The 3D-Transit system now allows detailed description of colonic motility and our results are supported by those previously suggested by manometry. It holds promise for future assessment of movement patterns to characterize different diseases and effects of treatment.

Aims We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs. Methods and results During 2000–12, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5–3.7, 3.8–4.0, 4.5–4.7, 4.8–5.0, and >5.0 mmol/L (reference: 4.1–4.4 mmol/L) was assessed using multivariable Cox regression. In total, 14 425 AF patients were included (median age: 78 years; women: 52%). Patients most often received beta-blocker monotherapy (29%), beta-blockers and digoxin combined (25%), digoxin monotherapy (24%), amiodarone monotherapy (3%), and verapamil monotherapy (3%). Increased 90-day mortality risk was associated with <3.5 mmol/L [hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.68–2.50], 3.5–3.7 mmol/L (HR 1.28, 95% CI 1.05–1.57), 4.5–4.7 mmol/L (HR 1.20, 95% CI 1.02–1.41), 4.8–5.0 mmol/L (HR 1.37, 95% CI 1.14–1.66), and >5.0 mmol/L: (HR 1.84, 95% CI 1.53–2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk. Conclusion In addition to hypo- and hyperkalaemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.

Background Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). Aim To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. Design and setting Qualitative study conducted in office-based general practice in Denmark. Methods Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. Results The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. Conclusion This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills. Key points Little is known about the educational needs of general practitioners striving to achieve ultrasound competences. General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills. Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.