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[2011] [SAT0069] FEASIBILITY OF A
STANDARDIZED ULTRASOUND EXAMINATION IN PATIENTS WITH RHEUMATOID
ARTHRITIS: QUALITY IMPROVEMENT AMONG
RHEUMATOLOGISTS
K. Ellegaard1, S. Torp-Pedersen1, R.
Christensen1, M. Stoltenberg2, A.
Hansen3, T. Lorenzen4, D. Jensen5,
L. Juul6, H. Lindegaard7, H.
Røgind8, P. Bülow9, S.
Cheysider10, M. Kowalski11, B.
Danneskiold-Samsøe1, H. Bliddal1
1The Parker Institute, Frederiksberg; 2Køge
Hospital, Køge; 3Gentofte University Hospital, Gentofte;
4Vejle Hospital, Vejle; 5Hørsholm Hospital,
Hørsholm; 6Copenhagen University Hospital, Copenhagen;
7Odense University Hospital, Odense;
8Frederiksberg Hospital, Frederiksberg;
9Bispebjerg Hospital, Copenhagen; 10Esbjerg
Hospital, Esbjerg; 11Aalborg Hospital, Aalborg,
Denmark
Background: Quality improvement is important to
facilitate specific and valid patient outcomes in pateints with RA.
Standardized examinations procedures may improve the validity of
ultrasound (US) examination measurements in this patient
group.
Objectives: The aim of this study was to
investigate the learning progress for rheumatologists during
training of a standardized US examination of the hand in patients
with rheumatoid arthritis (RA).
Methods: Thirteen rheumatologists having varying
experience in US were instructed by two qualified tutors. The
program consisted of two days with hands-on training in a
standardized US examination containing both grey-scale and Doppler
assessment followed by personal US examinations in their own
clinics. All examinations performed were sent to the tutors for
quality evaluation and feed back. The examinations were evaluated
according to a scoring sheet containing 144 items in wrist and MCP
joints. The examination was accepted if >80% of the
scores were correct.
Statistical analyses were basede on a linear mixed model: patient
and rheumatologists were applied as random factors when assessing
associations over time.
Results: A total of 104 patients were enrolled in
the study,of these 60 completed the 1 year follow-up
examination.The mean number of US examinations per patient was
three. Only 12.5% of the baseline examinations achieved a score
below 80%, indicating that the initial learning program was
sufficient. Furthermore, the number of correct scored achieved
improved significantly (p=0.0004) during the study period. A few
participants displayed a decreasing learning curve. The time spent
performing the standardized examination procedure decreased from
mean 34 min to a little less than 10 min during the training period
(p=0.0001).
Conclusions: Skills in a standardized US
examination can be achieved relatively fast improving the quality
of the measurement. Furthermore, the time spend on the examination
decreased to a satisfactory level during the study period. The
results of the training program indicate that US may be applied as
a valid measurement suitable for clinical practice and both single-
and multi-centre trials
Disclosure of
Interest: None Declared
Citation: Ann Rheum Dis
2011;70(Suppl3):544
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操作标准化可以提高风湿病医生超声检查RA的检测质量
Ellegaard K, et al. EULAR 2011.
Present No:SAT0069.
背景:
改善超声检查质量是重要的，这有助于提高对RA病人特异而有效的评估。将超声检查的操作标准化应该可以改善超声检查RA的有效性。
目的：通过培训标准化超声检查RA病人手部关节的操作，本研究将探究风湿病医生学习超声检查的过程。
方法：由两位有资质的导师对有着不同超声经验的13位风湿病医生进行辅导。培训计划包括为期2天的标准化超声检查上机培训，包括灰阶超声和多普勒超声，之后由每位风湿病医生各自在门诊进行超声检查。所有检查结果由递交给导师以进行质量评估并反馈。超声检查需填写一份包括144个项目的腕关节和掌指关节评估单。如果评估正确率超过80%，则相应的超声检查是合格的。
相关统计分析基于一个线性混合模型，在不同时间点评估相关性时，将病人和风湿病医生作为随机因素。
结果:
共招募104例病人，其中完成1年随访检查的共有60例。每例病人接受超声检查的平均次数为3次。基线期正确率低于80%的超声检查仅占12.%，表明初始培训项目的培训力度是足够的。进而在学习过程中，检查正确率又有显著改善(P
= 0.0004)。仅有少数学员的学习曲线称下降趋势。经培训后，风湿病医生执行标准化检查的平均耗时从最长的34分钟降至降至不足10分钟(p=0.0001)。
结论:
标准化超声检查的技巧可以相对较快地掌握，从而有助于改善超声检查质量。而且，超声检查耗时在培训后也缩短到令人满意的范围内。培训项目的结果表明超声可以作为有效检查手段而应用于常规临床以及单中心或多中心临床试验。
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