Abstract Body

NAFLD is a global public health issue, which progressively covers a spectrum of liver pathology, including steatosis, steatohepatitis, fibrosis, and cirrhosis, and their incidence increases exponentially. This study aimed to evaluate the diagnostic accuracy of the multiparametric-liver-ultrasonographic-screening with uses of artificial-intelligence performed by family doctors, compared to the evaluation performed by a specialist, at the targeted patients with a high-risk of NAFLD/NASH.

2.Methods

We conducted a multiparametric-liver-ultrasound-screening(MLUS) on 4751patients, with a high-risk of NAFLD/NASH, which presented as inclusion criteria: mixed dyslipidemia, obesity(BMI≥30), type2-diabetes, metabolic-syndrome(NCEP-criteria), chronic-lithiasis-cholecystitis, liver cirrhosis, chronic-hepatitis-B/hepatitis-C. APRI-score was initially calculated to stratify the fibrosis risk.

We use "standard-protocol", which could improve reproducibility and facilitate dynamic comparison, in grayscale, color/power-Doppler-US, and Strain-Elastography in standard-liver-scans as:transverse,oblique,and longitudinal-views. We established the cut-off/median-values(morphometric-ultrasound) of normal-ratios, between the anterior-posterior-diameters of the normal-liver-segments(Couinaud)/lobes, with the kidney/spleen-long-axis(not influenced by fatty-tissue-loading).

The high-risk-patients identified with NAFLD were first examined by a experienced-family-doctor subsequently compared with ultrasound-review by the specialist. We have developed a Smart-Computerized-Diagnostic-Algorithm to NAFLD/NASH-pathology for US-diagnosis by family-physicians. The agreement between family-physicians and specialists on each finding was evaluated using:Cohen’s-kappa-coefficient.

4. Results

We identified 4751-patients with NAFLD/NASH,or cirrhosis and subsequently confirmed by the specialist. The positive-results of this screening were:2592-steatosis, NASH/steatofibrosis-971persons, and 22-cases with Cirrhosis. The accuracy of liver-US-screening by FP was:95,87% with95%CI=95.27%to96.42%,Sensitivity:97,12%,Specificity:91,59%, which were subsequently confirmed by the specialist as the"Gold-Standard"-method through fibroscan. The prevalence of liver-pathology was:77,48% with 95%CI:76,26%at78.66%. Reports of the two groups of specialists for identifying NAFLD/NASH showed a very-good-strength of agreement-k=0.875;95%CI=0.864–0.887,standard-error:0,005.

Conclusions:

The uses of Multiparametric-Liver-Ultrasound-Screening(MLUS), morphometric-US(MUS), and artificial-intelligence(AI), performed by trained-family-physicians are comparable to diagnostic-liver-ultrasonography performed by the gastroenterologist.

Abstract Body

FOCUS is a complement of the clinical exam, for the evaluation of the structural and functional abnormalities of the heart, to the hemodynamic critical patient. Just a few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by family physicians. This study aimed to evaluate the diagnostic accuracy of FOCUS performed by family doctors compared to echocardiography performed by a cardiologist.

Method:
We made FOCUS on the patients which present after clinical-examination the suspicion of cardiac pathology(cardiomegaly,valvulopathy, pericarditis,endocarditis,congenital malformations,aneurysms,and arrhythmias) and used five-standard-cardiac-scans:Subxiphoid-view, Parasternal-long/short axis, Apical-four-chamber-view,and IVC-assessment. We conducted a prospective-observational-cross-sectional-study of 1780 patients with high-cardiovascular-risk. High-risk-patients identified on inclusion-criteria, were first examined by a family-doctor with expertise, subsequently compared with ultrasound review by cardiologists, to determine the accuracy of this application. We have developed a Computerized-Diagnostic-Algorithm of the cardiac-pathology detected by non-cardiologists. The agreement between family-physicians and cardiologists on each finding, was evaluated using Cohen’s kappa coefficient with 95%CI.

Results:
We identified 585 patients with cardiac-pathology and subsequently confirmed by the cardiologist. We did the descriptive-statistical-analysis of the echocardiographic-cases detected. The accuracy of FOCUS-screening in primary care, was 96.07% with a sensitivity:95.12% and specificity:96.57%,p<0.001, for all 1780 emergency-patients which were subsequently confirmed by the cardiologist as the"Gold-Standard"method. The prevalence of cardiac-pathology was:34.55% with 95%CI:32.34%at36.81%. Reports of the two-groups for identifying cardiac-pathology showed 95%-agreement(k=0.88;95%CI=0.81–0.95),standard-error:0,037.

Conclusions:
FOCUS performed by trained-family-physicians is comparable to echocardiography performed by cardiologists. It could be a reliable tool and screening-test for the initial diagnosis of patients suspected of cardiac-abnormalities and we propose as a complementary-diagnostic tool followed by referral to the cardiologist.

