Subject(s)
Dyspnea/diagnosis , Emergency Service, Hospital , Heart Failure/diagnosis , Lung/diagnostic imaging , Practice Patterns, Nurses' , Practice Patterns, Physicians' , Ultrasonography/standards , Diagnosis, Differential , Dyspnea/etiology , Female , Heart Failure/complications , Humans , Male , ROC CurveABSTRACT
In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7â±â12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400âpg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.
Subject(s)
Dyspnea/diagnostic imaging , Lung/diagnostic imaging , Nursing Diagnosis , Acute Disease , Aged , Dyspnea/diagnosis , Female , Heart Diseases/complications , Humans , Male , Natriuretic Peptide, Brain/blood , Predictive Value of Tests , Prospective Studies , Ultrasonography/methods , Ultrasonography/standardsSubject(s)
Porphyria, Acute Intermittent/diagnosis , Abdominal Pain/etiology , Aged, 80 and over , Alcoholism/complications , Bradycardia/etiology , Confusion/etiology , Female , Humans , Hypotension, Orthostatic/etiology , Male , Muscle Weakness/etiology , Porphobilinogen/urine , Prevalence , Retrospective Studies , Urinary Tract Infections/complications , Vomiting/etiology , Weight LossABSTRACT
BACKGROUND: Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. MATERIAL AND METHODS: We prospectively evaluated all consecutive outpatients referred for suspected DVT from January 2011 to December 2012. All patients underwent bilateral proximal lower limb CUS, first by trained nurses and then by physicians expert in vascular ultrasonography, with every group blinded with respect to each other. This test was repeated after 5-7 days in all negative or unclear examinations. Interobserver agreement and accuracy of nurse-performed CUS were calculated, considering the physician's final diagnosis as the reference test. RESULTS: Six hundred ninety-seven patients were included in the study. DVT was diagnosed in 122 patients by expert ultrasound physicians with an overall prevalence of 17.5% (95% confidence interval [CI] 15.8%-20.6%). Nurse agreement with the physician in DVT diagnosis was excellent (Cohen's κ 0.82, 95% CI 0.79-0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI 81.7%-87.1%) and a specificity of 97.0% (95% CI 95.8%-98.3%) with a diagnostic accuracy of 94.8% (95% CI 93.2%-96.5%). CONCLUSION: Our results suggest that nurse-performed CUS may be a potential useful alternative to physician performed CUS with a good accuracy. However, sensibility of nurse-performed CUS appeared suboptimal and future studies should incorporate in the evaluation of this technique other pretest tools that may increase its accuracy.
Subject(s)
Nursing/methods , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/diagnosis , Venous Thrombosis/nursing , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Observer Variation , Prospective Studies , Reproducibility of Results , Research Design , Sensitivity and Specificity , Ultrasonography , Young AdultABSTRACT
In this retrospective analysis, we analyzed all clinical record data in our Medical Division between January 2005 and December 2006 to evaluate an association between clomipramine treatment and glucose intolerance. Of 1997 patients, 154 (7.7%) had diabetes and 525 (26.3%) had depression. Diabetes prevalence was significantly higher in patients treated with clomipramine than in patients not treated [odds ratio 3.9, (2.2-7.0), p < 0.00001], independently by age and BMI. A possible causal role needs to be investigated in a prospective way.