Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

CONTEXT

Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored.

OBJECTIVE

The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions.

METHOD

We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training.

RESULTS

11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of "7-9" ratings) and 19 skills with a relative agreement (100% of "5-9" ratings).

CONCLUSION

These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.

Regional specificity of age effects on the neural correlates of episodic retrieval

We investigated age-related differences in episodic retrieval using a source memory procedure. Age-related differences in retrieval-related activity were analyzed in conditions where source recollection performance was statistically equivalent in young and older subjects. Analyses of BOLD activity revealed a network of regions where recollection effects were equivalent in magnitude in the two age groups. There were no regions where these effects were of greater magnitude in young than in older subjects. In some regions, however, there was a crossover interaction, such that retrieval-related effects reversed in direction between the two age groups. Further analyses of these interactions revealed a dissociation between a posterior hippocampal region where recollection-related activity was confined to the older group, and right fusiform and occipital regions where, in the young group only, activity elicited by studied items was of lower magnitude than activity to new items. We interpret the first of these age-related effects as an example of 'over-recruitment' in response to decline in neural efficiency, and discuss whether the second effect indexes an age-related decline in repetition priming.