Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals

Henwood, Patricia C.; MacKenzie, David; Liteplo, Andrew S.; Rempell, Joshua S.; Murray, Alice F.; Leo, Megan; Dukundane, Damas; Dean, Anthony J.; Rulisa, Stephen; Noble, Vicki E.

doi:10.7863/ultra.16.05073

Cited by 46 publications

(58 citation statements)

References 14 publications

(15 reference statements)

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“…POCUS is becoming standard of care for diagnostic and therapeutic interventions in a variety of clinical settings in highly developed medical systems (Bellamkonda et al 2015;Dietrich et al 2017;McLario and Sivitz 2015;Moore and Copel 2011). In recent years there has been an increasing effort to integrate POCUS into clinical care provided in resource-limited settings (Becker et al 2017;B elard et al 2018;Epstein et al 2018;Henwood et al 2017;Stanley et al 2017;Vinayak 2017;Vinayak and Brownie 2018;Zaver et al 2018). These efforts include initiatives to improve the relevance of ultrasound training programs enabling clinicians with a point-of care imaging modality.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Shokoohi

Raymond

Fleming

et al. 2019

Ultrasound in Medicine & Biology

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Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013À2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second-and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings. (

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Section: Introductionmentioning

confidence: 99%

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Shokoohi

Raymond

Fleming

et al. 2019

Ultrasound in Medicine & Biology

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“…Recently, a study in Kenya demonstrated the utility of a focused cardiac protocol applied in patient care by clinical officers [54]. Henwood et al also demonstrated that a longitudinal ultrasound training program could detect basic cardiac abnormalities with high sensitivity and specificity when compared to experienced sonographer interpretation [55]. These studies suggest that implementation of a focused CURLS protocol is feasible.…”

Section: Discussionmentioning

confidence: 99%

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

et al. 2019

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Background: Point-of-care ultrasound is increasingly being used as a diagnostic tool in resource-limited settings. The majority of existing ultrasound protocols have been developed and implemented in high-resource settings. In sub-Saharan Africa (SSA), patients with heart failure of various etiologies commonly present late in the disease process, with a similar syndrome of dyspnea, edema and cardiomegaly on chest X-ray. The causes of heart failure in SSA differ from those in high-resource settings. Point-of-care ultrasound has the potential to identify the underlying etiology of heart failure, and lead to targeted therapy. Based on a literature review and weighted score of disease prevalence, diagnostic impact and difficulty in performing the ultrasound, we propose a context-specific cardiac ultrasound protocol to help differentiate patients presenting with heart failure in SSA. Results: Pericardial effusion, dilated cardiomyopathy, cor pulmonale, mitral valve disease, and left ventricular hypertrophy were identified as target conditions for a focused ultrasound protocol in patients with cardiac failure and cardiomegaly in SSA. By utilizing a simplified 5-question approach with all images obtained from the subxiphoid view, the protocol is suitable for use by health care professionals with limited ultrasound experience. Conclusions: The "Cardiac ultrasound for resource-limited settings (CURLS)" protocol is a context-specific algorithm designed to aid the clinician in diagnosing the five most clinically relevant etiologies of heart failure and cardiomegaly in SSA. The protocol has the potential to influence treatment decisions in patients who present with clinical signs of heart failure in resource-limited settings outside of the traditional referral institutions.

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“…The ability to provide US imaging in resource‐limited environments can provide a unique perspective to medical providers and vastly improve their access to critical information for the medical decision‐making process . Ultrasound in developing countries has proved to be effective in obstetrics, trauma, cardiac and surgical emergencies, and procedural guidance, coupled with the fact that medical professionals have been successful in implementing programs in developing countries to train providers with limited medical training to conduct US scans . Perhaps with the introduction of DL models, these capabilities can be expanded even further.…”

Section: Deep‐learning Applications In Pocus Practicesmentioning

confidence: 99%

Enhanced Point‐of‐Care Ultrasound Applications by Integrating Automated Feature‐Learning Systems Using Deep Learning

Shokoohi

LeSaux

Roohani

et al. 2018

J of Ultrasound Medicine

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Recent applications of artificial intelligence (AI) and deep learning (DL) in health care include enhanced diagnostic imaging modalities to support clinical decisions and improve patients' outcomes. Focused on using automated DLbased systems to improve point-of-care ultrasound (POCUS), we look at DL-based automation as a key field in expanding and improving POCUS applications in various clinical settings. A promising additional value would be the ability to automate training model selections for teaching POCUS to medical trainees and novice sonologists. The diversity of POCUS applications and ultrasound equipment, each requiring specialized AI models and domain expertise, limits the use of DL as a generic solution. In this article, we highlight the most advanced potential applications of AI in POCUS tailored to high-yield models in automated image interpretations, with the premise of improving the accuracy and efficacy of POCUS scans.

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Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals

Abstract: A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.

Cited by 46 publications

References 14 publications

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

Enhanced Point‐of‐Care Ultrasound Applications by Integrating Automated Feature‐Learning Systems Using Deep Learning

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