Situación de la ecografía en la reumatología española 2012

Quality Health Care in Acute Shoulder Pain: What Is the Contribution of Musculoskeletal Ultrasound?

For the purpose of assessing the impact of ultrasound in patients with acute shoulder pain, we conducted an analysis of quality health care indicators: need for reevaluation of the pain, rate of referral to specialized medicine and length of time in the emergency department. We reviewed the 1,433 records of patients attended to between 2015 and 2016. Thirty days after the first examination, 90 patients (10.1%) had returned to the control group (56 through the emergency department and 34 because of the), whereas, in the ultrasound (US) group, 14 (2.5%) had returned at least once (12 through the emergency department and 2 because of the PCC) (P<.001). The rate of referral to specialized medicine in the control group was 36.5%, whereas in the US group it was 6.21% (P<.0001). The average length of stay was 94.5 (standard deviation [SD] 34.3) minutes in the control group and 105.4 (SD 40.1) minutes in the US group (P<.0001). Our results suggest that the practice of shoulder ultrasound improves health care quality in these patients, at the cost of a slight increase in health care time.

Practical ultrasound workshops to teach medical students basic concepts of ultrasound semiology

OBJECTIVES

To evaluate the effectiveness of practical ultrasound workshops for the acquisition and consolidation of conceptual learning about the basic physics and semiology of ultrasonography aimed at third-year medical school students doing the physical examination module of their studies.

MATERIAL AND METHODS

We carried out practical ultrasound workshops with two groups of 177 and 175 students in two consecutive academic years. All students had taken a class in basic radiology in the previous year. Students examined each other with ultrasonography under instructors' supervision in a two-hour session. Before and after the workshop, students did a seven-question multiple-choice test about basic semiology and answered two questions evaluating their degree of confidence in interpreting ultrasonographic images and handling the ultrasound scanner on a scale from 1 to 10.

RESULTS

No significant differences were found between the scores obtained in the two groups. Overall, the mean score on the multiple-choice test improved from 59.71% on the initial assessment to 88.29% on the post-workshop assessment (p <0.01). Confidence in interpreting images improved from 3.39/10 to 6.28/10 (p <0.01), and confidence in handling the equipment improved from 3.73/10 to 6.51/10 (p <0.01).

CONCLUSION

Practical workshops were useful for learning basic concepts about ultrasound imaging, allowing students to significantly improve their scores on the multiple-choice test. Students had a low level of confidence in their ability to interpret ultrasound images and handle the equipment before starting the workshop, but their confidence improved significantly after completing the workshop.

Implementation and role of modern musculoskeletal imaging in rheumatological practice in member countries of EULAR

Objectives

To document the current training, implementation and role of modern musculoskeletal imaging techniques: ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography, among rheumatologists in the member countries of the EULAR.

Methods

English-language questionnaires for each imaging modality developed by a EULAR task force were sent out to national and international scientific societies as well as imaging experts in the given modalities involved in research and/or training. The surveys were distributed via an online survey tool (SurveyMonkey). Simple descriptive and summary statistics were calculated from the responses.

Results

More than 90% of ultrasound (US) experts reported the availability of a US unit in their department. Suspicion of rheumatoid arthritis and spondyloarthritides were the main clinical indications for performing US for diagnostic purposes. Suspicion of sacroiliitis and degenerative spine disease were the most common indications to perform magnetic resonance imaging (MRI) or computed tomography (CT) for diagnostic purposes, while positron emission tomography was mainly performed to diagnose large vessel vasculitis and to investigate fever of unknown origin. The reported percentage of rheumatologists performing US was highly variable, ranging from more than 80% in 6% of countries to less than 10% in 15% of countries. The majority of experts (77%) reported that their national rheumatology societies organise musculoskeletal US courses, while courses in MRI or CT organised by the national rheumatology societies were less commonly reported (29% and 8%, respectively).

Conclusions

Rheumatologists in Europe utilise modern imaging techniques; however, access to the techniques and training offered is varied.

Progress of the attractiveness of Rheumatology among medical speciality training candidates (MIR) in Spain

OBJECTIVE

To describe the progress of the attractiveness of rheumatology at successive MIR calls, from 1983 to 2014.

METHODS

Candidates in the Spanish training system for medical doctors choose their specialties sequentially, ordered by their ranking in the qualifying exam (MIR). The highest, median and lowest rank of candidates choosing rheumatology training positions in every MIR call from 1983 to 2014 was requested from the Department of Management of Specialized Medical Training (General Department of Professional Regulation; Spanish Ministry of Health). To compare, the same data was requested for other specialties. In order to define and analyze the attractiveness of each specialty we introduce an 'index of attractiveness', based on the normalized difference of the actual median rank reported for each year and the average median obtained in 1000 simulations in which candidates choose specialties at random.

RESULTS

Regarding the median of the election of rheumatology, the range went from 244th in 1983 to 3394th in 2008, showing a progressive increase over the years in absolute figures. A mathematical simulation allowed quantifying the difference between the observed median and what would have happened if specialties had been chosen by pure chance. Results show a tendency to recover the attractiveness of rheumatology in recent years.

CONCLUSIONS

After a sharp decline in the attractiveness of rheumatology during the last years of the 20th century, there seems to be a recovery.

Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries

The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0–85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6–99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education.

Usefulness of ultrasonography in the assessment of peripheral enthesis in spondyloarthritis

Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis. However, in clinical practice, its presence often goes unnoticed because of the lack of precision and sensitivity of physical examination to detect it. Viable, valid and reliable imaging tests are needed for early diagnosis, as well as a good sensitivity to change to monitor therapeutic response. In this paper we review the most relevant aspects of current knowledge of the enthesis and discusses the validity of ultrasound for assessing enthesitis in spondyloarthritis and its sensitivity to change to monitor therapeutic response.