Enhancing Healthcare Team Outcomes
Overall, studies of ultrasound therapies have demonstrated it to be a safe, non-invasive, and effective procedure that clinicians can offer as primary or adjuvant therapy to traditional treatments.
There is level III evidence for the use of HIFU for atrial ablation in patients with atrial fibrillation. Ninet et al. found a cure rate of 80% at six months when HIFU was used to ablate aberrant atrial tissue causing paroxysmal and persistent atrial fibrillation.[6] Additionally, this procedure can be completed without cardiopulmonary bypass and without the ultrasound wand contacting blood. Complications like ARDS, SIRS, and hemodilution are common and well documented with the use of cardiopulmonary bypass, making HIFU a potentially safer alternative for atrial fibrillation cure.[16] However, this procedure is still experimental, and further studies focusing on effectiveness and safety are necessary.
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Numerous studies have shown level II and level III evidence for MRgFUS that demonstrate its safety and effectiveness for breast and uterine soft tissue masses. A systematic review conducted by Peek Et al. found the absence of a tumor or residual tumor in 95.8% of patients undergoing HIFU treatment for breast cancer.[17] Typically, breast cancer receives treatment with breast-conserving surgery or mastectomy. However, these procedures suffer from an increased risk of bleeding, infection, pain, and cosmetic issues. Thus, the need for alternative therapies, like HIFU, has increased. Additionally, some patients with significant co-morbidities may not be surgical candidates, or the surgery may. Hysterectomy can be curative for uterine fibroids but should only be an option for women who are no longer interested in bearing children.[18] Stewart Et al. found that 71% of women experienced symptom reduction at six months with a low incidence of adverse events.[19] Though no longitudinal studies examining the long-term effects of HIFU exist, Bohlmann Et al. reviewed 100 cases and found no increased risk of miscarriage or other obstetrical outcomes.[20] FDA approval of MRgFUS for uterine fibroids occurred in 2004, and numerous studies have demonstrated its effectiveness and safety
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Lastly, there is level III evidence for the use of low-intensity ultrasound for pain in degenerative musculoskeletal disorders. Muftic et al. compared two groups receiving low-intensity ultrasound treatment at varying power settings and found visual analog scores for the pain to decrease by approximately 4 points in both groups.[21] This study included men and women suffering from chronic limb or spine pain. However, a systematic review conducted on ultrasound therapy for a variety of musculoskeletal conditions found limited benefits.[22] Shanks et al. also found limited evidence for ultrasound therapy benefits in lower limb musculoskeletal conditions.[23] More robust studies with clear indications and procedural techniques need to be conducted to make broad conclusions on low-intensity ultrasound.
Interprofessional teamwork is an optimal approach to treating patients receiving ultrasound therapy. This team can include clinicians, specialists, mid-level practitioners, and physical therapists, depending on the condition being treated. All members of the interprofessional team should coordinate their activities and share information about the patient with the rest of the team to optimize patient outcomes.
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