scholarly journals Demonstration of a Longitudinal Action Medical Mission (LAMM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings

2020 ◽  
Author(s):  
Michael Steven Yao ◽  
Lauren Uhr ◽  
George Daghlian ◽  
Junedh M Amrute ◽  
Ramya Deshpande ◽  
...  
Keyword(s):  
Point Of Care ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
The United States ◽  
Point Of Care Ultrasound ◽  
Post Intervention ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Medical Education And Training ◽  
Medical Volunteerism

BACKGROUND: Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. OBJECTIVE: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. DESIGN: A retrospective study of such a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments. RESULTS: Post-intervention, a significant improvement was observed (p < 0.0001), and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested. CONCLUSION: Our results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

scholarly journals Demonstration of a Longitudinal Medical Education Model (LMEM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings

POCUS Journal ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 20-25
Author(s):  
Michael Yao ◽  
Lauren Uhr ◽  
George Daghlian ◽  
Junedh M. Amrute ◽  
Ramya Deshpande ◽  
...  
Keyword(s):  
Medical Education ◽  
Clinical Examination ◽  
Point Of Care ◽  
Healthcare Delivery ◽  
The United States ◽  
Objective Structured Clinical Examination ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Medical Education And Training

Background: Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. Objective: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. Design: A retrospective study of a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments. Results: Post-intervention, a significant improvement in POCUS competency was observed across six different fundamental areas of ultrasound (p < 0.0001). According to our objective structured clinical examination (OSCE), the mean assessment score increased from 0.47 to 1.68 out of a maximum score of 2 points, and each trainee showed significant overall improvement in POCUS competency independent of the initial competency pre-training (p < 0.005). There was a statistically significant improvement in POCUS application for five of the six medically relevant assessment categories tested. Conclusion: Our results provide a proof-of-concept for the longitudinal education-centered healthcare delivery framework in a resource-limited setting. Our longitudinal model provides local healthcare providers the skills to detect and diagnose significant pathologies, thereby reducing avoidable morbidity and mortality at little or no addition cost or risk to the patient. Furthermore, training local physicians obviates the need for frequent volunteering trips, saving costs in healthcare training and delivery.

Point of care ultrasound for sepsis management in resource-limited settings: response to Via et al.

2012 ◽  
Vol 38 (8) ◽  
pp. 1408-1409
Author(s):  
Martin W. Dünser ◽  
◽  
Emir Festic ◽  
Arjen Dondorp ◽  
Niranjan Kissoon ◽  
...  
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Sepsis Management ◽  
Resource Limited

scholarly journals Point-of-care Ultrasound Diagnosis of Pulmonary Hydatid Cyst Disease Causing Shock: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 403-406
Author(s):  
Alexandra Hill ◽  
Marco Guillén ◽  
David Martin ◽  
Andrea Dreyfuss
Keyword(s):  
Case Report ◽  
Hydatid Cyst ◽  
Surgical Intervention ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Diagnostic Studies ◽  
Resource Limited ◽  
Pulmonary Hydatid Cyst ◽  
Time Critical

Introduction: Point-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock. Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings. Case Report: We discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention. Conclusion: In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.

scholarly journals Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

Biosensors ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 133
Author(s):  
Benjamin Heidt ◽  
Williane Siqueira ◽  
Kasper Eersels ◽  
Hanne Diliën ◽  
Bart van Grinsven ◽  
...  
Keyword(s):  
Low Income ◽  
Value Chain ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Low Income Countries ◽  
Patient Treatment ◽  
Resource Limited Settings ◽  
Widespread Application ◽  
Resource Limited ◽  
Fundamental Research

Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

Point-of-Care Ultrasound: A Useful Diagnostic Tool in Africa

Praxis ◽  
2020 ◽  
Vol 109 (8) ◽  
pp. 608-614
Author(s):  
Omary Ngome ◽  
Martin Rohacek
Keyword(s):  
Point Of Care ◽  
Clinical Work ◽  
Traumatic Shock ◽  
Clinical Findings ◽  
Diagnostic Tools ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
The Impact ◽  
Work Up

Abstract. In resource limited settings with limited tests and diagnostic tools, most of diagnoses are based on clinical findings, and patients are managed empirically, e.g. with anti-tuberculosis drugs. This article aims at describing the use of point-of-care ultrasound in diagnosing the most important conditions in Africa, in addition to clinical work-up. Different protocols exist for the diagnosis of trauma-related disorders, tuberculosis, schistosomiasis, thromboembolism, causes of dyspnea, and non- traumatic shock. Point-of-care ultrasound might be a beneficial tool in Africa, aiding diagnostics and management of patients with these conditions. However, studies must be done to assess the impact of point-of-care ultrasound on mortality.

Point-of-Care Ultrasound in Resource-Limited Settings: Common Applications

2018 ◽  
Vol 111 (7) ◽  
pp. 424-433 ◽  
Author(s):  
Matthew Fentress ◽  
Thomas F. Heyne ◽  
Keith R. Barron ◽  
Neil Jayasekera
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Resource Limited

Ultrasound application in point of care by palliative medicine physicians: Initial experience of oncology palliative medicine consultation in two rural area hospitals in Costa Rica.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 254-254
Author(s):  
Karol Villalobos
Keyword(s):  
Costa Rica ◽  
Rural Areas ◽  
Palliative Medicine ◽  
Point Of Care ◽  
Limited Resources ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Portable Ultrasound ◽  
Resource Limited ◽  
Point Of Care Ultrasonography

254 Background: Point of care Ultrasonography (POCUS)—that is ultrasonography performed and interpreted by the clinician at the bedside—is a method of clinical focused evaluation assisted by ultrasound equipment which gives the health provider in limited resources conditions, a prompt and accurate diagnosis for a limited number of pathologies. Development of portable ultrasound equipment with accessible technologies in terms of health investment, allows developing such practice in non-conventional resource-limited settings as patient homes. Our proposal is to show point of care ultrasonography (POCUS) experiences by two Palliative Care specialist doctors with in government-managed Social Security service (CCSS) in rural areas in Costa Rica. Methods: Limited diagnosis examinations were performed both at the hospital as well as at out of hospital sites in rural areas of Turrialba, and San Carlos, Costa Rica. Percutaneous procedures took place at the hospital following monitoring and aseptic standards, using two different units (Contec CMS600P2B, Phillips Clearvue 550). Results: Each brief case presented in this article shows effective Point of Care Ultrasound uses for patients with life-limiting conditions in resource-limited settings. Use of this technology by palliative medicine specialists in these cases helped patients and their families by accelerating right diagnosis, limiting unnecessary hospital transportation or by helping making safer procedures. Conclusions: Point of care ultrasound usage by palliative medicine specialists is an innovation breaking paradigms that has shown in our case to be a successful help as an evaluation strategy in a limited-resources rural environment, with a frail population.

scholarly journals Stakeholder Perceptions of Point-of-Care Ultrasound Implementation in Resource-Limited Settings

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 153 ◽  
Author(s):  
Anna Maw ◽  
Brittany Galvin ◽  
Ricardo Henri ◽  
Micheal Yao ◽  
Bruno Exame ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Structured Interviews ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Point Of Care Diagnostics ◽  
Key Stakeholders ◽  
Imaging Point ◽  
Study Participants

Background: Nearly half of the world lacks access to diagnostic imaging. Point of care ultrasound (POCUS) is a versatile and relatively affordable imaging modality that offers promise as a means of bridging the radiology gap and improving care in low resource settings. Methods: We performed semi-structured interviews of key stakeholders at two diverse hospitals where POCUS implementation programs had recently been conducted: one in a rural private hospital in Haiti and the other in a public referral hospital in Malawi. Questions regarding the clinical utility of POCUS, as well as barriers and facilitators of its implementation, were asked of study participants. Using the Framework Method, analysis of interview transcripts was guided by the WHO ASSURED criteria for point of care diagnostics. Results: Fifteen stakeholders with diverse roles in POCUS implementation were interviewed. Interviewees from both sites considered POCUS a valuable diagnostic tool that improved clinical decisions. They perceived barriers to adequate training as one of the most important remaining barriers to POCUS implementation. Conclusions: In spite of the increasing affordability and portability of ultrasounds devices, there are still important barriers to the implementation of POCUS in resource-limited settings.

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