Estudio coste efectividad del proceso diagnóstico de la trombosis venosa profunda desde la atención primaria

Camps, Eva Fuentes; García, José Luis del Val; Bellmunt-Montoya, Sergi; Hmimina, Sara Hmimina; Jabalera, E. Gómez; Muñoz, Miguel Ángel

doi:10.1016/j.aprim.2015.05.006

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…a good knowledge of ultrasound scanning techniques among family physicians could help cut the cost of medical care, since family physicians' ability to interpret the results correctly would most probably reduce the number of improper referrals to specialists [3]. For example, Fuentes Camps et al [17] examined the cost effectiveness of the application of diagnostic algorithms to patients with first episodes of suspected deep vein thrombosis in primary care, compared to systematic referral to specialist centers. they demonstrated that: (1) one third of all referrals to hospital emergency rooms could have been avoided, and that (2) the diagnostic cost could have been reduced by € 8,620 according to oudega and € 9,741 according to Wells, per 100 patients visited.…”

Section: Introductionmentioning

confidence: 99%

Experiences of family physicians after a CME ultrasound course

Szwamel¹,

Polański²,

Kurpas³

2017

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Background. Ultrasonography is an inexpensive, safe, noninvasive tool for obtaining diagnoses without performing further imaging tests, and for the timely referral of patients to further diagnosis or specialist care. Objectives. to determine which ultrasound tests are most often performed by family physicians, and what factors contribute to their use of ultrasound imaging. Material and methods. this survey-based study using the authors' questionnaire was conducted in March 2016 among 81 primary care physicians who had completed weekend courses on ultrasound abdominal cavity imaging. Results. Family physicians most often took ultrasounds of the abdominal cavity (35/50; 70%) and thyroid gland (35/50, 12%). the odds of an ultrasound being performed at primary care centers with at least two physicians with the necessary skills were about 29.29 times higher than at centers with less than two skilled physicians (or 29.29, 95% Ci 3.77, 1347.92). Family physicians (46/81; 56.79%) referred 274 patients for further specialist diagnosis. the diagnosis of neoplastic disease was confirmed in 168 cases (168/274; 61.31%). the anomalies that were most often detected by family physicians using ultrasound imaging included: cholelithiasis (24/50; 48%), renal cysts (16/50; 32%), nephrolithiasis (5/50; 10%), aortic aneurysms (2/50; 4%). Conclusions. Family physicians' ability to perform ultrasound scans increases the probability of other doctors acquiring this skill. Weekend courses for family physicians significantly shorten patients' waiting time for such examinations. a network of professional and upto-date workshops improving the practical skills of family physicians in ultrasound diagnostics, as well as peer review groups focused on ultrasound diagnostics performed by family physicians, are recommended. Key words: Primary health care, ultrasonography, physicians, family. szwamel k, Polański P, kurpas D. Experiences of family physicians after a CME ultrasound course.

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Section: Introductionmentioning

confidence: 99%

Experiences of family physicians after a CME ultrasound course

Szwamel¹,

Polański²,

Kurpas³

2017

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“…Aunque la escala de Wells es la más utilizada en hospitales, en el trabajo "Estudio coste efectividad del proceso diagnóstico de la trombosis venosa profunda desde la atención primaria" [3] se comenta que ambas escalas presentan "sensibilidad y especificidad similar y no difieren en su validez diagnóstica. "…”

Section: Regla De Oudegaunclassified

“…Dicho diagnóstico debe realizarse con diversas entidades como celulitis, tromboflebitis superficial, rotura de quiste de Baker, desgarros musculares con hematoma, traumatismos de partes blandas, edema de estasis, síndrome postrombótico, artritis y linfedema [2]; aproximadamente, un 80-90% de los pacientes con clínica compatible con TVP, derivados desde la atención primaria, no presentan este diagnóstico [3]. Debido a ello, la TVP representa un desafío clínico para los médicos de todas las disciplinas, por lo que es esencial que el primer médico entre en contacto con la enfermedad para evaluar rápidamente, comenzar el tratamiento y remitir al paciente con el especialista [4], debido a que con el diagnóstico temprano es posible iniciar oportunamente el tratamiento que evite la manifestación pulmonar de la enfermedad.…”

Section: Introductionunclassified

Trombosis venosa profunda en extremidades inferiores: revisión de las técnicas de diagnóstico actuales y su simbiosis con el aprendizaje automático para un diagnóstico oportuno

Fong-Mata¹,

Inzunza-González

García-Guerrero

et al. 2020

Rev. Ci. Tec.

