ) , specificity of 99 % ( 350/354 ) , and an accuracy of 99 % ( 669/675 ) for acute appendicitis . CONCLUSION The addition of various operator-dependent techniques to grade d compression sonography is useful for allowing improved visualization of both normal and abnormal appendixes Aims We aim ed to study the diagnostic influence of adding a routine cardiovascular ultrasound screening of the cardiac anatomy and function , the pericardium , the pleura and the abdominal great vessels by the new pocket-size ultrasound device ( pUS ) with grey scale and colour Doppler imaging . Methods and results In 119 r and omly selected patients admitted to a cardiac unit at a non-university hospital , routinely adding a cardiovascular ultrasonography of only 4.4 min with a pocket-size device corrected the primary diagnosis in 16 % of patients . In addition , 29 % had the primary diagnosis verified and in 10 % an additional important diagnosis was made . Higher age predicted any diagnostic influence of pUS screening with an increase of 61 % ( P = 0.003 ) per 10 years of higher age . Overall , the pUS screening had a sensitivity and specificity with respect to detecting at least moderate pathology of 97 and 93 % . Positive and negative predictive values were 93 and 87 % , respectively . In the sub-group of subjects with a change in the primary diagnosis following pUS there was no false-negative or false-positive findings . Conclusion Screening by pUS assessed vascular and cardiac anatomy and function accurately and enabled correction of the diagnosis in 16 % of patients admitted to a cardiac unit . In 55 % of the participants , the cardiovascular ultrasound screening had important diagnostic influence . We suggest that it would be appropriate to implement strategies and systems for routinely adding an ultrasound cardiovascular examination to patients in cardiac units Background Pneumothorax is one of the leading causes of preventable death in trauma patients .  Chest radiograph has a lower sensitivity than a computed tomography ( CT ) scan for the diagnosis of pneumothorax . Objectives The objective of this study is to assess the accuracy of ultrasound ( US ) in diagnosing post-traumatic pneumothorax using a simplified diagnostic algorithm . Methods This prospect i ve study was carried out in two academic emergency departments with a combined annual emergency department census of 70 000 visits per year by convenient sampling . Emergency physicians underwent a 2-h training course using a two-step diagnostic algorithm . The trauma patients included suspected of having post-traumatic pneumothorax were evaluated by thoracic US and chest CT scan . The accuracy of US in identifying pneumothorax was measured by calculating the sensitivity , specificity , positive predictor value , and negative predictor value using CT scan as the gold st and ard . The performance of US was compared with chest radiograph , which was also done as a part of st and ard trauma care for all patients . Results From June 2009 until July 2009 , a total of 153 patients were included .  US had a sensitivity of 86.4 % , a specificity of 100 % , a positive predictor value of 100 % , and a negative predictor value of 95.6 % . Chest radiograph showed a sensitivity of 48.6 % , a specificity of 100 % , a positive predictor value of 100 % , and a negative predictor value of 85.1 % . The mean time to perform chest radiograph was 12 min , which was significantly higher than US , with a mean time of 2 min . All missed pneumothoraces in US evaluation were small in size . Conclusion After just a 2-h training course , emergency physicians showed a good success rate in finding pneumothoraces . Thoracic US can be an easy to learn and an accurate diagnostic modality for the detection of traumatic pneumothorax in emergency departments Purpose To compare the diagnostic performance of lung ultrasound and bedside chest radiography ( CXR ) for the detection of various pathologic abnormalities in unselected critically ill patients , using thoracic computed tomography ( CT ) as a gold st and ard . Methods Forty-two mechanically ventilated patients scheduled for CT  were prospect ively studied with a modified lung ultrasound protocol . Four pathologic entities were evaluated : consolidation , interstitial syndrome , pneumothorax , and pleural effusion . Each hemithorax was evaluated for the presence or absence of each abnormality . Results Eighty-four hemithoraces were evaluated by the three imaging techniques . The sensitivity , specificity , and diagnostic accuracy of CXR  were 38 , 89 , and 49 % for consolidation , 46 , 80 , and 58 % for interstitial syndrome , 0 , 99 , and 89 % for pneumothorax , and 65 , 81 , and 69 % for pleural effusion , respectively . The corresponding values for  lung ultrasound  were 100 , 78 , and 95 % for consolidation , 94 , 93 , and 94 % for interstitial syndrome , 75 , 93 , and 92 % for pneumothorax , and 100 , 100 , and 100 % for pleural effusion , respectively . The relatively low sensitivity of lung ultrasound  for pneumothorax could be due to small number of cases ( n = 8) and /or suboptimal methodology . Conclusions In our unselected general ICU population  lung ultrasound has a considerably better diagnostic performance than CXR for the diagnosis of common pathologic conditions and may be used as an alternative to thoracic CT BACKGROUND We examined the concordance between chest ultrasonography and chest radiography in patients with dyspnea , using chest CT scanning as the gold st and ard in case of mismatch between the two modalities . METHODS A prospect i ve , blinded , observational study was conducted in the ED of a university-affiliated teaching hospital . All consecutive patients presenting for dyspnea during a single emergency physician shift were enrolled independently from the underlying disease . Only patients with trauma were excluded . RESULTS Both ultrasonography and radiography were performed in 404 patients ; CT scanning was performed in 118 patients .  Ultrasound interpretation was completed during the scan , whereas the average time between radiograph request and its final interpretation was 1 h and 35 min .  Ultrasonography and radiography  exhibited high concordance in most pulmonary diseases , especially in pulmonary edema ( κ = 95 % ) . For lung abnormalities such as free pleural effusion , loculated pleural effusion 
    Output:
    
Chest ultrasonography , as a screening tool , has a higher diagnostic accuracy in identification of plural effusion compared to radiography .
The sensitivity of this imaging modality was found to be higher when performed by a radiologist or an intensivist and using 5 - 10MHz probes