***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: OBJECTIVE The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life ( QoL ) , readmission rates and healthcare costs for adults with heart failure ( HF ) living independently in the community . METHOD A systematic review of r and omised control trials was undertaken . Using the search terms nurse , education , heart failure , hospitalisation , readmission , rehospitalisation , economic burden , cost , expenditure and quality of life in PubMed , CINAHL and Google Scholar data bases were search ed . Papers pertaining to  nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were review ed . RESULT The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions , reduction in hospitalisation and a cost benefit . Additionally , higher functioning and improved QoL were also identified . CONCLUSION These results suggest that nurse-led patient education for adults with HF  improves QoL and reduces hospital admissions and readmissions . PRACTICE IMPLICATION S Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation Background The diagnosis and management of acutely dyspneic patients in re source -limited developing world setting s poses a particular challenge . Focused cardiopulmonary ultrasound ( CPUS ) may assist in the emergency diagnosis and management of patients with acute dyspnea by identifying left ventricular systolic dysfunction , pericardial effusion , interstitial pulmonary edema , and pleural effusion . We sought to assess the accuracy of emergency providers performing CPUS after a training intervention in a limited-re source setting ; a secondary objective was to assess the ability of CPUS to affect change of clinician diagnostic assessment and acute management in patients presenting with undifferentiated dyspnea . Methods and results After a training intervention for Haitian emergency providers , patients with dyspnea presenting urgently to a regional referral center in Haiti underwent a rapid CPUS examination by the treating physician . One hundred seventeen patients ( median age of 36 years , 56 % female ) were prospect ively evaluated with a st and ardized CPUS exam . Blinded expert review of ultrasound images was performed by two board certified cardiologists and one ultrasound fellowship trained emergency physician . Inter-observer agreement was determined using an agreement coefficient ( kappa ) . Sensitivity and Specificity with confidence intervals were calculated . Pre-test and post-test clinician impressions and management plans were compared to assess for a change . We enrolled 117 patients with undifferentiated dyspnea . Upon expert image review , prevalence of left ventricular systolic dysfunction was 40.2 % , and in those with systolic dysfunction , the average EF was 14 % ( ±9 % ) . The parasternal long axis ( PLAX ) single view was predictive of an overall abnormal echo with PPV of abnormal PLAX 95 % and NPV 93 % of normal PLAX . Weighted kappa for pericardial effusion between the Haitian physicians and two cardiology review ers was 0.81 ( 95 % CI 0.75–0.87 , p value < 0.001 ) and for ejection fraction was 0.98 ( 95 % CI 0.98–0.99 , p value < 0.001 ) . For lung ultrasound , a kappa statistic assessing agreement between the Haitian physician and the EP for pleural effusion was 0.73 , and for interstitial syndrome was 0.49 . Detailed test characteristics are detailed in Table 3 . Overall , there was a change in treating clinician impression in 15.4 % ( 95 % CI 9–22 % ) and change in management in 19.6 % ( 95 % CI 12–27 % ) of patients following CPUS . A significant structural heart disease was common : 48 % of patients were noted to have abnormal right ventricular systolic function , 36 % had at least moderate mitral regurgitation , and 7.7 % had a moderate to large pericardial effusion . Conclusions A focused training intervention in CPUS was sufficient for providers in a limited-re source setting to accurately identify left ventricular systolic dysfunction , pericardial effusion , evidence of interstitial syndrome , and pleural effusions in dyspneic patients . Clinicians were able to integrate CPUS into their clinical impressions and management plans and reported a high level of confidence in their ultrasound findings BACKGROUND Lung ultrasonography ( LUS ) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases . However , its use for the diagnosis of  acute decompensated heart failure ( ADHF ) still raises some concerns . We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a st and ard workup in differentiating ADHF from noncardiogenic dyspnea in the ED . METHODS We conducted a multicenter , prospect i ve cohort study in seven Italian EDs . For patients presenting with acute dyspnea , the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after ( 1 ) the initial clinical assessment and ( 2 ) after performing LUS ( " LUS-implemented " diagnosis ) .  All patients also underwent chest radiography .  