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#194 - 👣 Partnerships for Better POCUS Use in Neonatology (ft POCUS Collaborative)





Hello friends 👋

In this special episode of the Incubator Podcast, hosts Ben and Daphna are joined by a panel of distinguished guests from the National Neonatal POCUS Collaborative to explore the cutting-edge integration of Point of Care Ultrasound (POCUS) into neonatal care. This discussion features insights from Dr. Mackie Fraga, chair of the collaborative and attending at the Children's Hospital of Philadelphia, Dr. Shazia Bhombal, vice chair and associate professor of neonatology at Emory, and other key figures who are leading the way in POCUS research, education, and application within neonatology.

The conversation begins with the history and evolution of POCUS in neonatal care, highlighted by Dr. Yogen Singh's pivotal work on cardiac POCUS. The panelists discuss the collaborative's mission to standardize POCUS training, ensure quality and safety, and foster international guidelines and collaboration. With POCUS poised to redefine neonatal diagnostics and care, the episode emphasizes its role in enhancing decision-making, procedure guidance, and patient outcomes at the bedside.

The Incubator Podcast's latest episode not only sheds light on the innovative uses of POCUS across various neonatal conditions but also underscores the collaborative's efforts in overcoming challenges related to training, credentialing, and adoption in neonatal units worldwide. This episode is a must-listen for neonatal care professionals seeking to stay at the forefront of medical technology and improve care for their smallest patients through the integration of POCUS.


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You can find out more about the POCUS collaborative here:


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The articles covered on today’s episode of the podcast can be found here 👇

Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS; COMMITTEE ON FETUS AND NEWBORN AND SECTION ON RADIOLOGY; Section on Radiology Executive Committee, 2021–2022.Pediatrics. 2022 Dec 1;150(6):e2022060053. doi: 10.1542/peds.2022-060053.PMID: 37154781


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Bio for our guests:

Dr. Shazia Bhombal is a Clinical Associate Professor of Pediatrics in the Division of Neonatal and Developmental medicine and (by courtesy) in Pediatric cardiology at Lucile Packard Children’s Hospital at Stanford.  She serves as Medical Director of the NICU Heart Team at Stanford, Co-Director of the CRIB Program (Cardiac and Respiratory care for the Infant with BPD, https://www.stanfordchildrens.org/en/service/cardiac-bpd) and Director of the NICU Ultrasound Program. She completed fellowships in Neonatal Perinatal Medicine at LAC + University of Southern California and in Cardiology at Children’s Hospital Los Angeles. She started her career at Children's Hospital Los Angeles as Director of Neonatal Cardiology, with a dual faculty appointments in neonatology and cardiology.  At Stanford in her role as NICU liaison to the Cardiac ICU team, she has facilitated educational and clinical collaborations between the divisions. Her research interest lies in bronchopulmonary dysplasia and development of pulmonary hypertension as well as education and training for targeted neonatal echocardiography and point of care ultrasound in the NICU.


Belinda Chan is the Associate Professor in the Neonatology Division at University of Utah. She completed her medical school at the University of Southern California. She received her pediatrics residency and neonatology fellowship at the University of Southern California and Children's Hospital of Los Angeles. She is currently medical director of the University of Utah NICU. She is also appointed adjunct faculty at the University of Utah Hospital Radiology Department based on her achievement in POCUS. She has been the founder and director of the neonatal POCUS program in her institutions since 2018. She has published in peer-reviewed articles and book chapters on POCUS. She is a dynamic and enthusiastic speaker who has taught POCUS locally, internationally, and virtually. She has trained and credentialed many clinicians to be POCUS users.


Dr. Yogen Singh is a Full Professor of Pediatrics at the Loma Linda University School of Medicine, California. He is the Chair for ESPNIC Cardiovascular Dynamics Section and POCUS Working Group. He is passionate about echocardiography and point of care ultrasound (POCUS) training for the neonatal and paediatric intensivists so that they can be widely applied while making clinical decisions in emergency situations. He has led development of the ESPNIC evidence-based POCUS guidelines for use in neonatal and pediatric intensive care unit and “Expert Consensus Statement on Neonatologist Performed Echocardiography (NPE): Training and Accreditation in the UK”. He has published extensively in the peer review journals, especially around neonatologist performed echocardiography, neonatal hemodynamics and neonatal cardiology. He is Co-Director at ‘Point-of-care Echocardiography Course at University of Southern California (USC), Los Angeles, California, USA’ and Training in Intensive Care and Neonatal echocardiography (TINEC) course in Switzerland. As the Chair of ESPNIC hemodynamics section, he has led developing ESPNIC hemodynamic monitoring guidelines for the use in neonates and children. He has special interest in neonatal and peediatric hemodynamics and advanced functional echocardiography imaging. He is the Director of TNE, Neonatal Hemodynamics and POCUS at Loma Linda University Children’s Hospital. He has published extensively in this field - published over 70 papers and scholarly articles in the peer reviewed journals. He is an Associate Editor, for Frontiers in Pediatrics (Neonatology). As an invited speaker, he has been delivered >100 lectures in the prestigious national and international conferences.


Dr. Maria Fraga is a Professor of Clinical Pediatrics and an attending neonatologist physician at the Children’s Hospital of Philadelphia. Her professional interests are centered on the bedside assessment of neonatal cardiac hemodynamics, alongside procedural and diagnostic point-of-care ultrasound. Dr. Fraga has completed extensive training in functional neonatal echocardiography as well as various applications of Point-of-Care Ultrasound. Moreover, she has been instrumental in developing the “Clinician Performed Ultrasound Program” in the Neonatal Intensive Care Unit at The Children’s Hospital of Philadelphia, where she currently serves as the director. She has also been actively involved in teaching Ultrasound courses both nationally and internationally. Since 2015, Dr. Fraga has held the position of co-director of the CHOP Bedside Ultrasound Course, which provides multi-disciplinary training in pediatric and neonatal procedural and diagnostic ultrasound applications. Beginning in 2014, she has been the principal investigator (PI) for multicenter studies, granting her significant experience in conducting clinical research in critically ill infants. Currently, she is the site PI for a multicenter pilot trial titled “Milrinone in Congenital Diaphragmatic Hernia,” sponsored by the NICHD through the Neonatal Research Network (NRN). Dr. Fraga's specific area of interest includes education in Point-of-Care Ultrasound and neonatal hemodynamics, with a strong focus on improving patient care.


Dr. Sai Mukthapuram is a distinguished Neonatologist at Envision Health, South Florida, with a deep-seated passion for aiding premature and ill infants. His expertise lies in the utilization of point-of-care ultrasound to enhance diagnostic accuracy and patient care, emphasizing quality improvement and medical leadership within the neonatal field. Dr. Mukthapuram is also fervently dedicated to medical education, demonstrating a strong commitment to mentoring aspiring Neonatologists. Through his work, he aims to advance the field of Neonatology, ensuring that the next generation of medical professionals is well-equipped with the knowledge and skills necessary to continue improving outcomes for the most vulnerable patients.


