Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting

Abstract

We designed a pilot study of a training module for nurses to perform rheumatic heart disease echocardiography screening in a resource-poor setting. The aim was to determine whether nurses given brief, focused, basic training in echocardiography could follow an algorithm to potentially identify cases of rheumatic heart disease requiring clinical referral, by undertaking basic two-dimensional and colour Doppler scans. Training consisted of a week-long workshop, followed by 2 weeks of supervised field experience. The nurses' skills were tested on a blinded cohort of 50 children, and the results were compared for sensitivity and specificity against echocardiography undertaken by an expert, using standardised echocardiography definitions for definite and probable rheumatic heart disease. Analysis of the two nurses' results revealed that when a mitral regurgitant jet length of 1.5 cm was used as the trigger for rheumatic heart disease identification, they had a sensitivity of 100% and 83%, respectively, and a specificity of 67.4% and 79%, respectively. This pilot supports the principle that nurses, given brief focused training and supervised field experience, can follow an algorithm to undertake rheumatic heart disease echocardiography in a developing country setting to facilitate clinical referral with reasonable accuracy. These results warrant further research, with a view to developing a module to guide rheumatic heart disease echocardiographic screening by nurses within the existing public health infrastructure in high-prevalence, resource-poor regions.

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

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Echocardiographic Screening for Rheumatic Heart Disease in High and Low Risk Australian Children

“…23,[29][30][31] Simplified screening protocols have been proposed, such as the single criterion of a mitral regurgitant jet of ≥2 cm seen in any plane. 23 Applied to our high-risk cohort, this criterion would have a sensitivity of 63.0% and a positive predictive value of 73.3% for definite and borderline RHD, with a specificity and negative predictive value of >99%.…”

Implementing the Tri-Council Policy on Ethical Research Involving Indigenous Peoples in Canada: So, How’s That Going in Mi’kma’ki?

“…By recognizing the need for this relational ethic, research collaborations that result from these relationships can help to support capacity building, generate new research questions, and broaden understanding and knowledge for all involved (Colquhoun et al, 2013). Moreover, well-established research partnerships can result in research that helps to eliminate health disparities that may exist in the communities, as partnerships can both facilitate the use of culturally relevant research designs and methodologies, and be more responsive to the concerns of the community (Cochran et al, 2008).…”

“…These guidelines were widely regarded for both their rigor and the collaborative approach taken in their development. At the time, health researchers were becoming increasingly aware that research collaborations were necessary to enhance the impact of research on public health (Colquhoun et al, 2013). There was also a growing awareness among some researchers of a need to be supportive of Indigenous communities' desire to take control of research that was affecting them (Patterson, Jackson, & Edwards, 2006) and to respect the cultural norms and ethical obligations of knowledge sharing, such as gifts or honoraria for Elders or knowledge holders who participated in research (Brant Castellano, 2004;Castleden et al, 2012).…”