[Abdominal ultrasound: a diagnostic tool within the reach of general practitioners]. / Ecografía abdominal: una herramienta diagnóstica al alcance de los médicos de familia.

AIM: To assess the impact of training two general practitioners (GPs), on performing low complexity ultrasound examinations of the abdomen with diagnostic competence. STUDY DESIGN: A non-randomised, prospective, double blind evaluation study of the acquired competence. Ultrasound examinations were performed successively and independently by the GP and the radiologist, and registered on two sheets of an identical case report form. SETTING: Departments of Vic General Hospital and Vic Health Care Centre of the Catalan Health Institute. SUBJECTS: A total of 120 patients who needed a low complexity abdominal ultrasound from a total amount of 868 ultrasound examinations scheduled. MAIN MEASUREMENTS: The kappa index of the primary diagnosis (ultrasound diagnostic conclusion), as well as of the ultrasound findings for each abdominal organ was calculated. A good level of training was considered if a minimum kappa index of 0.80 was attained between general practitioner and radiologist. RESULTS: After six month running, an "ad interim" analysis showed a kappa index for the primary ultrasound diagnosis of 0.85. At the end of the study, an overall kappa index of 0.89 (95% CI: 0.82-0.98) was achieved. The agreement by organs was also high (pancreas and spleen excluded), as well as sensitivity (>75%) and specificity (>90%). CONCLUSIONS: The results of the study demonstrate the feasibility of the performance, by trained GPs, of ultrasound examinations of low complexity of the abdomen with diagnostic competence.

The Role of Teledermatology and Teledermoscopy in the Diagnosis of Actinic Keratosis and Field Cancerization.

Actinic keratosis (AK) and field cancerization are increasing health problems insufficiently diagnosed by primary care physicians. The objective of this study was to assess the validity and reliability of teledermatology (TD) and teledermoscopy in the diagnosis of AK and field cancerization in a gatekeeper healthcare model. A prospective diagnostic test evaluation was done to assess the diagnostic concordance, accuracy, and performance parameters and the interobserver and intraobserver concordances of TD and teledermoscopy compared with dermatologists' face-to-face evaluation or histopathology. A total of 636 patients with 1,000 keratotic skin lesions were included. TD diagnostic concordance for AK and field cancerization evaluation was very high and superior to primary care physicians' diagnosis (92.4% vs. 62.4% and 96.7% vs. 51.8%, P < 0.001). TD sensitivity, specificity, and positive and negative predictive values for AK diagnosis and field cancerization were high (range = 82.2-95.0) and better than primary care physicians' diagnosis. Teledermoscopy yielded better results in diagnostic concordance, performance parameters, and AK subtypes. Intraobserver and interobserver agreement was >0.83. TD and, to a greater extent, teledermoscopy may be valid and reliable tools for the diagnosis of AK and field cancerization and may improve diagnosis and correct allocation and management in gatekeeper healthcare systems. It can be an alternative tool to training primary care physicians in direct diagnosis of these lesions.