***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: Background The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the dem and towards the undergraduate anatomical curriculum . This r and omized controlled trial investigates whether musculoskeletal ultrasound ( MSUS ) or arthroscopic methods can increase the anatomical knowledge uptake . Methods Second-year medical students were r and omly allocated to three groups . In addition to the compulsory dissection course , the ultrasound group ( MSUS ) was taught by eight , didactically and professionally trained , experienced student-teachers and the arthroscopy group ( ASK ) was taught by eight experienced physicians . The control group ( CON ) acquired the anatomical knowledge only via the dissection course . Exposure ( MSUS and ASK ) took place in two separate lessons ( 75 minutes each , shoulder and knee joint ) and introduced st and ard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials . The theoretical anatomic learning outcomes were tested using a multiple-choice question naire ( MCQ ) , and after cross-over an objective structured clinical examination ( OSCE ) . Differences in student ’s perceptions were evaluated using Likert scale-based items . Results The ASK-group ( n = 70 , age 23.4 ( 20–36 ) yrs . )  performed moderately better in the anatomical MC exam in comparison to the MSUS-group ( n = 84 , age 24.2 ( 20–53 ) yrs . ) and the CON-group ( n = 88 , 22.8 ( 20–33 ) yrs . ; p = 0.019 ) . After an additional arthroscopy teaching 1 % of students failed the MC exam , in contrast to 10 % in the MSUS- or CON-group , respectively . The benefit of the ASK module was limited to the shoulder area ( p < 0.001 ) . The final examination ( OSCE ) showed no significant differences between any of the groups with good overall performances . In the evaluation , the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial ( p = 0.002 ; p < 0.001 ) . Conclusions The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy . Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts , but seems to be inferior to the arthroscopic 2D-3D-transformation , and is regarded by students as more difficult to learn . Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy , they have the potency to raise the interest in surgery The birth of the intermittent injectate-based conventional pulmonary artery catheter ( fondly nicknamed PAC ) was proudly announced in the New Engl and Journal of Medicine in 1970 by his parents HJ Swan and William Ganz . PAC grew rapidly , reaching manhood in 1986 where , in the US , he was shown to influence the management of over 40 % of all ICU patients . His reputation , however , was tarnished in 1996 when Connors and colleagues suggested that he harmed patients . This was followed by r and omized controlled trials demonstrating he was of little use . Furthermore , reports surfaced suggesting that he was unreliable and inaccurate . It also became clear that he was poorly understood and misinterpreted . Pretty soon after that , a posse of rivals ( bedside echocardiography , pulse contour technology ) moved into the neighborhood and cl aim ed they could assess cardiac output more easily , less invasively and no less reliably . To make matter worse , dynamic assessment of fluid responsiveness ( pulse pressure variation , stroke volume variation and leg raising ) made a mockery of his ‘ wedge ’ pressure . While a h and ful of die-hard followers continued to promote his mission , the last few years of his existence were spent as a castaway until his death in 2013 . His cousin ( the continuous cardiac output PAC ) continues to eke a living mostly in cardiac surgery patients who need central access anyway . This paper review s the rise and fall of the conventional PAC This study compared the efficacy of two cardiac anatomy teaching modalities , ultrasound imaging and cadaveric prosections , for learning cardiac gross anatomy . One hundred and eight first‐year medical students participated . Two weeks prior to the teaching intervention , students completed a pretest to assess their prior knowledge and to ensure that groups were equally r and omized . Students , divided into pre‐existing teaching groups , were assigned to one of two conditions ; “ cadaver ” or “ ultrasound . ” Those in the cadaver group received teaching on the heart using prosections , whereas the ultrasound group received teaching using live ultrasound images of the heart . Immediately after teaching , students sat a post‐test . Both teaching modalities