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The transcript of today's episode can be found below 👇


Ben Courchia MD (00:01.034)

Hello everybody, welcome back to the incubator podcast. We are back this Sunday with a new interview. Daphna, how are you this morning?

 

Daphna Yasova Barbeau, MD (she/her) (00:09.833)

I'm doing great, we got everybody. This is our biggest group ever, I think, in the studio, but we're all here.

 

Ben Courchia MD (00:16.818)

Yeah, we have a big crowd in the studio today. We have members of the team from the POCUS Collaborative, the National Neonatal POCUS Collaborative. I'm going to introduce our guests today one by one. Our first guest is Dr. Mackie Fraga, who is in attending a Children's Hospital of Philadelphia, and who is the chair of the National Neonatal POCUS Collaborative. Mackie, thank you for making the time and being on the show with us today.

 

Maky (00:43.829)

Thank you so much for having us.

 

Ben Courchia MD (00:46.61)

We are also joined by Dr. Shazia Bumble, who's an associate professor of neonatology at Emory in Atlanta, Georgia, and who's the vice chair of the POCUS Collaborative. Shazia, welcome to the show. Yep. We have Dr. Yogen Singh from the UK, who's a consultant in pediatric cardiology and neonatology at Addenbrookes Cambridge University Hospital, and who is the secretary of the POCUS Collaborative. No, no more.

 

Shazia Bhombal (00:57.21)

Thank you so much for having us.

 

Yogen Singh (01:14.511)

No, I think we need to change this one definitely. I don't know where this coming from this very old I'm not part of the Cambridge at all now. So can we change this? Yeah, no nobody's been so

 

Ben Courchia MD (01:22.063)

Oh, so sorry. Yeah, tell me.

 

Yogen Singh (01:26.943)

Can we? I'm at Loma Linda. I'm nowhere. No, I'm at Loma Linda University Hospital at the moment. So I'm a professor of pediatrics at Loma Linda University in California.

 

Ben Courchia MD (01:26.961)

So what are you?

 

Dr. Belinda Chan (01:28.826)

What are you?

 

Ben Courchia MD (01:40.406)

Okay, yeah, no problem. So let me restart that. We are also joined by Dr. Yogen Singh, who is a professor of pediatrics at Loma Linda University in a hospital in California, and who's the secretary of the POCUS Collaborative. Yogen, thank you for being on the show with us.

 

Yogen Singh (01:43.435)

Sorry about that, yeah.

 

Yogen Singh (01:56.659)

Thank you so much for having me here.

 

Ben Courchia MD (01:59.831)

Finally, we're joined with Dr. Bilynda Chen, who's an associate professor in the division of Neonatology at the University of Utah School of Medicine, and who's a member of the executive council of the PUCAS Collaborative. Bilynda, welcome to the show.

 

Dr. Belinda Chan (02:12.136)

Thank you for having me.

 

Ben Courchia MD (02:14.05)

And we have a veteran of the podcast and the Delphi conference, Dr. Sai Mukthaparam, who's an attending neonatologist here with Envision Physician Services in South Florida, and who's a member also of the executive council for the Pocus Collaborative. Sai, welcome back to the show.

 

Daphna Yasova Barbeau, MD (she/her) (02:17.251)

Hehehe

 

Sai Mukthapuram (02:28.746)

Thank you so much Ben and Daphna for having us on this podcast.

 

Ben Courchia MD (02:32.198)

Now you're welcome. I'm exhausted from introducing everybody, Daphna, go ahead, ask the first question.

 

Daphna Yasova Barbeau, MD (she/her) (02:36.221)

You got it. Well, you know, we really wanted to center the conversation. I'm glad that we're going to get this out there. Lots of people are going to be hearing about the collaborative, but we're hoping we can kind of start with the basics. So we wanted to learn a little bit about point of care ultrasound. We'll probably abbreviate that to POCUS for most of the discussion. But my first question is really more about the history of point of care ultrasound in neonatology.

 

Yogen, I know you were the lead author for the group's article in 2021, The Evolution of Cardiac Point of Care Ultrasound for the neonatologist. So maybe you can tell us a little bit about how point of care ultrasound has become established in neonatology.

 

Maky (03:22.736)

Oh

 

Maky (03:26.67)

Thank you.

 

Ben Courchia MD (03:26.876)

Jürgen, can you hear us?

 

Yogen Singh (03:30.803)

between intermittent I lost half of the content

 

Daphna Yasova Barbeau, MD (she/her) (03:34.043)

Oh no.

 

Ben Courchia MD (03:34.906)

Oh, that's all right. That's OK. Daphna was asking about the... Go ahead, Daphna. I'm sorry. I don't mean to.

 

Daphna Yasova Barbeau, MD (she/her) (03:42.061)

And really, if you can give us a little bit of background on the history of point of care ultrasound in neonatology.

 

Yogen Singh (03:48.831)

Perfect. So point of care of the sound is well established in the other specialties like in the adult specialties and is a standard of care in the adult specialties. When it comes to the neonates until five years back it was pretty new to the neonatology and in 2017-18 when we recognized that

 

It has tremendous potential. It can make a big difference for the neonates in the neonates and in their outcomes, especially in the emergency situations. At that point, internationally, it was well recognized that we need to join hands with our colleagues in the different countries and make some guidelines and also how we can bring this into practice.

 

It has exponential growth in the last five, seven years, and now it's becoming almost a standard care with the international guidelines. And it has been adopted in most of the big neonatal units across the world now, and who had not adopted is fast being adopted now.

 

Daphna Yasova Barbeau, MD (she/her) (05:10.265)

And Sai, maybe you can tell us a little bit really about kind of where we are in the state of point of care ultrasound. What is it currently being used for? What are some of the challenges that we still have to tackle to make this kind of a standard of care in all units?

 

Sai Mukthapuram (05:27.67)

Absolutely. Thank you for that question. And like Dr. Singh was saying before, I would say that POCUS has been there in terms of being used on day-to-day clinical practice in majority of medicine. And ever since ultrasound was invented, several subspecialties have took the lead and started using it on a day-to-day basis. And within neonatology, the past decade has been very exciting.

 

has adopted POCUS in day-to-day practice. Of course, we were the laggards in terms of adapting this practice, but now, at least the Neonatal National POCUS Collaborative and other international collaborators have definitely been encouraging the use of POCUS in our day-to-day practice. And in short, in one word or one sentence, I would say that it's definitely an extension of a stethoscope.

 

and it could be used for better understanding the clinical problems we deal with on a day-to-day basis and provide timely and efficient care to our sick newborns.

 

Ben Courchia MD (06:37.5)

My next question is for you, Macky. So then you guys are the founders of the Pocus Collaborative. What is the driving force behind saying, hey, we need to establish this collaborative on a national scale? What were some of the things you identified that really prompted you to have this discussion with your colleagues about putting this together?

