title: Feasibility of a standardized ultrasound examination in patients with rheumatoid arthritis: a quality improvement among rheumatologists cohort.
abstract: BACKGROUND
  Quality improvement is important to facilitate valid patient outcomes. Standardized examination procedures may improve the validity of US.The aim of this study was to investigate the learning progress for rheumatologists during training of US examination of the hand in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Rheumatologists with varying degrees of experience in US were instructed by skilled tutors. The program consisted of two days with hands-on training followed by personal US examinations performed in their individual clinics. Examinations were sent to the tutors for quality control. The US examinations were evaluated according to a scoring sheet containing 144 items. An acceptable examination was defined as > 80% correct scores.
  
  
  RESULTS
  Thirteen rheumatologists participated in the study. They included a total of 104 patients with RA. Only few of the initial examinations were scored below 80%, and as experience increased, the scores improved (p = 0.0004). A few participants displayed decreasing scores.The mean time spent performing the standardized examination procedure decreased from 34 min to less than 10 minutes (p = 0.0001).
  
  
  CONCLUSIONS
  With systematic hands-on training, a rheumatologist can achieve a high level of proficiency in the conduction of US examinations of the joints of the hand in patients with RA. With experience, examination time decreases, while the level of correctness is maintained. The results indicate that US may be applied as a valid measurement tool suitable for clinical practice and in both single- and multi-centre trials.
authors.affiliation: The Parker Institute, Copenhagen University Hospital, Denmark. parker@frh.regionh.dk
authors.forename: Karen
authors.initials: K
authors.lastname: Ellegaard
authors.forename: Søren
authors.initials: S
authors.lastname: Torp-Pedersen
authors.forename: Robin
authors.initials: R
authors.lastname: Christensen
authors.forename: Michael
authors.initials: M
authors.lastname: Stoltenberg
authors.forename: Annette
authors.initials: A
authors.lastname: Hansen
authors.forename: Tove
authors.initials: T
authors.lastname: Lorenzen
authors.forename: Dorthe V
authors.initials: DV
authors.lastname: Jensen
authors.forename: Hanne
authors.initials: H
authors.lastname: Lindegaard
authors.forename: Lars
authors.initials: L
authors.lastname: Juul
authors.forename: Henrik
authors.initials: H
authors.lastname: Røgind
authors.forename: Per
authors.initials: P
authors.lastname: Bülow
authors.forename: Stavros
authors.initials: S
authors.lastname: Chrysidis
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsoe
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002983:Clinical Competence / Q000592:standards*; D004493:Education; D005240:Feasibility Studies; D006801:Humans; D007858:Learning; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008875:Middle Aged; D058996:Quality Improvement; D012219:Rheumatology / Q000193:education / Q000592:standards*; D013585:Synovitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013997:Time Factors; D018608:Ultrasonography, Doppler / Q000592:standards*; D014955:Wrist Joint / Q000000981:diagnostic imaging; D055815:Young Adult