Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors.
Identifieur interne : 000126 ( Main/Exploration ); précédent : 000125; suivant : 000127Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors.
Auteurs : Vasileios F. Panoulas [Royaume-Uni] ; Anna-Lena Daigeler ; Anura S N. Malaweera ; Amrit S. Lota ; Dinnish Baskaran ; Syed Rahman ; Petros NihoyannopoulosSource :
- European heart journal cardiovascular Imaging [ 2047-2412 ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Cardiologie (enseignement et éducation), Compétence clinique (MeSH), Conception d'appareillage (MeSH), Examen physique (méthodes), Femelle (MeSH), Humains (MeSH), Maladies cardiovasculaires (), Maladies cardiovasculaires (diagnostic), Mâle (MeSH), Personnel médical hospitalier (MeSH), Programme d'études (MeSH), Statistique non paramétrique (MeSH), Systèmes automatisés lit malade (MeSH), Échocardiographie-doppler couleur (méthodes), Études par échantillonnage (MeSH), Études prospectives (MeSH), Étudiant médecine (MeSH).
- MESH :
- diagnostic : Maladies cardiovasculaires.
- enseignement et éducation : Cardiologie.
- méthodes : Examen physique, Échocardiographie-doppler couleur.
- Adulte, Compétence clinique, Conception d'appareillage, Femelle, Humains, Maladies cardiovasculaires, Mâle, Personnel médical hospitalier, Programme d'études, Statistique non paramétrique, Systèmes automatisés lit malade, Études par échantillonnage, Études prospectives, Étudiant médecine.
English descriptors
- KwdEn :
- Adult (MeSH), Cardiology (education), Cardiovascular Diseases (diagnosis), Cardiovascular Diseases (ultrasonography), Clinical Competence (MeSH), Curriculum (MeSH), Echocardiography, Doppler, Color (methods), Equipment Design (MeSH), Female (MeSH), Humans (MeSH), Male (MeSH), Medical Staff, Hospital (MeSH), Physical Examination (methods), Point-of-Care Systems (MeSH), Prospective Studies (MeSH), Sampling Studies (MeSH), Statistics, Nonparametric (MeSH), Students, Medical (MeSH).
- MESH :
- diagnosis : Cardiovascular Diseases.
- education : Cardiology.
- methods : Echocardiography, Doppler, Color, Physical Examination.
- ultrasonography : Cardiovascular Diseases.
- Adult, Clinical Competence, Curriculum, Equipment Design, Female, Humans, Male, Medical Staff, Hospital, Point-of-Care Systems, Prospective Studies, Sampling Studies, Statistics, Nonparametric, Students, Medical.
Abstract
AIMS
While patient history taking and physical examination remain the cornerstones of patient evaluation in clinical practice, there has been a decline in the accuracy of the latter. Pocket-size hand-held echocardiographic (PHHE) devices have recently been introduced and could potentially improve the diagnostic accuracy of both medical students and junior doctors. The amount of training required to achieve optimal results remains a matter of debate. We hypothesized that the use of PHHE after limited training in the form of a tutorial can improve the clinical diagnosis even in the hands of medical students and inexperienced physicians.
METHODS AND RESULTS
Five final-year medical students and three junior doctors without prior echocardiographic experience participated in a standardized 2 h PHHE bedside tutorial. Subsequently, they assessed 122 cardiology patients using history, physical examination, ECG and PHHE. Their final clinical diagnosis was compared against that of a consultant clinician's and also expert in echocardiography. A total of 122 PHHE were performed of which 64 (53%) by final-year medical students and 58 (47%) by junior doctors. Mean ± SD for diagnostic accuracy after history, physical examination, and ECG interpretation was 0.49 ± 0.22 (maximum = 1), whereas the addition of PHHE increased its value to 0.75 ± 0.28 (Z = -7.761, P<0.001). When assessing left ventricular systolic dysfunction by means of history and physical examination, specificity was 84.9% and sensitivity only 25.9%, whereas after including findings from PHHE, these figures rose to 93.6 and 74.1%, respectively.
CONCLUSION
The use of PHHE after brief bedside training in the form of a tutorial greatly improved the clinical diagnosis of medical students and junior doctors, over and above history, physical examination, and ECG findings.