 

Maky (07:01.011)

Yeah, thank you for the question. And actually, thank you so much for giving us this opportunity to disseminate our initiative. So the Neonatal POCUS Collaborative is really an open invitation to anyone who is interested in this field to come join us and work all together. So the many of us neonatologists and pediatricians that have been using point of care ultrasound for many years now.

 

I think we very quickly recognize that the use of point of care ultrasound represents a transformative change in how we practice medicine and also how we approach clinical practice. Not only this is determined, I would say, by the incorporation and introduction of focused teaching in medical school curriculums, but also by the realization, the unquestionable

 

realization that, for example, performing procedures guided by ultrasound is safer for the patient, improves providers' performance. And there is no question that this improves patient care. Same thing of coming up with a time-sensitive diagnosis at the bedside improves patient care. So, what we noticed in neonatology is that, first of all, there was growing interest.

 

in this field among neonatologists, but the work in Point of Care ultrasound was kind of being performed fragmented and siloed, right? We were having all these multiple silos and hospitals becoming interested in it, but you know being fragmented and working in silos, I mean, it's never efficient and it never leads to any progress.

 

And if anything, it would just lead to continuous repetition of the work. And this, you know, like what I'm talking, I just remember there was a manuscript many years ago, like 70 or 80 years ago in Nature, that I think the name for it was reproducibility crisis. And what I talked about was that more than 70% of researchers have actually tried and failed.

 

Maky (09:18.871)

to reproduce other scientists' experiments, which was terrible statistics. But I think this talks about transparency and data sharing, information sharing. And this is what we want to do. We want to just share all the work, work all together, join forces. And

 

and be transparent about the process, you know, like share our difficulties, our barriers, and also share our solutions so we can make progress in this field. So this was actually the background of what, why Shazia and I, a couple of years ago, started to dream about this project that finally came into life this past year.

 

Ben Courchia MD (10:09.562)

Right. And so, when did the collaborative officially take off? You said last year, was it 2023 or 2022?

 

Maky (10:18.731)

Yeah, it was actually 2023 and we had our launch session at PAS. So it was in May 2023 in DC.

 

Ben Courchia MD (10:28.658)

Very nice, very nice. And what is the, I guess this question could be for Shazia as well. Shazia, what is the mission statement of the collaborative? What are the objectives that I guess on the short term you guys are trying to achieve practically?

 

Shazia Bhombal (10:46.514)

Yeah, thank you for the question. And in building on what Maggie said so eloquently, we're really trying to provide structure, standardized training programs, provide a platform and resources that people can also be starting programs, have resources to be able to educate their fellows, their attendings, whoever's trying to learn ultrasound, and then to be able to have collaborations as well with our colleagues in cardiology and radiology so that we can ensure that our implantation is appropriate and safe. And so all these things are what we'd like to be able to do and to be able to

 

take all the experience that we have and not only be able to provide structure and provide a cohesiveness for this, but also so we don't all have to reinvent the wheel. There's no need for us to be developing the same, having the same discussions of what protocols we should have. How do we go through credentialing in all of our units? If we can have a standardized way of doing this, it'll make it a little bit more of an easier pathway for those programs who are one, trying to develop programs and don't have experience, but also for those that have experience and just need some help in trying to develop their structure.

 

So I think that's what we're really trying to help. And with so much interest in the enthusiasm of the participants who have already been leading some of our committees, which is just phenomenal, we really have been very lucky to have such a great cohort of people that are really interested in moving this forward. And so that's really what our hope is for this group, is to be able to have some resources, take POCUS off the ground, get it in a structured manner that...

 

we can continue to move forward safely, efficiently, and get the kids the care that they need.

 

Ben Courchia MD (12:19.838)

Yeah, I think the committees that you just brought up are a good example of how the collaborative is resonating with the community. Number one, you have five committees when they're called, there's research, there's education, there's guidelines, there's communications, and there's program development and credentialing. And the list of names of people that are attached to each of these committees would not make you believe that the collaborative is just a year old. Like.

 

Daphna Yasova Barbeau, MD (she/her) (12:39.77)

That's nice.

 

Daphna Yasova Barbeau, MD (she/her) (12:44.165)

Brand new, yeah.

 

Ben Courchia MD (12:45.938)

You would think this is a collaborative that's been established years in the past. So I think that's also a testament to the success of the idea. And the steering committee and the executive council of the collaborative is also, I think, to me representing the quality of the people that have coalesced around this endeavor. In terms of how do you plan on tackling some of these issues?

 

I guess one of the things that people always ask about is program development and credentialing. I think this is something that there's always maybe a desire in certain places, but there's a lot of obstacles. Can you give us a little bit of how you guys are reducing the amount of friction that people may have to go through in order to get program development and credentialing off the ground? And I'm directing this question to you, Mackie and Shazia, because I know that's your area of expertise.

 

Maky (13:41.843)

Yeah, so that's a great question. And that's the most difficult piece of our mission, I would say. Right. But the most needed. So we are really committed to this. So in terms of program development, there are many guidelines already written and out there, as you know, the clinical report and the technical report from the AP that says how to establish

 

point by step by step a program in any given institution and what is needed. So what the big part missing is the credentialing and the competency. However, as Shazia mentioned before, this has been done before. So learning from others is key. We are not starting from zero, right? And there is, there are, although I recognize there are some differences in neonates that we have to be cautious about compared to...

 

any other pediatric specialty, it's not that different, to be honest. So you know, like going by what has been accredited by emergency medicine in terms of competency and credentialing, it's what we are thinking or planning on doing. I think that special interest or...

 

our difference would be cardiac point of care ultrasound, where you know the American Society of Echocardiography have published guidelines for it excluding neonates, but coming up in a couple of months there will be a manuscript published about this which talks a little bit about cardiac ultrasound, establishing how many studies would be considered you know that

 

any given person would need to become competent. So we are also going to use that. And as you said, you know, like working with pediatric cardiology and pediatric radiology, that makes the huge difference because, you know, being transparent and the trust that we build by doing that is key for success. You want to add something else?

 

Dr. Belinda Chan (15:58.022)

Thank you.

 

Daphna Yasova Barbeau, MD (she/her) (16:11.533)

No. Okay. Yeah. I mean, I've always been a little bit surprised, especially given how this is the standard of care in the emergency medicine, some of our anesthesia colleagues, adult critical care. Why do you think that in pediatrics or specifically neonatology, why are we meeting maybe more challenges than some of our other colleagues?

 

Shazia Bhombal (16:12.358)

Yeah, that's what happened there.

 

Dr. Belinda Chan (16:20.5)

Thanks for watching!

 

Shazia Bhombal (16:36.29)

I think this is a good question. I think some of the challenges lie in the transitions that the neonates have. I mean, sort of this proof of life for if we're missing underlying pathology by doing ultrasounds that are not necessarily as comprehensive as they may need to be. And this is probably more in the lines of cardiac focus and discussions on cardiac. But in transitions in general, I will say our pediatric adult colleagues are always fairly jealous of our imaging abilities with...