After discharge , the cause of each patient 's dyspnea was determined by independent review of the entire medical record . The diagnostic accuracy of the different approaches was then compared . RESULTS The study enrolled 1,005 patients . The LUS-implemented approach had a significantly higher accuracy ( sensitivity , 97 % [ 95 % CI , 95%-98.3 % ] ; specificity , 97.4 % [ 95 % CI , 95.7%-98.6 % ] ) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup ( sensitivity , 85.3 % [ 95 % CI , 81.8%-88.4 % ] ; specificity , 90 % [ 95 % CI , 87.2%-92.4 % ] ) , chest radiography alone ( sensitivity , 69.5 % [ 95 % CI , 65.1%-73.7 % ] ; specificity , 82.1 % [ 95 % CI , 78.6%-85.2 % ] ) , and natriuretic peptides ( sensitivity , 85 % [ 95 % CI , 80.3%-89 % ] ; specificity , 61.7 % [ 95 % CI , 54.6%-68.3 % ] ; n = 486 ) . Net reclassification index of the LUS-implemented approach compared with st and ard workup was 19.1 % . CONCLUSIONS The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED . TRIAL REGISTRY Clinical trials.gov ; No. : NCT01287429 ; URL : www . clinical trials.gov PURPOSE Our institution has recently implemented a point-of-care ( POC ) ultrasound training program , consisting of an e-learning course and systematic practical h and s-on training . The aim of this prospect i ve study was to evaluate the learning outcome of this curriculum . MATERIAL S AND METHODS 16 medical students with no previous ultrasound experience comprised the study group . The program covered a combination of 4 well-described point-of-care ( POC ) ultrasound protocol s ( focus assessed transthoracic echocardiography , focused assessment with sonography in trauma , lung ultrasound , and dynamic needle tip positioning for ultrasound-guided vascular access ) and it consisted of an e-learning course followed by 4 h of practical h and s-on training .  Practical skills and image quality were tested 3 times during the study : at baseline , after e-learning , and after h and s-on training . RESULTS Practical skills improved for all 4 protocol s ; after e-learning as well as after h and s-on training . The number of students who were able to perform at least one interpretable image of the heart increased from 7 at baseline to 12 after e-learning , p<0.01 , and to all 16 students after h and s-on-training , p<0.01 . The number of students able to cannulate an artificial vessel increased from 3 to 8 after e-learning and to 15 after h and s-on training . CONCLUSION Medical students with no previous ultrasound experience demonstrated a considerable improvement in practical skill after interactive e-learning and 4 h of h and s-on training Abstract In clinical practice lung ultrasound ( LUS ) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea . The aim of this study was to assess the accuracy of nurse-performed LUS , in particular , in the diagnosis of acute cardiogenic pulmonary congestion . We prospect ively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014 . At admission , serum brain natriuretic peptide ( BNP ) levels and LUS was performed by trained nurses blinded to clinical and laboratory data . The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated . Two hundred twenty-six patients ( 41.6 % men , mean age 78.7 ± 12.7 years ) were included in the study . Nurse-performed LUS alone had a sensitivity of 95.3 % ( 95 % CI : 92.6–98.1 % ) , a specificity of 88.2 % ( 95 % CI : 84.0–92.4 % ) , a positive predictive value of 87.9 % ( 95 % CI : 83.7–92.2 % ) and a negative predictive value of 95.5 % ( 95 % CI : 92.7–98.2 % ) . The combination of nurse-performed LUS  with BNP level ( cut-off 400 pg/mL ) result ed in a higher sensitivity ( 98.9 % , 95 % CI : 97.4–100 % ) , negative predictive value ( 98.8 % , 95 % CI : 97.2–100 % ) , and corresponding negative likelihood ratio ( 0.01 , 95 % CI : 0.0 , 0.07).Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea . Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea . Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other setting Introduction Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five , existing methods of assessing dehydration status in children have limited accuracy . Objective To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children . Methods A prospect i ve cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research , Bangladesh ( icddr , b ) .  Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight  were obtained on patient arrival . Percent weight change was monitored during rehydration to classify children as having “ some dehydration ” with weight change 3–9 % or “ severe dehydration ” with weight change > 9 % . Logistic regression analysis and Receiver-Operator Characteristic ( ROC ) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity . Results 850 children were enrolled , of which 771 were included in the final analysis .  Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea , with each 1-point increase in the aorta to IVC ratio predicting a 1.1 % increase in the percent dehydration of the child . However , the area under the ROC curve ( 0.60 ) , sensitivity ( 67 % ) , and specificity ( 49 % ) , for predicting severe dehydration were all poor . Conclusions Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status , but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a re source -limited setting Introduction Our objective was to evaluate the effectiveness of h and s-on training at a bedside ultrasound ( US ) symposium ( “ Ultrafest ” ) to improve both clinical knowledge and image acquisition skills of medical students . Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma ( FAST ) US knowledge . Secondary outcome was improvement in image acquisition for either pulmonary or FAST . Methods Prospect i ve cohort study of 48 volunteers at “ Ultrafest , ” a free symposium where students received five contact training hours . Students were evaluated before and after training for proficiency in either pulmonary US or FAST . Proficiency was assessed by clinical knowledge through written multiple-choice exam , and clinical skills through accuracy of image acquisition . We used paired sample t-tests with students as their own controls . Results Pulmonary knowledge scores increased by a mean of 10.1 points ( 95 % CI [ 8.9–11.3 ] , p<0.00005 ) , from 8.4 to a posttest average of 18.5/2 
    Output:
    
Conclusions : Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases .