Background Nurses play a key role of interface between patients and the rheumatologist. There is an increasing evidence that specialist nurses can be involved in a wide range of advanced activities in patient management including clinimetry, patient education, counseling, capillaroscopy and intra-articular injections (1). Targeted ultrasound (US) could be another activity to consider in order to promote the extended role of rheumatology nursing (2).
Objectives To evaluate the learning curve of a nurse without experience in musculoskeletal US who attended an intensive training programme focused on the acquisition technique of US images at metacarpophalangeal (MCP) joints in patients with chronic arthritis.
Methods Two investigators (1 rheumatologist expert in US and faculty member of theEULAR US courses and 1 nurse without previous experience in US) participated in the exercise. US images were obtained from 6 selected patients with different chronic arthritis (3 rheumatoid arthritis, 3 psoriatic arthritis). The training program has been structured in two phases. The first phase (first day) has been focused on basic technical characteristics of the US equipment and the appropriate settings [greyscale and power Doppler (PD)] to obtain high quality US images. The second phase consisted of three sessions of intensive scanning activity (3 hours per day for three consecutive days). The US images acquired by the nurse have been successively evaluated by the rheumatologist. For each US image the following four parameters were considered using a qualitative score (not correct=0 or correct=1): 1= setting of the equipment; 2= visualization of bone profile and cartilage; 3= visualization of tendon; 4= position of the transducer. The possible score for each image ranged from 0 to 4.
Results A total of 48 images of MCP joints in 6 patients were assessed. The global scores attributed at the nurse US images showed a significant progressive improvement from the beginning to the end of the exercise [median (95% CI for the median): 2 (1.00 – 2.04) to 3 (3.00 – 4.00) p=0.0002].
Conclusions Our results suggest that a nurse without experience in US is able to acquire high quality US images of MCP joints in patients with chronic arthritis after a short intensive 12 hours training programme.
Carr A. Defining the extended clinical role for allied health professionals in rheumatology. ARC Conference Proceedings NO12, Arthritis Research Campaign, 2001, Chesterfi eld, UK.
Filippucci E, Unlu Z, Farina A, Grassi W. Sonographic training in rheumatology: a self teaching approach. Ann Rheum Dis 2003;62:565-67.
Disclosure of Interest None Declared
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