 

being able to see so much with our neonates as compared to the pediatrics with bone ossifications that we don't have to worry about. So we do see a lot pretty nicely. But I think part of that, Daphne, really is the considerations that neonates are in transition and the things that we're missing by not having a full comprehensive evaluation. And that's where we really want to be able to work with our colleagues from radiology and cardiology, as Maki mentioned, to say that when we do come up with these credentialing or these

 

guidelines and policies we're wanting to do, that we're doing this in collaboration so that we're trying to be as safe and as comprehensive as we can within the setting of trying to get the information that we need quickly. So.

 

Daphna Yasova Barbeau, MD (she/her) (17:48.333)

And this is very familiar to our team. It's something we are actively working on. So credentialing, you mean that somebody on the team would have the credentials through the hospital to be able to perform point of care ultrasound at the bedside and potentially bill for those services, which I think would be very useful for the team. Um, what are the next steps then? What, what does that look like for us to get to, to where we want to go?

 

Maky (18:17.826)

That is correct what you just said, but let me add that is already happening, but again, it's happening in silence, right? Every institution has their own credentialing process, right? So.

 

whatever it takes in any given institution, you become credentialed, you can perform point of crowd studies and you can build for them. Now, what the next step for us is to standardize that. So everyone will be doing exactly the same to achieve competency.

 

Ben Courchia MD (18:51.41)

At this time, the collaborative seems to have already a large number of members. I am just curious about how do you guys look at membership? Is it on an individual basis or is it on an institution-based? Meaning, let's say I am listening to this episode in the car and I say, oh, I want to join these guys. Do I have to submit an application for my center or is this something that me, person X, can actually start joining the collaborative?

 

Maky (19:21.183)

Yeah, it's an individual level for now So and it's very easy So we actually invite anyone who is listening to this podcast who wants to join us to go on our website the website is neoPOCUScollab.com and Right there you just subscribe and you subscribe to our collaborative you receive newsletters You can send me just an email saying what comedy you want to join and that's it

 

you're in and you will be part of the monthly meetings, depending on what committee you'll be participating in.

 

Ben Courchia MD (19:57.688)

This question is for, yeah, go ahead.

 

Sai Mukthapuram (19:59.775)

Ben, I was just going to add that joining the collaborative will be very easy. Like we were just saying that if anyone who's listening to this episode, we can send you a QR code that directs them directly to the website, newsletter subscription, and joining, like membership subscription letter.

 

It's a free membership, again, sorry, the word subscription sometimes may mean something. It's a free subscription. And I'll make sure we send you the QR code to be in the description of the episode so listeners could potentially use that in terms of joining the program.

 

Ben Courchia MD (20:34.094)

Oh, yeah. And then there's, and then there's show notes of this episode. We will link to the website that Mackie just gave out the neopocuscollab.com. And on the front, I mean, it's not like this is difficult on the front page of the website, you have the subscription form and I love it at right below. You also have the calendar. So like, you can actually see this has happened to me several times where I'm part of some collaborative and I forget that there's a meeting. So it's kind of nice to have the calendar on the

 

Sai Mukthapuram (20:42.562)

Perfect.

 

Ben Courchia MD (21:00.486)

on the page because you can see when the next meetups will take place. So all that stuff will definitely be linked. But I had a question for you, Sy, and for you, Belinda. As members of the Executive Council, I think, can you describe to us what are some of the benefits that the collaborative can provide to members who are joining? And maybe you can break this down into what can happen...

 

immediately, like what are the immediate benefits of just being part of that conversation? And over the long term, once you are part of this group, what you can potentially expect for both you and maybe your local unit.

 

Bill and I'm going to let you take this first.

 

Dr. Belinda Chan (21:46.804)

Great. Pocus is all about connecting people. We connect a doctor back to the bedside, holding a probe, like examining the baby away from the computer. And collaborative is taking another extra step, is to connect the people, like who is interested in Pocus together, both nationally and also internationally, like Dr. Yogen Singh, who has the...

 

I did a European guideline back in 2020. We have the extra T also from the other side. So by joining the collaboration, we meet the expert. We meet the expert from who's interested in POCUS in different institution. Like Mackie, who started the point of care ultrasound POCUS nationally, who has Dr. Singh who started in Europe when we write all these guidelines.

 

So we can actually, when you join, we can go to our education office hour. We can not just read that paper, but actually talk to them. Ask them about our day-to-day struggle. Ask them about, oh, what about this image? What about this case scenario? How would you approach differently? And then also connect with people who just starting the program. Oh, what other struggle do you have? What kind of machine do you use? And we have people to talk about it. And also it's fun and cool. We have a cool group of people.

 

Ben Courchia MD (23:08.8)

Ha!

 

Dr. Belinda Chan (23:09.832)

who do extra work. Doing point of care ultrasound, setting up a program, it's not easy, it is an extra step. A lot of places don't support. So we actually have take out our free time to learn, take out our free energy and resources to do this very important clinical tool. So whoever is in this collaborative group, other people who always want to take an extra step to do better for our patient.

 

And then with this cool group of people, why would you not want to join them and hang out with us, you know?

 

Daphna Yasova Barbeau, MD (she/her) (23:43.129)

Hehehe

 

Ben Courchia MD (23:43.194)

That's true. Belinda, you're saying such a, I mean, there's two things. Number one, I think it's my hope that as we have this conversation today, people can see how approachable you are, you all are. But I think you highlighted a point that to me is so important. I think in today's clinical environment, we have been forcefully, we have forcefully redefined the value of clinicians to metrics and productivity. And that is so pervasive that.

 

Daphna Yasova Barbeau, MD (she/her) (23:51.697)

Mm-hmm.

 

Ben Courchia MD (24:10.634)

The opportunity to redefine the value we can bring to our unit through something like Pocus is something amazing to say, hey, I'm going to bring value to my team by adding this new tool to our group, maybe even becoming an educator. I think that should not be undermined because we always complain and say, well, we don't want to be just valued based on how many patients we've seen, how much we've built. I think then these collaboratives like the Pocus collaborative is the opportunity.

 

to change, in my opinion, the paradigm and saying, hey, here's how I'm going to bring value to my team with something other than just billing and RVUs and all that stuff. So I think I just wanted to highlight that, because I think to me, that's we talk about, how are we going to change the paradigm? Well, this is it, in my opinion. Sai, what do you think long term, you're a member of the collaborative, and now you've been a member for six years, what would that look like for people who have been members for so long and say, well, now you've progressed through the early stages.

 

What do you think we can share for prospective members? Well, what will that look like down the line?

 

Sai Mukthapuram (25:14.218)

Absolutely. That's a great question. And I think the vision of this collaborative is that down the road, this would be a governing body that comes up with guidelines in helping with a national accreditation, like in terms of national emergency, point of care, ultrasound medicine groups, like they're able to work with groups like ACGME, work with other

 

like AAP, bigger bodies work together and come up with national guidelines, like where at least let's say we are setting up a program here in South Florida, we don't have to go to an individual medical staff office, try to work with them, spend months and years with them in order to get the credentialing through and just say, hey, I'm doing a UVC that you're already credentialing me for. I'm going to just use the ultrasound to do the UVC.

 

or I'm doing a spinal tap that you're already credentialing for, and I'm going to use an ultrasound to get better success and in a more efficient way. And my governing body, the National Focus Collaborative, helps. I'm certified. Or I'm certified according to the guidelines put out by the National Focus Collaborative. That would be one of the biggest goal and achievement that we envision in terms of being a part of this collaborative. It's a hefty goal.

 

It's definitely aim high is what I always look into. So I think that is going to be one of the biggest takeaway in terms of being a long term member. And I also want to emphasize the other pillars of work that the body is putting together. I think the strength of this collaborator is all the people who are actually behind the scenes, not on this podcast at this point, but are putting tremendous amounts of work. Just for example, if you take education,

 

Ben Courchia MD (26:52.083)

Yeah.

 

Sai Mukthapuram (27:09.27)

the number of webinars that the team has put together so far, the number of workshops within six months, like at three big national meetings, very successful, very highly attended workshops with efforts of individual members doing that. And in terms of research, there's like almost a series of publications planned out and research ideas that are being talked about. The website's up, like communications teams working a lot. So.

 

I do see that there's going to be a lot of great work coming out in the next six years, but in summary I would say those would be the hefty goals we've been looking at as a collaborative.

 

Ben Courchia MD (27:47.138)

And I think you're highlighting something too, that it's always an opportunity to get in on the ground floor of potentially a very important collaborative, a very important player in the field of neonatology. And so I guess my question for maybe Mikey and Jürgen is, let's say you are a trainee and you're like, man, like this might be something I want to get involved right now. I'm a fellow and maybe this is going to be my thing. Is that an opportunity fellows can join as well?

 

Maky (27:56.752)

I'm going to go ahead and start with the first question. I'm going to start with the question that I'm going to ask you. I'm going to ask you a question that I'm going to ask you. I'm going to ask you a question that I'm going to ask you. I'm going to ask you a question that I'm going to ask you. I'm going to ask you a question that I'm going to ask you. I'm going to ask you a question that I'm going to ask you.

 

Yogen Singh (28:15.955)

Absolutely, Ben. I think this collaborative is open to everyone. As Macky said initially, anybody who is interested in learning the focus can join really simple to join, very easy to join. Anybody can join. And in fact, we'll increase our fellows to join our collaborative early on because it has got tremendous potential with the collaborative in terms of the education, in terms of the research.

 

They can have the research ideas, can join the research projects as well. And then in terms of the getting involved in the guidelines and the developing the policies, they can learn so much from the senior people, from the experts as well. I think that, and the fellows are the future, they will be the flag bearers in the future as well. I think they are the, with the neonatologists for the future, we will embrace them with all our positivity and all our encouragement.

 

I think I will in my institution, I'll encourage all our fellows to join the collaborative and same I think other people will do as well.

 

Ben Courchia MD (29:21.49)

And I think, Mackie, if I could, oh sorry.

 

Maky (29:22.689)

I'm sorry.

 

courage every fellow to join us, every fellow who is interested in point of care ultrasound, you know, and take the advantage of, for example, participating in a research committee where they can bring a project and they can be the PI of a multi-center research project in point of care ultrasound. So that's, those are great advantages that we offer.

 

Ben Courchia MD (29:48.274)

And sometimes fellows are in an institution where they may say, oh, I don't really have a person there that's senior enough to show me the ropes, but maybe there's an opportunity through the collaborative to find also some mentorship and maybe develop long lasting relationship with somebody who has that experience and that dedication for mentorship to maybe build that relationship over the long term. Right. I mean, Shazia, you were going to say something. I'm hoping maybe you can tell us about potential mentorship and then.

 

Shazia Bhombal (30:17.25)

Yeah, no, thank you. I was going to mention too with one of the committees that mentioned the education committee. We're actually working with the ONTPD to try to help advance for our fellows as well. So Karina Lawrence and Kara Beth Carr are leads for the education committee. And they have been doing a phenomenal job with getting the webinars out, working on office hours, and really trying to be able to develop education all in general and specifically also with the fellows. So absolutely, I would echo Maki and Yogen with fellows getting involved.

 

the mentorship opportunities here. We all, as Belinda said this, well, we do this because we love doing it. And if we're, a means of success for us is also having other people do this and the fellows upcoming and taking on as leads for this as the years go on. So this is certainly something we would like to be able to achieve from mentorship standpoint and taking in fellows and taking in anyone who really wants to learn and be able to all together move this forward.

 

Ben Courchia MD (31:13.722)

You guys have mentioned several times now on this recording the webinars, which I think some of them are already available on the website and people can re-watch them. But you've also, and I think we all have an idea of what the webinar is supposed to be, but you mentioned also something called office hours. And I am wondering if you can tell us a little bit what office hours is, because I remember that in college when I used to go bother my professors. But for the POCUS Collaborative, what does that look like?

 

Maybe Mackie, you can tell us.

 

Maky (31:43.347)

Yeah, yeah. So besides the monthly webinars, we are offering a one hour a month, which we call office hours where we're going to meet. We have different items planned for the next few sessions.

 

like sharing a topic, going over cases, or simply open it up for questions from the audience or create a forum for discussion and questions and answer and try to help people who are joining with whatever questions they come up with. So that's what this is meant to be for. And yeah, as I said, it's every fourth Friday for one hour.

 

Ben Courchia MD (32:26.47)

And there's no shame in bringing any question to the office hours. I feel like some people may say like, Oh my God, I'm not going to have some very basic questions. These people are very advanced, but that's not the case. You can come up and say, Hey, this is the image I got. What's wrong with this? Like you can bring up whatever you want.

 

Maky (32:41.787)

Absolutely, yeah, and that's our idea, that you can bring, right, a clip that you don't know what you saw or you saw something very interesting and you want to share this with our community. So that's the idea behind the office hours.

 

Ben Courchia MD (32:51.723)

Mm-hmm.

 

Sai Mukthapuram (32:58.954)

and add...

 

Yogen Singh (33:00.232)

No clip is bad and no question is silly. In fact, we're encouraged to bring all those clips because we can tell, we can share our experience how those clips can be made better, how they can scan better. And also what you can miss on those clips, why quality of the imaging is important. I think those, even the inadequate clips will be really important for learning point of view for others as well.

 

And maybe I can add one more thing, Ben, going backwards. I think with the mentorship, I think with a focused collaborative, we are in a unique position and to provide this mentorship, I think we that's one of the biggest strength of our collaborative because we are so much expertise between us and traveling across different countries and within the US as well.

 

Ben Courchia MD (33:25.906)

Yes, I...

