Skills of primary healthcare physicians in paediatric cardiac auscultation

Germanakis, Ioannis; Petridou, Eleni; Varlamis, George; Matsoukis, Ioannis; Papadopoulou-Legbelou, Kyriakı; Kalmanti, Maria

doi:10.1111/apa.12062

Cited by 20 publications

(22 citation statements)

References 30 publications

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“…The final year veterinary student, who was trained to recognise soft cardiac murmurs in puppies immediately before the start of the study (in a total of 3 h on 3 separate days with weekly intervals), had a better agreement with the veterinary cardiology specialist than first opinion veterinary practitioners in identifying soft murmurs. Various human and veterinary studies have investigated inter-observer variability and the effect of teaching on recognising cardiac murmurs [8][9][10][11][12][13][14][15][16]. The majority of these studies describe a high inter-observer variability [8][9][10] and conclude that training has a positive effect on detecting murmurs, especially those with a low intensity [11][12][13][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check

Staveren

Szatmári

2020

Acta Vet Scand

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Background: The frequency that cardiac murmurs are identified and recorded in first opinion veterinary practices at the first health check in puppies is unknown. The aims of the study were to assess the agreement between first opinion veterinary practitioners, a veterinary student and a veterinary cardiology specialist on detecting murmurs, and to establish whether abnormal auscultation findings had been recorded in the health certificates of clinically healthy puppies. The study included prospective and retrospective investigations, where the prospectively collected auscultation findings from a veterinary cardiology specialist and a trained veterinary student were compared to auscultation findings recorded by first opinion veterinary practitioners. Results: Cardiac auscultation was performed on 331 client-owned, clinically healthy dogs at two time points: at age 34-69 days by a first opinion veterinary practitioner and at age 45-76 days, on average 9 days later, by a veterinary cardiology specialist and a trained veterinary student. Agreement among the three was compared for the presence of a murmur. The degree of inter-observer agreement was evaluated using Cohen's kappa. Auscultation findings, as noted in the pets' passports, from 331 puppies and 43 different first opinion veterinary practices, were retrospectively reviewed and prospectively compared with auscultation findings from a veterinary cardiology specialist. Agreement between the veterinary cardiology specialist and the first opinion veterinary practitioners was poor (ϰ = 0.01) and significantly different (P < 0.001). First opinion veterinary practitioners had recorded a cardiac murmur in only 1 of the 97 puppies in which the veterinary cardiology specialist detected a murmur. Two-hundred-and-fifty-two puppies were auscultated by both the veterinary cardiology specialist and the student. Their agreement was fair (ϰ = 0.40) and significantly different (P = 0.024). The agreement between the student and a first opinion veterinary practitioner on these 252 puppies was poor (ϰ = 0.03) and significantly different (P < 0.001). Conclusions: This study shows that soft cardiac murmurs are rarely documented during the first veterinary health check in puppies by first opinion veterinary practitioners. Although soft murmurs may not be clinically relevant, finding and recording them is evidence of a carefully performed auscultation. Missing a non-pathological murmur is not of clinical importance; however, missing a pathological murmur could prove detrimental for the individual puppy.

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Section: Discussionmentioning

confidence: 99%

Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check

Staveren

Szatmári

2020

Acta Vet Scand

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“…Previous study on primary physicians or general practioners' skills on pediatric cardiac auscultation showed low performances independent of training levels. 17 Therefore, possibilities of under or over diagnoses of heart murmurs could have happened during primary screening. Additional trainings on heart auscultation prior to primary screening for primary health care doctors who would perform the heart murmur examinations are needed to improve their performance.…”

Section: Discussionmentioning

confidence: 99%

Rationale and Study Design: The Screening of Congenital Heart Disease by Cardiac Auscultation and 12-Leads Electrocardiograph Examination in First-grade Elementary School Children in Province of Yogyakarta, Indonesia

Dinarti

Hartopo

Murni

et al. 2019

Preprint

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Background Congenital heart diseases (CHD) cause declining of functional capacity, cyanosis, arrhythmia, stroke, and death in adulthood. The screening for congenital heart disease in children has not been established in Indonesia. This results in a relatively high prevalence of uncorrected CHD in adulthood, who mostly have developed pulmonary artery hypertension. The screening program by cardiac auscultation and electrocardiography (ECG) in schoolchildren has been proven to be feasible in developed countries, which may also be feasible in Indonesia.Aim This study was planned to test and assess CHD screening methods based on electrocardiography examination in school children.Methods We conducted a screening program in first grade elementary school children in the Province of Yogyakarta, Indonesia. The schools were determined by purposive sampling. Trained general practitioners in community health centers participated in the screening. The physical examinations were done, which focused on cardiac auscultation and ECG examination. Those who had abnormal findings underwent trans-thoracic echocardiography to confirm the CHD.Results We collaborated with local governments in recruiting the participating community health centers and elementary schools. A total of 130 elementary schools from 5 districts in Yogyakarta Province were recruited, all without prior information on students’ presentation of symptoms.Conclusions This study is the first screening program that focuses on heart diseases in elementary school students in Indonesia. The success and feasibility of this program will give a valuable impact on preventing CHD complications during adulthood.

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“…Other examples are teaching clinical skills in multimedia systems (e.g. by Germanakis et al [ 32 ]) and conversational characters to teach clinical reasoning (e.g. by Summons et al [ 33 ]).…”

Section: Discussionmentioning

confidence: 99%

Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education

et al. 2015

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BackgroundThe term “virtual patients” (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term “virtual patient” and then classify its use in healthcare education.MethodsA literature review was conducted to determine all articles using the term “virtual patient” in the title or abstract. These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach.Results536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games.Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education.ConclusionsThe main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0296-3) contains supplementary material, which is available to authorized users.

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Skills of primary healthcare physicians in paediatric cardiac auscultation

Abstract: Clinical skills of primary healthcare physicians in paediatric cardiac auscultation, independent of training level or specialty, still leave potential for improvement. Multimedia-based teaching interventions represent an effective means of improving paediatric cardiac auscultatory skills.

Cited by 20 publications

References 30 publications

Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check

Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check

Rationale and Study Design: The Screening of Congenital Heart Disease by Cardiac Auscultation and 12-Leads Electrocardiograph Examination in First-grade Elementary School Children in Province of Yogyakarta, Indonesia

Virtual patients - what are we talking about? A framework to classify the meanings of the term in healthcare education

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