Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project
Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project
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DOI：
10.1093/ndt/gfw329
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发表时间：
2016-12-01
影响因子：
6.1
通讯作者：
Zoccali, Carmine
中科院分区：
文献类型：
--
作者：
Gargani, Luna;Sicari, Rosa;Zoccali, Carmine
在LUST试验（超声引导治疗肺水以预防高危终末期肾病患者死亡和心血管事件）的框架内，欧洲肾脏协会-欧洲透析移植协会的欧洲肾脏和心血管医学（EURECA-m）工作组建立了一个中央核心实验室，旨在培训和认证参与该试验的肾脏病学家和心脏病学家。所有参与者均由专家培训师通过完全基于网络的计划进行培训。 30名肾病专家和14名心脏病专家成功完成了培训。培训结束时，向学员提供了一组 47 个肺部超声 (US) 视频，要求学员估计每个视频中的 B 线数量。每个受训者和专家培训师之间的整个系列 47 个视频的组内相关系数 (ICC) 都很高（平均 0.81 +/- 0.21），并且除 5 个案例外，所有案例都 >0.70。经过进一步的培训，五名表现不佳的学员与专家培训师取得了满意的一致性（再培训后平均 ICC 0.74 +/- 0.14）。 Bland-Altman 图显示几乎没有偏差（均值 0.03 之间的差异）和严格的 95% 一致线限制（-1.52 和 1.45 US B 线）。只有四个案例重叠，但没有超出相同的限制。同样，应用于相同数据系列的斯皮尔曼相关系数非常高（r = 0.979，P < 0.0001）。肾病专家和心脏病专家可以通过完全基于网络的程序接受有效的培训来测量肺充血。这一基于网络的培训计划可确保 US B 线测量的高质量标准化，并为针对肺充血的临床试验提供简单、无成本且有效的准备步骤。
Within the framework of the LUST trial (LUng water by Ultra-Sound guided Treatment to prevent death and cardiovascular events in high-risk end-stage renal disease patients), the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis Transplant Association established a central core lab aimed at training and certifying nephrologists and cardiologists participating in this trial. All participants were trained by an expert trainer with an entirely web-based programme. Thirty nephrologists and 14 cardiologists successfully completed the training. At the end of training, a set of 47 lung ultrasound (US) videos was provided to trainees who were asked to estimate the number of B-lines in each video. The intraclass correlation coefficient (ICC) for the whole series of 47 videos between each trainee and the expert trainer was high (average 0.81 +/- 0.21) and >0.70 in all but five cases. After further training, the five underperforming trainees achieved satisfactory agreement with the expert trainer (average post-retraining ICC 0.74 +/- 0.14). The Bland-Altman plot showed virtually no bias (difference between the mean 0.03) and strict 95% limits of agreement lines (-1.52 and 1.45 US B-lines). Only four cases overlapped but did not exceed the same limits. Likewise, the Spearman correlation coefficient applied to the same data series was very high (r = 0.979, P < 0.0001). Nephrologists and cardiologists can be effectively trained to measure lung congestion by an entirely web-based programme. This web-based training programme ensures high-quality standardization of US B-line measurements and represents a simple, costless and effective preparatory step for clinical trials targeting lung congestion.