DOI: 10.1093/ehjci/jes140
PubMed: 22833550
Affiliations:
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Le document en format XML
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Panoulas</name><affiliation wicri:level="1"><nlm:affiliation>Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane road, London W12 0HS, UK. v.panoulas@imperial.ac.uk</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane road, London W12 0HS</wicri:regionArea><wicri:noRegion>London W12 0HS</wicri:noRegion></affiliation></author><author><name sortKey="Daigeler, Anna Lena" sort="Daigeler, Anna Lena" uniqKey="Daigeler A" first="Anna-Lena" last="Daigeler">Anna-Lena Daigeler</name></author><author><name sortKey="Malaweera, Anura S N" sort="Malaweera, Anura S N" uniqKey="Malaweera A" first="Anura S N" last="Malaweera">Anura S N. Malaweera</name></author><author><name sortKey="Lota, Amrit S" sort="Lota, Amrit S" uniqKey="Lota A" first="Amrit S" last="Lota">Amrit S. Lota</name></author><author><name sortKey="Baskaran, Dinnish" sort="Baskaran, Dinnish" uniqKey="Baskaran D" first="Dinnish" last="Baskaran">Dinnish Baskaran</name></author><author><name sortKey="Rahman, Syed" sort="Rahman, Syed" uniqKey="Rahman S" first="Syed" last="Rahman">Syed Rahman</name></author><author><name sortKey="Nihoyannopoulos, Petros" sort="Nihoyannopoulos, Petros" uniqKey="Nihoyannopoulos P" first="Petros" last="Nihoyannopoulos">Petros Nihoyannopoulos</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2013">2013</date><idno type="doi">10.1093/ehjci/jes140</idno><idno type="RBID">pubmed:22833550</idno><idno type="pmid">22833550</idno><idno type="wicri:Area/PubMed/Corpus">000043</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000043</idno><idno type="wicri:Area/PubMed/Curation">000043</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000043</idno><idno type="wicri:Area/PubMed/Checkpoint">000033</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000033</idno><idno type="wicri:Area/Ncbi/Merge">000251</idno><idno type="wicri:Area/Ncbi/Curation">000251</idno><idno type="wicri:Area/Ncbi/Checkpoint">000251</idno><idno type="wicri:Area/Main/Merge">000127</idno><idno type="wicri:Area/Main/Curation">000126</idno><idno type="wicri:Area/Main/Exploration">000126</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors.</title><author><name sortKey="Panoulas, Vasileios F" sort="Panoulas, Vasileios F" uniqKey="Panoulas V" first="Vasileios F" last="Panoulas">Vasileios F. Panoulas</name><affiliation wicri:level="1"><nlm:affiliation>Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane road, London W12 0HS, UK. v.panoulas@imperial.ac.uk</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane road, London W12 0HS</wicri:regionArea><wicri:noRegion>London W12 0HS</wicri:noRegion></affiliation></author><author><name sortKey="Daigeler, Anna Lena" sort="Daigeler, Anna Lena" uniqKey="Daigeler A" first="Anna-Lena" last="Daigeler">Anna-Lena Daigeler</name></author><author><name sortKey="Malaweera, Anura S N" sort="Malaweera, Anura S N" uniqKey="Malaweera A" first="Anura S N" last="Malaweera">Anura S N. Malaweera</name></author><author><name sortKey="Lota, Amrit S" sort="Lota, Amrit S" uniqKey="Lota A" first="Amrit S" last="Lota">Amrit S. Lota</name></author><author><name sortKey="Baskaran, Dinnish" sort="Baskaran, Dinnish" uniqKey="Baskaran D" first="Dinnish" last="Baskaran">Dinnish Baskaran</name></author><author><name sortKey="Rahman, Syed" sort="Rahman, Syed" uniqKey="Rahman S" first="Syed" last="Rahman">Syed Rahman</name></author><author><name sortKey="Nihoyannopoulos, Petros" sort="Nihoyannopoulos, Petros" uniqKey="Nihoyannopoulos P" first="Petros" last="Nihoyannopoulos">Petros Nihoyannopoulos</name></author></analytic><series><title level="j">European heart journal cardiovascular Imaging</title><idno type="eISSN">2047-2412</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Cardiology (education)</term><term>Cardiovascular Diseases (diagnosis)</term><term>Cardiovascular Diseases (ultrasonography)</term><term>Clinical Competence (MeSH)</term><term>Curriculum (MeSH)</term><term>Echocardiography, Doppler, Color (methods)</term><term>Equipment Design (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Medical Staff, Hospital (MeSH)</term><term>Physical Examination (methods)</term><term>Point-of-Care Systems (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Sampling Studies (MeSH)</term><term>Statistics, Nonparametric (MeSH)</term><term>Students, Medical (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Cardiologie (enseignement et éducation)</term><term>Compétence clinique (MeSH)</term><term>Conception d'appareillage (MeSH)</term><term>Examen physique (méthodes)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Maladies cardiovasculaires ()</term><term>Maladies cardiovasculaires (diagnostic)</term><term>Mâle (MeSH)</term><term>Personnel médical hospitalier (MeSH)</term><term>Programme d'études (MeSH)</term><term>Statistique non paramétrique (MeSH)</term><term>Systèmes automatisés lit malade (MeSH)</term><term>Échocardiographie-doppler couleur (méthodes)</term><term>Études par échantillonnage (MeSH)</term><term>Études prospectives (MeSH)</term><term>Étudiant médecine (MeSH)</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cardiovascular Diseases</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Maladies cardiovasculaires</term></keywords><keywords scheme="MESH" qualifier="education" xml:lang="en"><term>Cardiology</term></keywords><keywords scheme="MESH" qualifier="enseignement et éducation" xml:lang="fr"><term>Cardiologie</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Echocardiography, Doppler, Color</term><term>Physical Examination</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Examen physique</term><term>Échocardiographie-doppler couleur</term></keywords><keywords scheme="MESH" qualifier="ultrasonography" xml:lang="en"><term>Cardiovascular Diseases</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Clinical Competence</term><term>Curriculum</term><term>Equipment Design</term><term>Female</term><term>Humans</term><term>Male</term><term>Medical Staff, Hospital</term><term>Point-of-Care Systems</term><term>Prospective Studies</term><term>Sampling Studies</term><term>Statistics, Nonparametric</term><term>Students, Medical</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Compétence clinique</term><term>Conception d'appareillage</term><term>Femelle</term><term>Humains</term><term>Maladies cardiovasculaires</term><term>Mâle</term><term>Personnel médical hospitalier</term><term>Programme d'études</term><term>Statistique non paramétrique</term><term>Systèmes automatisés lit malade</term><term>Études par échantillonnage</term><term>Études prospectives</term><term>Étudiant médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>AIMS</b></p><p>While patient history taking and physical examination remain the cornerstones of patient evaluation in clinical practice, there has been a decline in the accuracy of the latter. Pocket-size hand-held echocardiographic (PHHE) devices have recently been introduced and could potentially improve the diagnostic accuracy of both medical students and junior doctors. The amount of training required to achieve optimal results remains a matter of debate. We hypothesized that the use of PHHE after limited training in the form of a tutorial can improve the clinical diagnosis even in the hands of medical students and inexperienced physicians.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS AND RESULTS</b></p><p>Five final-year medical students and three junior doctors without prior echocardiographic experience participated in a standardized 2 h PHHE bedside tutorial. Subsequently, they assessed 122 cardiology patients using history, physical examination, ECG and PHHE. Their final clinical diagnosis was compared against that of a consultant clinician's and also expert in echocardiography. A total of 122 PHHE were performed of which 64 (53%) by final-year medical students and 58 (47%) by junior doctors. Mean ± SD for diagnostic accuracy after history, physical examination, and ECG interpretation was 0.49 ± 0.22 (maximum = 1), whereas the addition of PHHE increased its value to 0.75 ± 0.28 (Z = -7.761, P<0.001). When assessing left ventricular systolic dysfunction by means of history and physical examination, specificity was 84.9% and sensitivity only 25.9%, whereas after including findings from PHHE, these figures rose to 93.6 and 74.1%, respectively.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The use of PHHE after brief bedside training in the form of a tutorial greatly improved the clinical diagnosis of medical students and junior doctors, over and above history, physical examination, and ECG findings.</p></div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country></list><tree><noCountry><name sortKey="Baskaran, Dinnish" sort="Baskaran, Dinnish" uniqKey="Baskaran D" first="Dinnish" last="Baskaran">Dinnish Baskaran</name><name sortKey="Daigeler, Anna Lena" sort="Daigeler, Anna Lena" uniqKey="Daigeler A" first="Anna-Lena" last="Daigeler">Anna-Lena Daigeler</name><name sortKey="Lota, Amrit S" sort="Lota, Amrit S" uniqKey="Lota A" first="Amrit S" last="Lota">Amrit S. Lota</name><name sortKey="Malaweera, Anura S N" sort="Malaweera, Anura S N" uniqKey="Malaweera A" first="Anura S N" last="Malaweera">Anura S N. Malaweera</name><name sortKey="Nihoyannopoulos, Petros" sort="Nihoyannopoulos, Petros" uniqKey="Nihoyannopoulos P" first="Petros" last="Nihoyannopoulos">Petros Nihoyannopoulos</name><name sortKey="Rahman, Syed" sort="Rahman, Syed" uniqKey="Rahman S" first="Syed" last="Rahman">Syed Rahman</name></noCountry><country name="Royaume-Uni"><noRegion><name sortKey="Panoulas, Vasileios F" sort="Panoulas, Vasileios F" uniqKey="Panoulas V" first="Vasileios F" last="Panoulas">Vasileios F. Panoulas</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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