BACKGROUND: Competence in point-of-care ultrasound (PoCUS) is widely recommended by several critical care societies. Despite numerous introductory short courses, very few doctors attain PoCUS competence because of the challenges in establishing longitudinal competence programs.RESEARCH QUESTION: To evaluate the methodologic quality of the literature on basic PoCUS competence processes in critical care. STUDY DESIGN AND METHODS:A systematic review to identify manuscripts meeting predefined inclusion criteria was performed using three medical databases (PubMed, OVID Embase, and Web of Science); using extra references from original articles, review articles, and expert panel guidelines; and by directly contacting authors for further information if required. The objectives, domains, and inclusion and exclusion criteria of the review were determined during discussions between experienced PoCUS educators. Data extraction and analyses were performed independently by three reviewers.RESULTS: Of the 5,408 abstracts extracted, 42 met the inclusion criteria for longitudinal PoCUS competence. Each study was described along four broad categories: general information, study design, and trainee characteristics; description of introductory course; description of longitudinal competence program; and grading of overall methodologic quality on a 4-point Likert scale. Thirty-nine studies (92.9%) were from a single center. Most studies lacked important details on study methodology such as prior ultrasound experience, pre-and postcourse tests, models for hands-on sessions, ratio of instructors to trainees, competence assessment criteria, number of scans performed by individual trainees, and formative and summative assessments. The studies were rated as follows: poor ¼ 19 (45.2%), average ¼ 15 (35.7%), good ¼ 4 (9.5%), and excellent ¼ 4 (9.5%). INTERPRETATION:Ther is very little high-quality evidence on PoCUS competence. To help frame policy guidelines to improve PoCUS education, there is a need for well-designed longitudinal studies on PoCUS competence.

Background: Breastfeeding is known to be central in an infant's nutrition and growth worldwide. Fewer mothers offer breast milk in this crucial period due to various misconceptions and cultural beliefs. Our objective was to assess the knowledge, attitude and practice of breast feeding and identify misconceptions regarding breast feeding practices in suburban south Indian town. Methodology: Observational study conducted in a tertiary teaching hospital of coastal south India. A total of 300 subjects including pregnant and nursing mothers attending the outpatient departments were recruited. Subjects were briefed orally, consent taken and a structured questionnaire administered by a single observer. Mothers who were unable to breast feed due to medical contraindications were excluded. The data was analysed using SPSS software. Univariate and binary regression analyses were performed for associations. Results: Among the subjects 36% had primary education and 12% were graduates. Majority (61%) lived in a joint family. Only 52.3% of the subjects received advice on breastfeeding during antenatal visits, out of which only 19.3% had a breast examination. 58.7% knew that breastfeeding should be initiated within 1 hour of child birth but only 48% of the mothers who had delivered initiated breastfeeding within 1 hour. 71.6% of the mothers knew that exclusive breastfeeding should be practised for 6 months. On univariate analysis mothers with more than 1 child, vaginal delivery and an educated partner had awareness of breastfeeding and practiced healthy breastfeeding. Conclusion: Our study emphasises the need to counsel mothers regarding breastfeeding practices early during antenatal visits and not postpone till after delivery, include the spouse for support, sensitise the health care giver and improve infrastructure for a successful breastfeeding initiation.

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