John Kugler

• Stanford Medicine

Background: Lung ultrasound (LUS) offers advantages over traditional imaging for diagnosing pulmonary conditions, with superior accuracy compared to chest radiographs and similar performance to CT at lower cost. Despite these benefits, widespread adoption is limited by operator dependency, moderate interrater reliability, and training requirements....

Background Deep learning (DL) programs can aid in the acquisition of echocardiograms by medical professionals not previously trained in sonography, potentially addressing access issues in underserved communities. This study evaluates whether DL-enabled devices improve limited echocardiogram acquisition by novice clinicians not trained on sonography...

Background The increasing linguistic and cultural diversity in the United States underscores the necessity of enhancing healthcare professionals' cross-cultural communication skills. This study focuses on incorporating interpreter and limited-English proficiency (LEP) patient training into the medical and physician assistant student curriculum. Thi...

Background Point-of-care ultrasound (POCUS) machines may utilize artificial intelligence (AI) to enhance image interpretation and acquisition. This study investigates whether AI-enabled devices improve competency among POCUS novices. Methods We conducted a randomized controlled trial at a single academic institution from 2021-2022. Internal medicin...

Importance: Studies show that ChatGPT, a general purpose large language model chatbot, could pass the multiple-choice US Medical Licensing Exams, but the model's performance on open-ended clinical reasoning is unknown. Objective: To determine if ChatGPT is capable of consistently meeting the passing threshold on free-response, case-based clinical r...

Objectives Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes. Methods We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-...

Introduction: Point-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes. Methods: We conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients...

Objectives Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID‐19. Methods This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with CO...

Background There is insufficient knowledge about how personal access to handheld ultrasound devices (HUDs) improves trainee learning with point-of-care ultrasound (POCUS). Objective To assess whether HUDs, alongside a yearlong lecture series, improved trainee POCUS usage and ability to acquire images. Methods Internal medicine intern physicians (...

Background Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID‐19. Previously described LUS manifestations for COVID‐19 include B‐lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID‐19 is unknown. Methods This study was conducted between...

Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for CO...

Background Capstone, or bootcamp, courses have been shown to increase the knowledge, skills, and self-efficacy of students prior to starting intern year and have been recommended by the Alliance for Clinical Education (ACE) to be incorporated into the fourth-year medical school curricula. However, a paucity of research exists regarding the explorat...

Introduction: Point-of-care ultrasound (POCUS) has the potential to transform healthcare delivery in the era of COVID-19 with its diagnostic and therapeutic expediency. It can be performed by clinicians already at the bedside, which permits an immediate and augmented assessment of a patient. Although lung ultrasound can be used to accurately diagno...

According to that old story, a local giving directions to a lost traveler says, “If I wanted to get there, I wouldn’t start from here.” Medicine finds itself far from the bedside,¹,2 seeking a way back, unsure where to begin.

BACKGROUND: Little is known about how to effectively train residents with point-of-care ultrasonography (POCUS) despite increasing usage. OBJECTIVE: This study aimed to assess whether handheld ultrasound devices (HUDs), alongside a year-long lecture series, improved trainee image interpretation skills with POCUS. METHODS: Internal medicine intern p...

Background: Little is known about how to effectively train residents with point-of-care ultrasonography (POCUS) despite increasing usage. Objective: This study aimed to assess whether handheld ultrasound devices (HUDs), alongside a year-long lecture series, improved trainee image interpretation skills with POCUS. Methods: Internal medicine int...

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers...

Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicin...

Technology has the potential to both distract and reconnect providers with their patients. The widespread adoption of electronic medical records in recent years pulls physicians away from time at the bedside. However, when used in conjunction with patients, technology has the potential to bring patients and physicians together. The increasing use o...

Their eyes grow wide each time I pull the machine from my shoulder bag. Patients often point out that they have never been examined so thoroughly, while students and residents ask the same things: “How do I get one?” and “How much do they cost?” The “wow” factor is powerful with the latest generation of pocket ultrasound machines. The ability to co...

In today's hospital and clinic environment, the obstacles to bedside teaching for both faculty and trainees are considerable. As electronic health record systems become increasingly prevalent, trainees are spending more time performing patient care tasks from computer workstations, limiting opportunities to learn at the bedside. Physical examinatio...

According to that old story, a local giving directions to a lost traveler says, “If I wanted to get there, I wouldn’t start from here.” Medicine finds itself far from the bedside,1,2 seeking a way back, unsure where to begin.That we have wandered far afield is plain to see. Core bedside skills of history taking and physical examination—still vital...

he traditional physical diagnosis course taught in the first two years of medical school has changed little in over half a century, and it deserves some scrutiny, if only because it is quite out of step with what students see when they begin on the wards during their clinical years. They are surprised to find that the house staff and attending staf...

Understand that many graduates from U.S. medical schools have poor clinical exam skills and rely increasingly on lab reports, imaging, and other diagnostic tests.Trying to learn the reflexes was particularly memorable. Many of us had been quick learners in other disciplines, and it was difficult for us to understand why clubbing the knee over and o...

Sitagliptin is a new oral glucose-lowering medication that acts via the incretin hormone system. The most common side-effects are headache and pharyngitis, and few serious adverse events were observed during clinical trials. Dose adjustment is recommended in renal insufficiency, but long-term safety experience is limited. We present a patient with...