Efficacy of a Standardized Computer-Based Training Curriculum to Teach Echocardiographic Identification of Rheumatic Heart Disease to Nonexpert Users

Beaton, Andrea; Nascimento, Bruno Ramos; Diamantino, Adriana C; Pereira, Gabriel Tensol Rodrigues; Lopes, Eduardo L; Miri, Cassio O; Bruno, Kaciane K; Chequer, Graziela; Ferreira, Camila Gonçalves; Lafeta, Luciana C; Richards, Hedda; Perlman, Lindsay; Webb, Catherine L.; Ribeiro, Antônio Luiz Pinho; Sable, Craig; Nunes, Maria do Carmo Pereira

doi:10.1016/j.amjcard.2016.03.006

Cited by 52 publications

(77 citation statements)

References 17 publications

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“…However, in resource‐limited health systems, like the Brazilian SUS, task shifting has proved to be a crucial tool to improve availability and reduce costs of screening, freeing high‐level personnel for more complex tasks 27. The efficacy of nurses, technicians, and other professionals in performing simplified protocols has been demonstrated, as has their accuracy for identifying positive cases, even in simplified protocols and with limited training 20, 30, 31, 32. Second, individual consents (and not collective consents) are required for any research procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, all consented children were consecutively included, without stratified sampling procedures, increasing the risk of bias associated with differences between groups (eg, higher median age in private schools). Fifth, because follow‐up confirmatory echocardiograms were not considered, prevalence estimates may be biased upward, especially for handheld devices 20. Last, the study was conducted in 2 metropolitan areas of the state of Minas Gerais, and the findings cannot be directly extrapolated to the entire country.…”

Section: Discussionmentioning

confidence: 99%

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

Nascimento

Sable

Nunes

et al. 2018

JAHA

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BackgroundConsidering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.Methods and ResultsThe PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (P=0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (P<0.001). Prevalence was higher in children ≥12 years (5.3% versus 3.1%; P<0.001) and girls (4.9% versus 4.0%; P=0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P<0.001) was independently associated with RHD.Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Nascimento

Sable

Nunes

et al. 2018

JAHA

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“…Second, follow-up confirmatory echos were not yet available for all positive patients, limiting inferences about the agreement with a ‘gold standard’. Although the accuracy of handheld devices compared with regular echocardiography has been demonstrated in other screening strategies,7 prevalence may be biased upwards and more definitive agreement data will be warranted in the near future. Third, participation in some subareas—especially the poorest neighbourhoods—was suboptimal, what may be an additional confounder.…”

Section: Discussionmentioning

confidence: 99%

“…With the development of handheld echocardiography and internet-based telemedicine solutions—both of which have been demonstrated in Brazil7—integration of screening strategies for CVD with the pre-existing public health system may be a future direction for early diagnosis and prioritisation of care in underserved areas.…”

Section: Introductionmentioning

confidence: 99%

Integration of echocardiographic screening by non-physicians with remote reading in primary care

Nascimento

Beaton

Nunes

et al. 2018

Heart

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“…10 Moreover, the educational process has proven to be effective, with a median 20% increase in knowledge about RHD, evaluated through structured pre- and post-tests applied to more than 1,100 school children. 11 …”

Section: Introductionmentioning

confidence: 99%

Challenges for the Implementation of the First Large-Scale Rheumatic Heart Disease Screening Program in Brazil: The PROVAR Study Experience

Santos

Carmo

Beaton

et al. 2017

Arquivos Brasileiros De Cardiologia

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Efficacy of a Standardized Computer-Based Training Curriculum to Teach Echocardiographic Identification of Rheumatic Heart Disease to Nonexpert Users

Cited by 52 publications

References 17 publications

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

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

Integration of echocardiographic screening by non-physicians with remote reading in primary care

Challenges for the Implementation of the First Large-Scale Rheumatic Heart Disease Screening Program in Brazil: The PROVAR Study Experience

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