 

Yogen Singh (33:51.167)

The biggest challenge for the POCUS training at the moment is lack of good mentors. Locally there are some mentors are there not in all units, not even in all the academic centers. I'm talking about POCUS mentors here. And even the mentors are there, they may not be mentors for all the different organs. Like say somebody can do the lung ultrasound only, somebody may be doing the vascular access only.

 

So this collaborative with our joining hands together, we can provide not only the mentorship in all the different specialties, but also people can learn from so much from across the board. And one thing which will be exploring really how can be in Cali mentorship we can provide in terms of the learning. And then mentees can bring those cases, their cases or the questions in the office hours.

 

That's why all doors will join together nicely there.

 

Ben Courchia MD (34:53.543)

Mm-hmm.

 

Sai Mukthapuram (34:54.802)

Ben, I also just wanted to add, like in terms of the office hours, that it could be a brand new trainee asking a research question in terms of focus if they don't have focus mentorship, like Juergen was saying. It could be a division chief or division leader or a seasoned neonatologist asking about, hey, I want to establish a program. What kind of machine should I buy for my unit? Or it could be an enthusiastic neonatologist like you, who's a site champion.

 

I'm dealing with my medical staff office in terms of credentialing, and these are my holdups. How can I help? So like all these like would be coming from like experts, discussing all these points and helping you out with experiences in terms of who have gone through similar paths before in order to help with success for the community.

 

Ben Courchia MD (35:43.918)

Sy giving some real life example of the things we are struggling with down here because man the medical office is giving me a run for my money. Oh my god.

 

Daphna Yasova Barbeau, MD (she/her) (35:49.754)

Give us a tough time. Yeah.

 

Ben Courchia MD (35:54.666)

Go ahead, definitely.

 

Dr. Belinda Chan (35:55.8)

I want to add onto it is there is, I embarrassed myself so many times. I have like, I'm good at like basic point of care ultrasound, but in terms of more advanced or better picture of the heart, it's more challenging. There's so many bad images I have shown to Yogen Singh that he is, even though he's big name, but he's humble enough that doesn't make me embarrassed or feel ashamed.

 

I just keep on getting better and better. But it's only when someone criticizes you with a very humble mind that you would able to improve. So I have to say like, join this collaborative. Like I have all these big names that you see on paper, but they're actually, they're just human. They're just very nice human that want to teach us and want to get this things better for everyone in the nation. So yes, there are no bad images, just an image that you're never shown.

 

So yes, I mean, looking forward to all the image that anyone can see, even just black and white screen, we're, we'll start with that. Yes. And your bad images, all the bad images.

 

Ben Courchia MD (36:53.494)

Mm-hmm.

 

Daphna Yasova Barbeau, MD (she/her) (36:53.509)

Hehehehe

 

Ben Courchia MD (37:01.31)

Send your bad images.

 

Yogen Singh (37:05.343)

for the records are amazing quality is really, really good. Excellent image quality.

 

Dr. Belinda Chan (37:11.135)

It's only because I get better by showing bad images first.

 

Ben Courchia MD (37:16.165)

I think many people may be wondering, well, POKES, Point of Care Ultrasound, there's now also a lot of things being done with hemodynamics. And so how do the two collaborate with one another? How are they different? And so I am wondering if you can explain to us a little bit, what are some of the differences between the work you guys are trying to do with Point of Care Ultrasound?

 

and also doing neonatal echocardiograms. Is that something that is part of the focus or is that something that's separate? How do you guys handle these two things and what do you see the future of these two in terms of collaboration? Maybe, yeah, I was going to say.

 

Maky (37:56.463)

I will leave again.

 

Shazia Bhombal (38:00.239)

Thank you for that.

 

Yogen Singh (38:01.541)

I can start in Shazia or you can start we can both chip in so yes

 

Shazia Bhombal (38:06.566)

Yeah, it's a really important question that you ask about a target neonatal echo and Pocus. I think there is a distinction between the two and there's certainly room for both to be available for neonatologists to utilize. It's always going to be a matter of understanding, training, protocol and guideline development. And when you think about, you know, we don't want to be in the situation where you have a baby that's crashing on you and you're trying to figure out is there a big paracardial fusion? Is that heart moving?

 

These are the questions that we want to be able to have a neon child at the bedside taking care of clinical patient, be able to put the ultrasound on and be able to see that. It doesn't mean that we're necessarily looking to see, is the baby's blood pressure getting worse over the next 12 hours? Do we think it's diastolic versus systolic function? That's going to be a more specific question that's going to require more training and advanced learning for that question, more understanding of hemodynamics.

 

Ben Courchia MD (38:43.088)

Mm-hmm.

 

Shazia Bhombal (39:03.122)

There's certainly room for, you know, neonatologists to be able to get more training and to do that, and there's so much great work that's being done by neonatologists, including Patrick McNamara, and a lot of the news here in the US and abroad that are really moving that field forward. But we do want to say that we are pretty distinct from that. And our goal within the POCUS Collaborative is not to take on TNE. It's really is just for cardiac POCUS, and we want to be able to work with our cardiology colleagues and our members who are within the cardiology world to be able to keep that somewhat distinct and be able to utilize

 

cardiac focus for the situations where he feels appropriate for Neonatologists who are doing focus.

 

Ben Courchia MD (39:38.762)

Mm-hmm.

 

Maky (39:39.886)

As this is a clinical tool, we want to be able to do this.

 

to make the clinical tool available for everyone, right? Especially when we are diagnoses at time sensitive diagnosis, right? So that's the idea of cardiac point of care ultrasound.

 

Yogen Singh (39:56.963)

I agree with Sai and Macky. I think in short band, I see a cardiac focus as an emergency tool. It's more for the emergency situations in terms of the cardiac focus you're talking about. We need a rapid assessment in the emergency situations is perfect, is powerful and you can detect those emergencies like cardiac tamponade and pericardial diffusion. Very poor contact

 

Yogen Singh (40:24.203)

When it comes to the detailed hemodynamic evaluation, definitely that's out of the scope of the cardiac focus. Then it comes to towards the TNE and the hemodynamic expertise. There you need more skills and expertise and longer training. That's why they're really complimentary. As you see, the focus is being adopted widely to develop the

 

TNE skills and hemodynamic skills will take longer time for any individual. And so we can train more people for the emergency situations for limited indications. And when they see anything abnormal, they can call for the help like the TNE or the peach cardiology people. So I think all the three things, three components, one the cardiac focus, which is mostly for the emergency situations, the TNE, which is for the hemodynamic evaluation, for the

 

PDA evaluation, pulmonary hypertension, hemodynamics, which is perfect, and then come the more comprehensive structural assessment of the heart, like a PEDS cardiology. And all three can work in collaboration to deliver really high quality care for the patients what they need really.

 

Ben Courchia MD (41:35.856)

Yeah, and I think that's so important because there are so many tools, so many aspects of point of care ultrasound that we can use for other organ systems like bladders, lungs, heads, gut. And like you said, sometimes we see a lot of hemodynamics being talked about on conferences, social media, and we say, oh my God, this seems like way out of my reach. But point of care ultrasound for these other organs is much more accessible, in my opinion.

