Focused Cardiac Ultrasound by Nurses in Rural Vietnam

Task shifting for point of care ultrasound in primary healthcare in low- and middle-income countries-a systematic review

“… 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 Thirty-five studies were prospective observational studies and one randomized controlled trial. 30 The majority of the included publications ( n = 20) were conducted on the African continent, 21 , 22 , 31 , 32 , 33 , 34 , 35 , 37 , 39 , 40 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 51 , 52 , 53 nine studies originated from the Americas, 24 , 27 , 29 , 38 , 41 , 45 , 54 , 55 , 56 two from Asia, 26 , 36 and three from Oceania 23 , 28 , 57 as shown in Figure 2…”

“…Ten publications reported on task shifting for POCUS in obstetric care, examining pregnancy and pregnancy related complications. 24 , 25 , 26 , 30 , 31 , 34 , 35 , 43 , 46 , 47 Nine and three publications reported on task shifting for chest POCUS for cardiac and pulmonary conditions respectively, including rheumatic heart disease screening, diagnosing cardiac structural anomalies, aneurysms and deep vein thrombosis, 23 , 28 , 30 , 36 , 38 , 39 , 45 , 55 , 57 , 58 and lung examinations to diagnose conditions such as pneumonia, tuberculosis, pleural effusion and atelectasia. 29 , 53 , 59 Further reported task shifting for POCUS applications included abdominopelvic examination for liver, gallbladder diseases, and kidney diseases, prostate hypertrophy and urinary tract infection, 21 , 32 , 41 , 42 , 44 , 54 breast and axillary examination for breast cancer screening, 40 , 56 examination in trauma patients for pneumothorax and internal haemorrhage, 48 examination for HIV associated tuberculosis, 33 and screening for abdominal cystic echinococcosis.…”

“…Identification of cardiac pathological 21 , 36 , 44 , 45 : e. g., mitral regurgitation, structural cardiac abnormality, heart failure, abdominal aortic aneurism, pericardial effusion, right ventricular dilation, vegetation, HIV associated cardiomyopathy…”

“… Kimberly et al 2010 35 Zambia/ Rural health centres and provincial hospital Midwives Sonosite 180; Sonosite Inc., Bothell, WA, USA Didactics courses, hands-on instruction, supervised scanning 3 weeks Change in clinical decision-making in 17% (74/441) examinations Heavy workload impeding integration of POCUS in daily care Difficulty in learning skills Absence of supervision Greenwold et al 2014 31 Mozambique/ Rural Health centres Nurse, Clinical officer 2 M-Turbo (Sonosite, Bothell, WA, USA) Lectures, hands-on training 8 weeks Identification of high-risk pregnancies and uterine fibroids in 23.5% (407/1734) leading to a change in management Referral of 3.6% (62/1734) women to district hospital Primary caesarean section in 1% (21/1734) None reported Swanson et al 2014 46 Uganda/ Rural health centres Midwives GE Logiq E ultrasounds (GE Healthcare Clinical Systems, Wauwatosa, WI, USA) Lectures, small-group tutorials, audio-visual material, supervised scanning 6 weeks Change in diagnosis in 11% (100/939) 18/25 patients referred based on POCUS findings were confirmed with pathology None reported Kawooya et al 2015 36 Uganda/ Rural health centres Midwives LOGIQe ultrasounds (GE Healthcare Clinical Systems, Wauwatosa, WI, USA) Lectures, small group tutorials, audio-visual materials, supervised scanning 3 months Increased utilization of and adherence to ANC services Increase in facility-based deliveries and obstetric referrals None reported Crispín Milart et al 2016 24 Guatemala/ Rural communities Nurse Laptop and USB ultrasound probe Theoretical lessons, supervised practical sessions with pregnant women 1 week No maternal mortality in intervention group compared to 5 maternal mortalities in control group 64 % reduction in neonatal mortality in intervention group Non-urgent referral recommended in 9.2% Training is demanding and requires regular reinforcement Viinayak et al 2017 47 Kenya/ Rural clinics Midwives Tablet-sized ultrasound scanner VISIQ (Philips Ultrasound, Inc., Bothell, WA, USA) Daily lectures, daily hands-on work 4 weeks Correct identif...…”

Utility of expert focused cardiac ultrasound in paediatric cardiology outreach clinics

“…Prior studies have demonstrated the utility of FCU in regions with inadequate resources performed by healthcare providers, including nurses, medical students, and physicians, with varying levels of education. [12][13][14] Riley et al evaluated FCU in outpatient paediatric clinics and found that it was successful for making decisions in 79% of patients where the majority of the inadequate studies were due to insufficient colour Doppler or lack of spectral Doppler ability. 7 Others have also highlighted that the most significant limitation of FCU was the lack of spectral Doppler.…”