increased students ' test scores by similar amounts but no significant difference was found between the two conditions , suggesting that both prosections and ultrasound are equally effective methods for teaching gross anatomy of the heart . Our data support the inclusion of either cadaveric teaching or living anatomy using ultrasound within the undergraduate anatomy curriculum , and further work is needed to compare the additive effect of the two modalities . Anat Sci Educ . © 2011 American Association of Anatomists Purpose We analyzed the efficacy of a point-of-care ultrasonographic protocol , based on a focused multiorgan examination , for the diagnostic process of symptomatic , non-traumatic hypotensive patients in the emergency department . Methods We prospect ively enrolled 108 adult patients complaining of non-traumatic symptomatic hypotension of uncertain etiology . Patients received immediate point-of-care ultrasonography to determine cardiac function and right/left ventricle diameter rate , inferior vena cava diameter and collapsibility , pulmonary congestion , consolidations and sliding , abdominal free fluid and aortic aneurysm , and leg vein thrombosis . The organ-oriented diagnoses were combined to formulate an ultrasonographic hypothesis of the cause of hemodynamic instability . The ultrasonographic diagnosis was then compared with a final clinical diagnosis obtained by agreement of three independent expert physicians who performed a retrospective hospital chart review of each case . Results Considering the whole population , concordance between the point-of-care ultrasonography diagnosis and the final clinical diagnosis was interpreted as good , with Cohen ’s k = 0.710 ( 95 % CI , 0.614–0.806 ) , p < 0.0001 and raw agreement ( Ra ) = 0.768 . By eliminating the 13 cases where the final clinical diagnosis was not agreed upon ( indefinite ) , the concordance increased to almost perfect , with k = 0.971 ( 95 % CI , 0.932–1.000 ) , p < 0.0001 and Ra = 0.978 . Conclusions Emergency diagnostic judgments guided by point-of-care multiorgan ultrasonography in patients presenting with undifferentiated hypotension significantly agreed with a final clinical diagnosis obtained by retrospective chart review . The integration of an ultrasonographic multiorgan protocol in the diagnostic process of undifferentiated hypotension has great potential in guiding the first-line therapeutic approach Ultrasound simulation allows students to virtually explore internal anatomy by producing accurate , moving , color , three‐dimensional rendered slices from any angle or approach leaving the organs and their relationships intact without requirement for consumables . The aim was to determine the feasibility and efficacy of self‐directed learning of cardiac anatomy with an ultrasound simulator compared to cadavers and plastic models . After a single cardiac anatomy lecture , fifty university anatomy students participated in a three‐hour supervised self‐directed learning exposure in groups of five , r and omized to an ultrasound simulator or human cadaveric specimens and plastic models . Pre‐ and post‐tests were conducted using pictorial and non‐pictorial multiple‐choice questions ( MCQs ) . Simulator students completed a survey on their experience . Four simulator and seven cadaver group students did not attend after r and omization . Simulator use in groups of five students was feasible and feedback from participants was very positive . Baseline test scores were similar ( P = 0.9 ) between groups . After the learning intervention , there was no difference between groups in change in total test score ( P = 0.37 ) , whether they were pictorial ( P = 0.6 ) or non‐pictorial ( P = 0.21 ) . In both groups there was an increase in total test scores ( simulator + 19.8 ±12.4%% and cadaver : + 16.4 % ± 10.2 , P < 0.0001 ) , pictorial question scores ( + 22.9 ±18.0 % , 19.7 ±19.3 % , P < 0.001 ) and non‐pictorial question scores ( + 16.7 ±18.2 % , + 13 ±15.4 % , P = 0.002 ) . The ultrasound simulator appears equivalent to human cadaveric prosections for learning cardiac anatomy . Anat Sci Educ 8 : 21–30 . © 2014 American Association of Anatomists Existing guidelines for the number of ultrasounds required before clinical competency are based not on scientific study but on consensus opinion . The objective of this study was to describe the learning curve of limited right upper quadrant ultrasound .  