 

to learn and I think we should, I think the point you guys are making is so crucial, not to confuse the two because one of them requires, like you said, extensive training, but the other can be learned with the proper guidelines and the proper framework. Daphna, you had a question.

 

Daphna Yasova Barbeau, MD (she/her) (42:22.457)

Yeah, no, to your point, Ben, I think there's still a lot of people in the community who feel like this is like, this is still very intimidating to me. And so I think we've talked about a lot of the really high level things we can do with the collaborative, but what about the kind of really novice learner, either a trainee or a very experienced neonatologist who says, well, I really would like to add this to my repertoire. I'm hoping you guys can talk about what's the best way to get started.

 

Yogen Singh (42:52.155)

best way to start is to join our national collaborative focus. Sorry, let me just say, so best way to start really to join our group, like join our group, because people get motivated and see what excellent stuff this group is doing really. And with the collaborative, they will see the potential and they will meet other people and they will see that most of us, we learn these skills later on as well. If I give my own example,

 

I was never trained into the lung focus of the vascular focus. I was trained into the more cardiology with the echocardiography, with the brain ultrasound. But we all learned on the go, really, what skills are needed, what skills I can learn which can make my clinical practice better, which I can utilize on the floor to deliver high quality care. Same applies to everyone, really. And good thing about the focus skills

 

Dr. Belinda Chan (43:47.508)

Thanks for watching!

 

Yogen Singh (43:50.715)

I mean, for most of the organs, it's less intimidating. These skills can be learned easily in a shorter duration of time. They have their limitations. You have specific indications, specific imaging. That's why you have to work within your scope of practice of the focus. And that's why it's really important to have the mentors, work with our colleagues, other specialties, like with their cardiology, with their radiology, because that's why you'll know.

 

A detailed assessment is far more extensive comprehensive evaluation than rapid assessment of the focus.

 

Dr. Belinda Chan (44:27.236)

I want to add that if you want to start learning, you can go to one of the Mackie's chop to the ultrasound course. This is where I started. That's where most of the people started, or you can, um, invite any of the expert to your, um, institution to run the course and teach, um, if you live in Hawaii, please invite me. I'm very happy to come. This is just a joke, but.

 

Daphna Yasova Barbeau, MD (she/her) (44:51.076)

I'm going to go to bed.

 

Dr. Belinda Chan (44:52.616)

but we're all here to help. Like, and like there's more and more to the ultrasound course at different places. That's always a good place to start. And then you can refine the skill in the office hour, in a webinar, in the collaborative. That will be the time where you refine the skill that you have some foundation have hold up properly in other courses.

 

Ben Courchia MD (45:12.979)

Mm-hmm.

 

Ben Courchia MD (45:17.272)

Um, yeah.

 

Maky (45:18.164)

At the institution level, you know, like, yeah, we do offer these courses, which are really like an introduction of all the Point of Care ultrasound applications available. But it's just truly a two-day course, and that's an introduction. And then you go back to your institution, and you need to find someone there who is practicing Point of Care ultrasound. And there is no doubt at this point that you will find not one people, a lot of people, in the emergency department, in pediatric critical care.

 

You know, the more people, I mean, this has been growing exponentially, really. So we are a lot of people who know how to do this and or are learning to do this. So and as I said, you know, I think it's just blending so much into clinical practice, especially, you know, with all the medical students coming from medical school ready to use an ultrasound machine. So, you know, it's just going to continue growing until, you know, it's going to be.

 

completely incorporated, right? Like blended in our daily. So yeah.

 

Ben Courchia MD (46:18.985)

Yeah.

 

Daphna Yasova Barbeau, MD (she/her) (46:21.327)

I love that it's becoming much more popular at conferences, certainly for the hands-on opportunities. And I can tell that on your website, you're really starting to develop kind of this individual organ educational collection. I wonder if there are other maybe online resources that you recommend?

 

Dr. Belinda Chan (46:24.369)

Mm-hmm.

 

Dr. Belinda Chan (46:43.527)

this

 

Yogen Singh (46:43.807)

I can start with that one. There are loads of resources are there and both which are some most of the free resources as well. So one of the website is 123sonography. This is the world's biggest focus of the in general ultrasound graphy website which host tons and tons of master classes bachelor classes in the adults in the periodics and they do

 

and they do certifications in those specialties, including interactive learning. It's not with the lectures, they have got the interactive integrated hands-on practice as well, where they demonstrate the skills. And we have been fortunate to join hands with them. And also, we have set up a bachelor class, a course, which covers all aspects of the focus, right from the cardiac focus to the lung focus. All the systems are there.

 

And it's not only one, then we've got the 101 focus as well. And a lot of material is available on the YouTube as well. So people can find a lot of material these days free of cost. And some of the conferences, pre-conference, half the course, they are really excellent resources as well. They're like teachers. People can see what they can learn really.

 

And then they, as Macky said, people need to go back to the base and also learn these skills under supervision, make their logbooks and before we can see the progress and they can be certified. And coming to the courses, the CHOF course is well recognized and we all have taught on the course. Other courses are in the many parts of the US country really, like Shazia used to run in Stanford one, I'm sure she'll start something in Emory as well.

 

Belinda runs a course in Utah for last good few years, for five years I taught on that course, that's excellent course as well. So there are various courses available for the learners. They don't have to travel too much as well and they can meet all the experts and enjoy those courses.

 

Dr. Belinda Chan (48:52.801)

What about simulator? A lot of simulators out there because the most important learning focuses hands-on.

 

Yogen Singh (49:00.027)

Thank you, Belinda. Thank you for asking this question. I think for a lot of organs, simulation may not, simulation is a very powerful tool to teach, powerful tool to teach the poker skills. For many, like say lung pokers or the vascular pokers, they may be less practical, but, or may be less needed, but when it comes to the cardiac pokers, simulators does a fantastic job. Most people who learn the pokers, they find cardiac pokers most intimidating.

 

with the simulators like one what we use commonly is the is the NeoEchoSim basically is a NeoNatalEchoSimulator neoechosim.com and that has got normal cases abnormal cases including emergencies like say baby in the cardiogenic shock and it is self-learning on the simulators simulator you can talk this stepwise is already directions are there and

 

how I teach my fellows, I will teach my fellows in the simulators first. I can see their progression once they can get some basic views, only then I'll take to the normal stable patients and then to the sick patients. That way I can be, I can, I can be assured of the quality of their training and also I can assure my colleagues of the quality assurance. One of the key important steps for our

 

Yogen Singh (50:28.495)

to their parents and to the wider world.

