Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study.

CONTEXT: Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored. OBJECTIVE: The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions. METHOD: We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training. RESULTS: 11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of "7-9" ratings) and 19 skills with a relative agreement (100% of "5-9" ratings). CONCLUSION: These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.

Seasonal influenza vaccination in pharmacy in France: description and determinants of the vaccinated at-risk population using this service, 1 year after implementation.

OBJECTIVES: Vaccination of the at-risk population against influenza by pharmacists was widely implemented in France in 2019. Only little data are available about the population using this service. We have explored the characteristics and determinants of the at-risk population vaccinated in pharmacy through a web-based cohort during the 2019-20 winter season. METHODS: This study is based on the data of the profile survey of at-risk over-18 vaccinated participants of the cohort GrippeNet.fr, for the 2019-20 winter season. Population characteristics were described using the inclusion questionnaire data. Factors associated with pharmacy influenza vaccination were analysed through a logistic regression model. KEY FINDINGS: In total, 3144 people were included in the study. 50.2% (N = 1577) of them were women and 65.5% (N = 2060) were over 65 years old. 29.5% (N = 928) of participants were vaccinated in pharmacy. 73.1% (N = 678) of participants vaccinated in pharmacy were over 65 years old and 46.6% (N = 432) had a treatment for one or more chronic disease. Factors positively associated with being vaccinated by a pharmacist were: being a man (OR = 1.25, 95% confidence interval [1.06-1.47]), being over 65 years old (OR = 1.97 [1.49-2.63]), living in a test region (OR = 1.62 [1.29-2.02] and 1.72 [1.43-2.07] depending on the year of the implementation of the experimentation) and being vaccinated against influenza in 2018/2019 (OR = 1.71 [1.32-2.21]). Factors negatively associated were: taking a chronic treatment (OR = 0.83 [0.70-0.97]), and living alone (OR = 1.40 [1.17-1.67] and being in contact with sick people (OR = 0.68 [0.50-0.93]). CONCLUSIONS: This study confirmed some factors associated with pharmacy influenza vaccination and feeds the debate on other uncertain factors. These findings can support public health authorities' willingness to enhance pharmacists' involvement in the future country-wide vaccination campaign. Our study also highlights the necessity to further investigate the impact of this measure in a few years.

Intrauterine Pregnancy Detection and Gestational Age Assessment During Early Pregnancy by a Handheld Point-Of-Care Ultrasound Device Compared to a High-End Ultrasound System. An Accuracy and Reliability Study.

Objective: The main objective of this study is the evaluation of the accuracy and reliability of a handheld point of care ultrasound device (POCUS-hd) for intrauterine pregnancy (IUP) detection compared to comprehensive reference transabdominal ultrasound (TU). The secondary objectives were to evaluate POCUS-hd for intrauterine pregnancy (IUP) detection compared to transabdominal and transvaginal ultrasound (TUTV), evaluate the inter-device agreement and inter-rater reliability of gestational age during early pregnancy. Methods: It is an observational transverse study with consecutive patient recruitment. Two blinded operators systematically used POCUS-hd and reference transabdominal ultrasound for IUP diagnosis. The accuracy of POCUS-hd for IUP diagnosis was expressed as sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). The gestational age (GA) was assessed based on the crown-rump length. The reliability and agreement of gestational age evaluation were assessed by Bland-Altman plots, kappa statistic, and intraclass correlation coefficients (ICC). Results: POCUS-hd compared to TU had a sensitivity of 95-100%, a specifcity of 90-100%, PPV of 95-100% and NPV of 90-100%. Inter-rater agreement for IUP detection using POCUS-hd was very good, kappa=1.0; CI95% [0.9-1.0]. The inter-device agreement limits (mean difference ± 2SD) for GA were: -3 to +2.3 days by Operator 1, -3.4 to +3.3 days by Operator 2 for POCUS-hd vs. TU and -3.1 to +2.3 days for POCUS-hd versus TUTV. Conclusion: This handheld POCUS device is an accurate and reliable diagnostic tool that can be used for IUP positive findings and GA assessment during early pregnancy by clinicians in family planning settings or general practice.

Immunization Catch-Up for Newly Arrived Migrants in France: A Cross-Sectional Study among French General Practitioners.

BACKGROUND: Migrants often undergo an incomplete vaccination program in regards to the French recommendations. The aim of this study was to evaluate the practices of French General Practitioners' (GPs) in terms of catch-up vaccination. METHODS: A cross-sectional study was carried-out in 2017-2018 in France. An online questionnaire was disseminated by email through scholarly societies to GPs involved in the care and the vaccination of migrants. Analyses included univariate and multivariate analysis with a logistic regression model. RESULTS: A total of 216 GPs completed the survey. A majority identified themselves with an average level regarding the prevention of infectious diseases among migrant populations (56.7%) and confirmed this is part of their daily practice (83.3%). The majority of respondents do not perform more than two injections on the same day. When compared to GPs working in health centres, those with a private practice are more likely to report returning to a full primary vaccination schedule (adjusted OR = 2.90, 95% CI [1.29-6.53]). Aside from the serology for hepatitis B and to a lesser extent for measles, other pre-vaccination serologies were not frequently used by GPs. When a migrant declares to be up-to-date with his immunisations, only 56.5% of doctors consider this information reliable. CONCLUSIONS: This study clarified the vaccination practices of GPs receiving migrant patients in consultation and showed its heterogeneity. An important need for benchmarks has been identified and these results were used for the elaboration of the French guidelines on vaccines catch-up.