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La Trombosis Venosa Profunda (TVP) es una manifestación de una Enfermedad Tromboembólica (ET). Cuando en una TVP los trombos venosos se desprenden y viajan a través del torrente sanguíneo pueden ocasionar una Trombo Embolia Pulmonar (TEP). La existencia de Trombosis Venosa Profunda (TVP) en las extremidades inferiores se ha descrito como uno de los principales factores de riesgo para el desarrollo de la TEP. Se considera que hasta el 90% de los émbolos pulmonares proceden de trombos venosos de las extremidades inferiores. Las técnicas más utilizadas para la detección de TVP son los modelos de probabilidad clínica, el dímero D y las pruebas de imagen no invasivas, como la ecografía para la TVP y la angiotomografía computadorizada (TC) para el embolismo pulmonar. Sin embargo, debido a la inespecificidad de los síntomas de la TVP, el umbral para ordenar una ecografía es bajo, además de ser un proceso complicado que requiere la participación de un médico especialista para su interpretación. En las últimas décadas el aprendizaje automático ha surgido como apoyo en la toma de decisiones para el diagnóstico de diversas enfermedades, algunas de las tecnologías más utilizadas en el campo de la medicina incluyen Support Vector Machine (SVM), Árboles de decisión y las Redes Neuronales Artificiales (RNA). En el presente artículo se hace una revisión de las tecnologías existentes para la detección de la TVP así como de los principales algoritmos de aprendizaje automático comúnmente utilizados en aplicaciones biomédicas; se propone el diseño de un sistema computarizado que utilice técnicas de aprendizaje automático como herramienta de apoyo para la detección oportuna de un posible padecimiento de TVP.

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“…The gold standard for diagnosis of DVT [14] is venography, which in addition to being invasive is highly expensive; hence, the most commonly used method in hospital emergency units is compression ultrasound [15]. However, none of the technologies mentioned is usually present in the primary care units [16], which is the first unit to which a patient comes to when feeling a symptom. In addition to this, the lack of experience of physicians regarding thromboembolic disease has caused legal situations where the main lawsuits cited "failure of physicians in the diagnosis and treatment of these diseases" [17].…”

Section: Introductionmentioning

confidence: 99%

An Artificial Neural Network Approach and a Data Augmentation Algorithm to Systematize the Diagnosis of Deep-Vein Thrombosis by Using Wells’ Criteria

et al. 2020

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The use of a back-propagation artificial neural network (ANN) to systematize the reliability of a Deep Vein Thrombosis (DVT) diagnostic by using Wells’ criteria is introduced herein. In this paper, a new ANN model is proposed to improve the Accuracy when dealing with a highly unbalanced dataset. To create the training dataset, a new data augmentation algorithm based on statistical data known as the prevalence of DVT of real cases reported in literature and from the public hospital is proposed. The above is used to generate one dataset of 10,000 synthetic cases. Each synthetic case has nine risk factors according to Wells’ criteria and also the use of two additional factors, such as gender and age, is proposed. According to interviews with medical specialists, a training scheme was established. In addition, a new algorithm is presented to improve the Accuracy and Sensitivity/Recall. According to the proposed algorithm, two thresholds of decision were found, the first one is 0.484, which is to improve Accuracy. The other one is 0.138 to improve Sensitivity/Recall. The Accuracy achieved is 90.99%, which is greater than that obtained with other related machine learning methods. The proposed ANN model was validated performing the k-fold cross validation technique using a dataset with 10,000 synthetic cases. The test was performed by using 59 real cases obtained from a regional hospital, achieving an Accuracy of 98.30%.

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Estudio coste efectividad del proceso diagnóstico de la trombosis venosa profunda desde la atención primaria

Abstract: The application of diagnostic algorithms when a DVT is suspected could lead to better diagnostic management by physicians, and a more cost effective process.

Cited by 8 publications

References 26 publications

Experiences of family physicians after a CME ultrasound course

Experiences of family physicians after a CME ultrasound course

Trombosis venosa profunda en extremidades inferiores: revisión de las técnicas de diagnóstico actuales y su simbiosis con el aprendizaje automático para un diagnóstico oportuno

An Artificial Neural Network Approach and a Data Augmentation Algorithm to Systematize the Diagnosis of Deep-Vein Thrombosis by Using Wells’ Criteria

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