 

Ben Courchia MD (50:34.21)

My last question for you guys is there are probably, we talked a lot about trainees and for some maybe like there's a theoretical aspect to point of view ultrasound, but there's a practical one like we've talked about, which is like, well, I don't have a probe. And there are many people that are looking online at things that are affordable saying like, oh, I'm a fellow. I may only have like maybe a couple thousand bucks that I can spare because my institution is not interested in buying an ultrasound machine at this time.

 

Um, for, for people who are considering that path, what would you tell them? Like just get, cause I know that, um, learning from Sai, I have remembered one principle, which is just get images, just keep getting images and you'll get better over time. Um, and, and maybe, maybe the probe doesn't matter as much as long as you just keep practicing. So what, what is your

 

What is your advice for people who are saying, well, I'm just going to go get myself a probe that I'm going to attach to my phone and start working on this because I'm not going to wait for my institution to get the probe. I'm leaving this open to all of you. So whoever wants to take this can go right ahead.

 

Shazia Bhombal (51:40.422)

I would just to take on one aspect of that. You'd be surprised at how often there's a machine sitting around the hospital that is not necessarily being utilized. When we started our program, we got machines from cardiology, that's older machine that was sitting on, which is, you know, it worked for us in the initial times and sometimes the ED. So first step before, understandable that there's going to be some time for getting your own machine, but if there's machines available with your collaborators within the hospital, that might be a good way to go.

 

Ben Courchia MD (51:48.339)

Oh.

 

Shazia Bhombal (52:08.774)

I'm going to let the word there are hand-helds that are available to use. Say some of the probes for the, and the size for the hand-helds can be a little bit big for our patient population, but there are neonates that, or there are units that are using some hand-helds. So it's not an unreasonable way to start, but I do encourage you to look around the hospital and talk with your collaborators to see if there is a machine that is available for use.

 

Yogen Singh (52:32.891)

I agree with Shazia, I think people can look around the machines, what is available and most of the time for the best access into the PICU, in the OB, emergency department, there are machines and people are generally very helpful. They'll be happy to share the machine. One thing, one thing I...

 

Ben Courchia MD (52:51.26)

I don't know about that. The PQ has been good at hiding that machine from me when I was a fellow. And while they did share, it was not always as smooth as you said.

 

Yogen Singh (53:02.599)

I think Ben, once you explain what you are doing, most people are helpful. Once you know, I want to learn, I want to at the end of the patient care, then they get helpful. And the smaller machine, Ben, people can buy what Sai and you are saying, they can buy, they are in a couple of thousands. But personally, I say they are the fun tools. I would personally discourage buying personal proofs. The reason for that one, the two important reasons. One.

 

Maky (53:14.116)

So, we're going to get started with the first question. So, what is the best way to get started? So, we're going to get started with the first question. So, what is the best way to get started?

 

Yogen Singh (53:30.295)

is the I'm a strong advocate of the clinical governance and we all should be. What you're imaging we are doing all should be stored whether they are good quality or bad quality. Good quality teach you a lot and when you show to your mentors we can learn what we could have missed on those one and why they are not good images and good images give them positive encouragement as well.

 

Maky (53:48.179)

I'm going to take a few minutes to get this out of the way. So I'm going to take a few minutes to get this out of the way.

 

Yogen Singh (53:55.211)

And whatever imaging we do, they all should be stored and they should be reviewed by someone. So that's the only way trainees and mentees will get better. Secondly, it will become your habit very soon. If you don't record these images, don't record everything, you will not record a future as well. And all these will be the medical records. I think in due course, we like they should be in corporate in the patient records, actually. So because they are all patient care related.

 

So I will say we should definitely encourage our hospital departments to buy the machine. But I understand when the resources are less, there are machines which are not expensive, which can be connected to the like, you're saying the probes, we can buy these simpler probes but they can connect you to a big like say tablet which has got one or two some

 

GB storage and they can be connected to the computer. There are ways, innovative ways are there where you can use the handheld proofs. But one important thing is that all images should be stored and reviewed. And lastly, what Shazia was saying, collaboration, collaboration with your colleagues, within this collaborative and within the other specialties. That's the key to make progress in this field.

 

Ben Courchia MD (55:16.638)

Yeah, when I started borrowing the PICU ultrasound machine within a week, there was like a big sticker on it that said PICU. And so I was like, okay, I got the message. Go ahead, Sy.

 

Sai Mukthapuram (55:17.664)

I.

 

Sai Mukthapuram (55:29.698)

I was just going to say, I think if you don't have any other option and you're just stuck with finding a way for yourselves, maybe consider that, but if not, collaborate with other departments. But the promising part of POCUS and the promising part of that, the future of POCUS in especially neonatology is that one, there is significant enthusiasm, there's a lot of motivation, and two, the technology is only going to advance. It's only going to get better.

 

Maky (55:34.989)

So, I'm going to go ahead and start the presentation. So, I'm going to start with the presentation of the first item, which is the

 

Sai Mukthapuram (55:59.614)

And who knows, like five, six years down the line, we may have these handheld probes with better footprints and better qualities, and we may be able to run focus workshops using these handheld probes. So it's definitely, and with Neonatal Focus Collaborative and organization like ours, at the helm of making this progress happen, we're only looking forward to this future and very excited to see where this takes us. And I think just...

 

stay motivated, stay enthusiastic and obtain images.

 

Shazia Bhombal (56:34.406)

Can I add one thing also? One thing just to keep in mind too, that AAP document that's mentioned a couple of times, the clinical techno guide does talk about within the AAP, that development of a neonatal Pocus program is a benefit. So taking that to your medical leadership also is important when you think about they have machines, plenty of machines for PICU, ED, many of these other departments. So.

 

Ben Courchia MD (56:34.791)

Yes, Shazia, go ahead.

 

Shazia Bhombal (56:59.574)

If it is actually at AAP saying that we should be having these programs, then taking that leadership may give a little bit of a push.

 

Ben Courchia MD (57:06.294)

Absolutely. I guess this is a great place for us to conclude this episode. We will link all the resources that you guys mentioned on the episode page. Go check out the work done by the Pocus Collaborative at neopocuscollab.com. Thank you all for making the time. I think if there's anything, the two takeaways are please join the collaborative and you are all a very approachable group of people that are also doing amazing work. So I encourage everybody to follow your advice. Thank you so much.

 

for being on with us today.

 

Maky (57:38.891)

Thank you so much for letting us participate. And I just want to finish saying that, tagging on what Shazia said before, that not only that we love doing this, because we truly do.

 

But more importantly, we believe this makes a difference for our patients and that a safe implementation of point of care ultrasound in the NICU, we are convinced that improves patient care. So thank you so much.

 

Ben Courchia MD (58:03.969)

You're welcome. Thank you, everybody.

 

Shazia Bhombal (58:04.378)

Thank you for having us.

 

Yogen Singh (58:05.455)

Thank you so much for having us.

 

Dr. Belinda Chan (58:07.688)

Thank you.

 

Sai Mukthapuram (58:07.894)

Yeah, thanks Ben and Daphna. This was a great opportunity for us. Thank you. We appreciate your time.

 

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