Within the framework of the LUST trial (LUng water by Ultra-Sound guided Treatment to prevent death and cardiovascular events in high-risk end-stage renal disease patients), the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis Transplant Association established a central core lab aimed at training and certifying nephrologists and cardiologists participating in this trial. All participants were trained by an expert trainer with an entirely web-based programme. Thirty nephrologists and 14 cardiologists successfully completed the training. At the end of training, a set of 47 lung ultrasound (US) videos was provided to trainees who were asked to estimate the number of B-lines in each video. The intraclass correlation coefficient (ICC) for the whole series of 47 videos between each trainee and the expert trainer was high (average 0.81 ± 0.21) and >0.70 in all but five cases. After further training, the five underperforming trainees achieved satisfactory agreement with the expert trainer (average post-retraining ICC 0.74 ± 0.14). The Bland-Altman plot showed virtually no bias (difference between the mean 0.03) and strict 95% limits of agreement lines (−1.52 and 1.45 US B-lines). Only four cases overlapped but did not exceed the same limits. Likewise, the Spearman correlation coefficient applied to the same data series was very high (r = 0.979, P < 0.0001). Nephrologists and cardiologists can be effectively trained to measure lung congestion by an entirely web-based programme. This web-based training programme ensures high-quality standardization of US B-line measurements and represents a simple, costless and effective preparatory step for clinical trials targeting lung congestion.
Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: A lust trial sub-project / Gargani, L.; Sicari, R.; Raciti, M.; Serasini, L.; Passera, M.; Torino, C.; Letachowicz, K.; Ekart, R.; Fliser, D.; Covic, A.; Balafa, O.; Stavroulopoulos, A.; Massy, Z. A.; Fiaccadori, E.; Caiazza, A.; Bachelet, T.; Slotki, I.; Shavit, L.; Martinez-Castelao, A.; Coudert-Krier, M. -J.; Rossignol, P.; Kraemer, T. D.; Hannedouche, T.; Panichi, V.; Wiecek, A.; Pontoriero, G.; Sarafidis, P.; Klinger, M.; Hojs, R.; Seiler-Mussler, S.; Lizzi, F.; Onofriescu, M.; Zarzoulas, F.; Tripepi, R.; Mallamaci, F.; Tripepi, G.; Picano, E.; London, G. M.; Zoccali, C.. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - 31:12(2016), pp. 1982-1988. [10.1093/ndt/gfw329]
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