This was a prospect i ve descriptive study . Ultrasounds collected over 1 year were review ed for interpretive and technical errors . Possible errors during bedside ultrasound of the gallbladder include incorrect interpretation , incomplete image acquisition , and improper or poor imaging techniques result ing in poor image quality . The ultrasound image quality was rated on a 4-point scale , with 1 = barely interpretable and 4 = excellent image quality . Required images were rated on an additional 4-point scale , with 4 = all required images were included and 1 = minimal images were recorded . There were 352 patients enrolled by 42 emergency physicians ( 35 residents and 7 attendings ) .  Gallstones were identified in 13.9 % of the patients , and 4.3 % of the ultrasounds were indeterminate . Interpretive and technical error rates decreased as the clinician gained experience . The number of poor quality ultrasounds decreased after an average of seven ultrasounds . Inclusion of all required images increased after 25 ultrasounds . Sonographers who had performed over 25 ultrasounds showed excellent agreement with the expert over-read , with only two disagreements , both from a single individual . It was concluded that clinicians are clinical ly competent after performing 25 ultrasounds of the gallbladder OBJECTIVES We aim ed to investigate the potential benefit of adding goal -directed ultrasound examinations performed by on-call medical residents using a pocket-size imaging device in patients admitted to a medical department . METHODS A total of 992 emergency admissions to the medical department at a nonuniversity hospital in Norway were included . Patients admitted on date s with an on-call medical resident r and omized to use a pocket-size imaging device  were eligible for pocket-size cardiac and abdominal ultrasound examinations or st and ard care . The cardiac examination included estimation of right and left ventricular sizes and global systolic function and regional left ventricular systolic function , evaluation for pleural and pericardial effusion , and valvular disease . The abdominal examination looked for signs of gross abnormalities of the liver , gallbladder , abdominal aorta , inferior vena cava , and urinary system . Six of 12 medical residents with limited ultrasound experience were r and omized to perform the examinations . Diagnostic corrections were made , and findings were confirmed by reference st and ard diagnostics . RESULTS A total of 199 patients were examined .  Median times used were 5.7 minutes for the cardiac examination and 4.7 minutes for the abdominal examination . In 13 patients ( 6.5 % ) , the examination result ed in a major change in the primary diagnosis . In 21 patients ( 10.5 % ) , the diagnosis was verified , and in 48 ( 24.0 % ) , an additional important diagnosis was made . CONCLUSIONS By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care , we corrected , verified , or added important diagnoses in more than 1 of 3 emergency medical admissions . Point-of-care examinations with a pocket-size imaging device increased medical residents '  diagnostic accuracy and capability Introduction : This study compared ultrasonography-guided ( USG ) placement with anatomic placement during internal jugular ( IJ ) central venous catheter ( CVC ) insertion by novice practitioners using a simulation model . Methods : A prospect i ve , r and omized , crossover study of 28 fourth year medical students was conducted with institutional review board approval . Participants viewed an instructional material before participation , and supervision was st and ardized . Participants were r and omly assigned to either USG or traditional l and mark method first , and each group served as its own crossover comparison . Paired t tests and & khgr;2 analysis were performed on matched-pair data . Results : Fifty-four percent of participants had at least one arterial stick without USG compared with 0 % when using USG . Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein : mean with USG = 1.5 advances ( 95 % CI , 1.0–1.9 ) , mean without USG = 10.4 advances ( 95 % CI , 7.8–13 ) , P < 0.001 ; time to successful cannulation : mean with USG = 58 seconds ( 95 % CI , 48–72 seconds ) , mean without USG = 338 seconds ( 95 % CI , 286–390 seconds 
    Output:
    
The use of ultrasound was not demonstrated to improve  students ' underst and ing of anatomy .
The benefit of ultrasound in teaching physical examination was inconsistent and rests on minimal evidence .
With POCUS ,  students ' diagnostic accuracy was improved for certain pathologies , but findings were inconsistent for others .