Abstract Body

NAFLD is a global public health issue, which progressively covers a spectrum of liver pathology, including steatosis, steatohepatitis, fibrosis, and cirrhosis, and their incidence increases exponentially. This study aimed to evaluate the diagnostic accuracy of the multiparametric-liver-ultrasonographic-screening with uses of artificial-intelligence performed by family doctors, compared to the evaluation performed by a specialist, at the targeted patients with a high-risk of NAFLD/NASH.

2.Methods

We conducted a multiparametric-liver-ultrasound-screening(MLUS) on 4751patients, with a high-risk of NAFLD/NASH, which presented as inclusion criteria: mixed dyslipidemia, obesity(BMI≥30), type2-diabetes, metabolic-syndrome(NCEP-criteria), chronic-lithiasis-cholecystitis, liver cirrhosis, chronic-hepatitis-B/hepatitis-C. APRI-score was initially calculated to stratify the fibrosis risk.

We use "standard-protocol", which could improve reproducibility and facilitate dynamic comparison, in grayscale, color/power-Doppler-US, and Strain-Elastography in standard-liver-scans as:transverse,oblique,and longitudinal-views. We established the cut-off/median-values(morphometric-ultrasound) of normal-ratios, between the anterior-posterior-diameters of the normal-liver-segments(Couinaud)/lobes, with the kidney/spleen-long-axis(not influenced by fatty-tissue-loading).

The high-risk-patients identified with NAFLD were first examined by a experienced-family-doctor subsequently compared with ultrasound-review by the specialist. We have developed a Smart-Computerized-Diagnostic-Algorithm to NAFLD/NASH-pathology for US-diagnosis by family-physicians. The agreement between family-physicians and specialists on each finding was evaluated using:Cohen’s-kappa-coefficient.

4. Results

We identified 4751-patients with NAFLD/NASH,or cirrhosis and subsequently confirmed by the specialist. The positive-results of this screening were:2592-steatosis, NASH/steatofibrosis-971persons, and 22-cases with Cirrhosis. The accuracy of liver-US-screening by FP was:95,87% with95%CI=95.27%to96.42%,Sensitivity:97,12%,Specificity:91,59%, which were subsequently confirmed by the specialist as the"Gold-Standard"-method through fibroscan. The prevalence of liver-pathology was:77,48% with 95%CI:76,26%at78.66%. Reports of the two groups of specialists for identifying NAFLD/NASH showed a very-good-strength of agreement-k=0.875;95%CI=0.864–0.887,standard-error:0,005.

Conclusions:

The uses of Multiparametric-Liver-Ultrasound-Screening(MLUS), morphometric-US(MUS), and artificial-intelligence(AI), performed by trained-family-physicians are comparable to diagnostic-liver-ultrasonography performed by the gastroenterologist.

Abstract Body

FOCUS is a complement of the clinical exam, for the evaluation of the structural and functional abnormalities of the heart, to the hemodynamic critical patient. Just a few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by family physicians. This study aimed to evaluate the diagnostic accuracy of FOCUS performed by family doctors compared to echocardiography performed by a cardiologist.

Method:
We made FOCUS on the patients which present after clinical-examination the suspicion of cardiac pathology(cardiomegaly,valvulopathy, pericarditis,endocarditis,congenital malformations,aneurysms,and arrhythmias) and used five-standard-cardiac-scans:Subxiphoid-view, Parasternal-long/short axis, Apical-four-chamber-view,and IVC-assessment. We conducted a prospective-observational-cross-sectional-study of 1780 patients with high-cardiovascular-risk. High-risk-patients identified on inclusion-criteria, were first examined by a family-doctor with expertise, subsequently compared with ultrasound review by cardiologists, to determine the accuracy of this application. We have developed a Computerized-Diagnostic-Algorithm of the cardiac-pathology detected by non-cardiologists. The agreement between family-physicians and cardiologists on each finding, was evaluated using Cohen’s kappa coefficient with 95%CI.

Results:
We identified 585 patients with cardiac-pathology and subsequently confirmed by the cardiologist. We did the descriptive-statistical-analysis of the echocardiographic-cases detected. The accuracy of FOCUS-screening in primary care, was 96.07% with a sensitivity:95.12% and specificity:96.57%,p<0.001, for all 1780 emergency-patients which were subsequently confirmed by the cardiologist as the"Gold-Standard"method. The prevalence of cardiac-pathology was:34.55% with 95%CI:32.34%at36.81%. Reports of the two-groups for identifying cardiac-pathology showed 95%-agreement(k=0.88;95%CI=0.81–0.95),standard-error:0,037.

Conclusions:
FOCUS performed by trained-family-physicians is comparable to echocardiography performed by cardiologists. It could be a reliable tool and screening-test for the initial diagnosis of patients suspected of cardiac-abnormalities and we propose as a complementary-diagnostic tool followed by referral to the cardiologist.