PURE01: An open label, single-arm, phase 2 study of the anti-programmed death (PD)-1 monoclonal antibody (moAb) pembrolizumab for neoadjuvant therapy of muscle-invasive urothelial bladder carcinoma (miUBC)

Abstract

Introduction: The use of advanced ultrasound (AUS) in the emergency department (ED) is limited, despite strong evidence supporting its use as a diagnostic aid and procedural guide in the ED. The objectives of this study were to summarize (1) current AUS use in Canadian EDs, (2) the perceived benefits of AUS use for daily clinical practice, and (3) barriers to AUS use in Canadian EDs. Method(s): Structured telephone interviews were conducted by a trained research assistant using the Diffusion of Innovations model for knowledge translation (KT). A grounded theory approach was used to construct a substantive theory of barriers to AUS use in the ED. The sampling frame included Canadian attending emergency physicians (EPs). Result(s): Twenty-one EPs from five Canadian provinces participated. Eighty-one percent were male, 15% were from community hospitals, all EPs had completed a basic ultrasound course, and 43% had completed an AUS course. EPs described common use of AUS in procedural guidance (i.e., central venous access), assessment of IVC/fluid status, cardiac function, and pulmonary pathology. Perceived benefits included marked improvements in diagnostic accuracy, patient flow, and patient safety (procedural guidance). Identified barriers to increased AUS use in the ED included time required for training and practice, demands of clinical duties, and lack of quality assurance. Conclusion(s): Canadian EPs are using AUS in daily practice and perceive improved diagnostic accuracy, patient flow, and safety as significant advantages of its use. Training, clinical efficiency, and quality assurance were identified as key barriers to AUS use. Further training of Canadian EPs in these techniques and future knowledge translation on the potential benefits of AUS may be needed to promote utilization by more Canadian EPs.