Cultura

Construction of an Assessment Instrument for the Diagnostic Competence of Deep Vein Thrombosis Using Doppler Ultrasound

VOLUME 22, 2025

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

María Fernanda Fernández Rodríguez, Marina Rugerio Ramos, Raúl Hernández Ordoñez, Luz Karina Ramírez Dueñas, Miriam Cabrera Jiménez, Santiago Oscar Pazarán Zanella, Roberto Silva Casiano

Abstract

Deep Vein Thrombosis (DVT) is one of the leading causes of cardiovascular death. Doppler ultrasound is the gold standard for diagnosis, but it has limitations due to its dependence on the skills of the imaging specialist. Radiologists in training need to develop cognitive, procedural, and attitudinal competencies. Therefore, it is imperative to have an instrument that objectively assesses the degree of diagnostic competence according to skill development. This descriptive, observational, longitudinal study focused on constructing an ad hoc rubric through a literature review. A pilot study was conducted to assess apparent validity, content validity, and interobserver agreement. A judging round was carried out for data analysis, and the modified Hernández-Nieto test was applied for quantitative content validation. Interobserver agreement was performed using Fleiss's kappa with the statistical program DATAtab. A rubric consisting of seven dimensions and four levels of execution was designed to evaluate the diagnostic competence of DVT by Doppler ultrasound. Appearance validation was performed using the Delphi method until the construct was unified. According to Hernández-Nieto, the content validity is excellent at 0.94, and the inter-observer agreement is good at 0. The evaluation instrument for diagnosing deep vein thrombosis using Doppler ultrasound is valid enough to be used with physicians in training. This allows for routine use in imaging education.

Keywords : Diagnostic competence, assessment instrument, deep vein thrombosis, Doppler ultrasound..
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty