Gargani Luna, Sicari Rosa, Raciti Mauro, Serasini Luca, Passera Mirko, Torino Claudia, Letachowicz Krzysztof, Ekart Robert, Fliser Danilo, Covic Adrian, Balafa Olga, Stavroulopoulos Aristeidis, Massy Ziad A, Fiaccadori Enrico, Caiazza Alberto, Bachelet Thomas, Slotki Itzchak, Shavit Linda, Martinez-Castelao Alberto, Coudert-Krier Marie-Jeanne, Rossignol Patrick, Kraemer Thomas Daniel, Hannedouche Thierry, Panichi Vincenzo, Wiecek Andrzej, Pontoriero Giuseppe, Sarafidis Pantelis, Klinger Marian, Hojs Radovan, Seiler-Mußler Sarah, Lizzi Fabio, Onofriescu Mihai, Zarzoulas Fotis, Tripepi Rocco, Mallamaci Francesca, Tripepi Giovanni, Picano Eugenio, London Gérard Michel, Zoccali Carmine
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Nephrol Dial Transplant. 2016 Dec;31(12):1982-1988. doi: 10.1093/ndt/gfw329. Epub 2016 Sep 26.
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.
在“LUST试验”（超声引导下肺部积水治疗预防高危终末期肾病患者死亡和心血管事件）的框架内，欧洲肾脏协会 - 欧洲透析移植协会的欧洲肾脏与心血管医学（EURECA - m）工作组设立了一个核心实验室，旨在培训和认证参与该试验的肾病学家和心脏病学家。所有参与者都通过一个完全基于网络的项目由专家培训师进行培训。30名肾病学家和14名心脏病学家成功完成了培训。培训结束时，向学员提供了一组47个肺部超声（US）视频，要求他们估计每个视频中的B线数量。每个学员与专家培训师之间针对这47个视频的整个系列的组内相关系数（ICC）很高（平均0.81±0.21），除了5个案例外，所有案例的ICC均>0.70。经过进一步培训，5名表现不佳的学员与专家培训师达成了令人满意的一致性（再培训后的平均ICC为0.74±0.14）。Bland - Altman图显示几乎没有偏差（均值差异为0.03），并且一致性界限的严格95%范围为（-1.52和1.45条US B线）。只有4个案例有重叠，但未超过相同范围。同样，应用于相同数据系列的Spearman相关系数非常高（r = 0.979，P < 0.0001）。通过一个完全基于网络的项目，可以有效地培训肾病学家和心脏病学家来测量肺充血情况。这个基于网络的培训项目确保了US B线测量的高质量标准化，并且是针对肺充血的临床试验的一个简单、低成本且有效的准备步骤。
