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.

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.

Adapter le parcours de soins prénatal par le repérage précoce d'un mal-être psychologique.

INTRODUCTION: The prevalence of poor mental health during pregnancy is estimated at 10% and it appears to be associated with increased maternal and child morbidity. This pilot study aims to assess the impact on pregnant women, their mental health, and health care trajectory of early identification of poor mental health during pregnancy. METHOD: This interventional study was carried out in three districts of Paris and included two groups. The intervention group was composed of pregnant women whose screening for poor mental health consisted in systematically asking them, in the first trimester of pregnancy, a single question. The control group was composed of pregnant women monitored as usual. All of these women benefited from a telephone interview eight to twelve weeks after their recruitment in order to assess their mental health in the second trimester of pregnancy and describe their care pathway. RESULTS: In the intervention group, women benefited from early prenatal interview more often and they felt that their medical care had improved their well-being during pregnancy more frequently (P < 0.05). Women in the control group found it harder to express their psychological difficulties, expressed them less frequently and had trouble with medical care follow-up when offered (P < 0.05). CONCLUSION: The early screening for poor mental health by a single question during pregnancy seems to positively change the care pathway of pregnant women with poor mental health. In addition, it could improve the well-being of pregnant women in the second trimester of pregnancy.

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.