[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]

[Use of clinical ultrasound in primary care: Multicenter prospective study]

OBJECTIVE

The objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca).

DESIGN

Observational, descriptive, longitudinal, prospective and multicenter study. SITE: CS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia).

PARTICIPANTS

One hundred and thirty-five patients were included.

INTERVENTIONS

Performance of clinical ultrasound in the primary care (PC) consultation.

MAIN MEASUREMENTS

Demographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected.

RESULTS

One hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients.

CONCLUSIONS

The use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals.

Validation of the Measuring Protocol for the Infraspinatus Muscle with M-Mode Ultrasound in Asymptomatic Subjects. Intra- and Inter-examiner Reliability Study

M-mode ultrasound is a reliable and valid instrument for assessing muscle activity. However, it has not been studied in any of the muscles belonging to the shoulder joint complex, particularly in the infraspinatus muscle. The aim of this study is the validation of the infraspinatus muscle activity measurement protocol with the M-mode ultrasound in asymptomatic subjects. Sixty asymptomatic volunteers were evaluated by two physiotherapists who were blinded; each of them carried out three measurements with the M-mode ultrasound in infraspinatus muscle and analysed the muscle thickness at rest and contraction, velocity of muscle activation and relaxation and Maximum Voluntary Isometric Contraction (MVIC). Intra-observer reliability was significant in both observers, showing good thickness at rest (ICC = 0.833-0.889), thickness in contraction (ICC = 0.861-0.933) and MVIC (ICC = 0.875-0.813); moderate in the activation velocity (ICC = 0.499-0.547) and relaxation velocity (ICC = 0.457-0.606). The inter-observer reliability also had good thickness at rest (ICC = 0.797), thickness in contraction (ICC = 0.89) and MVIC (ICC = 0.84); poor in relaxation time variable (ICC = 0.474) and not significant at the activation velocity (ICC = 0). The muscle activity measurement protocol of the infraspinatus muscle measured with M-mode ultrasound has been found to be reliable in asymptomatic subjects, for both the intra-examiner and inter-examiner.

Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study

BACKGROUND

The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills.

OBJECTIVES

To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies.

METHODS

A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan.

RESULTS

The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice).

CONCLUSION

Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.

Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia

Background: Currently, there are few studies that have analyzed the benefits of using lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.

El reto de la pandemia de la COVID-19 para la Atención Primaria

La COVID-19 ha provocado muchos cambios en el sistema sanitario y, por supuesto, en Atención Primaria. La pandemia ha marcado un antes y un después para la Atención Primaria, tanto a nivel organizativo en los centros de salud como en la manera de abordar las demandas y necesidades de los pacientes, y en el desempeño de la Medicina Familiar. En marzo de 2020 todos veíamos con preocupación cómo la Atención Primaria era invisible para las administraciones. La forma inicial de abordar la atención a la pandemia con un enfoque hospitalocentrista ha condicionado probablemente el diseño organizativo a lo largo de las diferentes oleadas. Al comienzo de la pandemia, la Atención Primaria no disponía de pruebas para el diagnóstico de la COVID-19, y fuimos testigos de cómo la inquietud y el miedo se apoderaba de los médicos y médicas de familia, muy especialmente en aquellas comunidades autónomas (CCAA) en las que el virus azotaba con fuerza a la población. La Atención Primaria, como siempre, se mantuvo cerca de la ciudadanía, priorizando la atención telefónica y dando respuesta a las demandas de los pacientes, muy especialmente al abordaje de la COVID-19. La Atención Primaria trabajó no solo como un eficaz muro de contención de la epidemia, sino también gestionando y resolviendo en el domicilio los casos leves o moderados que no necesitaban ingreso hospitalario. Sin embargo, para seguir haciendo frente a la pandemia y a la nueva situación se precisaban cambios organizativos y de gestión, más profesionales y nuevos roles. Es importante constatar que, para el buen desempeño de la Medicina Familiar del siglo XXI, para que la Atención Primaria salga reforzada de esta pandemia, las soluciones pasan por una adecuada financiación y una apuesta firme por mantener la longitudinalidad. Palabras clave: COVID-19, Medicina Familiar y Comunitaria, Atención Primaria de Salud, gestión de servicios sanitarios.