Abstractobjectives To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low-and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.methods The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.results A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).conclusions Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

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In an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24-h mortality and a number of patient care interventions.

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Long-term ultrasound knowledge and skill retention was high after a brief and intensive training intervention at an academic tertiary hospital in Ghana. Clinicians reported improvements in patient care and local practice patterns.

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Cluster EC ClearAsMud and cluster EA4 Kauala are lytic Siphoviridae bacteriophages that were isolated from soil in southern California using Microbacterium foliorum NRRL B-24224 as the host. The ClearAsMud and Kauala genomes are 52,987 bp and 39,378 bp, respectively, and contain 92 and 56 predicted protein-coding genes, respectively.

Study Objectives: Emergency point-of-care ultrasound (POCUS) performed by non-physician out-of-hospital providers has shown promise in limited applications but is not widely utilized. No studies have examined the use of critical care ultrasound (US) by non-physician out-of-hospital providers in the out-of-hospital setting. Our objective was to evaluate whether critical care US performed by out-of-hospital providers can clarify the cause of symptoms or change management.Methods: Twenty aeromedical flight nurses completed a didactic and hands-on US curriculum focusing on critical care applications (cardiac, pulmonary, inferior vena cava, Focused Assessment with Sonography in Trauma [FAST]). To assess competency, all providers subsequently passed an objective structured US exam. Portable ultrasound devices (SonoSite iVIZ) were used during patient transports from both scene activations and referring hospitals when deemed clinically indicated by the provider. Post-transport surveys rated provider confidence on a 5-point Likert scale in initial assessment of patient cardiac function, intravascular volume status, cause of hypotension, and cause of respiratory distress when applicable. If US was performed, providers rated if US clarified the cause of symptoms or changed management on a 5-point Likert scale. Associations were evaluated with between-groups t-tests and contingency table analysis.Results: Providers completed 829 surveys over 14 months and reported US use during 102 (12.3%) patient transports. Of the transports in which US was used, ICU to ICU (58.8%) was the most frequent, followed by ED to ED (28.4%), ED to ICU (4.9%) and scene to ED (2.9%). Providers agreed or strongly agreed that US use clarified the cause of patient symptoms in 67.4% and changed management in 36.4% of transports. Transports in which US was used were more likely to involve a critically ill patient (92%) than flights in which US was not used (73%) (p < 0.001). Providers were significantly more likely to use US when less confident in initial assessment of patient cardiac function, intravascular volume status, and cause of respiratory distress (p < 0.05).Conclusions: Non-physician out-of-hospital providers can learn and perform critical care US. Non-physician performed US can clarify the cause of patient symptoms and change management in the out-of-hospital setting.